MEDICAL
VISION
DENTAL
LIFE
DEPENDENT LIFE
VOLUNTARY LIFE
SHORT-TERM DISABILITY
CRITICAL ILLNESS
ACCIDENT
PET
EMPLOYEE ASSISTANCE
RETIREMENT PLAN
PET PLAN
BENEFITS AT A GLANCE
The medical plan is a Preferred Provider Organization (PPO).
The vision plan provides benefits for eye exams, frames, lenses and contact lenses.
Along with coverages for select dental procedures, the dental plan offers two free cleanings per year.
The employer sponsored life insurance policy provides benefits in the event of an employee’s death or dismemberment. All employees receive one time their annual salary in life insurance.
The employer sponsored dependent life insurance policy provides benefits in the event of a dependents’ death or dismemberment. Spouses of employees receive a $5,000 life policy; children receive a $2,500 policy.
Additional life insurance is available for purchase for employees and dependents.
Short-Term Disability allows for wage replacement in the event an employee is not able to work.
Critical Illness pays a lump sum payment for illness deemed critical in the plan.
Accident insurance pays lump sums for certain accidents covered in the plan.
Pet Benefit provides discounts on products, RX, and veterinary care. It also includes 24/7 pet telehealth and lost pet recovery service.
Wendell Foster offers a free EAP program through the HealthPark to help manage life’s challenges.
Wendell Foster offers a 403(b) plan to assist employees in planning for their future.
WHO IS ELIGIBLE?
Employees are eligible to participate in the Wendell Foster benefits program if they are a full-time employee scheduled to work 30 or more hours per week. Part-time employees who work 20 or more hours per week are eligible for benefits, with a higher cost applicable only to medical coverage. Less than part-time and PRN employees are not eligible for the benefits program.
Hourly employees are eligible to participate on the first day of the month following 60 days of employment. Hourly employees have 60 days from the date of hire to enroll in benefits with Wendell Foster.
Salaried employees are eligible to participate on the first day of the month following hire. Salaried employees have 60 days from the date of hire to enroll in benefits with Wendell Foster.
Eligible Dependents
When employees enroll in the benefits program, they may also cover eligible dependents in all plans with the exception of medical insurance. Dependent children are eligible for medical coverage, however, spouses are not. Eligible dependents include:
• Legal spouse (opposite-sex; same-sex) (Eligible for all coverages except medical insurance)
• Dependent children up to age 26, regardless of student status, marital status, resident or financial dependence. For purposes of this plan, the term child is defined as: natural child, stepchild, legally adopted child, a child for whom guardianship has been appointed, a Qualified Medical Child Support Order or a child age 26 or older who is considered a disabled dependent.
Important
Under the requirements of the Affordable Care Act (ACA), Social Security Numbers (SSN’s) are required for EACH dependent covered under an employer’s benefit plan. Please verify that all covered dependents have a SSN listed when completing enrollment forms.
Annual Enrollment
Employees may add, drop or make changes to benefits each year during Open Enrollment. Employees may also add or drop eligible dependents. Elections made during Open Enrollment take effect on the first day of the next calendar year and remain in effect throughout the year unless there is a qualified change in status.
Changing Benefits during the Year
The benefit elections made during Open Enrollment (or when enrolled as a new employee) remain in effect the entire year. Employees cannot change elections during the year unless there is a qualified change in status, including:
• Marriage, divorce, or legal separation
• Birth or adoption of a child
• Death of a spouse or dependent
• Loss or gain of outside coverage, dependent’s eligibility, legal guardianship, or Medicaid/Medicare entitlement
• Unpaid leave of absence
When there is a qualifying life event, employees must notify the Human Resource office within 30 days of the date of the life event. Otherwise, no benefit changes can be made until the next Open Enrollment period. Employees will be able to change benefit elections as long as the event is consistent with the qualifying life event.
MEDICAL BENEFITS
Wendell Foster offers employees and their eligible dependents a self-insured PPO health plan through Anthem Blue Cross Blue Shield. Anthem Blue Cross Blue Shield is one of the largest private health insurance providers in Kentucky, covering 96% of Kentucky Physicians and 100% of Kentucky Hospitals.
Blue PPO Network
• Anthem Blue Cross Blue Shield utilizes Blue PPO for network discounts. This network includes service types such as hospitals, physicians, therapists, and behavioral health professionals.
• When employees use a contracted in-network provider, they will pay less out of pocket, will not have to file any claims and will receive the highest level of benefits.
• Employees can use a provider outside the network, but costs may be significantly higher.
• When employees use a contracted in-network provider, they will pay less out of pocket, won’t have to file any claims and will receive the highest level of benefits.
• Employees can use a provider outside the network, but costs may be significantly higher.
To find a contracted doctor/hospital, visit: www.anthem.com/find-care and create a member account.
Preferred Provider Organization (PPO)
The PPO Plan offers in-and out-of-network benefits. Employees have the flexibility to see the physician of their choice. In-network provider costs are paid by the plan at a higher percentage than for the out-of-network providers, reducing out-of-pocket costs. Co-pays only apply to physicians in the network.
How to Use the Medical Plan
For non-emergencies: For a common illness or injury, like a cold, flu, minor cut or burn, there are a few options to get care. These are less expensive than going to the emergency room.
• Utilize Tele-medicine
• Call the doctor. If the office is closed, call the doctor’s after-hours number. In some extreme cases, a hospital visit may be in order. Present the group insurance ID card and make the required co-payment.
• Visit Urgent Care. Urgent Care Clinics offer care to patients for much lower costs than an Emergency Room. Often, the clinic will charge the office visit co-pay rather than the more expensive Urgent Care co-pay. Be sure to check the network website (www.anthem.com/find-care) to verify the clinic is in the network.
• A referral is not needed from the primary care physician to see a specialist. Present the group insurance ID card and make the required co-payment. The co-pays on the Wendell Foster plan are the same for both primary care doctors and specialists.
Prescription Drug Coverage
The medical plan provides prescription drug coverage through Anthem Blue Cross Blue Shield. Drug costs vary according to the classification tier within Anthem Blue Cross Blue Shield’s pharmacy formulary. When a prescription is filled at the participating pharmacy, employees will need to present their medical insurance ID card and make the required co-payment. Prescription mail order program is available and forms can be retrieved at the Human Resource office.
DEDUCTIBLE
The deductible is a specified dollar amount you must pay for covered services (other than an office visit) before the plan begins to consider paying for services at the coinsurance rate or 70% after deductible.
OUT-OF-POCKET
The out-of-pocket limit refers to the specified dollar amount of coinsurance you must pay before the plan pays for covered services. When the out-of-pocket specified dollar amount is attained, your plan begins to pay 100% of all covered charges.
MEDICAL BENEFITS CONT.
Wellness Credits
If employees choose to participate in the Wendell Foster Wellness Program, they may qualify for monthly wellness credits that will reduce the cost of the medical plan chosen. The program requires a blood draw and a health risk assessment. The five factors measured are:
• Cholesterol
• A1C
• Blood Pressure
• Body Mass Index
• Tobacco Use
For each factor falling within the National Institute of Health’s guidelines, a monthly wellness credit will be issued. This credit will equal $10 per factor for employee only coverage and $20 per factor for employee + children coverage. Participation in this program is voluntary. Screenings are conducted annually in partnership with Owensboro Health. Newly hired employees have 6 weeks from the date medical insurance is effective to complete the screening to receive credit in the current hire year. Similarly, current employees newly enrolled in health insurance also have a 6-week window to fulfill the screening requirements.
Medical insurance coverage concludes on the date of termination, with premiums prorated for the days of coverage in the last month
PPO Plan Design Medical Coverage
Deductible (Individual/Family)
Payment (In-Network)
$2,000/$4,000
Coinsurance 70% plan/30% employee
Out of Pocket Maximum (includes deductible)
$3,500/$7,000
Preventative Care 100%
Primary Care Physician Office Visit
Specialist Office Visit
Urgent Care Visit
LiveHealth Telemedicine
$20 Co-pay
$35 Co-pay
$35 Co-pay
$20 Co-pay
Emergency Room Services Deductible; then 30% coinsurance
Prescription Drugs
Formulary Brand
Non-Formulary Brand
*See Summary Plan Document for further details
Employee Only
These costs do not include wellness credits.
Part-Time premiums apply to employees working 20-29 hours per week.
Payment (In-Network)
$100 (excluding generic)
$10 Co-pay
$30 Co-pay (after deductible met)
$50 Co-pay (after deductible met)
DENTAL BENEFITS
Wendell Foster offers dental insurance through Paramount Dental, a subsidiary of HRI. There are no deductibles, no claim forms, no waiting periods and no pre-existing condition clauses. To find a participating in-network dentist visit www.insuringsmiles.com.
$1,500 annual maximum $1,500 lifetime orthodontic maximum
*See Summary Plan Document for further details
*Dental insurance premiums are owed for the full month if one or more days of coverage occur in that month.
Wendell Foster offers vision insurance through Davis Vision via HRI. Healthy eyes and clear vision are an important part of overall health and quality of life.
To find a participating in-network provider, visit www.davisvision.com.
Examination
Lenses
Frames
$10 Co-pay
Covered in full – Single vision, lined bifocal or trifocal after $25 co-pay
Every 12 months
Up to $130 plus 20% discount on overage Every 24 months
Contact Lenses (in lieu of glasses) Up to $130 plus 15% discount on overage Every 12 months
*See Summary Plan Document for further details
*Vision insurance premiums are owed for the full month if one or more days of coverage occur in that month.
LIFE BENEFITS
Basic Life And Accidental Death & Dismemberment Insurance
Lincoln administers Life & Accidental Death & Dismemberment (AD&D) Insurance for Wendell Foster employees. Life and Accidental Death & Dismemberment (AD&D) Insurance are some of the most valuable benefits available to employees. They are often referred to as “survivor” benefits because they provide financial security to loved ones in the event of death or severe injury.
Wendell Foster provides the following Life and AD&D Insurance benefits at no cost to employees:
Covered Person Benefit
One time employee’s annual salary* (Max $100,000)
Spouse
Child(ren)
$5,000
$2,500 per child
*See Summary Plan Document for further details
**Based on eligible benefits according to age reduction schedule.
In the event of an employee’s death, Life Insurance pays benefits to the listed beneficiary. A beneficiary is a person(s) or estate that will receive the benefit payment from the coverage provider. AD&D insurance protects employees in case of accidental death or injury.
Accelerated Life Benefit
If diagnosed with a terminal illness and have less than 12 months to live, employees may apply to receive up to 80% of their life insurance benefit to use for whatever they choose.
Life insurance premiums are owed for the full month if one or more days of coverage occurs in that month.
LIFE INSURANCE IMPUTED INCOME
Imputed income amount may apply. The IRS requires employees to be taxed on the value of employer-provided group term life insurance over $50,000. The taxable value of this insurance coverage is called “imputed income.”
Even though employees do not receive cash, employees are taxed as if they received cash in an amount equal to the value of this coverage.
Voluntary Life And Accidental Death & Dismemberment Insurance
Employees can elect additional term-life insurance for themselves through Lincoln. If employees elect additional coverage for themselves, they are also eligible to elect additional coverage for their spouse and/ or children. Supplemental coverage is provided to employees at discounted group rates. If employees choose to participate in this coverage, they will pay the full cost of the benefit for themselves and family members.
Coverage For Employees
Employees can choose to purchase additional life insurance coverage for themselves in increments of $10,000, up to a maximum of $500,000. The coverage amount should not exceed five times the employee’s annual salary. At the initial enrollment, employees have the option to select up to $130,000 in coverage without the need for Evidence of Insurability (EOI). However, if employees decide to elect an amount exceeding $130,000, Lincoln will initially provide the $130,000, and the additional amount will be issued following a review of the EOI. Employees who have previously declined coverage will be required to complete the EOI process. During each annual enrollment, employees can increase their coverage by two increments without the need for an EOI.
Coverage For Spouses
If an employee elects supplemental coverage for themselves, they can elect supplemental coverage for their spouse. Spouse coverage is available in $5,000 increments, up to 2.5 times the employee’s salary (not to exceed 50% of their supplemental life amount). If spousal coverage is elected during the initial eligibility period, the first $25,000 of coverage will be issued without EOI.
Coverage For Children
If an employee elects supplemental life insurance coverage for themselves, they can elect additional $10,000 in coverage for their dependent child(ren).
Premiums are based upon age. Life insurance premiums are owed for the full month if one or more days of coverage occurs in that month. Full age charts are available in the Human Resource Office.
SUPPLEMENTAL BENEFITS
Short-Term Disability
Wendell Foster offers two supplemental Short-Term Disability plans to employees at discounted group rates through Colonial Life Insurance Company. These plans replace a portion of an employee’s income in the event they become disabled due to a covered accident or illness. If employees choose to participate in this coverage they will pay the full cost of the benefit for themselves.
Option 1
Replaces a percentage of employee’s weekly salary for up to 3 months due to a non-work-related disability.
Option 2
Replaces a percentage of employee’s weekly salary for up to 12 months due to a non-work-related disability.
*Above options are based upon every $1,000 of benefits. **Supplemental Benefits only offered annually at Open Enrollment.
Critical Illness Insurance
Wendell Foster offers a supplemental Critical Illness Insurance plan to employees at discounted group rates through Colonial Life Insurance Company. This plan offers a $10,000 lump sum tax-free payment upon diagnosis of specific critical illnesses. This lump sum payment can be utilized by employees at their discretion. If employees choose to participate in this coverage they will pay the full cost of the benefit for themselves and any covered family members. These rates are locked and do not increase with age.
Covered at 100% of $10,000 benefit
Heart Attack Stroke Cancer Coma Blindness
End-Stage Renal Failure Permanent Paralysis
Occupational Infectious HIV/Hepatitis
Covered at 25% of $10,000 benefit
Major Organ Failure
Carcinoma Coronary Artery Surgery
$500 flat amount
Skin Cancer
*Certain policy exclusions and limitations apply. See policy certificate for details.
$100 Health Screening Benefit
To incentivize employees to be proactive in their health, Colonial Life offers a $100 health screening benefit. This benefit applies to employees who have any of the below screenings completed.
Stress test on bicycle or treadmill
Serum cholesterol test to determine levels of HDL & LDL
Breast Ultrasound
Skin Cancer Biopsy
Fasting blood glucose test
PSA (blood test for prostate cancer)
Mammography
Pap Smear/ThinPrep pap test
*Semi-monthly payroll rate
**Supplemental Benefits only offered annually at Open Enrollment.
Blood test for triglycerides
Colonoscopy/ Virtual Colonoscopy
Chest x-ray
EKG/ECG/ECHO
SUPPLEMENTAL BENEFITS
Accidental Benefits
Wendell Foster offers a supplemental Accident Insurance plan to employees at discounted group rates through Colonial Life Insurance Company. This plan offers cash payments for covered accidents. This lump sum payment can be utilized by employees at their discretion. If employees choose to participate in this coverage they will pay the full cost of the benefit for themselves.
Incidents
Three follow-up doctor’s visits
Payment
$150 to $7,500
$150 to $6,000 Accidental Death $25,000 Burns (based of size and/or degree) $1,000 to $12,000
*Certain policy exclusions and limitations apply. See policy certificate for details.
*Above rates are based upon $10,000 of benefits.
**Supplemental Benefits only offered annually at Open Enrollment.
***All Supplemental insurance premiums are owed for the full month if one or more days of coverage occur in that month.
Pet Benefit
Wendell Foster offers Pet Benefit to employees through Total Pet Plan. Enroll in Total Pet and get the same high-quality products and services your pets are used to, just at a lower price.
Discounts on Products & RX
• Up to 40% off on products like prescriptions, preventatives, food, toys, and more
• Shipping is always free and same-day pickup is available for most human-grade prescriptions View available products and pricing at: www.petplusbenefit.com
Discounts on Veterinary Care
• Instant 25% savings on all of your pet’s in-house medical services at participating vets
• No exclusions due to age, health, pre-existing conditions or type of pet Visit: www.petbenefits.com/search to locate a participating vet.
24/7 Pet Telehealth
• Access real-time vet support, even when your vet’s office is closed
• Unlimited support on your pet’s health, wellness, behavior and more
Lost Pet Recovery Service
• Durable tag can be scanned from any smart phone to access your contact information, helping lost pets return home quicker than a microchip
• Easily update your information online with no need to request a new tag
For more details and how to enroll, visit: www.petbenefits.com/land/wendellfoster.
EMPLOYEE ASSISTANCE
Wendell Foster’s Employee Assistance Plan (EAP), administered by the Owensboro HealthPark, is a free, convenient and confidential resource that can help make your life a little easier. Employees have access to six face-to-face counseling sessions with a HealthPark Counselor free of charge, per issue. This benefit is offered to employees (including PRN) and any individuals living within the employees’ household.
Resources available include:
• Marital and family problems
• Financial issues
• Healthy living
• Substance abuse
• Child and eldercare issues
19 RETIREMENT PLAN
Retirement 403(b) Plan - “the Plan”
At Wendell Foster, we are committed to offering resources to help employees map out their retirement goals – and, along with Principal Retirement, we are here to help employees at every step in their journey.
Eligibility
All Wendell Foster employees are eligible to participate in the Plan by making employee contributions to their account. These contributions can begin upon hire. Full-and-Part-time employees become eligible for company-paid contributions after one (1) consecutive year of employment and 1000 hours of work.
Employee Contributions
Employee contributions to the Plan can be either pre- or post-tax depending on the employee’s choice. Pre-tax contributions are deducted before taxes are calculated, meaning contributions to the Plan are not taxed until they are withdrawn from the Plan. Post-tax contributions are deducted after taxes are calculated, meaning most, if not all, taxes have already been paid on contributions in the Plan. Employees may change contributions at any time with no waiting period. Employees are always 100% vested in their contributions to the plan.
Wendell Foster Matching Contributions
If employees contribute from 1% to 3% of eligible compensation each pay period, Wendell Foster will match these contributions dollar for dollar, upon eligibility. Employees are 100% vested in the matching contributions after three (3) years of service with the organization.*
403(b) Plan Design
Wendell Foster Additional Contributions
Each pay period, Wendell Foster will make an additional contribution of 2% of eligible compensation, upon eligibility. Employees are 100% vested in the matching contributions after three (3) years of service with the organization.*
IRS Contribution Limits for 2025
• If you are under age 50, you can contribute a maximum of $23,500 in the Plan Year.
• If you will be age 50 or older by the end of the calendar year, you can contribute a maximum of $31,000 in the Plan Year.
*See 403(b) plan documents for full criteria.
ENROLL TODAY! Go to Principal Retirement’s website at www.principal.com or call the Principal Retirement Benefits line at 1-800-547-7754 for more information.
20 CARRIER CONTACT INFO
Medical
Anthem Blue Cross Blue Shield Plan Number: L01739
Customer Service: 1-833-578-4443
Website: www.anthem.com 1826 Elm Hill Pike
Vision
Davis Vision via HRI Plan Number: 83611501WF3A
Customer Service: 1-800-727-1444
Davis Vision via HRI
P.O. Box 659
Evansville, IN 47704-0659
Website: www.davisvision.com
Dental
Paramount Dental (Formerly HRI) Plan Number: 83611501WF3A
Customer Service: 1-800-727-1444
HRI
P.O. Box 659
Evansville, IN 47704-0659
Website: www.insuringsmiles.com
Life Claims
Lincoln
Customer Service: 1-877-275-5462
Lincoln Financial Group
P.O. Box 2616
Omaha, NE 68103-2616
Website: www.lincolnfinancial.com
Short-Term Disability, Critical Illness, and Accident
Colonial Life
Plan Number: C6208557
Customer Service: 1-800-325-4368
Colonial Life & Accident Insurance Company
P.O. Box 100195
Columbia, SC 29202-3195
Website: www.coloniallife.com
Pet Benefit
Pet Benefit Solutions
Customer Service: 1-800-891-2565
Pet Benefit Solutions
211 Boulevard of the Americas, Suite 403 Lakewood, NJ 08701
Website: www.petbenefits.com
Employee Assistance Program
Owensboro HealthPark
1-800-711-5751
270-688-1547
Employer Name: Wendell Foster
403(b) Plan
Principal Retirement
Plan Number: 473916
Customer Service: 1-800-547-7754
Website: www.principal.com
IMPORTANT NOTICES
The Affordable Care Act (ACA) and Federal regulations require Wendell Foster to provide benefit-eligible employees with the following important annual notices.
Private Health Information
A portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses the protection of confidential health information. It applies to all health benefit plans. In short, the idea is to make sure that confidential health information that identifies (or could be used to identify) you are kept completely confidential. This individually identifiable health information is known as “protected health information” (PHI), and it will not be used or disclosed without your written authorization, except as described in the Plan’s HIPAA Privacy Notice or as otherwise permitted by federal and state health information privacy laws. A copy of the Plan’s Notice of Privacy Practices that describes the Plan’s policies, practices, and your rights concerning your PHI under HIPAA is available from your medical-plan provider. For more information regarding this Notice, please contact Human Resources.
Women’s Health and Cancer Rights Act
Wendell Foster’s medical plans, as required by the Women’s Health and Cancer Rights Act of 1998, provide benefits for mastectomy-related services. These services include:
• All stages of reconstruction of the breast on which the mastectomy was performed
• Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses and treatment of physical complications resulting from a mastectomy (including lymphedema)
This coverage will be provided in consultation with the attending physician and the patient and will be subject to the same annual deductibles and coinsurance provisions that apply to the mastectomy. For more information, contact your medical plan provider.
Special Enrollment Rights
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself and your dependents in Wendell Foster’s medical plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards you or your dependents’ other coverage). However, you must request enrollment within 31 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, 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 your dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption or placement for adoption. For more information, please contact Human Resources.
Notice Of Prescription Drug Creditable Coverage
Wendell Foster provides a “Notice of Prescription Drug Creditable Coverage” to all Medicare-eligible participants on an annual basis. This notice states that under the Wendell Foster medical plan, employees have prescriptiondrug coverage that is, on average, as generous as the standard Medicare Prescription Drug Coverage.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
Notices of Rights to Designate a Primary Care Provider
For plans that require or allow for the designation of primary care providers by participants or beneficiaries: If the plan generally requires or allows the designation of a primary care provider, employees have the right to designate any primary care provider who participates in-network and who is available to accept employees or their family members. For information on how to select a primary-care provider and for a list of the participating primary-care providers, call Customer Service at the phone number on the back of the Medical ID card.
For plans that require or allow for the designation of a primary care provider for a child: For children, employees may designate a pediatrician as the primary care provider.
For plans that provide coverage for obstetric or gynecological care and require the designation by a participant or beneficiary of a primary-care provider: Employees do not need prior authorization from the plan or any other person (including a primary-care provider) in order to obtain access to obstetrical or gynecological care from a healthcare professional in-network who specializes in obstetrics or gynecology. The healthcare professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals.
IMPORTANT NOTICES CONT.
For a list of participating health-care professionals who specialize in pediatrics, obstetrics or gynecology, call Customer Service at the phone number on the back of the Medical ID card.
Newborns’ Act Disclosure
This Plan does not 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 cesarean section. Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Additional information, including State Rights required, are described in detail in the applicable Benefit Plan Description.
The Genetic Nondiscrimination Act of 2008 (GINA)
GINA prohibits a group health plan from adjusting group premium or contribution amounts for a group of similarly situated individuals based on the genetic information of members of the group. GINA prohibits a group health plan from requesting or requiring an individual or a family member of an individual to undergo genetic tests. Genetic information means information about an individual’s genetic tests, the genetic tests of family members of the individual, the manifestation of a disease or disorder in family members of the individual or any request for or receipt of genetic services, or participation in clinical research that includes genetic services by the individual or a family member of the individual. The term “genetic information” includes, with respect to a pregnant woman (or a family member of a pregnant woman), genetic information about the fetus and, with respect to an individual using assisted reproductive technology, genetic information about the embryo. Genetic information does not include information about the sex or age of any individual.
Wellness Program Notice
Wendell Foster’s wellness program is a voluntary wellness program available to all employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If employees choose to participate in the wellness program they will be asked to complete a voluntary health risk assessment or “HRA” that asks a series of questions about their health-related activities and behaviors and whether they have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). Employees will also be asked to complete a biometric screening, which will include a test for A1C, Blood Pressure, Cholesterol, Body Mass Index, and Tobacco use. Employees are not required to complete the HRA or to participate in the blood test or other medical examinations.
However, employees who choose to participate in the wellness program will receive an incentive of $10 per criteria (or $20 per criteria for Employee Plus medical plan) for each criterion that falls within normal limits as established by the National Institute of Health. Although you are not required to complete the HRA or participate in the biometric screening, only employees who do so will receive the wellness credit(s).
If you are unable to participate in any of the health-related activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting Human Resources.
The information from your HRA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program. You also are encouraged to share your results or concerns with your doctor.
Protections from Disclosure of Medical Information
Wendell Foster is required by law to maintain the privacy and security of employees’ personally identifiable health information. Although the Owensboro HealthPark and Wendell Foster may use aggregate information it collects to design a program based on identified health risks in the workplace, the Owensboro HealthPark will never disclose any personal information either publicly or to the employer, except as necessary to respond to a request from the employee for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies an employee that is provided in connection with the wellness program will not be provided to supervisors or managers and may never be used to make decisions regarding employment.
Employee health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and employees will not be asked or required to waive the confidentiality of their health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives an employee’s information for purposes of providing services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive an employee’s personally identifiable health information is the Owensboro HealthPark in order to provide services under the wellness program.
In addition, all medical information obtained through the wellness program will be maintained separate from personnel records, information stored electronically will be encrypted, and no information provided by employees as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event, a data breach occurs involving information provided in connection with the wellness program, we will notify employees immediately.
Employees may not be discriminated against in employment because of the medical information provided as part of participating in the wellness program, nor may employees be subjected to retaliation if they choose not to participate.
Questions or concerns regarding this notice, or about protections against discrimination and retaliation, can be discussed with Human Resources.
MARKETPLACE COVERAGE OPTIONS
General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace and health coverage offered through your employment. What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-ofpocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12% of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution—as well as your employee contribution to employment-based coverage—is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
1 Indexed annually; see www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.
Note: An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
HELPFUL DEFINITIONS
Annual Enrollment Period: A specific period during which employees can make changes to their benefit elections, typically once a year. This is when employees can select or change health plans, adjust retirement contributions, or make other benefit-related decisions.
Beneficiary: The person or entity named to receive the proceeds of a life insurance policy, retirement plan, or other benefit in the event of the plan participant’s death.
Co-Payment (Co-Pay): A fixed amount that an insured individual pays for specific covered services or prescriptions, typically due at the time of service.
Deductible: The amount of money an individual must pay out of pocket for covered medical expenses before their health insurance plan starts to cover costs. For example, if a plan has a $2,000 deductible, the insured individual is responsible for the first $2,000 of covered expenses.
Dependent: A person who relies on the primary plan participant (usually the employee) for financial support and qualifies for certain benefits under the employee’s plan. Dependents can include spouses, children, or other eligible family members.
Explanation of Benefits (EOB): A form provided directly to the member to explain how a health benefits claim was paid. In addition to claims payment information, the EOB often includes information on the appeals process.
Flexible Spending Account (FSA): A tax-advantaged account that allows employees to set aside pre-tax dollars for qualified healthcare or dependent care expenses. FSAs often have a “use it or lose it” provision, meaning funds not used by a certain deadline may be forfeited.
Network Providers: Healthcare providers (doctors, hospitals, clinics) that have contracts with an insurance company to provide services to plan members at a negotiated rate. Going to network providers often results in lower out-of-pocket costs for the insured.
Open Enrollment: A period of time when employees may make choices regarding their benefits for the following year. You should read enrollment materials carefully, since there are often substantial differences between health benefits plans.
Out-of-Pocket Maximum (OOPM): The maximum amount an insured individual must pay in a plan year for covered medical expenses. Once this limit is reached, the insurance plan covers 100% of eligible expenses.
Premium: The amount an employee pays for their health insurance coverage. Premiums are usually deducted from an employee’s paycheck.
Preventive Care: Healthcare services aimed at preventing or early detection of medical conditions. Preventive care is often covered at no cost or with low out-of-pocket costs by insurance plans.
Waiting Period: The period of time an employee must wait before becoming eligible for certain benefits, such as health insurance or retirement plans. Waiting periods can vary depending on the benefit and company policy.
In 1937, Edith and Wendell Foster’s daughter, Louise, was diagnosed with cerebral palsy and intellectual disabilities. Because of Louise, the Fosters committed their lives to supporting children with developmental disabilities.
Drafted in World War II, Wendell Foster served as a cook in a military hospital. He used the opportunity to learn from the medical staff who were engaged in the rehabilitation of physically disabled soldiers. Following the war, Mr. Foster approached his fellow veterans in Daviess County to help fund a home and school for children with disabilities.
At that time, services such as special education were not available. In response to this lack of services, the Fosters provided residential services to the children of seven local families. They also offered their home as a meeting place for families while their children received physical and occupational therapy in the Foster’s backyard and day services in their dining room.
In 1947, a volunteer board of directors incorporated the agency, adopted a charter and by-laws, and officially founded the organization now known as Wendell Foster, named in honor of its founder.
Wendell Foster is a private, non-profit 501(c)(3) corporation currently governed by a 13-member board of directors.
Now in its seventy-eigth year of operation, Wendell Foster has evolved into a community-based organization providing services on-site, in people’s homes, in some of the area school systems, and in community settings. Our guiding mission is to provide individualized supports and services, empowering people with disabilities to realize their dreams and potential.
From left to right: Edith, Wendell, and Louise Foster