US - Jagged Peak Benefit Guide 2018

2018 Employee Benefit Guide.

PLAN YEAR: September 1, 2018 through August 31, 2019

CONTENTS & CONTACT INFORMATION

JAGGED PEAK - FLORIDA Human Resources Phone Number Human Resources E-mail Address JAGGED PEAK - OHIO Human Resources Phone Number Human Resources E-mail Address

813-637-6900 Ext. 209

hr@jaggedpeak.com

513-830-0107

benefits-cinti@jaggedpeak.com

BROKER Company Name Broker Contact

M.E. Wilson Company

Amanda Sands

Company Phone Number Company Email Address

813-229-8021 Ext. 139 asands@mewilson.com

MEDICAL

page 3

Company Name

UMR

Company Phone Number Company Web Address

800-826-9781 www.umr.com

Provider Network

UnitedHealthcare, Choice Plus Network

TELEMEDICINE PROGRAM

page 5

Company Name

HealthiestYou 866-703-1259

Company Phone Number Company Web Address

member.healthiestyou.com

MEDLINK SUPPLEMENTAL

page 5

Company Name

MedLink / American Public Life

Company Phone Number

800-256-8606

HEALTH SAVINGS ACCOUNT (HSA)

page 6

Company Name

OptumBank

Company Phone Number Company Web Address

866-234-8913

www.optumbank.com

DENTAL

page 7

Company Name

MetLife

Company Phone Number Company Web Address

1-800-942-0854 www.metlife.com

VISION

page 8

Company Name

MetLife

Company Phone Number Company Web Address

1-855-638-3931 www.metlife.com

CONTENTS & CONTACT INFORMATION (Cont’d)

BASIC & VOLUNTARY LIFE

page 9

Company Name

MetLife

Company Phone Number Company Web Address

1-800-523-2894 www.metlife.com

SHORT AND LONG TERM DISABILITY

page 10

Company Name

MetLife

Company Phone Number Company Web Address

1-800-858-6506 www.metlife.com

VOLUNTARY BENEFITS

page 11

Company Name

MetLife

Company Phone Number Company Web Address

1-800-438-6388 www.metlife.com

LEGAL AID & ID THEFT PROTECTION

page 14

Company Name

MetLife

Company Phone Number Company Web Address

1-800-438-6388 www.metlife.com

401K RETIREMENT PLAN

page 14

PET INSURANCE

page 15

Company Name

Nationwide

Company Phone Number Company Web Address

1-855-874-4944

www.petinsurance.com/usjaggedpeak

EMPLOYEE ASSISTANCE PROGRAM

page 16

Company Name

MetLife

Company Phone Number Company Web Address

1-888-319-7819

www.metlifeeap.lifeworks.com

ADDITIONAL BENEFITS

page 17

ONLINE ENROLLMENT SYSTEM

page 19

Company Name

Web Benefits Design

Company Phone Number Company Web Address

1-888-574-7704

www.mybensite.com/usjaggedpeak

DISCLOSURE NOTICES

page 21

BENEFIT INFORMATION

BENEFIT

WHO PAYS THE COST?

YOUR BENEFITS PLAN

Jagged Peak pays the majority of the employee premium and contributes toward the dependent cost for all eligible employees.

Medical Insurance

Jagged Peak offers a variety of benefits allowing you the opportunity to customize a benefits package that meets your personal needs. In the following pages, you’ll learn more about the benefits offered. You’ll also see how choosing the right combination of benefits can help protect you and your family’s health and finances – and your family’s future .

Jagged Peak pays the entire cost of this benefit if the employee is enrolled in the company medical plan. Employees not on the company medical plan can still elect this benefit at their own cost.

HealthiestYou

MedLink

The employee pays the entire cost.

Dental Insurance

The employee pays the entire cost.

Vision Insurance

The employee pays the entire cost.

Basic Life/AD&D Insurance

Jagged Peak pays the entire cost.

Voluntary Life Insurance

The employee pays the entire cost.

Jagged Peak pays the entire cost for all Florida employees and Ohio salary/exempt employees. Ohio hourly/non-exempt employees pay the entire cost.

Short Term Disability

Long Term Disability

Jagged Peak pays the entire cost.

Voluntary Products

The employee pays the entire cost.

MetLife Legal

The employee pays the entire cost.

ELIGIBILITY

All Regular full-time employees and eligible dependents are eligible to join the Jagged Peak Benefits Plan on the 1 st of the month following 30 days.



Eligible dependents include :

WHEN CAN YOU ENROLL?

Your legal spouse

•

You can sign up for Benefits at any of the following times: • After completing your initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family- status change.

• Your married or unmarried natural children, step-children living with you, legally adopted children and any other children for whom you have legal guardianship, who are:

► Under 26 years of age

► A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits. To be eligible, a dependent must :

• Be unmarried and not have dependents of his or her own; AND

Be a resident of Florida or a student; AND

•

If you do not enroll at one of the above times, you must wait for the next annual open enrollment period.

• Not have coverage of their own, or covered under any other plan; AND

Not entitled to benefits under Medicare

•

BENEFIT INFORMATION

CHOOSING YOUR BENEFITS

You must actively choose any benefit that you pay for, or share in the cost with Jagged Peak. Your part of the cost is automatically taken out of your paycheck. There are two ways that the money can be taken out:

WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY? There is a definite advantage to paying for some benefits with before-tax money: Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.

• BEFORE YOUR TAXES ARE CALCULATED – medical, dental, vision, health savings account (HSA contributions)

• AFTER YOUR TAXES ARE CALCULATED – voluntary life, disability and voluntary products

MAKING CHANGES

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

If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another family status change.

Your marriage

•

Your divorce or legal separation

•

Birth or adoption of an eligible child

•

• Death of your spouse or covered child

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

WHEN COVERAGE ENDS

• Change in your work status that affects your benefits

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

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

• Change in your child’s eligibility for benefits

• Receiving Qualified Medical Child Support Order (QMCSO)



KEY BENEFIT TERMS

COBRA - A Federal law that allows workers and dependents who lose their medical, dental, or vision coverage to continue any of these coverages for a specified length of time by electing and paying for continuation benefits. Copayment - A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physician office visits and prescription drugs.

Deductible – The amount you pay toward medical and dental expenses each year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in deductibles, copayments and coinsurance during the year. Coinsurance – The amount you pay toward medical and dental expenses each year after you have met your annual deductible. In-patient – services or care received in a hospital that require admittance or a stay of at least 24 hours. Out-patient – services or care received at a medical facility that do not require overnight admittance, or a stay less than 24 hours.

Embedded – a deductible type that means a single member of a family doesn’t have to meet the full family deductible for after-deductible benefits to apply. Instead, the individual’s after-deductible benefits will begin as soon as he/she meets the individual deductible, even if the plan is for family coverage.

MEDICAL INSURANCE

The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.

Jagged Peak offers four medical plans through UMR and uses the UnitedHealthcare provider network. (To find participating providers go to www.umr.com and click on “Find a Provider”, then choose “UnitedHealthcare Choice Plus Network” from the network listing. Then follow the prompts to find a provider in your area.

US – Option 1

US – Option 2

US – Option 3

US – Option 4

IN-NETWORK:

Calendar Year Basis

Calendar Year

Deductible (Individual / Family)

$4,000 / $8,000

$2,000 / $4,000

$500 / $1,000

Embedded/Non-embedded

Embedded

Coinsurance

80% / 20%

50% / 50%

80% / 20%

100% / 0%

Maximum Out-of-Pocket (Individual / Family)

$6,000 / $12,000

$6,500 / $13,000

Deductible, Coinsurance & Copays

Out-of-Pocket Max Includes

Deductible and Coinsurance

Lifetime Maximum

Unlimited

Routine Preventive Services

Wellness Immunizations Mammography/Colonoscopy CO-PAYS Telemedicine Program

Covered 100%

$0 Copay – HealthiestYou – Call: 866-703-1259 or Login: member.healthiestyou.com

Referral Required

Office Visits Consultations for Illness / Injury

Deductible & Coinsurance

$40 copay

$25 copay

Specialist Visits

Deductible & Coinsurance

$65 copay

$55 copay

$40 copay

Inpatient Hospital

Deductible & Coinsurance

Deductible

Outpatient Surgery

Deductible & Coinsurance

Deductible

Emergency Room

Deductible & Coinsurance

$350 copay

$250 copay

$350 copay

Urgent Care

Deductible & Coinsurance

$100 copay

OUTPATIENT DIAGNOSTIC SERVICES

Lab Services (Freestanding Lab)

Deductible & Coinsurance

Covered 100%

X-Ray Services (Freestanding Lab)

Deductible & Coinsurance

Covered 100%

Complex Diagnostic

Deductible & Coinsurance

$300 copay

PRESCRIPTIONS Retail (30 day supply)

Deductible & Coinsurance

$15 / $45 / $90 / 25%

$10 / $40 / $70 / 25%

$10 / $30 / $50 / 25%

Mail Order (90 day supply)

Deductible & Coinsurance

2.5 x retail

OUT-OF-NETWORK Deductible (Individual / Family)

$12,000 / $24,000

$7,500 / $15,000

$1,500 / $3,000

Coinsurance

50% / 50%

70% / 30%

Not Available In-Network Benefits Only

Maximum Out-of-Pocket (Individual / Family)

$18,000 / $36,000

$19,500 / $39,000

Lifetime Maximum

Unlimited

MEDICAL CONTRIBUTION SCHEDULE

US – Option 1

Employee Cost Per Pay Period

Employee Only

$ 48.46 $216.92 $122.31 $258.46

Employee + Spouse Employee + Child(ren)

Family

US – Option 2

Employee Cost Per Pay Period

Employee Only

$ 57.69 $244.62 $150.00 $320.77

Employee + Spouse Employee + Child(ren)

Family

US – Option 3

Employee Cost Per Pay Period

Employee Only

$115.38 $323.08 $258.46 $408.46

Employee + Spouse Employee + Child(ren)

Family

US – Option 4

Employee Cost Per Pay Period

Employee Only

$145.38 $438.46 $346.15 $588.46

Employee + Spouse Employee + Child(ren)

Family

All employees = 26 pay periods

TELEMEDICINE PROGRAM

Your healthcare just got a whole lot easier!

With HealthiestYou you can connect with a doctor who can diagnose, treat, and prescribe over the phone 24/7/365. Using HealthiestYou can SAVE YOU TONS OF MONEY and no more time wasted in waiting rooms or trying to schedule an appointment.

Our doctors are licensed and can handle an array of common ailments including allergies, earache, sore throat, pink eye, strep throat, urinary tract infection, and many more! HealthiestYou is great for families because your spouse and dependents can use it too and there is no limit on the number of times called or the duration of each call.

Employee Cost Per Pay Period

Employees who are enrolled in a company medical plan

$0.00

Employees who are NOT enrolled in a company medical plan

$3.23

MEDLINK SUPPLEMENTAL

MedLink is a supplemental plan which can be used with certain Jagged Peak medical plans. It helps cover a portion or all of the deductible. MedLink is only available for employees who are enrolled in medical plan Options 2, 3 or 4.

Base Plan MedLink Plan

Enhanced Plan MedLink Plan

MedLink covers up to the lesser amount of 100% of your deductible or $2,500 for inpatient hospitalization on day 1 of your policy ($2,500 per covered person up to $7,500 max per policy period) and up to the lesser amount of 50% of your deductible or $1,250 per covered person (up to $3,750 max per policy period) for outpatient surgical or diagnostic services performed at a hospital or hospital affiliated outpatient center.

MedLink covers up to the lesser amount of 100% of your deductible or $4,000 for inpatient hospitalization on day 1 of your policy ($4,000 per covered person up to $12,000 max per policy period) and up to the lesser amount of 50% of your deductible or $2,000 per covered person (up to $6,000 max per policy period) for outpatient surgical or diagnostic services performed at a hospital or hospital affiliated outpatient center.

Employee Cost Per Pay Period

Base Plan

Enhanced Plan

Employee Only

$ 22.71 $ 52.25 $ 43.16 $ 72.68

$ 29.76 $ 68.44 $ 56.54 $ 95.22

Employee + Spouse

Employee + Child(ren)

Family

HEALTH SAVINGS ACCOUNT (HSA)

What is a Health Savings Account (HSA)?

It is an interest bearing account created to help you pay medical expenses. The funds in your HSA can be used to help pay your deductible, coinsurance and any qualified medical expenses not covered by your health plan (including dental and vision expenses). All of the money you contribute is tax-free when used to pay for qualified medical expenses. An HSA is your account. It goes with you if you change jobs or when you retire.

Our banking arrangement is through Optum Bank. Visit Optum Bank at www.optumbank.com to learn more about how you can save. If you have more questions, call the Customer Care Center at 866-234-8913.

IRS Annual Maximum HSA Contribution Limits (maximums include any employer contributions) 2018

2019

Employee Only

$3,450 $6,900

$3,500 $7,000

Family

Catch-up Amount for employees 55 years or older

Additional $1,000 annually

Health Savings Account – Eligible Expenses (partial list) • Acupuncture • Alcohol and drug dependency treatment • Ambulance • Artificial limbs • Breast reconstruction surgery (mastectomy-related) • Dental expenses (exams, cleanings, X-rays, root canals, bridges, etc.) • Diagnostic fees (X-rays, MRI’s, bloodwork, etc.) • Doctor fees (including Chiropractic services) • Drugs - prescription and over the counter (when ordered by physician) • Eyeglasses and exams, contact lenses & solutions, laser surgery • Fertility enhancements • Hearing aids and batteries • Hospital and Laboratory fees • Long-term care (medical expenses and premiums) • Nursing home • Physical and speech therapies • Psychiatric care • Smoking-cessation programs and products • Vasectomy • Weight-loss program (to treat a specific disease diagnosed by a physician)

DENTAL INSURANCE

Jagged Peak offers dental coverage through MetLife. The PPO Dental Plans allow you to use in- network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between MetLife’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plans.

DHMO

Low PPO

High PPO

FLORIDA EMPLOYEES ONLY

In-Network Only

In-Network

Out-of Network*

In-Network

Out-of Network*

Calendar Year Deductible

N/A

$50 / $150

$100 / $300

$25 / $75

Individual / Family Annual Maximum

Unlimited

$1,250

$2,250

Diagnostic & Preventive

Covered in full after deductible

Exams, Cleanings, Fluoride, X-Rays, Sealants Regular Restorative Services

See Fee Schedule

Covered in full

Amalgam Fillings, Extractions – Single Tooth, Endodontics (Root Canal), Periodontics (Gum Disease)

Covered 80% after deductible

Covered 50% after deductible

Covered 90% after deductible

Covered 80% after deductible

See Fee Schedule

Major Services

Covered 50% after deductible

Covered 25% after deductible

Covered 60% after deductible

Covered 50% after deductible

See Fee Schedule

Crowns, Bridges, Dentures Orthodontia Services

50% $500 Lifetime Maximum

50% $2,000 Lifetime Maximum

See Fee Schedule

Children only under the age of 19

DHMO

Low PPO

High PPO

Employee Cost Per Pay Period

Employee Only

$ 5.53 $ 9.72 $ 11.58 $ 16.31

$ 10.73 $ 21.77 $ 28.41 $ 42.17

$ 6.54 $ 13.25 $ 17.41 $ 26.34

Employee + Spouse Employee + Child(ren)

Family

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

Low PPO

High PPO

OHIO EMPLOYEES ONLY

In-Network

Out-of Network*

In-Network

Out-of Network*

Calendar Year Deductible

$50 / $150

$100 / $300

$25 / $75

Individual / Family Annual Maximum

$1,250

$2,250

Diagnostic & Preventive

Covered in full after deductible

Covered in full

Exams, Cleanings, Fluoride, X-Rays, Sealants Regular Restorative Services

Covered 80% after deductible

Covered 50% after deductible

Covered 90% after deductible

Covered 80% after deductible

Amalgam Fillings, Extractions – Single Tooth, Endodontics (Root Canal), Periodontics (Gum Disease) Major Services

Covered 50% after deductible

Covered 25% after deductible

Covered 60% after deductible

Covered 50% after deductible

Crowns, Bridges, Dentures

Orthodontia Services

50% $500 Lifetime Maximum

50% $2,000 Lifetime Maximum

Children only under the age of 19

Employee Cost Per Pay Period

Low PPO

High PPO

Employee Only

$ 6.54 $ 13.25 $ 17.41 $ 26.34

$ 10.73 $ 21.77 $ 28.41 $ 42.17

Employee + Spouse

Employee + Child(ren)

Family

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

VISION INSURANCE

Jagged Peak offers vision coverage through MetLife. The MetLife vision network consists of optometrists, ophthalmologists, opticians and optical retailers. You have the option of visiting any provider, however by choosing a participating provider, you receive the highest level of benefits.

Vision

In-Network

Out-of-Network

Routine Eye Exams

$10 copayment

Reimbursed up to $45

Lenses: Single

Copay applies

Reimbursed from $30 to $65 depending on type of lenses

Bifocal

Copay applies

Trifocal

Copay applies

Frames

$150 allowance + 20% discount

Reimbursed up to $70

Contact Lenses (elective)

$150 allowance

Reimbursed up to $105

Frequency Exam

Once every 12 months

Lenses or contact lenses

Once every 12 months

Frames

Once every 24 months

• Covered lenses include single vision, bifocal, trifocal and lenticular. • Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per year.

Employee Cost Per Pay Period

Employee Only

$3.35

Employee + Spouse

$5.65

Employee + Child(ren)

$5.76

Family

$9.11

BASIC & VOLUNTARY LIFE INSURANCE

Jagged Peak provides Basic Life insurance to all full-time employees working 30 or more hours per week. Eligible employees also have the option to purchase voluntary life insurance coverage through the group plan. The chart below provides an overview of the plan.

What is Life Insurance? Having adequate Life Insurance can help your family manage expenses and make a difficult transition less stressful by providing them with financial support after your death. AD&D (Accidental Death & Dismemberment) provides a benefit if you suffer a covered accidental death or injury.

BASIC LIFE AND AD&D

$20,000 for all employees **Basic Life and AD&D coverage is paid 100% by Jagged Peak**

Employee Only

Age Reductions

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

VOLUNTARY LIFE

Employee

Increments of $10,000 up to a maximum of $500,000 or 5x annual salary, whichever is less.

Employees Under Age 65

No evidence of insurability up to max of $150,000 (newly eligible employees only).

Increments of $5,000 up to a maximum of $100,000 or 100% of Employee amount, whichever is less.

Spouse

Spouses Under Age 65

No evidence of insurability up to max of $50,000 (newly eligible dependents only).

Children

Option of $1,000, $2,000, $4,000, $5,000 or $10,000 – 6 months to 26 years

VOLUNTARY LIFE Monthly rates per $1,000 of benefit

Age

Employee/Spouse

Child

<29

$0.043

$0.240

VOLUNTARY LIFE COST CALCULATION PER PAY PERIOD:

30-34

$0.049

35-39

$0.073

_____________________ Benefit Amount / 1,000 x____________________ Monthly Rate (from chart) = ____________________ x12 / # of pay periods (26) =____________________ Per Pay Period Cost

40-44

$0.134

45-49

$0.206

50-54

$0.313

55-59

$0.492

60-64

$0.834

65-69

$1.379

All employees = 26 pay periods

70+

$2.674

SHORT TERM DISABILITY INSURANCE

Jagged Peak provides Short Term Disability insurance to all full-time employees working 30 or more hours per week. The chart below provides an overview of the plan and who pays the cost.

What is Short Term Disability (STD)? STD insurance provides you with a weekly cash benefit to help you pay your bills and keep your life as routine as possible if you are unable to work due to a covered disability (injuries, recovery from surgery, even maternity leave).

Florida Employees & Ohio Salary/Exempt Employees

Benefit Percentage

60%

Maximum Weekly Benefit

$2,000

7 days - Accident 7 days – Sickness

Elimination Period

Duration of Benefit

13 weeks

Jagged Peak pays 100% of the Short Term Disability cost for all Florida employees and Ohio Salary/Exempt employees only.

Ohio Hourly/Non-Exempt Employees

Benefit Percentage

60%

Maximum Weekly Benefit

$1,000

7 days - Accident 7 days - Sickness

Elimination Period

Duration of Benefit

13 weeks

Monthly Rate per $10 of Weekly Benefit

SHORT TERM DISABILITY COST CALCULATION PER PAY PERIOD FOR OHIO HOURLY / NON-EXEMPT EMPLOYEES

AGE

<29

$0.37

_____________________ Weekly Base Pay (annual pay divided by 52) X .60 = ____________________ This is your weekly benefit (cannot exceed $1,000) /10

30-34

$0.37

35-39

$0.37

40-44

$0.37

X ____________________ Monthly Rate (from chart) = ____________________ Approximate monthly premium x12 /26 = ____________________ Approximate Per Pay Period Cost

45-49

$0.40

50-54

$0.48

55-59

$0.66

60-64

$0.77

65+

$0.80

LONG TERM DISABILITY INSURANCE

Jagged Peak provides Long Term Disability insurance to all full-time employees working 30 or more hours per week. The chart below provides an overview of the plan and who pays the cost.

What is Long Term Disability (LTD)? LTD insurance provides you with a monthly cash benefit to help you pay your bills if a covered disability prevents you from working for an extended period of time.

Long Term Disability

Benefit % of Monthly Covered Payroll

60%

Monthly Maximum

$6,000

Elimination Period

90 days

All Florida Employees and Ohio Salary/ Exempt: Normal Social Security Retirement Age

Benefit Duration

Ohio Hourly/ Non-exempt: 2 year maximum

Jagged Peak pays 100% of the Long Term Disability cost for all employees.

HOSPITAL INSURANCE

Jagged Peak provides Voluntary Hospital insurance to all full-time employees working 30 or more hours per week. The chart below provides an overview of the plans and rates.

Hospital Benefit Summary

Subcategory

Benefits

Low Plan

High Plan

Non- ICU Hospital Admission payable 1 time per Accident

$500

$1,000

Accident – Hospital Admission Benefit

Intensive Care Unit Admission payable 1 time per Accident

$1,000

$2,000

Non- ICU Hospital Confinement is payable for up to 31 days per covered person (starting on day 1) ICU Accident Hospital Confinement is payable for up to 31 days per covered person (starting on day 1) Inpatient Rehabilitation Benefit is payable for up to 15 days per covered person per accident, but not to exceed 30 days per calendar year.

$100

$200

Accident – Hospital Confinement Benefit

$200

$400

Rehab

$100

$200

Non-ICU Hospital Admission payable 1 time(s) per calendar year

$500

$1,000

Sickness – Hospital Admission Benefit

Intensive Care Unit Admission payable 1 time(s) per calendar year

$1,000

$2,000

Non-ICU Sickness Hospital Confinement is payable for up to 31 days per covered person (starting on day 1) ICU Sickness Hospital Confinement is payable for up to 31 days per covered person (starting on day 1)

$100

$200

Sickness – Hospital Confinement Benefit

$200

$400

Employee Cost Per Pay Period

Low Plan

High Plan

Employee Only

$ 3.76 $ 7.29 $ 6.81 $11.58

$ 7.52 $14.58 $13.61 $23.16

Employee + Spouse Employee + Child(ren)

Family

ACCIDENT INSURANCE

Jagged Peak provides Voluntary Accident insurance to all full-time employees working 30 or more hours per week. The chart below provides an overview of the plan and rates.

What is Accident Insurance? Accident coverage provides cash benefits that help cover unexpected expenses resulting from covered accidents on or off the job.

Accident Benefit Summary

Accident Coverage Type

24 Hour Coverage (on/off job)

You have a choice of a Low Plan or a High Plan. Benefits are based on a flat schedule amount that varies depending on the plan.

Benefit Amount

Benefits are reduced by 25% of the original amount at age 65 Benefits are reduced by 50% of the original amount at age 70

Age Reduction

Coverage for Accidental Death or Dismemberment, Fractures, Burns, Emergency Care, Medical Testing, Surgeries, and so much more!

Example of Covered Benefits

Below is only a sample list of the benefits provided by the Accident plans. Please refer to the MetLife summary for the complete benefit schedule.

Specific Service/Injury Type

Low Plan

High Plan

Paralysis: Two Limbs (paraplegia or hemiplegia)

$5,000

$25,000

Open Fractures: Forearm, Hand, Wrist (except fingers)

$500

$1,000

Open Fractures: Leg (tibia and/or fibula)

$2,000

$4,000

Burns: 3rd Degree w/ less than 10% of surface skin burnt

$500

$1,000

Ambulance: Air Transportation

$750

$1,000

Ambulance: Ground Transportation

$200

$300

Medical Testing: (X-Ray, MR/MRI, ultrasound, NCV, CT/CAT, EEG)

$100

$200

Employee Cost Per Pay Period

Low Plan

High Plan

Employee Only

$2.66 $5.26 $5.48 $6.86

$ 5.09 $10.07 $10.45 $13.09

Employee + Spouse Employee + Child(ren)

Family

CRITICAL ILLNESS INSURANCE

Jagged Peak provides Voluntary Critical Illness insurance to all full-time employees working 30 or more hours per week. The chart below provides an overview of the plan and rates.

What is Critical Illness Insurance? Critical Illness plans pay a lump sum upon diagnosis of a covered critical illness for you to use where it’s needed most. It can help pay coinsurances, deductibles, caregivers, loss of income or extra living expenses.

Critical Illness Benefit Summary

Benefit Amount

Employee may choose a lump sum of $15,000 or $30,000

Alzheimer’s Disease, Coronary Artery Bypass Graft, Heart Attack, Kidney Failure, Major Organ Transplant, Stroke

Example of Covered Conditions

Spouse Benefit

50% of employee's lump sum benefit

Child Benefit

50% of employee's lump sum benefit

CRITICAL ILLNESS (Monthly rates per $1,000 of benefit)

Employee + Spouse

Employee + Child(ren)

Attained Age

Employee Only

Family

<25

$0.32

$0.55

$0.60

$0.83

25–29

$0.34

$0.59

$0.62

$0.87

30–34

$0.48

$0.81

$0.75

$1.08

35–39

$0.68

$1.12

$0.95

$1.40

40–44

$1.06

$1.72

$1.33

$1.99

45–49

$1.62

$2.60

$1.90

$2.88

50–54

$2.35

$3.77

$2.63

$4.05

55–59

$3.30

$5.31

$3.57

$5.59

60–64

$4.81

$7.75

$5.08

$8.03

65–69

$7.27

$11.72

$7.54

$12.00

70+

$11.30

$18.02

$11.58

$18.30

CRITICAL ILLNESS COST CALCULATION PER PAY PERIOD:

_____________________ Benefit Amount (either $15,000 or $30,000) / 1,000 x____________________ Monthly Rate (from chart) = ____________________ x12 / # of pay periods (26)

=____________________ Per Pay Period Cost

All employees = 26 pay periods

LEGAL AID & ID THEFT PROTECTION

MetLaw is a voluntary benefit available to all eligible employees at Jagged Peak. The plan provides employees with legal consultation for personal legal matters, no matter how trivial or traumatic, all without having to worry about the high hourly legal costs. This benefit also includes Identity Theft benefits.

Services include: • Legal advice – personal legal matters • Letters/calls made on your behalf • Contracts and documents reviewed • Residential loan document assistance • Will, Living Will, and Health Care Power of Attorney preparation • Moving traffic violations • Family matters such as guardianship, adoption and/or name change representation • IRS audit assistance Employee Cost Per Pay Period

Employee (covers spouse and dependents)

$9.69

• Identity recovery services by CyberScout and up to $1 million of expense reimbursement for lost wages, reasonable and necessary expenses incurred and unauthorized electronic fund transfers • Credit Monitoring – monitors all three credit bureaus for activity, including credit inquiries, delinquencies and judgments • Participants and Spouses also get a dashboard view of credit scores from all three credit bureaus and one free annual credit report from each bureau • If identity theft is uncovered, the service provides unlimited access to fraud specialists who will work as long as it takes to restore the Participant’s or Spouse’s identity • Consultation – 24 / 7 / 365 live support for covered emergencies, unlimited counseling, identity alerts and data breech information • And much, much more!

401K RETIREMENT BENEFIT

The discretionary matching contribution may be up to 40% (or some lesser percentage) of a Participant’s elective contributions for an allocation period; provided, however, a Participant’s elective contributions in excess of 5% of his Compensation for an allocation period shall not be taken into account in determining his share of any discretionary matching contributions. The allocation period may be each payroll period or the Plan Year and shall be determined at the discretion of the Adopting Employer. The company’s matching contribution will not exceed 2% of your eligible compensation. Employees are fully vested after completing five years of service, as defined by the plan. The plan also allows rollovers from other qualified plans at any time. In addition, the plan allows participant access to accounts through loans and withdrawals according to plan provisions.

PET INSURANCE

You care about your pets and consider them members of your family. So why not give your pets the best health care available? The My Pet Protection plans shown below allow you to cover your dog or cat regardless of the their age! For more information, go to PetsVoluntaryBenefits.com or call 855-874-4944 To enroll, visit: www.petinsurance.com/usjaggedpeak

My Pet Protection w/ wellness

Employee Cost Per Pay Period (based on state of residence)

My Pet Protection

Dog

$38.95

$24.33

Florida

Cat

$23.37

$14.60

Dog

$32.97

$19.72

Ohio

Cat

$19.78

$11.83

EMPLOYEE ASSISTANCE PROGRAM

Employee Assistance Program (EAP)

We all need help every now and then. Problems are just a part of everyday life. In addition to the benefits provided under your MetLife Group Insurance coverage, you and your household members now have access to LifeWorks Employee Assistance Program (EAP) to help with the everyday challenges of life that may affect your health, family life and desire to excel at work. (EAP services are provided through an agreement with LifeWorks, which is not a subsidiary or affiliate of MetLife and the services provided are separate and apart from the insurance and services provided by MetLife.)

Consultation and support You and the members of your household are entitled to up to 5 consultations with a licensed clinician per incident, per individual, per calendar year. You have telephonic consultations for maximum convenience and anonymity. Please call 1-888-319-7819 anytime to speak with a clinician or schedule an appointment.

Your EAP can help you resolve a broad range of issues including:

• Marriage, Relationship and Family Problems • Problems at Work • Changes in Mood • Legal and Financial Issues • Stress and Anxiety • Alcohol and Drug Dependency • Identity Theft • Health and Wellness Concerns



We’re Here to Lend a Helping Hand: 1-888-319-7819

(TDD Callers Can Call: 1-800-999-3004)

Or online at www.metlifeeap.lifeworks.com Username: metlifeeap Password: eap

JAGGED PEAK PERKS

Many of Jagged Peak Clients have offered generous discounts to employees of Jagged Peak as a reward for their hard work, dedication and commitment to excellence represented by their brands. We are pleased to announce the following discounts available to employees of Jagged Peak from our Clients. NOTE: All discounts offered by Clients of Jagged Peak are intended for employees only and should not be shared with anyone other than immediate family members (this includes social media). Violators may have privileges revoked and in some cases, could face termination.

30% off (regular and sale priced items, final sale items excluded). To order: Contact Lisa Toney (lisa.toney@jaggedpeak.com) to obtain a discount code. Use code at checkout on www.calvinklein.com. Only one code may be used at time of purchase, MUST use a Jagged Peak email address to order. If the site is running a sale, you may use either the employee code/discount or the site discount/code, whichever is greater. 50% off (regular priced items and sales priced items) To order: Contact Ashlie Alvarez (ashlie.alvarez@tradeglobal.com) for a discount code (each Code is available for one-time use). Use code at checkout on www.ColeHaan.com

25% off (regular priced items, not sale or clearance), plus free shipping. To order: Complete order form (located on SharePoint on the Human Resources page) and submit to Pete Scudder (pete.scudder@jaggedpeak.com), Client Service Manager

25% off everything (excludes Private Sales, other announced promotions) All orders must ship from TG - flat $7.50 standard ground shipping fee. Rush shipping is available for $15 and $30. Any returns are to be given to your manager to forward to Hugo Returns. No Price Adjustments. HUGO BOSS does not support unauthorized reselling of product. Resellers will be prosecuted. TO ORDER: FOR OFFICE and CONTACT CENTER EMPLOYEES: Complete order form (located on SharePoint on the Human Resources page) and submit to Pete Scudder (pete.scudder@jaggedpeak.com), Client Service Manager. FOR WAREHOUSE EMPLOYEES in Cincinnati: Complete Order form and give to Security. 50% off plus free shipping. To Order: Send email to Chris Satchell (chris.satchell@jaggedpeak.com), Client Service Manager, for a discount code (each code is available for one-time use). Use code at checkout on www.footjoy.com

25% off (regular priced items and sales priced items), plus free shipping. To order: Send email to Lisa Toney (lisa.toney@jaggedpeak.com), Client Service Manager.

30% off (regular priced items only). To order: visit https://us.mcmworldwide.com . Create an account using your JaggedPeak email address. Example: Once you log-in under first.lastname@jaggedpeak.com, you will see the discount.

25% off (regular priced items, not sale or clearance). To order: Complete order form (located located on SharePoint on the Human Resources page) and submit to Stevie Frantz (Stevie.Frantz@tradeglobal.com), Catalog Manager (Contact Center)

20% off (regular priced items). To order: Contact Kristy Carmack (kristy.carmack@jaggedpeak.com), for a discount code . Order online http://www.narscosmetics.com.

30% off (regular priced items and sale priced items, excludes Clearance items). To order: Contact Brent Housel (Brent.Housel@jaggedpeak.com), Client Service Manager for a discount code. Use code at checkout on www.rockport.com.

JAGGED PEAK PERKS

20% off entire purchase. To order: Go to https://www.shiseido.com/on/demandware.store/Sites- Shiseido_US-Site/en_US/Account- StartRegister and REGISTER for an account. You MUST use your JaggedPeak.com email address when registering to be eligible. Email shelly.clapp@jaggedpeak.com and request to be added to the TG/Shiseido Employee Discount Group - discount will not be available until you have been added to the Group. 20% off (excludes Dior, Dior Homme, Fendi, Jack Spade, Maui Jim, and all sale merchandise. Not combinable with existing promotions on the website.) To order: Contact Kristy Carmack (kristy.carmack@jaggedpeak.com), for a discount code . Use code at checkout on www.SolsticeSunglasses.com 30% off (regular and sale priced items, final sale items excluded). To Order: Contact Lisa Toney (lisa.toney@jaggedpeak.com) to obtain a discount code. Use code at checkout on www.speedousa.com. Only one code may be used at time of purchase, MUST use a Jagged Peak email address to order. If the site is running a sale, you may use either the employee code/discount or the site discount/code, whichever is greater. 40% off (regular and sale priced items, final sale items excluded). To order: Contact Lisa Toney (lisa.toney@jaggedpeak.com) to obtain a discount code. Use code at checkout on www.shoptommy.com. Only one code may be used at time of purchase, MUST use a Jagged Peak email address to order. If the site is running a sale, you may use either the employee code/discount or the site discount/code, whichever is greater. 35% off (machines). To set up your account: Go to https://www.cswebresources.com/nespresso/discount_form.php. To access the web form, enter access code: 15PARTNER. If you are an existing Nespresso member enter your Customer ID# in the appropriate field. A confirmation email will be sent to you once the set-up is complete so you can log in to Nespresso.com and begin shopping with your discount. Account set-up processing time will take up to 5 business days.

30% off. To order: Use promo code: JaggedFriends

40% off. To order: Use promo code: HON1MB

Florida Employees can take advantage of discounts from multiple vendors. Examples include: • Anytime Fitness • AT&T • Costco • Keiser University Tuition Assistance • Medi Weight loss • and many more Ohio Employees can take advantage of discounts from multiple vendors. Examples include: • TG Perks: Discounts from over 240,000 retailers • Kings Island: Discounts on daily admission passes • Cedar Point: Discounts on daily admission passes • Tire Discounters: Friends and Family members receive discounts on products and services nationwide • Newport Aquarium: Discounted admission • Cincinnati Zoo: Discounted admission

For a complete listing of available discounts, visit the Oasis and PayCor employee portals.

www.mybensite.com/usjaggedpeak

1-888-574-7704

Required Annual Employee Disclosure Notices REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage; 5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. Further, a health insurer or health maintenance organization may not: 4. Require a mother to give birth in a hospital; or

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 The Women’s Health and Cancer Rights Act of 1998 requires Jagged Peak to notify you, as a participant or beneficiary of the Jagged Peak Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for: 1. All stages of reconstruction of the breast on which the mastectomy was performed; 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010 If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary. MICHELLE’S LAW

SECTION 111

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

REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

Required Annual Employee Disclosure Notices continued

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

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

The group health plan is a fully-insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements.

I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis- enrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information.

II. Insurer for group health plan will provide privacy notice

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

III. No intimidating or retaliatory acts

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

IV. No Waiver

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

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 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36

Made with FlippingBook Learn more on our blog