Effective January 1, 2025 for the J’s Full-Time Employees
This Benefits Enrollment Guide is a summary of the benefits offered to you. Refer to the Certificate of Coverage for more details.
A message from Leadership
A tradition of welcoming and excellence for more than 140 years.
Throughout our history, the J has been the central meeting place of the Jewish Community. It’s the one place where families, regardless of affiliation, can feel comfortable and welcome. We have evolved through the years to meet the changing needs of our members, our Jewish community and the entire St. Louis region.
Please take time to learn about the benefit options and rewards and choose those that best meet your personal and financial needs.
Jewish Community Center Health and Welfare Benefits Plan
Enrollment Guide is a general description of the Health and Welfare Benefit Plans provided to benefit eligible employees. We encourage you to review the detailed plan information contained in the Certificate of Coverage documents for each benefit plan available online in Paylocity or you may request a paper copy by calling the Human Resources Department at 314-442-3241.
YOUR ENROLLMENT CHECKLIST
• Read this guide for general information about your benefits options for the 2025 plan year.
• Review all enrollment information that you receive in your home mail and by email.
• Decide which benefits best fit your needs and your budget.
• Enroll by visiting Paylocity at paylocity.com .
• Verify your selections on your Benefits Enrollment Confirmation that is in Paylocity. Log into Paylocity go to your “My Current Coverage” and click on View PDF.”
Jewish Community Center Health and Welfare Benefits Plan
STAY CONNECTED
ADDRESS UPDATES
Throughout the year, you may receive important benefit information mailed to your home address. If you move, make sure to update your address and phone number by logging into Paylocity at Paylocity.com.
KEEPING YOU INFORMED
Visit Paylocity at Paylocity.com for easy access to important and useful information including:
• Your benefits
• Self Service Portal
• Payroll
• Community
• Announcements
You can access Paylocity any time from work, home and any mobile device using the Paylocity Mobile App.
Coverage and Enrollment
WHO IS ELIGIBLE FOR COVERAGE?
Employees who average at least 30 or more hours a week are considered full-time and eligible to participate in the Jewish Community Center health and welfare benefit plans.
Eligible dependents include:
• Your lawful spouse, including a legally separated spouse.
• Your dependent child(ren) through the end of the year in which they turn age 26.
• Your incapacitated child(ren) age 26 and over; however, you must provide documentation within 31 days of the end of the year in which your child turns age 26 and be approved for continued coverage.
QUALIFYING LIFE EVENT
You may experience a qualifying life-event that may affect you or your eligible dependents eligibility for benefits. Here are some examples of the most common qualifying life-events:
• Marriage
• Divorce
• Birth or adoption
• Dependents change in employment status that results in a loss or gain of coverage.
• Death
Enrollment changes can only be made within 31 days of the effective date of the qualifying life event and must be consistent with the change in status.
Documentation of Life Event
Documentation such as copies of birth certificates, marriage certificates and benefit confirmations of enrollment or termination will need to be submitted to Human Resources within 31 days of the effective date of the life event. Changes to your coverage will not be made until all documentation has been received and approved.
Changes to payroll deductions start with the next administratively possible paycheck after your benefits go into effect.
Coverage and Enrollment Coverage Defaults
WHEN COVERAGE BEGINS
Open Enrollment
Benefit elections made during open enrollment, during the month of November, become effective on January 1, 2025, and applicable payroll deductions begin with the first paycheck in January covering the period January 1 thru January 15.
Newly Eligible for Benefits
If you are a new “Full-Time” employee, your health and welfare benefits become effective on the first day of the month following your first day of work as a “Full-Time” employee.
If coverage begins because of a change in status, your coverage becomes effective on the first day of the month following the change in status to Full-Time. Payroll deductions start with the next administratively possible paycheck after your benefits go into effect.
Termination of Coverage
Your benefit coverage will end on the last day of the month in which you terminate employment or your status changes to part-time.
NEWLY ELIGIBLE FOR BENEFITS
If you are a new employee or newly eligible for benefits and you do not make benefit elections by your enrollment deadline:
1. Your coverage for voluntary benefits (medical, dental, vision, dependent care spending account, HSA, supplemental and dependent life insurance, accident and critical illness insurance) will be waived.
2. You will automatically be enrolled for the company-provided basic life insurance, AD&D, long-term disability insurance and Employee Assistance Program benefits.
SPECIAL ENROLLMENT NOTICE
If you decline health coverage in the Jewish Community Center Health and Welfare Benefits Plan for yourself or your dependents (including your spouse) because of other Health insurance coverage, you may in the future be able to enroll yourself and your dependents in the Jewish Community Center benefit plans if your dependents lose eligibility for that other coverage (or if another employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after you 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 31 days after the marriage or birth, adoption, or placement for adoption, and provide required documentation.
To request special enrollment or obtain more information, call Human Resources. Changes to payroll deductions start with the next administratively possible paycheck after your benefits go into effect.
ALREADY ENROLLED IN BENEFITS?
If you are currently participating in the health and welfare benefit plans and you do not confirm or change your benefit elections by the open enrollment deadline.
1. Your medical/prescription drug coverage will continue at the same coverage level and in the same medical coverage option.
2. Your current benefit elections for dental, vision supplemental life (employee, spouse or child), STD, Accident and Critical Illness and HSA employee contributions will carry over to the new plan year.
3. You are not able to contribute to the dependent care flexible spending account for the 2025 plan year since this benefit requires a new election every year.
4. If you elected No coverage in any of the voluntary benefits, you would default to No coverage during open enrollment.
Coverage Defaults Medical/Prescription Drugs with Anthem Blue Cross and Blue Shield
MEDICAL/PRESCRIPTION DRUGS WITH ANTHEM BLUE CROSS AND BLUE SHIELD
Having medical coverage provides you and your family with some financial protection in the event of illness or injury.
The medical coverage offered by the Jewish Community Center provides access to health care through Anthem Blue Cross and Blue Shield and includes:
• In-network preventive care covered at 100 percent with no deductible, if you use in-network providers.
• Access to providers in the Anthem Blue Cross and Blue Shield Blue Access Choice Network (including BJC providers), if enrolled in the Anthem Blue Cross and Blue Shield Blue Access Choice and Blue Access Choice PPO medical plans.
• Access to providers in the Blue Preferred Network (BJC providers not included), if enrolled in the Anthem Blue Preferred Select HSA medical plan.
• To find a provider, go to anthem.com/findadoctor. Select your plan/network from the drop down menu.
ONE MEDICAL PLAN. THREE OPTIONS.
When you enroll in the medical plan offered by the Jewish Community Center, you will need to choose one of three Anthem Blue Cross and Blue Shield coverage options - Blue Preferred Select HSA, Blue Access Choice PPO HSA, or Blue Access Choice PPO.
• Blue Preferred Select HSA medical plan does not use the BJC network.
• Blue Access Choice PPO HSA uses the BJC network.
• Blue Access Choice PPO uses the BJC network. The option you choose determines:
• Paycheck deductions. The amount you pay for medical/prescription drug coverage.
• Annual deductible: The amount you pay for covered non-preventive care before the plan pays benefits.
• Annual out-of-pocket maximum: The most you could pay in a calendar year for your share of covered services.
• Copay: The fixed dollar amount the plan pays for certain services.
• Coinsurance: The percentage the plan pays for covered services and the percentage you pay.
• Prescription drug costs: Your out-of-pocket expense for a prescription. For additional details about the medical plans, refer to the Certificate of Coverage available online in Paylocity or by calling the Human Resources department.
Medical/Prescription Drugs with Anthem Blue
Cross
and
Blue Shield Medical/Prescription Drugs with Anthem Blue Cross and Blue Shield
PRESCRIPTION DRUGS
Make the most of your new pharmacy benefits with Anthem
1. Register at anthem.com
• When you receive your member ID card, register on anthem.com to see and manage your prescriptions all in one place. Through the Anthem site, you’ll be able to.
• Have your medications delivered to your door with home delivery from CarelonRX pharmacy.
• Find a pharmacy, price a medication and refill or renew a prescription.
• Check your drug list (formulary) for cost effective medicines covered by Anthem.
• Compare costs of medications between home delivery and retail pharmacies.
2. Find ways to save on your prescriptions.
• You can save more on your prescription medicines by knowing which are covered by Anthem.
• Certain preventive medicines at little or no cost.
• Hundreds of generic and brand-name prescription medicines in every therapeutic class.
• Specialty medication from Anthem specialty pharmacy, if you have a complex or chronic condition.
3. Choosing a medicine on your drug list can help you pay less – especially when compared to paying out of pocket for medicines that aren’t covered.
4. Medicines are grouped in tiers. Your share of the cost dependents on which tier your medicine is on. Medications on lower tiers usually cost less.
5 WAYS TO SAVE MORE ON YOUR PRESCRIPTION MEDICATIONS.
1. Take medications on Anthem’s drug list.
2. Find out if there are generic or over-the-counter options.
3. Check your cost with Anthem’s Medication tool at anthem.com
4. Use pharmacies in Anthem’s network.
5. Order 90-day supplies of medications you take regularly.
Always check with your doctor before changing our medication.
Medical/Prescription Drugs with Anthem Blue Cross and Blue Shield
CHOOSE HOW TO FILL YOUR PRESCRIPTIONS
Local pharmacies
The Anthem plan includes local pharmacies at major retail chains, such as CVS, Walmart and Target. You’ll save the most money when you use one of these pharmacies. To find a pharmacy near you:
1. Log in anthem.com.
2. Choose Find a Pharmacy.
3. Enter your Zip code.
CarelonRx Pharmacy
For medications you take regularly, have your prescriptions delivered to your home with CarelonRx Pharmacy. Get started at anthem.com . Shipping is always free.
Specialty Pharmacy
If you have a complex or chronic condition treated with specialty medication – you’ll need to get it through Anthem’s specialty pharmacy. Your doctor will send the prescription to the specialty pharmacy for you, and it will be delivered to your home or your doctor’s office if it needs to be administered by a doctor.
Preapproval (prior authorization)
There are some medicines that may require Anthem’s review and approval – known as preapproval or prior authorization before they’re covered. Your doctor can start the process by calling the Pharmacy Member Services number on your member ID card or by downloading a preapproval form with Anthem’s website.
Your Anthem Plan Resources
ANTHEM SYDNEY HEALTH MOBILE APP
Download the Sydney Health app and manage your health and benefits anywhere getting access to the following resources:
• Find care and compare costs.
• Use your Health Dashboard to find news on health topics and health and wellness tips.
• See what’s covered and check claims.
• View and use digital ID cards.
• Check your plan progress.
• Fill prescriptions.
• Pull up your ID card whenever you need it.
• Find in-network providers, including walk-in urgent care clinics near you.
• Get cost estimates before you get care.
• View and pay claims for your whole family.
• Track spending and progress to meet your deductible.
• Get personalized tips to improve your health.
• You can also set up an account at anthem.com/register
EXPANDING YOUR VIRTUAL CARE OPTIONS
Accessing the care you need when you need it. The Sydney Health mobile app connects you to a team of doctors ready to help you on your time.
You can chat with a doctor 24/7 without an appointment.
• Receive urgent care support for health issues such as allergies, a cold, or the flu.
• Get new prescriptions for concerns such as a cough or a sinus infection.
Schedule a virtual primary care appointment.
• You can schedule routine care, including virtual annual preventive care (wellness) visits and prescription refills.
• Get personalized care plans for chronic conditions, such as asthma or diabetes.
Assess your symptoms with the Symptom Checker.
• When you’re sick, you can use the Symptom Checker on the Sydney Health app to answer a few questions about how you’re feeling. That information is found against millions of medical data points to provide care and advice tailored to you.
Save money and time with virtual care.
• The Sydney Health app brings care to you anywhere, anytime. The Sydney Health app is always free to use, while virtual primary care visits and on-demand urgent care through the app are available at low or no additional cost.
Your Anthem Plan Resources
YEARLY EYE EXAM
Regular eye exams provide a unique opportunity to find and detect serious health conditions like high blood pressure, heart disease, and diabetes. A comprehensive eye exam is included with your medical coverage at no extra cost. The eye exam is offered through Anthem’s Blue View Vision Network once each calendar year.
• The eye exam includes dilation and refraction.
• Discounts on glasses and contacts from in-network eye care providers is included.
PREVENTING DIABETES
Lark Digital Health Coaching gives you access to the tools you need to take steps to prevent type 2 diabetes. Available 24/7 on your smartphone, the Lark Diabetes Prevention Program is included at no extra. If you qualify, you’ll get a digital scale with the opportunity to earn a Fitbit.
Get started with a quick eligibility survey
Scan this QR code with your smartphone camera to get started or visit
enroll.lark.com/Anthem
Connect to healing. Find hope. Live your best life.
If you or a covered family member needs help with a mental health issue, you can find expert, compassionate and confidential care – often at low or no extra cost. You can access a wide range of programs and services online, on the phone, in person, or through video.
• Have a private secure video visit with a therapist, psychologist, or psychologist, or psychiatrist without leaving the privacy of your home. Using your smartphone, tablet or computer with a camera, you can:
• Talk with a licensed therapist in seven days or less.
• Visit a board-certified psychiatrist within two weeks.
To make an appointment, visit livehealthonline.com , call 888-548-3432 or go through Anthem’s SydneyHealth mobile app.
Your Anthem Plan Resources
AUTISM SPECTRUM DISORDER PROGRAM
This is a no-cost confidential program that builds a support system for families of members on the autism spectrum and helps parents understand care options. Specialty trained case managers can coordinate medical and community resources for you, including Applied Behavior Analysis (ABA) therapy. Call 1-844-451-1576
BUILDING HEALTHY FAMILIES
Building Healthy Families offers personalized, digital support through the Sydney Health mobile app or on anthem.com. This convenient hub offers an extensive collection of tools and information to help you navigate your family’s unique journey. You’ll have unlimited access to:
• Digital tools and resources for pregnancy and beyond.
• Health and wellness expertise for your family and pregnancy.
Dental with Anthem Blue Cross and Blue
Vision with Anthem Blue New Vision
KEEP YOUR EYES HEALTHY
Health Savings Account with Optum Bank
An HSA is a tax-favored savings account that allows you to save and pay for current and future qualified medical, prescription drug, dental and vision expenses tax-free. You are responsible for determining if you are eligible for an HSA.
BENEFITS OF AN HSA
Electing to participate in an HSA offers several advantages, including the following :
• IRS annual maximum. For 2025, your contributions cannot exceed $4,300 for employee only coverage and $8,550 for all other coverage levels. These annual maximums are increased by $1,000 if you are 55 and older.
• Employee contributions. You can make tax-free contributions to your HSA directly through payroll deductions.
• Triple tax benefits. The money you contribute to your HSA is not taxable upon deposit, interest accrues tax-free, and the money is not taxable upon withdrawal if used for qualified medical, prescription drug, dental and vision expenses.
• HSA funds never expire. The money in your HSA belongs to you and is not subject to the IRS “Use-it or Lose it” rule. Once you open an HSA, the account and funds in it stay with you from year to year, even if you change employers or health plans.
• Save for future health care expenses and retirement. Saving with an HSA is a great way to complement your retirement plan.
SPECIAL REQUIREMENTS FOR HSA
• You must be enrolled in a high deductible medical plan to open an HSA with Optum Bank.
• You must provide a physical home address (no P.O. Box address) to open your account.
• You cannot be covered by another medical plan that is not a high deductible health plan.
• You cannot be enrolled in Medicare.
• You cannot participate in an HSA if your spouse is enrolled in a general-purpose Health Care Spending Account (HCSA) through his or her employer.
• Sufficient funds must be in your account to receive reimbursement for a qualified expense.
• Your HSA contribution amount can be changed at any time by logging in to Paylocity.
• For tax purposes, you must retain itemized receipts for qualified health care expenses paid for with HSA funds.
Health Savings Account with Optum Bank
DOWNLOAD THE OPTUM MOBILE APP
View your balance, pay bills, upload receipts and track your progress.
USING HSA FUNDS
HSA deductions are semi-monthly and deducted on a pre-tax basis.
Once your Health Savings Account is set up, you will receive an Optum HSA Payment card in your home mail. When you use your HSA Payment Card the funds are automatically deducted from your HSA; therefore, you must have sufficient funds in your account when your card is swiped to pay an expense.
The funds in your account can be used to pay for qualified health care (medical, prescription drug, dental and vision) expenses for yourself, your spouse and your qualifying dependents, even if your dependents are not covered under your medical plan. Qualified expenses are eligible for reimbursement through your HSA as long as they are not paid or reimbursed through insurance or other sources. Here are some examples:
• Medical and prescription drug deductibles, copays and coinsurance
• Dental plan deductible and coinsurance
• Eyeglasses and contact lenses.
• COBRA premiums
Distributions from your HSA that are used to pay for nonqualified health care expenses will be included in your gross income for tax purposes and are subject to an additional 20 percent. The 20 percent penalty does not apply to distributions made if you become disabled, once you reach age 65, or after your death.
HSA and Medicare
If you are eligible for, or are planning to enroll in Medicare, you should carefully evaluate your participation in the HSA to avoid penalties for excess contributions. If you do not enroll in Medicare and remain in an HSA qualified health plan, you can continue to use your HSA as you did before age 65. For more information about Medicare, HSA eligibility, or how to correct ineligible contributions, contact your tax advisor or review IRS Publication 969, Health Savings Accounts and Other TaxFavored Health Plans. You can also call 800-Medicare (800- 633-4227) or visit Medicare.gov
Note: You must open your HSA account with Optum Bank before payroll deductions to your HSA can start. Your payroll deductions will be delayed until your HSA account is opened.
Dependent Care Flexible Spending Account (FSA) with Wex, Health
SAVE MONEY ON YOUR TAXES WITH A DEPENDENT CARE FSA ACCOUNT
Enjoy great savings when you use a dependent care FSA administered by Wex, Health. The Dependent Care FSA allows you to set aside pretax dollars to pay for qualified dependent care expenses. You decide how much to contribute each year up to the plan limits and this amount is divided evenly and deducted from each paycheck throughout the year.
Dependent Care FSA
Each year you may elect to set aside a minimum of $120 up to $5,000 into a Dependent Care FSA on a pretax basis to pay for qualified dependent care expenses. It is important to carefully estimate your annual dependent care expenses since any money left in your Dependent Care FSA at the end of the plan year will be forfeited.
These include expenses you incur for your dependents (typically for children under age 13) so you and your spouse can work, such as:
• Payments to day care or elder day care centers
• Babysitting in your home or someone else’s home
• Before and after-school care
• Day camp during school or summer vacations
• Dependent care providers must supply their federal tax ID number or Social Security number.
Special Requirements for Dependent Care FSA
• If your spouse participates in a Dependent Care FSA through his or her employer and you file your tax return jointly, the combined total of your reimbursements cannot exceed $5,000 each year
• Both you and your spouse must be employed (unless your spouse is a full-time student or incapable of self-care).
• Reimbursements are limited to the balance in your account
• Money not claimed for the plan year will be forfeited
Refer to IRS Publication 503, Child and Dependent Care Expenses as www.irs.gov for a list of potential eligible dependent care expenses.
Dependent Care Flexible Spending Account (FSA)
DEPENDENT CARE FSA IS “USE IT OR LOSE IT’ ACCOUNT
IRS rules require that you use the funds in your Dependent Care FSA each year or forfeit them. The plan year is from March 1, 2024 to February 28, 2025. You have three months after the end of the plan year (until May 31, 2025), to file claims for services incurred while you were participating during that plan year. Claims filed after the cutoff of May 31 are not eligible for reimbursement. Plan carefully to determine your annual Dependent Care FSA election because you cannot change your election midyear unless you have a life-changing event that allows you to make an election change.
NOTE: The current plan year for the dependent care flexible spending account is March 1, 2024 to February 28, 2025. The new plan year will begin March 1, 2025 and end on December 31, 2025. Look for information in midJanuary on how to make your dependent care election for the new plan year beginning March 1, 2025.
FILING FSA DEPENDENT CARE FSA CLAIMS
When you incur an eligible expense, you pay the bill as usual, then complete a claim form, attach proof of service (e.g. day care invoice) and submit to Wex Health at 866-451-3399 for reimbursement. You may submit claims online, by mail or fax. Dependent care reimbursements are released at the end of the time period in which expenses were incurred. Claim checks can be deposited directly into your personal bank account or mailed to your home.
NOTE: You cannot be reimbursed for dependent care expenses incurred while you are on a leave of absence because you are not working. The IRS allows participation in the dependent care FSA while you are working or looking for work.
FILING DEPENDENT CARE FSA CLAIMS DUE TO TERMINATION OF EMPLOYMENT
If your participation in the Dependent Care FSA ends due to termination of employment and you have unused amounts in your dependent care account with Wex, Health, you have 90 days after your termination date in which to submit claims that were incurred prior to your termination date.
BENEFITS BY WEX MOBILE APP
The Wex mobile app is an easy tool to use to help you manage your Dependent Care FSA throughout the year. You can easily check your balance, file a claim and track expenses.
Life & Disability Benefits with Hartford
The Jewish Community Center provides at no cost to you, basic life and AD&D insurance benefit to help protect the ones you love when it’s needed most.
BASIC LIFE INSURANCE
The Jewish Community Center provides at no cost to you, the basic life insurance benefit that is two-times or threetimes your annual earnings rounded to the next highest $1,000 for benefit eligible employees. (Annual earnings is your regular annual rate of pay (not including commissions, bonuses, or overtime pay) in effect on the date you were last actively at work.
Life & Disability Benefits with Hartford
SUPPLEMENTAL LIFE INSURANCE
Life is constantly CHANGING - We know how important it is
make sure you have enough
to protect the ones you love. You may purchase for you and your eligible dependents (spouse and/or child) life insurance coverage. Premiums are based on your age and your annual earnings. You are always
dependent life insurance that you purchase for your spouse or child.
It is important to name beneficiaries so that your life
benefit can be paid according to your wishes.
The beneficiaries you designate for your basic life and AD&D insurance can be different from the beneficiaries you designate for any supplemental life insurance you choose to purchase for yourself. You will designate your beneficiary(ies) at the time you make your life insurance election in Paylocity.
Evidence of Insurability
If you elect any amount over the Guaranteed Issue amount, you will need to complete an Evidence of Insurability (EOI) form. You download the EOI form in Paylocity when making your life insurance elections.
Return the completed form to the Human Resources Department. The additional life insurance coverage amount will not go into effect until the EOI is approved.
Additional Services
Ability Assist Counseling Services helps with:
• Emotional or Work-Life Counseling
• Financial Information and Resources
• Legal Support and Resources
• Health Care Navigation Services
For access over the phone call 800-964-3577 Visit guidanceresources.com to access resources for childcare, elder care, attorneys or financial planners.
1. First time user, click on the Register tab 2. In the Organization Web ID field, enter: HLF902
In the Company Name field enter: ALBILI
After selecting “ Ability Assist program ”, create your own confidential username and password
SUPPLEMENTAL
Life & Disability Benefits with Hartford
LONG-TERM DISABILITY
Basic Long-Term Disability (LTD) coverage is designed to provide a portion of your income if you are disabled and cannot work. After 90 calendar days of disability, you may begin receiving LTD benefits at 60 percent of your predisability monthly earnings. Hartford administers the LTD plan, and the Jewish Community Center pays the full cost of this benefit.
The maximum monthly benefit is $10,000 per month.
VOLUNTARY SHORT-TERM DISABILITY
The short-term disability insurance covers a portion of your income if you’re injured or sick and unable to work. This disability benefit can be coordinated with income from other sources, such as PTO and sick time during your disability. The employee pays the full cost of this benefit. You can choose one of two options.
Eligible Dependents for Life Insurance
• Your lawful spouse
• Your dependent children are eligible for coverage up to when they turn age 26.
• Your incapacitated child(ren) 26 and over who is supported by you and have medical documentation to support their disability.
Once you log into Paylocity, your rate & benefit amounts for employee and dependent life will be pre-populated and calculated for you.
Premiums are semi-monthly payroll deducted from each paycheck on an aftertax basis.
Pre-Existing condition limitation: If you receive treatment for a pre-existing condition within 6 continuous months of your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 consecutive months
Employee Assistance Program (EAP) with Anthem
ANTHEM EMPLOYEE ASSISTANCE PROGRAM
Ever wish someone was there to help when life gets busy and complicated? The Employee Assistance Program offers work and life support for you and your household family members to help manage anything from finding childcare to working through emotional health issues, all available at no cost to you. Services are confidential and available 24 hours a day, 7 days a week.
Just call 1-800-999-7222 or visit anthemEAP.com and enter company code: AnthemMissouri. The program provides:
Face-to-Face Counseling: You can receive confidential face to face counseling up to 4 sessions per person, per issue, per year where trained counselors will listen to your concerns about any issues including:
• Anxiety, depression, stress
• Marriage, family and/or relationship support
• Grief, loss, trauma and life adjustments
• Physical health and wellness, finances, legal issues
Emotional Well-Being Resources: You’ll receive resources and support to help you live your happiest, healthiest life, including digital self-help tools to help improve your emotional well-being. Visit anthemEAP.com
Talkspace: You will be matched with a therapist with whom you will have 24/7 access to confidential messaging via text, audio, or video and the ability to schedule a virtual visit in real-time. Visit talkspace.com and select “Get Started”. Provide the requested information and enter Anthem Missouri as your organization name.
LiveHealth Online: You will have access to 24/7 confidential counseling through scheduled visits over live text message, telephone, or video. Visit anthem.com to find virtual care options that are right for you.
Suicide and Crisis Lifeline: You have access to 24/7 confidential mental health support including prevention and crisis resources for anyone in distress. Call or text 988 or chat with someone at 988lifeline.org 24/7.
Accident Insurance with Hartford
If you or a covered family member must go to the hospital for an accident or injury, the Accidental Injury benefit provides an additional cash benefit after an accident. This will help you take care of the unexpected expenses – anything from deductibles to childcare and everyday bills.
Accident Follow-Up
Child(ren) - $12,500
Critical Illness with Hartford
Critical Illness insurance provides coverage for covered illnesses like cancer, a heart attack or stroke. Because these illnesses often incur greater than average medical costs, this policy provides a cash benefit to help cover the costs of those expenses where the traditional health insurance may fall short.
Critical Illness with Hartford
SEMI-MONTHLY RATES
Rates shown are per $1,000 of benefit and are based on the age of the employee on the effective date of coverage.
start date, the plan will not pay any benefit under the policy until you’ve been insured under the plan for 12 consecutive months.
Legal Information
Form 1095
In January of each year, the Jewish Community Center issues IRS Form 1095 to employees that includes certain information about the medical coverage it offers. You should keep the Form 1095 with other important tax documents. To ensure you receive this tax form and other important benefits materials, you must keep your mailing address updated in Paylocity. In addition, when enrolling yourself and eligible dependents for medical coverage through the J, we recommend you verify that the names and Social Security numbers of your dependents covered under the medical plan exactly match the information on the individual’s Social Security card (to ensure accuracy on your Form 1095). The J is not responsible for loss of benefits or failure to meet tax filing deadlines because you do not provide an up-to-date address and accurate personal and dependent information.
Legislation That Affects Your Coverage
• As a participant in the plans, you are entitled to current rights and protection under the law. Find a description of these federal laws in the back of this benefit enrollment guide.
• Employee Retirement Income Security Act (ERISA) of 1974
• Uniformed Services Employment and Reemployment Rights Act (USERRA) of 1994
The following plan information is also available online in Paylocity.
• Life/AD&D and LTD Insurance Certificates
• Medical, Dental and Vision Plans Certificate of Coverage, EAP Certificate of Coverage
• Accident, STD and Critical Illness Certificate of Coverage
• Summary Annual Reports (SAR)
• Notice of Privacy Practices
Jewish Community Center Retirement Savings Plan
START SAVING FOR TOMORROW, TODAY.
403(b):
• All employees are eligible to participate in the 403(b)-plan.
• You are always vested in your contributions.
• There is the convenience of making pre-tax contributions directly from your paycheck.
• You can make after-tax contributions into a Roth 403(b).
How to Enroll in the 403(b)
Contact Dan McGee at (314) 966-8070 to enroll in the 403(b)-retirement plan.
PROFIT SHARING WITH THE STANDARD
• Each year, the Jewish Community Center determines if a discretionary contribution will be made to its employee pension plan.
• You are eligible to enter the plan on the first day of the calendar year after satisfying the following requirements:
• Attaining 21 years of age or older
• Attaining 1,000 hours of service during the 12-month period beginning on your date of hire or any plan year beginning after your date of hire
• In addition to the requirements stated above, you must be employed on the last day of the plan year (Dec 31) to receive a profit-sharing contribution for that year.
ACCESSING YOUR RETIREMENT ACCOUNT WITH THE STANDARD Register Online
• Visit standard.com/login
• Select Create an Account
• Open the menu for My Retirement Plan using the down arrow, then choose create an Account
• Complete your personal information then create a unique username and password
• Activate your account within 24 hours (email will come from verify@standard.com )
After Activating, Connect to Your Retirement Account
• After you’ve verified your email address, return to standard.com/login to log in
• Turn on two-step verifications as instructed
• Connect to your retirement account on the Account Access screen
• Now you can see your account details by selecting Go to My Account
Jewish Community Center Retirement Savings Plan
Keep Your Account Secure
• Register Online
• Create a Unique username and strong password
• Log into your account monthly.
• Call 1-800-858-5420 for assistance
Vesting
Employer contributions into your pension plan vest over time, as follows: 2
The Plan’s Summary Plan Description (SPD) can be found online in Paylocity.
Benefits Resources
PAYLOCITY
Paylocity is an easy-to-use comprehensive website designed to help you manage your health and welfare benefits. Use it to:
• Make your benefits elections upon gaining eligibility and during open enrollment.
• Change your benefits due to life-changing event such as marriage or the birth of a child
• Update your health savings account (HSA) contributions
• Select and maintain your life insurance beneficiary designations
• View or print your Benefit Enrollment Confirmation; and
• Access the Certificate of Coverage documents for the medical, dental, vision, basic life and AD&D and supplemental life insurance, long-term and short-term disability, critical illness, accident and EAP benefit plans.
SELF-SERVICE SECURE PORTAL
Log into your Self-Service Portal at paylocity.com . First time users are required to create an account upon initial login.
Paylocity Mobile App
• You can download the Paylocity Mobile App from the Apple App Store for IOS devices or the Google Play Store for Android devices.
• You can access your pay and tax forms, personal information, timecards and request time off.
Vendor Contacts
EMPLOYEE ACKNOWLEDGMENT
When completing your benefits enrollment or other benefits or employment forms, you are attesting to the truth of your statements. Enrolling ineligible dependents, misrepresenting qualifying life events or making misrepresentations about your status, claims, or other information may cause the loss of plan benefits and subject you to discipline, up to and including termination.
This Benefits Enrollment Guide presents a brief summary of your choices under the Jewish Community Center Benefits Program. It is not intended as a complete description of each plan. Every effort has been made to ensure the accuracy of the information in this enrollment guide; however, in the event of a conflict between this guide and the actual plan document or applicable insurance policy or provider agreements, the plan document, insurance policy or provider agreement (as applicable) governs, except as they may provide otherwise.
Your rights Under ERISA and Other Applicable Law
This statement of ERISA rights is required by law and regulation.
As a participant in this Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:
Receive Information About Your Plan and Benefits
• Examine, without charge, at the office of the Plan Administrator and at other specified locations, all documents governing the Plan, including contracts and a copy of the latest annual report (Form 500 Series) filed by the Plan (if applicable) with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.
Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and copies of the latest annual report (Form 5500 Series), if applicable, and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies.
• Receive a summary of the Plan’s annual financial report (if applicable). If applicable, the Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.
COBRA – General Notice and Qualifying Event Notice
• Continue health care coverage for yourself, spouse, or dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review the summary plan description and the documents governing the Plan for the rules governing your COBRA continuation rights.
• Reduction or elimination of exclusionary periods of coverage for preexisting conditions under the group health plan (if applicable), if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when: (i) you lose coverage under the Plan; (ii) you become entitled to elect COBRA continuation coverage; (iii) your COBRA continuation coverage ceases; or (iv) you request a certificate of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.
Prudent Actions by Plan Fiduciaries
In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate the Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your employer, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.
Enforce Your Rights
If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of the plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part,
you may file suit in a state or federal court. In addition, if you disagree with the Plan’s decision (or lack thereof), concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistances from the U.S. Department of Labor or may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
Assistance with Your Questions
If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory, or the Division of Technical Assistance and inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue NW, Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.
Availability of Summary Health Information – Summary of Benefits and Coverage (SBC)
As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in case of illness or injury. Choosing a health coverage option is an important decision. To help you make an informed choice, the Plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.
Your 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. Also, a special enrollment period for group health plan coverage may be available if (i) you or your dependent child(ren) lose coverage under a Medicaid or CHIP plan, if that coverage is terminated due to loss of eligibility; or (ii) you or your dependent child(ren) become eligible for financial assistance under Medicaid or CHIP with respect to coverage under the Plan. However, you must request enrollment within 60 days of the occurrence of one of these events.
You may be required to provide supporting documentation when requesting special enrollment. To request special enrollment or obtain more information, contact the Human Resources department.
USERRA
The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), ENACTED October 13, 1994, significantly strengthens and expands the employment and reemployment rights of all uniformed service members.
Reemployment rights extend to person who have been absent from a position of employment because of “service in the uniformed services.” “Service in the uniformed services “means the performance of duty on a voluntary or involuntary basis in a uniformed service, including active duty, active duty for training, full-time National Guard duty, absence from work for an examination to determine a person’s fitness or any type of duty, funeral honors duty performed by National Guard or reserve members, or duty performed by intermittent disaster response personnel for the Public Health Service.
Reemployed service members are entitled to the seniority and all rights and benefits based on seniority that would have attained with reasonable certainty had they remained continuously employed. The returning Employee shall be entitled not only to nonseniority rights and benefits available at the time he or she left for military service but also to those that become effective during service.
Service members may be required to pay the employee cost, if an, of any funded benefit to the extent that other Employees on Leave Of Absence would be required to pay.
The law provides for health benefit continuation for persons who are absent from work to serve in the military. If a person’s health plan coverage would be terminated because of an absence due to military service, the person may elect to continue the health plan coverage for up to 24 months after the absence begins or for the period of service, whichever period is shorter. A waiting period or exclusion cannot be imposed upon reemployment unless a disability has been determined by the Secretary of Veterans Affairs to service-connected.
Retirement plans that are tied to seniority are given detailed treatment under the law. A reemployed person must be treated as not having incurred a break in service with the employer; military service must be considered service with the employer for vesting and benefit accrual.
Patient Protection Notices Required by the Affordable Care Act
The plan generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in your network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact your provider.
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 1-877-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 July 31, 2024. Contact your State for more information on eligibility.
ALABAMA - Medicaid
Website: http://myalhipp.com Phone: 1-855-692-5447
ARKANSAS - Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
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://hcpf.colorado.gov/child-health-plan-plus
CHP+ Customer Service; 1-800-359-1991/State Relay 711
Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/
HIBI Customer Service: 1-855-692-6442
ALASKA - Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com
Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx
CALIFORNIA - Medicaid
Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp
Phone: 916-445-8332
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
FLORIDA - Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidplrecover y.com/hipp/index.html Phone: 1-877-357-3268
GEORGIA - Medicaid INDIANA - Medicaid
GA HIPP Website: https://medicaid.georgia.gov/healthinsurance-premium-payment-program-hipp Phone: 678-564-1162, Press 2
Health Insurance Premium Payment Program
All other Medicaid
Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr
Family and Social Services Administration
Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
IOWA - Medicaid and CHIP (Hawki)
Medicaid Website:
Iowa Medicaid Health & Human Services
Medicaid Phone: 1-800-338-8366
Hawki Website
Hawki - Healthy and Well Kids in Iowa Health & Human Services
Hawki Phone: 1-800-257-8563
HIPP Website: Health Insurance Premium Payment (HIPP) Health & Human Services iowa.gov
HIPP Phone: 1-888-346-9562
KENTUCKY - Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website:
https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-877-524-4718
Kentucky Medicaid Website:
https://chfs.ky.gov/agencies/dms
MAINE - Medicaid
Enrollment Website
https://www.mymaineconnection.gov/benefits/s/?language=en
US Phone: 1-800-442-6003
TTY: Maine relay 711
Private Health Insurance Premium Webpage:
https://www.maine.gov/dhhs/ofi/applications-forms
Phone: 1-800-977-6740
TTY: Maine relay 711
KANSAS - Medicaid
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
LOUISIANA - Medicaid
Website: www.medicaid.la.gov or www.1dh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
NORTH CAROLINA - Medicaid
Website: https://medicaid.nedhhs.gov/ Phone: 919-855-4100
OKLAHOMA - Medicaid and CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
PENNSYLVANIA - Medicaid and CHIP
Website: https://www.pa.gov/en/services/dhs/apply-forMedicaid-health-insurance-premium-payment-program hipp.html
Phone: 1-800-6392-7462
CHIP Website: Children’s Health Insurance Program (CHIP) (pa.gov)
CHIP P)hone: 1-800-986-KIDS (5437)
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
MASSACHUSETTS - Medicaid and CHIP
Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840
TTY: 711
Email: masspremassistance@accenture.com
MINNESOTA - Medicaid MISSOURI - Medicaid
Website:
https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672
MONTANA - Medicaid
Website:
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Email: HHSHIPPProgram@mt.gov
NEVADA - Medicaid
Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
NEW JERSEY - Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/Medicaid/
Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
DHIP Website: http://www.n jfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 (TTY: 711)
Website: http:www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
NEBRASKA - Medicaid
Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633
Lincoln: 402-473-7000 Omaha: 402-595-1178
NEW HAMPSHIRE - Medicaid
Website: https://www.dhhs.nh.gov/programsservices/Medicaid/health-insurance-premium-program Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
NEW YORK - Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/ Phone:1-800-541-2831
TEXAS - Medicaid
Website: Health Insurance Premium Payment (HIPP)
Program: Texas Health and Human Services
Phone: 1-800-440-0493
VERMONT - Medicaid
Website: Health Insurance Premium Payment (HIPP) Program Department of Vermont Health Access Phone: 1-800-250-8427
WASHINGTON - Medicaid
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
WISCONSIN - Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002
NORTH DAKOTA - Medicaid
Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825
OREGON - Medicaid and CHIP
Website: http://healthcare.oregon.gov?Pages/index.aspx Phone: 1-800-699-9075
RHODE ISLAND - Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct Rite Share Line)
Website: http://dss.sd.gov Phone: 1-888-828-0059
UTAH - Medicaid and CHIP
Utah’s Premium Partnership for Health Insurance (UPP)
Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov
Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/
VIRGINIA - Medicaid and CHIP
Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select
https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hipp-program/s Medicaid/CHIP P:hone: 1-800-432-5924
WEST VIRGINIA - Medicaid and CHIP
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-My WVHIPP (1-855-699-8447)
WYOMING - Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/ Phone: 1-800-251-1269
SOUTH CAROLINA - Medicaid
SOUTH DAKOTA - Medicaid
Privacy of Protected Information – Availability of Health Insurance Portability and Accountabi8lity Act (HIPPA) Notice of Privacy Practices
The Plan maintains a HIPPA Notice of Privacy Practices that provides information to individuals whose protected health information (PHI) will be used or maintained by the Plan. If you would like a copy of the Plan’s HIPPA Notice of Privacy Practices, please contact the number located on the back of your member ID card.
Women’s Health and Cancer Rights Act of 1998
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed.
• Surgery and reconstruction of the other breast to produce a symmetrical appearance.
• Prothesis; 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. For more information, refer to the SPD or contact the Plan Administrator (contact information is provided under “General Information About the Plan” above.
Newborns & Mothers Health Protection Act (NMHPA)
The Newborns’ and Mothers’ Health Protection Act of 1996 (the Newborns’ Act), signed into law on September 26, 1996, requires plans that offer maternity coverage to pay for at least a 48-hour hospital stay following childbirth (96-hour stay in the case of a cesarean section). This law was effective for group health plans for plan years beginning on or after January 1, 1998.
On October 27, 1998, the Department of Labor, in conjunction with the Departments of the Treasury and Health and Human Services, published interim regulations clarifying issues arising under the Newborns’ Act. The changes made by the regulations are effective for group health plans for plan years beginning on or after January 1, 1999. The Newborns’ Act and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier.
The Newborns’ Act, and its regulations, prohibit incentives (either positive or negative) that could encourage less than the minimum protections under the Act as described above.
A mother cannot be encouraged to accept less than the minimum protections available to her under the Newborns’ Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery. The type of coverage provided by the plan (insured or self-insured) and state law will determine whether the Newborns’ Act applies to a mother’s or newborn’s coverage. The Newborns’ Act provisions always apply to coverage that is self-insured. If the plan provides benefits for hospital stays in connection with childbirth and is insured, whether the plan is subject to the Newborns’ Act depends on State law. Based on a recent preliminary review of State laws, if the coverage is in Wisconsin and several U.S. territories, it appears that the Federal Newborns’ Act applies to the plan. If the coverage is in any other state or the District of Columbia, it appears that State laws applies in lieu of the Federal Newborns’ Act.
All group health plans that provide maternity or newborn infant coverage must include a statement in their summary plan description SPD advising Act requirements.
MEDICARE PART D CREDITABLE COVERAGE NOTICE
Important Notice About Your Prescription Drug Coverage and Medicare
Please read this notice carefully for information about your current prescription drug coverage and your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan.
If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are 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) which offers prescription drug coverage. 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. The plan has determined the prescription drug coverage offered by the medical plan options is “creditable.” In other words, the plan has determined that the prescription drug coverage offered by the medical plan options under the plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays (and, therefore, is considered to be “creditable” coverage). Because your existing coverage is creditable coverage, you can keep this coverage and not pay a higher premium (a penalty) if you decide later 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 15 through December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two-month Special Enrollment Period (SEP) to join a Medicare drug plan.
What happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current coverage will be affected. Coverage between the plan and Medicare Part D may be coordinated. If you decide to join a Medicare drug plan and drop your current coverage, be aware you and your dependents may not be able to get this coverage back until open enrollment.
When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan ?
You should also know if you drop or lose your current coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you 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 percent of the Medicare base beneficiary premium per month for every month in which you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19 percent 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 Human Resources office for further information or call the phone number on the back of your medical insurance ID card.
Please note you will get this notice each year. You will also get it before the next period you join a Medicare drug plan, as well as if this coverage changes. You also may request a copy of this notice at any time.
Qualified Medical Child Support Orders (QMCSOs)
The plan will comply with the terms of a qualified medical child support order (QMCSO) A QMCSO is an order or a judgment from a court or administrative body (including a National Medical Support Notice) directing the Plan to cover a child of a participant under the group health plan coverage provided through the Plan. Federal law provides that a medical child support order must meet certain form and content requirements in order to be a QMCSO. When an order is received, each affected participant and each child (or the child’s representative) covered by the order will be given notice of the receipt of the order and a copy of the Plan’s procedures for determining if the order is valid. Coverage under the applicable coverage(s) of the Plan pursuant to a QMCSO will not become effective until the Plan Administrator determines that the order is a QMSCO.
If you have any questions or would like to receive, without charge, a copy of the Plan’s written procedure for determining whether an order is QMCCSO contact your carrier.
Staenberg Family Complex
I.E. Millstone Campus
Creve Coeur
2 Millstone Campus Drive
St. Louis, MO 63146
The St. Louis Jewish Community Center enriches lives, builds community, promotes inclusivity and creates meaningful Jewish experiences.
Marilyn Fox Building
Harry and Jeanette Weinberg Campus
Chesterfield
16801 Baxter Road
Chesterfield, MO 63005
www.jccstl.org Our Mission