CCSNH 2019 Open Enrollment & Benefits Guide - Staff & Administration

2019 Open Enrollment & Benefits Guide Staff & Administration

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

TABLE OF CONTENTS Highlights for 2019, Informational Meetings

4

Useful Contacts

5

Medical Plan Options (Anthem)

6

Medical Plan Comparison

10

Medical Plan Buy-Out Program

12

Resources to Help You Compare & Save

13

Wellness @ CCSNH

16

Dental Plan (Delta Dental)

17

Life, AD&D, LTD (MetLife)

19

Voluntary Benefits - Vision, FSAs, Supplemental Life

20

Employee Assistance Program

22

Additional Notices

23

To Do List

29

Open Enrollment for Plan Year 2019 is 11/12/18 through 11/27/18

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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Highlights for 2019

Same Plans, Generous Funding, New EAP

We are pleased to report that the benefits within our three medical plans remain unchanged for 2019.

CCSNH pays approximately 94% of plan premiums in addition to funding a Health Reimbursement Account to pay 50% of in-network plan deductibles.

MKS Performance Solutions is our new Employee Assistance Program provider.

They are available 24/7 to provide confidential support (see page 22).

River Valley CC, Room 174 October 25, 2018, 12:30pm

NHTI/System Office, MacRury 138 October 30, 2018, 1:00pm

Informational Meetings

NHTI/System Office, Sweeney 122 October 31, 2018, 12:00 pm

Manchester CC, Room 100 November 1, 2018, 12:45pm

White Mountains CC, Room 100 November 2, 2018 10:00am

Nashua CC, Auditorium November 5, 2018, 12:00pm

Lakes Region CC, CAT 216 November 6, 2018, 12:00pm

Great Bay CC, Room 125/126/127 November 7, 2018, 10:00am

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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USEFUL CONTACTS

GBCC Diane Carroll

x7603

dscarroll@ccsnh.edu

LRCC Stacey Emerton

x6730

semerton@ccsnh.edu

MCC Jeannie DiBella

x8006

jdibella@ccsnh.edu

NCC Cathy Barry

x1766

cbarry@ccsnh.edu

NHTI Susan Makee

x4227

smakee@ccsnh.edu

RVCC Kathleen Medaglia

x7050

kmedaglia@ccsnh.edu

WMCC Gretchen Taillon

x3003

gtaillon@ccsnh.edu

System Kathleen Medaglia

x7050

kmedaglia@ccsnh.edu

System Sara Sawyer

x7003

ssawyer@ccsnh.edu

System Richie Coladarci

x7012

rcoladarci@ccsnh.edu

A

V

D

Anthem BCBS 800.870.3122 anthem.com

Vitals SmartShopper 800.824.9127 vitalssmartshopper.com

Delta Dental 800.832.5700 nedelta.com

M

B

MKS Performance Solutions 888.657.7373 (Employee Assistance Program)

Benefit Strategies 888.401.3539 benstrat.com (HRA Administrator - Purple Plan Only)

C

D

csONE Delta Vision 888.227.9745 x2040 866.723.0513 combinedservices.com eyemedvisioncare.com (Flexible Spending Accounts)

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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MEDICAL BENEFITS CCSNH will continue to offer three medical plan options through Anthem BCBS to its benefitseligible, full-time employees. Each health plan has a $4,000/individual and $8,000/family in-network deductible, and CCSNH provides a Health Reimbursement Account for the purpose of funding 50% of the in-network annual deductible costs. In all three plans, you benefit from your active engagement in managing your personal health, and how you access your health services. To that end, we strongly encourage you to review each plan as further described in the subsequent pages, and engage in a dialogue with a member of your HR staff, our benefit plan consultant, or a representative from Anthem to ensure that you completely understand the benefits provided and the tools, resources, and support provided.

One important resource to you is anthem.com. Besides serving as a 24x7 resource to answer questions about your plan, on the website subscribers can also:  Order and print out a temporary member ID card if you lose yours  Check the status of a claim  Search for a doctor, specialist or hospital  Learn about hundreds of health and wellness topics

Cost The medical plan rates for employees are listed on page 10. Note that employee contribution rates for the White and Purple Plan are identical, while the Green Plan (National PPO) also includes the employer premium difference between the Green Plan and the White Plan.

Eligibility Full-time staff and administrators are eligible to participate in a CCSNH medical plan the first day of the month following 30 days of full-time employment. They can enroll themselves, their spouse (and their eligible dependents) and their dependent children to age 26.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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MEDICAL PLAN-WHITE OPTION The White Plan is a Point-of-Service Plan, meaning that it offers both in-network and out-of-network benefits, but benefits are richer when accessing in-network providers. It has a $4,000 individual deductible and an $8,000 family deductible for in-network providers; the first 50% of which is covered by CCSNH through a Health Reimbursement Account (HRA). Below is a high-level overview of the plan; a more comprehensive Summary of Benefits and Coverage is available on myCCSNH. – (CDHP Lumenos BlueChoice New England with HRA) Within the White Plan, you are 100% covered for Preventative Care. This includes: Child Preventative Care

*Office Visits for preventative services *Screening Tests for vision, hearing and lead exposure. Also includes pelvic exam and Pap tests for females who are 18, or have been sexually active * Immunizations (Hep A, Hep B, Diphthereria [Tetanus, Pertussis/DtaP],Chicken Pox, Influenza, Pneumonia, HPV-cervical cancer, H. Influenza Type B, Polio, Measles, Mumps, and Rubella (MMR))

Adult Preventative Care

*Office Visits for preventative services *Screening Tests (cholesterol and lipid level tests, colorectal cancer, prostate cancer, diabetes, and osteoporosis). Also, includes mammograms, as well as pelvic exams and Pap test. *Immunizations (Hep A, Hep B, Diphthereria [Tetanus, Pertussis/DtaP], Chicken Pox, Influenza, Pneumonia, HPV-cervical cancer)

For Other Care

First - You will use your CCSNH HRA allocation ($2,000 towards Individual Coverage, $4,000 toward Family Coverage) to pay towards covered expenses (see below).

Covered Expenses include, but are not limited to: -Physician Office Visits -Maternity Care

-Outpatient Hospital Services -Prescription Drugs -Durable Medical Equipment -Emergency Hospital Services -Inpatient and Outpatient Mental Health and Substance Abuse Services

-Inpatient Hospital Services -Diagnostic X-rays/Lab Tests -Physical, Speech, & Occupational Therapy

-Chiropractic Care -Home Health Care -Hospice Care

*Some covered services have limitations or other restrictions. Please refer to full Summary of Benefits and Coverage.

Then - If you use all the money in your HRA, you will pay out of pocket until you meet your annual deductible.

Annual Deductible

(in-network and out-of-network deductibles do not cross accumulate)

In Network $4,000 for Single $8,000 for Family

Out of Network $8,000 for Single $16,000 for Family

After - You meet your annual deductible, the plan pays 100% for network providers and 70% for out-of-network providers and your prescription costs will now be co-pays.

Prescriptions

Rx Retail: $10/$35/$50/30% coinsurance to $250 max Rx Mail (90 day fill): $20/$70/$150/limited mail order

Additional Cost Protections for You The total amount you spend out-of-pocket in this plan is limited. Once you spend that amount, the plan pays 100% of the cost of covered services for the remainder of the benefit year. Your Annual Out-of-Pocket Maximum consists of funds you spend from your HRA, your deductible responsibility, and your Rx-CoPay and/or Co-Insurance Amounts.

Annual Out-of-Pocket Maximums

In Network $6,850 Individual Coverage $13,700 Family Coverage

Out of Network $16,000 Individual $24,000 Family

The benefit summary shown above does not replace the official plan documents or contracts that govern your eligibility to participate in these plans or the amount of benefits you may receive. If there is a discrepancy between the official plan documents and this summary, your actual benefits will always be governed by the plan documents. Some of the above services may require precertification. Please confirm with Anthem.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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MEDICAL PLAN-GREEN OPTION The Green Plan has a plan design and benefits very similar to the White Plan. The main distinction is that the Green Plan uses the broader “National” network of providers, instead of the New England network used in the White and Purple Plans. This buy-up plan (the employee contributions are higher, see rates on page 11) may be suited for those who regularly access non-emergency care outside of New England. Below is a high-level overview of the plan; a more comprehensive Summary of Benefits and Coverage is available on myCCSNH.

– (CDHP Lumenos National PPO Health Plan, with HRA) Within the Green Plan, you are 100% covered for Preventative Care. This includes: Child Preventative Care

*Office Visits for preventative services *Screening Tests for vision, hearing and lead exposure. Also includes pelvic exam and Pap tests for females who are 18, or have been sexually active * Immunizations (Hep A, Hep B, Diphthereria [Tetanus, Pertussis/DtaP],Chicken Pox, Influenza, Pneumonia, HPV-cervical cancer, H. Influenza Type B, Polio, Measles, Mumps, and Rubella (MMR))

Adult Preventative Care

*Office Visits for preventative services *Screening Tests (cholesterol and lipid level tests, colorectal cancer, prostate cancer, diabetes, and osteoporosis). Also, includes mammograms, as well as pelvic exams and Pap test. *Immunizations (Hep A, Hep B, Diphthereria [Tetanus, Pertussis/DtaP], Chicken Pox, Influenza, Pneumonia, HPV-cervical cancer)

For Other Care

First - You will use your CCSNH HRA allocation ($2,000 towards Individual Coverage, $4,000 toward Family Coverage) to pay towards covered expenses (see below).

Covered Expenses include, but are not limited to: -Physician Office Visits -Maternity Care

-Outpatient Hospital Services -Prescription Drugs -Durable Medical Equipment -Emergency Hospital Services -Inpatient and Outpatient Mental Health and Substance Abuse Services

-Inpatient Hospital Services -Diagnostic X-rays/Lab Tests -Physical, Speech, & Occupational Therapy

-Chiropractic Care -Home Health Care -Hospice Care

*Some covered services have limitations or other restrictions. Please refer to full Summary of Benefits and Coverage.

Then - If you use all the money in your HRA, you will pay out of pocket until you meet your annual deductible.

Annual Deductible (in-network and out-of-

network deductibles do not cross accumulate)

In Network $4,000 for Single $8,000 for Family

Out of Network $8,000 for Single $16,000 for Family

After - You meet your annual deductible, the plan pays 100% for network providers and 70% for out-of-network providers.

Additional Cost Protections for You The total amount you spend out-of-pocket in this plan is limited. Once you spend that amount, the plan pays 100% of the cost of covered services for the remainder of the benefit year. Your Annual Out-of-Pocket Maximums consists of funds you spend from your HRA, your deductible responsibility and your Co-Insurance Amounts.

Annual Out-of-Pocket Maximums

In Network $6,850 Individual Coverage $13,700 Family Coverage

Out of Network $16,000 Individual $24,000 Family

The benefit summary shown above does not replace the official plan documents or contracts that govern your eligibility to participate in these plans or the amount of benefits you may receive. If there is a discrepancy between the official plan documents and this summary, your actual benefits will always be governed by the plan documents. Some of the above services may require precertification. Please confirm with Anthem.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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MEDICAL PLAN-PURPLE OPTION The Purple Plan is an Access Blue New England HMO Site of Service Plan, which is a health plan designed to reward members for using lower cost health care providers (e.g. independent labs are no cost to plan members). It requires up front copayments for doctor visits, specialty care, outpatient surgical (approved facilities), and prescriptions.

However, none of these expenses are applied to your deductible, meaning that the funding by CCSNH for your HRA is preserved for other medical expenses that are subject to your plan deductible. Below is a high-level overview of the plan; a more comprehensive Summary of Benefits and Coverage is available on myCCSNH. (Access Blue New England HMO Site of Service, with HRA) Services Covered 100% for Preventative Care Child Preventative Care

*Office Visits for preventative services *Screening Tests for vision, hearing and lead exposure. Also includes pelvic exam and Pap tests for females who are 18, or have been sexually active * Immunizations (Hep A, Hep B, Diphthereria [Tetanus, Pertussis/DtaP],Chicken Pox, Influenza, Pneumonia, HPV-cervical cancer, H. Influenza Type B, Polio, Measles, Mumps, and Rubella (MMR))

Adult Preventative Care

*Office Visits for preventative services *Screening Tests (cholesterol and lipid level tests, colorectal cancer, prostate cancer, diabetes, and osteoporosis). Also, includes mammograms, as well as pelvic exams and Pap test. *Immunizations (Hep A, Hep B, Diphthereria [Tetanus, Pertussis/DtaP], Chicken Pox, Influenza, Pneumonia, HPV-cervical cancer)

Lab tests furnished by an independent laboratory provider

Services Subject to Co-Payment Only Medical exams, injections (including allergy injections), office surgery and anesthesia Surgery and anesthesia in an independent ambulatory surgery center Physical/Occupational/Speech therapy (up to 20 visits per therapy, per member, per calendar year) Urgent care facility charge Chiropractic visit (chiropractic x-ray subject to deductible) Prescriptions

$25 per visit to your PCP $50/Visit to Specialist or Network Walk-In Center $125 per admission $50 per visit $125 per visit $50 Rx Retail: $10/$35/$50/30% coinsurance to $250 max Rx Mail (90 day fill): $20/$70/$150/limited mail order

Services Subject to Deductible You will use your HRA allocation from CCSNH to pay towards deductible expenses (see below). If you use all the money in your HRA, you will pay out of pocket until you meet your annual deductible. $2,000 HRA towards Individual Coverage $4,000 towards Family Coverage Lab tests furnished by a non-independent lab provider

Deductible

Urgent Care physician fee, CT scan, MRI

Deductible

Inpatient and Outpatient Hospitalization Emergency Room Services

Deductible $250 co-pay plus Deductible

Other services in Certificate of Coverage Annual Deductible

Deductible In Network $4,000 for Single $8,000 for Family

After you meet your annual deductible, you will continue to be responsible for any applicable copayments until you meet the out of pocket maximum of $6,600 (single) / $13,200 (family)

The benefit summary shown above does not replace the official plan documents or contracts that govern your eligibility to participate in these plans or the amount of benefits you may receive. If there is a discrepancy between the official plan documents and this summary, your actual benefits will always be governed by the plan documents. Some of the above services may require precertification. Please confirm with Anthem.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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MEDICAL PLAN COMPARISON Benefits

In Network Deductible(s) Plan Deductible Health Reimbursement Account Out of Pocket Maximum Physician Office Visits Primary Office Specialist Office Chiropractic Hospital Services Inpatient Hospitalization Outpatient Hospitalization Emergency Room Urgent Care Pharmacy Benefits Deductible Applies?

Tier 1: Generic Tier 2: Preferred Brand Name Tier 3: Brand Name Tier 4: Specialty Other Benefits Preventive Care Services Outpatient Surgery / Select Locations Independent Laboratory Services Hospital Laboratory Services X-Ray, MRI, CT Scan, PET Scan Vision Examination Durable Medical Equipment Non Network Benefits Deductible Coinsurance Out of Pocket Limit Network Network

High Deductible WHITE

High Deductible GREEN

Site of Service PURPLE

$4,000 (2x Family) $2,000 (2x Family) $6,850 (2x Family)

$4,000 (2x Family) $2,000 (2x Family) $6,600 (2x Family)

Deductible Deductible Deductible

$25 $50 $50 (unlimited)

Deductible Deductible Deductible Deductible

Deductible Deductible $250 Copay + Deductible $125 Copay + Deductible

YES $10 (2x Mail, 90 day) $35 (2x Mail, 90 day) $50 (3x Mail, 90 day) 30% coinsurance, $250 max. (limited mail order)

$0 $0 $0 $0

NO $10 (2x Mail, 90 day) $35 (2x Mail, 90 day) $50 (3x Mail, 90 day) 30% coinsurance, $250 max. (limited mail order)

100%

100%

Deductible

$125 Copay

Deductible Deductible Deductible $0 (every 2 years) Deductible

100% Deductible Deductible $0 (every 2 years) $100 Deductible then 20%

$8,000 (2 per family) 30% $16,000 single / $24,000 family

None None None

New England

National

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

New England

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MEDICAL PLAN EMPLOYEE CONTRIBUTIONS Bi-Weekly, Pre-Tax Payroll Deductions (calculated based on 26 pay periods) Single Employee + Family Coverage 1 Coverage Coverage (CDHP Lumenos BlueChoice New England, with HRA)

$30.00

$50.00

$65.00

$103.27

$209.73

$276.32

$30.00

$50.00

$65.00

(CDHP Lumenos National PPO Health Plan, with HRA)

(Access Blue New England HMO Site of Service, with HRA)

Employee Premium Contributions listed above are effective with the 1/18/19 pay date and subject to change pursuant to the in-force collective bargaining agreement or Board approval, as applicable.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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MEDICAL PLAN BUY-OUT PROGRAM CCSNH has a Medical Buy-Out Program that allows benefits-eligible full-time employees to receive a generous incentive payment for waiving your CCSNH health (medical and pharmacy) insurance benefits, should you elect available group coverage elsewhere. For a full-time employee who waives the medical benefit because they are either insured through a spouse’s or parent’s employer-provided non-CCSNH group health plan, or through a group plan available through other employment, s/he will receive:  $2,000/annually, when Employee Only coverage is waived  $3,000/annually, when Employee + 1 coverage is waived  $4,000/annually, when Family coverage is waived Payments are made on a bi-weekly basis in your payroll check and are subject to the tax laws of the Internal Revenue Service (IRS) as they apply to taxable fringe benefits. Please see below for answers to Frequently Asked Questions about the program.

When can I enroll?

Now, because it is Open Enrollment, and during the plan year only if a Qualifying Event occurs. New employees may also enroll within 31 calendar days after being eligible to receive CCSNH health benefits coverage. Annual enrollment in the medical insurance buy-out program is required.

How do I do so?

To enroll in the program, an employee must complete the Medical Buy-Out Enrollment/Change Form and submit the completed form, along with proof of other medical coverage to Human Resources. An employee, including current participants, must also elect (or re-elect) this option on the CCSNH Employee Self Service Portal at https://portal.adp.com by the Open Enrollment deadline of Tuesday, November 27. CCSNH medical coverage will not be terminated until other eligible coverage is in effect, appropriate documentation has been submitted, and such documentation has been approved by the CCSNH. Once I enroll, can I reinstate my CCSNH medical benefits?

Yes. As an active employee, you may withdraw from the buy-out program during Open Enrollment or during the plan year based on a Qualifying Event. To withdraw during the plan year, you must experience a Qualifying Event and provide proof of loss of coverage within 31 days after that loss.

Can I participate in the Medical Buy-Out Program and still elect the dental benefit?

Yes. CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

page 12

LIVEHEALTH ONLINE Given the rapid growth of telemedicine, we are pleased to highlight a way for you to access convenient and affordable care through Anthem BCBS – LiveHealth Online.

Using LiveHealth Online, you can have a video visit with a doctor or therapist on your smartphone, tablet or computer with a webcam that includes: 

Immediate access to board-certified doctors 24/7. It’s a great option for care when your doctor isn’t available. Doctors using LiveHealth Online can provide medical care for common conditions, like the flu, colds, pink eye and more.



The ability to have prescriptions sent to the pharmacy of your choice. Doctors in NH have the ability to prescribe medicine, based on the online visit. And they’ll even send prescriptions to the pharmacy of your choice, if needed.

Employees enrolled in the White Plan (CDHP Lumenos BlueChoice New England) or Green Plan (CDHP Lumenos National PPO) will pay $49 at the time of service, and can submit for reimbursement from their HRA afterward (contingent on available funds). Employees enrolled in the Purple Plan (Access Blue New England HMO Site of Service) will be charged only $10, reduced from $25 in 2018. Lastly, all other employees, full and part-time, that are not on our plans can also access the service for a flat fee of $49.

It’s quick and easy to sign up and get started. Just go to livehealthonline.com or download the mobile app.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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VITALS SMARTSHOPPER If you are enrolled in a CCSNH Anthem plan, SmartShopper is a voluntary program to help you be a savvy medical consumer by reminding you that you have choices when it comes to your health care.

If your doctor recommends a particular medical service, SmartShopper can tell you how much that test or procedure costs at different in-network facilities in your area. If you choose a cost-effective option, you can qualify for a cash reward.

SmartShopper is provided as part of your Anthem plan at no additional cost to you. Rewards range from $25 to $1,000, and rewards checks are mailed within 45 to 60 days of claim payment.

All health centers suggested by SmartShopper are part of the Anthem network and have met strict quality standards. The locations are well-known and fully licensed to provide services.

Click on the video below for steps on how to use the program, and then register at vitalssmartshopper.com or contact the SmartShopper Personal Assistant team at 1-800-824-9127 to learn more about the dozens of services eligible for rewards.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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OTHER RESOURCES TO HELP YOU COMPARE & SAVE As healthcare costs continue to rise, it is becoming more and more important for us to become educated consumers regarding our medical plan usage. This includes accessing tools that help us research cost and quality of healthcare and exploring alternatives to care. Below are a specific resources available to you through our health plan and other free resources dedicated to lowering your out-of-pocket costs.

NH HealthCost (nhhealthcost.nh.gov) was developed by the New Hampshire Insurance Department to improve the price transparency of health care services in New Hampshire. It allows you to compare the estimated cost of healthcare procedures by medical provider or facility and using claims data from the New Hampshire Comprehensive Health Information System database.

GoodRx (goodrx.com) was founded on the principle to enable smarter consumers to make better choices. It allows you to search by location to find out different prices of medications at local pharmacies and when discount coupons are available

Lastly, we are fortunate to have built a partnership in recent months with ConvenientMD (convenientmd.com), a New Hampshire-based company that provides timely treatment of non-life threatening injuries and illnesses at low-cost, walk-in urgent care centers. ConvenientMD has locations in Bedford, Concord, Dover, Exeter/Stratham, Keene, Merrimack, Nashua, Portsmouth and Windham/Greater Salem. As many of our employees are on the White plan whose services are initially funded 50% from an HRA, ConvenientMD has provided cards for these plan participants that ensure that our employees will never be charged up front.

To pick up a card, stop by your HR office.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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WELLNESS @ CCSNH As part of the CCSNH Community, you have access to a robust wellness program to improve your physical and mental well-being.

Fitness Reimbursement Programs Eligible CCSNH employees enrolled in an Anthem medical plan can take advantage of one of the following two fitness reimbursement programs each year.

Anthem Fitness Reimbursement Program Receive reimbursement of up to $450 per subscriber per calendar year (January 1-December 31) for membership dues at fitness clubs when they work out a minimum of eight times per month. A qualified fitness facility must include equipment for both cardiovascular and strength training and require a member to pay membership dues.

Anthem Home Exercise Equipment Reimbursement Program Receive reimbursement of up to $200 per subscriber per calendar year (January 1-December 31) for the purchase of home exercise equipment that provides a cardiovascular/muscular total-body workout.

On-Site Flu Shots Each fall on-campus flu shots are conveniently made available to CCSNH employees.

Community Health Education Reimbursement Programs CCSNH Anthem subscribers are eligible for reimbursement of up to $150 per family per calendar year for fees related to classes or group therapy for Smoking Cession, Nutrition Education, Weight Management, Stress Management, Physical Activity, Childbirth Education, and Parenting Education.

Campus Wellness Committees Campuses and the system office have employee-driven wellness committees. Get involved! Activities range from fitness programs and competitions to guest speakers on wellness and nutrition.

Wellness Incentives for Anthem Subscribers Tobacco-free If you certify you are tobacco-free or submit a Health Action Plan $50 gift card

Prevention If you get a preventative wellness exam and flu shot during the year Two Gift Cards Totaling $100

Online Wellness Information If you participate in an online wellness toolkit Up to $150 in Gift Cards

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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DENTAL PLAN - DELTA DENTAL The Delta Dental plan offered through CCSNH features 100% coverage for diagnostic/preventive care, three cleanings per calendar year, 80% coverage for basic restorative care, and 50% coverage for major restorative care up to calendar year maximum of $1,800 per person (all services combined).

In addition, the plan offers 50% orthodontia coverage for both adults and eligible children, up to a $1,500 lifetime maximum.

Members are free to visit any dentist, though you’ll get your best value with less hassle when you receive care from a Delta Dental PPO or Delta Dental Premier participating dentist. This is because participating dentists have agreed upon Delta Dental’s approved amounts for service so there will be no balance billing, and Delta Dental pays the dentist directly so there are no claim forms. Find participating dentists, look up benefits and claims, or access your ID cards on nedelta.com or on the Delta Dental app.

The following page contains a summary of benefits but to best understand how to use the plan as well as the specific benefits and plan provisions, please refer to the Dental Plan Description booklet posted on myCCSNH. Cost (Bi-Weekly Pre-Tax Employee Payroll Deductions) Level Employee Employee + 1 Family

Rate* $3.00 $5.00 $8.00

*Effective with 1/18/19 pay date and subject to change pursuant to the in-force collective bargaining agreement or Board approval, as applicable.

Eligibility Full-time staff and administrators are eligible to participate in a CCSNH medical plan the first day of the month following 30 days of full-time employment. They can enroll themselves, their spouse (and their eligible dependents) and their dependent children to age 26.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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DENTAL PLAN - DELTA DENTAL Diagnostic/Preventative Coverage A Deductible: None

Basic Restorative Coverage B

*Covered at 100%

*Covered at 80%

Diagnostic: Evaluations, 2x/calendar yr.

Basic Restorative: Amalgam(silver) fillings; Composite (white) fillings (anterior teeth only)

X-rays

Major Restorative Coverage C Deductible: $25 per person/calendar yr.** *Covered at 50%

Orthodontics Coverage D Deductible: None

Major Restorative Removable and fixed partial dentures (bridge)

Orthodontics:

*Covered at 50%

Correction of (crooked) teeth for adults and eligible children.

Complete dentures

Complete series or panoramic film, once in a 5 yr. period; bitewings, 2x/calendar yr.; x-rays of individual teeth as needed.

Preventative Cleanings, 3x/calendar yr.

Fluoride, 1x/calendar yr. to age 18

Space maintainers 1x/lifetime to age 16

Sealant application to permanent molars, 1x/three yr. period per tooth to age 19

Oral Surgery: Surgical and routine extractions Endodontics: Root canal therapy

Restorative Crowns Onlays

Emergency Palliative Treatment Periodontics: Treatment of gum disease Periodontal cleaning (maintenance procedures) Note: Cleanings are limited to three in a calendar year; these may be routine (Coverage A) or periodontal (Coverage B), or a combination of both.

Clinical crown lengthening - once per lifetime per site.

Denture Repair: Repair of a removable denture to its original condition Rebase and reline (dentures)

Calendar yr. Maximum: $1,800 per person (Coverages A, B, and C combined)

Lifetime Max: $1,500

*Benefit percentages are based upon the actual charges submitted up to the Maximum Allowable Charge for participating providers or Northeast Delta Dental’s allowance for non-participating providers. **Any expense incurred during the last 3 months of a calendar year which is applied against an individual’s deductible will also reduce his/her deductible for the next calendar year.

CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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BASIC TERM LIFE/AD&D AND LONG TERM DISABILITY

CCSNH provides Basic Life and Accidental Death and Dismemberment (AD&D) and Long Term Disability (LTD) insurance benefits through MetLife Insurance Company.

Basic Life Insurance is equal to one times (1X) an employee's basic annual earnings to a maximum of $300,000; the minimum benefit is $25,000. Basic Life features include, but are not limited to:  Continuation of Life insurance while totally disabled (as defined by the Group Policy)  Accelerated Benefits Option  Conversion and Portability AD&D features include, but are not limited to:  100% of the Basic Life Benefit  Continuation of Life insurance while totally disabled (as defined by the Group Policy)  Portability  Funeral planning and grief counseling services Note: There is an age reduction formula for Basic Life and AD&D of 50% at age 70.

In addition to the above, employees are automatically eligible for Travel Assistance services with MetLife’s AD&D coverage. Travel Assistance, administered by AXA Assistance USA, Inc., is a valuable benefit which offers employees and their dependents medical, travel, legal, financial and concierge services, 24 hours a day, 365 days a year while traveling internationally or domestically.

The Long Term Disability Plan coverage provides income replacement equal to 60% of monthly earnings with a maximum monthly benefit of $6,000. The waiting period is 180 calendar days (6 months). Eligible employees are automatically enrolled in this 100% company-paid plan.

MetLife also offers additional disability plan benefits to help you return to work and financial incentives and assistance in obtaining Social Security Benefits to help you get the maximum benefits from your coverage.

Eligibility Active, eligible full-time employees are automatically enrolled in this 100% company-paid plan on the first of the month following 30 days of employment.

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VISION PLAN – DELTA VISION Delta Vision is a voluntary, 100% employee-paid comprehensive vision plan with a network of both independent providers and retail chains through the EyeMed Vision Care network. This represents almost 88,000 providers nationwide including the most popular optical retail outlets such as LensCrafters, Target Optical, Sears Optical, JCPenney Optical and many Pearle Vision locations.

Below is a high-level overview of the plan benefits. For a more detailed summary, visit myCCSNH. Services Every 12 Months

Network

Non-Network (Reimbursement)

Annual Vision Exam

$10 Copay

$35 allowance

Frames

$130 Allowance, then 20% off balance

$65 allowance

Standard Plastic Lens

$25 Copay

Single: $25 allowance Bi-focal: $40 allowance Tri-focal: $55 allowance

Contact Lenses (in place of frame lenses)

$130 Allowance, then 15% off balance

Conventional: $104 allowance Disposable: $104 allowance

Like your medical and dental contribution, your vision premiums will be deducted bi-weekly from your pay on a pre-tax basis. The premium rates remain the same for 2019.

Cost (Bi-Weekly Pre-Tax Employee Payroll Deductions) Level Employee Employee + 1 Family

Rate $3.68 $6.31 $11.29

Eligibility Full-time staff and administrators are eligible to participate in a CCSNH medical plan the first day of the month following 30 days of full-time employment. They can enroll themselves, their spouse (and their eligible dependents) and their dependent children to age 26.

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FLEXIBLE SPENDING ACCOUNTS CCSNH offers you the opportunity to participate in a Health Care Reimbursement Account and/or a Dependent Care Reimbursement Account through csONE Benefit Solutions (previously Combined Services). These flexible spending accounts provide you a way to pay for eligible out-of-pocket health care not covered by your health plan and/or dependent care expenses on a pre-tax basis through payroll deductions, up to the IRS allowable limits. This means that contributions to your FSA are deducted before taxes are calculated on your pay. Examples of expenses that can be covered by a Health Care FSA include: co-payments and deductibles, vision care, acupuncture, non-covered dental and orthodontia care. Examples of expenses that can be covered by a Dependent Care FSA include: licensed day care or nursery schools and dependent care in your home. Eligible dependents must be under the age of 13, or incapable of self-care.

Please note that any unused funds that remain at the end of the calendar year beyond a permissible $500 rollover for the health care FSA, are forfeited per IRS regulations. Keep track of your account by using the csONE app.

Health Care FSA Dependent Care FSA

Administration Fee, paid by employee $3.65/month $3.65/month

Minimum Annual Contribution $200 n/a

Maximum Annual Contribution *$2,650 $5,000

Rollover $500 n/a

*Please note that if the IRS increases the maximum allowable annual contribution for 2019, the plan will be adjusted accordingly.

SUPPLEMENTAL LIFE INSURANCE During Open Enrollment, or anytime throughout the year, current employees can enroll in or increase their current supplemental life insurance policy, subject to an evidence of insurability. Supplemental life insurance, offered through MetLife, provides you the peace of mind of knowing that your family or close friends can continue to lead the lifestyle you have provided them while not burdening them with any debts. Supplemental coverage is voluntary, 100% employee paid, and deducted from your paycheck on a post-tax basis. This coverage is in addition to basic Life and AD&D (accidental death and dismemberment) insurance, which the CCSNH provides for you at no cost equal to one times (1x) your basic annual earnings to a maximum of $300,000. All coverage has an evidence of insurability requirement.

If you purchase additional coverage for yourself, you can also purchase spousal coverage to a maximum of $100,000 and life insurance of $3,000 for your eligible children.

For more information on Supplemental Life and AD&D coverage and rates visit myCCSNH.

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EMPLOYEE ASSISTANCE PROGRAM CCSNH partners with MKS Performance Solutions to address the full range of personal or professional challenges employees may experience to include: stress, life event changes, relationship issues, and health concerns.

MKS features:  Live 24/7 support  Face-to-face consultation sessions for employees and their household members  Legal and financial consultation  Childcare and eldercare information and resources  Crisis management services  An employee-accessible website with online resources, referral services and training

In addition, managers and supervisors can avail themselves of expert consultation regarding workforce performance and risk management issues.

Connect with a counselor by calling: 1.888.657.7373

Access resources online at: https://mks.personaladvantage.com (company code: CCSNH)

Maintenance of confidentiality is one of the most important aspects of EAP. Asserting and maintaining the confidentiality of employees’ participation in the program is the cornerstone of professional ethics as well as federal and state regulations that apply to EAP's.

Confidentiality in the EAP will be maintained within the rules established by federal and state law and professional ethical standards.

Disclosure of information shared by the employee to any source without the prior written consent of that employee is prohibited. This means that the fact that an employee has consulted with EAP, as well the details of the conversation, are usually protected against disclosure.

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ADDITIONAL NOTICES Please note the following required notifications: 

Summary of Benefits and Coverage



Women’s Health and Cancer Rights Act



Preventive Care Services



Department of Labor Model Exchange Notice (copy of DOL Notice is attached)



Newborns’ and Mothers’ Health Protection Act



General Notice of COBRA Continuation Coverage Rights (copy of COBRA Notice is attached)



Children’s Health Insurance Program Reauthorization Act



Medicare Part D Prescription Drug Coverage For more information regarding your health plan please contact your company Benefits Administrator Sara Sawyer (603) 230-3503.

---------------------------------------------------------------------------------------------------------------------------------------------Summary of Benefits & Coverage of Health Insurance Under the Affordable Care Act, health insurers and group health plans will provide the 180 million Americans who have private insurance with clear, consistent and comparable information about their health plan benefits and coverage.

Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage.

This summary of benefits and coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

An SBC must be provided to all “participants and beneficiaries” without charge regardless of group size and/or the employee’s intent to elect or waive benefits. Participants include employees or retirees who are, or may become, eligible for a benefit under the plan; beneficiaries include the participant’s dependents that may be entitled to coverage under the plan.

SBCs should be provided at the following times: -Initial enrollment: An SBC for each benefit package option for which the participant becomes eligible (e.g., new hires, qualifying status changes) must be included in any distribution of enrollment materials. If written enrollment materials are not distributed, the SBC must be furnished no later than the first date the individual is eligible to enroll in coverage.

-Open enrollment: An SBC for the benefit package option in which the participant is enrolled must be included with other open enrollment materials, and will be posted on myCCSNH. The regulations provide that if reenrollment is automatic, the SBC must be provided no later than 30 days before the beginning of the next plan year.

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-HIPAA special enrollment: Generally, an SBC for the benefit package option in which a special enrollee enrolls must be provided no later than 90 days after enrollment (the same time frame for providing an SPD). However, individuals who have not yet enrolled may request an SBC for any benefit package option at any time. These SBCs must be furnished as described below.

-On request: An SBC must be provided as soon as practical (but no more than seven business days) after a request.

--------------------------------------------------------------------------------------------------------------------------------------------Women’s Health and Cancer Rights Act (WHCRA) If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: -All stages of reconstruction of the breast on which the mastectomy was performed; -Surgery and reconstruction of the other breast to produce a symmetrical appearance; -Prostheses; and -Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.

Refer to the attached Anthem Blue Cross Blue Shield SBC (Summary of Benefits and Coverage) for specific member cost share effective January 1, 2018.

--------------------------------------------------------------------------------------------------------------------------------------------Health Insurance Preventive Care Services Legislation The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover preventive services and by eliminating cost sharing for those services.

Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.

Details on the specific preventive care services included, at no cost to members, through your Anthem Blue Cross Blue Shield health insurance plan are listed on the attached Preventive Services document --------------------------------------------------------------------------------------------------------------------------------------------Department of Labor Model Exchange Health Insurance Marketplace Notice Beginning no later than October 1, 2013, group health plan sponsors (employers) must give a written notice to each employee (regardless of the employee's plan enrollment status, if applicable, or of part-time or full-time status), providing information about coverage options under the state and federal health benefits exchanges (referred to as "the Health Insurance Marketplace" or "Marketplace").

The notice deadline of October 1, 2013, is the date when "open enrollment" begins for coverage through the Marketplace.

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For new employees, effective October 1, 2013, employers must provide the notice at the time of hiring.

For 2014 and later, if the notice is provided within 14 days of the employee's start date, then the DOL will consider the notice to be provided at the time of hiring.

-------------------------------------------------------------------------------------------------------------------------------------------Newborns’ and Mothers’ Health Protection Act (NMHPA) The Newborns’ and Mothers’ Health Protection Act of 1996 (the Newborns’ Act), signed into law on September 26, 1996, requires plans that offer maternity coverage to pay for at least a 48-hour hospital stay following childbirth (96hour stay in the case of a cesarean section).

This law was effective for group health plans for plan years beginning on or after January 1, 1998.

On October 27, 1998, the Department of Labor, in conjunction with the Departments of the Treasury and Health and Human Services, published interim regulations clarifying issues arising under the Newborns’ Act. The changes made by the regulations are effective for group health plans for plan years beginning on or after January 1, 1999.

The Newborns’ Act and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier.

The Newborns’ Act, and its regulations, prohibits incentives (either positive or negative) that could encourage less than the minimum protections under the Act as described above.

A mother cannot be encouraged to accept less than the minimum protections available to her under the Newborns’ Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery.

The type of coverage provided by the plan (insured or self-insured) and state law will determine whether the Newborns’ Act applies to a mother’s or newborn’s coverage.

The Newborns’ Act provisions always apply to coverage that is self-insured. If the plan provides benefits for hospital stays in connection with childbirth and is insured, whether the plan is subject to the Newborns’ Act depends on State law. Based on a recent preliminary review of State laws, if the coverage is in Wisconsin and several U.S. territories, it appears that the Federal Newborns’ Act applies to the plan. If the coverage is in any other state or the District of Columbia, it appears that State law applies in lieu of the Federal Newborns’ Act. -------------------------------------------------------------------------------------------------------------------------------------------Continuation Coverage Rights Under COBRA The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your CCSNH group health coverage. It can also become available to other members of your family who are covered under the CCSNH group health plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, please refer to the attached Initial COBRA letter and also, you should review the Plan’s Summary Plan Description or contact the Benefit Administrator.

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Medicaid and the Children’s Health Insurance Program (CHIP) Maine, Massachusetts, Vermont and New Hampshire Offer Free or Low-Cost Health Coverage to Children and Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, you can 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, you can 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, you can ask the state if it has a program that might help you pay the premiums for an employersponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2012. You should contact your state for further information on eligibility – MAINE - Medicaid

VERMONT -Medicaid

Phone: 1-800-977-6740

Phone: 1-800-250-8427

http://www.maine.gov/dhhs/ofi/public-assistance/index.html

http://www.greenmountaincare.org/

MASSACHUSETTS - Medicaid and CHIP

NEW HAMPSHIRE – Medicaid

Phone: 1-800-462-1120

Phone: 603-271-5218

http://www.mass.gov/eohhs/gov/departments/masshealth/

http://www.dhhs.nh.gov/ombp/index.htm

*To view additional states that have added a premium assistance program since January 31, 2012, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor

U.S. Department of Health and Human Services

Employee Benefits Security Administration

Centers for Medicare & Medicaid Services

1-866-444-EBSA (3272); www.dol.gov/ebsa

1-877-267-2323, Ext. 61565; www.cms.hhs.gov

-----------------------------------------------------------------------------------------------------------------------------------------------

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Medicare Part D Prescription Drug Coverage Employees, their spouses, and other dependents who will be or currently are 65 years old or older within the next year PLEASE READ If you or any of your dependents is Medicare Part D eligible and considering enrolling in the CCSNH Prescription Drug Coverage, please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the CCSNH 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.

Your employer, CCSNH has determined that the prescription drug coverage offered by Anthem Blue Cross Blue Shield 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.

The information on the following page will help you better understand how and when you can join a Medicare Drug Plan if you so choose.

Joining a Medicare Drug PlanYou can join a Medicare drug plan when you first become eligible for Medicare and each year from OCTOBER 15th until 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.

Your Current Coverage and a Medicare Drug PlanIf you decide to join a Medicare drug plan, your CCSNH coverage will not be affected.

Please see your Anthem Blue Cross Blue Shield SBC (Summary of Benefits and Coverage) plan description for more detail to compare the plan provisions/options between your CCSNH plan and the Medicare Part D coverage. You may also contact the Human Resources Department for more information and answers to your questions.

If you decide to join a Medicare drug plan and drop your CCSNH coverage, be aware that you and your dependents may or may not be able to get this coverage back, see your Anthem Blue Cross Blue Shield SBC (Summary of Benefits and Coverage) plan description for verification or contact your Human Resources Department for more information.

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 CCSNH and don’t join a Medicare drug plan CCSNH Open Enrollment and Employee Benefits Guide – Staff & Admin, Plan Year 2019

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within 63 continuous days after your current coverage ends, you may pay a higher premium (a Penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

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TO DO LIST: o Review this Benefits Guide and share it with your family. This Guide provides important information about your benefit options and their related costs. o If you are unclear about some of the terminology used, review this Glossary of Health Coverage and medical Terms. o

Attend one of the Open Enrollment on-campus presentations.

o If you are a current participant in the medical plan, use this once-a-year opportunity (outside of a qualified event) to transition to another plan, should you choose to do so. If you would like to make a change, you must select a new plan on the CCSNH Employee Self Service Portal at https://portal.adp.com by the Open Enrollment deadline of Tuesday, November 27. If you would like to remain in the same medical plan with the same elections, your coverage will continue uninterrupted. o If you are a current participant in the Medical Buy Out Program or wish to enroll for 2019, you must enroll/re-enroll by submitting a new Medical Insurance Buy-Out Enrollment/Change Form with proof of other non-CCSNH medical coverage. You will also need to elect this option on the CCSNH Employee Self Service Portal at https://portal.adp.com by the Open Enrollment deadline of Tuesday, November 27. o If you are a current participant in Delta Vision Plan or Flexible Spending Account program or wish to enroll for 2019, you must enroll/re-enroll on the CCSNH Employee Self Service Portal at https://portal.adp.com by the Open Enrollment deadline of Tuesday, November 27. o If you are a current participant in the Delta Dental plan and/or Supplemental Life Insurance programs and wish to continue participation with no changes, you need not do anything as your coverage will continue uninterrupted. New enrollees or those interested in making changes must do so on the CCSNH Employee Self Service Portal. o Get additional information and download any necessary forms by logging on to myCCSNH. o Ask questions. If you have additional questions after reading this Benefits Guide, contact any member of the Human Resources staff. o Verify your elections. Don’t forget to carefully check your pay stub to make sure you are enrolled for the benefits you elected. If you have questions or believe there is an error, contact Human Resources immediately.

About this Benefits Guide This Benefits Guide is not intended to be, nor shall it be construed as, a contract of any type. It highlights features of CCSNH’s health plans and it is not intended to cover the programs in detail. Every effort has been made to ensure the accuracy of the information presented however in the event of discrepancies, your coverage will be determined by the legal plan documents that govern the plan.

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