CONTENTS & CONTACT INFORMATION
Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.
BROKER
Provider Name
M.E. Wilson Company
Broker Contact
Amanda Sands
Provider Phone Number
813-229-8021 Ext. 139
Provider Email Address
asands@mewilson.com
MEDICAL
3
Provider Name
Cigna
Provider Phone Number
1-866-494-2111
Provider Web Address
www.cigna.com
DENTAL
7
Provider Name
Guardian
Provider Phone Number
1-800-541-7846
Provider Web Address
www.GuardianLife.com
VISION
8
Provider Name
Guardian
Provider Phone Number
1-800-541-7846
Provider Web Address
www.GuardianLife.com
FLEX SPENDING & HEALTH SAVINGS ACCOUNT
9
Provider Name
Discovery Benefits
Provider Phone Number
1-866-451-3399
Provider Web Address
www.discoverybenefits.com
LIFE AND AD&D AND VOLUNTARY LIFE AND AD&D
10
Provider Name
Mutual of Omaha
Provider Phone Number
1-877-999-2330
Provider Web Address
www.mutualof omaha.com
SHORT -TERM AND LONG -TERM DISABILITY
11
Provider Name
Mutual of Omaha
Provider Phone Number
1-877-999-2330
Provider Web Address
www.mutualof omaha.com
EMPLOYEE ASSISTANCE PROGRAM
12
Provider Name
Mutual of Omaha
Provider Phone Number
1-800-316-2796
Provider Web Address
www.mutualof omaha.com/eap
HOW TO ENROLL
13-14
DISCLOSURE NOTICES
15
BENEFIT INFORMATION
YOUR BENEFITS PLAN
BENEFIT
WHO PAYS THE COST?
JL Marine Systems offers a variety of benefits allowing you the opportunity to customize a benefits package that meets your personal needs. In the following pages, you’ll learn more about the benefits offered. You’ll also see how choosing the right combination of benefits can help protect you and your family’s health and finances – and your family’s future.
Company pays the majority of the employee portion of the Micro plan and a significant amount of the spouse & dependent portion
Medical Insurance
Dental, Vision and Voluntary Life
You pay entire cost
Basic Life Insurance
Company pays entire cost
Voluntary Life Insurance – Employee, Spouse and Dependent Children
You pay entire cost
Short-Term and Long-Term Disability
Company pays entire cost
ELIGIBILITY
All Regular full-time employees are eligible to join the JL Marine Systems Benefits Plan on the 1st of the month following 60 days. “Regular Full-Time Employees” must be regularly scheduled and working at least 30 hours per week.
You may also enroll your dependents in the Benefits Plan when you enroll. Eligible dependents include: • Your Spouse, unless you are legally separated or divorced; • Your married or unmarried natural children, step- children living with you, legally adopted children and any other children for whom you have legal guardianship, who are: - Under 26 years of age for medical; - To be eligible, a Dependent must: • Be Unmarried and not have dependents of his or her own; AND • Be a Resident of Florida or a Student; AND • Not have coverage of their own, or covered under any other plan; AND • Not entitled to benefits under Medicare
WHEN CAN YOU ENROLL?
You can sign up for Benefits at any of the following times: • After completing initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family- status change. If you do not enroll at one of the above times, you must wait for the next annual open enrollment period.
BENEFIT INFORMATION
WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?
CHOOSING YOUR BENEFITS
?
You must actively choose any benefit that you pay for, or share in the cost with JL Marine Systems. Your part of the cost is automatically taken out of your paycheck. There are two ways that the money can be taken out: • BEFORE YOUR TAXES ARE CALCULATED – medical, dental, vision and flexible spending accounts.
There is a definite advantage to paying for some benefits with before- tax money: Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.
• AFTER YOUR TAXES ARE CALCULATED – voluntary life and accidental death & dismemberment
Generally, you can only change your benefit choices during the annual benefits enrollment period. However, you may be able to change your benefit choices at anytime if you have a change in status including: • Your marriage • Your divorce or legal separation • Birth or adoption of an eligible child • Death of your spouse or covered child • Change in your spouse’s work status that affects his or her benefits • Change in your work status that affects your benefits • Change in residence or work site that affects your eligibility for coverage • Change in your child’s eligibility for benefits • Receiving Qualified Medical Child Support Order (QMCSO)
If you do not notify Human Resources within 30 days of a family status change,
you will have to wait until the next annual enrollment period to make benefit changes unless you have another family status change.
WHEN COVERAGE ENDS
Medical, Dental and Vision Coverage will stop on the last day of the month in which employment with the company ends. All other benefits terminate the day of termination.
COBRA – A Federal law that allows workers and dependents who lose their medical, dental, or vision coverage to continue any of these coverages for a specified length of time by electing and paying for continuation benefits. Coinsurance – The percentage of the medical or dental charge that you pay after the deductible has been met. Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physicians’ office visits and prescription drugs. Deductible – The amount you pay toward medical and dental expenses each calendar year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in coinsurance during the calendar year
GETTING MORE FROM YOUR HEALTHCARE DOLLARS
Extras
There are some additional benefits that are available to you as a Cigna member. These products / services offer a variety of discounts at no additional cost to you and your dependents on the plan.
Cigna.com
Register on myCigna.com Once you do, you can log in anytime, anywhere to: Manage and track claims View ID card information Find doctors and compare cost and quality ratings Review you coverage Track your account balances and deductibles
Health Information Line
It can be a fever in the middle of the night or a question about a popular medication. Whether you’re looking for general information or have a specific health concern, the health information line is open 24 hours a day, seven days a week. Dial 800.Cigna24 – (800) 244-6224 and you’ll be connected with a nurse who is ready to help answer your health questions.
Register today! Visit myCigna.com or get the myCigna Mobile App.
PRESCRIPTION DRUG BENEFITS AT A REDUCED COST
MyCigna Mobile App
You’re busier than ever. At Cigna, they get that. While they can’t wave a magic wand and make all the frusterating, time-consuming aspects of your life go away, they can give you a tool to help make your life easier. And healthier. The all-new myCigna Mobile App gives you a simple way to personalize, organize and access your important health information – on the go. The app puts you in control of your health, so you can get more out of life.
Q. What should I do if I have a problem getting a claim paid? A. Start by contacting the carrier’s member services number to determine the nature of the problem. If the issue is the way the doctor or other service provider has billed the claim, then contact your doctor or Claims Advocate at MEW. If the insurance company has an eligibility issue, contact Human Resources for assistance. Q. What is the difference between brand formulary, brand non-formulary, and generic drugs? A. Brand formulary is a prescription drug that is listed on the formulary (i.e., a list of prescription drugs covered by the plan). These drugs are protected by a patent issued to the original innovator or marketer. Brand non- formulary drugs are patent protected but are not listed. A generic equivalent drug can become available when the patent protection runs out, and is deemed equal in therapeutic power to the brand name originals. Q. When should I go the Urgent Care vs. Emergency Room? A. For non-life threatening injury/illness after normal doctor’s office hours Did you know you can obtain prescription drugs at local retailers at a reduced cost and sometimes even free? Publix offers a variety of generic Oral Antibiotic medications to you absolutely free. Bring in your prescription for an approved medication and receive it FREE, up to a 14-day supply. Publix recently approved a medication for diabetes. CVS, Target, Walgreens & WalMart also offer over 400 generic prescriptions for $4 and a 90 day supply for approx. $10. Remember DO NOT show your CIgna ID card to receive these benefits, or you will be charged your CIgna drug rate. FAQs
Care Consultants
Here when you need them. Extended Customer Service Hours provides you 24/7 access to a Cigna Care Consultant. Call at your convenience… 866-494-2111
In addition to the network of physicians, hospitals, emergency rooms, and urgent care clinics, you also have the option of going to the convenient care clinics located within some grocery and drug stores, for minor illness such as ear aches, colds, flu and so on. By selecting one of these providers, you pay only the regular office visit copay; a significant savings over the emergency room and urgent care copayments. Please visit the various websites for locations, hours of operations and scope of services.
CVS Minute Clinic: www.cvs.com Walgreen’s Take Care Clinic: www.walgreens.com
MEDICAL INSURANCE
The chart below provides a brief comparison of the available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.
JL Marine Systems offers 3 medical plans from Cigna. To find participating providers go to www.cigna.com and click on “Find a Doctor”, choose the appropriate plan type, and click continue. Then, narrow down your search based on location and provider type plans. This chart is intended only to highlight the benefits
v
OAP (HSA)
OAPIN 1000
OAP 250
Plan Options:
Micro with Battery Pak
Sportsman
Pro-Series
IN-NETWORK: Plan Year / Contract Year Basis
Calendar Year
Calendar Year
Calendar Year
Deductible (Individual / Family)
$1,500 / $4,500
$1,000 / $3,000
$250 / $750
Maximum Out-of-Pocket (Individual/Family)
$4,500 / $9,000
$4,000 / $8,000
$3,000 / $6,000
Deductible, Coinsurance, & Copays
Deductible, Coinsurance, & Copays
Deductible, Coinsurance, & Copays
Out-of Pocket Max Includes
Lifetime Major Medical Maximum
Unlimited
Unlimited
Unlimited
Coinsurance
80% / 20%
80% / 20%
80% / 20%
Routine Preventive Services
Wellness Immunizations Mammography/Colonoscopy CO-PAYS PCP Required / Open Access
Covered 100%
Covered 100%
Covered 100%
No
No
No
Telemedicine
Deductible & Coinsurance
$25 Copay
$20 Copay
Office Visits/Consultations for Illness/Injury
Deductible & Coinsurance
$25 Copay
$20 copay
Specialist Visits
Deductible & Coinsurance
$45 Copay
$45 copay
Inpatient Hospital
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance
Outpatient Surgery
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance
Emergency Room
Deductible & Coinsurance
$250 Copay
$200 copay
Urgent Care
Deductible & Coinsurance
$50 Copay
$50 copay
OUTPATIENT DIAGNOSTIC SERVICES Lab Services (Freestanding Lab)
Deductible & Coinsurance
Covered 100%
Covered 100%
X-Ray Services (Freestanding Lab)
Deductible & Coinsurance
Covered 100%
Covered 100%
Complex Diagnostic
Deductible & Coinsurance
$350 Copay
$200 Copay
PRESCRIPTIONS
(After annual deductible)
Retail (30 day supply)
$10 / $50 / $80
$10 / $50 / $80
$10 / $50 / $80
Mail Order (90 day supply)
3 X retail
3 X retail
3 x retail
OUT-OF-NETWORK:
Deductible (Individual / Family)
$1,000 / $3,000
$5,000 / $9,000
Maximum Out-of-Pocket (Individual/Family)
$9,000 / $18,000
In-Network Only
$6,000 / $12,000
Unlimited
Lifetime Major Medical Maximum
Unlimited
50%
Coinsurance
50%
HEALTH SAVINGS ACCOUNT
What is a Health Savings Account (HSA)?
It is an interest bearing account created to help you pay medical expenses. The funds in your HSA can be used to help pay your deductible, coinsurance and any qualified medical expenses not covered by your health plan (including dental and vision expenses). All of the money you contribute is tax-deductible when used to pay for qualified medical expenses. An HSA is your account. It goes with you if you change jobs or when you retire.
IRS Annual Maximum HSA Contribution Limits
2019
Employee Only
$3,500
Family
$7,000
Catch up amount for employees 55 years or older
Additional $1,000 Annually
JL Marine Systems Tax Free HSA Contributions
Single and Family Coverage
Annual Amount
$250
* Employer contributions: amount and frequency deposited to your Health Savings Account will be determined by JL Marine Systems and will not exceed the plan year contribution amount.
Health Savings Account – Eligible Expenses (partial list)
• Acupuncture • Alcohol and drug dependency treatment • Ambulance • Artificial limbs • Breast reconstruction surgery (mastectomy-related) • Dental expenses (exams, cleanings, X-rays, root canals bridges, etc.) • Diagnostic fees • Doctor fees (including Chiropractic services) • Drugs - prescription and over the counter (when ordered by physician) • Eyeglasses and exams, contact lenses & solutions, laser surgery • Fertility enhancements • Hearing aids and batteries • Hospital and Laboratory fees • Long-term care (medical expenses and premiums) • Nursing home • Physical and speech therapies • Psychiatric care • Smoking-cessation programs and products • Vasectomy • Weight-loss program (to treat a specific disease diagnosed by a physician)
8
MEDICAL INSURANCE
Employee Medical Payroll Deductions
Cigna OAP HSA- Micro with Battery Pak
Weekly Premium
Bi-Weekly Premium
Employee Only
$ 9.27
$ 18.55
Employee + Spouse
$128.13
$256.26
Employee + Child(ren)
$ 84.91
$169.82
Family
$200.16
$400.33
Cigna OAPIN 1000- Sportsman
Weekly Premium
Bi-Weekly Premium
Employee Only
$ 13.45
$ 26.91
Employee + Spouse
$156.11
$312.22
Employee + Child(ren)
$104.24
$208.47
Family
$242.57
$485.14
Cigna OAP 250- Pro Series
Weekly Premium
Bi-Weekly Premium
Employee Only
$ 34.97
$ 69.95
Employee + Spouse
$212.13
$424.26
Employee + Child(ren)
$147.71
$295.41
Family
$319.49
$638.98
9
DENTAL INSURANCE
JL Marine Systems offers dental coverage through Guardian. The Dental PPO Plan allows you to use in- network or out-of-network benefits. If out-of-network dentists are used, you will be responsible to pay the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plan.
DENTAL PPO Option 1
DENTAL PPO Option 2
In-Network
Out-of Network*
In-Network
Out-of Network*
CALENDAR YEAR DEDUCTIBLE Individual
$50
$50
$50
$100 $150
Family
$150
$150
$150
ANNUAL MAXMIUM
$1,000
$1,000
$1,500
$1,500
Diagnostic & Preventive
Exams Cleanings Fluoride X-Rays Sealants
Covered in full
Covered in full
Covered in full
Covered in full
Regular Restorative Services
Amalgam Fillings Extractions - Single Tooth Endodontics (Root Canal) Periodontics (Gum Disease) MAJOR SERVICES Crowns
Covered 80% after deductible
Covered 80% after deductible
Covered 80% after deductible
Covered 80% after deductible
Covered 50% after deductible Covered 25% after deductible
Covered 50% after deductible Covered 25% after deductible
Covered 50% after deductible Covered 50% after deductible
Covered 50% after deductible Covered 50% after deductible
Bridges Dentures
Orthodontia (child only)
Orthodontia Lifetime Maximum
$500
$1,500
Subject to balance billing. Please refer to your plan document for specific details.
DENTAL PPO Option 1
EMPLOYEE COST WEEKLY
EMPLOYEE COST BI-WEEKLY
Employee Only
$ 5.50 $12.75 $15.76 $23.06
$11.01 $25.51 $31.52 $46.12
Employee + Spouse
Employee + Child(ren)
Family
DENTAL PPO Option 2
EMPLOYEE COST WEEKLY
EMPLOYEE COST BI-WEEKLY
Employee Only
$ 5.91 $13.71 $18.51 $26.35
$11.83 $27.41 $37.02 $52.70
Employee + Spouse
Employee + Child(ren)
Family
VISION INSURANCE
JL Marine Systems offers vision coverage through Guardian. The Guardian vision network consists of optometrists, ophthalmologist opticians and optical retailers. You have the option of visiting any provider, however by choosing a participating provider, you receive the highest level of benefits.
Vision - Davis Vision
In-Network
Out-of-Network
Routine Eye Exams
$25 Copayment
Allowance up to $50
Allowance from $48 to $126 Depending on type of lenses
Lenses*
$25 Copayment
$150 allowance then 20% discount $150 allowance then 20% discount
Frames
$48 allowance
Allowance from $105 to $210 Depending on type of contacts
Contact Lenses
Frequency
Exam
Once every 12 months
Lenses or contact lenses
Once every 12 months
Frame
Once every 24 months
Covered lenses include single vision, bifocal, trifocal and lenticular. Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.
EMPLOYEE COST WEEKLY
EMPLOYEE COST BI-WEEKLY
Employee Only
$ .90 $2.16 $2.13 $3.48
$1.80 $4.32 $4.27 $6.96
Employee + Spouse
Employee + Child(ren)
Family
11
FLEXIBLE SPENDING ACCOUNT (FSA) DEPENDENT CARE ACCOUNT
TYPICAL ELIGIBLE EXPENSES The following is a partial list of typical expanses eligible for health care FSA reimbursement. A complete list can be found at https://www.irs.gov • Deductible for group health and/or dental plan • Copayments for group health and/or dental plan • Many charges that are not covered by health/dental plan are also eligible for FSA reimbursement, such as: • Eye exams, eyeglasses, contact lenses; • Hearing exams, hearing aids, • Physical exams and mammograms in excess of one per year; • Medical expenses of a dependent not covered by a health plan • Orthodontia YOUR CONTRIBUTION The Internal Revenue service limits the amount you can contribute to a dependent care FSA, up to: • $5,000 per year, if you are married and filing a joint return, or if you are a single parent • $2,500 per year, if married and filing separate federal tax returns Estimate what your daycare expenses will be for the year, and allocate enough from your pay, up to the allowable contribution, to cover those expenses. JUST REMEMBER THIS: FSA dollars are “use-it-or- lose-it” funds. Account balances cannot be carried over from year to year. If you have unused funds at the end of the plan year, or at the end of any applicable grace a period, those funds will be forfeited. That’s an IRS requirement. So estimate the amount you want to contribute to your FSA carefully. • A spouse who is physically or mentally incapable of self-care and has the same principal residence as you • A tax dependent of yours who is under age 13, or • Any other tax dependent of yours, such as an elderly parent, who is physically or mentally incapable of self-care and has the same principal residence as you QUALIFYING DEPENDENT A qualifying dependent is: • Vision corrective surgery (such as Lasik) • Smoking cessation programs an related prescription drugs.
JL Marine Systems offers a both Health Care and Dependent Care Flexible Spending Account to all active employees working 24 or more hours per week. You may elect to have both types of accounts and contribute separate pretax dollar amounts to each. These accounts are kept completely separate; for instance, you could not be reimbursed for dependent care expenses from the health care account. HEALTH CARE ACCOUNTS A health care FSA can reimburse you for eligible medical, dental and vision expenses, up to the amount you elect to contribute for the plan year. Beginning in January 2018, the IRS limits the amount you may contribute to $2,650 per year. This amount will increase in future years to reflect cost-of-living increases. A Dependent Care FSA is a great way to pay dependent care expenses and lower your taxable income. Dependent Care Spending Accounts are pre-tax, payroll deduction accounts established to reimburse employees for out-of-pocket dependent care expenses. To be considered eligible, dependent care expenses must be incurred by an employee who must arrange for care of an eligible dependent in order to work. For married employees, dependent care must be necessary so that both spouses can work YOUR CONTRIBUTION The Internal Revenue service limits the amount you can contribute to a dependent care FSA, up to: • $5,000 per year, if you are married and filing a joint return, or if you are a single parent • $2,500 per year, if married and filing separate federal tax returns Estimate what your daycare expenses will be for the year, and allocate enough from your pay, up to the allowable contribution, to cover those expenses. JUST REMEMBER THIS: FSA dollars are “use-it-or-lose- it” funds. Account balances cannot be carried over from year to year. If you have unused funds at the end of the plan year, or at the end of any applicable grace a period, those funds will be forfeited. That’s an IRS requirement. So estimate the amount you want to • elderly parent, who is physically or mentally incapable of self-care and has the same principal residence as you • A spouse who is physically or mentally incapable of self-care and has the same principal residence as you
BASIC LIFE AND AD&D & VOLUNTARY LIFE INSURANCE
JL Marine Systems provides life insurance to all active full time employees at no cost to the employee. The chart below provides an overview of the plan.
BASIC LIFE INSURANCE
Benefit Outline
Class 1 (Managers): $50,000 Class 2 (All Other Employees): $30,000
Benefit Amount
At age 65 reduce by 33% of original amount At age 70 reduce by 66% of original amount
Benefit Reduction Schedule
AD&D
Included - Equal to basic life
JL Marine Systems provides all active employees working 30 or more hours per week the option to purchase life insurance coverage through a group plan, at the employee’s cost..
VOLUNTARY LIFE INSURANCE
Employee Life
Increments of $10,000 up to $300,000. Minimum of $10,000
Guarantee Issue
$100,000
Increments of $10,000 up to $250,000. GI - $25,000 ($10,000 for spouse aged 65+)
Spouse Life
Dependent Life
Increments of $1,000 up to $10,000
AD&D (Employee Only)
Optional – If elected equal to life amount
Benefit Reduction Schedule
At age 65 reduce by 33% of original amount At age 70 reduce by 66% of original amount
Monthly Voluntary Life and AD&D Rates per $1,000 *Spousal Rates are based on employee age.
Age Table
Employee
Spouse $0.073 $0.080 $0.120 $0.194 $0.299 $0.487 $0.764 $1.061 $1.959 $3.201
Child(ren)
<29
$0.073 $0.080 $0.120 $0.194 $0.299 $0.487 $0.764 $1.061 $1.959 $3.201
30 – 34 35 – 39
40-44
45 - 49 50 - 54 55 - 59 60 - 64 65 - 69
$0.187
70+
13
SHORT AND LONG TERM DISABILITY INSURANCE
JL Marine provides short term disability insurance to all active full time employees, at no cost to the employee. The chart below provides an overview of the plan.
SHORT TERM DISABILITY
Benefit Percentage
60%
Maximum Weekly Benefit
$1,500
8th day Accident 8th day Sickness
Elimination Period
Duration of Benefit
12 weeks
JL Marine provides long term disability insurance to all active full time employees, at no cost to the employee. The chart below provides an overview of the plan.
LONG TERM DISABILITY
Benefit % of Monthly Covered Payroll
60%
Monthly Maximum
$9,000
Elimination Period
90 days
Benefit Duration
SSNRA
14
EMPLOYEE ASSISTANCE PROGRAM
When it is difficult to cope with problems, we often turn to family or friends for support. Unfortunately, sometimes that is not enough. Sometimes we need the ear of an experienced professional, one who will keep our concerns confidential and help guide us in the right direction.
Mutual of Omaha’s Employee Assistance Program (EAP) has trained professionals to work with you as you search for solutions to personal and workplace issues. Call the toll-free number on the back of your health plan ID card or log on to www.mutualofomaha.com/eap.
Your EAP is paid for in full by JL Marine Systems and is available 24 hours a day and 7 days a week to help guide you in the right direction when dealing with:
• Depression • Marital and Family Conflicts • Alcohol and Drug Use • Resiliency • Gambling Problems • Grief and Loss • Divorce and Family Law • Financial Issues • Stress and/or Anxiety
In addition to unlimited phone counseling, you are also entitled to up to 3 face to face visits with a referred counselor.
To contact EAP hotline directly and confidentially, call toll free at 1-800-316-2796 anytime.
If you would benefit from speaking with a professional face to face, the EAP staff can put you in touch with local experts and resources. If you prefer, you can access online resources at www.mutualofomaha.com/eap. This website is available when you need trusted, expert information, resources, referrals, or answers to everyday questions.
HOW TO ENROLL THROUGH WEB BENEFITS DESIGN
To complete the enrollment process, you will need the following information for yourself and any dependents you would like to cover (spouse and/or child(ren): • Social Security Number (SSN) • Date of Birth • Home address
HOW TO LOGIN
1
Go to www.mybensite.com/powerpole, to login you will need to enter the following information under ‘Create Account’:
• Last Name • Date of Birth • Last 4 of your social security number (SSN)
• Email address (the email you enter will become your username) • You will also be asked to create your password and confirm it.
In the portal you’ll have the ability to review benefits, summaries, forms, summary plan descriptions, provider search directories and other resources. Be sure you review this site and this guide to ensure you thoroughly understand your benefit options before enrolling.
2
LAUNCH ENROLLMENT Click on “Enroll Now”.
3
PERSONAL & DEPENDENT INFORMATION
Your personal info is already in the system, as are any currently covered dependents. Please review and correct any errors. If you’re unable to make these corrections please contact the Web Benefits Design.
If you need to add or remove a dependent, the Dependents page is where you can do so.
4
ENROLLMENT
The bar along the top tracks your progress in the enrollment process. You may also click back to previous pages here.
Please be sure all dependents you wish to cover are checked.
HOW TO ENROLL THROUGH WEB BENEFITS DESIGN
ENROLLMENT You may view plan costs within the plan option boxes and see plan overviews in the right column. Select a plan by clicking “Select Plan” Click the “Learn More” button for plan documents; such as benefit summary, provider search tools, SBCs, etc)
5
6 When plan elections (or waivers) have been confirmed, scroll to the bottom of the screen to continue .
As you select benefits the cost for coverage will reflect in your shopping cart . (located in the top right hand side of the screen)
If at any point during this process you have questions or require technical support, please reach out to The Benefits Hotline for assistance:
888-297-8052
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES
THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. Further, a health insurer or health maintenance organization may not: 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage; 4. Require a mother to give birth in a hospital; or 5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits. SECTION 111
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 The Women’s Health and Cancer Rights Act of 1998 requires JL Marine Systems to notify you, as a participant or beneficiary of the JL Marine Systems Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for: 1. All stages of reconstruction of the breast on which the mastectomy was performed; 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010. If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post- secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary. MICHELLE’S LAW
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES- CONT.
JL Marine Systems Brian Pompos| 813-689-9932 9010 Palm River Road, Tampa, FL 33619
Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of your health and claims records
• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in writing within 60 days. • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. • We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
Ask us to correct health and claims records
Request confidential communications
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. • We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. • We will make sure the person has this authority and can act for you before we take any action. • You can complain if you feel we have violated your rights by contacting us using the information at the top of this page. • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or
File a complaint if you feel your rights are violated
visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/. • We will not retaliate against you for filing a complaint.
Your Choices For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in payment for your care • Share information in a disaster relief situation • Contact you for fundraising efforts If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we nevershare your information unless you give us written permission:
• Marketing purposes • Sale of your information
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES- CONT.
Our Uses and Disclosures How do we typically use or share your health information? We typically use or share your health information in the following ways.
Help manage the health care treatment you receive
• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. • We can use and disclose your information to run our organization and contact you when necessary. • We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Run our organization
Example: We use health information about you to develop better services for you
Pay for your health services
• We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your dental plan to coordinate payment for your dental work Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.
Administer your plan
• We may disclose your health information to your health plan sponsor for plan administration.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
• We can share health information about you for certain situations such as: • Preventing disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety
Do research
• We can use or share your information for health research.
Comply with the law
• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
• We can share health information about you with organ procurement organizations. • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law
• We can use or share health information about you: • For workers’ compensation claims
enforcement, and other government requests
• For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES- CONT.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.
Effective 01/01/2019
This Notice of Privacy Practices applies to the following organizations. JL Marine Systems
PATIENT PROTECTION :
CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) OF 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states.
If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, 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. For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website. It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation.
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES- CONT.
MEDICARE PART D This notice applies to employees and covered dependents who are eligible for Medicare Part D. Please read this notice carefully and keep it where you can find it.This notice has information about your current prescription drug coverage with Cigna and about your options under Medicare’s prescription drug Plan. If you are considering joining, you should compare your current coverage including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plan (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Cigna has determined that the prescription drug coverage offered by the Welfare Plan for Employees of JL Marine Systems under the Cigna option are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You should also know that if you drop or lose your coverage with Cigna and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. When can you join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th to December 7 th . However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What happens to your current coverage if you decide to join a Medicare Drug Plan? - If you decide to join a Medicare drug plan, your current Cigna coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. - If you decide to join a Medicare drug plan and drop your current Cigna coverage, be aware that you and your dependents will be able to get this coverage back.
When will you pay a higher premium (penalty) to join a Medicare drug Plan? You should also know that if you drop or lose your current coverage with Cigna and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current prescription drug coverage… Contact our office for further information (see contact information below). NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Cigna changes. You also may request a copy of this notice at any time. For more information about your options under Medicare prescription drug coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800- 772-1213 (TTY 1-800-325-0778). Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount.
Date:
1/1/19
Name of Entity/Sender: Contact--Position/Office:
JL Marine Systems Brian Pompos 9010 Palm River Rd Tampa, FL 33619
Phone Number:
813-689-9932
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