Annual Notices
401(k) Retirement Plan
Fidelity Investments | 1-800-294-4015 | www.netbenefits.com Michael Berger, Client Specialist, Retirement Plan Services | The Trust Company 865-673-3562 | Email: mberger@thetrust.com
SUMMARY OF BENEFIT COVERAGE The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) requires health plans and health insurance issuers to provide a Summary of Benefits and Coverage (SBC) to applicants and enrollees. The SBC is provided by your Medical carrier. Its purpose is to help health plan consumers better understand the coverage they have and to help them make easy comparisons of different options when shopping for new coverage. This information is available when you apply for coverage, by the first day of coverage (if there are any changes), when your dependents are enrolled off your annual open enrollment period, upon plan renewal and upon request at no charge to you. PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer- sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). To see if any other states have added a premium assistance program since July 31, 2021 , or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565 Alabama ...................................................................................................................... 855-692-5447 Alaska .......................................................................................................................... 866-251-4861 Arkansas ...................................................................................................................... 855-692-7447 Colorado . ..................................................................................................................... 800-221-3943 Florida.......................................................................................................................... 877-357-3268 Georgia........................................................................................................................ 404-656-4507 Indiana......................................................................................................................... 877-438-4479 Iowa. ............................................................................................................................ 888-346-9562 Kansas ......................................................................................................................... 785-296-3512 Kentucky ...................................................................................................................... 800-635-2570 Louisiana....................................................................................................................... 888-6952447 Maine........................................................................................................................... 800-442-6003 Massachusetts............................................................................................................. 800-462-1120 Minnesota. ................................................................................................................... 800-657-3739 Missouri........................................................................................................................ 573-751-2005 Montana....................................................................................................................... 800-694-3084 Nebraska...................................................................................................................... 855-632-7633 Nevada......................................................................................................................... 800-992-0900 New Hampshire...........................................................................................................603-271-5218 New Jersey..................................................................................................................800-701-0710 New York......................................................................................................................800-541-2831 North Carolina..............................................................................................................919-855-4100 North Dakota................................................................................................................844-854-4825 Oklahoma..................................................................................................................... 888-365-3742 Oregon......................................................................................................................... 800-699-9075 Pennsylvania ................................................................................................................ 800-692-7462 Rhode Island................................................................................................................401-462-5300 South Carolina ............................................................................................................. 888-549-0820 South Dakota...............................................................................................................888-828-0059 Texas............................................................................................................................ 800-440-0493 Utah . ............................................................................................................................ 877-543-7669 Vermont ........................................................................................................................ 800-250-8427 Virginia......................................................................................................................... 800-432-5924 Washington.................................................................................................................. 800-562-3022 West Virginia................................................................................................................877-598-5820 Wisconsin ..................................................................................................................... 800-362-3002 Wyoming...................................................................................................................... 307-777-7531 For a listing of State websites, visit: https://www.dol.gov/sites/dolgov/files/ebsa/laws-and- regulations/laws/chipra/model-notice.pdf For states not listed: 877-543-7669 www.insurekidsnow.gov OMB Control Number 1210-0137 Expires 1/31/2023 AFFORDABLE CARE ACT (ACA) HEALTHCARE REFORM EXCHANGE NOTICE Under ACA, large employers are responsible to provide eligible employees with coverage that meets the affordability and actuarial value rules set by our government. The plans offered by your employer meet these standards. You will receive a separate notice with specific information. As a result, you and/or your dependents may not be eligible for a federal or state subsidy when applying for
coverage in the Healthcare Marketplace. HIPAA– PRIVACY ACT LEGISLATION The Health Plan and your health care carrier(s) are obligated to protect confidential health information that identifies you or could be used to identify you as it relates to a physical or mental health condition or payment of your health care expenses. If you elect new coverage, you and your beneficiaries will be notified of the policies and practices to protect the confidentiality of your health information. WOMEN’S HEALTH AND CANCER RIGHTS ACT The Women’s Health and Cancer Rights Act (WHCRA) includes protections for individuals who elect breast reconstruction in connection with a mastectomy. WHCRA provides that group health plans provide coverage for medical and surgical benefits with respect to mastectomies. It must also cover certain post-mastectomy benefits, including reconstructive surgery and the treatment of complications (such as lymphedema). Coverage for mastectomy-related services or benefits required under the WHCRA are subject to the same deductible and coinsurance or copayment provisions that apply to other medical or surgical benefits your group contract providers. GENETIC INFORMATION NONDISCRIMINATION ACT (GINA) OF 2008 Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. GINA also restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants, employees, or their family members. SECTION 111 OF JANUARY 1, 2009 Group Health Plans (GHP) are required to comply with the Federal Medicare Secondary Payer Mandatory Reporting provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007. It requires employers to report specified information regarding their GHP coverage (including Social Security numbers) in order for CMS to determine primary versus secondary payment responsibility. In essence, it helps determine if the Employer plan or Medicare/Medicaid/SCHIP is primary for those employees covered under a government plan and an employer sponsored plan. THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 provides that group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). An attending provider is defined as an individual who is licensed under applicable state law to provide maternal or pediatric care and who is directly responsible for providing such care to a mother or newborn child. The definition of attending provider does not include a plan, hospital, managed care organization or other issuer. In any case, plans may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Please contact us if you would like any additional information on The Newborns’ and Mothers’ Health Protection Act or WHCRA. MICHELLE’S LAW An amendment to the Employee Retirement Income Security Act (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC), this law ensures that dependent students who take a medically necessary leave of absence do not lose health insurance coverage. Michelle’s Law allows seriously ill college students, who are covered dependents under health plans, to continue coverage for up to one year while on medically necessary leaves of absence. The leave must be medically necessary as certified by a physician, and the change in enrollment must commence while the dependent is suffering from a serious illness or injury and must cause the dependent to lose student status. Under the law, a dependent child is entitled to the same level of benefits during a medically necessary leave of absence as the child had before taking the leave. If any changes are made to the health plan during the leave, the child remains eligible for the changed coverage in the same manner as would have applied if the changed coverage had been the previous coverage, so long as the changed coverage remains available to other dependent children under the plan. UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT OF 1994 (USERRA) The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) was signed into law on October 13, 1994. USERRA clarifies and strengthens the Veterans’ Reemployment Rights (VRR) Statute. The Act itself can be found in the United States Code at Chapter 43, Part III, Title 38. The Department of Labor has issued regulations that clarify its position on the rights of returning service members to family and medical leave under the USERRA. See 20 CFR Part 1002.210. USERRA is intended to minimize the disadvantages to an individual that occur when that person needs to be absent from his or her civilian employment to serve in this country’s uniformed services. USERRA makes major improvements in protecting service member rights and benefits by clarifying the law and improving enforcement mechanisms. It also provides employees with Department of Labor assistance in processing claims. USERRA covers virtually every individual in the country who serves in or has served in the uniformed services and applies to all employers in the public and private sectors, including Federal employers. The law seeks to ensure that those who serve their country can retain their civilian employment and benefits, and can seek employment free from discrimination because of their service. USERRA provides protection for disabled veterans, requiring employers to make reasonable efforts to accommodate the disability. USERRA is administered by the United States Department of Labor, through the Veterans’ Employment and Training Service (VETS). VETS provides assistance to those persons experiencing service connected problems with their civilian employment and provides information about the Act to employers. VETS also assists veterans who have questions regarding Veterans’ Preference. HIPAA SPECIAL ENROLLMENT SPECIAL ENROLLMENT NOTICE This notice is being provided to make certain that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive health insurance coverage at this time. Loss of Other Coverage If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
The PIH 401(k) Retirement Plan is administered by Fidelity Investments and enables you to save money for retirement to cover living expenses such as mortgage, utilities, auto, etc.
AUTOMATIC ENROLLMENT All eligible new hires are automatically enrolled in the 401(k) Plan at 6% of your weekly earnings on the first of the month following 60 days of employment. If you do not select an investment mix of your own, PIH has directed Fidelity to place your contributions into a Fidelity Investments target date fund that most closely aligns with your projected retirement date based upon your birth year. The 2023 maximum annual combined contribution for the Traditional and Roth 401(k) plans is $22,500. Participants age 50 and older may contribute an additional “catch-up” contribution of $7,500 per year. PIH established an Annual Increase Program (AIP) that auto increases your contribution by 1% annually until you reach the AIP cap of 10% or plan limit.
PIH's Contribution PIH matches $0.50 of every dollar you contribute up to 6%. You will get a full 3% match by contributing 6%. You may change the percentage you contribute to your retirement plan at any time during the plan year. You are always 100% vested in your own contributions. The company’s contribution is on a 5 year vesting schedule. Being vested means that you have the right to receive the money in your account when you retire or leave the company.
Years of Service for Vesting
Percentage
Less than 1
0
1
20
2
40 60
3
4
80
5
100
14
15
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