Benefits Guide
2021 Federally insured by NCUA
TABLE OF CONTENTS
2
Welcome
3
Benefit Cost Summary
4
Medical Insurance
5
Healthcare Plan Infographic
6
Teladoc
7
Dental Insurance
8
Vision Insurance
9
Flexible Spending Account (FSA)
10
Life & Disability Insurance
11
401(K)
12
Employee Assistance Program
13
Time Away From Work
14
Paid Medical Leave
15
Wellness Program | Benefits & Incentives
16
Wellness Program
17
TEAM Consumers
18
Team Rewards Card Benefits
19
Human Resource Team
20
Benefit Contact Information
21
Notice
1
WELCOME TO BENEFITS AT CONSUMERS CREDIT UNION At Consumers Credit Union, our employee benefit plans are designed to provide you and your family members with: •
Quality, comprehensive health care coverage.
•
Income protection benefits that offer a financial safety net if illness or injury prevent you from working.
•
Savings and retirement programs to help you invest in your financial future.
In this Benefits Guide, you’ll find information about all our employee benefit offerings. Everyone’s needs are different and may change as your life changes. To get the total value from your benefits, it’s important to get to know our programs and resources and how they work together to support and enrich your life every day. Spend a few minutes to review the programs to see which programs might work best for you. If you still have questions, contact Human Resources at 269-488-1734. Detailed information on Consumers’ benefit plans are available on Consumers Connect. Here you can access the Summary Plan Descriptions (SPDs) and Summaries of Benefits and Coverage (SBCs), which provide important plan rules and provisions. Consumers Connect will be your primary source of information on all benefit plans. If you have any questions, be sure to contact Human Resources.
How to Enroll? Your benefits enrollment is available 24 hours a day online through Dayforce. A Dayforce link can be found on Consumers Connect. To access Dayforce, you will need to use the consumerscu company code, your user ID and password. If you do not know your network ID or password, contact Human Resources.
When to Enroll? 1. You can elect or make changes once a year during Open Enrollment, unless you experience a qualifying change in status. 2. You must enroll within 31 days of your first day of employment or your status change to become benefits eligible.
Benefits Eligibility You are eligible for all benefits if you are a regular fulltime and certain benefits if you are part-time employee scheduled to work 20 hours or more per week. Check this guide for details on eligibility. If you elect coverage, your dependents also are eligible for medical, dental, vision and voluntary life insurance coverage. Eligible dependents include: •
Your legal spouse.
•
Your legal child(ren): Includes your natural, adopted or foster child(ren), stepchild(ren) or any child for whom you have legal custody to age 26.
•
Your eligible child if fully disabled and unmarried, provided he/she became fully disabled prior to age 19 or between the ages of 19 and 26, if the child was covered by the plan when the disability occurred.
When Coverage Begins If you are a new hire, coverage for most benefits begins the first of the month following 60 days of employment. If you have a change of status, benefits begin the first of the following month.
When Coverage Ends Coverage ends for most benefits on the last day of the month in which: •
Your regular work schedule is reduced to fewer than 20 hours per week;
•
Your employment with Consumers ends due to resignation, termination or death; or
•
You stop paying your share of the coverage.
Coverage for your dependents ends on the last day of the month that the dependent is no longer eligible. For dependent children (up to age 26), this is the end of the month in which they turn 26.
2
BENEFIT COST SUMMARY The premiums you pay each pay period are based on the plans and coverage level you choose. Consumers pays for 85% of your benefit premium for single coverage and 70% of your benefit premium for family coverage.
Full Time (30-40 hours)
Medical
Dental
Vision
Employee
$36.00
$2.00
$1.00
Employee +1
$152.00
$16.00
$2.00
Family
$198.00
$16.00
$3.00
Words to Know This guide was created to help you make important decisions about your health care. Understanding certain words will help you better understand the choices you need to make. Here are some definitions of words and phrases that you’ll see in this guide: MEDICAL PLAN DEDUCTIBLE: A fixed annual dollar amount that you pay out-of-pocket during the calendar year, toward health care services before the medical plan begins to pay. Details on the services that require satisfying the deductible are outlined in this guide and the plan documents. COPAY: A fixed dollar amount you pay at the time health care services or prescription drugs are received, regardless of the total charge for service. The medical plan pays the rest. Coinsurance: A fixed percentage of covered health care services or prescription drug costs that you pay, after the deductible amount (if any) was paid. The medical plan pays the rest. OUT-OF-POCKET MAXIMUM: The most you pay before the medical plan begins to pay 100% of eligible, in-netowork charges. IN-NETWORK: Health care professionals and facilities that have contracts with the medical, pharmacy, or dental plan to deliver services at a negotiated rate (discount). You pay a lower amount for those services. OUT-OF-NETWORK: A health care professional or facility that doesn’t participate in your plan’s network and doesn’t provide services at a discounted rate. Using an out-of-network health care professional or facility will cost you more. PRESCRIPTION DRUG COVERAGE GENERICS: Generic medications have the same active ingredients, dosage, and strength as their brand-name counterparts. You’ll usually pay less for generic medications. PREFERRED BRANDS: Preferred brand medications will usually cost more than generics but may cost less than nonpreferred brands on your plan. Also known as formulary brands. NON-PREFERRED BRANDS: Non-preferred brand medications generally have generic alternatives and/or one or more preferred brand options within the same drug class. You’ll usually pay more for non-preferred brand medications. Also known as non-formulary brands.
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MEDICAL INSURANCE | Priority Health The Consumers medical plan through Priority Health offers comprehensive care for you and your family. The plan offers a broad network of providers, prescription and 100% in-network preventive care.
Who is Eligible and When? All active employees working 30 hours or more per week. Benefits are effective on the first day of the month following 60 days of employment.
Priority Health | PPO Plan Deductible
In-Network
Out-of-Network
Employee
$500
$1,000
Employee +1
$1,000
$2,000
Family
$1,000
$2,000
Employee
$1,500
$3,000
Employee +1 or Family
$3,000
$6,000
Common Services
In-Network
Out-of-Network
Preventative Care
100% Covered
Deductible, then 60% covered
Office Visits (Non-preventative)
$30 Copayment
Deductible, then 60% covered
Specialist Visits
$45 Copayment
Deductible, then 60% covered
Out-of-Pocket Maximum
Emergency Room Visits
$150 Copayment
Urgent Care
$60 Copayment
Deductible, then 60% covered
In-patient Services
Deductible, then 80% covered
Deductible, then 60% covered
Outpatient Services
Deductible, then 80% covered
Deductible, then 60% covered
Chiropractic
$30 Copayment
Deductible, then 60% covered
Physical Therapy
$30 Copayment
Deductible, then 60% covered
MRI
$150 Copayment
Deductible, then 60% covered
Prescription Drugs
In-Network
Out-of-Network
Tier 1: $10 Copayment
Tier 1: $10 Copayment
Tier 2: $40 Copayment
Tier 2: $40 Copayment
Tier 3: $80 Copayment
Tier 3: $80 Copayment
Retail Pharmacy
4
OUR HEALTHCARE PLAN COSTS FOR MEDICAL SERVICES When you get sick, hurt or seek out medical treatment at a facility, these are your financial responsibilities: Please see the Consumers Credit Union summary of benefits and coverage for more details on specific coverages.
SINGLE
DEDUCTIBLE
COINSURANCE
You pay $
You pay 10% UP TO $
500
AFTER COINSURANCE MET You pay COPAYS and RX only
1,500
CONSUMERS PAYS 90%
CONSUMERS PAYS ALL (except copays)
FAMILY (2+)
You pay
1,000
$
You pay 10% UP TO $
MEDICAL PLAN COPAYS
0
$
30
$
45
Specialist visit
$
60
Urgent care visit
150
Emergency services/MRI
$
Joe was in an accident. His bill on the single insurance plan looked like this:
Chiropractic/ Physical therapy
30
$
EXAMPLE: MEET JOE
Preventative services
Office visit
$
You pay COPAYS and RX only
3,000
HOSPITAL BILL
$
Deductible (employee)
$
14,500
500
80% coinsurance (Consumers)
$
11,200
20% coinsurance (employee)
$
2,800
*Joe is responsible for paying $2,000 of the hospital bill, plus any Rx and follow-up visit copays.
15 Tier I $ 30 Tier 2 $ 60 Tier 3 $
PRESCRIPTION DRUG COVERAGE
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TELADOC If you’re at home or on the road, Teladoc can be your go-to-resource for convenient, quality medical care. Teladoc provides 24/7 access to U.S. board-certified doctors through the convenience of your phone, email, video or mobile app. Consumers pays the full cost of the Teladoc benefit.
Who is Eligible and When? All employees and household members upon employment.
Benefits You Receive: This service is useful when your primary care physician is not available or accessible, or on nights, weekend and holidays. You can ask questions for non-emergency medical issues or request a prescription or refill. Teladoc doctors can treat many medical conditions, including: •
Cold & flu symptoms
• Allergies • Bronchitis •
Urinary tract infection
•
Respiratory infection
•
Sinus problems
•
And more
Get Started with Teladoc Call 1-800-TELADOC (362-2667) or visit www.mydrconsult.com. Be sure to register now, so that you can use it right away when you need to speak with a doctor.
Contact Teladoc
Talk with a Doctor
Resolve your Issue
6
DENTAL | Delta Dental Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health.
Who is Eligible and When? All active employees working 30 hours or more per week. Benefits are effective on the first day of the month following 60 days of employment.
Benefits You Receive: Basic Plan In-Network
Out-of-Network
Preventative
100% No deductible
100% No deductible
Basic Restorative
80%
80%
Major Restorative
80%
80%
Orthodontia
50%
50%
Individual: $50
Individual: $50
Family: $150
Family: $150
Deductible
Annual Maximum Benefit (per person)
$1,500 (Diagnostic, Preventative, Basic and Major Services)
Orthodontia Lifetime Maximum (per person)
$1,000
Finding a Dentist Visit www.deltadentalmi.com to register for the consumer toolkit and find a participating dentist. Your out-of-pocket costs may be higher if you choose to use a non-preferred provider.
7
VISION | EyeMed Regular eye exams and good vision are important. Consumers comprehensive and flexible vision care plan administered by EyeMed, an experienced and recognized leader of managed vision programs.
Who is Eligible and When? All active employees working 30 hours or more per week. Benefits are effective on the first day of the month following 60 days of employment.
Benefits You Receive: Basic Plan In-Network
Frequency
Well-Vision Exam
$10 Copayment
Once every 12 months
Retinal Imaging
Up to $39
Once every 12 months
Frames
$150 allowance (20% discount on amount over allowance)
Once every 12 months
Lenses: Single Vision
$25 Copayment
Lined Bi-focal
$25 Copayment
Lined Tri-focals
$25 Copayment
Standard Progressive
$90 Copayment
Contacts (instead of glasses) Conventional Disposable
$150 allowance: 15% off balance over $150 $150 allowance: plus balance over $150
Once every 12 months
Once every 12 months
Providers EyeMed Vision Care offers a large network of providers, including RX Optical, LensCrafters, Pearle Vision and more. For a complete list of in-network providers, call 1-866-804-0982 or go to www.eyemed.com.
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FLEXIBLE SPENDING ACCOUNT (FSA) | Basic A Flexible Spending Account (FSA) allows employees to pay for eligible medical expenses and dependent and child-care expenses on a pre-tax basis reducing your taxable income. Consumers offers both a healthcare and dependent care FSA.
Who is Eligible and When? All active employees working 20 hours or more per week. Coverage is effective the first of the month following 60 days. Employees do not need to be enrolled in the health plan to participate.
Healthcare FSA •
May be used to pay for certain medical, dental, vision, hearing and pharmacy expenses
•
Expenses must be incurred during the plan year and must be submitted for reimbursement by March 31 of the following year
•
You may elect to contribute up to $2,750 per year
•
You may carryover up to $500 in unused contributions to the next year
Dependent Care FSA •
May be used toward care of your dependent(s) under the age of 13, or your spouse or dependent who is not capable of self-care
•
You may elect to contribute $5,000 if you are single or married filed jointly or $2,500 if you file separately.
•
There is no carry over option
Reimbursement Methods: 1.
Debit Card: Just swipe your debit card at point of sale! • New participants will get a new card. Current participants can use the same card from year to year.
2.
Submit for Reimbursement: • Use the Basic Flex App OR • Use the website: https://cda.basiconline.com. (Claims will be directly deposited, mailed as a check or put on a My Cash Card.)
Without FSA
With FSA
Gross annual pay (estimate)
$60,000
Gross annual pay (estimate)
$60,000
Estimated tax rate (30%)
– $18,000
Maximum annual Healthcare FSA contribution
– $2,650
Net Annual Pay
= $42,000
Adjusted Gross Pay
= $57,350
Estimated Annual Healthcare Expenses
– $2,600
Estimated tax rate (30%)
– $17,220
Final Take-Home Pay
= $39,400
Final Take-Home Pay
= $40,130
All figures in this table are estimates and based on an annual salary of $60,000 and maximum contribution limits to the benefit account. Your salary, tax rate and healthcare expenses, and tax savings may be different.
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LIFE & DISABILITY INSURANCE | Lincoln Financial Life and disability insurance is an important part of your financial security, especially if others depend on you for support. Consumers provides $25,000 basic life insurance/AD&D coverage and short- and long-term disability coverage at no cost to you. Lincoln Financial is the provider of these benefits.
Who is Eligible and When? All active employees working 30 hours or more per week. Benefits are effective the first of the month following 60 days of employment.
Voluntary Life and Dependent Life Insurance Coverage Guidelines
Employee
Spouse
Dependents
Minimum
$10,000
$5,000
$5,000
Maximum
5X annual salary up to $500,000
100% of employee’s benefit, up to $100,000
100% of employee’s benefit, up to $100,000
Guarantee Issue
5X annual salary up to $100,000
100% of employee’s benefit, up to $20,000
100% of employee’s benefit, up to $10,000
Evidence of Insurability: As a new hire you can elect up to $100,000 without evidence of insurability. During the annual benefits enrollment period, you can elect to increase your existing coverage up to $20,000 without satisfying evidence of insurability (EOI). If you initially waived coverage or if you are increasing your existing coverage by more than $20,000, EOI is required. Please note: Spouse and child coverage cannot exceed the sum of your company-paid basic life insurance and your own optional life insurance.
Short and Long Term Disability Disability Insurance
Short-Term Disability
Long-Term Disability
Benefits Begin
1st day following an accident 7th day following an illness
90 days of disability
Benefits Duration
13 Weeks
To age 61 or with limited duration benefits for employees disabled after age 65
Percentage of Income Replaced
70% of Weekly Pay
60% of Monthly Pay
Maximum Benefit
Up to $1,000 per Week
Up to $10,000 per Month 10
401(K) | Principal Financial Invest in your financial future by taking advantage of Consumers retirement savings plan. Not everyone has the same goals or needs, and that’s why Consumers offers two essential tools – the 401(k) and the Roth 401(k) – to help you build a more secure future. Consumers partners with Principal Financial for your retirement plan needs.
Eligibility and Employee Contributions All employees are eligible to contribute to the 401(k) plan the first of the month following 90 days of employment. You are automatically enrolled in the 401(k) plan at a 6% contribution rate. Your total contributions 401(k) and Roth cannot exceed the IRS limit. If you are age 50 or older you may make an additional catch up contribution. Please check your work email/home mail for more information from Principal.
Employer Matching Contributions Employees become eligible for employer matching contributions the first of the month following one year of employment and 1,000 hours. Consumers matches 100% on the dollar up to an employee’s 10% contribution. To make sure you are receiving the maximum match from Consumers you need to contribute 10%.
Vesting Vesting refers to the portion of your account that you “own”. Vesting is your non-forfeitable right to both your contributions and Consumers’ contributions to the plan. You are always 100% vested in your contributions. The amount you are vested in Consumers contributions depends on your years of service (credited after 1,000 hours during the period between your anniversary date) as follows:
Vested Amount 100%
80%
60%
40%
20%
0% 2 YRS
3 YRS Consumers Contribution
4 YRS
5 YRS
6 YRS
Personal Contribution
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EMPLOYEE ASSISTANCE PROGRAM | New Directions When life gets challenging and stressful, it is important to get help. Consumers offers an Employee Assistance Program (EAP) to all employees at no cost. New Directions is the provider of this benefit.
Who is Eligible and When? All employees and household members upon employment.
Benefits You Receive: When you need a trusted advisor to help you sort through personal issues that may affect your work, health and general well-being, this completely confidential counseling program is available to you. The EAP provides 24/7 confidential, professional counseling, education and referral services at no cost to you and your family members on a number of subjects, such as: • Relationships •
Stress management
•
Job pressures
•
Problems with children
•
Grief and loss
•
Stress, anxiety or depression
•
Legal and financial issues
You and your family members are eligible for eight session per issue, per year at no cost. EAP services are available to you toll-free 24/7 by phone, text or in person visits.
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TIME AWAY FROM WORK Consumers provides employees a generous Paid Time Off (PTO) and Paid Medical Leave program to refresh, recharge and take care of personal responsibilities.
Earning Paid Time Off Newly eligible (regularly scheduled 20 hours or more per week – 80 hours per month) employees are awarded PTO upon hire. •
Upon hire employees will receive a pro-rated amount of PTO for each full month remaining in the calendar year after their hire date.
•
Each January 1: Eligible employees receive PTO according to the schedule below.
•
•
Employees are eligible to carry over 50% of the amount received on January 1 to the next year
•
Ex. Jane is full-time and was hired on Feb. 15. On May 15, she is awarded 11 days (88 hours) of PTO.
Ex. Jane is awarded 96 hours on Jan. 1. She can roll over up to 48 hours to the next year.
Full-Time Employees
Part-Time Employees
Years Completed
PTO Hours
PTO Days
PTO Hours
PTO Days
<1
96
12
48
6
1
120
15
60
7.5
2
128
16
64
8
3
136
17
68
8.5
4
144
18
72
9
5
160
20
80
10
10+
200
25
100
12.5
PAID MEDICAL LEAVE (PML) Paid medical leave provides up to 40 hours for full-time and 20 hours for part-time to be used for your own or your eligible family members illness, healthcare appointments, disability waiting period and other health-related reasons. Paid medical leave is awarded each January first and can be used after 90 days of employment. If you are hired mid year, the amount of PML that you receive is pro-rated.
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2021 HOLIDAY SCHEDULE 2021 Holiday Schedule New Year’s Day
Friday, January 1
CLOSED
Memorial Day
Monday, May 31
CLOSED
Day after Independence Day
Monday, July 5
CLOSED
Labor Day
Monday, September 6
COSED
Thanksgiving Day
Thursday, November 25
CLOSED
Day after Thanksgiving
Friday, November 26
Open 9:00 a.m. - 1:00 p.m.
Christmas Eve
Friday, December 24
CLOSED
Christmas Day
Saturday, December 25
CLOSED
New Year’s Eve
Friday, December 31
Open 9:00 a.m. - 1:00 p.m.
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WELLNESS PROGRAM | Benefits and Incentives Consumers is committed to creating an environment for employees to achieve their best health. We offer reimbursement for fitness memberships to make it easier to take important steps in support of your physical and emotional well being.
Who is Eligible and When? All part and full time employees are eligible after one year of employment. You are eligible to submit for reimbursement one time per year. Please contact Human Resources for questions on fitness reimbursements.
1 Year of Service Completed
3 Years of Service Completed
Full-Time Employees
Part-Time Employees
50%
25 %
Up to $500
Up to $250
80 %
40 %
Up to $850
Up to $425
* Includes a one-time $75 reimbursement towards initiation fees.
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WELLNESS PROGRAM | Sonic Boom Who is Eligible and When? All employees including spouses!
Benefits You Receive: This personalized tool can be accessed 24/7 and provides a complete set of wellness resources to help you take charge of your health in areas such as nutrition, physical activity, stress reduction and more. Look for more information coming soon. •
Health Challenges: Register for several online challenges throughout the year where employees learn to take small steps each day toward improving health.
•
Healthy Activity Points & Incentives: All employees and spouses who participate in various health and wellness activities can earn Healthy Activity Points throughout the year. These points can be redeemed for gift cards.
Engagement Score
Device Integration
As you engage in Sonic Boom activities and challenges, you’ll increase your Engagement Score. Maintain as high of a score as you can to achieve new levels.
Easily sync exercise data from your activity-tracking device! You can earn points for reaching activity goals each day, check company-wide stats on real-time leader-boards and complete with coworkers in a variety of fun contests.
Challenge-of-the-Day (COD) Improving daily behavior is an every day thing. We provide you with an “aha!” moment every weekday with informative and inspiring health challenges delivered straight to your inbox (and portal/app). Complete the COD on your own, with coworkers or at home with your family!
Caught Ya Being Healthy Reward your peers for practicing healthy behaviors at work! Build camaraderie and feel good about the changes you’re making to improve your daily habits together.
Goals and Trackers Use our fun and automated goals and trackers to keep tabs on your hydrations, fruit/veggie intake, physical activity, mood, weight and more! Boost your score by hitting daily goals in each category.
Rewards Track your progress toward various health and wellness goals (and the incentives tied to them).
Challenge-of-the-Day (COD) Company-wide: We’ll periodically host “featured” contests - some will be competitive, some will be cooperative, some will be based on physical activity and some will be based on optimal nutrition, stress-reduction and more! Member-driven: You get to engage in custom challenges focused on any activity you want (and at any time).
My Health With biometric screenings, our Health Quality Assessment (HQA), and lifestyle coaching (through Coach’s Corner), you can track your current health status and — more importantly — get the feedback (and support) needed to improve.
Academy View articles, videos and other self-paced educational content to help with optimal nutrition, financial well-being and more!
Mobile App Check out the Sonic Boom Wellness mobile app for additional features and on-the-go tracking!
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WELLNESS PROGRAM | TEAM Consumers Who is Eligible and When? All employees are eligible the first of the month after 60 days of employement.
Benefits You Receive: Employees who opt in to this program will be eligible for up to $150 in reimbursements for paid registration for any competitive or charitable fitness event that has a registration fee and will also receive the 2020 TEAM Consumers branded logo gear. Any employee interested in joining TEAM Consumers should enroll through Dayforce—and will have $4 per pay period ($104 per year) taken out to cover some of the costs.
Eligible Events: •
Competitive or charitable fitness events with a registration fee
•
Consumers Credit Union sponsored events
•
Club Sports (such as soccer, golf, bowling, etc.)
For any questions on what qualifies as an eligible event, please email hrsecurity@consumerscu.org before registering!
Participant Events: •
Consumers logo gear to wear at all events
•
Reimbursement on event costs up to $150
•
Access to training guides (5K, 10K, half marathon, full marathon, etc.)
•
Training group (weekly training runs to participate in)
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As a Consumers Credit Union employee, you are eligible for a MastercardÂŽ TEAM Rewards Credit Card! By using our products like the Consumers TEAM Rewards card, you get firsthand experience with how our product works and can then better assist members with their experience! Plus, you will receive exclusive benefits!
Team Rewards Card Benefits 3x rewards for every dollar spent
No annual fee
10,000 reward points after first purchase (must be within 90 days)
Competitive premium rate of Prime + 1.99%
Experience Mastercard benefits and worldwide acceptance Earn rewards points on all your purchases, redeemable for merchandise, travel, gift cards and more Automatic approval for $2k limit with no credit pull
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MEET YOUR HUMAN RESOURCE TEAM
Shawn Premer | Chief HR Officer Ext. 1128
Jennifer Smith | Talent Acquisition & Retention Manager Ext. 1155
Robin Welch | Employee Rewards & Retention Manager Ext. 1734
Ally Garlitch | Talent Specialist Ext. 6066
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| BENEFIT CONTACT INFORMATION
Medical & Prescription Drugs
Dental Insurance
Customer service: 1.800.446.5674 www.priorityhealth.com
Customer service: 1.800.524.0149 www.deltadentalmi.com
Vision Insurance
Billing and Claim Issues
Customer service: 1.866.939.3633 www.eyemed.com
Sandy Vroepgop: 269.488.0305 svroegop@nulty.com
24/7 Medical Care Customer service: 1.800.362.2667 www.mydoctorconsult.com
app.sbwell.com
Flexible Spending Accounts Customer service: 1.800.521.3535 https://cda.basiconline.com
401(k) Customer service: 1.800.547.7752 www.principal.com / Contract (#809750)
Employee Assistance Program 24/7 Call Center: 800.624.5544 eap.ndbm.com
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NOTICES Genetic Information Nondiscrimination Act (GINA) The Genetic Information Nondiscrimination Act of 2008, GINA prohibits the improper use of genetic information in health insurance and employment. The Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future. Newborn’s and Mother’s Health Protection Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or the newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing the length of stay not in the excess of 48 hours (or 96 hours). Women’s Health and Cancer Rights Act Group health plan expenses for a mastectomy shall also include charges for the reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications relation to all stages of the mastectomy, including lymphedemas. Coverage shall be provided in a manner determined in consultation with the attending physician and the patient. Michelle’s Law Michelle’s Law allows seriously ill college students, who are covered dependents under health plans, to continue coverage for up to one year while on medically necessary leaves of absence. The leave must be medically necessary as certified by a physician, and the change in enrollment must commence while the dependent is suffering from a serious illness or injury and must cause the dependent to lose student status. Under the law, a dependent child is entitled to the same level of benefits during a medically necessary leave of absence as the child had before taking the leave. Further, if any changes are made to the health plan during the leave, the child remains eligible for the changed coverage in the same manner as would have applied if the changed coverage had been the previous coverage, so long as the changed coverage remains available to other dependent children under the plan. The Children’s Health Insurance Program Reauthorization Act of 2009 You may be eligible to enroll in your employer sponsored health plan if you or your dependent loses coverage under Medicaid or a state child health insurance plan, and you request coverage under the group health plan within 60 days of the loss of coverage. You may also be eligible to enroll if you become eligible for a premium assistance subsidy for the group health plan through Medicaid or a state child health insurance plan, and request coverage under the group health plan within 60 days of becoming eligible for assistance. USERRA Continuation of Coverage Rights Under the Uniformed Services Employment and Reemployment Rights Act if you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan and coverage for you and your dependents for up to 24 months while in the military. Even if you don’t elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally without any waiting periods or exclusions except for service-connected illness or injuries. Family and Medical Leave Act Coverage Rights During FMLA leave, the employer must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms. Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of the employee’s leave. Your Enrollment Rights If you enroll in your employer plan or waive coverage, you have special enrollment rights for situations which might come up in the future. For example: loss of other health insurance coverage (either through a spouse, parent or Medicaid), marriage, divorce, birth or adoption of child. If you experience any of these situations, you need to notify your HR department so that you and your dependents may enroll in the employer plan as of the date of the change. The insurance company needs to receive an updated enrollment form within 30 days of the special enrollment situation. The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.
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