Live Well. Work Well.
2018 Benefits Program Guide Effective January 1 – December 31, 2018
2018 Benefits Guide
Table of Contents Page Eligibility
1
Open Enrollment
3
Cost for Coverage
3
Plan Year
3
Making Changes During the Plan Year
4
Healthcare Program
5
Medical Resources
9
Dental Benefits
13
Vision Benefits
15
Employee Assistance Plan
16
Flexible Spending Accounts (FSAs)
17
Survivor Protection
19
Income Protection
21
Supplemental Benefits
22
401(k) Retirement Savings Plan
23
Legal Notices
25
Employee Premiums
31
Employee Benefits Booklet For EnCore Employees and Their Families
1
2018 Benefits Guide
Your benefits represent a significant investment on your behalf by EnCore and are an important part of your overall compensation. Understanding your benefits can help you take full advantage of them and maximize their value to you. This booklet describes the options available to you under the EnCore benefits program. Please read it carefully and keep this booklet in a safe place, so you can refer to it if you have questions.
Benefits At-A-Glance EnCore is committed to providing its employees with a competitive benefits program that gives you and your family a comprehensive level of coverage and protection. Your EnCore benefits program includes the following options:
Healthcare Program Medical/Prescription coverage o E nriched OAMC PPO o HMO AVN (Low)
o HMO California (High)
Dental Coverage o PPO
o DHMO
Vision Care Coverage Flexible Spending o PPO
Income Protection Long-Term Disability (LTD)
Survivor Protection Basic Life and Accidental Death and Dismemberment (AD&D) Insurance Supplemental Employee, Spouse, and Child Life and AD&D Insurance
Retirement/Financial Protection 401(k)
Supplemental Benefits Critical Illness
Accident Insurance
Accounts (FSAs)
o Dependent Care / Medical Care
Employee
Assistance Program (EAP)
2
2018 Benefits Program Eligibility Employee Eligibility
You are able to participate in the EnCore benefits program if you are a full-time employee regularly working at least 30 hours per week. If you meet these requirements, you are eligible to participate in the Medical/Prescription, Dental, Vision, Life/AD&D, Long-Term Disability, Critical Illness, and Accident Insurance plans. New employees – You must make your benefit elections within the timeframe designated by Human Resources. If you do not enroll for coverage during your initial eligibility period, you must wait until the next Open Enrollment period to enroll, unless you have a Qualifying Event (see page 4 for details). Note: Unless otherwise required by state mandate. Benefits begin on the first of the month following one month of service. Benefit enrollment may be delayed for any plans requiring Evidence of Insurability (EOI).
Dependent Eligibility Eligible dependents include spouse; qualified domestic partner (in states where mandated) with registration, and dependent children up to age 26, regardless of marital or student status (includes your own children, stepchildren, legally adopted children, your registered domestic partner’s children, and any other children for whom you are legal guardian). Children age 26 or older, who are permanently disabled and financially dependent on you for support, may remain covered on your health plan coverage, if they were covered under the plan prior to age 26. You may be asked to provide certification of the child’s disability annually.
Required Documentation for Eligible Dependents All employees are required to provide verification of dependent eligibility when enrolling in the EnCore benefits program. You must provide supporting documentation when adding your dependent(s) (e.g., marriage certificate when adding a spouse, birth certificate when adding a child, and domestic partnership registration when adding a domestic partner). If you do not provide the required documentation within the allotted time frame, your dependent(s) will be considered ineligible and unable to enroll in EnCore’s benefit plans or coverage will be canceled. You must notify Human Resources immediately if a covered family member loses eligibility during the year. As part of The Patient Protection and Affordable Care Act (PPACA), EnCore will be required to report annual health plan information to the Internal Revenue Service (IRS) to verify that you and your eligible family members are enrolled in coverage and are not subject to a tax penalty. In order for EnCore to satisfy this reporting requirement, you will be prompted at enrollment to provide the Social Security number (SSN) for all eligible dependent(s), regardless if you elect coverage for them or not.
Termination of Employment Your Medical/Prescription, Dental, Vision and EAP benefits will terminate on the last day of the month in which you experience termination of employment or reduction in hours of employment. All other benefits terminate on the last day of employment with EnCore or the date you experience a reduction in hours of employment.
3
2018 Benefits Guide
OPEN ENROLLMENT
Each year, EnCore holds an Open Enrollment period, during which time employees have the opportunity to evaluate their elections to be sure their health-care needs are met. If you are changing your benefit elections during the open enrollment period, those changes will take effect on January 1st, unless you are not actively at work or you have a pending Evidence of Insurability (EOI) request. Supplemental Life changes made while on Leave of Absence (FMLA, Personal Leave, Workers’ Compensation, Military Leave) will not become effective until the first of the month following your return to active employment status.
COST FOR COVERAGE
EnCore offers a benefits package that is not only comprehensive, but cost-effective for you and your family. The following benefits are provided at no cost to you: • Basic Life Insurance
• Basic Accidental Death and Dismemberment Insurance • Employee Assistance Plan (EAP)
You and EnCore share in the cost of your and your dependents’ medical and dental benefits. You pay 100% of the cost for other benefits you elect for yourself/dependent(s). You pay your portion of elected benefits through convenient payroll deductions. Premiums for Medical, Dental, Vision, and Flexible Spending Accounts are deducted on a pre-tax basis, ultimately reducing your taxable income. Your premiums for all other elected benefits are deducted on an after-tax basis.
PLAN YEAR
The plan year for EnCore’s benefit plan is January 1 to December 31. Medical and Dental plan deductibles and out-of-pocket maximums reset each year on January 1st. The Vision plan benefits will reset on a rolling 12-month basis depending on the last time you received services (i.e., if you have an annual eye exam on March 1, 2018, your next eligible exam will be March 1, 2019).
DON’T FORGET… Health Care Reform - The individual mandate states that as of January 1, 2014 most U.S. citizens must have health insurance. If you don’t, you may be required to pay a tax penalty. We cannot assist you in evaluating your options for coverage through the Federal or State Insurance Marketplace, but you can find more information to help you make your decision at www.healthcare.gov or call 1-800-318-2596.
4
MAKING CHANGES DURING THE PLAN YEAR
Enrollment changes outside the Open Enrollment period are not permitted, unless you experience a Qualifying Life Status Event (QLSE). Examples of Qualifying Life Status Events include: • Marriage, divorce or legal separation
• Birth, adoption or placement for adoption of a child • Death of spouse or dependent
• A change in employment status for you or your spouse affecting health-care coverage (such as changing from full-time to pa rt-time employment (i.e., a reduction in hours) or your spouse starting or ending employment) • A dependent child ceases to satisfy plan requirements (such as age limitations) • COBRA coverage under another plan is exhausted
• Entitlement to, or loss of, Medicare or Medicaid benefits Any changes to your elections must be made within 31 days of the event and must be consistent with the event. If you do not change your coverage and provide the proper documentation within 31 days of the Qualifying Life Status Event, the election will be denied and no exception will be made, per IRS guidelines. Complete the necessary forms from Human Resources and submit all required documentation to your local Human Resources representative within 31 days of the Qualifying Life Status Event (including newborns).
Qualifying Life Status Event Examples Below is a partial list of common Qualifying Life Status Events and how you can update your benefits mid-year. Qualified Event
Medical/Dental/Vision
Voluntary Life Insurance
FSAs
Marriage
Enroll self, spouse, and newly acquired child(ren) in all plans.
May enroll with Evidence of Insurability (EOI). If enrolled, may increase election with EOI. If enrolled, may add new spouse without EOI (up to $30k) and child(ren).
Enroll, drop, increase, or decrease contributions.
Death of Spouse
Enroll self and/or child(ren) in all plans and drop spouse.
May enroll with EOI. May drop spouse and enroll child(ren) if enrolled.
Enroll, drop, increase, or decrease contributions.
Birth/Adoption of Child
Enroll self and/or child(ren) in all plans.
May enroll with EOI. If enrolled, may increase election with EOI. If enrolled, may enroll spouse with EOI and new child(ren).
Enroll or increase contributions.
Divorce/Legal Separation
Enroll self and/or child(ren) in all plans and drop spouse.
May enroll with EOI. If enrolled, may increase election with EOI. If enrolled, may drop spouse and enroll child(ren).
Enroll, drop, increase, or decrease contributions.
5
2018 Benefits Guide
Maintaining good health is key to living a long productive life. By providing access to affordable preventive care, EnCore’s healthcare program can help you to lead a healthier lifestyle. But it’s up to you to be proactive about obtaining regular preventive exams and screenings. And, should you become ill or injured, the healthcare program provides all the resources you need to get the appropriate level of care for your situation.
Healthcare Program Medical Coverage
You may choose from three comprehensive medical/prescription plans through Aetna: • H MO AVN (Low) and HMO California (High) - With the HMO (health maintenance organization) plans, you and each of your enrolled family members must select a Primary Care Physician (PCP) from the Aetna HMO network. Your PCP will coordinate your health care needs, including referrals to specialists and approving further medical treatment. Services received outside of the HMO are not covered, except in the case of emergency medical care. • O pen Access Managed Choice (PPO) - With the Open Access Managed Choice (OAMC) PPO plan, you have the freedom to seek care from the provider of your choice and you do not have to select a primary care physician. You will maximize your benefits and reduce your out-of-pocket costs if you choose an in-network provider who participates in Aetna’s “Aetna Open Access/Managed Choice POS (Open Access)” network. These providers have agreed to charge members reduced, contracted fees instead of their typical fees. Plus, in-network providers will submit claims for you, saving you time and the hassle of paperwork. If you decide to access care out-of-network, your out-of- pocket costs will be higher and the plan will pay benefits only up to Aetna’s “allowed amount” for a particular health care service. If your out-of-network provider charges more than Aetna’s allowed amount, you will be responsible for paying those charges on your own. You generally will have to pay the full cost of the medical services up front, and then submit a claim to Aetna to be reimbursed for the covered portion of the charges.
6 Preventive Care In order to receive the full value of your plan, schedule your preventive care exams! Aetna covers these exams 100% (deductible waived) when you use an in-network provider. Preventive exams can help identify any potential health problems early on. Not all preventive care is recommended for everyone, so talk with your doctor to decide which services are right for you and your family. Preventive care is generally precautionary. For example, if your doctor recommends having a colonoscopy because of your age or family history, this would be considered preventive care. But, if your doctor recommends a colonoscopy to investigate symptoms you’re having, this would be considered diagnostic care, and your plan cost share will apply. Preventive care services include, but are not limited to the following services: • Annual Physicals • Flu Shots
• Immunizations
• Well-baby care
• Well women exams (Pap tests, mammograms, etc) • Prostate cancer screenings • Colonoscopy
Refer to Aetna’s benefit summary for full details.
HOW TO FILE A CLAIM HMO Plans Your medical care is coordinated by your PCP and Medical Group. Claims will be processed on your behalf by your medical office. OAMC PPO Plan If you utilize an in-network doctor, your medical office will submit the claim to Aetna on your behalf. Payment will be sent directly to the doctor. You will receive an Explanation of Benefits (EOB) from Aetna which will outline the payable charges and any member responsibility you may have. If you choose an out-of-network doctor, it is your responsibility to pay the provider and submit your claim to Aetna. You will be reimbursed according to the plan provisions. Claim forms are available online at www.aetna.com or by calling member services at 1-877-204-9186.
Coordination of Benefits (COB) When you or your covered dependents are insured under more than one PPO health insurance plan, the plans coordinate with each other on payments so that there are no duplicate payments for the same medical service. The order in which payments are made is determined as follows:
• The plan that covers the patient as an employee (non-dependent) pays first • The plan that covers the patient as a dependent pays second
• I f you and your spouse are both covered under your respective employer’s medical PPO plan, the “birthday rule” is applied to determine coverage for your children. The spouse born earlier in the calendar year is responsible for covering the children under his/her plan. Remember, the year of birth does not matter – only the month and day of birth
HMO Full Network
In-Network Only
$100/Individual $200/Family
$400/Individual $800/Family
Calendar Year Deductible
Outpatient surgery
Room & Board (semi-private room)
10% after deductible $200 copay after deductible
$250 copay after deductible
Not Covered
No Charge
No Charge
20% after deductible
Not Covered
Chiropractic Care
Hospitalization
No Charge
No Charge
No Charge
No Charge
No Charge No Charge
No Charge
$50 copay
$30 copay
10%
No Charge
$40 copay
$30 copay
20%
Well-Baby/Well-Child Care
"Prenatal Office Visits (maternity care, tests and procedures)"
"OB/GYN (well-woman exams)"
"Preventive Care (routine physical exams)"
Lab and X-Rays
Specialist Visits
Office Visits
Coinsurance
Next you will pay either a copay or coinsurance for covered services
Out-of-Network
OAMC Open Access Managed Choice POS
In-Network
OAMC Open Access Managed Choice PPO
Aetna OAMC PPO
20% after deductible
20% after deductible
$50 copay (up to 12 visits per year)
No Charge
No Charge
No Charge
No Charge
No Charge
$50 copay
$30 copay
20%
$500/Individual $1,500/Family
40% after deductible
40% after deductible
40% after deductible (up to 12 visits per year)
40% after deductible
40% after deductible
40% after deductible
40% after deductible
40% after deductible
40% after deductible
40%
$1,000/Individual $3,000/Family
40% after deductible
Unlimited
Providers within the OAMC network contact with Aetna and charge plan members a pre-negotiated fee for services. Out-of-network (OON) providers don't contract with Aetna. The plan will pay OON benefits based on Reasonable & Customary (R&C) fees within your service area. You may be responsible for fees above and beyond R&C.
First you may be required to meet a calendar year deductible before the plan pays benefits
Unlimited
Unlimited
You must designate a Primary Care Physician (PCP) within the Network when enrolling in the HMO plan. Your PCP will coordinate all of your medical care and refer you to a Specialist if needed. There is no outof-network coverage except for emergency care.
AVN Narrow Network
In-Network Only
HMO California (High)
Aetna High HMO
Lifetime Maximum Benefits
How it Works
Network of Providers
Plan Provision
HMO AVN (Low)
Aetna Low HMO
Medical Benefits Comparison Chart
7 2018 Benefits Guide
$20 copay $30 copay $50 copay
Generic
Brand
Non-Formulary
$60 copay $100 copay
Brand
Non-Formulary Included
$120 copay
$70 copay
$40 copay
No Charge
$60 copay
$35 copay
$20 copay
No Charge
No charge
40% after deductible
20% up to $150 maximum
$140 copay
$80 copay
$40 copay
No Charge
$70 copay
$40 copay
$20 copay
No Charge
$50 copay
20% after deductible
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Covered
Not Covered
Not Covered
Not Covered
40% after deductible
40% after deductible
$150 copay then 20% after deductible
$35 copay
$3,000/Individual $6,000/Family
$2,000/Individual $4,000/Family
$3,400/Individual $6,800/Family
$6,800/Individual $13,700/Family
If you receive care in a network hospital or other facility, be sure whenever possible that all care is coordinated within the network, to receive the highest level of benefits under the plan. This includes doctors who might provide services such as anesthesia or labs that provide necessary testing. Remember, any services received from providers outside of the Aetna OAMC network will be treated as out-of-network care.
TIP‌
Calendar Year Out-of-Pocket Maximum (includes all copayments, coinsurance and deductibles)
Then, if you meet the annual out-of-pocket maximum, the plan will pay 100% of the cost of covered services for the remainder of the year.
Specialty
Included
$40 copay
Generic
Specialty Drugs (Mail Order Only)
No Charge
FDA Approved women's contraceptives
Mail Order Pharmacy (90-day supply)
No Charge
FDA Approved women’s contraceptives
Retail Pharmacy (30-day supply)
No charge
Outpatient
10% after deductible
$150 copay after deductible
$200 copay after deductible 20% after deductible
$35 copay
$35 copay
Inpatient
Mental Health/Substance Abuse
Emergency Room
Urgent Care
Emergency Care
8
9
2018 Benefits Guide
Medical Resources Finding a Provider
You can locate an Aetna provider by visiting Aetna’s website at: www.aetna.com. Select “Individuals & Families” then “Find A Doctor” and follow the prompts. When prompted to select a plan, choose from the following: • HMO AVN (Low) plan - under State Based Plans, select “(CA) Aetna Value Network “HMO” • HMO California (High) plan - under Standard Plans, select “HMO”
• OAMC PPO (High) plan - under Aetna Open Access Plans, select “Managed Choice POS (Open Access)” It is up to you to check each time you visit the doctor or are referred to another provider to ensure they are within your plan’s network. If you have any questions about your network, call Aetna toll free at 877-204-9186.
Pre-Certifying Care HMO Plans – Your PCP will coordinate any required pre-authorizations needed for major services (i.e. surgery, hospital care, etc). OAMC PPO Plan – You are responsible for obtaining pre-authorizations from Aetna before you incur major services. This will ensure that you receive the maximum allowed benefits. To pre-certify your care, call Aetna Member Services at 1-877-204-9186.
Aetna Navigator As a medical plan member, you have access to a personalized, secure website to help you manage your health and health benefits. Go to www.aetnanavigator.com, select “Register Now” and follow the prompts. The site provides many benefits: • Ask Ann, a virtual assistant programmed to answer your questions in real time • Compare costs for office visits, tests and procedures • Save on health-related products and services • Store and share your personal health history
• Get instant access to claims and Explanation of Benefits • Track your health goals
• Research prescription drugs
• Find forms and order ID cards
INFORMED HEALTHLINE With the Informed Health Line, you can speak to a registered nurse about health issues that are on your mind — whenever you need to. You can call as many times as you need at no extra cost and your covered family members can use it too. Call toll-free 1-800-556-1555.
10 Virtual Visits with Teladoc Take a doctor with you anywhere you go! Teladoc provides you and your enrolled family members with 24/7/365 access to U.S. board-certified doctors and pediatricians by phone or online video. With Teladoc you can:
• R esolve many of your medical issues - Teladoc doctors can diagnose, recommend treatment and prescribe medication, when appropriate, for many of your medical issues.
• S peak with U.S. board-certified doctors - Aetna’s national network includes the highest quality, state-licensed doctors who will call you back within 22 minutes, on average • U se it anywhere/anytime - On vacation? Stuck home at with sick kids? 3 a.m. and need care now? No problem. Teladoc doctors are available 24/7/365 via phone and online video consultations.
• Save money - Teladoc costs you much less than urgent care or ER visits.
• R eceive quality care for many conditions - Sinus problems, cold and flu symptoms, bronchitis, urinary tract infection, allergies, respiratory infection, poison ivy, and more!
GET STARTED WITH TELADOC TODAY! Step 1:
Set up your account. Simply go to Teladoc.com/Aetna and click “Set up account.”
Step 2:
Complete your medical history. Informed doctors equal better care. Log in to your account and complete the My Medical History section.
Step 3:
Request a consultation. A Teladoc doctor is just a click or call away. Visit Teladoc.com/Aetna or call 1−855−Teladoc.
Mail Order Prescription Program If you take maintenance medications for conditions such as high blood pressure, asthma or diabetes, Aetna’s Rx Home Delivery service can save you time and money. Standard shipping is free. When using the mail order service, you will receive a 3-month (90-day) supply for the cost of only two months; you pay for two and get one free! For additional information, call Aetna Rx Home Delivery at 1-800-RX AETNA (1-888-792-3862) or log in to www.aetnanavigator.com.
Aetna Simple Steps Wellness Program Aetna members and their enrolled spouses are encouraged to participate in the Aetna Simple Steps to a Healthier Life program. The first step is easy – answer a few short questions about your health to get the ball rolling. Your responses are kept confidential, just between you and Aetna. Of course, you can always share your results with your doctor, too. Aetna will then recommend health coaching programs designed to help you improve your health and well-being. If you complete the online health survey along with one of the online coaching programs, you are eligible to receive a $50 gift card. Your spouse can earn this too! Log in to your Aetna Navigator portal at www.aetnanavigator.com to get started.
11
2018 Benefits Guide
Disease and Case Management Programs Disease Management - programs designed to provide members with the resources to: • Manage chronic diseases
• Reduce unnecessary hospitalization and healthcare costs • Increase members’ quality of life
Case Management Services - include core activities that focus on offering education, accelerating access to care and providing early identification and monitoring of chronic conditions. Examples of the programs and services include: • Health Education and Reminder programs
• Admission Counseling through Treatment Decision Support • Transitional Case Management to prevent readmissions
• General Condition Management to educate members about identified health needs
• Complex Case Management for ongoing or long-term assistance to address specialized health needs You are encouraged to take advantage of Aetna’s resources to help manage your condition and be as healthy as possible. When your health is at stake, why wait? Call Aetna directly at 1-866-269-4500. The more quickly you act, the more in control you can be.
Aetna Discount Programs
Aetna provides members with access to discount programs including: • Vision care
• Gym memberships • Health coaching
• Personal Trainings
• Weight Loss programs (Nutrisystem, Jenny Craig, etc) • Exercise equipment
• Massage therapy, acupuncture and chiropractic care • Hearing aids
• Yoga equipment
• Nutrition services Log in to your Aetna Navigator portal at ww.aetna.com for more information.
DID YOU KNOW... Health care costs continue to outpace the rate of inflation? But we can all do our part by being an informed health care consumer. One way to do that is to seek care at the right place, at the right time. Almost 50 percent of visits to the emergency room (ER) are unnecessary. There are other options often more appropriate than the ER that can save you time and money, such as Urgent Care. Call 1-877-804-9186 for help
12
IMPORTANT DEFINITIONS Copayment (copay) A fixed, predetermined dollar amount you are responsible for paying (usually for network expenses like a doctor’s office visit or prescription drugs) Coinsurance Your share of the costs of a health care service. It’s usually figured as a percentage of the amount to be charged for services. You start paying coinsurance after you’ve paid your plan’s deductible. Deductible Dollar amount you are responsible for before the insurance carrier will share in the cost of your covered medical services. Emergency Care Treatment for a condition that is severe, begins suddenly or unexpectedly and requires immediate medical attention to avoid serious injury or death. Network A group of providers (doctors, hospitals, dentists, etc.) who meet certain credentialing standards and agree to charge pre-set negotiated fees for their services to participating patients. Out-of-Pocket Maximum (OOP) The total dollar amount you must pay, after meeting your deductible, before the plan pays 100% of covered services. You are responsible for a portion of your cost until you reach this amount.
13
2018 Benefits Guide
Dental Benefits
Our Dental plans encourage preventive care and provide coverage for a wide range of dental services to help you and your covered family members maintain dental health. You may choose from two comprehensive plans through MetLife: • Dental Health Maintenance Organization (DHMO) • Dental Preferred Provider Plan (DPPO)
DHMO Plan Similar to the medical HMO plan, you must select a primary care dentist in the MetLife network to provide your care. If specialty care is needed, your general dentist must provide the necessary referral. Out-of-network treatment is not covered. With this plan there are no deductibles, no annual maximums, and no charges for most preventive services. For all other services, you pay fixed copays depending on the procedure. Discuss your treatment plan with your primary care dentist to determine how much your copay will be.
PPO Plan In-Network Care - MetLife network dentists agree to charge pre-set, negotiated fees for their services. You may visit a dentist within the MetLife network and pay for your services at the in-network level. Your out-of-pocket costs may be less if you use a MetLife provider, but with the PPO plan the choice is yours. As an added convenience, network dentists generally file claim forms on your behalf. Out-of-Network Care - If you use a dentist outside of the MetLife network, your out-of-pocket expenses are usually higher and you may have to pay the provider the entire bill up front and file a claim with MetLife. Your level of reimbursement is based on Reasonable and Customary (R&C) charges, which MetLife covers in the 99th percentile. You are responsible for any difference between the provider’s actual charge and the R&C amount.
Pre-determination of Care If your dentist anticipates that charges for a service will exceed $300, it is important to obtain a predetermination from MetLife. Pre-determination lets you and your dentist know in advance what MetLife will pay for any service recommended for you. MetLife acts promptly in returning the pre-determination voucher to your dentist with patient eligibility and scope of benefits. MetLife’s payment of the pre-determined amount is determined upon continued employee eligibility. Payment may be reduced due to Coordination of Benefits with other coverage for which the patient is eligible
HOW TO FILE A CLAIM If you use an in-network dentist, your dental office will submit the claim to MetLife on your behalf. Payment will be sent directly to the dentist. If you choose an out-of-network dentist, you may have to submit the claim to MetLife. Download a claim form from www.metlife.com/dental.
The address for claims is:
MetLife Dental Claims P.O. Box 981282 El Paso, TX 79998-1282
14 MetLife Online Dental Resources
MetLife’s website, www.metlife.com/dental, offers valuable information for you and your family members to learn more about dental conditions. You can: • Access plan information by signing in to MyBenefits (or register)
• R esearch the MetLife Oral Health Library for information and tools relating to preventive care, special dental issues, special care for children and seniors, and dental health terms and trivia
Finding a Provider You can locate a MetLife Dentist by visiting MetLife’s website at: www.metlife.com/dental. Enter your zip code in the search tool and choose your network.
• D ental DHMO - under the “Select Your Network” drop down, choose “Dental HMO/Managed” and select MET185 as the plan name • Dental DPPO – under the “Select Your Network” drop down, choose “PDP Plus”
Dental Benefit Overview
DHMO Plan Provision
In-Network
PPO PPO Dentists
Non-PPO Dentists $50/Individual $150/Family
Calendar Year Deductible
None
Calendar Year Maximum
Unlimited
$2,000/Individual
N/A
N/A
99th percentile
Preventative Services
Refer to copay schedule
Plan pays 100%; deductible waived
Plan pays 100% of contracted fee; deductible waived
Basic Services
Refer to copay schedule
Plan pays 80%
Plan pays 80% of contracted fee
Major Services
Refer to copay schedule
Plan pays 50%
Plan pays 50% of contracted fee
Implants
Refer to copay schedule
Plan pays 50%
Plan pays 50% of contracted fee
Orthodontia Services
$1695 copay – adults $1695 copay - children
UCR
$1,500/Individual
Plan pays 50%, up to a lifetime maximum benefit of $2,000 per Individual
The annual dental deductibles and benefit maximums are based on a calendar year (January 1 – December 31).
15
2018 Benefits Guide
Vision Benefits
Vision care benefits are provided through MetLife. MetLife has one of the largest networks of private practicing optometrists, ophthalmologist and opticians. The plan encourages preventive vision care through regular eye examinations, and provides benefits for medically necessary eyeglasses and contact lenses. You can choose any eye care provider with this plan, however, you will receive the highest level of benefits when you choose a MetLife provider. Simply call a MetLife provider to schedule an appointment and tell them you are a MetLife member – no ID card or claim for required. If you choose an out-of-network provider, you’ll be required to pay the full amount at the time of your visit and submit a claim to MetLife for reimbursement. MetLife will reimburse you up to the amount allowed under the out-of-network reimbursement schedule. To find a MetLife vision provider, visit www.metlife.com/vision. Under “Find a Vision provider” enter your ZIP code and select “Vision PPO Plan.”
Vision Benefit Overview PPO
Plan Provision
In-Network
Exam Once every 12 months
$10 copay
Up to $45
$25 copay $25 copay $25 copay
Up to $30 Up to $50 Up to $65
Frames Once every 24 months
Covered up to $130 + 20% discount on amount over $130 (Costco: $70 allowance)
Up to $70
Contact Lenses Once every 12 months (Instead of glasses)
Covered up to $130
Up to $105
Lenses Once Every 12 months • Single Vision • Bifocal • Trifocal
Out-of-Network Reimbursement
SPECIAL DISCOUNTS In addition to the vision benefits provided through your EnCore benefits program, MetLife offers special discounts on many non-covered services, such as additional pairs of glasses, special lens options and LASIK surgery.
16
Employee Assistance Plan
The Employee Assistance Plan (EAP) administered by Unum, is designed to help you maximize your health and effectiveness at home and at work. Through this plan, you receive confidential, personal support for a wide range of issues, from everyday concerns to serious problems. EnCore provides this program for you and your household family members at no cost to you. Whether you want to resolve a family situation, find legal resources, or get advice about a financial concern, EnCore’s EAP can help. The EAP offers unlimited access to Master’s level consultants by phone, resources and tools online, and up to three face-to-face visits with a consultant for help with a short-term problem. You can access the EAP by phone or going on line at: • English - 1-800-854-1446
• Spanish - 1-877-854-2147
• TTY / TDD - 1-800-993-3004
• www.lifebalance.net (user id and password: lifebalance) You will be connected to an experienced specialist. Available 24 hours a day, 365 days a year, these specialists are experts in helping people identify the nature of their problems and finding the right resources to address them.
Unum’s EAP Online Resources This website also allows all benefit eligible employees and their household members to access databases, articles, tools and resources to help them learn more about balancing health, work, and life. You can: • Research articles on such topics as child/parenting issues, wellness, aging and adult/elder issue
• Access databases to search for child care providers, elder care providers and find resources for chronic conditions • Find community resources such as 12-step programs, self-help groups, and more
17
2018 Benefits Guide
Flexible Spending Accounts (FSAs) FSAs are accounts that allow you to set aside a portion of your salary that is not subject to federal income, Social Security and, in most cases, state and local taxes. You can then use this money to pay for eligible medical care and dependent care expenses. And, because that portion of your income is not taxed, you decrease your taxable income and increase your takehome pay. The accounts are voluntary and administered through IGOE. You decide if you want to participate and how much you want to contribute to the Medical Care and/or Dependent Care FSA. You must re-enroll in the FSA during each open enrollment period with coverage effective date of January 1.
Medical Care FSA You may contribute up to $2,650 of pre-tax money for the 2018 calendar year to the Medical Care FSA to pay for eligible expenses that you and your eligible dependents incur during the plan year. The Medical Care FSA is a supplement to our benefit menu and is not intended as a replacement to the medical plan. A debit card will be loaded with the value of your annual Medical Care FSA election and allows you to pay qualified out-of-pocket medical care expenses not covered by insurance, such as: • Deductibles, copays and coinsurance • Prescription drugs
• Orthodontia services
• Eyeglasses and contact lenses • LASIK eye surgery
• Treatment of alcoholism or drug dependency
• O ver-the-counter (OTC) health-related supplies that do not require a prescription from your doctor such as bandages/ wraps, diabetic supplies, contact lens solution/ supplies, reading glasses, thermometers and catheters
• O ver-the-counter (OTC) drugs that require a written prescription (Rx) from your doctor such as pain relievers, cold and flu remedies or allergy and sinus products Save your receipts While most medical care FSA expenses can be verified automatically, you may be required to substantiate the expense. You may also be required to submit a completed claim form for reimbursement. Any unsubstantiated claims are subject to tax implications on your W-2 and/or additional withholdings from future paychecks.
Dependent Care FSA You may contribute up to $5,000 of pre-tax money for the 2018 plan year to the Dependent Care FSA. If you are married and you and your spouse file separate tax returns, the maximum amount you may contribute is $2500 for the plan year. If your spouse’s employer offers a Dependent Care FSA, you and your spouse can contribute a combined maximum of $5,000 to your accounts for the plan year. You can use your Dependent Care account to pay for eligible expenses during the year, such as: • Day care provided by individuals inside or outside of your home
• Day care at a licensed nursery school, day camp (not sleep away camp), or day care center • Day care for adult dependents (unable to care for themselves)
18 If you participate in the Dependent Care FSA, you will need to provide the taxpayer identification number (or social security number) of the caregiver. An eligible dependent means: your child under age 13; or a mentally or physically disabled spouse, parent or other relative who spends at least eight hours a day in your home. In addition, you must claim the person as a dependent on your federal income tax return.
How to File a Claim If you elect the Medical Care FSA you will receive a debit card, which will permit you to pay for your 2018 eligible expenses directly. If you are unable to pay for your qualified medical care expenses with the debit card, a manual claim form will need to be processed for reimbursement. If you enroll in the Dependent Care FSA, you will need to submit a manual claim form for reimbursement. All approved manual claims will be processed for reimbursement via manual check. You have a three-month period following the end of the plan year in which to file claims for expenses incurred during the plan year. This means that all claims incurred between January 1, 2018 and December 31, 2018 must be filed by March 31, 2018. However, if you terminate employment mid plan year, you have a 90-day period following your employment termination date in which to file claims incurred as an active employee during the plan year. Tracking Your Expenses – You can keep track of your account balance anytime by accessing IGOE’S website at www.goigoe.com.
Grace Period EnCore’s Medical Care FSA has a “grace period” that follows the end of the plan year during which any amounts unused at the end of the year may be used to reimburse eligible expenses during the grace period. The grace period will begin on the first day of the next plan year and will end two (2) months and fifteen (15) days later.
Important FSA Guidelines If you elect to participate in these accounts, you must enroll each year in order to continue participating. Enrollment is never automatic. As with any tax-advantage program, there are some rules in exchange for the tax break: • You cannot transfer money between your Medical Care and/or Dependent Care FSA
• Y ou cannot change the amount you originally elect to contribute during the year – unless you have a Qualifying Life Status Event • Y ou cannot claim expenses on your federal income tax return if you‘ve already been reimbursed for them through an FSA • You must spend all monies set aside in each account during the plan year
• The IRS regulates that any monies left in your account cannot be carried over and will be forfeited
• T he FSA is based on the calendar year, as are your taxes. If you have questions about claiming expenses on your tax returns versus reimbursement through the FSA, consult your tax adviser Plan for upcoming medical care and/or dependent care expenses carefully and enjoy your tax break! For a more detailed list of eligible medical care expenses, contact IGOE at 800-633-8818 or www.goigoe.com
19
2018 Benefits Guide
Survivor Protection
Life insurance is designed to provide a level of financial protection to your family in the event of your death. Accidental Death and Dismemberment (AD&D) insurance provides an additional benefit if your death results from an accident, or if an accident causes certain serious injury. These benefits are offered through UNUM.
Basic Life and AD&D Insurance Once you are eligible, EnCore provides you with Basic Life and AD&D insurance coverage at no cost to you in the amount of 1x your annual base salary (rounded to the next $1,000 multiple) to a maximum benefit amount of $200,000. The value of the company-paid Life and AD&D insurance coverage over $50,000 will be counted as imputed income and is subject to federal, state, and Social Security taxes. However, the effect on your taxes should be minimal.
Supplemental Life and AD&D Insurance If you determine you need more than the Basic Life and AD&D coverage provided by EnCore, you may purchase additional coverage for yourself and your eligible family members at affordable group rates. The premium is deducted from your pay and is portable, allowing you to continue coverage should you ever leave EnCore. Plan Provision You* Your Spouse** Your Child(ren)**
Up to 5x your base annual salary, in increments of $10,000; to a maximum of $500,000. Coverage amounts are rounded to the next higher $1,000. Increments of $5,000. Maximum of 100% of employee amount; not to exceed $500,000. Under 6 months of age: $1,000. Over 6 months of age: Up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. Guarantee Issue
You*
$150,000
Your Spouse**
$30,000
Your Child(ren)**
All guarantee issue
* Your life insurance and AD&D benefits will decrease to 65% at age 65; 40% at 70; and 25% at age 70. ** You can enroll your dependents in these plans only if you are enrolling for coverage. Age reductions noted above also apply to spouse insurance.
20 ACTIVELY AT WORK Your insurance coverage will be delayed if you are not in active employment status because of an injury, sickness, or leave of absence on the date that insurance would otherwise become effective. Your dependent’s insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that, as a result of an injury, sickness or a disorder, your dependent is confined to a hospital or similar situation; is unable to perform two or more activities of daily living (ADLs) because of physical or mental incapacity resulting from an injury or sickness; is cognitively impaired; or has a life-threatening condition. Exception: Infants are insured from live birth.
Evidence of Insurability (EOI) EOI is required by Unum if you:
• Are already enrolled and are increasing your and/or your spouse’s coverage above the guarantee issue amount
• P reviously waived coverage and are electing Employee and/or Spousal Voluntary Life and AD&D for the first time, regardless of the amount.
• E nroll during the initial enrollment period as a new hire, or are newly eligible for benefits and/or adding newly eligible spouse/domestic partner above the guarantee issue amount. If you are making changes which require EOI, you will be required to complete Unum’s Evidence of Insurability form and submit directly to Unum. You and your spouse’s coverage amount will be effective the first of the month following Unum’s approval.
Conversion (Basic and Supplemental) You can covert basic and supplemental life insurance to an individual whole life policy (individual rates apply), which builds cash value, any time coverage is lost for any reasons, such as: • Termination of employment
• Becoming ineligible for benefits due to a reduction in hours • Ported coverage ends
• E nCore’s policy is canceled and coverage is not provided through a successor carrier or replacement coverage is less than what you had in force. Important: Must be covered under Unum’s policy for at least 5 years to be eligible
Portability (Basic and Supplemental) You can take your supplemental life insurance with you and pay for it at group rates, if: • Your employment has been terminated
• You have become ineligible for benefits due to a reduction in hours
• Y ou have lost membership in an eligible class and are covered under a class for which portability is offered, and are under age 70 Evidence of Insurability (EOI) is not required for the ported amount; however, if coverage is increased or added, you will need to supply evidence of insurability.
21
2018 Benefits Guide
Income Protection
Would you like to meet your financial responsibilities if you were ill or injured and could not work for a period of time? EnCore offers Long-Term Disability coverage, provided through UNUM, to you in the event of serious illness or injury preventing you from being able to work.
Long-Term Disability Plan Provision Benefit
60%
When benefits begin
After 180-day elimination period
Maximum Monthly Benefit Benefit Duration
60% of monthly earnings, not to exceed $8,000 Social Security Normal Retirement Age (SSNRA) with Reducing benefit based on schedule below Age at Disability Less than Age 62 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 or older
Maximum Period of Retirement To SSNRA 60 months 48 months 42 months 36 months 30 months 24 months 18 months 12 months
How to File a Claim To initiate a Long-Term Disability claim, register for your secure online access at www.unum.com/claims. By registering, you will be able to access required forms and manage your claim activity. You may also obtain a hardcopy of the Long-Term Disability Claim Form from Human Resources. Unum representatives are available to assist you with the claim process by calling Unum’s toll-free number at: 800-421-0344, 5 a.m. to 5 p.m. Pacific Standard Time, Monday through Friday.
Pre-existing Conditions The Long-Term Disability Plan has a pre-existing condition limitation. A pre-existing condition is a sickness or injury, including all related conditions and complications – for which, in the three months before your coverage starts, you: 1. received medical treatment, consultation, care or services including diagnostic measures; 2. took prescribed drugs or medicine; and
3. the disability begins within the first 12 months after your effective date of coverage.
22
Supplemental Benefits Accident
Accident insurance, provided through UNUM, is designed to help you meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic, that happens off the job. Accident insurance pays cash benefits directly to you, if you or your covered family members have suffered a covered injury and need treatment. It can off-set out-of-pocket costs such as co-pays, deductibles and other expenses that medical insurance may not cover. • No medical questions asked • Family coverage available
• Coverage for unlimited number of accidents
Critical Illness Critical Illness insurance, provided through UNUM, is designed to help employees offset the financial effects of a catastrophic illness with a cash benefit if an insured member is diagnosed with a covered illness such as heart attack, stroke, or major organ failure. This plan is designed to complement your existing medical coverage. • Critical Illness coverage pays a lump sum amount upon diagnosis and pays in addition to any other insurance coverage. • $20,000 guarantee issue amount • $50 annual wellness benefit
• Spouse coverage available; dependent children automatically covered at 50% of your benefit at no additional cost • No medical questions asked
• 1 2/12 pre-existing condition limitation. A pre-existing condition under this plan is a sickness or injury including all related conditions and treatments for which the date of diagnosis is in the first 12 months prior to and 12 months after the effective date of coverage.
23
2018 Benefits Guide
401(k) Retirement Savings Plan
Plan for retirement by contributing to the 401(k) Retirement Savings Plan on a pre-tax or after-tax basis. The plan offers a wide variety of investment funds so you can choose what best meets your needs.
Eligibility You are eligible to enroll at the beginning of the month following 90 days of consecutive employment, if you are at least 21 years of age.
24 Advantages of Contributing The 401(k) Retirement Savings Plan helps you meet your financial goals with the following advantages:
• T ax savings on pre-tax contributions » You may contribute 1 - 100% of your pay, up to the annual IRS maximum » 2018 IRS Maximum: $18,500 » Catch-up contributions age 50 and over (2018 IRS Maximum - $6,500) » You may choose to save on a pre-tax basis, a Roth after-tax basis, or a combination of these methods. • Convenient payroll deductions
• Matching contributions from EnCore
• C hoice of investment funds - The core menu of investment options offered in the Plan allow you to build your own custom portfolio, choose a pre-built portfolio called a Predetermined Model, or select one investment based on the year in which you plan to retire.
Pre-tax Contributions With traditional pre-tax contributions, the amount you contribute to the plan and any investment earnings are not currently taxable to you. Your contributions are deducted from your paycheck before taxes are taken out. Both contributions and earnings are taxed when you withdraw from the plan.
Roth 401(k) Contributions With Roth contributions, your contributions are made after tax. However, if tax law requirements are met, you can withdraw your contributions plus any plan earnings tax free.
EnCore Matching Contributions EnCore will make a matching contribution to your account each payroll period.
Vesting Vesting refers to your ownership of a benefit. You are always 100% vested in your contributions to the Plan and rollover contributions, plus any earnings they generate. Employer contributions to the Plan, plus any earnings they generate, are immediately 100% vested.
Receiving Benefits Because 401(k) plans are designed for retirement savings, there are rules that specify when you can receive funds from the plan. Before age 59½, you may withdraw funds only if you leave EnCore, become disabled or experience a financial hardship as allowed by the IRS. Any funds you receive before age 59½ may be subject to current taxes and possibly a financial penalty.
Information and Assistance - OneAmerica • O nline at www.oaretirement.com
• T oll free telephone at 1-800-660-6282 • O neAmerica smartphone app
25
2018 Benefits Guide
LEGAL NOTICES Healthcare Reform Notice
The individual mandate states that as of January 1, 2014 most U.S. citizens must have health insurance. If you don’t, you may be required to pay a tax penalty. We cannot assist you in evaluating your options for coverage through the Federal or State Insurance Marketplace, but you can find more information to help you make your decision at www.healthcare.gov or call 1-800-318-2596.
Continuation of Benefits Under COBRA If a qualifying event occurs that causes you, your spouse, or your children to lose coverage under our group health care plan, you have a legal right under COBRA to purchase a temporary extension of group health coverage. Qualifying events include reduction in work hours, termination of employment (except for gross misconduct), death of the employee, legal separation or divorce, or loss of eligibility for child coverage. The purchase price of continuing coverage is the full cost of the premium for similarly situated active employees, plus 2 percent (50 percent in certain cases) to help pay for administrative costs. The period for which the coverage can be continued depends on the nature of the qualifying event. Employees or family members who otherwise would lose coverage must inform the COBRA Administrator of their election of COBRA coverage within 60 days of the qualifying event.
26 There is no waiting period, no exclusion for pre-existing conditions, and no physical examination when electing continuation coverage. Any amounts already paid toward deductibles and coinsurance during the current year count under the continuation policy. Employees and family members can elect full coverage or medical coverage without dental insurance and can choose from the three different health plans offered to active employees. This policy statement is a brief description of the health care continuation plan and does not fully explain employees’ rights under COBRA. You should read the COBRA notice you received when you first enrolled in the group health plan or the summary plan description for a fuller explanation. Copies of the COBRA notice and summary plan description can be obtained by contacting the Plan Administrator.
Patient Protection Notice for HMO Medical Plan Participants You have the right to designate any Primary Care Physician (PCP) who participates in your plan’s HMO network and who is available to accept you or your family members. For children, you may designate a pediatrician as the PCP. If you do not select a PCP when you enroll, Aetna will automatically assign you to an open PCP near your home. To change your PCP, you will need to contact Aetna Member Services. NOTE: You do not need prior authorization from Aetna or from any other person (including a PCP) in order to obtain access to obstetrical or gynecological care from a health care professional in your plan’s HMO network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact Aetna Member Services
Privacy Rights EnCore is committed to the privacy of your health information. The administrators of the EnCore Health Benefits Plan use strict privacy standards to protect your health information from unauthorized use or disclosure. The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. You may receive a copy of the notice by contacting the Plan Administrator.
Special Open Enrollment Rights for Certain Individuals Under Health Insurance Portability and Accountability Act of 1966 (HIPAA) If you decline enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, in the future you may be able to enroll yourself and your dependents in one of the health care options offered by the Plan Sponsor, provided you request enrollment within 30 days after your other coverage ends. 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, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you otherwise decline to enroll, you may be required to wait until the group’s next open enrollment to do so. You may also be subject to additional limitations on the coverage available at that time. Furthermore, if you are an employee who is eligible for coverage but not enrolled, you shall be eligible to enroll for coverage within 60 days after (a) becoming ineligible for coverage under a Medicaid or Children’s Health Insurance Program (CHIP) plan; or (b) being determined to be eligible for financial assistance under a Medicaid, CHIP, or state plan with respect to coverage under the plan.
27
2018 Benefits Guide
Wellness Amendment EnCore may, from time to time, implement or adopt one or more wellness programs or disease management programs under this plan that offer you the opportunity to qualify for discounts on the cost of benefit options or other financial incentives if you and/or your eligible family members participate in the program or satisfy certain health standards. If EnCore chooses to offer a wellness program or disease management program, its terms and conditions will be communicated to you and it will be administered in compliance with all applicable laws. If you or your family members choose not to participate, or stop or otherwise fail to qualify in one of these wellness or disease management programs, any adjustments will be automatically applied to the cost of your Benefit Options and to your salary reductions (if any) under our Cafeteria Plan. If it is unreasonably difficult due to a medical condition for you to achieve the standards for the reward under this program, or if it is medically inadvisable for you to attempt to achieve the standards for the reward under this program, contact your divisional HR representative to discuss another way to qualify for the reward. Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact your divisional HR representative and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.
Newborn’s and Mother’s Health Protection Act of 1996 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 issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you are eligible for health coverage, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer- sponsored health coverage, but need assistance in paying their health premiums. If you or your eligible family members are already enrolled in Medicaid or CHIP, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your eligible family members are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your family members might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employersponsored plan.
28 Once it is determined that you or your eligible family members are eligible for premium assistance under Medicaid or CHIP, you and your eligible family members are eligible to enroll in the Company’s health plan – as long as you and your eligible family members are eligible, but not already enrolled in the Company’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance
Medicare Part D
If you (or your eligible family members) have Medicare or will become eligible for Medicare in the next 12 months, please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with EnCore 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. Important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. M edicare 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. E nCore has reviewed its current prescription drug coverage offered under its plans and has determined that prescription drug coverages offered are, on average, for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and are therefore considered Creditable Coverage. If you are enrolled in one of the EnCore medical plans, your existing coverage is Creditable Coverage. This means you can keep the coverage under that benefit option and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, OR you decide to drop your current EnCore coverage, you will also be eligible for a two (2) 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, and keep your current coverage, your current coverage will not be affected. Please see your Certificate of Coverage for a complete description of the current drug benefit. If you decide to join a Medicare drug plan, and drop your current coverage, you and your eligible family members will be able to get the coverage under the medical benefit options in force at the next Open Enrollment period, assuming you meet eligibility requirements at that time. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? If you drop or lose your current Creditable Coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
29
2018 Benefits Guide
In addition, starting with the end of the last month that you were first eligible to join a Medicare drug plan, if you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage: Contact your divisional HR representative. 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 EnCore changes. You also may request a copy of this notice at any time. 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).
Notice of Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 requires group health plans to make certain benefits available to participants who have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits 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
• Treatment of physical complications of the mastectomy, including lymphedema Our plan complies with these requirements. Benefits for these items generally are comparable to those provided under our plan for similar types of medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined by the patient and her physician. Our plan neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending providers to provide care inconsistent with these requirements. If you would like more information about WHCRA required coverage, you can contact the plan administrator at our telephone number: 323-667-2000.
Registered Domestic Partner (RDP) Contributions Your contributions to cover an RDP are the same as those to cover a legal spouse. However, because of Internal Revenue Code (IRC) restrictions, in most cases, the fair market value of your RDP’s or RDP’s children’s (if they are not federal tax dependents) healthcare coverage will be taxable to you as imputed income. This value is determined by the amount that The Company pays in premium for RDP coverage. This amount raises your taxable gross income. Also, the payroll deductions to cover an RDP must be taken on an after-tax basis.
30
IMPORTANT CONTACT INFORMATION In addition to EnCore’s Human Resources Department, you are also encouraged to access our benefit providers at the phone numbers and websites listed below: BENEFIT
Medical (Aetna) Member Services Pharmacy Service Rx Home Delivery 24 Hour NurseLine
POLICY # 80502
TELEPHONE
WEBSITE
1-877-204-9186 1-800-238-6279 1-888-792-3862 1-800-556-1555
www.aetnanavigator.com Download the Aetna App*
Dental (MetLife Dental)
5940353
1-800-275-4638
Vision (Metlife Vision)
5940353
1-866-939-3633
N/A
1-800-633-8818 FSA: Option 1 COBRA: Option 2
LTD: 632463 Basic: 632464 Voluntary: 632465 Accident/CI: R0663146
LTD and Life/AD&D 1-800421-0344 Accident/CI 1-800-635-5597
N/A
1-800-660-6282
Flexible Spending Accounts (IGOE) Unum Benefits Long-Term Disability Basic & Voluntary Life/AD&D Accident Critical Illness
401(k) Retirement Savings Plan (OneAmerica)
*Available for FREE at the App Store or Google Play.
mybenefits.metlife.com Download the MetLife App*
www.metlife.com/vision Download the MetLife App* www.goigoe.com
www.unum.com/
www.oaretirement.com
31
2018 Benefits Guide
Employee Premiums
Employee insurance premiums are taken on a semi-monthly basis for a total of 24 pay periods per year. The amounts reflected below are the semi-monthly premiums, except for Supplemental Life and AD&D, and Long-Term Disability. Use the Premium Calculation worksheet to calculate the semi-monthly premium for these plans. All rates except for Supplemental Life and AD&D, Long-Term Disability, Accident, and Critical Illness are deducted on a pre-tax basis under the Company sponsored Section 125 Cafeteria Plan. BASIC LIFE INSURANCE AND AD&D - UNUM
BUSINESS TRAVEL ACCIDENT – UNUM
Company paid - 1x annual salary to a maximum of $200k
Company paid – Principal sum 6x annual salary to a maximum of $2m
Coverage Level Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Coverage Level Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
FLEXIBLE SPENDING ACCOUNT – IGOE $2,650 annual Medical Care max. contribution $5,000 annual Dependent Care max. contribution
MEDICAL - AETNA HMO AVN (Low) HMO California (High) OAMC PPO (annual salary under $40,000 / annual salary of $40,000 and above) $11 / $16 $27 / $38 $50 $75 / $119 $93 / $147 $189 $68 / $107 $84 / $133 $171 $106 / $169 $132 / $209 $269 DHMO $3.50 $8 $8.50 $12
DENTAL – METLIFE
DPPO $14 $28 $32 $46
CRITICAL ILLNESS - UNUM Employee - $20,000 Spouse - $10,000 Issue Age (non-tobacco user/tobacco user) (non-tobacco user/tobacco user) <25 $6.60 / $9.50 $3.70 / $5.15 25 – 29 $7.10 / $11.30 $3.95 / $6.05 30-34 $9.10 / $15.60 $4.95 / $8.20 35 – 39 $12.10 / $22.50 $6.45 / $11.65 40 – 44 $16.80 / $32.70 $8.80 / $16.75 45 – 49 $22.80 / $44.80 $11.80 / $22.80 50 – 54 $29.80 / $59.60 $15.30 / $30.20 55 – 59 $39.00 / $75.70 $19.90 / $38.25 60 – 64 $49.70 / $90.50 $25.25 / $45.65 65 – 69 $55.80 / $94.30 N/A 70+ $99.40 / $151.50 N/A
VISION - METLIFE PPO $3.64 $6.86 $6.16 $10.17 GROUP ACCIDENT - UNUM Wellness and Sickness Hospital Confinement included Employee $9.19 Employee + Spouse $15.92 Employee + Child(ren) $17.80 Employee + Spouse + child(ren) $24.54
32 SUPPLEMENTAL LIFE - UNUM Issue Age <25 25 – 29 30-34 35 – 39 40 – 44 45 – 49 50 – 54 55 -59 60 - 64 65 – 69 70+ Child(ren)*
Employee/Spouse Rate per $1,000 of Coverage $0.057 $0.057 $0.065 $0.089 $0.138 $0.219 $0.373 $0.599 $0.802 $1.265 $2.203 $0.063
LONG-TERM DISABILITY Employee Rate per $100 of Coverage $0.070 $0.120 $0.210 $0.380 $0.590 $0.800 $0.940 $1.080 $0.920 $0.570 $0.410
SUPPLEMENTAL AD&D - UNUM Rate per $1,000 of Coverage Employee Spouse Child
$0.036 $0.038 $0.030
*This rate is per family unit regardless of the number of children.
Important - Life and LTD rates: Your rate will increase as you grow older and move into the next age bracket.
Premium Calculation Term Life
Coverage Amount
Employee
Spouse
Children
$
$
$
AD&D
Coverage Amount
Employee
Spouse
Children
$
$
$
Long-Term Disability Annual Salary $
Increment ÷
÷
÷
$1,000
$1,000
$1,000
Increment ÷
÷
÷
$1,000
$1,000
$1,000
Increment ÷
$100
Rate ×
×
×
Rate ×
×
×
Rate ×
$
$
$
$0.036
$0.038
$0.030
$
Semi-Monthly Premium
÷ by 2 =
$
÷ by 2 =
$
÷ by 2 =
$
Semi-Monthly Premium
÷ by 2 =
$
÷ by 2 =
$
÷ by 2 =
$
Semi-monthly Premium ÷ by 24 =
Note: If your annual salary exceeds $160,000, use this amount.
$
Live Well. Work Well. DISCLAIMER This guide is intended to provide an overview only of the benefits offered by EnCore. It is not an offer of coverage or intended to offer medical advice. It does not contain all plan provisions, limitations and exclusions. Consult your plan documents (Schedule of Benefits, Certificate of Coverage, Group Insurance Certificate, Booklet, Booklet- Certificate, Group Policy) to determine governing contractual provisions relating to your plan. In the event of a conflict between this guide and your plan documents, the plan documents will always govern.