MicroLumen 2018 Benefits Guide

2018 Benefits at a Glance


January 15, 2014 – December 31, 2014


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

HUMAN RESOURCES Robin Reynolds, VP, Finance Email




BROKER Company Name

M.E. Wilson Company

Broker Contact

Katie Reeves Miller


813-229-8021 Ext. 132




page 3


United Healthcare (Policy # 0910469)



Web Address



page 4


Sun Life (Policy # 5487438)


Assurant Dental Network



Web Address

www.sunlife.com/onlineadvantage www.sunlife.com/findadentist

Mobile App

Sun Life Benefit Tools


page 5


Sun Life (Policy # 5487438)


VSP/ Signature



Web Address



page 6


United Healthcare (Policy # 305382)

SHORT-TERM AND LONG-TERM DISABILITY page 7 Provider United Healthcare (Policy # 305382)

WORKSITE page 8 Provider AFLAC Agent Seth Van Steenbergen Phone 813-812-4883 Email seth_vansteenbergen@us.aflac.com


page 9



Who pays the cost?

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

Medical Insurance


MicroLumen 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

MicroLumen provides vision coverage on a voluntary basis. You are responsible for 100% of the cost.

Vision Insurance

Basic Life Insurance

MicroLumen pays 100% of the cost for Basic Life coverage.

MicroLumen provides you the option to purchase additional life insurance for yourself, spouse, and child(ren). This is offered on a voluntary basis. You are responsible for 100% of the cost.

Voluntary Life Insurance

Short & Long Term Disability

MicroLumen pays 100% of the cost for employee disability coverage.

MicroLumen offers a variety of voluntary worksite benefits for you to choose from. You are responsible for 100% of the cost. Please refer to page 10 for product overview.

Worksite Benefits


All Regular full-time employees are eligible to join the MicroLumen Benefits Plan on the 1st of the month following 30 days. “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.

Eligible dependents include:

Your legal spouse

• 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





You are required to actively choose any benefits paid for by MicroLumen 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:

There is a definite advantage to paying for some benefits with before-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.

• AFTER YOUR TAXES ARE CALCULATED – Voluntary life and worksite products


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:

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.

Your marriage

Your divorce or legal separation

• Birth or adoption of an eligible child

• Death of your spouse or covered child


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

Medical, dental, and vision coverage will stop on the last day of the month in which employment with the company ends. Life and disability coverage will end on the last date you are employed with MicroLumen.

• Change in your work status that affects your benefits

• Change in residence or work site that affects your eligibility for coverage

• Change in your child’s eligibility for benefits

• Receiving Qualified Medical Child Support Order (QMCSO)


Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physicians’ office visits and prescription drugs. Deductible – The amount you pay toward medical and dental expenses each year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in deductibles, coinsurance and copayments during the year.



MicroLumen offers medical coverage through United Healthcare (UHC), this benefit is paid for 100% by MicroLumen. 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.

You, and each of your covered dependents, are each responsible for the first $500 of the deductible. Once each of you has satisfied this amount MicroLumen’s HRA will being to pay for the cost of covered services, up to $3,500 per individual. The HRA is administered by UHC, the HRA will automatic pay your providers once the claim is processed.

PPO Network: Choice Plus

IN-NETWORK: DEDUCTIBLE: Plan Year or Calendar Year Basis

Calendar Year

Deductible (Individual / Family)

$4,000 / $11,200


100% / 0%

OUT OF POCKET MAXIMUM: Maximum Out-of-Pocket (Individual/Family)

$5,000 / $12,000

Maximum Includes

Deductible, Copays, & Prescription Copays


Immunizations Mammography/Colonoscopy OFFICE VISITS: Referral Required

Covered 100%


Office Visits (Illness/Injury)

$20 Copay

Specialist Visits

$40 Copay

HOSPITAL SERVICES: Inpatient Hospital


Outpatient Surgery


Emergency Room

$200 Copay

Urgent Care

$75 Copay

DIAGNOSTIC TESTING: Independent/Freestanding Lab

Covered 100%

Complex Diagnostic


PRESCRIPTIONS: Retail (30 day supply) Tier 1 / 2 / 3 OUT-OF-NETWORK 1 Deductible (Individual / Family) Maximum Out-of-Pocket (Individual/Family)

$10 Copay / $35 Copay / $60 Copay

$5,000 / $10,000

$6,250 / $12,500


70% / 30%

1 Charges are subject to balance billing 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.



MicroLumen offers dental coverage through Sun Life. The Dental PPO Plan allows you to use in-network or out-of- network benefits. If out-of-network dentists are used, you will be responsible for pay the difference between Sun Life’s allowed amount and what the dentist may charge, also known as “balance billing”.

The chart below provides a brief overview of the plan.

To find a network provider go to www.sunlife.com/findadentist and select the Assurant Dental Network. Once you have enrolled you can register your account on www.sunlife.com/onlineadvantage to search providers and view claims.

Dental PPO Plan

Out-of Network 1


Calendar Year Deductible Individual






Annual Maximum

Per covered member

$1,500 $1,500

Preventive Services

Covered in full

Covered in full

Exams, Cleanings, & Fluoride

Basic Services

Fillings, Simple Extractions, & Periodontal Maintenance

0% after deductible

20% after deductible

Major Services

Crowns, Bridges, Perio, Endo, Surgical Extractions, Root Canal, & Dentures

40% after deductible

50% after deductible


Child only

50% $1,000 lifetime maximum per person

50% $1,000 lifetime maximum per person

Basis of Payment

Contracted Rate

Maximum Allowable Amount

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

Employee Cost (Semi-Monthly)

Employee Only

$10.95 $24.77 $24.78 $39.49

Employee + Spouse

Employee + Child(ren)




MicroLumen offers vision coverage through Sun Life. Sun Life uses the VSP network. To search in-network providers vision www.VSP.com . You have the ability to see in and out of network providers. If using 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.

To find an in-network provider go to www.VSP.com . When searching make sure to indicate your network is the “Signature” network.

Vision VSP Signature Network

Out-of-Network 1


Routine Eye Exams

Every 12 months

$10 Copay

Reimbursed up to $52


Every 12 months

Single Vision Lined Bifocal Lined Trifocal Lenticular

Reimbursed from $55 to $125, depending on type of lenses

$25 Copay

Frames 2

Every 24 months

$20 Copay provides, $130 Allowance PLUS 20% off the overage

$57 allowance

Contact Lenses (in lieu of glasses)

Every 12 months

$130 allowance

Reimbursed up to $105

1 Reimbursable amount, less applicable copay. 2 Get 30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same day as your exam. Or get 20% off from any VSP doctor within 12 months of your last exam.

Employee Cost (Semi-Monthly)

Employee Only

$ 3.06 $ 6.12 $ 5.82 $ 9.14

Employee + Spouse

Employee + Child(ren)





MicroLumen provides life insurance to all active full time employees at no cost to the employee.

Basic Life and AD&D Insurance

Employee Benefit Amount


35% at age 65 60% at age 70 75% at age 75 85% at age 80

Age Reduction Schedule

Included Equal to Basic Life

Accidental Death & Dismemberment (AD&D)

Portability and Conversion




MicroLumen offers all full-time eligible employees the option to purchase additional life insurance. If you purchase additional life insurance for yourself you may also purchase life insurance for your spouse and/or child(ren).

Rates are based on five year age bands, if you move age bands mid year, the rate will adjust as of the first of the month following your birthday. The rate for a spouse’s coverage is based on the employee’s age. The reduction of benefits, starting at age 65, also applies to Voluntary Life. See chart above, included within Basic Life and AD&D Insurance.

This coverage is available through United Healthcare.

Voluntary Life Insurance




Benefit must be purchased in increments of:




To a maximum of:

$500,000 (not to exceed 5x the employee’s salary)

$250,000 (not to exceed 50% of employee benefit)

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

Guaranteed issue amounts (applicable during 2018 open enrollment and newly eligible employees) $150,000 (not to exceed 3x the employee’s salary) $25,000





MicroLumen provides short term disability insurance to all active full time employees, at no cost to the employee.

The chart below provides an overview of the plan.

Short Term Disability

Benefit Percentage

60% of basic earnings

Maximum Weekly Benefit

$1,500 per week

Benefits commence on the 15 th day after an accident or illness

Elimination Period

Duration of Benefit

24 weeks

Definition of Earnings

Base Salary


MicroLumen provides long term disability insurance to all active full time employees, at no cost to the employee.

The chart below provides an overview of the plan.

Long Term Disability

Benefit % of Monthly Covered Payroll

60% of basic earnings

Monthly Maximum

$10,000 per month

Benefits commence on the 181 st day

Elimination Period

Benefit Duration

Social Security Normal Retirement Age (SSNRA)

Definition of Earnings

Base Salary



The below list of benefits are offered to you through AFLAC. These benefits are available to you on a voluntary basis, with the premium deducted from your paycheck, and allow you the opportunity to cover your spouse and/or child(ren). Premiums will vary by employee and policies selected. Please contact John Grubbs for more information and enrollment. 813-335-8500 Grubbs.John@gmail.com


Additional life insurance policy up to $250,000 at your expense.


Cash benefit to assist with out-of-pocket costs of hospitalization not covered by your major medical insurance.


Cash benefit for everyday expenses and medical treatment when a covered accident occurs.


Assistance with costs of treatment if you experience a covered health event, such as: • Heart attack • Stroke • Paralysis


Assistance with expenses for cancer treatment, from initial diagnosis of a covered cancer through treatments and follow up visits.


Additional Short Term Disability at your expense to cover the remaining 40% not covered by the company STD plan.



Required Annual Employee Disclosure Notices

THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. Further, a health insurer or health maintenance organization may not: 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage;


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

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

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

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

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


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

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

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

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


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



Required Annual Employee Disclosure Notices continued continued



If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website. It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation. CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) OF 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states.

I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis-enrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information. requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements. The group health plan is a fully-insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the

II. Insurer for group health plan will provide privacy notice

The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor.

III. No intimidating or retaliatory acts

The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA.

IV. No Waiver

The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan.


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



When will you pay a higher premium (penalty) to join a Medicare drug Plan? You should also know that if you drop or lose your current coverage with 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 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 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 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. • 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 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 MicroLumen 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 United Healthcare 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 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 Medicare Drug Plan?

Date: 1/1/18 Name of Entity/Sender: MicroLumen Contact--Position/Office: Robin Reynolds

1 MicroLumen Way Oldsamr, FL 34677

Phone Number:




The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create the most comprehensive health insurance reform ever under taken in recent history by our Country. Many of the new law’s required changes have already been incorporated into company health plans across the country since the effective date in September of 2010. However, there will be many more changes taking place in the months to come, as more guidance is issued by the government to employers, insurance carriers and individuals. One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each year thereafter. In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2018, the greater of $695 or 2.5% of taxable income; and After 2018, the penalty is indexed for inflation. However, there are two ways to avoid the tax penalty: You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered “affordable” (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of your W-2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000. Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule:

If you obtain coverage through an Exchange:

The Exchange will eventually sell insurance policies at certain levels of coverage: • Bronze level – a medical plan designed to pay 60% of covered medical benefits; • Silver level – a medical plan designed to pay 70% of covered medical benefits; • Gold level – a medical plan designed to pay 80% of covered medical benefits; • Platinum level – a medical plan designed to pay 90% of covered medical benefits; • Catastrophic – available to young adults up to age 30 or those exempt from the individual mandate (additional requirements may apply) If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer- provided coverage that is considered “unaffordable” or pays benefits that are below the “Bronze” plan discussed above, there are tax credits available to help you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and co pays. More information on these credits will be provided to you later. If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid. Other changes to take effect in 2014 are: The health plan may no longer exclude coverage of a pre- existing condition; The health plan may not impose more than a 90-day waiting period for coverage; Your plan may no longer place an annual limit on key benefits in the plan; Your health plan must allow dependent children up to age 26 to enroll in coverage, regardless of the availability of employer-sponsored coverage where they work. You may only obtain coverage through an Exchange if you are not participating in your employer’s plan.


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.

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