Kisinger Campo & Associates

2016 Benefits at a Glance

PLAN YEAR:

January 15, 2014 – December 31, 2014

CONTENTS & CONTACT INFORMATION

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

HUMAN RESOURCES Name, Title Email

HR@BankofTampa.com

Phone

813-xxx-xxxx

BROKER PARTNER – M.E. WILSON COMPANY Broker Contact

Amanda Sands

Phone

813-229-8021

Email

ASands@mewilson.com

MEDICAL

page 3

Provider

UHC

Phone

xxx-xxx-xxxx

Web Address

www.myUHC.com

DENTAL

page 5

Provider

UHC

Phone

xxx-xxx-xxxx

Web Address

www.FloridaBlue.com

VISION

page 6

Provider

Advantica

Phone

xxx-xxx-xxxx

Web Address

www.AdvanticaBenefits.com

LIFE INSURANCE

page 7

Provider

Mutual of Omaha

Phone

xxx-xxx-xxxx

Web Address

www.MutualofOmaha.com

SHORT TERM AND LONG TERM DISABILITY page 8 Provider Mutual of Omaha Phone xxx-xxx-xxxx Web Address www.MutualofOmaha.com

DISCLOSURE NOTICES

page 9

BENEFIT INFORMATION

Benefit

Who pays the cost?

Kisinger Campo & Associates pays 100% of the cost of medical coverage. Kisinger Campo & Associates reimburses up to $3,500 of the deductible, after you pay the first $500. Kisinger Campo & Associates offers dental coverage on a voluntary basis. You are responsible for 100% of the cost. Kisinger Campo & Associates reimburses employees up to $400 per year for dental bills, Kisinger Campo & Associates offers vision coverage on a voluntary basis. You are responsible for 100% of the cost.

Medical Insurance

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.

Dental Insurance

Vision Insurance

Basic Life Insurance

Kisinger Campo & Associates pays 100% of the cost for Basic Life coverage.

Short & Long Term Disability

Kisinger Campo & Associates pays 100% of the cost for employee disability coverage.

Kisinger Campo & Associates offers a variety of voluntary worksite benefits for you to choose from. You are responsible for 100% of the cost. Please refer to page 9 for product overview.

Worksite Benefits

ELIGIBILITY

All Regular full-time employees are eligible to join the Kisinger Campo & Associates Benefits Plan on the 1st of the month following your date of hire. “Regular Full-Time Employees” must be regularly scheduled and working at least 30 hours per week.

Part-time employees, those working 20-29 hours per week, are eligible for medical, dental, and vision insurance.

You may also enroll your dependents in the Benefits Plan when you enroll.

Eligible dependents include:

Your legal spouse

WHEN CAN YOU ENROLL?

• Your married or unmarried natural children, step-

children living with you, legally adopted children and any other children for whom you have legal guardianship, who are:

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

► Under 26 years of age;

• After completing your initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family-status change. If you do not enroll at one of the above times, you may enroll during the next annual open enrollment period .

► A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits. To be eligible, a Dependent must: • Be unmarried and not have dependents of his or her own; AND

Be a resident of Florida or a student; AND

Not have coverage of their own, or covered under any other plan, including Medicare

1

BENEFIT INFORMATION

?

CHOOSING YOUR BENEFITS

You are required to actively choose any benefits paid for by Kisinger Campo & Associates or that you pay for or share in the cost of. Your part of the cost is automatically taken out of your paycheck. There are two ways that the money can be taken out:

WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?

There is a definite advantage to paying for some benefits with before-tax money:

• BEFORE YOUR TAXES ARE CALCULATED – Medical, Dental, and Vision

Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.

• AFTER YOUR TAXES ARE CALCULATED – Voluntary worksite products

MAKING CHANGES MAKING CHANGES

Generally, you can only change your benefit choices during the annual benefits enrollment period. However, you may be able to change your benefit choices during the plan year if you have a change in status including:

Your marriage

• Change in your work status that affects your benefits

Your divorce or legal separation

• Change in residence or work site 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

• Receiving Qualified Medical Child Support Order (QMCSO)

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

If you fail to notify Human Resources within 30 days of a

family status change, you will be required to wait until the

next annual enrollment period to make benefit changes

unless you have another family status change.

WHEN COVERAGE ENDS

Coverage will stop on the last day of the month in which employment with the company ends.

2

MEDICAL INSURANCE

Kisinger Campo & Associates offers medical coverage through UHC. 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 Plus” network. The chart below provides a briefly overview of the medical plan offered.

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 .

Plan A BlueOptions xxxx

Plan B BlueOptions xxxx

Plan C BlueOptions xxxx

IN-NETWORK

Embedded *

Non-Embedded *

Non-Embedded *

* Please see bottom of page X for explanation of Embedded vs Non-Embedded

DEDUCTIBLE (your first dollar cost for covered in-network claims) Deductible (Individual / Family) $ / $

$ / $

$ / $

COINSURANCE (your responsibility on claims costs once you’ve met the deductible) Member% OUT OF POCKET MAXIMUM (once met all in-network covered services are covered by the plan) Maximum Out-of-Pocket (Individual / Family) $ / $ $ / $ Member%

Member%

$ / $

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

Office Visits (Illness/Injury)

__% after deductible

__% after deductible

__% after deductible

Specialist Visits

__% after deductible

__% after deductible

__% after deductible

HOSPITAL SERVICES Inpatient Hospital

__% after deductible

__% after deductible

__% after deductible

Outpatient Surgery

__% after deductible

__% after deductible

__% after deductible

Emergency Room

__% after deductible

__% after deductible

__% after deductible

Urgent Care

__% after deductible

__% after deductible

__% after deductible

DIAGNOSTIC TESTING Lab, X-Ray, Advanced Imaging (MRI, CAT, PET, etc.)

__% after deductible

__% after deductible

__% after deductible

PRESCRIPTIONS

Medical deductible first, then Medical deductible first, then

Retail (30 day supply) Tier 1 / 2 / 3 / 4

$ / $ / $

$ / $ / $

$ / $ / $

H.S.A Compatible

No

Yes

Yes

OUT-OF-NETWORK 1 Deductible

$ / $

$ / $

$ / $

Coinsurance

Member%

Member%

Member%

Out of Pocket Maximum

$ / $

$ / $

$ / $

Cost for coverage per paycheck

Employee only

$

$

$

Employee + Spouse

$

$

$

Employee + Child(ren)

$

$

$

Employee + Family

$

$

$

1 Charges are subject to balance billing

3

HOW THE MEDICAL PLANS WORK

STARTING WITH THE BASICS (KEY TERMS)

Deductible : When enrolled in the medical coverage you are a UHC member. As a member you receive their discounted rate for all medical services and prescription drugs with their network providers. This discount is typically 50%-70% off the amount charged to someone without insurance. You are responsible for the discounted rate on all medical services and/or prescriptions subject to the deductible Coinsurance: is cost-sharing. You and UHC sharing in the cost for service subject to the deductible after you have met the deductible. The medical summary chart reflects each medical plans coinsurance amount, this is the percent of cost you're responsible for once you’ve met the deductible, UHC is responsible for the reminder.

Copayment: (aka Copay) – A flat fee that you pay for medical services or prescriptions.

Out of Pocket Maximum is the maximum amount you will pay in deductible costs, coinsurance and copays during the policy year.

EMBEDDED V.S. NON-EMBEDDED

On an Embedded plan no one individual would be responsible for more than the individual deductible and no family would exceed more than the family deductible collectively.

On a Non-Embedded plan the family deductible can be met by one individual or the family collectively.

HEALTH SAVINGS ACCOUNT (H.S.A.)

When you’re enrolled in a qualified High Deductible Health Plan (HDHP) you and you employer can contribute to your H.S.A account. What are the perks?

• Your contributions are pre-tax . • Money rolls over year to year, you never lose it. • It’s owned by you . The account and money in it are your’s to keep whether you retire, come off the group plan, or leave. • It’s easy to use ! Optum Health Bank sends you a H.S.A card when you open an account. The card is just like a debit card, simply swipe the card when you want to use the funds.

Maximum Contribution Limits* 2016 2017

Single Coverage

$3,350

$3,400

Family Coverage $6,650

$6,750

* Individuals who are age 55 or older may contribute an additional $1,000 per year .

ELIGIBLE EXPENSES

• Alcohol & drug dependency treatment • Artificial Teeth • Acupuncture & Chiropractic services

• Hearing aids & batteries for use • Hospital, Surgical, lab & X-Ray fees • Long-term care (expenses & premiums) & Nursing home • Physical & speech therapies • Smoking-cessation programs & products

• Dental expenses (exams, X-rays, root canals, bridges, etc.) • Diagnostic devices (blood sugar test kits for diabetics) • Prescription drugs • Eyeglasses, exams, laser eye surgery, Contact lenses & solution

• Vasectomy • Wheelchairs • Etc.

4

DENTAL INSURANCE

Kisinger Campo & Associates offers dental coverage through UHC. The Dental PPO Plan allows you to use in-network or out- of-network benefits. To find in-network providers go to www.FloridaBlue.com and select “Find a Doctor and More”, search based on your specifics within the “PPO” network. If out-of-network dentists are used, you will be responsible for pay the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.

Base PPO Plan

Premium PPO Plan

In-Network

Deductible (applies to Basic & Major services)

$

$

Individual

$

$

Family

Annual Maximum (per covered member)

$

$

Preventive Services

Covered in full

Covered in full

Exams, Cleanings, & Fluoride

Basic Services

Fillings, Simple Extractions, Perio & Endo (other than those listed below)

__% after deductible

__% after deductible

Major Services Crowns, Bridges, Surgical

__% after deductible

__% after deductible

Extractions, Root Canal, Dentures, Osseus Surgery & Endo Molars

Orthodontia (child only)

Member% $ lifetime maximum per person

None

Out-of Network 1

__ th % Usual & Customary Charges

Basis of Payment

Deductible (applies to Basic & Major services)

$ / $

$ / $

Annual Maximum (per covered member)

$

$

Services Preventive

Covered in full __% after deductible __% after deductible

Covered in full __% after deductible __% after deductible

Basic Major

Orthodontia (child only)

Member% $ lifetime maximum per person

None

Cost for coverage per paycheck

Employee only

$

$

Employee + Spouse

$

$

Employee + Child(ren)

$

$

Employee + Family

$

$

1 Subject to balance billing. Please refer to your plan document for specific details.

5

VISION INSURANCE

Kisinger Campo & Associates offers vision coverage through Advantica. The Advantica vision plan allows you the flexibility to see any provider. To search in-network providers go to www.AdvanticaBenefits.com and search under “future member”. For out-of-network claims you pay expenses at the time of service and file a claim for reimbursement. Below is a list of the reimbursement schedule.

Your vision is important to your health. Whether your vision is 20/20 or less than perfect, everyone should receive regular vision care.

Vision

Out-of-Network 1

In-Network

Routine Eye Exams

Every __ months

$__ Copay

Reimbursed up to $

Lenses 2

Every __ months

Single Vision Bifocal Trifocal Lenticular

Reimbursed up to $__, depending on type of lenses

$__ Copay

Frames

Every __ months

$__ Copay provides, $ Allowance PLUS __% off cost over the allowance

Reimbursed up to $

Contact Lenses (in lieu of glasses)

Every __ months

Elective Contact Lenses Preferred Non-Preferred

$__ Copay provides you a $ allowance $__ Copay provides you $ allowance

Reimbursed up to $

Medically Necessary

$__ Copay

Reimbursed up to $

Cost of coverage per paycheck

Employee only

$

$

Employee + Spouse

$

$

Employee + Child(ren)

$

$

Employee + Family

$

$

1 Reimbursable amount, less applicable copay.

2 Lenses benefit listed are for a pair of lenses.

6

LIFE INSURANCE

BASIC LIFE AND AD&D INSURANCE

Kisinger Campo & Associates provides all benefit eligible employees with Life and Accidental Death & Dismemberment (AD&D) benefit, up to 2x your annual salary (not to exceed $400,000). This benefit is with Mutual of Omaha. Kisinger Campo & Associates pays 1000% of the cost of coverage, this benefit is at NO COST TO YOU

Age Reduction Schedule

At age…

The original amount of benefit will reduced by …

XX XX

__% __%

Please be sure to assign your beneficiary at initial eligibility and update as needed.

VOLUNTRAY LIFE INSURANCE

Kisinger Campo & Associates gives you the option to purchase additional Life and AD&D insurance for yourself and your dependents. This coverage is available through Mutual of Omaha. What is Guarantee Issue (GI)? GI is the maximum benefit you can receive without having to provide proof of good health, Evidence of Insurability (EOI). GI is only available at initial eligibility. If you’re requesting coverage outside your initial eligibility, you must submit EOI to Mutual of Omaha for review. EOI can be provided online at www.mutualofomaha.com/EOI or submitted by paper .

Guarantee Issue amounts

$150,000 (not to exceed $500,000 your annual salary)

Employee

Spouse 1

$50,000

1 You must elect voluntary life insurance for yourself to have dependent coverage. The dependent benefit cannot exceed the employee benefit.

$10,000 (not to exceed 50% of the employee benefit )

Child(ren) 1

Employees may elect a benefit s as low as $_____ in increments of $____ to a maximum of $____ (not to exceed $500,000).

You may elect a benefit for your spouse for as low as $_____ in increments of $____ to a maximum of $____ (not to exceed 50% f the employee benefit amount). .

You may elect a benefit for your Child(ren) for $5,000 or $10,000, not to exceed 50% of your benefit amount. Children do not require EOI to enroll at initial enrollment or when/if increasing the benefit from $5,000 to $10,000. The cost for coverage for 1 or more children is the same and all children must have the same benefit amount. A child may remain on the policy until through the age of 21, through the age of 25 if they are a full-time student.

Reduction of benefits for voluntary life is the same age and benefits schedule as that for Basic Life.

Please be sure to assign your beneficiary at initial enrollment and update as needed.

7

DISABILITY BENEFITS

SHORT TERM DISABILITY

Kisinger Campo & Associates provides you Short Term Disability (STD) through Mutual of Omaha. Kisinger Campo & Associates pays 100% of the cost for coverage, this benefit is at NO OCST TO YOU!

Short Term Disability (STD) provides you a benefit, should you become temporarily disabled because of illness, injury or a condition, like pregnancy. Please note, STD does not provide for any job protection status, job protection may be provided for you by the Family Medical Leave Act (FMLA), if applicable. Weekly disability benefits would begin on the 31 st day of an injury or illness and would continue to a maximum of __ weeks. The benefit allots you 60% of your weekly earning, to a maximum of $1,500 per week. If your disability exceeds the duration of STD you will begin to receive the Long Term Disability (LTD) benefit.

LONG TERM DISABILITY

Kisinger Campo & Associates provides you Long Term Disability (LTD) through Mutual of Omaha. Kisinger Campo & Associates pays 100% of the cost for coverage, this benefit is at NO OCST TO YOU!

Long Term Disability (LTD) provides you a long term continuation of income should you become disabled for a period longer than __ consecutive days.

Monthly disability benefits would begin on the __ day of an injury or illness and would continue until you reach Social Security Normal Retirement Age (SSNRA). The benefit allots you 60% of your monthly earning, to a maximum of $x,000 per month

WORLDWIDE TRAVEL ASSISTANCE

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.

The Employee Assistance Program (EAP) is here for just that. The EAP is available to you and your family, providing you access to highly-trained professionals to help you find solutions to a variety of issues. This program is through Mutual of Omaha. In addition to telephonic you also receive up to 3 face-to-face sessions per calendar year.

TYPES OF SERVICES AVAILABLE

• Grief • Balancing work and home • Parenting • Drug and/or alcohol abuse

• Stress and mental health • Resiliency • Depression • Gambling and other addictive behaviors

• Parenting • Financial issues • Life changes • Relationship issues

Kisinger Campo & Associates pays 100% of the cost of coverage, this program is at no cost to you!

EAP staff members are available 24 hours a day, 7 days a week, every day of every year! These professionals may be reached at 1-800-316-2796 or by logging onto www.MutaulofOmaha.com/EAP .

8

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 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;

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998

The Women’s Health and Cancer Rights Act of 1998 requires Kisinger Campo & Associates to notify you, as a participant or beneficiary of the Kisinger Campo & Associates Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for:

1. All stages of reconstruction of the breast on which the mastectomy was performed;

2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema.

These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information.

MICHELLE’S LAW

The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010 If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary.

4. Require a mother to give birth in a hospital; or

5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice.

These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information.

SECTION 111

Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits.

9

REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

Required Annual Employee Disclosure Notices continued continued

HIPAA PRIVACY POLICY FOR FULLY- INSURED PLANS WITH NO ACCESS TO PHI

PATIENT PROTECTION:

If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website. It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation. 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.

10

Required Annual Employee Disclosure Notices - Continued 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 UHC 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 UHC 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 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. 6/1/16 Name of Entity/Sender: Kisinger Campo & Associates Contact--Position/Office: Name Address Tampa, FL xxxxx Phone Number: 813-xxx-xxxx Date: • 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 UHC 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 Kisinger Campo & Associates 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 UHC 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 UHC 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 UHC coverage, be aware that you and your dependents will be able to get this coverage back. When can you join a Medicare Drug Plan?

11

HEALTHCARE REFORM AND YOU

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.

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.

Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule:

In 2014, the greater of $95 or 1% of taxable income;

In 2015, the greater of $325 or 2% of taxable income;

In 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.

12

The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by your employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.

Presented by:

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

Made with FlippingBook - Online magazine maker