2018 Benefits at a Glance September 1 st , 2018 – August 31 st , 2019
INTRODUCTION
INTRODUCTORY PERIOD
Starting date of employment, everyone is on a 3-month introductory employment period. At the end of the 3 months your supervisor reviews your performance.
PAYROLL / PAY PERIOD
Payroll runs every 2 weeks (bi-weekly). Kisinger Campo & Associates (KCA) does NOT hold back the first check.
KCA offers direct deposit to any financial institution in the United States. Upon completion of the Direct Deposit forms and submission to your H.R. Department, the first payroll will be a "pre-note" (dry run). You will receive a check for your first payroll. Your Direct Deposit will be effective on the second payroll. Contact your Human Resources Department for the forms if you are interested.
PERSONAL TIME OFF (PTO)
PTO is an accumulation of time from which you draw for vacation, sick leave, doctor’s visits, child school activities, etc.
During the 1st -5th year of employment, you will accumulate PTO by a formula which is 4.0 hours per pay period, equivalent to 13 days. This rate increases at 5 year intervals. You are not entitled to PTO until after the 3 month introductory period. If an exempt (salaried) employee is permitted a partial day absence(s) by a supervisor during the 3 month introductory period, and of he/she has not attained 40 hours of “worked” time at the end of the week, his/her accumulated PTO bank will be reduced to the extent necessary for attaining a 40 hour week. Paid time off for full day absences during the 3 month introductory period is not permitted.
CONTENTS & CONTENT INFORMATION
Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.
ENROLLMENT SYSTEM - WEB BENEFITS DESIGN Web Address
www.mybensite.com/kca
HUMAN RESOURCES Email
Colleen.Carter@kisingercampo.com
Phone
813-xxx-xxxx
BROKER PARTNER – M.E. WILSON COMPANY Broker Contact
Katie Miller
Phone
813-984-3602
kmiller@mewilson.com
MEDICAL Provider
page 3
UHC
Phone
866-314-0335
Web Address
www.myUHC.com www.uhc.com/virtualvisits
DENTAL Provider
page 6
Anchor Benefit Consulting, Inc.
Phone
407-667-8766
VISION
page 7
Provider
Superior Vision 800-507-3800
Phone
Web Address
www.SuperiorVision.com
HEALTH SAVINGS ACCOUNT & FLEXIBLE SPENDING ACCOUNT
page 8
LIFE INSURANCE
page 9-10
Provider
Sun Life
SHORT TERM AND LONG TERM DISABILITY
page 11
Provider
Sun Life
DISCLOSURE NOTICES
page 13
BENEFIT INFORMATION
Benefit
Who pays the cost?
Kisinger Campo & Associates pays approximately 70%-85% of the employee cost and 70%-75% of the dependent cost for health coverage.
Medical
Kisinger Campo & Associates offers dental coverage on a voluntary basis.
Dental
YOUR BENEFITS PLAN
Kisinger Campo & Associates 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.
Kisinger Campo & Associates offers vision coverage on a voluntary basis.
Vision
Kisinger Campo & Associates pays 100% of the cost for Basic Life and AD&D coverage.
Basic Life and AD&D
Kisinger Campo & Associates offers additional life coverage on a voluntary basis.
Voluntary Life
Kisinger Campo & Associates pays 100% for towards short term disability coverage.
Short TermDisability
Kisinger Campo & Associates pays 50% of the cost for long term disability coverage.
Long TermDisability
PRE-TAX BENEFITS
CHOOSING YOUR BENEFITS
The premium for elected coverages are taken from your paycheck automatically. There are two ways that the money can be taken out, pre-tax or post –tax.
WHY DO I PAY FOR BENEFITS WITH PRE-TAX MONEY?
There is a definite advantage to paying for some benefits with pre-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.
WHICH BENEFIT PREMIUMS ARE TAKEN BEFORE TAX?
PRE tax –
Medical, Dental, and Vision
POST tax –
$
$
Life and Disability
$
1
ELIGIBILITY
All Regular full-time employees are eligible to join the Kisinger Campo & Associates Benefits once the waiting period has been satisfied. Coverage will begin on the 1 st of the month following 30 days from your date of hire. “Regular Full-Time Employees” must be regularly scheduled and working at least 30 hours per week. You may also enroll your dependents in the Benefits Plan when you enroll.
WHO’S AN ELIGIBLE DEPENDENT?
• Your legal spouse or domestic partner (with appropriate documentation)
• Your married or unmarried natural children, step-children living with you, legally adopted child(ren) and any other child(ren) for whom you have legal guardianship, up to age 30.
WHEN CAN YOU ENROLL?
You can sign up for Benefits at any of the following times:
• As a new hire, at your initial eligibility date.
• During the annual open enrollment period, effective September 1 st of each year.
• Within 30 days of a qualified family-status change.
If you do not enroll at one of the above times, you may enroll during the next annual open enrollment period.
MAKING CHANGES
Generally, you can only change your benefit elections during the annual benefits enrollment period. However, you may be able to change your benefit elections during the plan year if you have a change in status including:
•
• Change in your work status that affects your benefits
Your marriage or divorce
•
• Change in residence that affects your eligibility for coverage
Birth or adoption of an eligible child
•
• Change in your child’s eligibility for benefits
Death of your spouse or covered child
• Change in your spouse’s work status that affects your benefits
• Receiving QualifiedMedical Child Support Order (QMCSO)
You must submit documentation as proof of life event to Colleen.Carter@kisingercampo.com within 30 days. The IRS allows changes to be made within 60 days for those eligible for Medicaid or CHIP under HIPAA Special Enrollment Rights.
If you fail to do so you will be required to wait until the next annual enrollment period to make benefit changes unless you hav e another family status change.
WHEN DOES COVERAGE ENDS?
Coverage will run through the end of the month following termination / resignation.
Upon termination / resignation of employment, proratedmedical / dental / voluntary life premiums will be taken from the final payroll check.
2
MEDICAL INSURANCE
Kisinger Campo & Associates offers medical coverage through United Healthcare (UHC). You have three plan options to choose from. To find participating providers go to www.myuhc.com and click on “Find a Doctor”, then follow the prompts to complete the search within the “Choice/Choice Plus” network. The chart below provides a brief overview of the medical plans offered.
HMO Choice S56
Choice Plus O74
HDHP / HSA
IN-NETWORK DEDUCTIBLE (your first dollar cost for covered in-network claims) Deductible (Individual / Family)
$1,750 / $3,500
$0 / $0
$500 / $1,000
COINSURANCE (your responsibility on claims costs once you’vemet the deductible) 0% OUT OF POCKET MAXIMUM (once met all in-network covered services are covered by the plan) MaximumOut-of-Pocket (Individual / Family) $2.500 / $5,000
0%
0%
$2,500 / $5,000
$500 / $1,000
Maximum Includes
Deductible, Coinsurance, Prescription Costs & Copays
PREVENTIVE CARE Wellness, Immunizations, Mammography, Colonoscopy, etc.
Covered 100%, no cost to you
OFFICE VISITS Referral Required
No
Virtual Visits (refer to page 5)
Up to $50
$15 Copay
$25 Copay
Office Visits (Illness/Injury)
Covered 100% AFTER deductible
$15 Copay
$25 Copay
Specialist Visits
Covered 100% AFTER deductible
$25 Copay
$25 Copay
HOSPITAL SERVICES Inpatient Hospital
Covered 100% AFTER deductible
$500 Copay per admission
Covered 100% AFTER deductible
Outpatient Surgery
Covered 100% AFTER deductible
$250 Copay
Covered 100% AFTER deductible
Emergency Room
Covered 100% AFTER deductible
$150 Copay
$100 Copay
Urgent Care
Covered 100% AFTER deductible
$25 Copay
$50 Copay
DIAGNOSTIC TESTING Lab & X-Ray Advanced Imaging (MRI, CAT, PET, etc.)
Covered 100% AFTER deductible
Covered 100%
Covered 100%
Covered 100% AFTER deductible
$250 Copay
Covered 100% AFTER deductible
Medical deductible FIRST then,
PRESCRIPTIONS
Retail (30 day supply) Tier 1 / 2 / 3
$10 / $30 / $50
$10 / $30 / $50
$10 / $30 / $50
Medicare (Part D) Creditable
Yes
Yes
Yes
OUT–OF-NETWORK
Refer to plan summary for details . Copies can be found within forms library on the Benefits Portal.
Deducible Out of Pocket
$3,500 / $7,000 $10,000 / $20,000
$1,000 / $2,000 $11,000 / $22,000
None
Bi-Weekly Cost for Coverage
Employee Only
$56.98
$72.79
$152.18
Employee + Spouse
$203.99
$265.48
$440.37
Employee + Child(ren)
$191.07
$260.39
$414.61
Employee + Family
$335.20
$456.81
$713.17
1 Charges are subject to balance billing
3 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.
CARE24® SERVICES Care24 provides you with support services and health information to help you when needed. The service offers you a wide range of health and well-being information through a toll-free telephone number, and is provided at no cost to you as part of your health plan. These services and health information include:
• • •
• •
Health coaching Emotional support
End of Life care and support
Grief counseling
Connection to legal and financial services
Care24 is an ideal and trustworthy source of information and support that allows you to speak directly to an experienced registered nurse or master’s-level counselor at any time. Care24® services offers a variety of other services and support options, including:
• 24-hour availability through the toll-free number • Audio library for access to recorded health and well-being messages • Live Nurse Chat connecting you to a registered nurse for personal online conversation—24hours a day • Oral health • Books
1-888-887-4114
Visit myuhc.com
TERMS TO KNOW
When you enroll in coverage you become a UHC member. A member of UHC gets access to their network of providers (doctors and facilities) – these are in-network providers. UHC members receive Discounted Rates with these in-network providers. Discounted Rate
Copays
Copays are set dollar amounts you pay for specific services. These cost are typically collected at the time of service. EX: you have a $50 copay for a visit to your primary care physician.
Services not subject to a copay are subject to your deductible. You pay first dollar costs for claims subject to your deductible and you receive the Discounted Rate for all covered claims with an in-network provider. Deductible
Coinsurance
Coinsurance is a cost share. Once you meet the deductible UHC will share in the cost of your claims. 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.
Out-of-Pocket
This amount is the maximum amount you will pay towards covered services on the plan for the calendar year. This amount includes the amounts you pay in deductible, coinsurance, copays, and prescription copays.
4
PRESCRIPTIONS & WAYS TO SAVE
Ask your doctor or pharmacist if your brand medication has a generic or lower cost alternative.
SAVING ON PRESCRIPTIONS
A wide range of generic medications are offered at low cost at your local pharmacy. Specific generic drugs are available at Target, Wal-Mart, and/or CVS for $4 for a 30-day supply and $10 for a 90-day supply ! Certain antibiotics are available at Publix for FREE !
90 DAY SUPPLY FOR MAINTENANCE MEDICATIONS
There are 2 other ways to save – 1. Using UHC’s OptumRX Mail Order program can save you time and money ! A 90 day supply of your medication is delivered to your door and you are reminded when a refill is needed. The cost to use mail order is 2.5 times the retail cost, that means you get a 90 day supply for the cost of a 75 day supply! The program is calledMail Services Member Select.
2. UHC’s OptumRX Preferred90 allows you to fill a 90 day supply of your maintenance medications at CVS for 2.5 times the retail cost, that means you get a 90 day supply for the cost of a 75 day supply!
VIRTUAL VISITS
Virtual visits allow you to see and talk to a doctor from a mobile device or computer without an appointment, 24/7. A majority of visits take between 10- 15 minutes, and virtual visits are a part of your health benefits.
Through a virtual visit, doctors can diagnose and treat a vast range of non-emergency medical conditions and provide services such as writing a prescription, if needed. This includes:
• • • • •
Allergies
• • • • • •
Migraine/headaches
Bladder infection
Pink eye
Bronchitis Cold/cough
Seasonal flu
Sinus problems
Fever
Sore throat
Stomach ache
Access virtual visits :
To get started, go to www.uhc.com/virtualvisits and choose from provider sites where you can register for a virtual visit. After registering and requesting a visit you will pay your portion of the service cost and then you will enter a virtual waiting room. Payment for service cost can be remitted via credit card. During your visit you will be able to talk to a doctor about your health concerns, symptoms and treatment options.
Virtual visits are subject to the cost of your PCP copay ($15 or $25 Copay) on the HMO Choice and Choice Plus plans. If you are on the HDHP/H.S.A plan the cost for virtual visits is subject to your deductible, but the cost will not exceed $50 per visit.
5
DENTAL INSURANCE
Kisinger Campo & Associates offers dental coverage through Anchor Benefit Consulting, Inc. The Dental Plan allows you to see any provider and/or specialist you choose. The chart below provides a brief overview of the plan
Accepting Dentist: Patient presents ID card to dentist. The dentist can verify benefits via toll free number on ID card. At the time of visit, patient pays a $15.00 office visit co-payment and any applicable coinsurance. Dentist then files a claim for a balance.
Non-Accepting Dentist: Patient pays entire fee at time of visit or makes suitable arrangements with dentist’s office. Patient submits copay of bill and proof of payment with a claim form and patient is reimbursed for charges less a $20.00 copay and any applicable coinsurance.
DENTAL PLAN
In-Network
Calendar Year Deductible
NONE
Annual Maximum (per covered member)
Per covered member
$1,800
Tier 1
100% of the first $150
Tier 2
70% of the next $100
Tier 3
50% thereafter
Ortho
Lifetime Benefit
$1,800
Bi-Weekly Cost for Coverage
$14.59
Employee Only
$29.55
Employee + 1
$44.50
Employee + 2 or more
6
VISION INSURANCE
Kisinger Campo & Associates offers vision coverage through Superior Vision. The Superior Vision plan allows you the flexibility to see any provider. To search in-network providers visit www.Superiorvision.com and in search based on your location in the “Locate a Provider” box. You will be asked to select your network, please select “Superior National”. When you utilize an out-of-network provider you pay expenses at the time of service and file a claim for reimbursement. Below is a list of the reimbursement schedule.
Vision Superior National Network
In-Network
Routine Eye Exams
Every 12 months
$10 Copay
Lenses 2
Every 12 months
Single Vision Bifocal Trifocal
$10 Copay Factory scratch coating is covered 100% Lens upgrades are available at 20% of retail pricing.
Ultraviolet coat Tints, solid or gradients Anti-reflective coat
$15 Copay $25 Copay $50 Copay
Polycarbonate High index 1.6 Photochromics
$40 Copay for single vision / 20% off retail for bifocal & trifocal $55 Copay for single vision / 20% off retail for bifocal & trifocal $80 Copay for single vision / 20% off retail for bifocal & trifocal
Frames
Every 24 months
$10 Copay provides a $150 allowance PLUS 20% off cost over the allowance allowance
Contact Lenses (in lieu of glasses) 1
Every 12 months
Elective Contact Lenses Contact Lens Fitting 2
$150allowance
Standard Specialty
Covered in full $50 allowance
Out-of-Network
Routine Eye Exams
Every 12 months Reimbursed up to $28-33 Every 12 months Reimbursed up to $28 Reimbursed up to $40 Reimbursed up to $53 Reimbursed up to $53 Every 24 months Reimbursed up to $70 Every 12 months Reimbursed up to $100 Reimbursed up to $100
Lenses 2 Single
Bifocal Trifocal Progressives
Frames
Contact Lenses (in lieu of glasses) Elective Medically Necessary
Bi-Weekly Cost for Coverage
Employee Only
$3.99
Employee + Spouse
$7.49
Employee + Child(ren)
$7.85
1 Reimbursable amount, less applicable copay.
Employee + Family
$11.86
1 Lenses benefit listed are for a pair of lenses 2 Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi-focal lenses.
7
HEALTH SAVINGS ACCOUNT (H.S.A)
Employees enrolling in the HDHP Medical Plan may open and contribute to a Health Savings Account (H.S.A). With an H.S.A you have the ability to put money side, through payroll deductions, to help pay for H.S.A eligible expenses. The contributions you make are taken pre-tax.
Kisinger Campo and Associates will contribution towards your H.S.A, $1,250 for an individual and $2,750 for those with dependent medical coverage.
2018 IRS Annual Maximum* HSA Contribution Limits
Employee Only
$3,450
Employee + Spouse, Child(ren) or both
$6,900
Additional $1,000 annually catch-up amounts for available for employees 55 years or older
*The above chart with maximum contributions reflects the total annual maximum. Your total annual contributions and those made by KCA may not exceed the maximums listed.
WHAT ARE THE BENEFITS OF A H.S.A?
The money you put aside is PRE-TAX The H.S.A is a bank account in your name. If you retire or should you leave KCA you take this account with you. The account rolls over year to year. You will not have to forfeit any unused funds. You will receive a debit card upon opening an H.S.A for quick and easy utilization of the fund. The list of eligible expenses is vast! These expenses include things covered under the medical, dental, and vision coverage – as well as some items that aren't! FLEXIBLE SPENDING ACCOUNT (F.S.A) You have the option to contribute to a Flexible Spending Account (F.S.A). There are 2 types of F.S.As. (1) Healthcare F.S.A and (2) Dependent Care F.S.A. With an F.S.A you have the ability to put money side, through payroll deductions, to help pay for F.S.A eligible expenses. The contributions you make are taken pre-tax.
If you participate in the H.S.A, you are NOT permitted to participate in the Healthcare F.S.A. You are, however, eligible to participate in the dependent Care F.S.A.
2018 IRS Annual Maximum FSA Contribution Limits
Healthcare F.S.A.
$2,650
Single or married and files a separate tax return
$2,500
Dependent Care F.S.A.
Married and files a joint tax return as single/head of household
$5,000
Examples of H.S.A and Healthcare F.S.A eligible expenses are as follows:
•
Dental expenses
• • • • • • • •
Acupuncture and Chiropractic services Alcohol and drug dependency treatment
• Prescription Drugs and Over the Counter Drugs (when ordered by a doctor) • Eye surgery (laser eye surgery or radial keratotomy) Fertility enhancements • Hearing aids and batteries for use • Long-termcare and Nursing home • Maternity Expenses • Organ transplants • Wheelchairs
Ambulance
Artificial limbs
Contact lenses and solution Physical and speech therapies
8
Smoking-cessation programs and products
Vasectomy
WELLNESS & COMMUNITY SERVICE PROGRAM
KCA Wellness and Community Service Program (KWCS)
KWCS offers financial incentives for engaging in healthy and responsible activities that may ultimately lead to improving your long-term wellbeing. KWCS is available to all full- time KCA/KCCS (referred to collectively as KCA) employees. Participating is as simple as engaging in healthy and responsible activities and logging your activities in the Wellness Tab of the Employee Info Center in Vison. Full details will be provided at enrollment.
401(k)
After you have been an employee at KCA for a period of 3 months, you will be eligible for our 401(k) plan. KCA will match 50% of the first 4% of your elected deferral and dollar for dollar up to 6% of your elected deferral.
This makes a total of 4% match on your deferral. In addition, KCA offers financial planning provided by CapTrust at no charge to the employee.
$ $ $
Basic Life Insurance and AD&D
KCA provides all benefit eligible employees with $20,000 in Life and AD&D insurance.
The cost of this benefit is 100% paid for by KCA, at no cost to you!
9
VOLUNTARY LIFE INSURANCE
Kisinger Campo & Associates offers employees the option to purchase additional life insurance. This coverage is offered on a voluntary basis through Sun Life. If you purchase voluntary life insurance for yourself, you can purchase voluntary life insurance for your spouse and/or child(ren).
EMPLOYEE
HOW MUCH LIFE INSURANCE CAN I PURCHASE?
You may purchase a benefit in increments of $10,000; a minimum of $10,000 up to a maximum of $500,000, or 5x your annual salary (whichever is less).
WHAT’S GUARANTEE ISSUE?
Guarantee Issue (GI) is the amount you can purchase as a newly eligible employee without having to provide evidence of good heath (aka Evidence of Insurability (EOI)). The GI is $150,000 or 5x your annual salary, whichever is less.
SPOUSE
HOW MUCH LIFE INSURANCE CAN I PURCHASE FOR MY SPOUSE?
You may purchase a benefit in increments of $5,000; a minimum of $5,000 up to a maximum of $100,000, not to exceed 100% of your voluntary life benefit.
WHAT’S GUARANTEE ISSUE?
Guarantee Issue (GI) is the amount you can purchase as a newly eligible employee without having to provide evidence of good heath (aka Evidence of Insurability (EOI)). The GI is $30,000, not to exceed 100% of your voluntary life benefit.
WHEN WOULD I NEED TO SHOW EVIDENCE OF GOOD HEALTH TO GET LIFE INSURANCE?
If you elect a benefit over GI, a benefit outside of your newly eligible period, or an increase to your current benefit for you and/or your spouse you will be required to provide Evidence of Insurability (EOI). Completed EOIs should be submitted to Sun Life directly. A copy of the EOI form can be found within the library of the Enrollment Portal.
CHILD(REN)
HOW MUCH LIFE INSURANCE CAN I PURCHASE FOR MY CHILD(REN)?
You may purchase a benefit of $10,000. Sun Life does not require EOI or child(ren), the cost for the $10,000 benefit is the same for one or multiple children.
WHAT HAPPENS WHEN YOU AND/OR YOUR SPOUSE TURN 70?
When you reach age 70 a 50% reductionof benefits will apply as of the first of the new policy year. When your spouse reaches age 70 their voluntary life benefit will end.
WHAT HAPPENS IF YOU LEAVE KCA?
Your voluntary life coverage offers the option of portability or conversion. Portability is a continuation of voluntary group term life insurance for those under the age of 70, cost of coverage is based on current group rates (subject to change as of renewal). Under conversion, an individual flexible premium universal life policy may be purchased. The cost for coverage would be based on individual life amounts and will differs from the group rates (typically higher in cost). You have 30 days from the date of terminated coverageto apply. This process is handled directly with Sun Life.
10
Kisinger Campo & Associates provides you short term disability (STD) insurance. STD is insurance for your paycheck should you become disabled due to an off the job injury or illness for a period of time. SHORT TERM DISABILITY
Kisinger Campo & Associates pays 100% of the cost for LTD coverage.
This benefit is at NO COST TO YOU.
WHEN WOULD THE BENEFIT START?
Benefits would begin on the 8 th day from injury or illness.
HOW MUCH WOULD THE BENEFIT PAY? The benefit would pay 60% of your weekly pre-disability earnings to a maximum of $1,500.00 per week.
HOW LONG WILL THE BENEFIT PAY?
The benefit would pay out to a maximum of 26 weeks or until you no longer meet the definition of disability, whichever occurs first.
VOLUNTARY LONG TERM DISABILITY
Kisinger Campo & Associates offers you the option to purchase long term disability (LTD) insurance. LTD is also insurance for your paycheck should you become disabled off the job.
If you enroll in LTD, Kisinger Campo & Associates will cover 50% of the cost for LTD coverage.
WHEN WOULD THE BENEFIT START?
Benefits would begin on the 180 th day from injury or illness. The LTD would continue disability coverage and benefit at the end of STD.
HOW MUCH WOULD THE BENEFIT PAY? The benefit would pay 60% of your monthly pre-disability earnings to a maximum of $10,000.00 per month.
HOW LONG WILL THE BENEFIT PAY?
The benefit would pay out until you are no longer disabled or Social Security Normal Retirement Age.
PRE-EXISITING CONDITIONS ARE EXCLUDED. If you had a pre-existing condition within the 6 months prior to coverage becoming effective, you would not be eligible to claim for any disability resulting from that condition if the disability occurs within 12 months of the start of coverage.
WHEN WOULD I NEED TO SHOW EVIDENCE OF GOOD HEALTH TO GET LTD INSURANCE?
If you elect coverage outside your newly eligible period you will be required to provide Evidence of Insurability (EOI). Completed EOIs should be submitted to Sun Life directly.
11
EMPLOYEE ASSISTANCE PROGRAM
All benefits eligible employees are automatically enrolled in the Employee Assistance Program (EAP) through Sun Life’s partnership with CompPsych. The EAP program is a confidential resource available 24/7 to help you and your household family members deal with a variety of life stages and/or concerns.
CompPsych’s EAP provide the following services and resources:
• • •
Legal resources
• •
Health Risk Assessment Online Will Preparation
Financial resources Work / Life resources
Below are examples of concerns and situations the EAP can assist with:
• • • • •
Depression, stress and anxiety Relationship difficulties Financial and legal advice Family issues and parenting Child and elder care support
• • • • •
Dealing with domestic violence Substance abuse and recovery
Work-related issues
Grief
Eating disorders
EMERGENCY TRAVEL ASSISTANCE
All benefits eligible employees are automatically enrolled in the Emergency Travel assistance. The service is available to you and/or your family members are traveling 100 or more miles from home, domestically or abroad. If a medical, dental, or personal emergency occurs while on a business trip (excluding spouses business travel) or on vacation.
Below are samples of the services provided:
• Pre-qualified medical, legal, interpreter, and other resources anywhere in the world • Over the phone medical consultation and referrals to English speaking Western trained physicians • 27/7 operations center staffed with multi-lingual medical professionals • Emergency medical evacuation • Transport of a minor child back home or family member to visit patient • Lost prescription assistance • Trauma counseling
IDENTITY THEFT PROTECTION
All benefits eligible employees are automatically enrolled in the Identity Theft Protection through Sun Life’s partnership with Assist America’s SecurAssist Identity Protection Program. The program can help restore your identity if stolen with 24/7 telephone and guidance by anti-fraud experts and a dedicated caseworker to notify credit bureaus and file paperwork to correct credit reports, cancel stolen cards and reissue new cards. The program can also help protect your identity BEFORE fraud happens. You may store your credit card information in SecurAssist’s ISO 27001 certified storage vault for monitoring. You will be notified if your financial and/or medical identity has been compromised.
For all services Call 877-736-4739
12
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES
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 restrictingbenefits for any hospital lengthof 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 attendinghealth 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 healthmaintenance organizationmay not:
1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverageunder the terms of the plan, solely to avoid providing such length of stay coverage;
2. Provide monetary payments or rebates to mothers to encouragesuch mothers to accept less than the minimum coverage;
3. Provide monetary incentives to an attendingmedical provider to induce such provider to provide care inconsistent with such lengthof 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 lengthof 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 newMedicare 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 informationon your benefits enrollment form when enrolling into benefits.
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
The Women’s Health and Cancer Rights Act of 1998 requires Kisinger Campo & Associates Hospitality to notify you, as a participant or beneficiary of the Kisinger Campo & Associates Hospitality 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 consultationwith your attending physician for:
1. All stages of reconstruction of the breast on which the mastectomy was performed;
2. Surgery and reconstructionof 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 Certificateof 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.
13
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES continued
Required Annual Employee Disclosure Notices continued
HIPAA PRIVACY POLICY FOR FULLY-INSURED PLANS WITH NO ACCESS TO PHI
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 healthplan is not subject to most of HIPAA’s privacy requirements.
I. No access to protected health information (PHI) except for summary health informationfor limited purposeand 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.
II.
Insurer for group health plan will provide privacy notice
The insurer for the group healthplan 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 intimidatingor retaliatory acts
The group health plan shall not intimidate, threaten, coerce, discriminateagainst, 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.
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 (includinga 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 healthcare professionals, however, may be required to comply with certain procedures, including obtaining prior authorizationfor certain services, following a pre-approved treatment plan or procedures for making referrals. For a list of participating healthcare professionals who specialize in obstetrics or gynecology, or for informationon 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 applicationmay invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation.
14
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES continued
Required Annual Employee Disclosure Notices continued
CHILDREN’S HEALTH INSURANCE PROGRAMREAUTHORIZATION 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 eligiblefor State premium assistance. Please note that premium assistance is not available in all states. If you or your children are eligiblefor 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 eligiblefor these premium assistance programs but you may be able to buy individual insurance coverage through the Health InsuranceMarketplace. 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 coveragewithin 60 days of beingdetermined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444- EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health planpremiums. The following list of states is current as of July 31, 2016. Contact your Statefor more information on eligibility –
ALABAMA – Medicaid
FLORIDA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447
Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268
ALASKA – Medicaid
GEORGIA – Medicaid
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Website: http://dch.georgia.gov/medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507
ARKANSAS – Medicaid
INDIANA – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website: http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864
COLORADO – Medicaid
IOWA – Medicaid
Medicaid Website: http://www.colorado.gov/hcpf Medicaid Customer Contact Center: 1-800-221-3943
Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562
KANSAS – Medicaid
NEW HAMPSHIRE – Medicaid
Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218
KENTUCKY – Medicaid
NEW JERSEY – Medicaid and CHIP
Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
LOUISIANA – Medicaid
NEW YORK – Medicaid
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447
Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831
15
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES continued
Required Annual Employee Disclosure Notices continued
MAINE – Medicaid
NORTH CAROLINA – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711
Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100
MASSACHUSETTS – Medicaid and CHIP
NORTH DAKOTA – Medicaid
Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825
MINNESOTA – Medicaid
OKLAHOMA – Medicaid and CHIP
Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
MISSOURI – Medicaid
OREGON – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075
MONTANA – Medicaid
PENNSYLVANIA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084
Website: http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462
NEBRASKA – Medicaid
RHODE ISLAND – Medicaid
Website:http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/ Pages/accessnebraska_index.aspx Phone: 1-855-632-7633
Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300
NEVADA – Medicaid
SOUTH CAROLINA – Medicaid
Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900
Website: http://www.scdhhs.gov Phone: 1-888-549-0820
SOUTH DAKOTA – Medicaid
WASHINGTON – Medicaid
Website: http://dss.sd.gov Phone: 1-888-828-0059
Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program- administration/premium-payment-program Phone: 1-800-562-3022 ext. 15473
TEXAS – Medicaid
WEST VIRGINIA – Medicaid
Website: http://gethipptexas.com/ Phone: 1-800-440-0493
Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx Phone: 1-877-598-5820, HMS Third Party Liability
UTAH – Medicaid and CHIP
WISCONSIN – Medicaid and CHIP
Website: Medicaid: http://health.utah.gov/medicaid CHIP: http://health.utah.gov/chip Phone: 1-877-543-7669
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002
VERMONT– Medicaid
WYOMING – Medicaid
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531
VIRGINIA – Medicaid and CHIP Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282
To see if any other states have added a premium assistance program since July 31, 2016, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Healthand Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collectiondisplays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collectionof information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.
16
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES continued
MEDICARE PART D
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 United Healthcare 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 premiummay 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 nineteenmonths without creditable coverage, your premiummay 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 noticeor 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 United Healthcare 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 fromMedicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Call your State Health InsuranceAssistance 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. • Visit www.medicare.gov
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 United Healthcare and about your options under Medicare’s prescription drug Plan. If you are considering joining, you should compare your current coverage includingwhich drugs are covered at what cost, with the coverage and costs of the plans offeringMedicare 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 throughMedicare 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 coveragefor a higher monthly premium. 2. UnitedHealthcare has determined that the prescription drug coverage offered by the Welfare Plan for Employees of Kisinger Campo & Associates Hospitality under the UnitedHealthcare option are, on averagefor all plan participants, expected to pay out as much as the standard Medicare prescription drug coveragepays and is thereforeconsidered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverageand 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 United Healthcare and don’t enroll in Medicare prescription drug coverage after your current coverageends, 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 fromOctober 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 eligiblefor 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 United Healthcare 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 United Healthcare coverage, be aware that you and your dependents will be able to get this coverage back. When can you join a MedicareDrug Plan?
Date:
09/01/2018
Name of Entity/Sender: Contact--Position/Office:
Kisinger Campo & Associates Colleen Carter 201 N Franklin Street, Suite 400 Tampa, FL 33602
813-871-5331
Phone Number:
17
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 23 Page 24 Page 25 Page 26 Page 27Made with FlippingBook - professional solution for displaying marketing and sales documents online