Benefits at a Glance December 1, 2018 ‐ November 30, 2019
Contents & Contacts
BROKER Company Name Broker Contact
M.E. Wilson Company
Alison Leon
Company Phone Number Company Email Address
813‐229‐8021 Ext. 146 aleon@mewilson.com
MEDICAL
page 3
Company Name
Meritain
Company Phone Number Company Web Address
1‐800‐925‐2272
www.mymeritain.com Aetna, Choice POS II
Network
PHARMACY Company Name
CVS/caremark 1‐800‐334‐8134
Company Phone Number Company Email Address
RxHelp@rxbenefits.com
TELEMEDICINE Company Name
page 5
Teledoc
Company Phone Number Company Web Address
1‐800‐362‐2667
www.mydrconsult.com
DENTAL
page 6
Company Name
Sunlife Financial 800‐247‐6875
Company Phone Number Company Web Address
www.sunlife.com/onlineadvantage
VISION
page 7
Company Name
Sunlife Financial 800‐877‐7195 www.vsp.com
Company Phone Number Company Web Address
LIFE INSURANCE Company Name
page 8
Sunlife Financial 1‐800‐451‐2513 www.sunlife.com
Company Phone Number Company Web Address
SHORT TERM AND LONG TERM DISABILITY
page 8
Company Name
Sunlife Financial 1‐800‐451‐2513 www.sunlife.com
Company Phone Number Company Web Address
EMERGENCY TRAVEL ASSISTANCE AND IDENTITY THEFT PROTECTION
page 9
Company Name
Sunlife Financial 1‐800‐451‐2513 www.sunlife.com
Company Phone Number Company Web Address
VOLUNTARY PRODUCTS
page 10
Company Name
Sunlife Financial 1‐800‐451‐2513 www.sunlife.com
Company Phone Number Company Web Address
ONLINE ENROLLMENT
page 11
Online Enrollment Company
ExponentHR
Web Address
www.exponenthr.com
DISCLOSURE NOTICES
page 13
Your Benefits
DEX Imaging imaging offers a variety of benefits allowing you the opportunity to customize a benefits package that meets your personal needs. In the following pages, you will learn more about the benefits offered. You will 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.
Medical
DEX Imaging pays the majority of the employee cost for the Meritain medical plans.
Dental
DEX Imaging offers you the option to elect this voluntary benefit. You pay the full cost for coverage.
Vision
DEX Imaging offers you the option to elect this voluntary benefit. You pay the full cost for coverage.
Basic Life
DEX Imaging pays the entire cost.
Short‐Term and Long Term Disability
DEX Imaging offers you the option to elect this voluntary benefit. You pay the full cost for coverage.
DEX Imaging offers you the option to elect voluntary Critical Illness, Accident, Cancer and Gap Insurance. You pay the full cost for coverages.
Voluntary Benefits
Pre‐tax benefits
?
You must actively choose any benefit that you pay for or share in the cost with through DEX Imaging.
Why do I pay for benefits pre‐tax?
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.
Your part of the cost is automatically deducted from your paycheck. Premiums for medical, dental, and vision are deducted pre‐tax.
1
Eligibility
Employees working 30 + hours/week are eligible for benefits the first of the month following 60 days. If you enroll in the benefits you may also cover your eligible dependents, these include:
Your legal 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
When can you enroll?
You can sign up for benefits at any of the following times: • After completing your 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.
Examples of qualified family‐status changes are as follows: • Your marriage • Your divorce or legal separation
• 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)
• 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
If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another family status change.
When does coverage end? Coverage will stop on the last day of the month in which your employment with the company ends.
2
Medical
DEX Imaging offers two medical plans through Meritain. The below chart provides an overview and comparison of these plans. To find a participating provider, visit www.aetna.com and select “find a doctor”. DEX Imaging uses the Aetna Choice POS II network.
Option A CORE
Option B BUY‐UP
IN‐NETWORK CALENDAR DEDUCTIBLE (the amount you are responsible for before Meritain shares in claims costs) Individual / Family $2,000 / $4,000 COINSURANCE (percent of claims costs you pay once you’ve met the deductible) 40% OUT OF POCKET MAXIMUM (the maximum you will pay for covered services in a calendar year) Individual / Family $6,350 / $12,700
$1,500 / $3,000
10%
$3,000 / $6,000
Maximum Includes
Deductible, Coinsurance, Copays & Prescriptions
PREVENTIVE CARE Wellness, Immunizations & Mammograms OFFICE VISITS PCP or Referral Required
Covered 100%
No
Office Visits (Illness / Injury)
$60 Copay
$60 Copay
Specialist Visits
40% after deductible
10% after deductible
HOSPITAL SERVICES Inpatient Hospital Outpatient Surgery Emergency Room
40% after deductible 40% after deductible 40% after deductible 40% after deductible
10% after deductible 10% after deductible 10% after deductible 10% after deductible
Urgent Care
DIAGNOSTIC TESTING Independent/Freestanding Lab
40% after deductible 40% after deductible
10% after deductible 10% after deductible
Complex Diagnostic
PRESCRIPTIONS
Generics: Covered 100% (Deductible waived) Brand copays apply after Deductible: Preferred: $50 Non‐Preferred: $75 Injectables: $125 Generics: Covered 100% (Deductible waived) Brand copays apply after Deductible: Preferred: $125 Non‐Preferred: $187.50
Generics: Covered 100% (Deductible waived) Brand copays apply after Deductible: Preferred: $30 Non‐Preferred: $50 Injectables: $125 Generics: Covered 100% (Deductible waived) Brand copays apply after Deductible: Preferred: $75 Non‐Preferred: $125
Retail (30 day supply)
Mail Order (90 day supply) Mandatory for all maintenance medications. Can be obtained at either a CVS retail store or through Caremark Mail‐order service.
The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits 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.
3
Option A CORE
Option B BUY‐UP
OUT‐OF‐NETWORK 1 Deductible
$3,000 / $6,000 $6,000 / $12,000
$4,000/$8,000 $12,700/$25,400 60%
Maximum Out‐of‐Pocket
Coinsurance
30%
PERSONAL HEALTH FUND
$500/ Single (after $1,500 deductible) $1,000/ Family (after $3,000 Deductible) Rx costs are excluded
$500/ Single (after $1,000 Deductible) $1,000/ Family (after $2,000 Deductible) Rx costs are excluded
Cost for coverage (per paycheck)
Option A CORE $ 61.11 $242.71 $219.71 $371.54
Option B BUY‐UP $110.77 $323.61 $291.64 $488.15
Employee only
Employee + Spouse Employee + Child(ren) Employee + Family
The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits 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.
4
Telemedicine
THERE IS NO CHARGE FOR THIS BENEFIT – NO COPAY!
Teladoc is the on‐demand healthcare solution that gives you the medical care you need, when you need it. You can talk to a doctor anytime, anywhere about non‐emergency medical conditions.
With Teladoc, you can talk to a doctor 24/7/365 by phone, online video or mobile app. Use Teladoc for medical advice and care when: • Your primary care doctor is not open • You are at home, traveling or do not want to take time off work to see a doctor • You need a prescription or refills. ( Please note, there is no guarantee you will be prescribed medication ).
Common conditions treated (but not limited to):
• Eye/ear infections • Bronchitis • Sinus infections
• Headaches/migraines • Rash/skin infections • Allergies
• Cold/Flu • Stomachache/diarrhea • Urinary tract infections
Teladoc is available only to employees who are enrolled in one of the DEX Imaging medical plans
5
Dental
DEX Imaging offers 2 dental plan options through Sunlife Financial. The PPO Dental plans allow you to use in‐network or out‐of‐network benefits. If out‐of‐network dentists are used, you will be responsible for paying the difference between Sunlife’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plans.
LOW PPO Dental Plan
HIGH PPO Dental Plan
IN‐NETWORK CALENDAR YEAR DEDUCTIBLE (applies to basic and major services only) Individual $50
$50
$150
$150
Family
ANNUAL MAXIMUM (maximum Sunlife will pay towards claims per year) Per covered person $1,250
$1,250
DIAGNOSTIC & PREVENTIVE
Exams, Cleanings (2 in 12 months), X‐Rays, Sealants, etc.
Covered in full
Covered in full
BASIC SERVICES
Amalgam Fillings, Extractions ‐ Single Tooth, Endodontics (Root Canal) & Periodontics (Gum Disease)
20% after deductible
Covered in full after deductible
MAJOR SERVICES Crowns, Bridges & Dentures OUT‐OF‐NETWORK* CALENDAR YEAR DEDUCTIBLE
50% after deductible
40% after deductible
$100 / $300
$100 / $300
ANNUAL MAXIMUM
$1,250
$1,250
SERVICES Diagnostic & Preventive Basic Major
You pay 0% after deductible 50% after deductible 75% after deductible
You pay 0% after deductible 20% after deductible 50% after deductible
Cost for coverage (per paycheck)
Employee
$ 8.74 $20.48 $22.01 $33.19
$13.27 $31.12 $33.43 $50.42
Employee + Spouse Employee + Child(ren) Employee + Family
6 • Subject to balance billing. Please refer to your plan document for specific details.
Vision
DEX Imaging offers vision coverage through Sunlife Financial. The vision plan allows you the flexibility to see any provider. Your provider may ask you to pay expenses at the time of service and then file a claim for reimbursement. Below is a list of the reimbursement schedule.
Vision VSP Provider Network
IN‐NETWORK EXAMS
Every 12 months $10 Copay
LENSES
Every 12 months
Single vision Lined bi‐focal Lined tri‐focal Lenticular
$25 Copay (lens add‐ons may be available at a discount of 20% off retail prices)
FRAMES
Every 24 months $25 Copay provides $130 allowance + 20% discount on overage
CONTACT LENSES (in lieu of glasses)
Every 12 months
Elective
Up to a $130 allowance
$25 Copay
Medically Necessary OUT‐OF‐NETWORK EXAMS
Reimbursed up to $52
LENSES
Reimbursed up to $55‐$125 depending on lenses
FRAMES
Reimbursed up to $57
CONTACT LENSES (in lieu of glasses)
Reimbursed up to $105 Cost for coverage (per paycheck)
Employee
$2.89 $5.79 $6.37 $9.26
Employee + Spouse Employee + Child(ren) Employee + Family
The chart below provides a brief overview of the vision plan. This chart is intended only to highlight the benefits 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.
7
Life and AD&D
Basic Life & AD&D
Employee Life
$10,000 **The Basic Life & AD&D insurance is paid 100% by DEX Imaging** Voluntary Life Insurance
Employee Life
Increments of $10,000 up to $500,000
$200,000 < age 65 $ 50,000 age 65-69 $ 10,000 age 70+ (for timely entrants/ newly eligible employees)
Employee Guarantee Issue
Spouse Life
Increments of $5,000 up to lesser of 50% of employee's amount or $250,000.
Spouse Guarantee Issue $50,000 (for timely entrants/ newly eligible employees)
Dependent Life
$1,000 increments up to lesser of 10% of the employee’s amount or $10,000
AD&D
Included – Equal to life amount
At age 65: 35% reduction At age 70: 60% reduction At age 75: 75% reduction At age 80: 85% reduction
Benefit Reduction Schedule
Disability
Short Term Disability DEX Imaging offers voluntary short term disability (STD) insurance to all active full time employees. The benefit begins on the 15 th day of accident or sickness and pays 60% of your weekly earning to a maximum of $1,250. The benefit will pay up to a maximum of 11 weeks.
The employee pays 100% of the Short Term Disability premium. Refer to the online enrollment system for cost.
Long Term Disability DEX Imaging offers voluntary long term disability insurance to all active full time employees. The benefit starts to pay once the short term disability benefit is exhausted, or after 90 days from the accident or sickness. The benefit pays 60% of your monthly earnings to a maximum of $15,000. The benefit can continue until you are no longer disabled or SSNA (Social Security Normal Retirement Age).
The employee pays 100% of the Long Term Disability premium. Refer to the online enrollment system for cost.
8
Travel Assist and ID Theft Protection
We are pleased to offer you Emergency Travel Assistance and Identity Theft Protection through Assist America. These extra services are included as part of your Basic Life/AD&D provided by DEX Imaging. These valuable services offer additional protection you can use today – giving you peace of mind and helping you face emergencies.
Emergency Travel Assist
The following Assist America services are available to all employees: • Medical consultation, evaluation, and referral • Hospital admission
• Critical care monitoring • Prescription assistance
• Legal and interpreter referrals • Emergency medical evacuation
This is not medical insurance. No claims for reimbursement will be accepted. All services must be arranged and provided by Assist America. Spouse business travel excluded. If you or your family member needs assistance while more than 100 miles away from home, call or e‐mail: Within the U.S.: 800‐872‐1414 Outside the U.S.: 609‐986‐1234 email: medservices@assistamerica.com
Your membership number: 01‐AA‐SUL‐100101
Identity Theft Protection
Services provided by Assist America’s SecurAssist Identity Program are available to all employees. If you are the victim of financial or medical identity fraud, or if you’d like to store your card information in one central location call: 877‐409‐9597 Your membership number: 01‐AA‐SUL‐100101
To proactively protect your credit cards, register them for Identity Fraud Protection surveillance: www.secureassist.com/sunlife Access Code: 18327
9
Voluntary Benefits
Critical Illness
• Sunlife Financial’s Critical Illness Product provides for an insured to receive a benefit payment upon diagnosis of any qualified and covered critical illness or condition up to $10,000. • Conditions include, but are not limited to: • heart attack • Stroke • Paralysis • Coma • Cancer
Accident
• 24 hour coverage for both on and off the job accidents • Provides a fixed benefit for accidental injuries such as fractures and dislocations and related expenses, such as emergency room visits and physical therapy. Daily hospital and ICU benefits are also included, as well as an Accidental Death and Dismemberment provision.
Cancer
• Provides a fixed benefit for the early detection, incidence and treatment of cancer as well as related expenses. • Related expenses include: • Cancer screenings • Second surgical opinion • Surgery and general anesthesia
• Hospital confinement • In‐hospital doctor visits • Radiation and Chemotherapy • Blood and plasma • Skin Cancer • Prosthesis • Extended‐care facility • Hospice • Ambulance
Gap Plan
• Covers certain portions of the employee’s cost (co‐insurance, co‐pays and deductibles) for covered hospital expenses up to an annual maximum of $2,000 • Includes benefits for in‐hospital expenses such as hospital confinements and emergency room treatment.
Refer to Sunlife Financial handouts for additional information and cost
10
Online Enrollment
11
Online Enrollment
12
Required Annual Employee Disclosure Notices Required Annual Employee Disclosure Notices
THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 The Women’s Health and Cancer Rights Act of 1998 requires DEX Imaging to notify you, as a participant or beneficiary of the DEX Imaging 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. MICHELLE’S LAW 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.
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. SECTION 111 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.
13
Required Annual Employee Disclosure Notices continued
HIPAA PRIVACY POLICY FOR FULLY‐INSURED PLANS WITH NO ACCESS TO PHI
PATIENT PROTECTION: 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. 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. CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) OF 2009
I . No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis‐enrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. § 160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis‐ enrollment information. The group health plan is a fully‐insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R. § 164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements. The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis‐enrollment information to the group health plan and the plan sponsor. III. No intimidating or retaliatory acts The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA. IV. No Waiver The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan. II. Insurer for group health plan will provide privacy notice
14
Required Annual Employee Disclosure Notices - Continued
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 DEX Imaging 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. DEX Imaging has determined that the prescription drug coverage offered by the Welfare Plan for Employees of DEX Imaging under the DEX Imaging 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 DEX Imaging 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 DEX Imaging 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 DEX Imaging 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 DEX Imaging 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 DEX Imaging 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:
12/01/2018 DEX Imaging
Name of Entity/Sender: Contact‐‐Position/Office:
Liz Shaver 5109 W. Lemon Street Tampa, FL 33609
Phone Number:
813‐288‐808 0
15
Healthcare reform and you
If you obtain coverage through an Exchange:
The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create the most comprehensive health insurance reform ever under taken in recent history by our Country. Many of the new law’s required changes have already been incorporated into company health plans across the country since the effective date in September of 2010. However, there will be many more changes taking place in the months to come, as more guidance is issued by the government to employers, insurance carriers and individuals. One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each year thereafter. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule: In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2017, the greater of $695 or 2.5% of taxable income; and After 2017, the penalty is indexed for inflation. However, there are two ways to avoid the tax penalty: You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered “affordable” (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of your W‐2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000. Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility.
The Exchange will eventually sell insurance policies at certain levels of coverage: • Bronze level – a medical plan designed to pay 60% of covered medical benefits; • Silver level – a medical plan designed to pay 70% of covered medical benefits; • Gold level – a medical plan designed to pay 80% of covered medical benefits; • Platinum level – a medical plan designed to pay 90% of covered medical benefits; If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer‐provided coverage that is considered “unaffordable” or pays benefits that are below the “Bronze” plan discussed above, there are tax credits available to help you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and co pays. More information on these credits will be provided to you later. If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid. Other changes that were effective in 2014 The health plan may no longer exclude coverage of a pre‐existing condition; The health plan may not impose more than a 90‐day waiting period for coverage; Your plan may no longer place an annual limit on key benefits in the plan; Your health plan must allow dependent children up to age 26 to enroll in coverage, regardless of the availability of employer‐ sponsored coverage where they work. You may only obtain coverage through an Exchange if you are not participating in your employer’s plan.
16
General Notice of COBRA Rights
Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out‐of‐ pocket costs. Additionally, you may qualify for a 30‐day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries may elect COBRA continuation coverage, but they may be required to pay for the coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent‐employee dies; • The parent‐employee’s hours of employment are reduced; • The parent‐employee’s employment ends for any reason other than his or her gross misconduct; • The parent‐employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the employer sponsoring the Plan.
17
How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18‐month period of COBRA continuation coverage can be extended: Disability extension of 18‐month period of COBRA continuation coverage: If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18‐month period of COBRA continuation coverage. Second qualifying event extension of 18‐month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
18
New Health Insurance Marketplace Coverage Options and Your Health Coverage
Form Approved OMB No. 1210-0149 (expires 5-31-2020)
PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance : the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact:
Liz Shaver – 813-288-8080
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name
4. Employer Identification Number (EIN)
DEX Imaging, Inc.
59-3251429
5. Employer Address
6. Employer Phone Number
5109 W. Lemon Street
813-288-8080
7. City
8. State
9. Zip Code
Tampa
FL
33609
10. Who can we contact about employee health coverage at this job?
Liz Shaver
11. Phone Number (if different from above)
12. E-mail address
813-288-8080
lizs@tonertype.com
1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs
Here is some basic information about health coverage offered by this employer: • As your employer, we offer a health plan to:
X All Employees. Eligible employees are:
All Full Time Employees working at least 30 hours.
Some employees. Eligible employees are:
•
With respect to dependents:
X We do offer coverage. Eligible Dependents are:
Your Legal Spouse. 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.
We do not offer coverage.
X If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
**Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.
The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers, but will help ensure employees understand their coverage choices.
13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in the next 3 months?
Yes (Continue)
13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the employee eligible for coverage? (mm/dd/yyyy) (Continue)
No (STOP and return this form to employee)
14. Does the employer offer a health plan that meets the minimum value standard*? Yes (Go to question 15)
No (STOP and return form to employee)
15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't include family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/ she received the maximum discount for any tobacco cessation programs, and didn't receive any other discounts based on wellness programs. a. How much would the employee have to pay in premiums for this plan? $ b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly
If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don’t know, STOP and return form to employee.
16. What change will the employer make for the new plan year? Employer won’t offer health coverage Employer will start offering health coverage to employees or change the premium for the lowest-cost plan available only to the employee that meets the minimum value standard.* (Premium should reflect the discount for wellness programs. See question 15)
$
a. How much would the employee have to pay in premiums for this plan?
_________________________
b. How often?
Weekly
Every 2 weeks
Twice a month
Monthly
Quarterly
Yearly
1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (Section 36(c)(2)(C)(ii) of the Internal Revenue Code of 1986)
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23Made with FlippingBook - professional solution for displaying marketing and sales documents online