2024 E MPLOYEE BENEFITS GUIDE
WELCOME TO YOUR BENEFIT ENROLLMENT GUIDE 2024 PLAN YEAR
Please note: This benefit guide contains the basic information about your benefits program. It does not cover every detail; but it does provide a general description of each benefit plan. Every effort has been made to ensure that the information is accurate. However, this guide is not an insurance policy. If there is any question as to coverage, benefit eligibility, or interpretation, the insurance contract and the Certificate of Coverage you receive from the insurance carrier will govern the administration of your benefits. If you would like additional or specific information, please contact the Human Resources Department. This guide explains each type of coverage, and provides examples to help you determine your benefit and payroll deduction amounts. We encourage you to take the time to review the enrollment guide prior to enrollment. Open Enrollment will begin Monday, September 23 rd and you have until midnight on Sunday, September 29 th to select your benefits. Keep in mind that the benefits you select during this enrollment will be effective October 1 st , 2024 and will continue through September 30 th , 2025. Terry Miller Service Company is proud to offer you a comprehensive benefits package for the upcoming plan year. This enrollment guide will assist you in determining the coverage levels that will provide you and your family with the protection that gives you peace of mind.
ADDITIONAL INFORMATION
ELIGIBILITY: As a Terry Miller Service Company employee, you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package after 90 days of employment.
WHO IS AN ELIGIBLE DEPENDENT? You can enroll the following dependents in our group benefit plans: • Your legal spouse • Your natural, adopted, or stepchildren living with you, or any other children whom you have legal guardianship, up to age 26 • Unmarried children of any age if disabled and claimed as a dependent on your federal income taxes
WHEN YOU CAN ENROLL IN BENEFITS:
• During your initial new hire eligibility period • During the annual Open Enrollment period for a October 1 st effective date
If you fail to enroll within the time frame given for the new hire eligibility or annual enrollment window, you will not be able to elect benefits again until the next Open Enrollment period, and you will not have coverage, unless you experience a qualified life event. Please make your elections on time, or you may experience a delay in using your benefits.
QUALIFYING LIFE EVENTS are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage. Qualifying Life events include: • Marriage, divorce, or legal separation • Death of spouse or other dependent • Birth or adoption of a child • You or your spouse experience a work event that effects your benefits • A dependent’s eligibility status changes due to age, student status, marital status, or employment • Relocation into or outside of your plan’s service area You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.
HOW TO ENROLL
Step 1: Creating your Employee Navigator Account
Welcome Email:
• You will receive a Welcome email from Employee Navigator • Click on the “Registration Link” in the email • Create an account with username and password of your choice
• Go to https://www.employeenavigator.com/benefits/Account/Register • Enter [First Name], then [Last Name] • Enter your Company Identifier [tmillersc] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYY • Click “Next” to continue • When prompted, your username will be as follows: [First Name].[Last Name] Option 2:
Step 2: Complete HR Tasks
• Once your account is set up, you will be taken to your employee homepage.
• On the homepage, click the “Complete HR Tasks” to begin your new hire tasks first.
• The first few tasks require you to put in demographic information and e-sign for online acknowledgment.
T I P If you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”
Step 3: Benefit Elections
• To enroll dependents in a benefit, click the checkbox next to the dependent’s name under “Who am I enrolling?” If you do not click on their name(s), they will not get the insurance. • Below your dependents you can view your available plans and the cost per pay period. To elect a benefit, click Select Plan underneath the plan cost.
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Step 4: Forms
• If you have elected benefits that require a beneficiary designation, Primary Care Physician or completion of an Evidence of Insurability form, you will be prompted or required to complete.
Step 5: Review & Confirm Elections
• Review the benefits you selected on the enrollment summary page to make sure they are correct then click “Sign & Agree” to complete your enrollment. Print a summary of your elections for your records.
T I P If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps in the drop down bar to complete them. ALL STEPS MUST BE COMPLETED! Step 6: HR Tasks (if applicable) • To complete any required HR tasks, click “Start Tasks”. If your HR department has not assigned any tasks, you’re finished!
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NETWORK:
MEDICAL COVERAGE
Insurance Carrier:
Angle Health Medical Insurance: Cigna PPO Network
Medical Plan:
$3,000 Copay Plan
$5,000 Copay Plan
In-Network: Primary Care Visits
$20 Copay
$25 Copay
Specialist Care Visits
$50 Copay
$75 Copay
Urgent Care
$75 Copay
$85 Copay
Emergency Room Care
Deductible; then $250 Copay
Deductible; then $300 Copay
Preventative Visit Copay
$0
$0
Diagnostic Testing (X-Ray / Blood Work)
Deductible; then 20% Coinsurance
Deductible; then 20% Coinsurance
Advanced Imaging
Deductible; then 20% Coinsurance
Deductible; then 20% Coinsurance
Plan Coinsurance
80%
80%
Employee Deductible
$3,000
$5,000
Family Deductible
$6,000
$10,000
Employee Out-of-Pocket Max
$5,000 (includes deductible)
$7,000 (includes deductible)
Family Out-of-Pocket Max
$10,000 (includes deductible)
$14,000 (includes deductible)
Inpatient Hospital
Deductible; then $250 Copay
Deductible; then $300 Copay
Outpatient Hospital or Facility
Deductible; then 20% Coinsurance
Deductible; then 20% Coinsurance
Out-of-Network Plan Coinsurance
50%
50%
Employee Deductible
$6,000
$10,000 $20,000 $14,000 $28,000
Family Deductible
$12,000 $10,000 $20,000
Employee Out-of-Pocket Max
Family Out-of-Pocket Max
Prescription Drugs 30-day supply Tier 1 - Generic
$15 Copay $50 Copay $75 Copay
$20 Copay $60 Copay $85 Copay
Tier 2 - Preferred
Tier 3 - Non-Preferred
Tier 4 - Specialty
Deductible; then 20% Coinsurance
Deductible; then 20% Coinsurance
Employee Weekly Deduction Employee Only
$36.64 $206.88 $185.60 $341.67
$33.94 $191.62 $171.91 $316.46
Employee + Spouse Employee + Child(ren)
Family
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Hello!
The Angle Experience
Re-imagining The Health Insurance Experience Meet your new health plan! At Angle, we’re building a modern health insurance company to bring quality, tech-enabled health plans to our members. Healthcare is complex, but we’re here to make it easy, affordable, and convenient. This guide provides information about your medical plan benefits and services offered through Angle Health. Born out of frustration from the personal healthcare experiences of our team, we founded Angle Health to bring a truly technology-enabled solution to health insurance. One where members don't have to spend hours navigating the complex maze of health systems and aren’t left to "figure out" their health insurance in order to access the right care.
The App Our fully digital platform delivers a personalized member experience that centers around ease of use, personalization, and better access to care.
Our Vision Bring transparency, simplicity, and humanity to healthcare so that people can live their best lives.
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The Angle Care Team Angle Health does the heavy lifting so you don’t have to. Members have access to resources and real-time chat with Angle Health’s care team; a dedicated cadre of healthcare professionals to guide members through the entire care journey. Our care team helps you navigate the complex health care system with convenient and friendly human support so you don’t have to.
Member Services • Personalized service with a focus on making wellness easy. • Expert counseling in navigating the ins and outs of our convoluted health system. • Single touchpoint solutions with an actual human on the other end. • 1:1 support available via chat, email, & phone • Dedicated team members available to field questions and connect you with experts to provide clinical guidance through your wellness journey.
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Make The Most Of Your PPO Plan. PPO is a type of health plan that contracts with medical providers such as hospitals and doctors to create a network of participating providers.
Defining a Network – Who are my providers?
Providers in our network include doctors, hospitals, pharmacies- anywhere you receive care. When it comes to defining physicians there are two types you should be familiar with: • Primary Care Physician (PCP): Your general doctor for basic needs • Specialist Care Physician (SCP): Your doctor who specializes in certain types of care (knees, eyes, etc.) Providers who have contracted with the plan are “in-network” and providers who have not contracted with the plan are “out-of- network.” You are not required to choose a Primary Care Physician. You have a complete choice of providers within your network.
Referrals to specialty providers are not required
Increased flexibility
• Angle’s PPO does not require the use of in- network providers, however, visiting an out- of-network provider generally will result in additional cost sharing for you. • Providers who are in-network can be used with generally lower cost sharing for you. • PPO networks allow you to have the most flexibility in accessing any providers as you see fit. You typically have access to many more doctors than an HMO (Health Maintenance Organization).
Finding or Changing your Provider
Not sure if your provider is in network? Check out the provider search tool: anglehealth.com/network-directories. As always, we encourage you to reach out to our Care Team if you are looking for a new provider or have any questions.
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Accessing Care: Know Where To Go With so many options for health care services, it can be confusing to understand where you should go for care when you need it. There’s big differences between a visit to the emergency room and your primary care provider.
Routine Medical Care
Emergency Care
Urgent Care
Need immediate help? call 9-1-1 if you have an emergency or life- threatening situation. In an emergency, you should get care from the closest hospital that can help you.
Preventive Services Chronic Condition
Minor Illnesses & injuries that are not emergencies, but should be treated within 24 hours.
Management Vaccinations Overall Health Improvement
Behavioral Health
Virtual Visits through DoD
Local Urgent Care
In-Office Prim. Care
• General Inqiries • Health Education and Wellness • Chronic Condition Management
Check network status through the Angle App or by calling the Care Team
Angle Care Team
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The Angle Health Mobile App With the Angle Health App, members have access to resources and real-time chat with Angle's care team in addition to many self-serve features right at your fingertips. Care Navigation Your dedicated member care team is always just a chat away. Members can conveniently access our friendly (human) support team through the app or web browser. Healthcare iscomplicated: whether you’re managing a complex condition, or just want some extra help navigating the system, ourteam is here to guide you through your care journey. Find Providers And Facilities Searching for doctors and facilities is easy From the home screen in your app or browser, simply click on "facilities" to see the map view of in-network facilities near your location. Click on the upper right filter to search for specific facilities. Virtual Care Angle is proud to partner with virtual healthcare provider, Doctor on Demand, to provide convenient and accessible healthcare options to our members. Doctor on Demand allows you to schedule an appointment with a provider in minutes directly from the app or member portal. See page 13 to learn more about Doctor on Demand services. *Most health plans offer $0 cost share for visits. Access Your Plan Information Forgot your physical ID card at home? Don't sweat it. You can access your digital ID card via the mobile app and share with your provider's office.Use our app for common health plan ques- tions, like deductible spend, insurance ID cards, how the plan pays for specific benefits, and much more!
App Store
Google Play
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Preventive Care All health plans cover preventive care at 100%— that means no copay,coinsurance, or deductible.
Preventive care, lab work, examinations and counseling
Keeping Healthcare Costs Low 1. Stay Up to Date on your Preventive Care Check your Plan Documents to confirm what preventive care services are recommended and covered for you and your family 2. Get Care in the Right Place: Scheduling your appointments with a provider who in your plan’s network to reduce costs. 3. Regular Primary Care: Seeing a primary care provider regularly to stay ahead of health problems can help you be healthier and save on healthcare costs.
Annual physical exams Complete Blood Count (CBC), and screenings for colon, lung, prostate, and other cancers. Screenings are preventive for diabetes, cholesterol, glaucoma, hearing loss, chlamydia, Human Papillomavirus (HPV), Human Immunodeficiency Virus (HIV), hepatitis viruses B and C.
Procedures Preventive care procedures such as
mammograms, Pap tests, bone density/DEXA scans, and counseling for weight loss, smoking cessation, alcohol misuse, and more.
More Tools for Good Health
Recommended adult and child immunizations
1. Angle Health Member Portal : Log into your account at www.anglehealth.com/providers to search for a primary care provider. 2. Angle Health Care Team: Your dedicated member care team is always just a chat away to ease the burden of care coordination. 3. Doctor On Demand by Included Health offers Urgent Care visits and Behavioral Health visits using the convenience of telemedicine. You can schedule your telemedicine appointment with an urgent care provider or therapist seven (7) days a week, 24 hours a day.
Adult immunizations are covered from a tetanus shot to your annual flu shot. And your children’s annual wellchild exams and immunizations are also covered as preventive care.
Contraception and Breastfeeding Supplies & Support
Most contraceptives for women are covered by your pharmacy benefits as a preventive service. This may include generic oral medication, the patch, Intrauterine Devices (IUDs) and injections. *For services to be covered as preventive, your doctor must bill your claim with preventive codes. If your provider finds a condition that needs further testing or treatment, you’ll need to pay regular copays, coinsurance, or deductibles
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Doctor On Demand
Angle and Doctor On Demand Angle is proud to support our members with convenient and accessible healthcare options. Access board certified physicians, psychiatrists, psychologists, and psychotherapists, anytime and anywhere with Doctor On Demand’s (DOD) Total Virtual Care. As an Angle Health plan member, you can access your favorite DOD provider right from your smartphone, tablet, or computer - directly from the Angle app or portal.
Doctor On Demand Services Available to Angle Members
Everyday and Urgent Care
Behavioral Health
• 24/7 behavioral health care - on demand or by appointment. • Psychiatry visits including medication management. • Therapy visits: psychologist or master level therapist.
• 24/7 medical care - on demand or by appointment. • New and refill prescription orders. • Lab test orders, results interpretation, consultation and escalation. • COVID-19 screening, assessment and testing referral.
What Doctor On Demand Practitioners Treat
Everyday and Urgent Care
Behavioral Health
• Anxiety and Depression • Stress • Postpartum Depression • Trauma and loss • Post Traumatic Stress Disorder • Behavioral Therapy • Social Anxiety • Insomnia
• Cold & Flu • Sinus infections • Bronchitis and Pneumonia • Urinary Tract Infections • Vomiting and Diarrhea • Conjunctivitis • Vaginal and Yeast Infections • Cellulitis and Skin Conditions • Women’s Health • Men’s Health • Labs & Screenings
• Allergies • Asthma • High Cholesterol • High Blood Pressure • Weight Management How Do I Access Doctor On Demand? Angle and Doctor On Demand have partnered to create a single sign on experience. • Sign on directly through the Angle website or app to access Doctor on Demand. • Seamless login process using the same email and password. Telemedicine services from designated providers are covered in full; all others are covered at their respective Office Visit levels. * After 1/1/2023, telemedicine must be $0.00 after deductible for HSA-eligible plans.
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The Angle Experience
QUESTIONS? WE’RE HERE FOR YOU
Download the Angle App to chat with our Care Team, or reach out by phone Mondays – Fridays, 8am – 6pm (MST) Phone: +1 (855) 937-1855
App Store
Google Play
Please refer to your Angle Health Onboarding Email for your log-in credentials. If you have any questions please don’t hesitate to reach out to a member of our Care Team.
Thank You!
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DENTAL BENEFITS
Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower.
Keeping your teeth and gums clean and healthy will prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health.
Your dental plan is through MetLife and offers “in and out-of-network” benefits.
Insurance Carrier:
MetLife Dental Insurance
PPO Dental Plan You pay:
Plan Type:
Calendar Year Deductible
$50 Individual / $150 Family
Calendar Year Maximum
$1,000
Preventive Services
100%
Basic Services
80%
Major Services
50%
Orthodontia (dependent children only)
N / A
Out-of-Network Reimbursement
90th Usual & Customary
Employee Weekly Deduction Employee Only
$6.26
Employee + Spouse
$13.05
Employee + Child(ren)
$13.95
Family
$22.16
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VISION BENEFITS
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.
Your vision plan is through MetLife and offers “in and out-of-network” benefits.
Insurance Carrier:
MetLife Vision Insurance
In-Network You pay:
Out-of-Network You are reimbursed:
Eye Exam every 12 months
$10 Copay
Up to $45
Lenses every 12 months • Single Vision
$15 Copay $15 Copay $15 Copay $15 Copay
Up to $30 Up to $50 Up to $65 Up to $100
• Bifocal • Trifocal • Lenticular
Frames every 24 months
$15 Copay; then $130 Allowance
Up to $70
$130 Allowance Medically Necessary: $0
Up to $105 Medically Necessary: Up to $210
Contacts every 12 months
Employee Weekly Deduction Employee Only
$1.56 $3.14 $2.66 $4.38
Employee + Spouse Employee + Child(ren)
Family
*Contacts benefit is in lieu of eyeglass frames and lens benefit.
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BASIC LIFE AND AD&D INSURANCE COVERAGE
Terry Miller Service Company provides all Full-Time employees with Basic Life and Accidental Death & Dismemberment at no cost to you.
MetLife Basic Life w/AD&D Insurance
Eligibility Requirement Life Insurance Benefit
All Full-Time Employees
$30,000
Guarantee Issue
Yes
Accidental Death & Dismemberment Benefit (AD&D)
Same as Basic Life Amount
VOLUNTARY TERM LIFE INSURANCE COVERAGE
As a supplemental benefit, Terry Miller Service Company allows eligible employees to purchase additional life insurance coverage for yourself and your dependents. This coverage is paid for by you and is offered through MetLife. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.
MetLife Voluntary Life w/AD&D Insurance
Eligibility Requirement
All Full-Time Employees
Employee Benefit Amounts Employee
Up to $500k in increments of $10k
Spouse
50% of Employee to $100k in increments of $5k
Child(ren)
Flat $10k
Guarantee Issue (Newly Eligible Employees) Employee
$50k $25k $10k
Spouse
Child(ren)
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M ember C laims A dvocate
Employee Benefit Assistants You Can Count on
Terry Miller Service Company provides you and your family members a complimentary member claims service to help with claims, billing, missing ID cards and more.
give member claims advocate a call if :
• You received a provider bill or EOB and feel the claim was processed incorrectly • You are at the doctor or pharmacy and having trouble with your coverage • You need to confirm if a provider is In-Network • You are missing your ID card
Y ou can reach the M ember C laims A dvocate team by phone or email :
Monday through Friday, 8:30 AM EST - 5:00 PM EST
Charlie McDaniel - cmcdaniel@yatesins.com Resa Carter - rcarter@yatesins.com (706) 323-1600
FREQUENTLY ASKED QUESTIONS
What is included in the Medical Out-of-Pocket maximum? What is included in the Pharmacy Out- of-Pocket maximum? The Medical Out-of-Pocket maximum is the maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible and any coinsurance member responsibility. The Pharmacy OOP includes only phar- macy co-pays. The Medical OOP does NOT include monthly premiums, or billing from out-of-network providers. What is an in-network vs out-of-network provider? Angle Health contracts with a wide range of doctors, as well as specialists, hospitals, labs, radiology facilities and pharmacies. These are the providers that are considered “in your network”. Specifically, each of these providers has agreed to accept Angle Health’s contracted rate for your medical care and services rendered. The contracted rate includes both Angle Health’s share of the cost, and the member’s. Your share may be in the form of a co-payment, deductible, or co-insurance. For example, Angle Health’s contracted rate for a primary care visit might be $125. The Plan has a $25 co-payment for the visit; the member will pay $25 of the cost and your insurance plan will pay the remaining $100. An “out-of-network” provider is a medical doctor or facility that is not in contract with Angle Health. This means that the provider may charge members higher rates for medical services and care, outside of the standard “in-network” rates. For example, a out-of-network provider may charge $200 for a primary care visit. Angle Health may pay an adjustment of an out-of-network benefit of $80 dollars to the provider, so the member may be balance-billed for the remaining $120 cost of the visit. When can I change my beneficiary information for my Basic Life Insurance? Any time! It is important that all beneficiary information be kept up-to-date. You may need to change it after a marriage, divorce, or birth of a child.
Term
Definition
Network Office Visit (PCP)
The “per visit” co-pay cost for a primary care or standard network doctor.
The “per visit” co-pay cost for a specialized doctor (cardiologist, OB/GYN, orthopedic, gastrointestinal, etc.) The amount of money a member owes for any In-network health care services before co- insurance coverage begins. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) Deductibles run on a calendar year basis. After any applicable deductible is met, the remaining cost of any in-network health care service is divided between the insurance carrier and the member. A 70% / 30% network co-insurance would divide the cost of a service with 70% paid by the insurance carrier and 30% paid by the member. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) The maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible, any co-insurance member responsibility, primary care and specialist office visit co-pays, ER or Urgent Care co-pays, and prescription co-pays / costs. The OOP does NOT include monthly premiums, billing from out-of-network providers, or spending for non-essential health benefits. The cost of a one month supply of a prescription drug. All covered drugs are designated into tiered levels based on drug usage, cost, and clinical effectiveness. Tier 1 usually includes generics, while Tier 2 generally includes preferred brand name medications. Tier 3 typically includes non-preferred brand name medications, Tier 4 usually includes higher cost drugs and Specialty Drugs are covered under a separate tier.
Specialist Office Visit
Network Deductible
Co-Insurance
Network Out-of-Pocket Maximum (OOP)
Prescription Drug Tiers and Monthly Co-Pays
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LEGAL NOTICES
Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www. healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2022. Contact your State for more information on eligibility –
ALABAMA - Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447 ALASKA - Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: Customer Service@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default. aspx ARKANSAS - Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) COLORADO - Medicaid Website: http://www.colorado.gov/hcpf Customer Contact Center: 1-800-221-3943 KANSAS - Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 KENTUCKY - Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUSIANA - Medicaid Website: http://dhh.louisiana.gov/index.cfm/ subhome/l/n/331 Phone: 1-888-695-2447
FLORIDA - Medicaid Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268 GEORGIA - Medicaid Website: http://dch.georgia.gov/medicaid - click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 INDIANA - Medicaid 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 IOWA - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 MAINE - Medicaid Website: http://maine.gov/dhhs/ofi/public-assistance/ index.html Phone: 1-800-442-6003 TTY: Maine relay 711
MASSACHUSETTS - Medicaid and CHIP Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120 MINNESOTA - Medicaid Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739
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LEGAL NOTICES
MISSOURI - Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 1-800-692-7462 RHODE ISLAND - Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300 SOUTH CAROLINA - Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid
Phone: 573-751-2005 MONTANA - Medicaid Website: http://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084 NEBRASKA - Medicaid
Website: http://www.dhhs.ne.gov/Children_Family_ Services/AccessNebraska/Pages/accessnebraska_ index.aspx Phone: 1-855-632-7633 NEVADA - Medicaid Website: http://dwss.nv.gov/ Phone: 1-800-992-0900 NEW HAMPSHIRE - Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218 NEW JERSEY - Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/cli- ents/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK - Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA - Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA - Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825 OKLAHOMA - Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON - Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx http://oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 PENNSYLVANIA - Medicaid Website: http://www.dhs.pa.gov/hipp
Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 UTAH - Medicaid and CHIP Medicaid Website: http://health.utah.gov/medicaid CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669 VERMONT - Medicaid Website: http://www.greenmountaincare.org Phone: 1-800-250-8427 VIRGINIA - Medicaid and CHIP Medicaid & CHIP Website: http://www.coverva.org/programs_premi- um_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282 WASHINGTON - Medicaid Website: http://www.hca.wa.gov/free-or-low-costhealth-care/pro- gram-administration/premiumpayment- program Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA - Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/ default.aspx Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN - Medicaid and CHIP Website: http://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Phone: 1-800-362-3002 WYOMING - Medicaid Website: http://wyequalitycare.acs-inc.com/ Phone: 307-777-7531
To see if any more States have added a premium assistance program since January 31, 2022, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
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LEGAL NOTICES
22 | Terry Miller Service Company 2024 Benefits Guide coverage will be provided in a manner determined in consultation with the attending physician and the patient, for all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment of If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, Important Notices about Medical Coverage HIPPA Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 30 days after the marriage, birth, adoption, or placement for adoption. Effective April 1, 2009 special enrollment rights also exist in the following circumstances: • If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program (SCHIP) coverage; or • If you or your dependents become eligible for premium assistance under an optional state of Medicaid or SCHIP program that would pay the employee’s portion of the health insurance premium. NOTE: In the two above listed circumstances only, you or your dependents will have sixty (60) days to request special enrollment in the group health plan coverage. An individual must request this special enrollment within sixty (60) days of the loss of coverage described at bullet one, and within sixty (60) days of when eligibility is determined as described in bullet two. Women’s Health and Cancer Rights Act of 1998 Annual Notice
physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under this plan. Our plan complies with these requirements. Benefits for these items generally are compatible to those provided under our plan for similar types of medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined by consultation between the attending physician and the patient. Our plan neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending providers to provide care inconsistent with these requirements. If you would like more information on WHCRA benefits, call Yates LLC at (706) 323-1600. 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 collection displays 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, not withstanding 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 collection of 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.
MEDICARE PART D
Medicare Part D Notice of Creditable Coverage Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Terry Miller Service Company and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare 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. There are two important things you need to know about your currant coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. Terry Miller Service Company has determined that the prescription drug coverage offered by Angle Health plans are on average for all plan participants, expected to pay out as much as 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. When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. 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 Join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Terry Miller Service Company coverage may or may not be affected. See pages 7-9 of the CMS Disclosure of Creditable Coverage to Medicare Part D Eligible Individuals Guidance (available at https://www.cms.hhs.gov/Creditable Coverage/ ), which outlines the prescription drug plan provisions / options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D. If you do decide to join a Medicare drug plan and drop your current Terry Miller Service Company coverage, be aware that you and your dependents may or may not be able to get this coverage back.
When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Terry Miller Service Company 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 a creditable prescription drug coverage, your monthly premium may go up by 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 further information, call Yates LLC at (706) 323-1600. 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 Terry Miller Service Company changes. You may also request a copy of this notice at any time. 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: Medicare Part D Notice of Creditable Coverage, cont. Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of 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 Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium.
23 Terry Miller Service Company 2024 Benefits Guide |
COBRA
What is COBRA continuation health coverage? The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions amend the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to require group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated. What does COBRA do? COBRA requires continuation coverage to be offered to covered employees, their spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to certain specific events. COBRA continuation coverage is often more expensive than the amount that active employees are required to pay for group health coverage, since the employer usually pays part of the cost of employees’ coverage and all of that cost can be charged to individuals receiving continuation coverage. What group health plans are subject to COBRA? The law generally applies to all group health plans maintained by private-sector employers with 20 or more employees, or by state or local governments. The law does not apply to plans sponsored by the Federal Government or by churches and certain church-related organizations. In addition, many states have laws similar to COBRA, including those that apply to health insurers of employers with less than 20 employees (sometimes called mini-COBRA). Check with your state insurance commissioner’s office to see if such coverage is available to you. Who is entitled to continuation coverage under COBRA? In order to be entitled to elect COBRA continuation coverage, your group health plan must be covered by COBRA; a qualifying event must occur; and you must be a qualified beneficiary for that event. Plan Coverage COBRA covers group health plans sponsored by an employer (private-sector or state/local government) that employed at least 20 employees on more than 50 percent of its typical business days in the previous calendar year. Both full-and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of a full-time employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time. Qualified Beneficiaries A qualified beneficiary is an individual covered by a group health plan on the day before a qualifying event occurred that caused him or her to lose coverage. Only certain individuals can become qualified beneficiaries due to a qualifying event, and the type of qualifying event determines who can become a qualified beneficiary when it happens. A qualified beneficiary
must be a covered employee, the employee’s spouse or former spouse, or the employee’s dependent child. In certain cases involving the bankruptcy of the employer sponsoring the plan, a retired employee, the retired employee’s spouse or former spouse, and the retired employee’s dependent children may be qualified beneficiaries. In addition, any child born to or placed for adoption with a covered employee during a period of continuation coverage is automatically considered a qualified beneficiary. An employer’s agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries. Are there alternatives for health coverage other than COBRA? If you become entitled to elect COBRA continuation coverage when you otherwise would lose group health coverage under a group health plan, you should consider all options you may have to get other health coverage before you make your decision. There may be more affordable or more generous coverage options for you and your family through other group health plan coverage (such as a spouse’s plan), the Health Insurance Marketplace, or Medicaid. If you become entitled to elect COBRA continuation coverage when you otherwise would lose group health coverage under a group health plan, you should consider all options you may have to get other health coverage before you make your decision. There may be more affordable or more generous coverage options for you and your family through other group health plan coverage (such as a spouse’s plan), the Health Insurance Marketplace, or Medicaid. Under the Health Insurance Portability and Accountability Act (HIPAA), if you or your dependents are losing eligibility for group health coverage, including eligibility for continuation coverage, you may have a right to special enroll (enroll without waiting until the next open season for enrollment) in other group health coverage. For example, an employee losing eligibility for group health coverage may be able to special enroll in a spouse’s plan. A dependent losing eligibility for group health coverage may be able to enroll in a different parent’s group health plan. To have a special enrollment opportunity, you or your dependent must have had other health coverage when you previously declined coverage in the plan in which you now want to enroll. You must request special enrollment within 30 days from the loss of your job-based coverage. Losing your job-based coverage is also a special enrollment event in the Health Insurance Marketplace (Marketplace). The Marketplace offers “one-stop shopping” to find and compare private health insurance options. In the Marketplace, you could be eligible for a tax credit that lowers your monthly premiums and cost-sharing reductions (amounts that lower your out-of- pocket costs for deductibles, coinsurance and co-payments), and you can see what your premium, deductibles, and out-of- pocket costs will be before you make a decision to enroll.
24 | Terry Miller Service Company 2024 Benefits Guide
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