2019 Employee Benefits Summary Overview Plan Year: April 1, 2019 – March 31, 2020
USALCO 2019 Employee Benefits
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All About Enrollment Employer-Provided Benefits As an eligible employee, USALCO automatically provides you with several benefits. USALCO pays the full cost of life insurance, short and long term disability coverage, and an employee assistance plan. You are not required to make any contributions for these benefits.
Optional Benefits In addition to the employer-provided benefits, eligible employees may enroll in optional benefits including medical, dental, vision, voluntary life insurance for self, spouse and dependents and retirement plans. You contribute toward the cost of the optional benefits that you elect.
When Coverage Begins For all USALCO benefits, coverage begins the first of the month following your date of hire. •
New hires/transfers: You must enroll during your first 31 days of employment with USALCO. If you do not, your coverage will be waived and your next opportunity to enroll in benefits without a qualifying event will be during next year’s annual open enrollment period, typically held in February of each year for the upcoming plan year.
•
Current employees: Each year you have an opportunity to review your benefit elections during the annual open enrollment period, typically in February, and make changes for the upcoming plan year.
When Coverage Ends For most benefits, coverage will end on the last day of the month in which: •
Your regular work schedule is reduced to fewer than 30 hours per week;
•
Your employment with USALCO ends due to resignation, termination, or death;
•
Or you stop paying your share of the coverage.
Your dependent coverage ends: •
When your coverage ends;
•
Or the last day of the month in which the dependent is no longer eligible:
•
For dependent children up to age 26: end of the month in which they turn 26.
How to Change your Coverage Mid-Year The IRS provides strict regulations about changes to pre-tax elections during the plan year. If you experience a qualified IRS family status change mid-year, you are permitted to make a change within 31 days of the event. If the change request is not completed within 31 days of the event, you will not be able to change your elections until the annual open enrollment period. Below are some of the more commonly known qualified family status changes: •
Marriage, divorce, annulment, or permanent separation from a domestic partner
•
Birth of a child
•
Placement of a foster child or child for adoption with you
•
Obtaining legal guardianship of a child
•
Change in employment status that affects benefits eligibility
•
Return from an unpaid leave of absence
•
Gain or loss of coverage
The change you request must be consistent with the qualifying event. All mid-year changes require documentation, which must also be provided within 31 days of the event. Please contact the EONE BAT Team if you have questions.
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USALCO 2019 Employee Benefits
All About Enrollment Who Can Enroll You are eligible for benefits if you are a regular, full-time employee. If you elect coverage, your dependents are also eligible for medical, dental, vision, and life insurance coverage. Eligible dependents include: •
Your Spouse and legal child(ren)
•
Natural children, adopted children, foster children, step children, your domestic partner’s children, or any child for whom you have legal custody
•
Children up to age 26; through the end of the month of their 26th birthday.
•
Regardless of age, if fully disabled and unmarried, provided s/he became fully disabled either prior to age 19 or between the ages of 19-26 if the child was covered by the plan when the disability occurred
How to Enroll Signing In
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•
Go to www.workforcenow.adp.com
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Enter your User Name.
•
Your user name is the user ID you received when you completed self-registration.
•
Enter your Password.
•
Your password is the one you created during selfregistration.
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Click Sign In.
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Once in the system, you will see a welcome note for Open Enrollment
•
You will click on the “start this enrollment” link and the wizard will take you through the enrollment process
•
Once complete, you will click on the “complete enrollment” link
•
The first page you will come to is your Beneficiary and Dependents Page •
Make sure you have all of your dependents in the system if you want to enroll them in any of your benefits.
•
If you dependent is ALSO your beneficiary, you will use the Dependent/Beneficiary option when entering their information into ADP
•
You will need the DOB and SSN for every dependent and beneficiary you enter into ADP in order for the system to save their information.
USALCO 2019 Employee Benefits
Medical Insurance USALCO gives you the option of choosing one of three UMR/United Healthcare plans to best meet your needs. All three plans: •
Use the United Healthcare Choice Plus network,
•
Use Optum Rx as the administrator for all Pharmacy claims
•
Cover preventive care at 100%,
•
Provide the same type of coverage.
Glossary Copay
a fixed fee amounts that you pay at the time you receive services
Deductible
the set amount you must typically pay before coinsurance starts
Coinsurance
the portion of expense you must pay for care, in most cases, after meeting your deductible
Out-of-Pocket Maximum
the maximum amount you could pay for care within a calendar year, including copays and deductibles
Preventive Services
routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems
Premiums
your payroll deductions, which are the amounts you pay to belong to a health plan
In-Network
the doctor or health care facility has a partnership with the insurance carrier to bring you lower costs
Providers
a doctor or health care facility
Our Plans Traditional PPO is our richest plan design, which maximizes coverage at the point of service, so if you and your family would like to pay the least out of pocket at the doctor’s office, then this plan is the right one for you. PPO HSA #1 offers the same rich benefit design as the Traditional PPO, but requires a little more out of pocket at the time of service. It comes with lower premiums than the Traditional PPO. This plan can be paired with a Health Savings Account. PPO HSA #2 requires the most at the time of service, but comes with the lowest premiums. This plan can be paired with a Health Savings Account.
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USALCO 2019 Employee Benefits
Medical Insurance United Healthcare Choice Plus PPO The PPO network allows you to choose any provider you want each time you need care. There are no requirements to choose a primary care physician (PCP) to coordinate your care. When you use in-network provers, your out-of-pocket expenses are kept to a minimum.
HSA Plan #1 Medical Coverage
HSA Plan #2
PPO Plan #3
In-Network
Out-of-Network
In-Network
Out-of-Network
In-Network
Out-of-Network
Deductible (Ded) Individual / Family
$1,800 / $3,600
$4,000 / $8,000
$3,500 / $7,000
$5,000 / $10,000
$1,000 / $2,000
$4,000 / $8,000
Out-of-Pocket Maximum Individual / Family
$2,300 / $4,600
$6,250 / $12,500
$4,000 / $8,000
$6,250 / $12,500
$2,500 / $5,000
$6,250 / $12,500
100%
80%
100%
70%
80%
70%
Coinsurance Preventive Care
No Charge
20% Coinsurance
No Charge
30% Coinsurance
No Charge
30% Coinsurance
PCP Office Visit (No PCP selection required)
Ded
Ded, then 20%
Ded
Ded, then 30%
$30 Copay
Ded, then 30%
Specialist Office Visit (No referral required)
Ded
Ded, then 20%
Ded
Ded, then 30%
$30 Copay
Ded, then 30%
Mental Health Outpatient Office Visits
Ded
Ded, then 20%
Ded
Ded, then 30%
Ded, then 20%
Ded, then 30%
Inpatient Hospital Stays
Ded
Ded, then 20%
Ded
Ded, then 30%
Ded, then 20%
Ded, then 30%
Short Term Rehab (PT, OT, Skilled Nursing Facility)
Ded
Ded, then 20%
Ded
Ded, then 30%
$30 Copay, then 20%
Ded, then 30%
Diagnostic, Lab and X-Ray
Ded
Ded, then 20%
Ded
Ded, then 30%
No Charge
Ded, then 30%
Imaging (CT, PET scan, MRIs, Nuclear Scans)
Ded
Ded, then 20%
Ded
Ded, then 30%
No Charge
Ded, then 30%
Urgent Care Facility
Ded
Ded, then 20%
Ded
Ded, then 30%
Ded
Ded, then 30%
Hospital Emergency Room (copay waived if admitted)
Ded
Treated as In Network
Ded
Treated as In Network
$100 Copay, then 20%
Treated as In Network
Inpatient Hospital Facility Services
Ded
Ded, then 20%
Ded
Ded, then 30%
Ded, then 20%
Ded, then 30%
Outpatient Hospital Facility Services
Ded
Ded, then 20%
Ded
Ded, then 30%
Ded, then 20%
Ded, then 30%
Durable Medical Equipment
Ded
Ded, then 20%
Ded
Ded, then 30%
Ded, then 20%
Ded, then 30%
Prescription Coverage Rx Deductible Rx OOP Maximum Tier I
Shared with Medical
Shared with Medical
None
Shared with Medical
Shared with Medical
$4,100 Individual / $8,200 Family
$10 Copay ($20 Copay)
$10 Copay ($20 Copay)
$10 Copay ($20 Copay)
Tier II
$30 Copay ($60 Copay)
$30 Copay ($60 Copay)
$35 Copay ($70 Copay)
Tier III
$50 Copay ($100 Copay)
$50 Copay ($100 Copay)
$60 Copay ($120 Copay)
2 x Retail
2 x Retail
2 x Retail
90-Day Maintenance
USALCO Contributes to you HSA Account! USALCO makes HSA Contributions to all employees enrolled in an HSA-qualified plan. If you are enrolled as “Employee Only” you may receive $600 per year and those enrolled as “Employee & Dependents” may receive $1,200 per year. Contribution are made based on your tenure of service with USALCO. USALCO’s contribution amounts into your HSA Account accumulate to the total of the IRS Annual Contribution Maximum Limit. Please be advised HSA Contribution Amounts are based on calendar year and do not follow our medical plan year. Please remember to set up your Sandy Spring HSA so you can begin to receive Employer contributions. Contributions cannot begin until you establish an account.
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USALCO 2019 Employee Benefits
Health Savings Account (HSA) Reasons to Love an HSA: Triple Tax Savings •
You can contribute to your HSA using tax-free dollars
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You can use the money in your HSA to pay for health care expenses with tax-free money
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Whatever you don’t use in a year rolls over to the next year, and earns interest that is also tax-free!
You decide how and when to use the funds in your account - you can use the funds to pay for your health care expenses or save them for future health care costs. The account may be used to build funds for retirement. Once you reach age 65, you can continue to use while in retirement.
Standard Deductible HSA Plan #1
High Deductible HSA Plan #2
Plan Deductible and Maximums
Plan Deductible and Maximums
Individual
Non-Individual
Individual
Non-Individual
In Network Deductible
$1,800.00
$3,600.00
In Network Deductible
$3,500.00
$7,000.00
In Network OOP Max
$2,300.00
$4,600.00
In Network OOP Max
$4,000.00
$8,000.00
2019 IRS HSA Contribution Limit
$3,500.00
$7,000.00
2019 IRS HSA Contribution Limit
$3,500.00
$7,000.00
Contributions
Contributions
Individual
Non-Individual
Individual
Non-Individual
USALCO Contribution
$600.00
$1,200.00
USALCO Contribution
$600.00
$1,200.00
Employee Deductible Responsibility
$1,200.00
$2,400.00
Employee Deductible Responsibility
$2,900.00
$5,800.00
Employee OOP Responsibility
$1,700.00
$3,400.00
Employee OOP Responsibility (capped at IRS Maximum)
$2,900.00
$5,800.00
Remaining IRS Limit
$2,900.00
$5,800.00
Remaining IRS Limit
$2,900.00
$5,800.00
Additional Savings Per Pay Required to fund: Individual
Non-Individual
Remaining deductible
$50.00
$92.31
Remaining deductible & OOP Max
$70.83 $120.83
Max IRS contribution for 2019
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Account Savings Per Pay Required to fund: Individual
Non-Individual
Remaining deductible
$120.83
$223.08
$130.77
Remaining deductible & OOP Max
$120.83
$223.08
$223.08
Max IRS contribution for 2019
$120.83
$223.08
USALCO 2019 Employee Benefits
Dental & Vision Insurance Dental Insurance USALCO offers you a generous dental plan that allows you to see any dentist you choose. You are encouraged to verify that the dentist accepts United Healthcare dental pricing. Please refer to the chart below for an overview of benefits. Benefit the Plan Pays Plan Year Deductible (Class B and C, waived Class A)
$50 Individual / $150 Family
Annual Plan Year Maximum Benefit
$2,000 per person per year
Class A - Preventive Care (such as cleaning, exams, and X-rays)
100% of UCR
Class B - Regular Restorative Care (such as fillings & root canals)
80%
Class C - Major Restorative Care (such as dentures, bridgework, crowns)
50%
Class D - Orthodontia (covered to age of 19) (such as braces & retainers)
Not Covered
Vision Insurance With our vision plan, you’ll get a great value on your eye care and eye wear. Using your vision benefit is easy as well. Members will be required to pay for services rendered at the time of service and then submit for reimbursement. There is no ID card needed! Maximum Benefit the Plan Pays Eye Exam (once every 12 months)
Covered at 100%
Lenses (one pair every 12 months)
$75 Single Vision $100 Bifocal $175 Trifocal $200 for Progressive
Frames (one pair every 24 months)
$100 allowance
Contact Lenses in lieu of glasses Medically Necessary* (every plan year)
$250
Elective (every plan year)
$150
*Medically Necessary contact lenses are non-elective contact lenses prescribed when certain medical conditions hinder vision correction through regular eyeglasses. Contact lenses are considered a medical necessity when they are the generally accepted standard of treatment for the condition and not elective in lieu of glasses.
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USALCO 2019 Employee Benefits
Employee Contributions Plan Year - April 1, 2019 to March 31, 2020
Employee Weekly (52) Premiums HSA #1
HSA #2
PPO #3
Bundled Medical, Dental & Vision
Dental Only
Vision Only
Unbundled
Unbundled
Payroll Deductions
Employee Only
$29.36
$15.67
$82.68
$1.03
$0.60
Employee + Children
$74.86
$51.07
$179.59
$3.86
$1.18
Employee + Spouse
$88.79
$54.64
$191.54
$3.86
$1.18
Family
$109.75
$67.55
$211.07
$9.02
$1.79
Dental Only
Vision Only
Unbundled
Unbundled
Employee Semi-Monthly (24) Premiums HSA #1
HSA #2
PPO #3
Bundled Medical, Dental & Vision Payroll Deductions
Employee Only
$63.61
$33.95
$179.14
$2.23
$1.31
Employee + Children
$162.20
$110.65
$389.12
$8.37
$0.26
Employee + Spouse
$192.38
$118.39
$415.01
$8.37
$2.56
Family
$237.79
$146.35
$457.32
$19.55
$3.87
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USALCO 2019 Employee Benefits
Basic Life & AD&D Basic Group Term Life & Accidental Death & Dismemberment USALCO provides full-time permanent employees with Life and AD&D coverage and pays the full cost of the coverage. Coverage eligibility for new employees will become effective the first of the month following the date of employment. The benefit provided for reach eligible employee is 2X their basic annual earning up to a maximum of $250,000.
Additional Voluntary Life & Accidental Death & Dismemberment All full-time permanent employees of USALCO are eligible to purchase Additional Voluntary Life/AD&D coverage. Coverage eligibility for new employees will become effective after the first of the month following the date of employment. The maximum benefit available for each eligible employee is 100% of Employee Amount with a maximum of $500,000 or 5 times annual earnings, whichever is less, 100% of the employee election up to $250,000 for a Spouse and 100% of employee election up to $10,000 for each dependent child. The Flat Guarantee Issue Amount for each is as follows: •
Employee (Under Age 65) $100,000; Spouse (Under Age 65) $50,000; Children $10,000
Short-Term & Long-Term Disability USALCO also provides full-time permanent employees with short-term and long-term disability income benefits, and pays the full cost of this coverage. Coverage eligibility for new employees will become effective the first of the month after active employment. In the event you become disabled from a non-work-related injury or sickness, disability income benefits are provided as a source of income.
Short-Term Disability
Long-Term Disability
Benefits Payable
• 8th day of disability due to injury • 8th day of disability due to illness
After 90 days of disability
Benefit Percentage
60% of basic weekly salary
60% of basic monthly salary
Maximum Benefit Amount
$1,000 per week
$7,500 per month
Maximum Benefit Period
12 weeks
Social Security Normal Retirement Age
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USALCO 2019 Employee Benefits
Employee Assistance Program Mutual of Omaha Employee Assistance Program (EAP) Life’s not always easy. Sometimes a personal or professional issue can affect your work, health and general well-being. When facing life’s challenges, you often turn to family or friends for support. But sometimes that’s not enough. Sometimes you need an experienced professional to talk with to know you’re not alone. The EAP through Mutual of Omaha provides useful tools and resources that can guide you through a difficult time. Best of all it is confidential and at no additional cost to you.
What can they help with? •
Overcoming stress
•
Crisis at home or work
•
Addiction, depression, & other emotional issues
•
Career goals
•
Management support
•
Work-life balance
•
Stress, relaxation, and personal well-being
•
Personal & family goals
Financial or Legal Questions? Mutual of Omaha can help with those as well! •
Online will preparation
•
Online legal forms library
•
Telephonic financial consultation
•
Online library of legal and financial tools & resources
Your program includes 3 face to face counseling sessions!
To use your EAP Benefit, call toll free 800-316-2796 or go online to www.mutualofomaha.com/eap
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USALCO 2019 Employee Benefits
Telemedicine
Download the app today, it’s quick and easy! Visit Teladoc.com/mobile or visit your app store. Then follow these 3 easy steps: 1. Create an Account – it only takes a few minutes. After downloading the app you will provide a brief medical history so the doctors have the information they need to provide you with quality medical care. You can also add family members so they have access to around the clock care. 2. Talk with a Doctor Now – you have the option to speak with the first available Teladoc doctor, or schedule and appointment. Within minutes a doctor will call ready to listen, diagnose and prescribe medication, if needed. Afterwards you can choose to share the results with your PCP. 3. Pick Up Your Rx – if an Rx is needed, the Teladoc doctor can send it right to your local pharmacy for pickup!
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor. USALCO 2019 Employee Benefits 11
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
Your ID Card and EOBs Have you every wondered what all that stuff on your ID card really means? Here’s a sample of what you might see. Each plan is different.
An explanation of benefits (EOB) is not a bill, It simply tells you everything you want to know about your claims. Your EOB includes:
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 12
•
Services received
•
Cost of the Services
•
What you owe for the services received
•
Explanation of codes used on the EOB
•
Section showing how close you are to meeting plan Deductibles and Out of Pocket Maximums
UMR.com and Find a Provider Make UMR.com your first stop for managing your healthcare with a fast and easy to use web portal. Some of the great tools available to you on the Member tab are: • • • •
Health Cost Estimator Claim Cost Summary Find a Provider Personalized Health Center
• •
Order Replacement ID Cards Glossary of Insurance Terms
UMR.com makes it easy to find participating providers. Just go to UMR.com and there will be a link the middle of the page for you to search the provider directory, you don’t even have to log in! When searching for providers you will use the United Healthcare Choice Plus Network And don’t forget the Mobile Site!! No app to download, just go to UMR.com on your smartphone and you can access all of the same information that you do from your computer. You will use the same user name and password that you do for your UMR.com portal on the web.
Optum Rx OptumRx.com is a fast, safe and secure way to manage your prescription benefits online. You have access to many tools and resources to manage your prescriptions. •
Search for drug pricing and lower-cost alternatives
•
Refill and renew mail service pharmacy prescriptions
•
Transfer your retail prescriptions to our mail service pharmacy
•
View your mail service order status and claim history
•
Sign up for medication reminders via text message
•
View your OptumRx benefits in real time
Access your prescription information from the UMR website. Follow these steps: 1.
Visit umr.com
2.
In the left margin menu, select members.
3.
Login by entering your username and password in the top right login section. If you have not yet registered for a member account, select New user? Register here shown underneath username field.
4.
Once successfully registered and/or logged in, select Pharmacy from the menu on the left. The website will redirect you to your online services home page. Once on the pharmacy home page, you click on OptumRx or the Visit the pharmacy button to enter optumrx.com and begin to take advantage of the many tolls and features that will help you manage your pharmacy benefit. On your first visit, you will also need to register at optumrx.com – just follow the simple instructions.
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 13
Mobile website Use your smartphone to access our mobile website. •
Request prescription refills
•
Check order status
•
Locate a retail pharmacy
•
Search your plan’s formulary
•
Register via our mobile website
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
Contacts & Resources Contact information for all of your vendors is included below. For claims and benefit information please contact your Payroll and Benefits Department or the Employee One Benefit Advocate Team.
UMR
Medical, Dental, Vision, Find a Provider
www.umr.com/members | (800) 826-9781
UMR
Rx and Pharmacy
www.umr.com/member | (800) 826-9781
OptumRx
Rx and Pharmacy
www.optumrx.com | (877) 559-2955
Mutual of Omaha
Life, AD&D, and Voluntary Life
Mutual of Omaha
Short-Term and Long-Term Disability
claims fax: (402) 997-1865 disability.management@mutualofomaha.com
Mutual of Omaha
Employee Assistance Program (EAP)
www.MutualofOmaha.com/eap | (800) 316-2796
Teladoc
Telemedicine
www.Teladoc.com | (800) 835-2326 (TELADOC)
Sandy Spring
Health Savings Account (HSA)
www.sandyspringbank.com/personal/banking/heal th-savings-accounts/form
Medical Administrator
www.MutualofOmaha.com | (800) 877-5176 Claims fax: (402) 351-8565 gps.east@mutualofomaha.com
www.MutualofOmaha.com | (800) 877-5176
(800) 399-5919 HSA@sandyspringbank.com
PNC
Retirement Account – 401k
www.retirementdirections.com | (800) 374-4631
USALCO
Adrienne Roper, PHR
Human Resources
Payroll & Benefits Manager
(410) 354-0100 x 2307 | aroper@USALCO.com
participantservices@pncadvisors.com
Benefit Advocate Team mybenefits@employee1.net Your EONE Benefit Advocate Team (BAT) is available Monday through Friday during normal business hours to provide concierge level support with matters relating to your group health and welfare benefits. Sometimes health insurance can be confusing and stressful if you feel you’re not getting the help you need. The EONE BAT team is familiar with your benefits and can help explain how your plan works. If you’re experiencing a billing issue, need assistance resolving a claim, or just have general questions about your benefits, email: mybenefits@employee1.net, or give us a call us at: 1-877-719-EMP1(3671).
> Concierge-Level Support > Billing Issues > Claims Resolution > Important Dates > Qualifying Events > General Benefits Information
> Contacts, and more…
Support services provided for USALCO members and their dependents. Benefit Advocate Team (BAT) is not affiliated with, nor represents, the, USALCO 2019 Employee Benefits a 14
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
Continuation of Health Coverage Consolidated Omnibus Budget Reconciliation Act (COBRA) You must notify Human Resources within 30 days of the following COBRA events: •
divorce or legal separation
•
death of an employee
•
dependent child’s loss of dependent status
Individual election rights to continuation of coverage Loss of Coverage due to:
Voluntary or Involuntary loss of employment Max Continuation for covered individuals: You 18 Months Spouse 18 Months Child 18 Months Loss of Coverage due to: When any covered member loses health insurance coverage based on a termination of employment or the occurrence of other qualifying events, the member will be eligible to elect continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Once your termination of health insurance coverage is processed you will receive a COBRA packet in mail from CoreSource. You will have 60 days to elect COBRA. Once COBRA is elected your coverage is retroactive to the date you lost coverage. There will be no lapse in coverage. Please contact a USALCO insurance representative for additional information on pricing regarding COBRA coverage. Each individual who is covered by the health plan immediately preceding the member’s COBRA event has independent election rights to continue his or her medical or vision coverage. The right to continuation of coverage ends at the earliest of when: •
you, your spouse or dependents become covered under another group health plan: or,
•
you become entitled to Medicare: or,
•
you fail to pay the cost of coverage: or,
•
your COBRA Continuation Period expires.
For more information visit: www.dol.gov/ebsa/cobra.html
Disability (at the time of event) Max Continuation for covered individuals: You 29 Months Spouse 29 Months Child 29 Months Loss of Coverage due to:
Your Death Max Continuation for covered individuals: You n/a Spouse 36 Months Child 36 Months Loss of Coverage due to:
Your Divorce or Legal Separation Max Continuation for covered individuals: You n/a Spouse 36 Months Child 36 Months Loss of Coverage due to:
You become entitled to Medicare Max Continuation for covered individuals: You n/a Spouse 36 Months Child 36 Months
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 15
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
Annual Notices Right to Rescind Coverage PPACA requires group health plans to provide notice 30 days prior of group health plan termination. The rules prohibit rescissions except in very limited situations such as employees who commit fraud or make intentional misrepresentations. For example, if plan documents require employees enrolling family members to assert that these individuals meet plan eligibility requirements and to immediately notify the employer if their status changes, rescission might be possible for an employee who intentionally misrepresented marital status to obtain coverage for a friend. Prospective terminations of coverage and retroactive terminations for failure to pay premiums or contributions are not rescissions. USALCO Group Health Plan the privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) require the Group Health Plan (the “Plan”) to periodically send a reminder to participants about the availability of the Plan’s Privacy Notice and how to obtain a copy of this notice. The Privacy Notice explains participants’ rights and the Plan’s legal duties with respect to protected health information (PHI) and how the plan may use and disclose PHI. Mothers’ and Newborns’ 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 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 insurers may not, under federal law, require that a provider obtain authorization from the plan or issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Medicare Information Attention Members who are Medicare eligible or who have Medicare eligible dependents—(or those who will soon be eligible). Coordination of benefits between the group plan and Medicare Parts A & B depends on specific criteria and reason for election of Medicare. Please contact the USALCO Insurance Team for more information in regards to these criteria and how the coordination of benefits would be determined.
Uniformed Services Employment and Reemployment Rights Act (USERRA) Health Insurance Protection if you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan 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 illnesses or injuries. Women’s Health and Cancer Rights Act of 1998 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 or 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 lymphedemas.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan. COBRA Under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, COBRA qualified beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to award termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. COBRA coverage is not extended for those terminated for gross misconduct. Upon termination, or other COBRA qualifying event, the former fellows and any other beneficiary will receive COBRA enrollment information.
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 16
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
Medicare Part D Notice Important Notice from the employer about Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage and 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: 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. The employer has determined that the prescription drug coverage offered by the plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. If you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide To Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your group coverage will not be affected. You and your dependents can keep this coverage if part D is elected and the plan will coordinate with Part D. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will be able to get this coverage back but you/they may have to wait until the next open enrollment plan. 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 group coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information about This Notice or Your Current Prescription Drug Coverage. Contact your HR Manager for further information. It is always best to discuss your personal situation with a Medicare expert when you are considering your options. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this group coverage changes. You also may request a copy of this notice at any time. More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov or call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1- 800-772-1213 (TTY 1-800-325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 17
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
New Health Insurance Marketplace Coverage Options PART A: General Information What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2015 for coverage starting as early as January 1, 2016. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.65% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit. Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer- offered coverage. Also, this employer contribution – as well as your employee contribution to employer -offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact your HR department. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
Part B: Information about Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. Employer Name Employer Identification Number (EIN) USALCO Employer Address Employer Phone Number 2601 Cannery Ave 410City State Zip Code Baltimore MD 21226 Who can we contact about employee health coverage at this job? Adrienne Roper Phone number (if different from above) Email Address 410-354-0100 ext.2307 aroper@usalco.com ▪ Eligible members regularly scheduled to work more than 30 hours each week. ▪ Dependent coverage - eligible dependents are spouses/domestic partners and children (biological, adopted and step-children) ▪ Coverage meets minimum value standards and the cost of this coverage is intended to be affordable based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. *** If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Above is the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 18
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230
Medicaid and CHIP 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 you 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 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 program that might help you pay the premiums for an employer-sponsored 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 for eligible for premium assistance. To view a list of states that offer added premium assistance or for more information on special enrollment rights, you can contact either:
US Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-ERSA (3272)
US Department of Health and Human Services Centers for Medicare and Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565
Coordination of Benefits with other coverage IF YOU
SITUATION
PAYS FIRST
PAYS SECOND
Are covered by Medicare and Medicaid
Entitled to Medicare and Medicaid
Medicare
Medicaid, but only after other coverage (such as employer group health plans) have paid
Entitled to Medicare Are 65 or older and covered by a group health plan because you or your spouse is still working
Have an employer group health plan after you retire and are 65 or older
The employer has 20 or more employees
Group Health Plan
Medicare
The employer has less than 20 employees
Medicare
Group Health Plan
Entitled to Medicare
Medicare
Retiree Coverage
Entitled to Medicare Are disabled and covered by a large group health plan from your work, or from a family member who is working
Have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) and group health plan coverage (including a retirement plan)
Have ESRD and COBRA coverage
The employer has 100 or more employees
Large group health plan
Medicare
The employer has less than 100 employees
Medicare
Large group health plan
First 30 months of eligibility or entitlement to Medicare
Group health plan
Medicare
After 30 months of eligibility or entitlement to Medicare
Medicare
Group health plan
First 30 months of eligibility or entitlement to Medicare
COBRA
Medicare
After 30 months
Medicare
COBRA
Support services provided for USALCO members and their dependents. The EONE Benefit Advocate Team (BAT) is not affiliated with, nor USALCO 2019 Employee Benefits 19
EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230