PAR 2017 Benefits Guide































Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.























Katie Reeves 813-229-8021 Ext. 132


Who pays the cost?

PAR pays 100% of the cost of coverage. Employees are responsible for a portion of dependent coverage.



PAR 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.

PAR pays 100% of the cost of coverage. Employees are responsible for a portion of dependent coverage.

Dental and Vision

Basic Life

PAR pays the entire cost.

You may elect coverage for yourself, and eligible dependents on a voluntary basis and you will be responsible for the cost.

Voluntary Life

Short & Long Term Disability PAR pays the entire cost.


You must actively choose benefits that are paid by PAR, employee paid, or share in the cost with PAR. Your part of the cost is automatically taken out of your paycheck.

WHY PAY FOR BENEFITS WITH BEFORE-TAX MONEY? There is a definite advantage to paying for some benefits with before-tax money. By taking the money out before your taxes are calculated it lowers the amount of your pay that is taxable. Therefore, you pay less in taxes. ?



All regular full-time employees (those who work 30 hours or more each week)* are eligible to join the PAR Benefits Plan. You are eligible to enroll in the benefits once you have satisfied the following waiting periods:

Medical, Dental, Vision, and/or Life Insurance: 1 st of the month following 30 days from your date of hire.

Disability: 1 st of the month following 90 days from your date of hire.

401(k): 1 st of the quarter following 3 months from your date of hire. (01/01, 04/01, 07/01 or 10/01) *the 401(k) plan does not have a requirement for employees to be full time to participate

You may also enroll your dependents in the Benefits Plan when you enroll, eligible dependents include:

Your legal spouse

• Your married or unmarried natural children, step-children living with you, legally adopted children, any other children for whom you have legal guardianship up to age 26 unless they are eligible for employer sponsored benefits themselves.

• Child(ren) named under Qualified Medical Child Support Order (QMCSO).

• Disabled child(ren) who have reached the max age but who are physically or mentally incapable of self support (medical certification required).


You can sign up for Benefits at any of the following times :

• After completing your initial eligibility period as a newly eligible employee • During the annual open enrollment period (occurring in December of the following calendar year) • Within 30 days of a qualified family-status change

What qualifies as a family status change?

As mentioned above, outside of your new hire eligibility and your annual open enrollment you may be able to change your benefit choices during the plan year if you experience a qualifying life event. The following list provides examples of qualified life events:

• Your marriage, divorce or legal separation

Birth or adoption of an eligible child

• Death of your spouse or covered child

• Change in you or your spouse’s work status that affects his or her benefits

• Change in your child’s eligibility for benefits

• Receiving Qualified Medical Child Support Order (QMCSO)

Any change in you benefit changes must be consistent with the family status change or qualified life event. You must notify Human Resources and provide documentation within 30 days of a family status change.

Please submit enrollment forms to HR. Forms can be located at



PAR offers medical coverage through Meritain Health Plan, utilizing Aetna’s Open Choice PPO network. The chart below provides a brief overview of the plan.

Summary of Services


Out-of-Network 1

Calendar Year Deductible Individual Family

None None

$200 $600

Out-of-Pocket Limit (co-pays) Individual Family Office Visits (Physician or Specialist) Urgent Care Center Mental Health

$1,000 $3,000

$2,200 $6,600

$20 co-pay

30% after deductible


$20 copay


Diagnostic Laboratory/Radiology

No Charge (LabCard/Quest)

30% after deductible

Maternity Smoking Cessation Hospitalization


30% after deductible

Outpatient Surgery

No Charge

No Charge (deductible waived)

Emergency Room


30% (deductible waived)

Prescription Drug Benefit (Retail) Tier 1 – Generic Tier 2 – Preferred Brand

$20 co-pay $40 co-pay $60 co-pay 10% co-pay


Tier 3 – Non–preferred Brand Tier 4 – Injectable

Prescription Drug Benefit (Mail Order, 90-day supply) Tier 1 – Generic

$40 co-pay $80 co-pay $120 co-pay 10% co-pay


Tier 2 – Preferred Brand Tier 3 – Non-preferred Brand Tier 4 – Injectable

1 Charges are subject to balance billing

Login to to check coverage and copay information for specific medications. In most instances, a brand name drug will be designated as a non-preferred option when a generic equivalent is available.

Bi-weekly cost for coverage

Salary up to $50,000

Salary from $50,000 - $99,999

Salary from $100,000 - $149,999

Salary $150,000 and up

Employee Only

No Cost

No Cost

No Cost

No Cost

Employee + Spouse or Child





Employee + Family





The chart above 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 above 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.



In-network physicians and facilities (providers) are those contracted with Meritain under Aetna Open Choice PPO. The contract holds these providers to negotiated rates for services and the responsibility to file all claims to Meritain. You will receive the highest level of benefit by utilizing in-network providers. In-Network


Out-of-network physicians and facilities (providers) are those not contracted with Meritain. Your PPO plan offers you in and out-of-network benefits. These providers may not file claims on your behalf. Meritain will processed claims based on the amount considered reasonable and customary. As these providers are not contracted, they may balance bill you.

What’s balance billing?

The provider can bill you the difference between the total amount billed and the reasonable and customary amount.

Claims forms can be found on the PAR network at the Intranet under Resources  Company Information  Forms Library


The percent of the cost for the claim you are responsible for. The amounts you pay in coinsurance apply to your out of pocket maximum.


The set cost for services that are pre-negotiated with in-network provider. These cost are typically collected at the time of service.


This amount is the maximum amount you will pay towards services on the plan for the calendar year. This amount includes the amounts you pay in coinsurance, copays, and prescription copays.

Preventive Care

PAR strongly believes in the importance of health and wellness. PAR’s medical and dental plans provide your and your covered dependents annual access to preventive services at NO COST. Preventive service include, but are not limited to, the following:  Adult and child screening (such as blood pressure, cholesterol, type 2 diabetes, obesity, HIV, breast cancer, cervival cancer, etc)

 Adult and child immunization (such as Hepatitis A and B, Herpes zoster, Influenza, Pneumococcal , Meningococcal, etc)



Nothing is more important than your health and maintaining good health directly affects your quality of work. PAR encourages you to engage in healthy activities.

After you complete 90 days of employment, PAR will reimburse you UP TO $300 towards your cost in a wellness program. Reimbursement can apply toward the following:

 Your cost for annual membership in a health club or gym.

Weight Watchers membership

 Other fitness activities, such as yoga or jazzercise classes

Funds provided shall not exceed $300 in any 12 month period. Reimbursement will be provided by submitting a paid receipt to the CFO.


Teladoc connects you with board-certified doctors 24/7/365 through the convenience of phone or video consults. Teladoc doctors can diagnose, recommend treatment and prescribe medication if medically necessary for many non emergency medical issues. Teladoc is great for colds, allergies, respiratory inflections, earaches and much more!

Login to to pre-register your medical history to easily and quickly access Teladoc when you need it! Be sure to save Teladoc in your phone, 1- 800-362-2667.


When moms-to-be take good care of themselves during pregnancy, they improve the chances of a healthy delivery. The Tomorrow’s Child Maternity Management program is available to all pregnant covered participants. This program provides you with helpful information and regular contact from a maternity management nurse. The nurses coordinate a complication free care plan for pregnancy and delivery.

To enroll contact Tomorrow’s Child program at 1-800-641-3224.



MyMeritain is filled with resources to help you with the following:

• Health Care plan overview

• Find an in-network doctor or facility • Medical and Dental deductible and out of pockets. • FSA balance

• Claim information

• Claim history and claims status • Pull Explanation of Benefits (EOB) • HIPAA authorization to disclose Protected Health Information (PHI)

• Cost information

• Healthcare Bluebook – you can compare medical treatment costs • Estimate costs for common services

• Find in-network doctors and hospitals • Health Tools

• Health and wellness links as well as drug information by WebMD • Access personal health dashboard

• My Benefits

• Request and print a new ID card • See who is covered under your plan • Access plan document and pharmacy plan

First time logging in?

• Go to and click on “ Register ” • Click on the “ Member ” tab • Enter your Group ID (RB848) and click “ Continue ” • Enter your personal info, as prompted, then click “ Next ” (middle initial and suffix are optional). • Review your information, You can click “ Cancel ” to start over, or “ Previous ” to make changes. You can confirm your information by clicking “ Yes, I am ”. Then, just click “ Next ”. • Create a username and password. Your password must be at least ten characters long and contact at elast one of the following:

- Uppercase letter - Lowercase letter - A number - One of the following symbols ( # $ ! % ^ @ & * ) = + -

• Choose your security question and answer • Review the terms and conditions, and click “ I agree to terms and conditions ” and “ Submit ”, or click “ Cancel ”



Flexible Spending Accounts (FSAs) are tax effective, money saving options that will help you pay for qualified expenses. Elected contributions into a FSA will be deducted from your paycheck on a pre-tax basis. Meaning you do not pay federal income tax, Social Security taxes, or state and local taxes on your contribution(s).

PAR offers you the opportunity to participate in two programs.

1. Healthcare FSA

The Healthcare FSA funds can be used for qualified expenses for medical, dental and vision costs. Funds can be used towards copays, coinsurance amounts, prescriptions, and additional out-of-pocket expenses. When you enroll in the Healthcare FSA you will receive a debit card, you may use this debit card to pay for eligible expenses at the time of service. Otherwise you may submit for reimbursement via the FSA Claims Form. Your full contribution to the Healthcare FSA is available day 1.

Maximum Annual Contribution


2. Dependent Care FSA

The Dependent Care FSA funds are to be used for eligible dependent care expenses. Please note, Dependent Care FSA reimbursements cannot exceed your account's current year-to-date balance. You must accrue the funds before reimbursed.

Maximum Annual Contribution Single (or married filing jointly) Married (filing separately)

$5,000 $2,500


Flexible Spending Accounts (FSAs) offer sizable tax advantages. The trade-off is that these accounts are subject to strict IRS regulations, including the use-it-or-lose-it rule. According to this rule, any unused funds will not be refunded or rolled over to a future plan year. Unused funds must be forfeited. If you are unable to estimate your health care and dependent care expenses accurately, it’s better to be conservative with your contributions.

Need to file a claim? Claims forms can be found on



PAR offers dental coverage through Meritain. The Dental Plan helps you to pay for most necessary dental services and supplies. You are free to select your own dentist. Benefits are subject to usual and customary charges. The chart below provides a brief overview of the plan.

Dental Benefits

Deductible (applies to Basic & Major services)


Annual Maximum (per covered member )


Preventive Services

Covered 100%

Exams & Cleanings

Basic Services

• Fillings • Simple Extractions • Periodontics & Endodontics (including root canals)


Major Services

• Crowns • Bridges • Dentures • TMJ 1


Orthodontia (children under the age of 19)

50% Lifetime Maximum of $1,500

1 Lifetime maximum benefit for TMJ is $1,000

Bi-weekly cost for coverage

Salary up to $50,000

Salary up to $50,000 - $99,999

Salary up to $100,000 - $149,999

Salary up to $150,000

Employee Only

No Cost

No Cost

No Cost

No Cost

Employee + Spouse and/or Child(ren)






PAR offers vision coverage through Meritain, utilizing the Outlook Vison Services to provide discounts to you on optical services. However you are free to choose any optical supplier you wish. Below is a list of the reimbursement schedule.



Maximum Benefit

Routine Eye Exams

Every 12 months



Every 24 months



Single Vision Mutlifocal

$75 $150

Every 12 months

Contact Lenses

Every 12 months


Need to file a claim? Claim forms can be found on



PAR continues to provide all full-time eligible employees Life Insurance with a $50,000 benefit. This coverage is through Mutual of Omaha.

Please note there is a reduction of benefits to 65% at age 65 and 50% reduction at age 70. Reductions become effective on the first of the month that coincides with or follows the day you reach stated age. Any reduced amount of insurance will round to the nearest dollar.


PAR continues to offer all full-time eligible employees the option to purchase additional Life Insurance . If you purchase additional life insurance for yourself you may also purchase life insurance for your spouse and/or child(ren). This coverage is through Mutual of Omaha.

Please note there is a reduction of benefits to 65% at age 65 and 50% reduction at age 70. Spouse coverage terminates at age 70. Children 14 days and older are eligible dependents.

Voluntary Life Insurance




Benefits must be purchased in increments of:




To a maximum of:

5x your annual salary, up to $300,000

100% of the employee’s benefit, up to $100,000


Guarantee issue (applicable for newly eligible employees) : Lesser of, 5x your annual salary or $100,000

Lesser of, 100% of the employee’s benefit or $10,000


Calculate your cost for coverage:




x $

= $


Monthly cost for coverage

Benefit Amount Requested

Rate based on age (see charts)



Child(ren) Monthly Cost

Benefit $5,000 $10,000

Cost per $1,000 of benefit


$1.00 $2.00

Smoker Non-Smoker

0 -29

0.12 0.16 0.21 0.28 0.48 0.75 1.28 1.78 2.83 5.77

0.07 0.09 0.10 0.13 0.22 0.34 0.58 0.97 1.57 4.07

0.07 0.09 0.10 0.13 0.22 0.34 0.58 0.97 1.57 4.07

30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69

70 +



Short Term Disability

PAR provides short term disability (STD) insurance to all active full time employees. If you are unable to work due to a non-work related accident or illness STD provides you partial pay. The chart below provides an overview of the plan.

This coverage is paid for 100% by PAR and is provided through Mutual of Omaha.

Benefit Percentage

60% of pre-disability earnings

Maximum Weekly Benefit $2,400 per week Elimination Period: Accident Injury

Benefits commence on the day of an accident Benefits commence on the 8 th day of an illness

Duration of Benefit

up to 13 weeks

Long Term Disability

PAR provides long term disability (LTD) insurance to all active full time employees, at no cost to the employee. The chart below provides an overview of the plan.

This coverage is paid for 100% by PAR and is provided through Mutual of Omaha.

Benefit Percentage

60% of pre-disability earnings

Maximum Monthly Benefit

$10,000 per month

Benefits commence on the 90 th day

Elimination Period

Duration of Benefit

Social Security Normal Retirement Age (SSNRA)



All eligible employees and dependents have access to Mutual of Omaha’s Employee Assistance Program (EAP). This program is paid for by PAR and offers confidential support, resources and information to get through life’s challenges. When it’s difficult to cope with problems, we often turn to family and/or friends for support. Unfortunately, many times that’s 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.

What types of services are available ?

Stress and mental health

Life changes


Relationship issues



• Gambling and other addictive behaviors • Parenting • Financial issues

Balancing work and home


Drug and/or alcohol abuse

Call 1-800-316-2796 24 hours a day. If you should require additional guidance, the EAP can refer you to a local professional for up to 5 face to face visits.


All eligible employees and dependents have access to Mutual of Omaha’s Travel Assistance Program. The program helps you avoid unexpected bumps in the road anywhere in the world. Any single trip up to 120 days in length and more than 100 miles from home.

The Worldwide Travel Assistance helps by providing daily currency exchange rates, travel advisories, inoculation requirements, consulate and embassy locations as well as passport and travel document help.

Emergency Travel Support Services provides translation services, document replacement, lost or stolen baggage, and emergency payment and cash.

Identity Theft Assistance helps you whether you're traveling or at home. This benefit provides education, prevention and recovery information to help protect your identify. If you need assistance call a case manager anytime.

Mutual of Omaha provides these programs through AXA Assistance. AXA can be reached at 1-800-856-9947 or outside the US at 312-935-3658.



Thorough the 401(k) plan, you and PAR work as partners to help build financial security for retirement. PAR will match 100% on the first 3% of your salary and 50% up to the next 2% of the salary.

When you participate, your savings grow in two ways: 1. Through your contribution (pre-tax or Roth post-tax) 2. Through the investment growth of your account

Your salary deferral amount can be modified on January 1, April 1, July 1 and October 1, but your investment allocation can be changed periodically by using the Newport Group website. All PAR match funds are fully-vested as soon as the funds go into your account.


PAR makes contributions to the profit sharing portion of PAR’s retirement savings plan on your behalf. The profit sharing contribution is based on PAR profitability and allocated to all eligible participants. Eligible participants include employees on payroll as of December 31 st who were hired on or before July 1 st . The profit contributions are subject to a vesting schedule based on the years of service. To earn a year of service you must be credited with at least 1,000 hours of service during the plan year.

Years of Service














Step-by-step instructions

Online 1. Go to 2. Enter your login ID (typically your social security number) 3. Enter your personal identification number (PIN), you can change your PIN once you're logged onto the site. 4. Click the “Login” button, this will bring you to your home page. Phone 1. Call 1-888-401-5488 (have your SSN and PIN available) 2. Choose amount these options 1. Press 1 – Automated system 2. Press 2 – to speak to a Client Service Representative 3. If you choose the automated system, you will be prompted for your social security number and PIN 4. Make a selection from the menu, the site gives you access to a variety of tools, you’ll have access to:

Balance and transaction history

• Transfer assets between investment options • Plan documents • Loans • Fund performance

Statements on demand

Personalized rates of return

Personalized forecast



Employees are encouraged to schedule sufficient time off for relaxation to promote good physical and mental health. For this reason, PAR provides a generous paid time off (PTO) program to all employees regularly scheduled to work 30 or more hours per week.

PTO is intended to be used for purposes including vacations, unpaid holidays, illness or time away from work for personal or family matters. Absences should be scheduled in advance with supervisory approval. Unscheduled absences are strongly discouraged except due to illness or emergency situations.

Eligible employees start earning PTO during the first pay period with PAR. Staff with less than 90 days of service may not take extended time away except under special circumstances and with supervisory approval. The quantity of leave time per year varies on the hours you are regularly scheduled to work each week and your length of service with PAR.

Years of Service

Regularly scheduled 30-39 hours/week

Regularly scheduled 40+ hours/week

First 2 years

12 days (3.70 hrs/pay period)

17 days (5.24 hrs/pay period

2+ to 6 years

17 days (5.24 hrs/pay period)

22 days (6.77 hrs/pay period)

6+ to 9 years

19 days (5.85 hrs/pay period)

24 days (7.39 hrs/pay period)

9+ to 13 years

21 days (6.47 hrs/pay period)

26 days (8.00 hrs/pay period)

13+ to 20 years

22 days (6.77 hrs/pay period)

27 days (8.31 hrs/pay period)

20+ years

23 days(7.80 hrs/pay period)

28 days (8.62 hrs/pay period)

Birthday Leave Each full-time and part-time employee will receive leave credit for their birthday. Full-time staff will receive 8 hours during the pay period in which your birthday falls. Part-time staff will receive a share proportionate with the average hours routinely worked. This amount is NOT included in the schedule above.

XC Club (Exceptional Commitment) During the celebration of the company’s 30 th anniversary, an additional amount of leave time was instituted to reflect employees exceptional commitment to PAR. The additional leave time awards one extra day annually to all employees with 10-19 years of service, two extra days annually to all employees with 20 years of service, and three extra days to all employees with 30 years of service. These amounts are NOT included in the schedule above.

Volunteer Day PAR encourages staff to donate their time to those in need. In an effort to promote volunteerism, PAR provides each employee with 8 hours of leave per calendar year to be used while assisting a charitable organization.



PAR donates a portion of company profits to those in need and encourages out staff to donate time and/or resources for the purpose of helping others. PAR is committed to assisting the various charitable organizations in which employees are personally involved.

PAR will match an employee’s contribution to a qualified charitable entity up to a maximum of $500 per calendar year per employee. United Way contributions will be matched by the company at a rate determined by management and are excluded from the employees maximum match per year.


PAR supports and encourages continued training and development of its employees. Full-time employees with at least 6 months of service are entitled to submit tuition reimbursement requests to their manager. The program covers courses taken at an accredited two or four year college or university which may enhance your job related skills or contribute to new skills that PAR could potentially utilize in your department or within some other area of PAR in the future.

PAR will reimburse the employee up to 75% (with a maximum of $3,000 per year for tuition and books) for courses successfully completed with a grade of C or better.


Travel Accident Insurance

Travel accident insurance is provided by Mutual of Omaha in the amount of $1,000,000 for death of an employee while traveling on PAR business. Aggregate limit (maximum payout) for one accident is $5,000,000.

Supplemental Insurance Coverage

PAR offers a number of optional hospitalization and income protection plans through AFLAC. Premiums are solely the responsibility of the employee and are taken through payroll deductions. If interested, please contact the HR department for additional information.



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;


The Women’s Health and Cancer Rights Act of 1998 requires PAR to notify you, as a participant or beneficiary of the PAR 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.

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.



Required Annual Employee Disclosure Notices continued continued



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. 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.

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. 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 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

II. Insurer for group health plan will provide privacy notice

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.


Required Annual Employee Disclosure Notices - Continued REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES



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 Aetna 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 Aetna 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: • 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, 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. • Visit

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 Aetna 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. UnitedHealthcare has determined that the prescription drug coverage offered by the Welfare Plan for Employees of PAR under the UnitedHealthcare 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 Aetna 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. _______________________________________________________ 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 Aetna 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 Aetna coverage, be aware that you and your dependents will be able to get this coverage back. When can you join a Medicare Drug Plan?

Date: 1/1/17 Name of Entity/Sender: PAR Contact--Position/Office: Donna Drackett

16204 N. Florida Avenue Lutz, FL 33549

Phone Number:




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. In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2016, the greater of $695 or 2.5% of taxable income; and After 2016, 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. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule:

If you obtain coverage through an Exchange:

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; • Catastrophic – available to young adults up to age 30 or those exempt from the individual mandate (additional requirements may apply) 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 to take effect in 2014 are: 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.






















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