EMPLOYEE BENEFITS Open Enrollment and Summary of Material Modifications (For Full-Time Employees)
January 1, 2024 – December 31, 2024
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please read the Individual Creditable Coverage Disclosure notice for more information. If you have questions about your options, please, contact Human Resources, or our Benefits Consultant, Parker, Smith & Feek.
Table of Contents
Voluntary Accident......................................................15
Welcome to Taylor Metal Products ........................ 1
Eligibility Requirements .......................................... 2
Important Legal Information...................................17
Open Enrollment ....................................................... 2
Healthcare Reform..................................................17
Online Enrollment ..................................................... 2
Annual Reminders...................................................18
Important Notice from Taylor Metal Products about Your Prescription Drug Coverage and Medicare .......................................20 Premium Assistance under Medicaid and the Children’s Health Insurance Program ......23
What Do I Have To Do? .......................................... 3
Where Do I Go If I Have Questions? .................. 3
Benefits Advocacy – Here To Help ..................... 4
How Much Do I Have To Pay?.............................. 4
Contact Information................................................. 5
Medical Coverage.......................................................... 6
Pharmacy Coverage ...................................................... 8
Virtual and Telephonic Care ...................................... 9
Dental Coverage ..........................................................11
Vision Coverage ...........................................................12
Supplemental life / voluntary AD&D Coverage .........................................................................13
Supplemental Life ...................................................13
The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the 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 a discrepancy between the Benefits Summary and the actual plan documents, the actual plan documents will prevail. For specific tax or legal advice, please consult with your own tax or legal advisor for assistance. 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.
All Rights Reserved – Parker, Smith & Feek
WELCOME TO TAYLOR METAL PRODUCTS
Our health care plan renews on January 1 st every year. Every year we review our benefit plan offerings, consider what we offer, the cost for the year and what we can afford. We consider our levels of benefits, our insurance company performance, and the cost to both you and the company. Based on this review, and in consultation with our benefit consultant, we have made the following decisions for our benefit offerings for this plan year:
• Regence Group Administrators (RGA) will continue to administer our medical benefits. • Our medical network will continue through Blue Cross/Blue Shield network providers • CVS/Caremark will continue to administer our prescription drug program but through RGA. • Reliance Standard will continue to be our benefit partner for these benefits
• Voluntary Dental (through the Ameritas Dental Network) • Voluntary Vision (through the VSP Choice Vision Network)
• Supplemental Life • Voluntary AD&D • Voluntary Accident • On-Call 24/7 Worldwide Travel Assistance
Please keep in mind that our health plan is a self-funded plan. This means that Taylor Metal assumes the financial risk for providing health care benefits, rather than paying an insurance company to assume this risk. Your health care claims are “processed” by RGA, however the money they use to make those payments comes directly from Taylor Metal, which is funded by the premiums paid by both the company and you.
1
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Eligibility Requirements
Employee
Dependents
Waiting Period
Your legal spouse Dependent children may be covered until age 26 Your legal spouse Dependent children may be covered until age 26
Hourly Non-Exempt Employees regularly scheduled at least 30 hours per week
1st of the month coincident with or next following 60 days from hire
Salary Non-Exempt Managers regularly scheduled at least 30 hours per week
1st of the month coincident with or next following date of hire
For new employees, this is your chance to enroll in the Taylor Metal Products Employee Benefits Plan. You must enroll yourself and your dependents within 30 days of becoming eligible for benefits. You can enroll eligible dependents at the same time you enroll yourself. If you don’t enroll, or you waive coverage, you’ll receive the employer sponsored benefits shown below:
• 24/7 Worldwide Travel Assistance
Once you’re enrolled in benefits, you generally aren’t allowed to make changes until the next annual Open Enrollment. Open Enrollment is your one chance each year to review your coverage and make changes to your benefits. It’s also your chance to enroll if you declined coverage when you first became eligible. Open Enrollment changes take effect on January 1 st each year.
Other than during Open Enrollment, you can make changes to your benefits during the year only if you experience a qualifying status change. Please refer to the Special Enrollment section later in this document (page 18).
Open Enrollment This is the time of year to add or drop coverage for any eligible family members. It is also the time when you can decide what coverage you need for yourself and/or your eligible family members: medical, dental and/or vision. If you do not enroll an eligible spouse or child now because they have coverage through another employer, you may only add that person on our plan during next year’s Open Enrollment period, unless you experience a qualified family status change. Please refer to the Special Enrollment section later in this document (page 18).
Online Enrollment
The Open Enrollment elections process is online through Paycom and will be open from October 30 th through December 8 th . Use the “SHOW ME HOW” Guide from Paycom for enrollment instructions.
2
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
What Do I Have To Do?
Complete Online Benefit Elections via PAYCOM.
This is your opportunity to add coverage for yourself, spouse and children who were previously eligible but not enrolled, it is also the time to make changes to your coverage elections. If you wish to drop coverage for yourself or any dependents, now is the time to do so. Finalize & Submit Elections in Paycom no later than December 8 th . Contact HR if you need assistance.
Review your contact information , including personal email, address, and phone number
Dependents (those who are covered on your medical, dental and vision plans). Review all dependents for accuracy, including date of birth and relationship. Add or remove as needed. Beneficiaries (those who would be named on life insurance and retirement policies). Review all beneficiaries for accuracy. Add or remove as needed. Benefit Selections (selecting your coverage) – Review each of the coverage options available. Select the correct coverage level (Employee, Employee & Spouse, Employee & Child(ren), Employee & Family). Make a single selection in each section. Your costs are listed in the summary review.
ALL ELECTIONS MUST BE COMPLETED ONLINE BY DECEMBER 8 TH
Where Do I Go If I Have Questions?
Staff are encouraged to reach out to their managers first for questions or general enrollment support – they are usually able to assist with troubleshooting general questions or can quickly direct staff to the appropriate point of contact for support.
Human Resources Email HR@taylormetal.com Phone 503-967-7515 Fax 971-273-7327
General questions can always be directed to our central HR line. Based on your question you will be connected with the right team member for support.
3
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Benefits Advocacy – Here To Help
Parker, Smith & Feek, Inc.
Taylor Metal has also partnered with Parker, Smith & Feek to provide you and your family with individualized assistance with insurance problems you are unable to resolve directly with the carriers. This includes claims issues, eligibility questions, network problems and general healthcare or insurance questions.
Your Account Manager
Phone
Megan Malvick
mamalvick@psfinc.com
503.416.4309
How Much Do I Have To Pay?
The following per pay period contributions are effective January 1, 2024.
Voluntary Dental
Voluntary Vision
Medical
Medical
Per Pay Period Deductions
Taylor Metal Products Pays
You Pay
You Pay
You Pay
$212.83
Employee
$51.28
$11.86
$2.86
$222.46
Employee and Spouse*
$409.20
$24.16
$5.72
Employee and Child*
$218.67
$224.40
$26.79
$4.85
Employee and Child(ren)*
$219.12
$288.88
$26.79
$4.85
$226.77
Employee and Family*
$583.85
$40.71
$7.99
* Includes benefits coverage for domestic partners and their children. Due to IRS regulations, contributions for domestic partners are made on a post-tax basis. In addition, any premiums paid by Taylor Metal will be considered taxable income.
Please note that when your contributions are taken out of your paycheck on a pre-tax basis, as allowed by Section 125 of the Internal Revenue Code. IRS rules state that once you make your enrollment election for the year, you will not be allowed to change that election until the next Open Enrollment period, unless you have a change in family status, such as marriage, divorce, birth of a child, or change in employment status. This means you may not drop coverage for a dependent during the year unless there is a qualified change in family status.
4
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Contact Information
Refer to this list when you need to contact a benefits vendor. For general information, contact Human Resources.
Medical
RGA
866-738-3924
www.accessrga.com
Pharmacy
CVS/Caremark
866-885-4944
www.caremark.com
General Mental Health
TalkSpace
www.talkspace.com/partnerinsurance
Substance Use Disorders
Boulder
866-347-9635
www.startboulder.care
Ameritas (Reliance Matrix)
Voluntary Dental
800-497-7044
www.rsli.com/dental-vision
Vision Service Plan – VSP (Reliance Matrix)
Voluntary Vision
800-877-7195
www.vsp.com
Supplemental Life - Voluntary AD&D Insurance
Reliance Matrix
800-351-7500
www.reliancestandard.com
Voluntary Accident
Reliance Matrix
800-351-7500
www.reliancestandard.com
In the U.S. Toll-Free 800-456-3893 Outside U.S. Collect 603-328-1966
Travel Assistance
On-Call
w ww.reliancestandard.com
503-967-7515
Human Resources
Human Resources
HR@taylormetal.com
Megan Malvick 503-416-4309
Benefits Advocacy
Parker, Smith & Feek
mamalvick@psfinc.com
5
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
MEDICAL COVERAGE
RGA (Regence Group Administrators)
Benefits Summary
The plan encourages you to use in-network providers by charging you lower co-pays and co-insurance amounts. In-network providers agree to bill RGA directly and to accept a negotiated fee as payment in full. Out-of-Network providers have not and are reimbursed based on Medicare reimbursement rates. You may have to pay amounts above that charge (also called balance billing). To find a list of in-network providers, go to accessrega.com and search for providers. The deductible and out-
DON’T FORGET YOUR ANNUAL EXAM. PREVENTIVE CARE IS COVERED 100%.
of-pocket maximum are on a calendar-year basis and reset every January 1 st . In-network and out-of-network deductibles and out-of- pocket maximums are “aggregated,” such that Covered Services applied to one also apply to the other.
6
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Preferred Provider
Participating Provider
Out of Network
Annual Deductible Individual
$1,500 $3,000
$1,500 $3,000
$1,500 $3,000
Maximum per family
Out-of-Pocket Maximum Individual Maximum per family
$4,500 $9,500
$4,500 $9,500
$4,500 $9,500
Preventive Care Routine Exam
Covered in full
Covered in full
50%, after deductible
Laboratory Services
Physician Services Office Visits Specialist
$25 copay* $25 copay*
50%, after deductible 50%, after deductible
50%, after deductible 50%, after deductible
Outpatient X-Ray and Laboratory Services
30%*
50%, after deductible
50%, after deductible
Urgent Care
$45 copay*
50%, after deductible
50%, after deductible
Emergency Services
$300 copay then paid at 100%, deductible waived
Hospital Services
Inpatient and Outpatient
30%, after deductible
50%, after deductible
50%, after deductible
Outpatient Rehabilitation 20 visits per calendar year
$25 copay*
Mental Health Outpatient
Covered in full
50%, after deductible
50%, after deductible
Spinal Manipulations
20 visits per calendar year
$25 copay*
Acupuncture
20 visits per calendar year
$25 copay*
Massage Therapy
$25 copay*
*Deductible does not apply. Balance billing may occur with Out of Network Services.
7
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
PHARMACY COVERAGE
CVS Caremark Unless your doctor requires the use of a brand name drug, your prescription may automatically be filled with a generic equivalent (when available). If you request a brand name drug when a generic equivalent is available, you may be required to pay the difference in cost.
Retail (30-day supply)
Mail Order (90-day supply)
Generics
$15
$37.50
Preferred Brand
$30
$75
Non-Preferred Brand
$50
$125
Specialty Drugs
Paid at applicable Copay listed above
Preventive Drugs (generic)
No charge
Our medical plans offer what is called “creditable coverage , ” which means a Medicare - eligible person will not have to buy a Medicare Part D supplement for prescription drugs, and will not be subject to the 1% per month late enrollment charge assessed by Medicare for purchasing Part D at a later date. If you have questions about your options, please contact Human Resources.
Notice regarding Medicare Part D
Retail prescriptions from an out-of-network pharmacy are covered at 60% after the applicable copay. There is no coverage for specialty drugs or mail order from a pharmacy not in the network.
8
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
VIRTUAL AND TELEPHONIC CARE
Talkspace Behavioral Health Care
You can receive behavioral health counseling through TalkSpace. Once you have established a relationship with your provider, you have access to unlimited text messaging. Go to the TalkSpace site at www.talkspace.com/partnerinsurance . Complete the QuickMatch provider finder tool, review your best matches and choose your personal provider.
Addiction Help
Boulder Care
Medication and virtual counseling to help you quit. They have an emphasis on opioid, alcohol and other substance abuse counseling.
Go to www.startbouldercare.com or call 866-347-9635 to get started.
9
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Lyn Health Chronic Condition Management Support
Through Lyn Health, a team of primary care providers, mental health counselors, dieticians, pharmacists, and other specialists will work together to design a coordinated care experience and fill any existing gaps in your care. Your Plan does the behind-the- scenes work to determine if you’re eligible for Lyn services, which depends on the condition you have and your claims history. You may receive a call from one of our Care Managers or an email from Lyn Health if:
• You’ve been diagnosed with more than one health condition that requires ongoing management.
• You’ve had appointments with multiple clinical specialists.
You’re taking multiple medications.
•
At that time, if you’re interested in Lyn services, all you’ll have to do is follow the prompts to be connected with a Care Partner, who will collaborate with you to schedule appointments, set goals, help you to understand your condition and treatment plan, and more.
Telehealth with MDLIVE
Behavioral Health and Psychiatry
MDLIVE provides 24/7 access to a therapist or psychiatrist via phone or video. It can be used for many of your behavioral health needs and replace expensive visits and can be scheduled days in advance instead of months in advance with most providers. Below are some of the things that MDLIVE can help with:
• Addictions • Anxiety • Child and Adolescent Issues • Depression
• Coping with Loss or Grief • Parenting Counseling and Advice
• Panic Disorders • And much more!
Get Started with MDLIVE
Register with the RGA Member Portal
1. Visit accessrga.com and select Oregon. 2. Select the RGA Member Login button at the top of your screen 3. Log in to your member portal or create an account in just a few minutes by selecting “Create an account” on the bottom of the login page. 4. Once logged in, scroll down your home dashboard to “Explore Your Benefits” and select the tile labeled “See a doctor now” to access MDLIVE.
Or Register with a Virtual Health Assistant
Text Sophie at RGA to 635483 and follow the link to register. You can also activate your account or talk to a doctor now at www.mdlive.com/rga or by calling 1-877-596-8826.
10
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
DENTAL COVERAGE
Reliance Matrix / Ameritas Contracted providers agree to bill Reliance Matrix directly and to accept a negotiated fee as payment in full. Allowable charges for out-of-network providers are paid based on the maximum reimbursable charge, as determined by Reliance Matrix. You may be responsible for any additional amounts (also called balance billing). To find a list of in-network providers, go to www.rsli.com/dental-vision and search for providers.
PPO Network Classic PPO Network (CA Only)
Out-of-Network
Annual Deductible Individual
$50 $150
Maximum per family
Preventive Care* (exams, x-rays, etc.)
Covered in full
Covered in full
Basic Services (fillings, extractions, etc.)
You pay 20%, deductible applies
You pay 20%, deductible applies
Major Services (crowns, bridges, dentures, etc.)
You pay 50% deductible applies
You pay 50%, deductible applies
Annual Maximum
$1,500 per person
Orthodontia
50% up to $1,000 Lifetime Maximum (Children Only)
11
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
VISION COVERAGE
Reliance Matrix / VSP Contracted providers agree to bill VSP directly and to accept a negotiated fee as payment in full. Allowable charges for out-of-network providers are paid based on allowed amounts, as determined by VSP. You may be responsible for any additional amounts (also called balance billing).
Contracted providers agree to bill VSP directly and to accept a negotiated fee as payment in full. If you use a non-VSP provider, you will need to submit a claim to VSP and you will be reimbursed up to the scheduled amounts.
VSP Choice Network
All Other Providers
Vision Exam
Reimbursed up to $45 allowance (less $10 copay)
Every calendar year
$10 copay
Eyeglass Lenses
Reimbursed from $30 to $100 (less $25 copay/depending on lens type)
Every calendar year
$25 copay
Frames
Covered in full up to retail allowance of $130 ($70 Costco/Walmart). Additional $20 towards featured frames and 20% discount on amounts over the allowance
Every other calendar year
Reimbursed up to $70 allowance
Contact Lenses
Every other calendar year In lieu of Glasses
Up to $130 allowance for elective lenses Member cost up to $60 for fitting copay
Reimbursed up to $105 (elective lenses)
12
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
SUPPLEMENTAL LIFE / VOLUNTARY AD&D COVERAGE
Supplemental Life
Reliance Matrix
If you want supplemental group life insurance, you may purchase amounts through payroll deductions. You must be enrolled in supplemental life to purchase life insurance for your spouse or child. If you have already purchased supplemental life you can increase your election as described below. Please note that if your election exceeds the guarantee issue, medical underwriting is required. You may elect an amount for supplemental AD&D that is different than your supplemental life election. You must be enrolled in supplemental life to enroll in supplemental AD&D.
REMINDER: IF YOU RECENTLY HAD A FAMILY STATUS CHANGE, THIS IS A GOOD TIME TO UPDATE YOUR BENEFICIARY INFORMATION.
Coverage details are continued on the following page.
13
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Employee
Spouse
Child
Term Life Insurance
Lesser of 5x annual earnings up to $500,000 maximum
$100,000 (cannot exceed 100% of your coverage)
Benefit Available
$10,000
$25,000
$5,000
$2,000, $3,000, $4,000, $5,000 or $10,000
Available in increments of:
$100,000
$25,000
$10,000 ($1,000 age 14 days/6 mos)
Guaranteed Issue
AD&D
Benefit Available
Same as Life
Same as Life
Same as Life
Guaranteed Issue
Full Benefit
Full Benefit
Full Benefit
Age Reduction Schedule
At age 65, benefit reduces to 65% of original amount At age 70, benefit reduces to 40% of original amount At age 75; benefit reduces to 20% of original amount
Reduction schedule applies to Life, AD&D and Supplemental benefits
Increasing your Election
When can I increase my Election?
At Open Enrollment
At Open Enrollment
At Open Enrollment
Medical underwriting applies if you previously declined this coverage and if the new election is over the guaranteed issue amount.
Is there medical underwriting?
Because the premium is based on your age, when you go from one age bracket to the next, monthly deductions will increase to reflect the new age bracket. Age brackets are in 5-year increments (30 – 34, 35 – 39, etc.). If applicable, your new deductions will be deducted from your paycheck with the first payroll after January 1 st .
Reliance Standard “Lock - In” feature
If you previously enrolled for coverage, you can increase your employee or spouse supplemental life coverage amounts with no medical questions or health exams, up to the guaranteed issue amounts listed below, during open enrollment.
You can increase this amount by up to $50,000 (Employee) or $10,000 (Spouse) during this limited open enrollment period.
This allows you to increase your benefit with no health questions by those amounts. If you would like to purchase coverage or increase your benefit more than this, you can apply by providing proof of your good health (called evidence of insurability), and you need to be approved by Reliance Standard.
Please refer to the Reliance Matrix benefit summary for the cost.
14
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
VOLUNTARY ACCIDENT
Reliance Matrix If you wish to purchase voluntary accident insurance, this benefit provides a range of fixed, lump-sum benefits for injuries resulting from a covered accident. These benefits are paid directly to you and may be used for any reason, from deductibles and prescriptions to transportation and childcare. Please refer to the Reliance Matrix benefit summary for more information.
Coverage details are continued on the following pages.
15
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
16
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
IMPORTANT LEGAL INFORMATION
Healthcare Reform
The Affordable Care Act (ACA) is complex and you may have questions about how it impacts you, your family and your benefits. There are three items you should know.
First, the individual mandate (the requirement that all individuals have health insurance) remains in place. What has changed is the penalty associated with it. As of January 1, 2019, the ACA tax penalty is repealed and you won’t have to pay anything if yo u don’t enroll.
Second, the Health Insurance Marketplace still exists. You can shop for and enroll in insurance plans through the exchange and still apply for income-based subsidies.
Third, for most people, the plans we offer are considered affordable and neither you nor any family members are eligible for the federal subsidies available in the Health Insurance Marketplace, even if you choose not to enroll in Taylor Metal ‘s plan.
Please refer to your Notice of Health Insurance Marketplace Coverage for general information. For additional information on Marketplace options in your area and subsidy calculators, go to www.healthcare.gov or call 1-800-318-2596.
17
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Annual Reminders
Special Enrollment
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), allows a Special Enrollment period in addition to the regular Open Enrollment period. Only the following individuals may enroll outside the Open Enrollment period:
• Individuals who previously waived coverage under this program because they had other coverage and then involuntarily lost the other coverage. Enrollment must occur within 30 days of the loss of other coverage; • New dependents due to marriage, birth, adoption or placement for adoption. The eligible employee and other dependents who previously did not elect to be covered under the employer’s health care plan may also enroll at the time the new dependent is enrolled. Enrollment must occur within 30 days of date of marriage, or 30 days of a birth, adoption or placement for adoption; • A court has ordered coverage be provided for a spouse or minor child under this plan and request for enrollment is made within 60 days after issuance of such court order; • If employee and/or dependent(s) become ineligible for Medicaid or the Children’s Health Insurance program and request coverage under our plan within 60 days of termination (Please read the Medicaid and the Children’s Health Insurance Program notice for more information); or • If employee and/or dependent(s) become eligible for the state premium assistance program and request coverage under our plan within 60 days after eligibility is determined.
Notice Regarding t he Women’s Health and Cancer Rights Act of 1998
As required by the Women’s Health and Cancer Rights Act (WHCRA) of 1998, this plan provides coverage for:
• All stages of reconstruction of the breast on which the mastectomy has been performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and physical complications of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter.
Contact Human Resources for more information.
HIPAA Privacy Practices
The Health Insurance Portability and Accountability Act (HIPAA) requires employers to adhere to strict privacy guidelines and establishes your rights with regard to your personal health information. You received a copy of the Taylor Metal Products Group Health Plan Privacy Notice when you were hired. This notice describes how medical information about you may be used and disclosed, and how you can access that information.
If you have any questions regarding the HIPAA Privacy Notice, or would like another copy, please contact Human Resources.
18
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
COBRA
CONTINUING COVERAGE THROUGH COBRA If you are actively enrolled in a COBRA eligible benefit and coverage is terminated as described above, you do have the option of continuing the same level of benefits for up to 18 months through Federal COBRA. You will be charged the full monthly premium for these benefits plus a 2% administrative fee. An information packet will be mailed to you. You then have 60 days to elect Federal COBRA coverage and continue your health benefits. To continue coverage, you must fill out the election form and return it along with payment for coverage from the day your coverage through your employer ended. A confirmation of benefits will be mailed to you. It will be your responsibility to make a monthly COBRA payment to keep your insurance in force. You will have 30 days to remit payment to keep your COBRA coverage current. COBRA QUALIFYING EVENTS Qualifying 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 coverage. COBRA establishes only the minimum requirements for continuation coverage. A plan may always choose to provide longer periods of continuation coverage. The following are qualifying events for covered employees if they cause the covered employee to lose coverage: • Termination of the employee's employment for any reason other than gross misconduct; or • Reduction in the number of hours of employment. The following are qualifying events for the spouse and dependent child of a covered employee if they cause the spouse or dependent child to lose coverage: • Termination of the covered employee's employment for any reason other than gross misconduct; • Reduction in the hours worked by the covered employee; • Covered employee becomes entitled to Medicare; • Divorce or legal separation of the spouse from the covered employee; or • Death of the covered employee COVERAGE NOT AVAILABLE FOR CONTINUATION THROUGH COBRA For plans that do not offer continuation of coverage through COBRA, you may still have the option to continue that coverage through the carrier directly. Depending on the contract and type of plan, you may have the option to Port or Convert these coverages for continuation after your active status terminates. If you elect to continue one or more of the coverages available here, you would be responsible for paying premiums directly to the carrier. Reach out to the carrier directly or review the Certificate of Coverage for additional details on these options.
BENEFITS OFFERED THROUGH COBRA
BENEFITS NOT OFFERED THROUGH COBRA
Medical & Rx
Supplemental Life & Voluntary AD&D
Voluntary Dental
Voluntary Accident (Plans B & C)
Voluntary Vision
19
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Important Notice from Taylor Metal Products 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 Taylor Metal Products 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. Taylor Metal has determined that the prescription drug coverage offered by the Taylor Metal Products Employee Benefit 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?
Plan Participants who also are eligible for Medicare have the following three options concerning prescription drug coverage:
• You may stay in the Plan and not enroll in the Medicare prescription drug coverage at this time. You will be able to enroll in the Medicare prescription drug coverage at a later date without penalty, either (1) during a Medicare prescription drug open enrollment period (October 15 – December 7 of each year); or (2) if you lose Plan coverage. This is the best option for most Plan participants who are eligible for Medicare. • You may stay in the Plan and also enroll in Medicare prescription drug coverage at this time. The Plan will pay prescription drug benefits as the primary payer in most instances. Medicare will pay benefits as a secondary payer,
20
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
and thus the value of your Medicare prescription drug coverage will be greatly reduced. Your current coverage under the Plan pays for other health benefits as well as prescription drugs and will not change if you choose to enroll in Medicare prescription drug coverage. • You may reject all coverage under the Plan and choose coverage under Medicare as your primary and only payer for all medical and prescription drug expenses. If you do so, you will not be able to receive coverage under the Plan, including prescription drug coverage, unless and until you are eligible to reenroll at the next enrollment period for which you are eligible, if any. Your current coverage pays for other types of health expenses, in addition to prescription drugs, and you will not be eligible to receive any of your current health and prescription drug benefits if you reject coverage under the Plan and choose to enroll in Medicare, including a Medicare prescription drug plan, as your primary and only payer.
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 Taylor Metal 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 November 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 Taylor Metal 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 (1-800-633-4227). TTY users should call 1-877-486-2048.
21
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
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).
Date: January 1, 2024 Name of Entity/Sender: Taylor Metal Products Contact — Position/Office: Human Resources Address: 4566 Ridge Drive N.E. Salem, OR 97301 Phone Number: 503-967-7515
22
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Premium Assistance under Medicaid and t he Children’s Health Insurance Program If you or your children are eligible for Medicaid or the Children’s Health Insurance Program (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, 2023. Contact your State for more information on eligibility.
ALABAMA – 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 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
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: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pa ges/default.aspx
ARKANSAS – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/fl medicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268
CALIFORNIA – Medicaid
Website: Health Insurance Premium Payment (HIPP) Program: http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov
23
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
GEORGIA – Medicaid
MASSACHUSETTS – Medicaid and CHIP
GA HIPP Website: https://medicaid.georgia.gov/heal th-insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/p rograms/third-party-liability/childrens-health- insurance-program-reauthorization-act-2009-chipra Phone: (678) 564-1162, Press 2
Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: (617) 886-8102
MINNESOTA – Medicaid
Website: https://mn.gov/dhs/people-we- serve/children-and-families/health-care/health- care-programs/programs-and-services/other- insurance.jsp Phone: 1-800-657-3739
INDIANA – Medicaid
Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/ pages/hipp.htm Phone: 573-751-2005
MONTANA – Medicaid
IOWA – Medicaid and CHIP (Hawki)
Website: http://dphhs.mt.gov/MontanaHealthcarePr ograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov
Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/ medicaid-a-to-z/hipp HIPP Phone: 1-888-346-9562
NEBRASKA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
KANSAS – Medicaid
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-766-9012
NEVADA – Medicaid
Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
KENTUCKY – Medicaid
NEW HAMPSHIRE – Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.g ov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/ind ex.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov
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. 5218
NEW JERSEY – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanser vices/dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
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)
NEW YORK – Medicaid
MAINE – Medicaid
Website: https://www.health.ny.gov/health_care/me dicaid/ Phone: 1-800-541-2831
Enrollment Website: https://www.mymaineconnectio n.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 Phone: 1-800-977-6740 / TTY: Maine relay 711
NORTH CAROLINA – Medicaid
Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100
24
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
NORTH DAKOTA – Medicaid
UTAH – Medicaid and CHIP
Website: http://www.nd.gov/dhs/services/medicalse rv/medicaid/ Phone: 1-844-854-4825
Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669
OKLAHOMA – Medicaid and CHIP
VERMONT – Medicaid
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
Website: https://dvha.vermont.gov/members/medic aid/hipp-program Phone: 1-800-250-8427
OREGON – Medicaid
VIRGINIA – Medicaid and CHIP
Website: http://healthcare.oregon.gov/Pages/index. aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075
Website: https://www.coverva.org/en/famis-select https://www.coverva.org/en/hipp Medicaid/CHIP Phone: 1-800-432-5924
PENNSYLVANIA – Medicaid
WASHINGTON – Medicaid
Website: https://www.dhs.pa.gov/Services/Assistanc e/Pages/HIPP-Program.aspx Phone: 1-800-692-7462 CHIP Website: https://www.dhs.pa.gov/CHIP/Pages/ CHIP.aspx CHIP Phone: 1-800-986-KIDS (5437)
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
WEST VIRGINIA – Medicaid and CHIP
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
RHODE ISLAND – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
WISCONSIN – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/badgercar eplus/p-10095.htm Phone: 1-800-362-3002
SOUTH CAROLINA – Medicaid
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
WYOMING – Medicaid
SOUTH DAKOTA - Medicaid
Website: https://health.wyo.gov/healthcarefin/medi caid/programs-and-eligibility/ Phone: 1-800-251-1269
Website: http://dss.sd.gov Phone: 1-888-828-0059
TEXAS – Medicaid
Website: http://gethipptexas.com/ Phone: 1-800-440-0493
To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
U.S. Department of Health and Human Services
Employee Benefits Security Administration
Centers for Medicare & Medicaid Service
www.dol.gov/agencies/ebsa
www.cms.hhs.gov
1-866-444-EBSA (3272)
1-877-267-2323, menu option 4, ext. 61565
25
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27Made with FlippingBook - PDF hosting