RSM Electron
2025 Benefits Overview
Table of Contents
3 Welcome
4 Eligibility and Enrollment
6 Medical Benefits
11 Dental Benefits
13 Vision Benefits
15 HealthJoy
18 LifeInsurance
19 Disability Insurance
20 HSA
21 Contacts
22 Notices
2
Welcome
At RSM Electron we appreciate your commitment and contributions to our company’s success. Each year, we strive to offer benefit plans to our employees that not only reward you for your hard work, but offer you and your family comprehensive and affordable health and wellness protection. We are confident that you will find our 2025 benefit offerings to be of excellent value to you and to your dependents. In the following pages, you will find a summary of our benefit plans for 2025. Please read this guidebook carefully as you prepare to make your elections for the upcoming plan year to ensure that you select the coverage that is right for you. Our benefit programs remain highly competitive for 2025.
About this Guidebook
This Benefits Guidebook describes the highlights of RSM Electron’s benefits program in non- technical language. Your specific rights to benefits under the plan are governed solely, and in every respect, by the official plan documents, and not the information in this guidebook. If there is any discrepancy between the descriptions of the program’s elements as contained in this benefits guidebook and the official plan documents, the language in the official plan documents shall prevail as accurate. Please refer to the plan-specific documents published by each of the respective carriers for detailed plan information. You should be aware that any and all elements of RSM Electron’s benefits program may be modified in the future, at any time, to meet Internal Revenue Service rules, or otherwise as decided by RSM Electron.
Plan Year
The RSM Electron benefit programs begins on January 1 st , 2025 and ends on December 31 st , 2025.
3
Eligibility & Enrollment
Employee Eligibility All full-time employees working 30 or more hours per week are eligible for company-offered benefit plans after one month following date of hire. Dependent Eligibility Employees who are eligible to participate in the RSM Electron benefit program may also enroll their dependents. For the purposes of our benefit plans, your dependents are defined as follows:
• Your spouse or domestic partner
• Your dependent children to age 26
• Children up to age 29 for Medical; (if not married, live in NY, not eligible for insurance with their employer, and are not covered by Medicare. • Your disabled child(ren) up to any age(if disabled prior to the age of 19). Domestic Partners Domestic partners are eligible to enroll as a dependent in some of RSM Electron plans. A marriage certificate is necessary to qualify for domestic partner coverage. Changing Your Benefits (Qualifying Life Events) Per Internal Revenue Service (IRS) rules, employees enrolled in pre-tax benefit plans may only make elections or changes to their plans once per year with the exception of the following Qualifying Life Events:
Marriage
•
• Birth, adoption or placement for adoption of an eligible child
• Divorce, or annulment of marriage
• Loss of spouse’s job or change in work status
(when coverage is maintained through spouse’s plan)
• A significant change in your or your spouse’s health coverage that is attributable to your spouse’s employment
Death of spouse or dependent
•
Loss of dependent status
•
• Employer-directed transfers to facilities out of the benefits network
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• Becoming eligible for Medicare or Medicaid during the plan year
30 Days
Qualifying Life Events allow you to make plan changes outside of the Annual Enrollment Period. For any allowable changes, you must inform Human Resources within 30 calendar days of the qualifying event. Benefit changes that are requested due to a ‘change of mind’ cannot be allowed until the next annual Enrollment Period. For additional information concerning plan changes, please contact Human Resources.
5
Medical Benefits We all need healthcare that protects our physical health as much as healthcare that protects our financial well-being. That is why RSM Electron believes it is important to invest in quality plans that are cost effective, easy to use and valuable to you. RSM Electron provides the following medical benefits through Anthem:
▪ Anthem PPO w/HSA
▪ Anthem PPO
2025 Employee Contributions for Medical Benefits Per Week
Level
Anthem PPO w/HSA
Anthem PPO
$24.08
$119.87
Employee
$61.89
$312.32
Employee + Family
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Medical Benefits Plan Comparison
Anthem PPO w/HSA
Anthem PPO
In-Network
Out-of-Network
In-Network
Out-of-Network
Annual Deductible
$3,000/$6,000
$6,000/$12,000
$1,000/$2,500
$2,000/$5,000
Annual Out-of- Pocket Maximum
$5,000/$10,000
$10,000/$20,000
$3,000/$7,500
$6,000/$15,000
20% Coinsurance after Ded.
40% Coinsurance after Ded.
$25 Copay; Ded. Does not apply
40% Coinsurance after Ded.
Primary Care Visit
Specialist Office Visit
20% Coinsurance after Ded.
40% Coinsurance after Ded.
$40 Copay; Ded. Does not apply
40% Coinsurance after Ded.
20% Coinsurance after Ded.
40% Coinsurance after Ded.
$50 Copay; Ded. Does not apply
Urgent Care Visit
Covered as In-Network
20% Coinsurance after Ded.
40% Coinsurance after Ded.
Prescription Drug
$10/$35/$70
Not covered
Emergency Room
20% Coinsurance after Ded.
$150 Copay per visit; Ded. Does not apply
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
Inpatient Services
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
Outpatient Services
Outpatient Lab and X-ray
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
Radiology
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Choose your doctor and see them every time…online. You can see the same primary care doctor on an ongoing basis through scheduled video visits on your computer or mobile device. Get regular personal health visits and checkups with LiveHealth Online Virtual Primary Care. It’s like an office visit with a primary care provider (PCP) — without the office. Choose from board-certified, in-network PCPs, and have the same doctor taking care of you over time for treatment including: chronic conditions, preventative care, referrals, acute care.
With Live H ealth Online Virtual Primary Care you can get:
Care for diabetes, the flu and other health issues.
Referrals for X-rays, blood work, and specialists.
Prescriptions sent to your local pharmacy.
Appointments 8 a.m. – 6 p.m. (Mon – Fri).
We’ve got you covered. Simplify your life with LiveHealth Online Virtual Primary Care.
Virtual primary care visits are available through the Sydney SM Health and LiveHealth Online apps, and/or Anthem.com and LiveHealthOnline.com
Most conditions can be cared for virtually, but there are circumstances that require in-person care. If you need in-person care, or to connect with a specialty doctor, we can help you access the care you need.
Prescription availability is defined by physician judgment and state regulations.
LiveHealth Online is offered through an arrangement with Amwell, a separate company, providing telehealth services on behalf of your health plan.
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Register with us for quick, secure, digital access to all your plan information
Keep on top of your health, dental, and vision benefits with 24/7 access to your
plan details. Register on our Sydney SM Health app or through our website at
anthem.com/register so your account is ready to use when you need it.
There is no cost, and it only takes a few minutes.
Once you’re registered, you’ll have one place you can go for all your plan and
benefits information. You can review coverage and claims, find care, estimate
cost of care, manage your prescriptions, and access your digital plan ID card.
Have your plan ID card ready to get started
Download our free Sydney Health app and select Register new account or go to anthem.com/register .
Select your identification type (in most cases, this is your member ID).
Enter your plan ID number, full name, and date of birth. Follow the one-time security prompt and create a username and password. (You’ll use the same login information when you log in to either the app or website.) Review your information to complete your registration.
◁ Scan this QRcode with your phone’s camera to download our Sydney Health app today.
GET IT ON
On-screen experiences may vary due to personalization, benefit plans, and ongoing enhancements. Sydney Health is offered through an arrangement with Carelon Digital Platforms, a separate company offering mobile application services on behalf of your health p l a n .
AnthemBlueCross andBlueShieldis the tradenameof: InColorado: Rocky MountainHospital andMedicalService,Inc.HMOproducts underwrittenbyHMOColorado, Inc. Copies of Coloradonetwork access plansareavailableonrequestfrom memberservicesor canbeobtained by goingto anthem.com/co/networkaccess.In Connecticut:AnthemHealth Plans,Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia:BlueCross BlueShieldHealthcarePlanof Georgia, Inc. andCommunityCareHealthPlanof Georgia, Inc. In Kentucky: Anthem HealthPlans of Kentucky, Inc. InMaine: Anthem HealthPlans of Maine, Inc. In Missouri(excluding30 counties in the KansasCity area): RightCHOICE®ManagedCare, Inc. (RIT),Healthy Aliance®LifeInsurance Company(HALIC),and HMOMissouri,Inc.RITandcertainaffiliatesadministernon-HMObenefitsunderwrittenbyHALICandHMObenefitsunderwrittenbyHMOMissouri,Inc.RITandcertainaffiliatesonly provideadministrativeservicesfor self-fundedplansanddo not underwrite benefits.In Nevada:Rocky MountainHospital and Medical Service,Inc.HMOproducts underwrittenbyHMOColorado, Inc., dbaHMONevada.In NewHampshire:AnthemHealthPlans of NewHampshire,Inc.HMOplansareadministeredby AnthemHealthPlans of NewHampshire,Inc.andunderwrittenbyMatthewThorntonHealthPlan,Inc.In17 southeasterncountiesof NewYork: Anthem HealthchoiceAssurance,Inc.,and Anthem HealthchoiceHMO,Inc. In thesesamecounties AnthemBlueCross andBlueShieldHPis the tradenameof AnthemHP.LLC.In Ohio:CommunityInsuranceCompany.In Virginia:AnthemHealthPlans of Virginia, Inc. trades asAnthemBlueCross andBlueShield,andits affiliate HealthKeepers, Inc. tradesas AnthemHealthKeepersprovidingHMOcoverage,and their serviceareais all of Virginiaexceptfor the Cityof Fairfax,theTownof Vienna, andthe area east of StateRoute123. In Wisconsin:BlueCrossBlueShieldof Wisconsin(BCBSWI),underwritesor administersPPOandindemnitypoliciesandunderwrites the out of network benefitsin POSpoliciesofferedbyCompcareHealthServicesInsuranceCorporation(Compcare)or WisconsinColaborativeInsuranceCorporation(WCIC).Compcareunderwritesor administersHMOor POSpolicies; WCICunderwrites or administersWel Priority HMOor POSpolicies.Independentlicenseesof the BlueCross andBlueShieldAssociation.Anthemisaregisteredtrademarkof AnthemInsurance Companies, Inc. 13206MUMENABS VPOD Rev. 0 3 / 2 3 66048541-148813823
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Wellbeing Solutions
Focus on your well-being and earn rewards up to $700
The more activities you complete, the greater your reward The Wellbeing Solutions program connects you with easy-to-use digital health and wellness tools that can help you stayour best. Whenoyucmplete any of the activities listed below sponsored byour empl er, u’ll earn rewards to put towdaler ctronic gift cards for slect retai rs. You choose the activities you’d like to complete to receive the maxi of $700.
Activity Type Activities
Amount
Have an annual preventive wellness exam or well-woman exam with your doctor
$20
Get an annual cholesterol test 1
$5
Have a colorectal cancer screening (ages 45 and older)
$25
Preventive care
Have a routine mammogram (women ages 40 to 74)
$25
Have an annual eye exam 2
$20
Get an annual flu shot
$10
1053316MUMENABS VPOD 05/23
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Dental Benefits
2025 Employee Contributions for Dental Benefits Per Week
Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with our dental benefit plan.
Level
Meritain DPPO Plan
$3.00
Employee
$6.35
Employee + Spouse
$5.91
Employee + Child(ren)
$9.72
Employee + Family
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Meritain Dental DPPO Plan
Services
In-Network
Out-of-Network
$100/$300
$100/$300
Annual Deductible
$2,500
$2,500
Annual Maximum Benefit
Plan pays 100%
Plan pays 100%
Preventive Dental Services (exams, fluoridee, bitwing x-rays, cleanings)
Frequency
See schedule below
See schedule below
Deductible
Deductible
Basic Dental Services (periodontal maintenance, peridontal surgery, root canal)
then 20%
then 20%
Frequency
See schedule below
See schedule below
Deductible
Deductible
Major Dental Services (crowns, bridges, dentures, implants)
then 50%
then 50%
See schedule below
See schedule below
Frequency
50%
50%
Orthodontia Services
$1,000
$1,000
Orthodontia Lifetime Max
Preventitive Dental Services Frequency: Exams & Cleanings: 1in 6 months | Fluoride & Bitewing X-rays: 1in 12 months Basic Dental Services Frequency: Periodontal Maintenance: 2 in 1year less the number of teeth cleanings Peridontal Surgery: 1in 36 months | Root Canal: one per tooth per lifetime
Major Dental Services Frequency: 1in 5 years
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Vision Benefits
Regular eye examinations can not only determine your need for corrective eye wear but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone.
2025 Employee Contributions for Vision Benefits Per Week
Level
Aetna Vision Plan
$0.51
Employee
$1.21
Employee + Family
13
Aetna Vision Plan
Benefits
In-Network
Out-of-Network
$10 Copay
Up to $25
Eye Exam
$25 Copay
Up to $10
Single Vision Lenses
$25 Copay
Up to $25
Bifocal Lenses
$25 Copay
Up to $55
Trifocal Lenses
$25 Copay
Up to $55
Lenticular Lenses
$130 allowance then 20% off
Up to $65
Frames
$105 allowance then 15% off
Up to $75
Contact Lenses Elective
Contact Lenses Medically Necessary
Covered 100%
Up to $200
Frequency is 1per calendar year for exams, lenses, contact lenses, and 1per 2 calendar years for frames.
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Help For Your Healthcare Journey. With 24/7 access to our dedicated healthcare concierge team, visits, and care navigation tools, you never have to walk alone. HealthJoy helps you locate in-network doctors, find extra savings on your prescriptions, and navigate your benefits. Our mobile app and dedicated member support team are always on hand to help make it easier to stay healthy and well. HealthJoy is the virtual access point for all your healthcare navigation and employee benefits needs. We’re provided free by your employer to help understand and make the most of your benefits. We connect you and your family with the right benefits at the right moment in your care journey, saving you time, money, and frustration. HealthJoy Makes it Easier to be Healthy and Well.
BENEFITS
RX SAVINGS
HSA / FSA
HEALTHCARE CONCIERGE
APPOINTMENT BOOKING
PROVIDER RECOMMENDATIONS
WALLET
REVIEW
SUPPORT
It saved me the time I would have spent Googling results, calling specialists, and searching for an appointment. Instead, I just put in the request, and HealthJoy did the work. The app is like my little assistant! “ ” Veronica, AZ
Chat with us today by logging into the HealthJoy app or call (877) 500-3212
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Online Medical Consultations AT HEALTHJOY
Simple. Convenient. Affordable. HealthJoy is an easy and trusted way for adults and children to request visits with board-certified medical providers on demand for minor illnesses and injuries. Get the care you need, when and where you need it by using the HealthJoy app — 24/7/365.
When to use HealthJoy Online Medical Consul t ations:
YOU’RE NOT FEELING YOUR BEST. Our medical team can diagnose common medical concerns and offer personalized care.
IT’S THE MIDDLE OF THE NIGHT. Illness and injury often happen at inconvenient times, so we offer care 24/7/365.
YOU NEED A SHORT-TERM PRESCRIPTION.
YOU’RE TRAVELING. Get diagnosed and have a prescription sent to a local pharmacy nearby, wherever life takes you.*
HealthJoy providers can send new prescriptions and short-term refills to your pharmacy.
We can help with:
⯈ Medication refills (short-term)*
⯈ Abrasions, bruises
⯈ Diarrhea, vomiting, nausea
⯈ Colds, flu and fever
⯈ Sore throat, cough, congestion ⯈ Allergies, hives, skin infections
⯈ Urinary tract infections
⯈ Headaches, body aches
⯈ Eye infections, conjunctivitis
“My daughter had an infection, so within 10minutes I got a live consultation from a physician. He was able to diagnose the infection and send a prescription to my pharmacy. This saved me so much time!”
⯈ And more!
⯈ Bites and stings
⯈ Minor headaches, arthritic pains
For best service, use the HealthJoy iPhone or Android app or call (877) 500-3212.
HEALTHJOY MEMBER
- SHANNON P.
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How to Download and Activate HealthJoy HealthJoy is the first stop for all your healthcare and employee benefits needs. We’ve created an easy and seamless process to get started today! Below are some of the many methods you can use to activate your HealthJoy account:
APP STORE
WEBINAR
SMS
FLYER
POSTCARD
Download the App Use one of the above methods to download the HealthJoy app, such as scanning the QR code on this flyer. The app is available for Android, iPhone, and iPad. Sign Up Open the HealthJoy app, click “Sign Up,” and enter the email address tied to your employee benefits. If you use a different email, you'll need to answer additional security questions, including date of birth and the last four digits of your SSN, to verify your identity.
1
2
NOTE: An email address is required to create your HealthJoy account.
3
Activate You'll receive an activation link via email and/or SMS after verifying your identity and plan benefits. Lastly, you’ll be prompted to create a password of at least eight characters to secure your account. The entire process will take less than three minutes to complete.
17
Employer Paid Life Insurance
Your family depends on you in many ways and you’ve worked hard to ensure their financial security. But if something happened to you, will your family be protected? Life insurance provides a financial benefit that your family can depend on. RSM Electron pays the entire cost of Basic Term Life Insurance and Basic AD&D for you and you are automatically enrolled upon meeting eligibility.
Type
Available Coverage
2 time annual salary to a max of $100,000
Basic Term Life and AD&D
Age 70 75
Reduction 35% 45%
Benefit Reductions
Voluntary Life Insurance If you would like to purchase additional benefits the following options are available:
Type
Available Coverage
Increments of $10,000 up to $500,000; Guaranteed Issue: $100,000
Employee Voluntary & AD&D
Increments of $5,000 up to $100,000 or 50% of employee coverage; Guaranteed Issue: $50,000
Spouse Voluntary Life/AD&D
$1,000 up to $10,000 per child enrolled
Child Voluntary Term Life/AD&D
Voluntary Term Life Rates per $1,000
Age
<30
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69
70+
Rates $0.070 $0.080 $0.100 $0.150 $0.260 $0.420 $0.660 $1.030 $1.850 $3.320
Child
Employee AD&D
Spouse AD&D
Child AD&D
$0.252
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Disability Benefits
You rely on your paycheck for so many things, but what if you were suddenly unable to work due to an accident or illness? Disability insurance can help replace lost income and make a difficult time a little easier.
Short-Term Disability
Long-Term Disability
60% of weekly pre-disability earnings to a max of $2,000
60% of monthly pre-disability earnings to a max of $10,000
Coverage Amount
Maximum payment period: Maximum length of time you can receive disability benefits. Accident benefits begin: The length of time you must be disabled before benefits begin. Illness benefits begin: The length of time you must be disabled before benefits begin. Minimum work hours/week: Minimum number of hours you must regularly work each week to be eligible for coverage.
To age 65, standard ADEA
26 weeks
Day 15
Day 181
Day 15
Day 181
30
30
19
HSA
An HSA works with a high deductible heath plan (HDHP), and allows you to use before-tax dollars to reimburse yourself for eligible out-of-pocket medical expenses for you, your spouse and your dependents, which in turn saves you on taxes and increases your spendable income. Both you and your employer can contribute to your HSA.
HSA’s have many benefits such as:
• An HSA is yours. Funds in your HSA account stay with you, even if you change jobs or retire.
• Contribute tax free. An HSA reduces your taxable income. The money is tax free both when you put it in and when you take it out to cover qualified medical expenses.
• Grow funds tax free. An HSA grows with you. When your HSA account balance reaches the minimum balance requirement, your funds can be invested in mutual funds yielding tax-free earnings.
• Spend tax free. Withdrawals used for eligible expenses are tax free.
• Funds can be withdrawn anytime for medical expenses, even after you enroll in Medicare.
• After age 65, the funds can be used for any purpose, without penalty.
Requirements of participation:
• Must be covered on the HSA medical plan to contribute funds to the HSA.
• May not be covered under any medical plan that is not an HSA, including an FSA in your name or in your spouse's name.
• May not be entitled to (eligible for AND enrolled in) Medicare benefits.
• May not be eligible to be claimed as a dependent on another person’s tax return.
Notes: If you choose to enroll in the HSA Medical Plan you can also choose to enroll in the HSA. You must open the account to receive the employer contribution.
2025 HSA Contribution Limits: • $4,300 Individual • $8,550 Family • 55 or older $1,000 catch-up contribution
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Need additional information? Have a question about one of your benefits? Keep this brochure handy for a quick reference for all of your benefit needs. If you still have questions, please contact your Human Resources Department. Contact
Plan
Administrator
Phone #
Website
Medical
Anthem
800-331-1476
www.anthem.com
Dental
Meritain Health
888-324-5789
www.meritain.com
Vision
Aetna
877-973-3238 www.aetnavision.com
Life Insurance
New York Life
800-225-5695 www.newyorklife.com
Disability Benefits
New York Life
800-225-5695 www.newyorklife.com
HSA
Fidelity
800-343-3548
www.fidelty.com
21
Notices
Health Insurance Portability and Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and security of certain individually identifiable health information, called protected health information (or PHI). You have certain rights with respect to your PHI, including a right to see or get a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy Practices, describing how your PHI may be used and disclosed and how you get access to the information, contact Human Resources. Women’s Health and Cancer Rights Act Enrollment Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Woman’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: 1. All stages of reconstruction of the breast on which mastectomy was performed. 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses. 3. Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles, copays, and coinsurance applicable to other medical and surgical benefits provided under your medical plan. If you would like more information on WHCRA benefits, call your plan administrator. Newborns’ and Mothers’ Health Protection Act Disclosure Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). 60-DAY SPECIAL ENROLLMENT PERIOD In addition to the qualifying events listed in this enrollment guide, you and your dependents will have a special 60-day period to elect or discontinue coverage if: You or your dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or You or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP HIPAA Special Enrollment Notice 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 and your dependents in RSM Electron medical plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward 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 a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program {CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy. To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact your plan administrator.
22
Notices
COBRA
** Continuation Coverage Rights Under COBRA**
Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
Your spouse dies; Your spouse’s hours of employment are reduced;
Your spouse’s employment ends for any reason other than his or her gross misconduct;
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both);
or You become divorced or legally separated from your spouse.
23
Notices
COBRA
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
The parent-employee dies; The parent- employee’s hours of employment are reduced; The parent- employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:
The end of employment or reduction of hours of employment;
Death of the employee;
The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days (or enter longer period permitted under the terms of the Plan) after the qualifying event occurs. You must provide this notice to your Plan Administrator. How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.
24
Notices
COBRA
Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of The month after your employment ends; or The month after group health plan coverage based on current employment ends. If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or Bis effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
For more information visit https://www.medicare.gov/medicare-and-you.
If you have questions:
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/agencies/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov.
Keep your Plan informed of address changes.
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
25
Notices
MEDICARE PART D
Important Notice from RSM Electron About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with RSM Electron 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 current 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. RSM Electron has determined that the prescription drug coverage offered by the RSM Electron plan is, 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 to 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 Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current RSM Electron coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current RSM Electron coverage, be aware that you and your dependents may not be able to get this coverage back.
26
Notices
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 RSM Electron 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 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 More Information About This Notice Or Your Current Prescription Drug Coverage: Contact the person listed below for further information. 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 RSM Electron 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:
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 (H300-633-4227) 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 (a penalty).
27
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
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 July 31, 2024. Contact your State for more information on eligibility –
ALABAMA – Medicaid
ALASKA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx
ARKANSAS – Medicaid
CALIFORNIA – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov
FLORIDA – Medicaid
COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)
Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecover
y.com/hipp/index.html Phone: 1-877-357-3268
CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442
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GEORGIA – Medicaid
INDIANA – Medicaid
GA HIPP Website: https://medicaid.georgia.gov/health- insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party- liability/childrens-health-insurance-program-reauthorization- act-2009-chipra Phone: 678-564-1162, Press 2
Health Insurance Premium Payment Program All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864 Member Services Phone: 1-800-457-4584
IOWA – Medicaid and CHIP (Hawki)
KANSAS – Medicaid
Medicaid Website: Iowa Medicaid | Health & Human Services Medicaid Phone: 1-800-338-8366 Hawki Website: Hawki - Healthy and Well Kids in Iowa | Health & Human Services Hawki Phone: 1-800-257-8563 HIPP Website: Health Insurance Premium Payment (HIPP) | Health & Human Services (iowa.gov) HIPP Phone: 1-888-346-9562
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660
KENTUCKY – Medicaid
LOUISIANA – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328
Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms
MAINE – Medicaid
MASSACHUSETTS – Medicaid and CHIP
Enrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en _US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms
Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com
Phone: 1-800-977-6740 TTY: Maine relay 711
MINNESOTA – Medicaid
MISSOURI – Medicaid
Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
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MONTANA – Medicaid
NEBRASKA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov
Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
NEVADA – Medicaid
NEW HAMPSHIRE – Medicaid
Website: https://www.dhhs.nh.gov/programs- services/medicaid/health-insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 15218 Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
NEW JERSEY – Medicaid and CHIP
NEW YORK – Medicaid
Medicaid Website: http://www.state.nj.us/humanservices/
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
dmahs/clients/medicaid/ Phone: 1-800-356-1561 CHIP Premium Assistance Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 (TTY: 711)
NORTH CAROLINA – Medicaid
NORTH DAKOTA – Medicaid
Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100
Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825
OKLAHOMA – Medicaid and CHIP
OREGON – Medicaid and CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid and CHIP
RHODE ISLAND – Medicaid and CHIP
Website: https://www.pa.gov/en/services/dhs/apply-for- medicaid-health-insurance-premium-payment-program- hipp.html Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437)
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA – Medicaid
SOUTH DAKOTA - Medicaid
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
Website: http://dss.sd.gov Phone: 1-888-828-0059
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