2022-2023
EMPLOYEE
BENEFITS
Welcome! Our people are our most valuable asset. That’s why we strive to offer an exceptional benefits program to meet your needs and the needs of your family. Please take time to carefully review the benefits offered before making your elections. Remember to refer to this guide year-round to ensure you get the most out of your benefits.
TABLE OF CONTENTS
Benefits Overview........................................................4
Family Care....................................................................27
Benefit Basics..............................................................5
Carrot Family Planning................................................31
CareFirst BlueChoice HMO Benefit Summary.....7
CareFirst Wellness & Disease Management.........34
CareFirst HealthyBlue Advantage POS Benefit Summary........................................................................10
CareFirst Gender-Diverse Services........................36
CareFirst HealthyBlue PPO with HSA Benefit Summary........................................................................13
HIV/Health Equality Care...........................................38 CareFirst Health Digital Resource...........................40
CareFirst Prescription Drug Program.....................16
CareFirst Know Before You Go................................42
CareFirst Resources...................................................18
Principal 401(k) Retirement Account......................44
CloseKnit Primary Care..............................................20
Other Benefits..............................................................46
Health Advocate Support..........................................21
Paid Time Off................................................................47
MetLife Dental Plan.....................................................22
Employee Discounts...................................................48
VSP Vision Plan............................................................23
Pet Health Insurance...................................................50
Flexible Spending Accounts......................................24
Career Development...................................................55
The Standard - Employee Assistance Program....25
Legal Notices................................................................57
2022 EMPLOYEE BENEFITS – 3
BENEFITS OVERVIEW As a valued Human Rights Campaign employee, you receive competitive compensation and benefits as part of the total value of employment. The following chart shows the type of coverage offered by HRC, the plan name and type along with the name of the individual carrier providing the coverage:
COVERAGE TYPE
PLAN NAME
PLAN TYPE
CARRIER NAME
Major Medical
BlueChoice HMO
HMO
CareFirst Blue Cross BlueShield
Major Medical
HealthyBlue Advantage POS
POS-style HMO
CareFirst Blue Cross BlueShield
Major Medical
Healthy Blue- PPO HSA
PPO with HSA
CareFirst Blue Cross BlueShield
Prescription Drugs
CareFirst RX Plan
Pharmacy
CareFirst Blue Cross BlueShield
Dental
MetLife Dental
PPO
MetLife Dental
Vision
VSP
VISION
VSP
Employee Assistance Program
Life Services Toolkit
EAP
The Standard
Life Insurance
The Standard
Life/AD&D/LTD/STD
The Standard
Retirement
Principal Financial Group
401 (k)
Principal Financial Group
FSA & HSA
Benefit Strategies
FSA & HSA
Benefit Strategies
VENDOR RESOURCES CAREFIRST
Sharecare Wellness, Blue Rewards, Blue 365, Close Knit
DISCOUNTS
Calm App, Congressional Credit Union, National Geographic Credit Union, Capital Bike Share, Verizon, Docubank, Vida Fitness, Robeks, HRC Store
HEALTH ADVOCATE This guide is a summary of the employee benefits provided by HRC. If there is a discrepancy between the benefits illustrated in this guide and the official plan document, the plan document will always govern. Rev 03/2022 2022 EMPLOYEE BENEFITS – 4
BENEFIT BASICS ELIGIBILITY Employees You are eligible to participate in our benefits package if you are regularly scheduled to work more than twenty (20) hours per week. Benefits start on the first day of employment.
Dependents Your legally married spouse or domestic partner and/or any biological, adopted, foster or stepchildren, children of a domestic partner, or any child for whom you are court appointed as legal guardian (up to age 26)
KEY TERMS TO KNOW Deductibles are the amount you pay for covered health care services before your insurance plan starts to pay. Co-payments (copays) are the fixed dollar amounts (for example, $30) you pay for covered health care, typically paid at the time of service. Coinsurance is the percentage of costs of a covered health care service that you pay (for example, 20%) after you’ve paid your deductible. An out-of-pocket maximum is the most you have to pay for covered services in a plan year before the plan pays 100% of covered expenses for the rest of the plan year. Covered services that count towards the out-of-pocket max include deductibles, copays and coinsurance. Your plan may have a separate Rx out-of-pocket maximum. Generic drugs contain the same active ingredients as brand-name drugs, but generally are less expensive.
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BENEFIT BASICS CONT. Preferred brand drugs are brand-name drugs that are listed on the plan’s preferred list of prescription drugs. Non-preferred brand drugs are brand-name drugs that are not included listed on the plan’s preferred list of prescription drugs. These may not be covered under the plan. Specialty drugs are used to treat certain health conditions. These drugs tend to be a little more expensive.
WHEN CAN YOU MAKE CHANGES TO BENEFITS? Generally, changes are only allowed under the following circumstances. Open Enrollment Periods You may change your election annually during Open Enrollment for a April 1st effective date. Qualifying Life Events (QLEs) / Change in Family Status Outside of annual Open Enrollment, you may change your benefit elections during the year only if you experience a Qualifying Life Event (QLE). Below are examples of life events that may allow you to make a change. Changes must be made within 30 days of the event. • Marriage, divorce or legal separation • Birth or adoption of a child • Change in your child’s dependent status • Death of your spouse, domestic partner, child, or other qualified dependent • Change in residence • Change in your spouse’s benefits or employment status
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BENEFITS SUMMARY Health Insurance Coverage
(Staff located outside of the DC Metro area must enroll in POS or PPO with HSA)
CareFirst BlueCross BlueShield is our group health insurance carrier. We offer individual coverage as well as coverage for dependents and domestic partners who meet the criteria set by CareFirst BlueCross BlueShield. An affidavit of Domestic Partnership will be required. Premium payments via pre-tax payroll deduction may be required depending upon the employee’s coverage election. The three products offered to you are as follows:
Eligibility: First Day of Employment Rates Effective April 1, 2022 through March 31, 2023
BlueChoice - HMO (Health Maintenance Organization) *Option for non-DC based staff and DC-based staff
The HMO provides comprehensive care for the insured, including doctors’ visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy. Care is provided through doctors and other health care professionals under contract. Generally, the choice of doctors and hospitals is limited to those that are in the HMO network. However, exceptions can be made in emergencies or when medically necessary.
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HMO bi-weekly pre-tax payroll deductions (includes Vision & Dental insurance):
EMPLOYEES EARNING LESS THAN $44,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$0.00
Individual + One Child
$0.00
Individual + One Adult
$0.00
Individual + Children
$0.00
Family
$0.00
EMPLOYEES EARNING $45,000 TO $48,499 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$31.55
Individual + One Child
$58.43
Individual + One Adult
$62.12
Individual + Children
$64.89
Family
$93.87
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HMO bi-weekly pre-tax payroll deductions (includes Vision & Dental insurance):
EMPLOYEES EARNING $48,500 TO $51,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$63.18
Individual + One Child
$122.12
Individual + One Adult
$125.82
Individual + Children
$160.43
Family
$189.41
EMPLOYEES EARNING $52,000 TO $54,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$94.68
Individual + One Child
$184.89
Individual + One Adult
$188.58
Individual + Children
$254.58
Family
$283.56
EMPLOYEES EARNING $55,000+ COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$126.18
Individual + One Child
$247.66
Individual + One Adult
$251.35
Individual + Children
$348.73
Family
$377.71
2022 EMPLOYEE BENEFITS – 9
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BENEFITS SUMMARY HealthyBlue Advantage - POS (Point of Service) *Option for non-DC based staff and DC-based staff
In an effort to reduce escalating health costs, Carefirst developed an innovative portfolio of products called HealthyBlue. HealthyBlue is designed to increase your awareness of health status, encourage healthy behaviors, offer you meaningful incentives, remove obstacles to preventative screenings and primary care services, and offer you choices in where you receive care. No cost for in-network preventive care, PCP care, lab and x-ray. Freedom to choose your doctor, regardless of whether they are in or out of the BlueChoice network.
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POS pre-tax bi-weekly payroll deductions (includes Vision & Dental Insurance):
EMPLOYEES EARNING LESS THAN $44,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$24.61
Individual + One Child
$44.62
Individual + One Adult
$48.31
Individual + Children
$44.13
Family
$73.11
EMPLOYEES EARNING $45,000 TO $48,499 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$56.00
Individual + One Child
$107.39
Individual + One Adult
$111.08
Individual + Children
$138.29
Family
$167.27
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POS pre-tax bi-weekly payroll deductions (includes Vision & Dental Insurance):
EMPLOYEES EARNING $48,500 TO $51,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$87.84
Individual + One Child
$171.08
Individual + One Adult
$174.77
Individual + Children
$233.82
Family
$262.80
EMPLOYEES EARNING $52,000 TO $54,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$119.23
Individual + One Child
$233.85
Individual + One Adult
$237.54
Individual + Children
$327.98
Family
$356.96
EMPLOYEES EARNING $55,000+ COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$150.61
Individual + One Child
$296.62
Individual + One Adult
$300.31
Individual + Children
$422.13
Family
$451.11
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BENEFITS SUMMARY HealthyBlue – PPO (Preferred Provider Organization) with HSA (Health Savings Account) *Option for non-DC based staff and DC-based staff
This is a cross between traditional fee-for-service and an HMO. Like an HMO, there are specific doctors and hospitals to choose from. In a PPO, though, it is possible to use doctors who are not part of the plan and still receive some coverage. This type of plan is well suited for individuals who want an HMO-style prepaid plan, but also want to use a doctor that is not part of the network. As with HMO’s, these plans are geared towards preventative care and include a broad range of services. The PPO has a Health Savings Account (HSA). A Health Savings Account (HSA) is a taxadvantaged account offered in conjunction with a High Deductible Health Plan (HDHP). The account is held with a designated trustee or custodian. The account allows you to contribute a portion of your paycheck—before taxes—into an account to be used for eligible health expenses.
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PPO with HSA bi-weekly pre-tax payroll deductions (includes Vision & Dental insurance):
EMPLOYEES EARNING LESS THAN $44,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$45.30
Individual + One Child
$85.92
Individual + One Adult
$89.61
Individual + Children
$106.14
Family
$135.12
EMPLOYEES EARNING $45,000 TO $48,499 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$76.68
Individual + One Child
$148.69
Individual + One Adult
$152.38
Individual + Children
$200.29
Family
$229.27
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PPO with HSA bi-weekly pre-tax payroll deductions (includes Vision & Dental insurance):
EMPLOYEES EARNING $48,500 TO $51,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$108.53
Individual + One Child
$212.38
Individual + One Adult
$216.07
Individual + Children
$295.83
Family
$324.81
EMPLOYEES EARNING $52,000 TO $54,999 COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$139.91
Individual + One Child
$275.15
Individual + One Adult
$278.84
Individual + Children
$389.98
Family
$418.96
EMPLOYEES EARNING $55,000+ COVERAGE
STAFF BI-WEEKLY PRE-TAX COST
Individual
$171.30
Individual + One Child
$337.92
Individual + One Adult
$341.61
Individual + Children
$484.14
Family
$513.12
2022 EMPLOYEE BENEFITS – 15
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PRESCRIPTION DRUG PROGRAM Eligibility: First Day of Employment Rates Effective April 1, 2022 through March 31, 2023 The prescription drug program is included with your health care benefits. This is a three-tier program and there are different co-pays depending on the three tiers. The current co-pays are as follows:
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PHARMACY BENEFITS BENEFITS
BLUECHOICE HMO 1-S
HEALTHYBLUE POS ADVANTAGE C-S
HEALTHY BLUE PPO E-S WITH H.S.A
Annual Rx Deductible
$200 Individual
$400 Family
$200 Individual
$400 Family
Integrated with Medical Deductible
Retail (34 day)
Mail Order (90 day)
Retail (34 day)
Mail Order (90 day)
Retail (34 day)
Mail Order (90 day)
Preventive
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Tier 1 (Generic)
$15.00
$30.00
$15.00
$30.00
$15.00
$30.00
Tier 2 (Preferred Brand)
$35.00
$70.00
$35.00
$70.00
$35.00
$70.00
Tier 3 (NonPreferred Brand)
$60.00
$120.00
$60.00
$120.00
$60.00
$120.00
Tier 4 (Preferred Specialty Drugs)
50% up to a $100 max
50% up to a $200 max
50% up to a $100 max
50% up to a $200 max
50% up to a $100 max
50% up to a $200 max
Tier 5 (Non-Preferred Specialty Drugs)
50% up to a $150 max
50% up to a $300 max
50% up to a $150 max
50% up to a $300 max
50% up to a $150 max
50% up to a $300 max
Suggestions for Saving Money on Prescriptions: • If you take brand-preferred or non-preferred brand drug, speak with your doctor about switching to a generic drug. • Many big box retailers (i.e. Target, Walmart, COSTCO, etc) have pharmacies and offer a $4 drug list. If you currently are taking a drug that they offer, you could save money. • Carefirst’s preventive drug list provides certain prescriptions for a $0 copay (including aspirin, folic acid, fluoride, iron supplements and FDA approved contraceptives for women). • Consider Carefirst’s Mail Service Pharmacy. You can use the program online, by mail or by phone. Call the number on the back of your member ID card and have your medication, doctor’s name/phone number and credit card information ready.
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RESOURCES MY ACCOUNT Access your plan information, view claims, check the drug formulary, and more. Registration is required for MyAccount.
SHARECARE® WELLNESS Sharecare® is a free, comprehensive wellness program included as part of your medical plan. It provides a wealth of customized tools and resources that are easy to use and understand. Take the RealAge® online health assessment, complete your health profile and get a personalized health timeline. How It Works You can access the program’s personalized tools whenever and where you want, either through the mobile app or online at www.carefirst.com/sharecare.
BLUEREWARDS HMO participants can earn financial incentives for participating in activities like taking the RealAge assessment, consenting to receive wellness emails, selecting a primary care provider, and completing a health screening. You and your spouse can earn rewards to be used towards your annual deductible and out-of-pocket expenses. Rewards will be loaded to a Visa Incentive Card which can then be used towards plan deductibles and outof-pocket costs. To get started, log into MyAccount.
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RESOURCES CONT. CAREFIRST BLUE 365 DISCOUNT PROGRAM This program provides discounts on a broad range of alternative therapies and wellness services, like gym memberships and fitness gear. It is free to you as a CareFirst member. Visit www.blue365deals.com.
CAREFIRST MOBILE APP Available to download from the Apple App Store or Google Play. Access your personalized plan information, find innetwork doctors, view ID cards, and check claims and deductible status.
CAREFIRST VIDEO VISITS When your PCP is not available, CareFirst Video Visits allow you to connect with a board-certified doctor on your smartphone, tablet or computer without an appointment! Video Visits cost the same as your Office Visit copay. CareFirst Video Visits are intended for the treatment of uncomplicated, non-emergency health concerns, like treatment for a cold, rash or flu. Go to www.carefirstvideovisit.com for full details.
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CloseKnit: You–Centric Primary Care
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Health Advocate provides support for healthcare and insurance issues, finds qualified doctors and hospitals, and most importantly helps to resolve complex benefits and claims issues. Membership in Health Advocate is provided to you by the Human Rights Campaign at no cost.
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PPO DENTAL Eligibility: First Day of Employment At the time of service, you may choose either a PPO participating dentist or any nonparticipating dentist. With the PPO plan, savings are possible because the PPO participating dentists have agreed to provide care at a negotiated fee schedule. Non-participating benefits are subject to reasonable and customary charge limits. Dental coverage includes:
BENEFIT DESCRIPTION Class I: Preventive & Diagnostic Care
Oral Exams, Cleanings, Bitewing and Full Mouth X-Rays, Fluoride (dependents to age 19), Sealants, Space Maintainers (limited to nonorthodontic treatment)
Annual Plan Year Deductible
Applies to all Services except Preventive
Annual Plan Year Maximum Benefit Class II: Basic Restorative Care
Periodontal Maintenance, Emergency Palliative Treatment, Amalgam & Composite Fillings, Simple Extractions, Root Canals
Class III: Major Restorative Care
Crowns , Dentures, Bridges, Periodontal Root Planning & Scaling or Surgery, Surgical Extractions, Repairs (Crowns), Implants, General Anesthesia
Class IV: Orthodontia
Dependent children & Adults have coverage for braces & orthodontic care. Lifetime Maximum: $1,000
OUT OF NETWORK
OUT OF NETWORK
Dental Plan Pays
Dental Plan Pays
100%, No Deductible
100%, No Deductible
$50 per Individual / $150 per Family $2,000 per person
90% After Deductible
40% After Deductible
60% After Deductible
40% After Deductible
50% After Deductible
50% After Deductible
NOTE: If you visit a dentist who does not participate with MetLife Dental, you may be subject to higher out-of-pocket costs and be balance billed up to the provider’s charges. You may also need to file your own claim forms. Some covered services have limitations based on your age or how often they are used. Refer to your plan documents for details on covered services and benefit levels.
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VISION PLAN Did you know that without vision coverage, an exam and prescription glasses can cost $300 or more? With VSP, you’ll save!
Eligibility: First Day of Employment Rates Effective April 1, 2022 through March 31, 2023
VSP VISION PLAN SUMMARY Benefit Description
In-Network
Out-Of-Network
Benefit Frequency
Routine Exam
$10 Co-Pay
Up to $50
Once Every 12 Months
Prescription Glasses
$10 Co-Pay
Frames
• 225 allowance for a wide selection of frames • $245 allowance for featured frame brands • 20% savings on the amount over your allowance
Up to $70
Every 24 Months
Lenses
• Covered in full • Single Vision, Lined Bifocal, Lined Trifocal and progressive lenses • Polycarbonate lenses for dependent children • Add’l co-pays may apply for lens enhancements
• Single Vision Lenses - Up to $50 • Lined Bifocal Lenses - Up to $75 • Lined Trifocal Lenses - Up to $100
Every 12 Months
Contact Lenses
• $150 allowance for contacts; co-pay does not apply • Contact lenses exam (fitting and evaluation) up to $60 co-pay
Up to $105
Every 12 Months
VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. 2022 EMPLOYEE BENEFITS – 23
FLEXIBLE SPENDING ACCOUNTS (FSA) Lower your health care out-of-pocket expenses by about 1/3... by paying for them with TAX-FREE DOLLARS. Enroll in a Healthcare Flexible Spending Account (FSA) plan. It’s simple: you set aside a certain amount of money through payroll deduction, and it is automatically protected from taxes. Then, you reimburse yourself for health, dental and vision care expenses with the tax-free dollars. Use a debit card to pay for your FSA expenses, or use a variety of easy ways to request reimbursement. For those on an HSA plan, Enroll in a Limited Purpose Flexible Spending Account (LPFSA) plan to set aside additional money for your vision and dental expenses. Working parents will love the Dependent Care Flexible Spending Account (FSA) program. You can protect a portion of your paycheck from taxes, and use that tax-free money to pay for your out-ofpocket dependent care expenses. By avoiding tax on your out-of-pocket dependent care expenses, you can save 30% or more on those expenses. For those who commute to work, you will love our Parking and Transit Flexible Spending Accounts (FSAs). You could save up to 40% on your commuting or parking expenses by setting aside those pre-tax dollars. For DC based employees please remember that we have SmartTrip benefits for metro commuters.
Eligibility: First Day of Employment
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EMPLOYEE ASSISTANCE PROGRAM – LIFE SERVICES TOOLKIT Confidential, short-term outpatient counseling services are offered at no cost to help resolve personal problems such as parenting concerns, marriage and family distress, financial, alcohol and drug abuse, emotional stress, and other life crises.
Eligibility: First Day of Employment
BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) Basic Life and Accidental Death & Dismemberment (AD&D) is at one-times your annual salary to a maximum of $500,000 and is paid 100% by the Human Rights Campaign. Voluntary purchase of additional Life/AD&D coverage amounts is also available; see below.
Eligibility: First Day of Employment
SHORT-TERM DISABILITY INSURANCE After 14 days of continuous disability, on the 15th day this policy pays you a weekly benefit of 60% of your salary up to a maximum of $2,000.00 per week. Maximum benefit period of 90 days. HRC pays 100% of the premium.
Eligibility: First Day of Employment
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LONG-TERM DISABILITY INSURANCE After 90 days of continuous disability, this policy pays you 60% of your monthly salary, up to a maximum of $15,000 per month. HRC pays 100% of the premium.
Eligibility: First Day of Employment
VOLUNTARY LIFE AND AD&D Regular full-time employees have the opportunity to choose between $10,000 and $500,000 of term insurance in $10,000 increments for self and spouse or domestic partner. Voluntary life insurance of up to $10,000 for children is also available. A guaranteed issue for voluntary life between $10,000 and $200,000 is in effect for you and for your spouse up to $50,000 within your first thirty days of hire. After thirty days, evidence of insurability will be required for any amount of voluntary life you choose to purchase.
Eligibility: First Day of Employment
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FAMILY CARE FAMILY AND MEDICAL LEAVE HRC supports the District of Columbia Family and Medical Leave Act of 1990 (“DC FMLA”) and incorporates the DC FMLA as its family and medical leave policy. Some of the important terms and conditions of the DC FMLA are summarized below. In all cases, however, the terms an conditions of the DC FMLA shall govern.
ELIGIBLE EMPLOYEES To be eligible for family and medical leave, you must be employed by HRC for at least one year without a break in service and have worked at least 1,000 hours during the 12 month period immediately preceding the request for family or medical leave.
LEAVE ENTITLEMENT Two distinct types of leave are available under this policy: (i) unpaid family leave, for certain events within the employee’s family and (ii) unpaid medical leave, for the employee’s own serious health condition. The total leave entitlement available under this FMLA policy is sixteen (16) workweeks.
FAMILY LEAVE/PAID PARENTAL LEAVE An eligible employee is entitled to up to 16 paid workweeks of family leave during any 24 month period for: 1. the birth of a child; 2. the placement of a child with the employee for adoption or foster care; 3. the placement of a child with the employee, for whom the employee permanently assumes and discharges parental responsibilities; and 4. the care of a family member with a serious health condition. The entitlement to family leave under (1) through (3) above expires twelve (12) months after the birth of the child or placement of the child with the employee. For the purpose of family leave, the definition of family member is: Someone to whom the employee is related by blood, legal custody,
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FAMILY CARE CONT. marriage or registered domestic partnership or civil union; a child who lives with an employee and for whom the employee permanently assumes and discharges parental responsibility; and a person with whom the employee shares or has shared, within the previous year, a mutual residence and with whom the employee maintains a committed relationship. A “committed relationship” is demonstrated by such factors as, but not limited to: Mutual economic interdependence including joint bank accounts, joint tenancy, shared lease, and joint and mutual financial obligations such as loans, domestic interdependence including close association, public presentment of the relationship, exclusiveness of the intent of the relationship as evidenced by a will or life insurance.
MEDICAL LEAVE An eligible employee is entitled to up to 16 paid workweeks during any 24 month period, for instances when the employee becomes unable to perform the functions of their position. The medical leave expires when the employee again becomes able to perform the functions of the position. For purposes of both family leave and medical leave, the definition of serious health conditions is the same: A physical or mental illness, injury or impairment that involves inpatient care in a hospital, hospice or residential health care facility or continuing treatment or supervision at home by a health care provider or other competent individual.
INTERMITTENT LEAVE Medical leave, and family leave to take care of a family member with a serious health condition, may be taken intermittently when medically necessary. However, the employee must provide HRC with reasonable prior notice and make an effort to schedule the treatment or supervision in a manner that does not unduly disrupt the operations of HRC.
CALCULATION OF LEAVE AVAILABLE HRC calculates the amount of medical leave available to an employee on a “rolling” basis measured backwards from the date that an employee takes any medical leave.
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FAMILY CARE CONT. NOTICE OF INTENT TO TAKE LEAVE In general, where the need for family and medical leave is foreseeable, the employee is required to provide HRC with thirty (30) days’ notice of the intent to take leave. Where the leave is not foreseeable, the employee is required to provide notice upon the discovery of the need for leave, or as soon as possible thereafter.
RELATIONSHIP TO PAID LEAVE An employee taking family leave can elect to use paid vacation, personal, compensatory or parental leave provided by HRC as part of the leave period, which HRC will count against the sixteen (16) workweeks of family leave available. The employee can also apply for short term disability and state leave. Any paid sick leave provided by HRC that the employee elects to use for medical leave will count against the sixteen (16) workweeks of medical leave available. If the employee depletes all of their leave on approved FMLA, HRC will provide the employee with sick leave donation. Essentially the employee will have 16 weeks of paid leave.
CERTIFICATION OF A SERIOUS HEALTH CONDITION When an employee requests medical leave due to their own serious health condition or requests family leave due to the serious health condition of a family member, HRC may require the employee to provide a certification from a health care provider. The certification must include: 1. the date the serious health condition commenced; 2. the probable duration of the condition; and 3. the facts which would entitle the employee to leave. For medical leave, the certification must also include a statement that the employee is unable to perform the functions of their position. For family leave, the certification must also include an estimate of the amount of time needed by the employee to care for the family member. HRC’s right to require certification exists not only at the time leave is requested, but extends to anytime during the leave.
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FAMILY CARE CONT. RESTORATION TO POSITION Upon return from family or medical leave, with a doctors note, an employee will be restored to the position they held at the time leave commenced or to a position having equivalent benefits, pay, seniority and conditions of employment. While the employee will not lose any benefit or seniority accrued prior to the taking of leave, the employee will not accrue benefits or seniority during the leave period. In general, the employee is not entitled to any right, employment benefit or position of employment other than that to which the employee would have been entitled had they not elected FMLA leave.
BENEFITS DURING PERIOD OF LEAVE HRC will maintain coverage under the group health, life and long-term disability insurance plans, and the 401k plan for an employee on family or medical leave, at the same level and under the same conditions that coverage would have been provided had the employee not taken leave. Employee will have to reimburse HRC for the employee portion of the premium while on unpaid leave.
Carrot Carrot is an HRC sponsored benefit that provides flexible financial coverage and expert care navigation across the U.S. and 60+ countries. The Carrot program covers fertility education and assessments, fertility preservation (egg, sperm, and embryo freezing), in-vitro fertilization (IVF), donor-assisted reproduction (including surrogacy), and adoption. Employees, employee spouses and/or domestic partners are eligible to participate in the Carrot program on the first day of employment provided that the employee is full-time and benefits-eligible (scheduled to work 30+ per week). This plan will integrate with your CareFirst BCBS medical plan, if enrolledin that plan. The benefit will provide reimbursement up to $5,000 per plan year. Employees do not need to be enrolled in HRC’s medical plan to take advantage of Carrot benefits. Please contact Human Resources for additional information.
2022 EMPLOYEE BENEFITS – 30
COVERED TREATMENTS AND SERVICES All benefits eligible employees will have a plan year maximum of $5,000 available.
T E S T ING A N D D I A G NO STICS
T R E A TM ENTS
• Initial fertility consultation
• In vitro fertilization (IVF)
• Transvaginal ultrasound baseline
• Intrauterine insemination (IUI)
• Semen analysis
• Donor sperm acquisition
• Lab tests and diagnostic procedures
• Donor egg acquisition
• Genetic carrier screening
• Egg and sperm storage • Shipping and transport of materials
FE R T ILITY P R E S ERV A TION
• Egg retrieval
A D O P T IO N & S U R R O G A CY
• Sperm freezing
• Adoption agency services
• Egg freezing
• Adoption related legal services
• Embryo freezing
• GC-related legal services • GC-related agency services
2022 EMPLOYEE BENEFITS – 31
MEDICAL EXPERT SPECIALTIES AND TOPICS FERTILITY
• Initial consultations • Fertility preservation
EMOTIONAL SUPPORT
• Emotional support for adoption, fertility, and GC journeys
• In vitro fertilization (IVF) • Male fertility and preservation
ADOPTION & SURROGACY
PRESCRIPTION SUPPORT
• Medication and treatment questions • Injection administration
• U.S. domestic adoption
• International adoption • Foster to adopt adoption • Gestational carrier journeys
LGBTQ+
PREGNANCY
• Medical questions • Labor and birth plans • Nutrition in pregnancy • Lactation and breastfeeding support
• Navigating LGBTQ+ family building journeys
2022 EMPLOYEE BENEFITS – 32 20
NEXT STEP S
KEY THINGS TO REMEMBER
Key things to remember
1. Activate your member account Sign up at app.get-carrot.com/signup
2. Explore your benefit guide and expert-authored content Learn about specific topics, treatments and options
3. Once you’re ready to embark on your family-forming journey, get your personalized Carrot Plan 4. Find a Carrot Partner clinic for priority booking and negotiated discounts. 5. Request your Carrot Card 6. Use your Carrot Card or pay out of pocket and get reimbursed Carrot Card: Upload a receipt within 2 weeks of receiving care Out of pocket: Invoices can be submitted up to 30 days after your plan year ends
QUESTIONS? WE’VE GOT YOU COVERED.
Email support@get-carrot.com for answers
© 2021 Carrot. Confidential; not for distribution.
2022 EMPLOYEE BENEFITS – 33
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Wellness and Disease Management
Delivering a new, personalized experience WELLNESS AND DISEASE MANAGEMENT CareFirst BlueCross BlueShield (CareFirst) has partnered with Sharecare, Inc.* to launch a new CareFirstand BlueCross (CareFirst) has partnered with Sharecare, Inc.* to launch a newtoward wellness diseaseBlueShield management program that fully supports your employees’ efforts wellness and diseaseIntegrating management program that supports yourthe employees’ toward health improvement. technology andfully real-time data, programefforts provides your health improvement. Integrating technology and real-time data, the program provides your employees with greater awareness of their health status and tailored resources to help them employees improve it. with greater awareness of their health status and tailored resources to help them improve it.
Built into all our health plans with no additional administrative costs, the wellness program offers your population exclusive features including: Built into all our health plans with no additional administrative costs, the wellness program offers your population exclusive features including:
RealAge® test: This unique online health assessment shows the age of the body your employees are living in versus their calendar age.
Challenges: A variety of challenge options are available that help support and motivate your employees to achieve their health goals.
Personalized content: Based on their well-being goals, motivation and interests, each individual receives customized tips, insights and tools.
Health Profile: Provides employees with easy access to the evolving story of their health including biometric information, lab results and medications, all in one place.
Trackers: The program enables syncing of wearable devices that monitor the daily habits influencing your employees’ health like stress, sleep, steps, nutrition, biometric values and more.
Blue Rewards: Employees can earn incentives for participating in activities like taking the RealAge test, consenting to receive wellness emails, selecting a primary care provider and completing a health screening.
Employees can download the mobile app to access program tools and resources whenever and wherever they want.
*Sharecare, Inc. is an independent company that provides health improvement management services to CareFirst members.
*Sharecare, Inc. is an independent company that provides health improvement management services to CareFirst members. 2022 EMPLOYEE BENEFITS – 34
Specialized programs If your employees are looking for extra support for a health condition or to meet a specific goal like quitting tobacco, the program’s focused resources can help: ■■
■■
Health coaching: Confidential, high-touch coaching focusing on lifestyle and/or disease management provides one-on-one support with a primary coach to foster a trusting, collaborative relationship that accelerates behavior change. Coaching sessions are unique for each participant, delivered with the frequency and through the channels they prefer to encourage sustained engagement. Weight management program: Through personalized telephonic coaching support, and web-based tools and resources, this program provides an individualized approach that fits into each participant’s lifestyle to support long-term weight management.
■■
Tobacco cessation program: Participants receive expert guidance through coaching specialists, supportive and encouraging communications based on their preferences and an online community to make quitting even more successful. Program support is tailored to each employee depending on their readiness to quit and any health conditions.
■■
Financial well-being: Individuals are empowered to take control of their finances by making small changes that add up to big results.
For more information, contact your CareFirst account representative.
This wellness program is administered by Sharecare, Inc., an independent company that provides health improvement management services to CareFirst members. Sharecare, Inc. does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the health improvement management services it provides. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc. This wellness program is administered by Sharecare, Inc., an independent company that provides health improvement management services to CareFirst members. Sharecare, Inc. does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the health improvement management services it provides. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
SUM4499-1N (8/18)
■
Wellness Account Flier
2022 EMPLOYEE BENEFITS – 35
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GENDER AFFIRMING CARE We understand that insurance can be difficult, that is why CareFirst BlueCross BlueShield (CareFirst) is changing the way we deliver care to our transgender, gender expansive, and nonbinary member populations.
We do this by: • Working with our transgender, gender expansive, and non-binary members to assist in navigating and getting the most from their insurance benefits. • Covering medically necessary procedures for transition and gender related care including: • Gender-affirming surgeries • Hormone Therapies • Lab Testing • Behavioral Health Support • Routine Medical Care • Family Planning and Support • Mental Health Care • Pediatric Transgender and Nonbinary Care • Educating our providers on appropriate care and competencies for the gender-diverse member population. • Delivering resources for providers and case managers to adequately manage and address concerns for our gender-diverse member populations.
2022 EMPLOYEE BENEFITS – 36
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GENDER AFFIRMING CARE CONT. • Providing ongoing training for CareFirst associates that reinforces the importance of using members’ preferred pronouns and names. • Programs, such as CareFirst’s Behavioral Health Digital Resource, offer supportive communities that encourage sharing and provide support to all members. This resource, available through 7 Cups, a global behavioral health company, is offered at no cost to CareFirst members with medical benefits. The Behavioral Health Digital Resource offers trained volunteer listeners who provide support in more than 140 languages, robust online communities (including some specific to LGBTQ+ needs) with trained moderators, and personalized growth paths. The resource is available 24/7. To access, visit www.7cups.com/carefirst. 1
Actual plan coverage may vary, depending on the terms of your employer’s specific medical and pharmaceutical plan. Plan deductible, coinsurance and/or copay requirements may apply. Additional plan conditions, including exclusions and limitations, may apply. See your plan documents for costs and details of coverage. Coverage pursuant to CareFirst Medical Policy: 7.01.123 “Gender Affirmation Services/Gender Dysphoria”
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association.
2022 EMPLOYEE BENEFITS – 37
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HIV/HEALTH EQUITY CARE The Human Rights Campaign avidly supports those in the HIV-positive community, and wants all employees to know about the prevention and treatment resources available to them. PrEP, also known as pre-exposure prophylaxis, is used as a prevention treatment for those at risk for receiving an HIV diagnosis from sex or drug injection use. PrEP has proven to be highly effective at preventing HIV infection and comes in two brand forms. Truvada is prescribed for all individuals who are at risk for receiving an HIV-1 diagnosis and can be given to those who weigh at least 77 pounds. Descovy is also given to individuals who are at risk for receiving an HIV diagnosis but is not prescribed for those who were assigned female at birth. Both PrEP forms can only be administered for those who are already HIV negative before and while taking the prescription medicine. Treatment options are also widely available. HIV treatment is called antiretroviral therapy (ART), typically involving a combination of medications to form a treatment regimen. ART reduces the viral load of the individual taking the regimen to an undetectable level, allowing them to live a healthier and longer life. Those who maintain an undetectable viral load have no risk of transmitting HIV
2022 EMPLOYEE BENEFITS – 38
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HIV/HEALTH EQUALITY CARE CONT. to their sexual partner. It is imperative that those who receive an HIV-positive diagnosis begin ART as soon as possible to promote a healthy immune system. There are currently over a dozen FDA approved ART medications available, all of which address various issues and lifestyles. Your primary care physician can advise you on which medications will work best for you. The Human Rights Campaign is a proud member of the #workingpositively campaign, which asks employers to serve as influential role models in supporting their HIV-positive employees. Misinformation and stigma continue a culture of exclusion and discrimination, however practicing inclusive policies such as #workingpositively fosters a trustworthy and safe workplace environment. Since 2019, over 100 companies have signed the #workingpositively pledge, a declaration to end workplace discrimination against employees living with HIV. The pledge includes a commitment to fight stigma, welcome employees living with HIV, create opportunities for employees to partner with HIV/AIDS related community-based organizations, honor privacy, and promote commitment internally to employees and externally on social media platforms. Interested employees are welcome to read more about the #workingpositively campaign here on our resource page.
2022 EMPLOYEE BENEFITS – 39
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2022 EMPLOYEE BENEFITS – 40
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CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, inc., which are independent licenses of the BlueCross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered services marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. SUM5820-1E (10/21)
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2022 EMPLOYEE BENEFITS – 41
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Know Before You Go
Your money, your health, your decision Choosing the right setting for your care—from allergies to X-rays—is key to getting the best treatment with the lowest out-of-pocket costs. It’s important to understand your options so you can make the best decision when you or your family members need care.*
Primary care provider (PCP) The best place to get consistent, quality health care is your primary care provider (PCP). If you have a medical issue, having a doctor who knows your health history often makes it easier to get the care you need.
24-Hour Nurse Advice Line Registered nurses are available 24/7 to discuss your symptoms with you and recommend the most appropriate care. Call 800-535-9700 anytime to speak with a nurse.
CareFirst Video Visit When your PCP isn’t available and you need urgent care services, CareFirst Video Visit securely connects you with a doctor, day or night, through your smartphone, tablet or computer. In addition, you can schedule visits for other needs such as behavioral health support from a therapist or psychiatrist, guidance from a certified nutritionist or breastfeeding support from a lactation consultant. It’s a convenient and easy way to get the care you need, wherever you are. Visit carefirstvideovisit.com to get started.
Convenience care centers (retail health clinics) These are typically located inside a pharmacy or retail store (like CVS MinuteClinic or Walgreens Healthcare Clinic) and offer care for nonemergency situations like colds, pink eye, strep tests and vaccinations. These centers usually have evening and weekend hours.
*
Urgent care centers Urgent care centers (such as Patient First or ExpressCare) provide treatment for injuries and illnesses that require prompt medical attention but are not life-threatening (sprains, minor cuts, flu, rashes, minor burns). These centers have doctors on staff and offer weekend/after-hours care.
Emergency room (ER) Emergency rooms treat acute illnesses and trauma. Go to the ER right away if you or a family member have sudden symptoms that need emergency care, including (but not limited to): chest pain, trouble breathing or head trauma. Prior authorization is not needed for emergency room services.
The medical providers mentioned in this document are independent providers making their own medical determinations and are not employed by CareFirst. CareFirst does not direct the action of participating providers or provide medical advice. 2022 EMPLOYEE BENEFITS – 42
When you need care When your PCP isn’t available, being familiar with your options will help you locate the most appropriate and cost-effective medical care. The chart below shows how costs* may vary for a sample health plan depending on where you choose to get care. Sample cost
Video Visit
(urgent care services)
■■
$20
Urgent Care
(e.g., Patient First or ExpressCare)
Emergency Room
■■ ■■
Convenience Care (e.g., CVS MinuteClinic or Walgreens Healthcare Clinic)
Sample symptoms
■■
$20
■■ ■■
■■
$60
■■
■■
■■
$200
■■ ■■
■■
24-Hour Nurse Advice Line *
$0
24/7
Rx
Cough, cold and flu Pink eye Ear pain
✔
✔
Cough, cold and flu Pink eye Ear pain
✘
✔
Sprains Cut requiring stitches Minor burns
✘
✔
Chest pain Difficulty breathing Abdominal pain
✔
✔
Did you know that where you choose to get lab work, X-rays and surgical procedures can have a big impact on your wallet? Typically, services performed in a hospital cost more than non-hospital settings like LabCorp, Advanced Radiology or ambulatory surgery centers.
If you are unsure about your symptoms or where to go for care, call 800-535-9700, anytime day or night to speak to a registered nurse.
The costs in this chart are for illustrative purposes only and may not represent your specific benefits or costs.
To determine your specific benefits and associated costs: ■
Log in to My Account at carefirst.com/myaccount;
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Check your Evidence of Coverage or benefit summary;
■
Ask your benefit administrator; or
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Call Member Services at the telephone number on the back of your member ID card.
For more information and frequently asked questions, visit carefirst.com/needcare. PLEASE READ: The information provided in this document regarding various care options is meant to be helpful when you are seeking care and is not intended as medical advice. Only a medical provider can offer medical advice. The choice of provider or place to seek medical treatment belongs entirely to you.
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc., The Dental Network and First Care, Inc. are independent licensees of the Blue Cross and Blue Shield Association. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). The Blue Cross® and Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
SUM3424-1P (10/19)
2022 EMPLOYEE BENEFITS – 43
401(K) INVESTMENT/ RETIREMENT ACCOUNT To help you achieve your long term retirement goals, HRC offers a 401(k) plan: • Upon eligibility, employees may elect to make tax defer red contributions to the plan. Employees are 100% vested in their tax deferred contributions. • Upon eligibility, new employees will be automatically enrolled in the plan, contributing 3% of their pay, unless they go online and choose a different percentage. • After 90 days o f service, HRC will contribute 3 % of your salary, THEN MATCH 1/2 the first 5% you • Employees may make Roth 401(k) contributions if they choose to. • Sign up at www.principal.com HRC’s group number # 459589
Eligibility: First of the month following 90 days for both employee deferrals and Safe Harbor contribution
2022 EMPLOYEE BENEFITS – 44
401(K) INVESTMENT/RETIREMENT ACCOUNT CONT. EMPLOYER CONTRIBUTION The employer contribution is calculated against quarterly earnings. All employer contributions are funded on a quarterly basis.
YEAR
CONTRIBUTION LIMITS
2022
The IRS imposes several limits on the amount that can be contributed to your 401(k) plan account in a year.
LIMIT
PRE-TAX CONTRIBUTION
$20,500.00
The maximum pre-tax amount you can contribute each year to your 401(k) plan account is determined by the IRS. This amount is your IRS pre-tax limit for the given year even if you work for more than one employer. There are several different limits that apply to a 401(k) plan in addition to the overall contribution limit. These limits could result in a contribution limit less than that specified by the IRS.
2022 EMPLOYEE BENEFITS – 45
CATCH-UP CONTRIBUTIONS If you will reach age 50 or older during the calendar year January 1-December 31 and are making the maximum Plan or IRS pretax contribution, you may make an additional “catch-up” contribution each pay period.
2022 Catch-up Limit: $6,500 annually Certain restrictions may apply to withdrawals from the plan. Details of any restrictions may be found in the plan document.
OTHER BENEFITS
• Through a payroll deduction, you can buy transit fare (and parking fees at Metro parking lots) through SmartBenefits with pre-tax income. • Each month, the dollar value of your monthly commuting benefit is conveniently added directly to your SmarTrip® card. • Visit www.wmata.com for more details.
SmartBenefits is available to Washington Metropolitan area staff only.
2022 EMPLOYEE BENEFITS – 46
PAID TIME OFF The Human Rights Campaign understands the importance of having a well-balanced life on and off work. We offer time-off programs that are market competitive including time off for vacation, sick, personal, Military Duty, Jury Duty, and Sabbatical Leave. We also offer telecommuting options for those positions that are eligible.
VACATION LEAVE Employees earn two weeks (75.00 hours) of vacation for the first two years of employment. Three weeks (112.50 hours) for year three and then four weeks (150.00 hours) upon completion of four years (and beyond). Vacation is accrued in hours each pay period.
Eligibility: After 90 Days of Employment
PERSONAL LEAVE Regular full time employees receive four personal leave days per calendar year. Cannot carry over.
Eligibility: Immediately
SICK LEAVE Employees earn one day per month with a maximum accrual of thirty days. Sick leave is accrued in hours each pay period.
Eligibility: Once hours have accrued
ADDITIONAL LEAVE Nine Federal holidays and occasional office closings.
Holidays Days Eligibility: Immediately
NOTE: HRC follows the Federal government regarding closings and delayed arrivals for inclement weather. 2022 EMPLOYEE BENEFITS – 47
EMPLOYEE DISCOUNTS Calm.com All HRC staff receive a free premium subscription to Calm.com, the world’s #1 app for mental fitness. Whether you have 30 seconds or 30 minutes, Calm content is made to suit your needs from music, sleep stories, relaxing sounds and so much more. www.calm.com
Congressional Federal Credit Union Not for profit financial cooperative that offers you the best rates on loans, credi t cards, and saving products: www.congressionalfcu.org
National Geographic Credit Union Not for profit credit union associated with National Geographic Society that offers you great rates on loans, credit cards and bank accounts: www.NationalGeographicFCU.org
Capital Bike Share Puts 1,100 bicycles at your fingertips. You can choose from over 110 stations across Washington, D.C. and Arlington, VA and r eturn the bike to any station near your destination. Check out a bike for your trip to work, Metro, run errands, go shopping, or visit friends and family. www. capitalbikeshare.com
Verizon 18% monthly discount for wireless services and a 25% accessories discount for HRC staff. Must apply through website that verifies your hrc.org email address. Can only be used for one discount. Discount may be used for yourself, a family member (or family plan). These are applied after 1-2 billing cycles. www.verizonwireless.com/discount-program/#
2022 EMPLOYEE BENEFITS – 48
EMPLOYEE DISCOUNTS CONT. iPhone Benefits Employees can work with IT on iPhone purchases, where IT purchases a new phone for the employee and deduct the cost from their paycheck over 8 pay periods.
DocuBank The nation’s l argest electronic access service for healthcare directives. When you store your healthcare directives with DocuBank, you receive a customized wallet card that makes these documents, and your critical emergency information, instantly available via automated fax or secure webpage. Free for all HRC Staff, spouses, & dependents.
Vida Fitness Center Discount on Premiere Fitness Centers in DC
Robeks ($) 20% off for HRC staff, must show HRC ID
HRC Store ($) 20% off for HRC staff, except for clearance merchandise
Plumbenefits Entertainment Guide Employees of HRC now have access to a free new benefit service, Plum Benefits! Discounts up to 50% off entertainment and High Demand Sold Out Seats. Signing up is free and easy: 1. Visit www.plumbenefits.com/signup. 2. Use your HRC email address to get started. 3. Read and follow the steps on our site.
Aflac Benefits offered by Aflac are Accident Advantage, Hospital Confinement Indemnity, Cancer Protection Assurance and Critical care Protection
2022 EMPLOYEE BENEFITS – 49
What is pet health insurance? Pet health insurance provides coverage for veterinary services related to your pet being hurt or sick. Some companies, like Pets Best, also provide coverage for routine/preventative care. Pet health insurance does not cover pre-existing conditions. If a pet has a pre-existing condition, there are many other conditions that can be covered unrelated to the pre-existing issue.
2
CONFIDENTIAL
How Pet Insurance Works
Get Treatment
Pay at the Veterinary Office
File a Claim with Pets Best
Get Reimbursed by Pets Best
2022 EMPLOYEE BENEFITS – 50
Plan Overview Plan Coverage
Essential
Plus
Elite
Annual Coverage Limit for Unexpected Accidents and Illness
Unlimited
Unlimited
Unlimited
Annual Deductible
$250
$250
$250
Reimbursement Percentage
90%
90%
90%
Accidents, Illnesses, Cancer, Hereditary Conditions, Emergency Surgeries & Rx Meds* Accidents & Illness Exam Fees Associated with the Diagnosis of Your Pet for an Eligible Injury or Illness. This is not intended to cover routine exams. Rehabilitative, Acupuncture & Chiropractic Coverage to Treat Eligible Injuries and Illnesses. BestWellness Add-On for Routine Care The BestWellness plan pays up to $535 per year for routine annual exams, blood work, vaccines, and more with no deductible.
Accident-Only Coverage If your pet currently has Addison’s Disease, Cushing’s Disease, Diabetes, Cancer, Feline Leukemia or Feline Immunodeficiency Virus, they can enroll for Accident Only coverage, but will be ineligible for illness coverage. The Accident Only plan does not cover medical issues such as illness or cancer, but provides up to $10,000 in annual coverage for things like broken legs, snake bites, accidental swallowing and more. Coverage starts at $9 per month for dogs, and $6 per month for cats.*
BS-FLER-102021-V3-APIC Pet Insurance coverage offered and administered by Pets Best Insurance Services, LLC and underwritten by American Pet Insurance Company, a New York insurance company headquartered at 6100 4th Ave. S. Suite 200 Seattle, WA 98108. Please see www.americanpetinsurance.com to review all available pet health insurance products underwritten by APIC. Terms and conditions apply. See policy for details. *Most plans cover prescription medications. Download our formulary at petsbest.com/coverage. $7/month for cats and $10/month for dogs in WA. Coverage applies to eligible conditions only and is subject to all terms, conditions, limitations and exclusions in the policy. Please review policy form for complete details.
Pets Best is a Synchrony (NYSE: SYF) Health and Wellness solution.
Routine Care Coverage Routine care coverage for dogs and cats helps pay for regular veterinary visits. From regular checkups, to dental cleanings and blood work, routine care helps catch diseases early to ensure a longer, happier, and healthier life for your pet. Routine care coverage is an excellent way to budget for your pet’s expected medical expenses, especially if you have a new kitten or puppy. There are two tiers of routine care coverage that can be added to one of our pet health insurance plans for an additional premium at the time you enroll, or at your annual renewal. Benefits are available to you on your policy start date, so you can start using your routine care plan as soon as your policy goes into effect.
Essential Wellness
BestWellness™
$16/Month ($14/Month in Washington)
$26/Month ($30/Month in Washington) Pays up to the following, per year, with no deductible:
Pays up to the following, per year, with no deductible:
Spay/Neuter + Teeth Cleaning
$0
Spay/Neuter + Teeth Cleaning
Rabies
$15
Rabies
$15
$150
Flea/Tick Prevention
$50
Flea/Tick Prevention
$65
Heartworm Prevention
$30
Heartworm Prevention
$30
Vaccination/Titer
$30
Vaccination/Titer
$40
Wellness Exam
$50
Wellness Exam
$50
Heartworm Test or FELV Screen
$25
Heartworm Test or FELV Screen
$30
Blood/Fecal/Parasite Exam
$50
Blood/Fecal/Parasite Exam
$70
Microchip
$20
Microchip
$40
Urinalysis or ERD
$25
Deworming
$20
Urinalysis or ERD Deworming
$15 $20
Total Annual Benefits
$305
Total Annual Benefits
$535
Routine care plans not sold as a stand-alone plan and if purchased must be added to a BestBenefit Accident and Illness Plan.
RCFLER-102021-V3-APIC Pet Insurance coverage offered and administered by Pets Best Insurance Services, LLC and underwritten by American Pet Insurance Company, a New York insurance company headquartered at 6100 4th Ave. S. Suite 200 Seattle, WA 98108. Please see www.americanpetinsurance.com to review all available pet health insurance products underwritten by APIC. Terms and conditions apply. See policy for details. * 50% and 60% reimbursement levels available in CA. Deductible up to $2,000 available in CA. Not available in all states.
Pets Best is a Synchrony (NYSE: SYF) Health and Wellness solution.
Pets Best Plan Options
Terms and conditions apply. See policy for details.
5
Terms and conditions apply. See policy for details.
What’s Not Covered CONFIDENTIAL
Pre-Existing Condition
Coverage Not Included with Plan Selected
(e.g. Accident Only Plan, or Did Not Buy Wellness Coverage)
Non-Veterinary Expenses
(e.g. Boarding, Grooming, Vitamins, Supplements, Food)
This list is not exclusive, please refer to policy form for complete list of exclusions.
This list is not exhaustive, please refer to policy form for complete list of exclusions.
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Enrollment It’s easy! Visit http://www.petsbest.com/HRCPETS or call 888-984-8700 and reference your discount/referral code: HRCPETS You will receive a 5% group discount + an additional 5% discount if enrolling more than 1 pet* Quoting and choosing your plan takes as little as 5 minutes No medical records are required to enroll
You can pay your pet’s premiums with a credit/debit card or via ACH. You can pay monthly, quarterly, semi-annually or annually. Your pet’s policy start date will be the day after you enroll your pet. From the policy start date there will be a 3 day waiting period for accident coverage, a 14 day waiting period for illness coverage and a 6 month waiting period for cruciate ligament events. If you choose to add wellness coverage, that coverage will begin on your pet’s policy start date. 7
CONFIDENTIAL
*5% group discount is not available in AK, HI and TN
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CAREER DEVELOPMENT As part of our total value of employment, the Human Rights Campaign encourages professional development and opportunities for growth:
TUITION REIMBURSEMENT Tuition Reimbursement is a financial assistance program established as an employee benefit to help HRC’s current employees further their education. The program’s intent is to expand the employee’s knowledge, skills, and abilities, and thereby, enhance job performance, value to the organization, and access to career opportunities within the organization. HRC pays 50% of the cost of eligible courses, up to $5,000 per year. For qualifying employees, HRC will also provide an interest-free forgivable loan for HRC’s contribution to tuition payments, provided that the employee agrees to the terms listed in the policy.
LINKEDIN LEARNING All employees are eligible for a license to access LinkedIn Learning, which offers thousands of online training modules on topics to support your professional goals from business, to technology, and personal leadership development.
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CAREER DEVELOPMENT CONT. PROFESSIONAL DEVELOPMENT The Human Rights Campaign recognizes that training and professional development of our employees is a fundamental element, and is of importance to the staff. HRC will assist employees to enhance their skills that are useful in their current position or to deve lop skills required for changes in job description or transfers and promotions within the organization.
PARTICIPATION IN PROFESSIONAL TRADE ORGANIZATIONS The Human Rights Campaign will pay all reasonable costs required to be incurred by professional employees in order to maintain their licensures as professionals. Costs may include educational courses, license fees & dues required to maintain membership in professional organizations or associations.
SUPERVISOR TRAINING To ensure that we are supporting high quality management practices, all supervisors at the Human Rights Campaign are required to take several courses. This includes a management training through The Management Center, as well as several internal trainings focused on management practices at HRC.
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Human Rights Campaign
Important Legal Notices
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 5 for more details. IMPORTANT NOTICE: This document is provided to help employers understand the compliance obligations for Health & Welfare benefit plans, but it may not take into account all the circumstances relevant to a particular plan or situation. It is not exhaustive and is not a substitute for legal advice.
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Important Legal Notices Affecting Your Health Plan Coverage THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (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. Therefore, the following deductibles and coinsurance apply: Deductible Coinsurance BlueChoice HMO $0 / $0 100% HealthyBlue Advantage POS $1,000 / $2,000 100% HealthyBlue BluePreferred PPO w/HSA $2,000 / $4,000 100%
NEWBORNS ACT DISCLOSURE - FEDERAL 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 issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
NOTICE OF SPECIAL ENROLLMENT RIGHTS If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your dependents in this plan if: • coverage is lost under Medicaid or a State CHIP program; or • you or your dependents become eligible for a premium assistance subsidy from the State. In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. Page 2 of 12
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To request special enrollment or obtain more information, contact the person listed at the end of this summary.
CONTACT INFORMATION CONTACT INFORMATION Questions regarding any of this information can be directed to: Krystal Gutierrez 1640 Rhode Island Avenue NW Washington, DC 20036 202-216-1521 Krystal.gutierrez@hrc.org
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MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE FOR USE ON OR AFTER APRIL 1, 2011
OMB 0938-0990
If you are receiving this electronically, you are responsible for providing a copy of this notice to any Medicare Part D-eligible dependents who are covered under the group health plan.
Important Notice from Human Rights Campaign About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Human Rights Campaign 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. Human Rights Campaign has determined that the prescription drug coverage offered by the Human Rights Campaign 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 15thto 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.
CMS Form 10182-CC
Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this information collection is
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estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. OMB 0938-0990
MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE FOR USE ON OR AFTER APRIL 1, 2011
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 current Human Rights Campaign coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage; for those individuals who elect Part D coverage, coverage under the entity’s plan will end for the individual and all covered dependents, etc.). 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 Human Rights Campaign coverage, be aware that you and your dependents will be able to get this coverage back.
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 Human Rights Campaign 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 the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Human Rights Campaign changes. You also may request a copy of this notice at any time.
CMS Form 10182-CC
Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this information collection is
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estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE FOR USE ON OR AFTER APRIL 1, 2011
OMB 0938-0990
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: Name of Entity/Sender: Contact--Position/Office: Address: Phone Number: CMS Form 10182-CC
02/15/2022 Human Rights Campaign Krystal Gutierrez 1640 Rhode Island Avenue NW, Washington, DC 20036 202-216-1521 Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this information collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
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Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of October 15, 2021. Contact your State for more information on eligibility –
ALABAMA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447
ALASKA – Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.asp x
ARKANSAS – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA – Medicaid
Website: Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hipp Phone: 916-445-8322 Email: hipp@dhcs.ca.gov
COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)
Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health-insurance-buyprogram HIBI Customer Service: 1-855-692-6442
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.c om/hipp/index.html Phone: 1-877-357-3268
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GEORGIA – Medicaid
Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp Phone: 678-564-1162 ext 2131
INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584
IOWA – Medicaid and CHIP (Hawki)
MASSACHUSETTS – Medicaid and CHIP
Website: https://www.mass.gov/info-details/masshealthpremium-assistance-pa Phone: 1-800-862-4840
MINNESOTA – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-andfamilies/health-care/health-care-programs/programs-andservices/other-insurance.jsp Phone: 1-800-657-3739
MISSOURI – Medicaid
Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp HIPP Phone: 1-888-346-9562
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084
KANSAS – Medicaid
KENTUCKY – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov
MONTANA – Medicaid
NEBRASKA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov
LOUISIANA – Medicaid
NEVADA – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-6185488 (LaHIPP)
Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
Enrollment Website: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-442-6003 TTY: Maine relay 711
Website: https://www.dhhs.nh.gov/oii/hipp.htm Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext 5218
MAINE – Medicaid
NEW HAMPSHIRE – Medicaid
Private Health Insurance Premium Webpage:
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https://www.maine.gov/dhhs/ofi/applications-forms Phone: -800-977-6740. TTY: Maine relay 711
NEW JERSEY – Medicaid and CHIP
SOUTH DAKOTA - Medicaid
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
Website: http://dss.sd.gov Phone: 1-888-828-0059
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
Website: http://gethipptexas.com/ Phone: 1-800-440-0493
Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100
Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669
NEW YORK – Medicaid
NORTH CAROLINA – Medicaid
NORTH DAKOTA – Medicaid
TEXAS – Medicaid
UTAH – Medicaid and CHIP
VERMONT– Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
Website: https://www.coverva.org/en/famis-select https://www.coverva.org/en/hipp Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-800-432-5924
OKLAHOMA – Medicaid and CHIP
OREGON – Medicaid
VIRGINIA – Medicaid and CHIP
WASHINGTON – Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPPProgram.aspx Phone: 1-800-692-7462
Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
Website: https://www.dhs.wisconsin.gov/badgercareplus/p10095.htm Phone: 1-800-362-3002
PENNSYLVANIA – Medicaid
RHODE ISLAND – Medicaid and CHIP
SOUTH CAROLINA – Medicaid Website: https://www.scdhhs.gov Phone: 1-888-549-0820
WEST VIRGINIA – Medicaid
WISCONSIN – Medicaid and CHIP
WYOMING – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/programsand-eligibility/ Phone: 1-800-251-1269
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To see if any other states have added a premium assistance program since October 15, 2021, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 1/31/2023)
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New Health Insurance Marketplace Coverage Options and Your Health Coverage
Form Approved OMBNo.1210-0149 (expires 6-30-2023)
PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.
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 2013 for coverage starting as early as January 1, 2014.
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 9.5% 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.1
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 aftertax 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.
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.
1 An employer - sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.
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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. 3. Employer name
4. Employer Identification Number (EIN)
Human Rights Campaign
52-1243457
5. Employer address
6. Employer phone number
1640 Rhode Island Ave NW
202-216-1521
7. City
8. State
9. ZIP code
Washington
DC
20036
10. Who can we contact about employee health coverage at this job? Krystal Gutierrez 11. Phone number (if different from above)
12. Email address Kyrstal.gutierrez@hrc.org
Here is some basic information about health coverage offered by this employer: • As your employer, we offer a health plan to: X All employees. Eligible employees are: Active, full-time employees working 30 or more hours consistently per week.
Some employees. Eligible employees are:
•
With respect to dependents: X We do offer coverage. Eligible dependents are: Employee’s legal dependents would be children, step children, adopted children, legal guardianship, domestic partner and legal spouse. Dependent children are covered until their 26th birthday.
We do not offer coverage. X
If checked, this coverage meets the minimum value standard*, and the cost of this coverage to you 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. Here's 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. • An employer - sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (Section 36 B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)
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This guide is for general information purposes only. It provides an overview of the plans available through the benefits program. The plans contain certain limitations and exclusions which may affect your coverage. Please review your Evidence of Coverage or Summary Plan Description for details. It does not replace or supplement the plan documents. If there is any conflict between the information in this guide and the plan documents, the plan documents will govern.