Make a commitment to a healthly, active lifestyle in 2011!
2 0 11 E M P L O Y E E B E N E F I T S
ent and CEO id s re P e th m A Message fro
ique and TEC) is a un G : Q A D S A c. (N r national & Systems, In issions of ou m gy l lo ca no iti cr ch e Te se ing th unwaverGlobal Defen to strengthen inned by the d rp te de ca un di is de s ny es been to exciting compa home and abroad. Our succ al has always go r ou d an at s d deterkforce security client ly-skilled wor our passion an e gh ar hi r sh ou ho of w t le en ing commitm ceptional peop d motivate ex we do. an in ng ta hi re yt t, er attrac nce in ev lle ce ex e ev hi y part of mination to ac ckage is a ke pa s fit ne be oyee views to lar market re ehensive empl gu pr re m e co ak d rt an de ng ide every We un Offering a stro goal is to prov ion program. nt ur O te . re ns d tio an lu t so you meet our recruitmen g best-in-class nefits to help in be er liv of de ty e rie ar va e tent and wide ensure that w with a consis ee oy pl al goals. em C GTE ily and financi m fa , al on rs ogram’s your unique pe outlining our pr de ui G its ef en that you TEC B available so ge t to you the G ra en ve es co pr e to th d g understandin We are please assist you in to ns tio s. op ed y ne man fit your portuniose that best t miss your op n’ do may select th u yo at th riod runs from so make sure enrollment pe is important, t en en op llm xt contact ro ne en he Benefits tions, please igible. T el es e qu ar y u an yo ve hen Benefits you ha ty to enroll w ge 1 of the 22, 2010. If pa r be on em ed ov st N (li to epresentative November 10 Resources R an um H l ca your lo mission. Guide). our important d an C E T G n to and dedicatio ur hard work yo r fo u yo Thank Sincerely John Hillen fficer ef Executive O President & Chi
What’s Inside
For Questions Call the Crawford Benefits Helpline at: 800-330-8065 Monday - Friday - 8:30 a.m. - 5 p.m., ET
Frequently Asked Questions . . . . . . . . .2 Eligibility . . . . . . . . . . . . . . . . . . . . . . . .4
Employee Classification/
Local HR Representatives: GTEC - Corporate, Cyber Solutions and Mission Systems (DC Metro and Brookhaven) – Cassidy Fuentes at 301-858-1249
Benefits Eligibility . . . . . . . . . . . . . . . .6
Medical . . . . . . . . . . . . . . . . . . . . . . . . .7
Prescription . . . . . . . . . . . . . . . . . . . . . .9
Dental . . . . . . . . . . . . . . . . . . . . . . . . .10
GTEC - Mission Systems (VA Beach, SC, and CA) – Gina Hughes at 757-962-3981
Vision . . . . . . . . . . . . . . . . . . . . . . . . . .11
Flexible Spending Accounts . . . . . . . .12 Life Insurance . . . . . . . . . . . . . . . . . . .15
Disability . . . . . . . . . . . . . . . . . . . . . . .16
GTEC - Defense Engineering (Easton, Frederick and APG) – Danielle Adams or Debbie Siachos at 410-820-9140
Profit Sharing . . . . . . . . . . . . . . . . . . .17
401(k) . . . . . . . . . . . . . . . . . . . . . . . . .17
Holidays . . . . . . . . . . . . . . . . . . . . . . .17
PTO . . . . . . . . . . . . . . . . . . . . . . . . . . .18
GTEC - Intelligence Solutions – Aprille Brown at 703-744-1523
Contact Information CareFirst BCBS PPO
CareFirst BCBS HMO
Addtional Benefts . . . . . . . . . . . . . . . .19 Premium Calculator . . . . . . . . . . . . . .20
877-691-5856
www.bluecares.com
877-691-5856
www.carefirst.com
Delta Dental
800-932-0783
www.deltadentalins.com
Crawford Advisors - FSA
800-657-6265
https://fsa.crawfordadvisors.com
Medco - Prescription Drug VSP - Vision
MetLife - Life & Disability
800-818-6632
800-877-7195
800-638-6420
www.medco.com
www.vsp.com
Principal - 401(k)
800-547-7754
www.principal.com
Crawford Advisors - HelpLine
800-330-8065
GTEC@crawfordadvisors.com (e-mail)
Ceridian - EAP
GTEC HR
GTEC IS HR
888-267-8126
301-858-1230 703-744-1523
Follow these steps if you require assistance:
www.lifeworks.com
hr@gtec-inc.com
HR.IS@gtec-inc.com
»» Call the plan provider carrier. You will need your ID number or Social Security number along with date of service and provider name.
»» If you require further assistance, contact Crawford Advisors using the toll-free Benefits HelpLine. Please have the same information available.
»» If you should still require assistance, you may contact a representative at your company.
Our goal is to make certain that you receive the correct coverage under the benefits plan. We are here to help with any issues that may arise.
{1}
10/10
Frequently Asked Questions (FAQs)
4) Will I receive ID Cards for the health benefits that I sign up for? Yes. The medical, prescription, and dental plans all have separate cards. The only plan that does NOT have an identification card is the vision plan through VSP (see Question 8 below to understand how the vision plan works).
1) What is the difference between an HMO and a PPO plan? HMO offers in-network hospitals and health care professionals that its members must use. These health care professionals are either employed by or under contract to the HMO. To see an in-network specialist, you will need a referral from your Primary Care Physician (PCP). See pages 7 & 8 and the Summary Plan Description (SPD) for more information.
Note: If you enroll in the HMO plan, every member of your family will receive his or her own card. On the other hand, ID cards for the PPO plan will be issued in only the employee’s name. For the dental insurance plan, the standard is only one card per household (in employee’s name only) and additional cards may be ordered, but any/all cards will still only be in the employee’s name.
PPOs are more flexible than HMOs; however, more out-of-pocket costs are to be expected since you will have to pay a deductible and co-insurance based on the level of service. A PPO consists of a group of hospitals and health care professionals who agree to provide care to members at a reduced cost. A PPO is designed to provide affordable health care while maintaining flexibility for its members who do not have to use the services within the network but are encouraged to do so. Staying within the network means that your benefits costs are lower than going outside of the network. If members go outside of the network, they are still covered but the out-of-pocket cost is higher (co-insurance + deductible). With the PPO plan, you are also given the option of seeing various providers WITHOUT a referral.
5) What should I do if I have a medical emergency out of state? If you are experiencing a life threatening illness or injury while traveling, please seek care immediately. The HMO and PPO plans do cover medical emergencies even if you are outside of the service area. Please contact CareFirst (telephone number is located on the back of your ID card) as soon as it is reasonably possible to coordinate care. Note: Co-payments and hospitalization fees apply (see the benefit summary on page 8 and the SPD for more information).
Note: Co-insurance is defined as the percentage of the allowed benefit allocated between CareFirst and the Member share in the payment for covered services. Deductible means the dollar amount of covered services based on the allowed benefit, which must be incurred BEFORE CareFirst will pay for all or part of remaining services. See pages 7 & 8 and the SPD for more information.
6) When does the deductible apply? Do I have to pay a deductible for preventive care? For the PPO medical plan, the deductible applies to diagnostic-lab, xray services, speech, occupational and physical therapy, inpatient hospitalization, outpatient surgery/service, skilled nursing service, home health care, inpatient and outpatient mental health and substance abuse, and durable medical equipment. For the dental plan, the deductible applies for basic services (filings, oral surgery, endodontics, and periodontics), orthodontics, and major services (crowns, inlays, onlays and prosthodontics).
2) Is the HMO option available to all employees? No, the option to enroll the HMO plan is currently only being offered to employees who are residents of the MD, DC and Northern VA area. The HMO plan is a Washington, DC regional plan, while the PPO plans are national plans. Consequently, the HMO plan is limited to the residents of the DC-Metropolitan area.
For the medical and dental insurances, the deductible is waived for preventative and well-child visits. However, for other medical care, the co-pay applies.
3) Is there a pre-existing condition clause when I first enroll into the CareFirst BCBS medical plan? Yes, there is a pre-existing condition limitation that applies to the PPO medical plans. However, as of January 1, 2011, the pre-existing condition provisions does not apply to children under age 19. This is defined as a condition (whether physical or mental, and regardless of the cause of the condition) for which medical advice, diagnosis, care or treatment was recommended or received by a licensed practitioner within a 3-month period prior to the enrollment date. This means that there will be no coverage for 12 months for pre-existing condition(s). However, a pre-existing condition does not include pregnancy.
There is no deductible for the HMO plan.
See page 8 for the benefits summary and the SPD for detailed information.
&
7) How do I enroll in or make changes to the 401(k) plan? What are the 401(k) contribution maximums for 2011? To enroll in or make changes to the 401(k) plan, go to www.principal.com or call a Principal retirement specialist at 800-5477754. You can enroll or make deferral changes on a quarterly basis: January 1, April 1, July 1, and October 1. To enroll, you will need the plan ID/ contract number which is 5-18383.
QA CareFirst will require you to complete a Statement of Health (SOH) form. Proof of creditable coverage can reduce or eliminate the 12-month pre-existing condition exclusion period. Creditable coverage means coverage under a group health plan (including employer sponsored, governmental and church plans) or health insurance coverage (including group, individual, and short-term, limited duration coverage).
Note: The 2011 maximum deferral set by the IRS is $16,500 (+ $5,500 catch-up contribution for participant’s age 50 years old or older).
8) How do I elect or change my 401(k) designated beneficiary? In order to elect or change your designated beneficiary for the retirement plan, you can either go online to www.principal.com or contact your HR Representative for the paper Beneficiary form. Be sure to have the plan ID number with you when electing or changing your beneficiary. See number 7 above for the plan ID number.
Note: The pre-existing condition exclusion period will be reduced by the amount of prior creditable coverage as of the enrollment date, UNLESS there is a significant break in coverage immediately preceding the enrollment date. Significant break is defined as “the period of 63 consecutive days during all of which the individual does not have any creditable coverage.”
{2}
Frequently Asked Questions (FAQs)
13) If I do not elect Short Term Disability (STD) or Long-Term Disability (LTD), what happens if I get sick? If you are sick longer than 14 days and you did not elect the STD or LTD plans, you can use your leave. If you have no available leave, then you can request Leave without Pay (LWOP) or FMLA (if eligible) depending on your circumstances. Please see your HR Representative for more details.
9) As an adult, can I get orthodontia care? Orthodontics is only available for dependents under the age of 19. It is covered at 50% and there is a LIFETIME benefit maximum of $1,500. For a participating dentist, go online to www.deltadentalins.com or call 800-932-0783. When selecting a dentist, please note that the following options are available: Delta Dental PPO Participating Dentist, Delta Dental Premier Participating Dentist or Non-Participating Dentist. Be sure to provide our group number when you call (# 7126).
Note: The STD and LTD plans have a pre-existing condition limitation. This means that these benefits will not be paid if the employee has been employed for less than one year and has a pre-existing condition 3 months prior to the effective date of the STD and LTD plans.
10) How does the vision plan work? Locate a network doctor by calling VSP at 800-877-7195 or visit the website at www.vsp.com. Note: there is NO insurance card provided for the VSP. Therefore, to make an appointment, tell the doctor that you are a VSP member, provide your name, date of birth, employer’s name and group # 12123648. Exam, contact lenses (if medically necessary) and lenses are covered in full once per year (if network provider). Frames and elective contact lenses are covered up to a plan allowance of $120 every other calendar year (if using a network provider). See the schedule of benefits on page 11.
14) Can I take my life insurance with me if I leave the company? If you elect supplemental life insurance (employee, spousal and dependent), then the life insurance is portable. At the time of termination, HR will provide you with the MetLife life insurance paperwork. You will have 2 options: 1) you have the option of converting your supplemental life insurance policy(ies) into an individual life insurance policy(ies) under the Conversion feature, or 2) you can continue group coverage under the Portability feature. MetLife will be responsible for recordkeeping, billing, customer service, and claim certification. The MetLife numbers are:
11) If there is a life status change (i.e., marriage, divorce, addition of a dependent, etc.) or I just moved, what should I do? E-mail or call your HR Representative who will provide you with the right forms to complete. If you wish to add eligible dependents or drop a dependent(s) from coverage, you must contact HR within 31 days of the benefit change; otherwise the change will take effect on January 1 of the following year. For address changes, please notify your HR Representative via e-mail immediately.
Conversion: 1-877-ASK-MET7 (1-877-275-6387) or Portability: 1-888-252-3607
15) How does the supplemental life insurance plan work? To supplement your Basic Life Insurance coverage, you can purchase employee life insurance in multiples of $10,000 up to maximum of 5 times your annual earnings or $500,000. For spousal life insurance, you may purchase in multiples of $5,000 up to a maximum of $100,000. Additionally, for dependent life insurance (until age 19, or up to age 25 if the child is a full-time student), you may purchase coverage in multiples of $2,000 up to a maximum of $10,000.
12) When submitting my claim form for the HealthCare Flexible Spending Account (FSA), what documents are needed? When is the deadline to submit my receipts for the FSA Program? For out-of-pocket medical, dental and vision expenses, you should provide the claim form, your receipt and the EOB (Explanation of Benefits) payment notice that is mailed to your home from the insurance providers. If you do not have the EOB, you can call the insurance providers or go online to print out your list of claims. The CareFirst BCBS website is www.bluecares.com; the Delta Dental Insurance website is www.deltadentalins.com; and the VSP Vision Plan’s website is www.vsp.com—you will need to create a username and password to print your list of claims. For prescription and over-thecounter drugs (with a doctor’s note or prescription), the actual receipt is sufficient. Note: you can complete the Electronic Direct Deposit Information Form, attach a voided check, and return via mail or fax to Crawford Advisors, LLC. See page 12 for additional FSA information.
Note: If you wish to purchase additional employee and/or spousal life insurance for the first time, other than as a new hire, or you wish to increase your current amounts beyond the guaranteed issue limits, you may be required by the carrier to fill out a medical questionnaire called a Statement of Health (SOH). This SOH form should be returned directly to MetLife. The guaranteed issue amounts at the time of the NEW HIRE period are $200,000 for employee life and $30,000 for spousal life. During open enrollment, any new election or incremental change in excess of $10,000 requested by employees will require the completion of the SOH form. For more information regarding the supplemental life insurance policy, see page 15.
&
QA
Additionally, you have 90 days after December 31 to file a claim for reimbursement of out-of pocket expenses. For the official IRS list of eligible expenses, please refer to IRS Publication 502 at www.irs.gov.
Note: If you participate in the FSA Program and you leave the company, you may submit for reimbursement any qualified expenses incurred on or before the date of your separation. You will also have 90 days after December 31 to file a claim for reimbursement of these expenses.
{3}
eligibility Open Enrollment Instructions
Eligibility Requirements
You are eligible to participate in the benefits program if you are a permanent, full-time or part-time employee, working a normal schedule of at least 30 hours per week. Note: If your child is a part-time or full-time employee eligible for benefits through GTEC, he or she must elect themselves directly, and can not be enrolled as your dependent.
Each year, you have the opportunity to change your benefit elections during Open Enrollment.
Please refer to this guide to gain a complete understanding of the benefits being offered. To make any changes to your existing benefits or to enroll in a 2011 Flexible Spending Account (FSA), you must complete the enrollment form and return it to your local Human Resources Representative or enroll online at www.e-enroll.com during the Open Enrollment period.
Section 125
Newly Hired/Eligible Employees
Newly hired or newly eligible employees must complete an online or paper enrollment form even if they choose to waive coverage. Health coverage, if elected, will begin on the first day of the month following your date of hire, provided you enroll within 30 DAYS FROM your date of hire. Completed enrollment serves as a request for coverage and authorizes any payroll deductions necessary to pay for that coverage. Coverage for eligible dependents generally begins on the same day your coverage is effective.
Any elections made will remain in effect and cannot be changed or revoked until the next annual Open Enrollment period, unless the change is due to and consistent with a family/life status change.
Grandfathered Plan
The GTEC believes this group health plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan or policy may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at 1-301-858-1230. You may also contact the Employee Benefits Security Administration, U. S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
{4}
Certain benefits described in this guide may be purchased with pre-tax payroll deductions as permitted by Section 125 of the Internal Revenue Service Code. When you purchase benefits with pre-tax dollars, you reduce your taxable income, so fewer taxes are taken out of your paycheck. You can actually have more spendable income than if the same deductions were taken out on an after-tax basis.
Benefit Changes
The benefit elections you make during Open Enrollment will remain in effect for the entire year. You will not be able to change or revoke your elections once they have been made unless a family/life status change occurs. For purposes of health, dental, vision, and FSAs, you will be deemed to have a Family/Life Status Change if: • your marital status changes through marriage, the death of your spouse, divorce, legal separation, or annulment;
• your number of dependents changes through birth, adoption, placement for adoption, legal guardianship, or death of a dependent; • you, your spouse, or dependent terminate or begin employment;
• you, your spouse, or dependent experience an increase or reduction in hours of employment (including a switch between part-time and full-time employment; commencement of or return from an unpaid leave of absence);
• gain or loss of eligibility under a plan offered by your, your spouse’s or dependent’s employer (e.g., if your dependent switches from hourly to salaried employment and your dependent’s employer’s plan covers only salaried employees);
• your dependent satisfies or ceases to satisfy the requirements for coverage under the Plan due to attainment of age, or similar circumstance; or
• a change in residence for you, your spouse or your dependent resulting in a gain or loss of eligibility.
eligibility cont’d Eligible Dependents for Medical, Dental, and Vision Coverage
In order to be permitted to make a change of election relating to your health, dental, vision, and FSAs coverage due to a Family/Life Status Change, the Status Change must result in you, your spouse or dependent gaining or losing eligibility for health, dental, vision, and FSAs coverage under this Plan or a plan sponsored by another employer by whom you, your spouse, or dependent are employed. The election change must correspond with that gain or loss of eligibility.
Your eligible dependents include:
• A spouse to whom you are legally married.
• A dependent child under age 26. Coverage will terminate at the end of the month of the dependent child’s 26th birthday, provided dependent(s) do not have access to other employer-based coverage.
You may also be permitted to change your elections for health coverage under the following circumstances: • a court order requires that your child receive accident or health coverage under this plan or a former spouse’s plan;
Dependents to Age 26 Individuals denied, ineligible for coverage, or whose coverage ended due to the lack of dependent coverage attainment before age 26, are eligible to enroll in the GTEC health plan. Individuals may request enrollment for such children 30 days from the date of notice. Enrollment will be effective January 1, 2011.
• you, your spouse, or dependent becomes entitled to Medicare or Medicaid;
• you have a Special Enrollment Right; or
• there is a significant change in the cost or coverage for you or your spouse attributable to your spouse’s employment. This is not applicable for Health FSAs, only Dependent Care FSAs.
You must communicate your Family/Life Status Change to your local Human Resources Representative and make your benefit elections within 31 days of the Family/Life Status Change.
Special Enrollment
If you are waiving enrollment in the medical 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 or your dependents in the medical plan, provided that you request enrollment within 31 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 31 days after the marriage, birth, adoption, or placement for adoption. (CHIP) Special Enrollment Period
Gain or loss of eligibility for Medicaid or CHIP coverage will now be treated as a Special Enrollment Right. The Plan will permit an employee or a dependent of an employee who is eligible, but not enrolled, to enroll under the PLAN if either of the following two conditions are met: (1) The employee or dependent is covered under a Medicaid plan or under a state child health plan and the coverage is terminated due to loss of eligibility AND the
If a dependent child is mentally or physically challenged, coverage may be extended beyond these age limits.
employee requests coverage under the group health plan no later than 60 days after the loss of eligibility. (2) The employee or dependent becomes eligible for assistance for coverage under the group health plan, Medicaid plan or state child health plan AND the employee requests coverage under the group health plan no later than 60 days after the employee or dependent is determined to be eligible for assistance. Availability of Notice of Privacy Practices Plan participants in the employer-sponsored health and welfare benefit plan are reminded that the Company’s Notice of Privacy Practices may be obtained by submitting a written request to the Human Resources Department.
The Company respects your Privacy and within this Guide, Carriers Certificate Booklets and your Plan Documents you'll see information regarding the protections that are in place for your Personal Health Information under HIPAA. HIPAA protects your information for an illness or an injury that you already have. GINA protects all plan participant's genetic information (things that may turn into an illness later). Under GINA your genetic information is protected (much like HIPAA) and no carriers can refuse to cover you or your dependents as a result of any genetic information.
{5}
eligibility cont’d Employee Classifications / Benefits Eligibility Definitions
Full-time Part-time Temporary
At least 40 hours per week Less than 40 hours per week Hired for a specified period of time or as required
Full-time Part-time (30-39 hours)
Participate in all benefits
Participation in Benefits
Paid Time Off (PTO), Bereavement/Funeral Leave, Holidays, Jury Duty Leave, Military Leave, Official Facility Closing (OFC) Leave, Maternity/Paternity Leave are prorated. All insurance benefits (medical, dental, vision, life, disability) May participate in Pre-Tax Contribution Plan
May participate in 401(k), Discretionary Employer Contribution/Profit Sharing Plan & FSA Education reimbursement
Technical course/Professional Development payment consideration Professional membership reimbursement EAP
Part-time
(20-29 hours)
Referral bonus
PTO, Bereavement/Funeral Leave, Holidays, Jury Duty Leave, Military Leave, OFC Leave, Maternity/Paternity Leave are prorated.
May participate in 401(k), Discretionary Employer Contribution/Profit Sharing Plan & FSA
Technical course/Professional Development payment consideration (if a job requirement) EAP
Part-time (19 hours or less)
Temporary
Referral bonus May participate in 401(k) plan
Technical course/Professional Development payment consideration (if a job requirement) EAP, FSA, Referral bonus
May participate in 401(k) plan
Referral bonus
{6}
group # - 1900216
medical What is a Preferred Provider Organization (PPO)?
your covered dependents. Your PCP will provide routine care, refer you to in-network specialists, and file claim forms. You can change your PCP at any time.
In-Network (Preferred Providers)
HMO Plan Highlights • PCP required • Referrals to specialists • In-network benefits only (except for emergency and urgent care) • No claim forms
The CareFirst BCBS PPO plans (either the 90/70 or the 80/70) provide employees with two options. You have the option of utilizing in-network (preferred providers) or you may go to an out-of network (participating and non-participating) provider. The payment levels vary under each option.
There are no out-of-network benefits in an HMO, except in an emergency or urgent care situation.
BCBS PPO Preferred Providers are doctors, hospitals, and other health care providers who have agreed to honor your membership card and bill BCBS directly for services rendered. Providers and BCBS negotiate “allowed benefit” amounts, which are accepted as payment in full and you benefit because your out-ofpocket costs are kept to a minimum.
Pre-Existing Condition Limitation
There is a pre-existing condition limitation that applies to the PPO plans only. However, as of January 1, 2011, the pre-existing condition provision does not apply to children under age 19. This is defined as a condition (whether physical or mental and regardless of the cause of the condition) for which medical advice, diagnosis, care or treatment was recommended or received by a licensed practitioner within a 3 month period prior to the enrollment date. This means that there will be no coverage for 12 months of pre-existing condition(s). However, a pre-existing condition does not include pregnancy.
Out-of-Network (Participating and Non-participating) There are two types of providers that are considered out-of-network: Participating and Non-Participating.
BCBS Participating Providers have also contracted with BCBS to honor your membership card and bill BCBS directly for services rendered. They agree to accept an “allowed benefit” amount for covered medical services. For example, when you go to an out-of-network participating provider, the service will only be paid at 70% of the “allowed benefit” after the out-of-network deductible has been met. You will be responsible for the remaining 30% coinsurance since your provider is non-preferred.
CareFirst BCBS will require you to complete a statement of health (SOH) form. Proof of creditable coverage can reduce or eliminate the 12-month pre-existing condition exclusion period. The pre-existing condition exclusion period will be reduced by the amount of prior creditable coverage as of the enrollment date, unless there is significant break in coverage (greater than 63 days) immediately preceding the enrollment date.
Non-Participating Providers have no contractual status with BCBS and will not be reimbursed directly by BCBS. You are responsible for paying your provider in full, and then you are reimbursed directly by BCBS based on the “allowed benefit” for the services rendered. These providers can “balance bill” you the difference between the total charge and the percentage of the “allowed benefit” reimbursed by BCBS.
Coordination of Benefits (COB)
Medical benefits must be “coordinated” if you or your covered dependents are insured under more than one health insurance plan. The plans coordinate with each other on payments so that there are no duplicate payments for the same medical service.
Claim Payments and Cost Sharing
The order in which payments are made is determined as follows:
• The plan that covers the patient as an employee (non-dependent) is considered the primary plan, initially responsible for payment.
The cost of a covered service is either paid in full by BCBS or shared between BCBS and you. This shared amount is referred to as coinsurance. For most benefits, your coinsurance will be less if you seek care from in-network providers. If you seek care out-of-network, the plan will pay a percentage of the cost for covered services, up to the amount BCBS allows after the out-of-network deductible has been met. Many services are covered at 100% of the allowance after you pay a set fee, called your copayment.
• The plan that covers the patient as a dependent is the secondary plan.
• When a dependent child is covered by the plan of more than one parent, (unless court ordered) generally the plan of the parent whose birthday falls earlier in the year is considered the primary plan.
What is a Health Maintenance Organization (HMO)?
Insurance Cards
For the HMO plan, every member of your family will receive his or her own insurance card. On the other hand, insurance cards for the PPO Plan will be issued in only the employee’s name.
Depending on your location, the HMO may be a viable option for you — it is only available to MD, DC and Northern VA residents. The HMO plan gives you access to quality care from a broad network of participating physicians. At enrollment, you choose a primary care physician (PCP) for yourself and each of
{7}
medical cont’d Benefit Summary Deductible
Out-of-Pocket Maximum
90/70 PPO
In-Network
80/70 PPO
Out-of-Network
In-Network
$200 individual/$400 family
HMO
Out-of-Network
In-Network Only
$500 individual/$1,000 family
$1,000 individual/$2,000 family
$2,000 individual/$4,000 family
None
None
Office Visit
$10 copay
70%*
$10 copay
70%*
$15 PCP/$25 Specialist
Well Child Visit
$10 copay
70%*
$10 copay
70%*
$15 copay
Diagnostic - Lab, X-Ray Routine Physical
Mammography
Allergy Consultation
OB/GYN Office Visit Maternity Care
Speech, Occupational & Physical Therapy Chiropractic Service 50 visits/year
90%*
$10 copay
$10 copay
$10 copay
$10 copay
70%*
80%*
70%*
70%*
$10 copay
70%*
$15 copay
70%*
$10 copay
70%*
$25 copay
70%*
$10 copay
70%*
90%*
70%*
90%*
70%* 100 visits/year
$10 copay 80%*
80%*
70%*
70%* 100 visits/year
$10 copay
70%*
Acupuncture 20 visits/year ER Visit copay waived if admitted
$10 copay
70%*
$10 copay
70%*
$50 copay
$50 copay, 70%*
$50 copay
$50 copay, 70%*
Outpatient Surgery/Service
90%*
70%*
80%*
70%*
Home Health Care
90%*
Skilled Nursing Service
Inpatient Mental Health & Substance Abuse
Outpatient Mental Health & Substance Abuse
Durable Medical Equipment
90%*
70%*
$300 copay, then 80%*
70%* 30 days/year
80%*
70%*
80%*
90%*
70%*
$10 copay
70%*
$10 copay
90%*
70%*
80%*
$25 copay $25 copay 60 visits/90 days year 50% coinsurance $500 benefit per year $25 copay
$50 copay
$300 copay, then 70%*
70%* 30 days/year
$300 copay, then 80%*
$25 copay
70%*
70%*
90%*
$25 copay
70%*
$10 copay
Inpatient Hospitalization
$25 copay
70%*
$300 copay, then 70%* 70%*
$300 admission copay $50 copay
$300 admission copay maximum 60 days per year Covered in full
$300 admission copay
70%*
*DEDUCTIBLE APPLIES
$25 copay
50% coinsurance
This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. Additional limitations and exclusions may apply. Some services may require preauthorization. For more detailed information, refer to the Summary Plan Description.
How to Find an In-Network Provider
• For the PPO plans, log on to www.bluecares.com, select the Find Doctors or Hospitals Nationwide link. • For the HMO plan, log on to www.carefirst.com, select the Find Doctors.
• Or call the customer service number on your ID card.
{8}
group # - CADRX4U
prescriptions
Medco by Mail
When you enroll in the BCBS medical plan, you are automatically enrolled in prescription coverage through Medco. You will receive a separate ID card for your prescription program through Medco.
Mail-order service for prescriptions that are considered maintenance, or long-term, is available through Medco. With Medco By Mail, you can save money and have a 90day supply of your medication mailed directly to you. Standard delivery is 3 to 5 days after Medco receives the refill order.
• Medco offers an extensive retail pharmacy network with almost 60,000 retail pharmacies in its network.
• Medco’s interactive voice response call system, “first-call resolution” customer service policy, and around the clock pharmacist availability all help you get the service you deserve.
You can choose to have your prescriptions filled in three different ways. • Online at www.medco.com
• Convenient mail-order service for maintenance drugs.
• By phone at 1-800-633-2662
• A Web site designed just for you – after a one-time registration at www.medco.com.
• By fax at 1-800-837-0959
www.medco.com
• Certain drugs require prior authorization and management and may not be covered under the plan. You will be advised of any requirements by the pharmacist prior to dispensing. You may contact Medco to discuss alternatives.
Medco has a convenient, time-saving Web site that offers various features to help you get the most from your prescription drug benefit plan. Through the Web site, you can: • Refill, renew or request new Medco By Mail prescriptions • Track the status of mail-order pharmacy orders • Compare pricing and coverage for brand-name and generic drugs • Print Medco By Mail order forms • Request claim forms for prescriptions filled at nonparticipating pharmacies • Locate and get directions to a participating retail network pharmacy • Take charge of your health with health and wellness information, tools and resources Click on the Register now link and have the member number on your prescription ID card handy. Simply follow the instructions to complete the registration.
Retail Prescription Drug Plan
• Simply present your ID card along with your prescription to any participating pharmacy at time of purchase.
• The pharmacist will verify the eligibility status and file the claim electronically - saving both time and money. • Pay the applicable co-pay (listed below) and leave with your prescription. • Retail prescriptions are filled for up to a 30-day supply.
Preferred Prescriptions®
Preferred Prescriptions® is Medco’s list of medications covered under the prescription drug plan at a lower copayment. The list was reviewed by an independent panel of physicians and pharmacists. Your doctor may be able to help you save money by prescribing generic and preferred brand-name drugs if appropriate. For an up-todate and complete listing of these drugs, log on to www.medco.com and click on the Drug Information link or register and create your own account for personalized information.
Medicare Part D
The prescription drug plan is creditable coverage. Medicare-eligible participants need not enroll in a separate Medicare D drug plan.
Copayments
Retail - 30-day supply Generic
$10
Non-preferred Brand
$40
Preferred Brand
Mail Order - 90-day supply
$25
Generic
$10
Non-preferred Brand
$40
Preferred Brand
{9}
$25
dental
group # - 7126 Amount or the dentist’s actual charge, whichever is less. The dentist may or may not file your claim for you. In addition, you may be responsible for the difference between the provider’s charges and Delta’s Allowed Amount.
The best way to maintain your oral health is through a sound program of regular dental care. The Delta Dental plan meets your needs so minor problems do not become major ones.
Insurance Card
This plan provides both in- and out-of-network benefits, but you still have the freedom to choose your dentist. Your total out-of-pocket cost is less if you go to a Delta Dental PPO or Premier dentist, and will be higher if you go to a non-participating dentist.
For the dental insurance plan, the standard is only one ID card per household (in the employee’s name only). However, additional cards may be ordered but any/all cards will remain in the employee’s name.
The in-network level of benefits is based on Delta’s Maximum Plan allowance (Allowed Amount) or the dentist’s actual charge, whichever is less. This means that the provider will accept Delta’s Allowed Amount as payment in full for covered services. In addition, the provider will file the claim directly with Delta, so there is less paperwork for you. You can find a participating Delta Dental PPO or Premier dentist by calling 800-932-0783 or you can go online to www.deltadentalins.com. Be sure to provide our group number when you call (#7126).
Submitting Out-of-Network Claims
You do not need to utilize a Delta claim form as most providers will use the Standard American Dental Association claim form. These forms should be available in your dental office. The address to submit claims is:
Delta Dental One Delta Drive Mechanicsburg, PA 17055
Should you choose a dentist outside of the network, your level of reimbursement will be based on Delta’s Allowed
Summary of Benefits
Calendar Year Deductible Maximum Calendar Year Benefit
$50 per covered individual - $150 family maximum $1,500 per covered individual
Basic Services • Fillings • Oral surgery • Endodontics, Periodontics
80%
Preventative Services • Visits, Exams, X-rays • Cleanings • Fluoride treatments - to age 19 • Sealants, Space Maintainers - to age 14
Major Services • Crowns, Inlays, Onlays • Prosthodontics
Orthodontics • Dependents under the age of 19 only
100%, deductible waived
50% 50%, $1,500 lifetime benefit maximum
This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. Additional limitations and exclusions may apply. For more detailed information, refer to the Summary Plan Description.
{10}
vision
group # - 12123648 Non-Network Providers
Vision coverage is provided through Vision Service Plan (VSP). Please note you will not receive an ID card for vision care coverage.
1. Services and materials obtained from a non-network provider will be reimbursed up to amounts shown on the Schedule of Benefits less any copayments.
In order to get the most from this plan, you should select a participating doctor from their nationwide network of providers. If you use a participating doctor, covered services are paid in full after you pay the required copayment. VSP also provides coverage for non-network providers; however, you will receive a greater benefit by using their network doctors.
2. For out-of-network reimbursement, you will need to pay the entire bill when you receive services, then send your itemized receipts and full patient & member information to VSP.
3. Claims must be submitted within six (6) months of your date of service.
Payment is made according to the set fee schedule shown below.
4. Keep a copy of the claim information for your records and send the originals to the following address:
Network Providers
VSP Out-of-Network Provider Claims 3333 Quality Drive Ranch Cordova, CA 95670
1. Locate a network doctor by calling VSP at 800-8777195 or by visiting their Web site at www.vsp.com.
2. When you call to make an appointment, tell the doctor that you are a VSP member. You will need to provide your name, date of birth, employer’s name, and plan ID/group number (which is 12123648).
Laser Vision Correction
VSP’s Laser Vision Care program provides members with a discount off the cost of laser surgery obtained through VSP contracted doctors, surgeons, and laser centers. This program includes the two most common laser vision correction procedures: laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratomileusis (PRK). Call your network doctor to check if he or she is participating in this program.
3. After you make an appointment, your doctor will contact VSP to verify your eligibility and plan coverage. The network doctor will also obtain authorization so that you can receive an eye exam and corrective wear, if necessary. If, for some reason, VSP’s records indicate that you are not currently eligible for services, the network doctor will notify you.
Schedule of Benefits
Plan frequencies and copayments apply to both network and non-network services. Frequency Exam Once every calendar year Copayment Exam Lenses Once every calendar year Materials Frames Once every other calendar year Network Provider Non-Network Provider Service Exam Covered in full Plan reimburses up to $52 Single Vision Lenses Covered in full Plan reimburses up to $55 Bifocal Lenses Covered in full Plan reimburses up to $75 Trifocal Lenses Covered in full Plan reimburses up to $95 Frames Covered up to $120 allowance Plan reimburses up to $45 Contact Lenses (instead of a complete pair of prescription glasses) Medically Necessary* Covered in full Plan reimburses up to $210 Elective** Plan reimburses up to $120 Plan reimburses up to $105
$10 $25
*The carrier will determine when contact lenses are “medically necessary.” **When contact lenses are purchased instead of lenses and frames. This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailed information, refer to the Summary Plan Description.
{11}
flexible spending accounts Dependent Care Flexible Spending Account
Our benefits plan offers you a unique way to save money on health care and dependent care expenses through participation in a Flexible Spending Account (FSA). There are two types of FSAs - Health Care and Dependent Care. You can choose to participate in one or both of these accounts. If you choose to participate, you will be able to pay for the following types of expenses with pre-tax dollars:
You may use pre-tax dollars from your Dependent Care FSA to pay expenses for care when the services enable you and/or your spouse to work outside of the home. These include: expenses for the care of a dependent child, spouse or elderly parent inside your home (including housekeepers, cooks or maids who provide care in your home), and expenses outside your home, such as babysitters, nursery schools, or day care centers. The IRS defines an eligible dependent as:
• out-of-pocket health care expenses such as medical, dental and vision deductibles and co-payment amounts; prescription glasses; orthodontia; prescription or overthe-counter drugs (with a prescription).
• A child under the age of 13
• A dependent child over the age of 13 who is physically or mentally incapable of self-care, claimed as a dependent on your income tax return
• child care and other dependents’ day care expenses such as day care centers or in-home day care for an incapacitated spouse or elderly parent.
• A dependent parent incapable of self-care, who you may claim as a dependent on your income tax return.
You fund the accounts via a payroll deduction each pay period. Money that you contribute to your FSA is not subject to social security taxes, federal, and in most cases, state income taxes. This lowers the taxes you pay and gives you more spendable income.
Only the portion of expenses which enable you to remain employed are eligible. Educational expenses are not eligible.
Note: In order for your FSA contributions to be eligible for reimbursement, you must obtain a tax identification or social security number from your provider which will be reported on your Federal Income Tax return.
Health Care Flexible Spending Account
It is not necessary to “sign up” specific family members for participation in your Health Care FSA. You may submit expenses incurred by any of your dependents, whether or not they are covered by the insurance plans you have through the Company.
Contribution Limits
Consider your expenses carefully before you decide how much to contribute to each account. If your eligible expenses turn out to be less than the amount contributed to your account, federal law requires that the unused balance be forfeited - the “Use it or Lose it” rule. Do not contribute more than you are reasonably certain to use.
Eligible health care expenses include many of the out-ofpocket expenses you pay to maintain your health and well-being. These include deductibles and coinsurance expenses that are not covered by your medical plan, expenses for glasses or contact lenses, and more. A detailed listing of some eligible Health Care expenses is included later in this section.
The maximum annual amount you may contribute to a Health Care FSA is $3,000. The maximum annual amount you may contribute to a Dependent Care FSA is $5,000 (or $2,500 if you are married and file a separate tax return).
Over-the-Counter (OTC) Drugs
Beginning January 1, 2011, the IRS requires a doctor’s note or prescription for OTC products purchased in order for them to be reimbursed under the Health Care FSA.
Review your expenses for health and dependent care and you will probably find ways to make the FSAs work for you. You should remember, however, that money paid into your Health Care FSA cannot be used for Dependent Care expenses or vice versa.
{12}
flexible spending accounts -
cont’d
Claims and Reimbursement
Status Changes
Requests for reimbursement from your FSAs may be made online or by completing a claim form. See your FSA “Welcome Packet” for details. Claim forms should be faxed to Crawford Advisors 410-771-9487, along with proof of expenses (i.e. receipts or Explanation of Benefits) from your provider detailing provider name, date expense incurred, description of service and/or name of medication and your cost. Reimbursements are generally distributed twice a month.
Federal regulation prohibits you from changing your enrollment or the amount of your election during the plan year. You are only eligible to change your elections during the year if you have a status change. Only benefit changes consistent with the change in status are permitted. Status Changes that may warrant a change in benefit elections are described elsewhere in this benefit guide.
If you request a reimbursement for more money than is currently in your Dependent Care Account, you will be reimbursed the total balance of your account. The remainder of your request will be considered on subsequent processing dates.
Your participation in the FSAs will end on the date of your separation from employment. This means that you may submit for reimbursement any qualified expenses incurred on or before the date of your separation. You have 90 days after the end of your plan year to file a claim for reimbursement of these expenses. Please contact your Human Resource Representative for more details.
If You Leave the Company
Direct Deposit
Direct deposit is a fast and convenient way to receive FSA reimbursements promptly. This option allows you to have your reimbursements deposited directly into your savings or checking account. Direct deposit eliminates trips to the bank to cash or deposit checks and the possibility of a check being delayed, destroyed, or lost in the mail.
Eligible Expenses
For the official IRS list, please refer to IRS Publication 502, available at www.irs.gov. Note that health insurance premiums cannot be reimbursed through a Health Care FSA although they are included in IRS Publication 502. Also, Health Care FSAs may not reimburse other insurance premiums or expenses for long-term care.
This option is available at no cost to you. To enroll, complete an Electronic Direct Deposit Information Form, attach a voided check, and return via mail or fax to Crawford Advisors, LLC. Contact information can be found on the form. Each time you are issued a reimbursement, a statement will be sent to you confirming the amount of reimbursement and any other pertinent spending account details.
{13}
flexible spending accounts -
cont’d
Examples of Eligible Health Care Expenses
Acupuncture Alcoholism treatment Ambulance Artificial limbs Artificial teeth (not cosmetic) Autoette Blindness, special educational aids to mitigate condition Braille books and magazines, cost in excess of regular edition Capital expenditures, primarily for medical care, not including increase in property value Car, equipped to accommodate wheelchair passengers Car for the physically challenged Care for a mentally challenged individual Chiropractor fees Christian Science treatment Coinsurance or copayments for health care Contact lenses Contact lens cleaners and solutions Contraceptives, prescription* Cosmetic surgery, only if due to congenital abnormality, accident or trauma injury, or disfiguring disease Crutches Deductibles for health care expenses Dental fees Dentures Diagnostic fees
Doctor fees Domestic aid, type that would be rendered by a nurse Drug addiction, recovery from Drugs, prescription* Durable medical equipment Eye examinations and glasses First aid supplies, such as bandaids Guide animals, cost and maintenance Hearing aids, telephone, specially equipped Home improvement for medical considerations Hospital care, inpatient Hospital services Insulin Laboratory fees Laser Vision Correction Laetrile by prescription Lead paint removal, if child with lead paint poisoning Legal expenses, authorization of treatment for mental illness Lip reading expenses for the deaf Medical supplies, prescription Medical thermometers Mentally challenged person’s cost for special home Nurse’s fees, including room, board and Social Security tax if paid by taxpayer Obstetrical fees Operations Orthodontia, non-cosmetic
Osteopath fees Patterning exercises for child with disabilities Personal kits for cholesterol, colorectal cancer, home drug, ovulation indicators, & pregnancy screening and testing Physician fees Physical therapy Psychiatric care Psychologist and psychotherapist fees Radial Keratotomy Remedial reading and language training Routine physicals and other non-diagnostic services or treatments Schools or teachers, special relief of disability Sexual dysfunction, hospitalization for Sterilizing operation Surgical fees Transplant, donor’s costs Transportation/lodging cost incurred essentially and primarily for medical care Vasectomy Vitamins, prescription (medically necessary)* Weight loss program under a physician’s care Wheelchair Wig, upon physician advice for medical reason X-rays
Adoption, medical costs of natural mother Adoption, legal fees Air conditioner, increase in property value Babysitting Capital expenses, increase in property value Car insurance, medical coverage Central vacuum system Chauffeur, salary of Childcare (may be eligible for Dependent Care FSA or tax credit) Clothing Concierge or membership fees Contact lens insurance policy Cosmetics Cosmetic surgery, unless due to congenital abnormality, accident or trauma injury, or disfiguring disease Cruise vacation
Dancing lessons Deprogramming services Diaper service Drugs, used to benefit overall general health, dietary supplements, such as vitamins Dust elimination system Ear piercing Electrolysis Exercise equipment not specifically prescribed by physician Face lift Fallout shelter for prevention of disease Funeral expenses Furnace Gravestone Hair transplants Health club dues Health spa
Heating system Hygienic supplies Insurance premiums Legal expenses, for divorce upon medical advice Marriage counseling Maternity clothes Residence, loss on sale, move medically recommended Self-help, medical Spiritual guidance or counseling Swimming lessons Tattoos Toiletries, such as toothpaste, shaving lotion, soap Trip for general health improvement Vacations, health restorative Vacuum cleaner for alleviation of dust allergy Wig, not prescribed by physician
Examples of Non-Eligible Health Care Expenses
Beginning January 1, 2011, the IRS may require a doctor’s note or prescription for OTC products purchased in order for them to be reimbursed under the Health Care FSA. Note: The itemized lists within this publication describe some of the items that are eligible for reimbursement under your Health Care Flexible Spending Account and some that are not eligible. They do not include all possible eligible or ineligible items and there may be some exceptions even for items included on these lists. The Plan can generally reimburse you for expenses for you and your spouse or dependents (for federal tax purposes) that are deductible medical expenses (with certain exceptions). The Plan will not reimburse anyone for items that the Plan Administrator determines are not eligible under applicable law. For more details about deductible medical expenses, see IRS Publication 502, which is available from your local IRS office, or online at www.irs.gov. However, note that health insurance premiums, long term care insurance premiums and expenses for long term care cannot be reimbursed through a Health Care Flexible Spending Account, even though they are deductible medical expenses listed in Publication 502.
{14}
life insurance Basic Life Insurance
Annual Earnings
Life insurance provides financial protection for your family in the event of your death. The Company provides coverage for Basic Life Insurance equal to an amount of one times your annual earnings to a maximum of $100,000, rounded up to the next $1,000. The plan is employer-paid and provided at no cost to you.
Annual earnings are determined as follows:
• Regular Employees - gross annual rate of pay excluding overtime and other extra pay. • Commissioned Employees - includes commissions and/or bonuses averaged for the most recent 12-month period.
Benefit Reduction Schedule
At age 70, the life insurance benefit in force will reduce to 50%, and terminate at retirement.
Evidence of Insurability
If you wish to purchase additional employee and/or spousal life insurance for the first time, other than as a new hire, or you wish to increase your current amounts beyond the guaranteed issue limits, you may be required by the insurance carrier to fill out a medical questionnaire called a Statement of Health or Evidence of Insurability. This form should be returned directly to MetLIfe. The amounts you elect during Open Enrollment in excess of the guaranteed issue limits will not be effective until you are approved for coverage by the insurance carrier.
Supplemental Life Insurance
Employee Life
To supplement your Basic Life Insurance coverage, you may purchase Supplemental Employee Life Insurance in multiples of $10,000 up to a maximum of five times your annual earnings or $500,000. Any new election or incremental change in excess of $10,000 requested by employees (other than as a new hire) requires evidence of insurability. If you are increasing your existing coverage by $10,000, no evidence of insurability is necessary. New hires electing amounts in excess of three times annual earnings or $200,000 are subject to evidence of insurability.
Basic Accidental Death & Dismemberment
Spousal Life
Basic Accidental Death & Dismemberment (AD&D) insurance provides additional coverage should you become injured in an accident or in the event of your accidental death. The benefit is equal to your basic life insurance. Evidence of insurability is not required.
You may purchase life insurance coverage for your spouse in multiples of $5,000 up to a maximum of $100,000. New hires electing coverage within 30 days of date of hire have a spousal guaranteed issue amount of $30,000. Evidence of insurability is required for higher amounts of coverage. For current employees, any new election or incremental increase in excess of $5,000 requires evidence of insurability. Please note that if both you and your spouse are employees eligible for benefits through GTEC, then each individual can only purchase employee life insurance. Both employees will not be eligible to purchase spousal life insurance.
Supplemental AD&D
Supplemental AD&D is also available in increments of $10,000, up to a maximum of $500,000. You may purchase supplemental AD&D for your spouse and dependents as well. Evidence of insurability is not required.
Dependent Life
You may purchase coverage for each of your dependent children until age 19, or up to age 25 if the child is a fulltime student. Coverage is purchased in multiples of $2,000 up to a maximum of $10,000.
Refer to the inside back cover to calculate premium.
{15}
disability insurance Short-Term Disability
Long-Term Disability
We recognize that disabilities can have a major impact on your life and finances. To ensure that some of your income will continue if you are unable to work due to a disability that extends for more than five consecutive workdays, the Company provides you an option to select short-term disability (STD).
Long-term disability (LTD) coverage provides income replacement if you continue to be disabled and unable to perform the material duties of your job. This benefit is provided to all full-time employees through MetLife and paid for by both the Company and the employee.
LTD provides 60% of monthly earnings to a maximum of $10,000 per month. Benefits begin after 91 days of continuous disability and continue until you are no longer disabled or reach the maximum benefit period as shown in the policy.
Benefits are payable for a non-occupational injury or illness after 13 days of disability. The STD plan continues part of your pay for up to 11 weeks from the date of disability. If a medical condition is job-related, it is considered Workers’ Compensation rather than STD.
Payments may be reduced by other income sources such as government-provided disability benefits that an employee is eligible to receive. Such benefits are triggered by the employee’s disabling condition and are not age-based. These government-provided benefits include Social Security disability payments and Workers’ Compensation.
The STD program is administered by MetLife. In order to receive STD benefits, you must be under the regular care of a licensed treating physician who practices within the scope of his/her license, and your disability must be certified through MetLife. MetLife verifies medical necessity for all health-related absences and helps ensure your confidentiality.
Pre-Existing Condition Limitation
The benefit level is 60% of your pre-disability earnings to a weekly maximum of $1,500.
LTD benefits will not be paid for a disability caused by a pre-existing condition. A pre-existing condition is defined as a sickness or illness for which you received medical treatment, consultation, care or services including diagnostic measures, or had taken prescribed drugs or medicines in the three months prior to the effective date of your coverage.
Pre-Existing Condition Limitation
STD benefits will not be paid for a disability caused by a pre-existing condition. A pre-existing condition is defined as a sickness or illness for which you received medical treatment, consultation, care or services including diagnostic measures, or had taken prescribed drugs or medicines in the three months prior to the effective date of your coverage. Pregnacy is not considered a pre-existing condition.
Please see the SPD for more details.
Refer to the inside back cover to calculate premium.
Benefits for a disability that results from a pre-existing condition will be paid if your elimination period starts after the earlier of the date for which you:
• have not received medical treatment, consultation, care or services for the pre-existing condition for 3 consecutive months; or
• have been insured for 12 consecutive months from the date such insurance takes effect. Refer to the inside back cover to calculate premium.
{16}
401(k), profit sharing, holidays 401(k) - Plan ID/Contract #5-18383
Discretionary Employer Contribution/Profit Sharing Plan - Plan ID/Contract # 5-18383
The 401(k) option allows eligible employees to defer part of their income for their retirement. The Principal Financial Group provides record-keeping services for the retirement plan. This 401(k) plan provides various investment options for employees to choose from.
The GTEC Discretionary Employer Contribution/Profit Sharing Plan is designed to provide employees additional discretionary contributions to their retirement plan. GTEC may contribute a discretionary amount of at least 3% of an eligible employee’s compensation to the plan if profit goals are met. Significantly exceeding profitability goals may increase annual contribution.
Employees are eligible to participate in the 401(k) on the next quarterly entry date following date of hire. Employees can enroll in the 401(k) plan by calling the voice response system or a Principal retirement specialist at 800-547-7754 or by logging on to www.principal.com. Enrollment is held quarterly - January 1, April 1, July 1, and October 1.
Eligibility is based on an employee working at least 1,000 hours within the plan year (January 1 through December 31) and being an active employee on December 31. To qualify for vesting, an employee must work at least 1,000 hours in the plan year. This plan has a 5-year vesting schedule (20% per year).
The Company will match the employee’s deferral of income (dollar for dollar) up to 5%. You must have salary deferrals in order to receive the company’s match which is on a per pay period basis.
Holidays
The maximum deferral is based on calendar limits set by the Internal Revenue Service. Additional catch-up contributions for ages 50 and over are allowed up to IRS maximum. For 2011, the 401(k) IRS contribution limit is $16,500. Employees age 50 or over can “catch up” on retirement savings by contributing an additional amount of $5,500 on a pre-tax basis.
GTEC offers 10 paid Holidays per year. Some locations will observe (6) standard Holidays and four (4) floating Holidays. The 6 standard Holidays are: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. For employees at client facilities or Government sites, the Holiday schedule is that of the client facility or Federal Government, up to ten (10) days per year.
Employees are eligible to participate in the 401(k) prior to the next quarterly entry date following date of hire.
Employees who work at GTEC offices that have other designated Holidays must follow the Holiday schedule posted at their facility.
Vesting - CHANGE
You are always fully vested in any contribution you make to the 401(k) Plan, as well as any earnings on that money. Company contributions and earnings received on or after January 1, 2011, on the 401(k) match will follow the schedule listed below. To be credited for a year of service, one must work 1,000 hours within a plan year (January 1 through December 31).
Employees eligible for floating: Depending on when employees are hired during the year, floating Holidays eligibility will be prorated.
Keep in mind, Holidays cannot be carried over from year to year; so, if employees do not use all ten (10) Holidays within the calendar year, they will not be carried over or cashed out.
Years of Service Vested Interest 1 full year 0% 2 full years 50% 3 full years 100% All existing (earned prior to January 1, 2011) GTEC 401(k) match and Intelligence Solutions discretionary match which was previously subject to a 5 year vesting schedule will follow the above vesting schedule.
In cases where an employee is part-time and works more than 19 hours but less than 40 hours per week, Holidays will be accrued on a pro-rated basis.
Note: For current Intelligence Solutions employees who are immediately vested, your existing employer match (prior to January 1, 2011) will remain 100% vested. However, effective January 1, 2011, all future 401(k) match will be based on the new vesting schedule listed above.
{17}
PTO Paid Time Off (PTO)
Sick Leave “Grandfather” Clause: GTEC (MS, DE, Corp.) employees hired prior to December 16, 2009:
GTEC provides paid time off to eligible employees to cover vacation, illness for employees or dependents, and personal time off. The PTO benefit accrues per pay period based on years of service. Employees hired prior to December 16, 2009, please see “grandfather” clause below. NEW Employees hired on or after December 16, 2009, will accrue PTO based on the following schedule: Years of Service Paid Time Off 0-1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 + years
The separate sick leave accrual was eliminated as of January 1, 2010. As of January 1, 2010, employees who had existing sick leave balances were able to maintain up to eighty (80) hours of sick leave for future use while building up their PTO balance (which includes paid time off for sick leave).
All balances above 80 hours are maintained in a sick catastrophic account (SCAT) for future use. Eligibility to access your SCAT account requires approval based on a serious medical condition or when you have been approved for Family Medical Leave (FMLA).
15 days 16 days 17 days 18 days 19 days 20 days 21 days 22 days 23 days 24 days 25 days 26 days 27 days 28 days 29 days 30 days
Per GTEC policy, at the time of termination, Holidays, Sick Leave Balances and SCAT balances will not be paid out. However, accrued and unused PTO balances will be paid out at the time of termination.
PTO “Grandfather” clause:
Below is the PTO schedule for Intelligence Solutions employees hired prior to December 16, 2009:
PTO “Grandfather” clause: GTEC (MS, DE, Corp.) employees hired prior to December 16, 2009: The PTO schedule is as follows: • Less than one (1) year of service – incumbent employees will earn 15 days of PTO until they reach their one year anniversary; then, they follow the (1) to five (5) years of service grandfather clause. • One (1) to five (5) years of service – incumbent employees will be grandfathered in at twenty (20) days of paid time off until they reach their sixth year anniversary. • Six (6+) plus years of service – incumbent employees will earn 15 days plus one (1) additional day per year of service up to a maximum of 30 days. For example, you must have six years of service to receive 21 days of PTO (15 + 6 days for 6 service years = 21 days of PTO).
Below is the PTO schedule for GTEC (MS, DE, Corp.) employees hired prior to December 16, 2009: Years of Service Paid Time Off 0-1 year 1-5 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 + years
15 days 20 days 20 days 21 days 22 days 23 days 24 days 25 days 26 days 27 days 28 days 29 days 30 days
{18}
Years of Service 0-1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10+ years
Paid Time Off 20 days 21 days 22 days 23 days 24 days 25 days 26 days 27 days 28 days 29 days 30 days
In cases where an employee is part-time and works more than 19 hours but less than 40 hours per week, PTO will be accrued on a pro-rated basis.
Employees may carry over unused PTO balances at the end of each year, but will automatically cash out any unused PTO of over 160 hours on their annual performance review date each year. Employees are eligible to cash out PTO in 40 hour increments but cannot cash out below 80 hours.
additional benefits, COBRA Administrative Leaves
Technical Courses/Professional Development
Employees may participate in professional technical courses, training seminars, and/or professional development activities, with prior approval. GTEC may pay 100% of registration or enrollment fees for a job-related technical course/professional development activity if approved in advance by the appropriate supervisor or Program Manager.
• Bereavement/Funeral Leave (3 days) • Family Medical Leave
• Jury Duty and Court Leave (5 days)
• Maternity/Paternity Leave (10/5 days) • Military Leave
Pay Periods
• Official Facility Closing (OFC) Leave (8 hours)
Awards, Incentives, and Other Benefits
Pay periods are semi-monthly from the 1st through the 15th of the month and the 16th through the last day of the month. Employees are paid twice a month - on the 15th and the last day of the month. If the payday falls on a weekend or holiday, the employee will be paid on the previous workday. Direct deposit is available to up to 5 different bank accounts. Direct deposit is not immediate; pre-note account verification must be conducted by Accounting.
• Employee Recognition and Awards Program: awards and bonuses are given on a discretionary basis, based on individual performance and contribution to the company’s mission. • Employee Referral Bonus Program
• Annual Events: Summer Picnic and Holiday Celebration
COBRA
• Professional Membership Reimbursement
Employee Assistance Program (EAP)
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, COBRA qualified beneficiaries (QBs) generally are eligible for group coverage for a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
The LifeWorks Employee Assistance Program provides professional counseling to employees and family members at no cost to the employee. Up to 3 in-person assessment/counseling sessions are available per year. As needed, the EAP will also refer employees and dependents to qualified independent resources, which can provide either inpatient or outpatient treatment as required.
Upon termination, or other COBRA qualifying event, the former employee and any other QBs will receive COBRA enrollment information. COBRA coverage is not available for those terminated for gross misconduct.
• To contact LifeWorks you may call 888-267-8126, or • log on to www.lifeworks.com o User ID: EAP
o Password: lifeworks
Educational Tuition Assistance Program
Employees of GTEC may apply for educational assistance provided that the course(s) taken are related to the employee’s work or to satisfy related degree requirements. Specific program information should be obtained from Human Resources. The plan provides 80% of tuition, fees, and required text books and study materials (for grades of A or B) up to a maximum of $5,250 per calendar year.
Qualifying events for employees include voluntary or involuntary termination of employment, and the reduction in the number of hours of employment. Qualifying events for spouses or dependent children include those events above, plus the covered employee’s becoming entitled to Medicare; divorce or legal separation of the covered employee; death of the covered employee; and the loss of dependent status under the plan rules.
If a QB chooses to continue group benefits under COBRA, they must complete an enrollment form and return it to the Plan Administrator with the appropriate premium due. Upon receipt of premium payment and enrollment form, the coverage will be reinstated. Thereafter, premiums are due on the 1st of the month. If premium payments are not received in a timely manner, Federal law stipulates that your coverage will be cancelled after a 30-day grace period.
{19}
premium calculator Calculate Your Monthly Cost: (A+B+C+D+E+F+G+H+I+J+K) = ____________
Medical
Per Pay Premium: Total Monthly Cost / _2_ = ____________
CareFirst BCBS 90/70 PPO Plan Employee Only
Employee/Child
Employee/Spouse Family
Monthly
Per Pay
$168.00
$84.00
$77.00
$213.00
$292.00
CareFirst BCBS 80/70 PPO Plan
$58.00
$145.00
$191.00
CareFirst BCBS HMO Plan
$39.50
$101.00
$135.00
DeltaDental PPO Plan Employee Only Two Party
Family
Vision
Vision Service Plan Employee Only
Two Party
Family
$95.50
$79.00
Employee/Spouse
Dental
$72.50
Per Pay
$43.00
Family
$25.50
Monthly
Employee Only
Employee/Child
$146.00
$116.00
Employee/Spouse Family
$106.50
Per Pay
$51.00
Employee/Child
$38.50
Monthly
Employee Only
$67.50
$20.00
$10.00
$5.50
$33.00
$16.50
Monthly
Per Pay
$6.60
$11.82
__________________ (A)
$50.50
Per Pay
$4.34
Medical Insurance:
$21.50
Monthly $11.00
Calculate Your Monthly Cost:
$2.17
$3.30
Dental Insurance:
___________________ (B)
Vision Insurance:
___________________ (C)
$5.91
Basic Life and AD&D Insurance
Life and AD&D Insurance: Company-Paid
{20}
premium calculator cont’d Supplemental Life and AD&D Insurance Monthly Life Rates
Age
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 and over
Employee per $10,000
$0.600 $0.630 $0.840 $1.060 $1.300 $1.950 $3.250 $5.810 $7.860 $14.85 $24.05
Child per $2,000 - $0.32
Spouse per $5,000
$0.300 $0.315 $0.420 $0.530 $0.650 $0.975 $1.625 $2.905 $3.930 $7.425 $7.425
Monthly AD&D Rates Employee per $10,000
All Ages
$0.30
Child per $2,000 - $0.12
Age
$0.15
___________ X __________ = ____________ (D) # of increments of $10,000
rate per $10,000
Monthly Cost
Spouse Supplemental Life:
___________ X __________ = ____________ (E) # of increments of $5,000
rate per $5,000
Monthly Cost
Child(ren) Supplemental Life:
___________ X __$0.32___ = ____________ (F) # of increments of $2,000
rate per $2,000
Monthly Cost
Employee Supplemental AD&D:
___________ X __$0.30____ = ____________ (G) # of increments of $10,000
rate per $10,000
Monthly Cost
Spouse Supplemental AD&D:
___________ X __$0.15____ = ____________ (H) # of increments of $5,000
Monthly STD Rates
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 and over
Spouse per $5,000
Employee Supplemental Life:
Per $10 of Benefit $.281 $.311 $.281 $.281 $.331 $.340 $.420 $.525 $.642 $.719
rate per $5,000
Monthly Cost
Child(ren) Supplemental AD&D:
___________ X __$0.12____ = ____________ (I) # of increments of $2,000
rate per $2,000
Monthly Cost
Long-Term Disability:
_____ / 100 = ____ X $0.34 X .68 = _______ (J)
Monthly Salary
Total
LTD Rate
Emp. %
Monthly Cost
Short-Term Disability:
______ X 0.06 = ______ X ______ = _______ (K) Weekly Salary
{21}
Total
Monthly Rate
Monthly Cost
Please Note: This booklet provides a summary of the benefits available. It is not a Summary Plan Description. The Company reserves the right to modify, amend, suspend, or terminate any plan at any time, and for any reason without prior notification. The plans described in this book are governed by insurance contracts and plan documents, which are available for examination upon request. We have attempted to make the explanations of the plans in this booklet as accurate as possible. However, should there be a discrepancy between this booklet and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern. In addition, you should not rely on any oral descriptions of these plans, since the written descriptions in the insurance contracts or plan documents will always govern.
200 International Circle • Suite 4500 • Hunt Valley, MD 21031 800-330-8065 • e-mail: gna@crawfordadvisors.com