2022 PLAN YEAR benefit enrollment guide
C lass 3 - A ll O ther E ligible E mployees
Yates LLC is proud to offer you a comprehensive benefits package for the 2022 - 2023 plan year. Keep in mind that the benefits you select during this enrollment will be effective June 1st, 2022 and will continue through May 31st, 2023.
TABLE OF CONTENTS
I ntroduction . . . . . . . . . . . . . . . . . . . . . . Employee Navigator . . . . . . . . . . . . . . . Medical . . . . . . . . . . . . . . . . . . . . . . . . . . FSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic Life AD&D . . . . . . . . . . . . . . . . . . Disability . . . . . . . . . . . . . . . . . . . . . . . . . Aflac Products . . . . . . . . . . . . . . . . . . . . MetLaw . . . . . . . . . . . . . . . . . . . . . . . . . Employee Assistance Program . . . . . . FAQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . Legal Notices . . . . . . . . . . . . . . . . . . . . Medicare Part D. . . . . . . . . . . . . . . . . . COBRA. . . . . . . . . . . . . . . . . . . . . . . . . . Exchange Notices. . . . . . . . . . . . . . . . . Contact Information. . . . . . . . . . . . . . .
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YATES LLC 2022 BENEFIT GUIDE
About Deductions
In preparation of your enrollment, please have the following information readily available for you and your dependent(s): • Date(s) of birth • Social Security Number(s): Mandatory • Full name, relationship, and Social Security Number(s) for Life Beneficiary(ies). (Beneficiaries must be at least 18 years old or you will be required to name a guardian for him/her.) Information Needed for Enrollment Voluntary life, long-term disability and short-term disability insurance premiums are deducted on a post-tax basis and may be changed outside of the Open Enrollment period. Premiums for medical, dental and vision plans are all deducted on a pre-tax basis because they are covered under Section 125 of the Internal Revenue Code. Once you elect benefits you will not be approved to make changes to your election or drop coverage until the next Open Enrollment period, unless you have a qualifying event.
All Eligibility
Qualifying Life Events
As a Yates LLC employee, you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package after 30 days of employment. You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include:
Qualifying events are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage.
Qualifying events include:
• Marriage • Divorce or legal separation • Birth or adoption of a child • Death of spouse or dependent child • Change in employment status • Loss of other coverage • Entitlement to Medicare or Medicaid • Child turning 26 years old
• Your legal spouse • Your children up to age 26 (as identified in the plan document)
*Once your elections are effective, they will remain in effect through the plan year.
You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.
YATES LLC 2022 BENEFIT GUIDE
3
How to Enroll
Step 1: Creating your Employee Navigator Account
Welcome Email:
• You will receive a Welcome email from Employee Navigator • Click on the “Registration Link” in the email • Create an account with username and password of your choice
• Go to https://www.employeenavigator.com/benefits/Account/Register • Enter [First Name], then [Last Name] • Enter your Company Identifier [yates] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYY • Click “Next” to continue • When prompted, your username will be as follows: [First Name].[Last Name] Option 2:
Step 2: Complete HR Tasks
• Once your account is set up, you will be taken to your employee homepage.
• On the homepage, click the “Complete HR Tasks” to begin your new hire tasks first.
• The first few tasks require you to put in demographic information and e-sign for online acknowledgement.
T I P If you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”
Step 3: Benefit Elections
• To enroll dependents in a benefit, click the checkbox next to the dependent’s name under “Who am I enrolling?” If you do not click on their name(s), they will not get the insurance. • Below your dependents you can view your available plans and the cost per pay period. To elect a benefit, click Select Plan underneath the plan cost.
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YATES LLC 2022 BENEFIT GUIDE
Step 4: Forms
• If you have elected benefits that require a beneficiary designation, Primary Care Physician or completion of an Evidence of Insurability form, you will be prompted or required to complete.
Step 5: Review & Confirm Elections
• Review the benefits you selected on the enrollment summary page to make sure they are correct then click “Sign & Agree” to complete your enrollment. Print a summary of your elections for your records.
T I P If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps in the drop down bar to complete them. ALL STEPS MUST BE COMPLETED!
Step 6: HR Tasks (if applicable)
• To complete any required HR tasks, click “Start Tasks”. If your HR department has not assigned any tasks, you’re finished!
YATES LLC 2022 BENEFIT GUIDE
5
Medical and Pharmacy Coverage
Yates LLC offers the following plans through Meritain Health.
Insurance Carrier: Medical Plan Number:
Meritain Health Medical Insurance
Basic Plan
Standard Plan
In-Network: Office Visit Copay - Primary Care
$25 Copay, then 100% Deductible waived $20 Copay, then 100% Deductible waived Office Visit Copay - Specialist Care $50 Copay, then 100% Deductible waived $40 Copay, then 100% Deductible waived Urgent Care Copay $50 Copay, then 100% Deductible waived $50 Copay, then 100% Deductible waived Emergency Room Care $200 Copay, then 100% Deductible waived $200 Copay, then 100% Deductible waived Preventative Visit Copay 100% Deductible waived 100% Deductible waived Diagnostic Testing & Blood Work 70% after Deductible 80% after Deductible Bloodwork-Quest Diagnostics 100% 100% Imaging 70% after Deductible 80% after Deductible Imaging - US imaging $250 Copay, then Deductible waived $250 Copay, then Deductible waived Coinsurance 70% 80% Employee Deductible $1,000 $2,000 Family Deductible $3,000 $6,000 Employee Out-of-Pocket Max $5,500 $5,000 Family Out-of-Pocket Max $12,700 $12,700 Inpatient Hospital 70% after Deductible 80% after Deductible Outpatient Hospital or Facility 70% after Deductible 80% after Deductible Inpatient/Outpatient Physician Fees 70% after Deductible 100% Deductible waived Out-of-Network: Coinsurance 50% 60% Employee Deductible $4,000 $3,000 Family Deductible $12,000 $9,000 Employee Out-of-Pocket Max $11,500 $9,000 Family Out-of-Pocket Max $34,500 $27,000 Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic $7 Copay $7 Copay Tier 2 - Formulary $40 Copay $40 Copay Tier 3 - Non-Formulary $70 Copay $70 Copay Tier 4 - Specialty Contact ShaRx @ 314-451-3555, Option 1 or sharx@sharxplan.com Mail Order (90 Day Supply) 2x Copay Semi-Monthly Deduction Employee Only $30.00 $62.50 Employee + Spouse $100.00 $125.00 Employee + Child(ren) $80.00 $105.50 Family $137.50 $175.00
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YATES LLC 2022 BENEFIT GUIDE
Yates LLC – Time to get more money in your paycheck What is a Flexible Spending Account (FSA)? It is a plan which allows you to set aside funds, on a pre-tax basis, to pay for eligible expenses you incur during the plan year for medical, dental, pharmacy and/or vision services related to you or your dependents. There are two accounts – Medical Flexible Spending and Dependent Care Flexible Spending . How do I get this tax savings? You determine the amount you want to allocate for participation in either, or both, accounts and complete the enrollment form during your Open Enrolment period. The amount you elect to set aside is not taxed, you end up with more money in your pocket. The amount you allocate is divided evenly over the course of the year and deducted from your payroll, reducing your applicable tax each pay period. Who can I “cover” with my allocation? Expenses for you and your dependents are reimbursable under this plan if they are deemed eligible by the IRS guidelines. How do I get this tax savings? You determine the amount you want to allocate for participation in either, or both, accounts and complete the enrollment form during your Open Enrolment period. The amount you elect to set aside is not taxed, you end up with more money in your pocket. The amount you allocate is divided evenly over the course of the year and deducted from your payroll, reducing your applicable tax each pay period. Who can I “cover” with my allocation? Expenses for you and your dependents are reimbursable under this plan if they are deemed eligible by the IRS guidelines. Yates LLC – Time to get more money in your paycheck What is a Flexible Spending Account (FSA)? It is a plan which allows you to set aside funds, on a pre-tax basis, to pay for eligible expenses you incur during the plan year for medical, dental, pharmacy and/or vision services related to you or your dependents. There are two accounts – Medical Flexible Spending and Dependent Care Flexible Spending .
Medical Flexible Spending Account • Budget and save for qualified known medical expenses for you and your family for the upcoming plan year, June 1, 2022 to May 31, 2023. • Your entire election amount is available the first day of the plan year. Maximum election amount is $2,850 . • Yates LLC plan has the grace period/carry over. This means you can still incur expenses and spend down your 2022 balance through August 31, 2023/carry over up to $570 into the next plan year. Medical Flexible Spending Account • Budget and save for qualified known medical expenses for you and your family for the upcoming plan year, June 1, 2022 to May 31, 2023. • Your entire election amount is available the first day of the plan year. Maximum election amount is $2,850 . • Yates LLC plan has the grace period/carry over. This means you can still incur expenses and spend down your 2022 balance through August 31, 2023/carry over up to $570 into the next plan year.
Without an FSA • Examples of Eligible Expenses: Child care for infant child Before and after school care Pre-School Summer day camp Dependent Care FSA Tax Savings Example: With an FSA $500 $500 Dependent Care Flexible Spending Account • Set aside money pre-tax to pay for day care/child care expenses for the upcoming plan year, June 1, 2022 to May 31, 2023. • Expenses for children under the age of 13 who are tax dependents and disabled spouse or disabled dependents of any age can be reimbursed. • Maximum election amount is $5,000 ($2,500 if married filing single). • This is a pay as you go account, funds are not paid in advance of your deposits. • Expenses for children under the age of 13 who are tax dependents and disabled spouse or disabled dependents of any age can be reimbursed. • Maximum election amount is $5,000 ($2,500 if married filing single). • This is a pay as you go account, funds are not paid in advance of your deposits. • Examples of Eligible Expenses: Child care for infant child Before and after school care Pre-School Summer day camp Dependent Care FSA Tax Savings Example: Dependent Care Flexible Spending Account • Set aside money pre-tax to pay for day care/child care expenses for the upcoming plan year, June 1, 2022 to May 31, 2023.
• Examples of Eligible Expenses 1 : Prescription Medication Copays & Deductibles Chiropractic Care • Examples of Eligible Expenses 1 : Prescription Medication Copays & Deductibles Chiropractic Care
Charges Diabetic Supplies Physical Therapy Vision Care Dental Treatments Orthodontia Diabetic Supplies Physical Therapy Vision Care Dental Treatments Orthodontia
Medical FSA Tax Saving Example:
Gross taxable wage Federal, FICA & State Tax Dependent care cost Amount left to spend Federal, FICA & State Tax Gross taxable wage
Gross taxable wage Dependent care election Federal, FICA & State Tax Amount left to spend
Savings
$113 $101 $108
$500 $450 $480 $220 $100
Deductible
-113.25
-96.15
Co-pays Medical FSA Tax Saving Example:
Take home pay $386.75 Taxable wage Without an FSA
$403.85 With an FSA
Prescriptions
Gross taxable wage
-96.15
-91.47
$49 $22 Savings $113
$500
$500
Contacts/Vision services
Charges
Dental Deductible Total Prescriptions Co-pays
$500 $450 $480 $220 $100
Dependent care election Federal, FICA & State Tax Amount left to spend
$290.60
$312.36
-113.25
-96.15
$16 $101 $108
$75
Over-the-counter items+
FSA Tax Savings per week Take home pay $386.75 Taxable wage
$21.78
$1,795
$409
$403.85
Annual Savings
$1,132.56
Dependent care cost
-96.15
-91.47
$49 $22 $16
Contacts/Vision services
800-444-1922 ext. 1 • www.basiconline.com
YATES LLC 2022 BENEFIT GUIDE
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Dental
Amount left to spend
$290.60
$312.36
$75
Over-the-counter items+
FSA Tax Savings per week
$21.78
Total
$1,795
$409
Annual Savings
$1,132.56
Dental Coverage
Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower. Your PPO dental plan is through MetLife and offers “in and out-of-network” benefits.
Insurance Carrier:
MetLife Dental Insurance
Plan Type:
High Plan
Low Plan
Calendar Year Deductible
$50 Individual / $150 Family
$50 Individual / $150 Family
Calendar Year Maximum
$5,000
$1,000
Preventive Services
100%
100%
Basic Services
80%
50%
Major Services
50%
50%
Endo/Perio
80%
50%
Out-of-Network Reimbursement
90th Usual & Customary
Maximum Allowable Charge
Semi-Monthly Deduction Employee Only
$24.20
$9.69
$49.78
$22.10
Employee + One
$58.76
$42.27
Employee + Two or more
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YATES LLC 2022 BENEFIT GUIDE
Vision Coverage
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them. Your PPO vision plan is through MetLife and offers “in and out-of-network” benefits.
Insurance Carrier:
MetLife Vision Insurance
Plan Type:
In-Network
Out-of-Network
Exam Services
$10 Copay
$45 allowance
Lenses - Single lined
$10 Copay
$30 allowance
Lenses - Bifocal lined
$10 Copay
$50 allowance
Lenses - Trifocal
$10 Copay
$65 allowance
Contacts / Lenses
$ 130 allowance; then 20% off any remaining balance
Up to $105
Frames
$130 allowance; then 20% off any remaining balance
Up to $70
Frequency for Exam / Lenses / Frames
12 months / 12 months / 24 months
Semi-Monthly Deduction Employee Only
$4.48
$8.43
Employee + One
$12.00
Employee + Two or more
YATES LLC 2022 BENEFIT GUIDE
9
Basic Life and AD&D Insurance Coverage
Yates LLC provides all Full Time employees with Basic Life and Accidental Death & Dismemberment at no cost to employees.
Insurance Carrier:
Basic Life Insurance
Basic Life w/ AD&D Eligibility Requirement Life Insurance Benefit
All Full Time Employees
$25,000
Guarantee Issue
Yes
Accidental Death & Dismemberment Benefit (AD&D)
Same as Basic Life Amount
Spouse - $5,000 Child - $2,000
Dependent Life
Voluntary Term Life Insurance Coverage
As a supplemental benefit, Yates LLC allows eligible employees to purchase additional life insurance coverage for yourself and your dependents. This coverage is paid for by you and is offered through MetLife. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.
Insurance Carrier:
Voluntary Life Insurance
Voluntary Life w/ AD&D Eligibility Requirement Employee Benefit Amounts Employee
All Full Time Employees
minimum of $10,000 / up to $500,000 in increments of $10,000 minimum of $5,000 / up to $100,000 in increments of $5,000
Spouse
Child(ren)
minimum of $5,000 / up to $10,000
Guarantee Issue Employee
$200,000 $50,000
Spouse
Child(ren)
$5,000
10 YATES LLC 2022 BENEFIT GUIDE
Disability Insurance Coverage
The goal of Yates LLC’s Disability Insurance Plan is to provide you with income replacement should you be unable to work due to a non-work-related illness or injury. The company provides employees with Short-Term Disability income benefits at no cost to employees. Long-Term Disability is voluntary. Both the short term and long term disability coverages are offered through MetLife.
Insurance Carrier:
Short-Term Disability Insurance
Plan Type:
Employer Paid
Eligibility Requirement
Class 3 - All Eligible Employees
Benefit Percentage
60%
Waiting Period - Accident Waiting Period - Sickness Maximum Weekly Benefit Pre-Existing Condition
7 Days 7 Days $1,500 3 / 12
Benefit Duration
12 Weeks
Insurance Carrier:
Long-Term Disability Insurance
Plan Type:
Voluntary
Eligibility Requirement
Class 3 - All Eligible Employees
Waiting Period
90 Days
Benefit Percentage
60%
Maximum Monthly Benefit
$5,000 SSNRA 2 Years 3 / 12
Benefit Duration
Own Occupation Definition
Pre-Existing Condition
*Maximum Monthly Benefit varies by classification.
11 YATES LLC 2022 BENEFIT GUIDE
AC
GROUP ACCIDENT
Benefits available for spouse and/or dependent children. Benefits for both inpatient and outpatient treatment of covered accidents. Guaranteed Issue - No underwriting required to qualify for coverage.
PLAN FEATURES 24-Hour or Non-occupational Coverage. No limit on the number of claims. Supplements and pays regardless of any other insurance programs.
PLAN BENEFITS
Accidental Death and Dismemberment Accidental Common Carrier Death (Plane,Train, Boat or Ship) $100,000 Accidental Death $50,000 Double Dismemberment $25,000 Single Dismemberment $6,250 Loss of One or More Fingers or Toes $1,250 Partial Amputation of Fingers or Toes (Including at least $100 onejoint)
Major Injuries Fractures* (open reduction) Hip/Thigh
$6,750 $6,075 $5,400 $5,062 $4,050 $3,375 $3,375 $2,700 $2,700 $2,362 $2,362 $2,025 $1,350
Vertebrae (except processes)
Pelvis
Skull (depressed)
Leg
Forearm/Hand/Wrist Foot/Ankle/Knee cap
Hospital Benefits Paralysis Hospital Admission
Shoulder blade/Collar bone
$10,000 $1,000
Lower Jaw (Mandible)
Skull (Simple)
$400 $200 $125
Hospital Intensive Care (per day) Hospital Confinement (per day)
Upper Arm/Upper Jaw Facial bones (except teeth) Vertebral Processes Coccyx/Rib/Finger/Toe Dislocations* (open reduction) Hip
Medical Fees
$540
Specific Injuries Burns
$100–$10,000
$5,400 $3,900 $3,000 $2,400 $2,100 $1,800 $1,500 $1,200
$25–$400 $100–$400 $400–$600 $100–$400 $50–$250
Lacerations
Knee (not knee cap)
Ruptured Disc
Shoulder
Tendons/Ligaments Torn Knee Cartilage
Foot/Ankle
Hand
Eye Injuries
Lower Jaw
$10,000
Coma
Wrist
$200
Concussion
Elbow
$50–$150
Emergency Dental Work
$480
Finger/Toe
Additional Benefits Internal Injuries
Catastrophic Accident Rider $100,000 We will provide this benefit due to an accidental injury that re- sults in the loss and irrecoverable use of sight (in both eyes), hear- ing (in both ears), speech, arms or legs. Benefit reduces by 50% at age 65. Benefit payable after 365 day elimination period. $250 We will pay this benefit if the insured is admitted to a hospital and confined as a resident bed patient due to a covered sickness. We will pay this benefit once for each covered sickness. $100 We will provide this benefit beginning on the first day of hospi- tal confinement, per day, for up to 30 days, per hospital confine- ment. Sickness Rider Hospital Admission Hospital Confinement
$1,000
$500 $500
Air Ambulance
Prosthesis
$150–$300
Transportation
$250 $100 $100 $100 $100
Exploratory Surgery
Ambulance Blood/Plasma
Appliances
Family Lodging Benefit
$60 $25 $25
Wellness Benefit
Accident Follow-up Treatment
Physical Therapy
*Closed reduction pays a benefit 150% less than open reduction.
CAI7780
12 YATES LLC 2022 BENEFIT GUIDE
GROUP CRITICAL ILLNESS CI
Covered Specific Critical Illnesses: CANCER (Internal/Invasive) ....................................................100% HEART ATTACK (Myocardial Infarction) ............................100% STROKE (Apoplexy or Cerebral Vascular Accident) ......100% MAJOR ORGAN TRANSPLANT ..............................................100% RENAL FAILURE (End Stage)....................................................100% CARCINOMA IN SITU ....................................................................25% CORONARY ARTERY BYPASS SURGERY ................................25% NOTE: If a benefit is paid for carcinoma in situ, the internal cancer benefit will be reduced by 25%. If a benefit is paid for coronary artery bypass surgery, the heart attack benefit will be re- duced by 25%. All covered conditions are subject to the definitions found in your certificate.
PLAN BENEFITS First Occurrence Benefit After the waiting period, a Lump Sum Benefit is payable upon initial diagnosis of a covered illness. Employee benefit amounts available from $5,000 to $50,000. Spouse coverage is also avail- able in benefit amounts up to $25,000. If you are deemed ineligible due to a previous medical condition you still retain the ability to purchase spouse coverage. Additional Occurrence Benefit If an insured collects full benefits for a criti- cal illness under the plan and later has one of the remaining covered ill- nesses, then we will pay the full benefit amount for each additional illness. Occurrences must be separated by at least 6 months.
Re-Occurrence Benefit If an insured collects full benefits for a covered condition and is later diagnosed with the same condition, we will pay the full benefit again.The two dates of diagnosis must be separated by at least 12 months or for Cancer, 12 months treatment free. Cancer that has spread (metastasized) even though there is a new tumor, will not be considered an additional oc- currence unless the Insured has gone treatment free for 12 months.
25% Child Coverage at no Additional Cost Each dependent child is covered at 25 percent of the primary insured amount at no additional charge.
$50 Health Screening Benefit (employee and spouse) After the Waiting Period, pays a maximum of $50 for any one covered health screening test per calendar year.We will pay this benefit regardless of the results of the test. Covered health screening tests include (but are not limited to): mammography, colonoscopy, pap smear, breast ultrasound, chest x-ray, PSA (blood test for prostate can- cer), stress test on a bicycle or treadmill, and bone marrow testing. FEATURES Guaranteed Issue $10,000 employee/$5,000 spouse based on 20% participation and 50 applications • $5,000 employee based on 10% participation and 25 applications.
Same Day Coverage Coverage will be effective the date the employee signs the application pending underwriting approval.
Portability Employees can keep coverage at same rates and benefits if they leave their job, with certain stipulations.
Cancer Option May be sold with or without cancer benefit.
Premium Options May be sold on tobacco/non-tobacco structure or uni-tobacco structure.
HEART RIDER
PARALYSIS ................................................................................................100% SEVERE BURNS ........................................................................................100% COMA ........................................................................................................100% LOSS OF SPEECH ....................................................................................100% LOSS OF SIGHT ........................................................................................100% LOSS OFHEARING ..................................................................................100% ADDITIONAL BENEFIT RIDER
SPECIFIED SURGERIES OF THE HEART ........................................100% CORONARY ARTERY BYPASS SURGERY, MITRAL VALVE REPLACE- MENT/REPAIR, AORTIC VALVE REPLACEMENT/REPAIR, SURGICAL TREATMENT OF ABDOMINAL, AORTIC ANEURYSM INVASIVE HEART PROCEDURES AND TECHNIQUES ....................10% ANGIO CLOST BUSTING, BALLOON ANGIOPLASTY, LASER ANGIO- PLASTY, ATHERECTOMY, STENT IMPLANTATION, CARDIAC CATHETERI- ZATION, AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR, PACEMAKERS
CAI2880
13 YATES LLC 2022 BENEFIT GUIDE
HI2
G
group Hospital indemnity
Supplemental Hospital Indemnity Policy Series CA8500-MP This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions.
PLAN BENEFITS
PLAN 2
$200
Hospital confinement per day (up to 180 days per confinement) This benefit is paid when a Covered Person is confined to a hospital as a resident bed patient because of a Covered Sickness or as the result of Injuries received in a Covered Accident. To receive this benefit for Injuries received in a Covered Accident, the Covered Person must be confined to a hospital within six months of the date of the Covered Accident. Hospital admission per admission The benefit is paid when a Covered Person is admitted to a hospital and confined as a resident bed patient because of Injuries received in a Covered Accident or because of a Covered Sickness. In order to receive this benefit for Injuries received in a Covered Accident, the Covered Person must be admitted to a hospital within six months of the date of the Covered Accident. Hospital intensive care per day This benefit is paid when a Covered Person is confined in a hospital intensive care unit because of a Covered Sickness or due to an Injury received from a Covered Accident. To receive this benefit for Injuries received in a Covered Accident, the Covered Person must be admitted to a hospital intensive care unit within six months of the date of the Covered Accident. surgical benefit up to the amount shown If an insured has surgery performed by a physician due to an Injury received in a Covered Accident or because of a Covered Sickness, we will pay the appropriate surgical benefit amount shown in the Schedule of Opera- tions. The surgical benefit paid will never exceed the maximum surgical benefit designated in the plan. The surgery can be performed in a hospital (on an inpatient or outpatient basis), in an ambulatory surgical center, or in a Physician’s office. anestHesia benefit up to the amount shown When an insured receives benefits for a surgical procedure covered under the Surgical Benefit, we will pay the appropriate benefit amount shown in the Schedule of Operations for anesthesia administered by a Physi- cian. However, the anesthesia benefit paid will not exceed 25 percent of the amount paid under the Surgical Benefit. Hospital emergency room/pHysician benefit (medical fees) maximum per visit If an insured is injured in a Covered Accident or has treatment as the result of a Covered Sickness, we will pay the following benefit: physician (per visit) – $50 laboratory fees (per visit) – $25 X-ray (per visit) – $50
$300
$200
$2,000
$500
$50
injections/medications (per visit) – $25 maximum $250/insured per calendar year maximum $1,000/family per calendar year maximum $50/per visit
$25
Well baby care benefit per visit We will pay the Well Baby Care Benefit amount associated with each benefit plan option when an insured baby receives well baby care (four visits per calendar year per insured baby). For this plan, a baby is a Dependent Child 12 months of age or younger. This benefit is payable only if coverage is issued with the Dependent Children Rider. out-of-Hospital prescription drug benefit five-prescription maximum per year We will pay an indemnity benefit, based on the plan definitions, for each prescription filled for a Covered Person. Prescription drugs must meet three criteria: (1) be ordered by a Doctor; (2) be dispensed by a li- censed pharmacist; and (3) be medically necessary for the care and treatment of the patient. This benefit is subject to the Out-of-Hospital Prescription Drug Benefit Maximum.
$10
14 YATES LLC 2022 BENEFIT GUIDE
CAI85802 4/11
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USING THE PLAN IS EASY. Simply give us a call or log into our members’ site to view your plan coverage and find attorneys. As long as you use a Network Attorney for a covered matter there are: No deductibles or co-payments - No waiting periods or claim forms - No limits on usage
For more information visit our website: info.legalplans.com and enter access code: LegalCM or call: 800.821.6400 Monday - Friday: 8:00 am - 8:00 pm (EST/EDT)
Where available, you may also visit us at www.metlife.com/mybenefits
15 YATES LLC 2022 BENEFIT GUIDE
© 2018 MetLife Services and Solutions, LLC.
MetLaw
CONSUMER PROTECTION MATTERS • Disputes over Consumer Goods and Services • Small Claims Assistance
IMMIGRATION ASSISTANCE • Advice and Consultation • Preparation of Affidavits and Powers of Attorney • Review of Immigration Documents JUVENILE MATTERS • Juvenile Court Defense, including Criminal Matters • Parental Responsibility Matters TRAFFIC OFFENSES • Defense of Traffic Tickets (excludes DUI) • Driving Privilege Restoration (Includes License Suspension due to DUI) PERSONAL PROPERTY PROTECTION • Assistance for disputes over goods and services • Consultations and Document Review for Personal Property Issues
DEFENSE OF CIVIL LAWSUITS • Administrative Hearings • Civil Litigation Defense • Incompetency Defense • Pet Liabilities • School Hearings
DOCUMENT PREPARATION & REVIEW • Affidavits; Deeds; Demand Letters • Mortgages • Promissory Notes • Review of Any Personal Legal Documents
ELDER LAW MATTERS • Consultations and Document Review for issues related to your parents including Medicare, Medicaid, Prescription Plans, Nursing Home Agreements, Leases, Notes, Deeds, Wills and Powers of Attorney as these affect the Participant
REAL ESTATE MATTERS • Boundary or Title Disputes • Eviction and Tenant Problems (Primary Residence - Tenant Only) • Home Equity Loans (Primary, Secondary or Vacation Home) • Property Tax Assessment • Sale, Purchase or Refinancing (Primary, Secondary or Vacation Home) • Security Deposit Assistance (For Tenant) • Zoning Applications
ESTATE PLANNING DOCUMENTS • Codicils • Healthcare Proxies • Living Wills • Powers of Attorney (Healthcare, Financial, Childcare) • Simple and Complex Wills • Trusts (Revocable and Irrevocable) FAMILY LAW • Adoption and Legitimization • Guardianship or Conservatorship • Name Change • Prenuptial Agreement • Protection from Domestic Violence
HERE’S HOW TO ENROLL: • Select MetLaw during your benefit enrollment period. • Your cost for the Plan will be automatically deducted from your paychecks. • Once you enroll, you must remain in the Plan for the entire Plan year.
1 These benefits provides the Participant with access to LifeStages Identity Management Services and FraudScout Triple Bureau Credit Monitoring Services provided by CyberScout, LLC. CyberScout is not a corporate affiliate of Hyatt Legal Plans.
FINANCIAL MATTERS • Debt Collection Defense • Foreclosure Defense • Negotiations with Creditors • Personal Bankruptcy • Tax Audit Representation • Tax Collection Defense IDENTITY THEFT MATTERS • Identity Theft Defense
Exclusions: Please see your plan description for complete details. No service (including consultations) will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the employer, MetLife ® and affiliates, and plan attorneys; 3) matters in which there is a conflict of interest between the employee and spouse or dependents, in which case services are excluded for the spouse and dependents; 4) appeals and class actions; 5) farm matters, business or investment matters, matters involving property held for investment or rental, or issues when the participant is the landlord; 6) patent, trademark and copyright matters; 7) costs and fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Group Legal Plans are provided by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, group legal plans are provided through insurance coverage underwritten by Metropolitan Property and Casualty Company and Affiliates, Warwick, Rhode Island. L1217501056[exp0219][All States][DC,PR] ML3wCreditMonitoringRM
• LifeStages - Identity Management Services 1 • FraudScout - Triple Bureau Credit Monitoring 1
16 YATES LLC 2022 BENEFIT GUIDE
Employee Assistance Program
Employee Assistance Program
Professional support and guidance for everyday life
Life doesn’t always go as planned. And while you can’t always avoid the twists and turns, you can get help to keep moving forward. We can help you and your family, those living at home, get professional support and guidance to make life a little easier. Our Employee Assistance Program (EAP) is available to you in addition to the benefits provided with your MetLife insurance coverage. This program provides you with easy-to-use services to help with the everyday challenges of life — at no additional cost to you.
Expert advice for work, life, and your well-being The program’s experienced counselors provided through LifeWorks — one of the nation’s premier providers of Employee Assistance Program services — can talk to you about anything going on in your life, including: • Family: Going through a divorce, caring for an elderly family member, returning to work after having a baby • Work: Job relocation, building relationships with co-workers and managers, navigating through reorganization • Money: Budgeting, financial guidance, retirement planning, buying or selling a home, tax issues • Legal Services: Issues relating to civil, personal and family law, financial matters, real estate and estate planning • Identity Theft Recovery: ID theft prevention tips and help from a financial counselor if you are victimized • Health: Coping with anxiety or depression, getting the proper amount of sleep, how to kick a bad habit like smoking • Everyday Life: Moving and adjusting to a new community, grieving over the loss of a loved one, military family matters, training a new pet Convenient and confidential help when you want it, how you want it Your program includes up to 5 phone or video consultations with licensed counselors for you and your eligible household members, per issue, per calendar year. You can call 1-888-319-7819 to speak with a counselor or schedule an appointment, 24/7/365. When you call, just select “Employee Assistance Program” when prompted. You’ll immediately be connected to a counselor. If you’re simply looking for information, the program offers easy to use educational tools and resources, online and through a mobile app. There is a chat feature so you can talk with a consultant to guide you to the information you are looking for or help you schedule an appointment with a counselor. Log on to metlifeeap.lifeworks.com, user name: metlifeeap and password: eap
Help is always at your fingertips. Our mobile app makes it easy for you to access and personalize educational content important to you. Search “LifeWorks” on iTunes App Store or Google Play. Log in with the user name: metlifeeap and password: eap
17 YATES LLC 2022 BENEFIT GUIDE
Employee Assistance Program
Answers to important questions
When you need some support, we’re here to help.
Are Employee Assistance Program services confidential? Yes. Any personal information provided to LifeWorks stays completely confidential.* How do I get help? Getting professional help is just a phone call away. Simply call 1-888-319-7819 to speak with a counselor or to schedule a phone or video conference appointment. These services are available 24 hours a day, 7 days a week. When is the right time to call? That’s up to you. Counselors are here whenever you need them —whether you simply need to talk or want guidance on something you are going through. Is my Employee Assistance Program included with my MetLife coverage? Yes. There is no cost to you because your employer pays for the services provided within our program. While we offer a broad range of services, there may be some assistance that’s not included. You can still work with counselors for these services by arranging to pay for them directly. Does the program have any limitations? While we offer a broad range of services, we may not cover all services you may need. Your Employee Assistance Program does not provide: • Inpatient or outpatient treatment for any medically treated illness • Prescription drugs • Treatment or services for intellectual disability or autism • Counseling services beyond the number of sessions covered or requiring longer term intervention • Services by counselors who are not LifeWorks providers • Counseling required by law or a court, or paid for by Workers’ Compensation
Phone 1-888-319-7819
Web metlifeeap.lifeworks.com user name: metlifeeap and password: eap
Mobile App user name: metlifeeap and password: eap
*MetLife and LifeWorks abide by federal and state regulations regarding duty to warn of harm to self or others. In these instances, the consultant may have a duty to intervene and report a situation to the appropriate authority.
Some restrictions may apply to all of the above-mentioned services. Please contact your employer or MetLife for details.
Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 OPT1 L1217501239[exp0119][All States][DC,GU,MP,PR,VI] © 2017 METLIFE, INC.
18 YATES LLC 2022 BENEFIT GUIDE
Frequently Asked Questions What is included in the Medical Out-of-Pocket maximum? What is included in the Pharmacy Out- of-Pocket maximum? The Medical Out-of-Pocket maximum is the maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible and any coinsurance member responsibility. The Pharmacy OOP includes only pharmacy co-pays. The Medical OOP does NOT include monthly premiums, or billing from out-of-network providers. What is an in-network vs out-of-network provider? Meritain Health contracts with a wide range of doctors, as well as specialists, hospitals, labs, radiology facilities and pharmacies. These are the providers that are considered “in your network”. Specifically, each of these providers has agreed to accept Meritain Health’s contracted rate for your medical care and services rendered. The contracted rate includes both Meritain Health’s share of the cost, and the member’s. Your share may be in the form of a co-payment, deductible, or co-insurance. For example, Meritain Health’s contracted rate for a primary care visit might be $125. The Plan has a $25 co-payment for the visit; the member will pay $25 of the cost and your insurance plan will pay the remaining $100. An “out-of-network” provider is a medical doctor or facility that is not in contract with Meritain Health. This means that the provider may charge members higher rates for medical services and care, outside of the standard “in-network” rates. For example, a out-of- network provider may charge $200 for a primary care visit. Meritain Health may pay an adjustment of an out-of-network benefit of $80 dollars to the provider, so the member may be balance-billed for the remaining $120 cost of the visit. When can I change my beneficiary information for my Basic Life Insurance? Any time! It is important that all beneficiary information be kept up-to-date. You may need to change it after a marriage, divorce, or birth of a child. You can go into Employee Navigator anytime to update your beneficiary.
Term
Definition
Network Office Visit (PCP) The “per visit” co-pay cost for a primary care or standard network doctor.
The “per visit” co-pay cost for a specialized doctor (cardiologist, OB/GYN,
Specialist Office Visit
orthopedic, gastrointestinal, etc.)
The amount of money a member owes for any In-network health care services before co-insurance coverage begins. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) Deductibles run on a calendar year basis. After any applicable deductible is met, the remaining cost of any in-network health care service is divided between the insurance carrier and the member. A 70% / 30% network co-insurance would divide the cost of a service with 70% paid by the insurance carrier and 30% paid by the member. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) The maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible, any co-insurance member responsibility, primary care and specialist office visit co-pays, ER or Urgent Care co-pays, and prescription co-pays / costs. The OOP does NOT include monthly premiums, billing from out-of-network providers, or spending for non-essential health benefits. The cost of a one month supply of a prescription drug. All covered drugs are designated into tiered levels based on drug usage, cost, and clinical effectiveness. Tier 1 usually includes generics, while Tier 2 generally includes preferred brand name medications. Tier 3 typically includes non-preferred brand name medications, Tier 4 usually includes higher cost drugs and Specialty Drugs are covered under a separate tier.
Network Deductible
Co-Insurance
Network Out-of-Pocket Maximum (OOP)
Prescription Drug Tiers and Monthly Co-Pays
19 YATES LLC 2022 BENEFIT GUIDE
Legal Notices
Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families 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). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2021. Contact your State for more information on eligibility –
ALABAMA - Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447 ALASKA - Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: Customer Service@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default. aspx ARKANSAS - Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) COLORADO - Medicaid Website: http://www.colorado.gov/hcpf Customer Contact Center: 1-800-221-3943 KANSAS - Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 KENTUCKY - Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUSIANA - Medicaid Website: http://dhh.louisiana.gov/index.cfm/ subhome/l/n/331 Phone: 1-888-695-2447
FLORIDA - Medicaid Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268 GEORGIA - Medicaid Website: http://dch.georgia.gov/medicaid - click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 INDIANA - Medicaid Healthy Indiana Plan for Low-Income Adults 19-64 Website: http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone: 1-800-403-0864 IOWA - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 MAINE - Medicaid Website: http://maine.gov/dhhs/ofi/public-assistance/ index.html Phone: 1-800-442-6003 TTY: Maine relay 711
MASSACHUSETTS - Medicaid and CHIP Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120 MINNESOTA - Medicaid Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739
20 YATES LLC 2022 BENEFIT GUIDE
Legal Notices
MISSOURI - Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
RHODE ISLAND - Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300 SOUTH CAROLINA - Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid
Phone: 573-751-2005 MONTANA - Medicaid Website: http://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084 NEBRASKA - Medicaid
Website: http://www.dhhs.ne.gov/Children_Family_ Services/AccessNebraska/Pages/accessnebraska_ index.aspx Phone: 1-855-632-7633 NEVADA - Medicaid Website: http://dwss.nv.gov/ Phone: 1-800-992-0900 NEW HAMPSHIRE - Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218 NEW JERSEY - Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/ medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK - Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA - Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA - Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825 OKLAHOMA - Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON - Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx http://oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 PENNSYLVANIA - Medicaid Website: http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462
Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 UTAH - Medicaid and CHIP Medicaid Website: http://health.utah.gov/medicaid CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669 VERMONT - Medicaid Website: http://www.greenmountaincare.org Phone: 1-800-250-8427 VIRGINIA - Medicaid and CHIP Medicaid & CHIP Website: http://www.coverva.org/programs_premi- um_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282 WASHINGTON - Medicaid Website: http://www.hca.wa.gov/free-or-low-costhealth-care/pro- gram-administration/premiumpayment- program Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA - Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/ default.aspx Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN - Medicaid and CHIP Website: http://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Phone: 1-800-362-3002 WYOMING - Medicaid Website: http://wyequalitycare.acs-inc.com/ Phone: 307-777-7531
To see if any more States have added a premium assistance program since January 31, 2021, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
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