C la ss 2 LI V E YOUR LIF E FA MOUS LY
TEAM MEMBER BENEFITS 2016-2017 F O N TAI N E B L E AU
L IV E YOUR L IFE FAMOUSLY FON TAIN E BL E AU’S V IE W Dear Team Members, We are pleased to announce a variety of new and exciting enhancements to the 2016 – 2017 benefits plan. Because you are our #1 investment, we believe it’s important to take care of you and your loved ones. With this said, we offer excellent choices in healthcare coverage and other benefits, so each of our Team Members can attain and maintain a healthy and balanced lifestyle. NEW ENHANCEMENTS • bswift: We are pleased to introduce bswift, an online platform that allows our eligible Non-Union Team Members to enroll and manage all benefit selections by simply accessing the Fontainebleau enrollment website at myFB.bswift.com. The website has helpful tools to assist Team Members such as: • Enhanced Call Center: Allows Team Members to contact 844.781.9048 (toll free) regarding eligibility, benefit plans, enrollment periods, or any other additional plan design questions. •
Mobile Application for bswift Benefit Enrollment.
•
Ask Emma Avatar: Avatar program named Emma to explain benefit plans to Team Members.
• $250 Credit for the Cigna Select Health Savings Account (HSA) Plan. Fontainebleau will provide a $250 credit to all eligible Non-Union Team Members who join the Cigna HSA Plan. The Health Savings Account allows Team Members to select more cost-effective, appropriate care. • New Ancillary Benefit Plan Provider: Aetna has replaced Colonial as our provider for critical illness, accident, and hospital confinement offering better rates. An Aetna representative will be at Open Enrollment. • Wellness Raffle Prizes: Raffle prizes will be extended for a chance to win from numerous healthy prize selections for those that enroll on the website on Monday, July 18. Choosing the right health care and benefits package for you and your loved ones is very important to your well-being and peace-of-mind. Please do not miss your opportunity to take advantage of this exclusive benefits program during Non-Union Team Member Benefits Open Enrollment Monday, July 18, 2016 – Friday, July 22, 2016. Sincerely,
Phil Goldfarb President and Chief Operating Officer
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PL AY YOUR PART.... KNOW YOUR BENEFITS
KEY DEFINITIONS
The Fontainebleau benefits program is designed to recognize the diverse needs of our Team Members. Our plan strives to: ƒ Provide competitive and comprehensive benefit options that allow you to design your own plan based on your individual needs ƒ Maintain benefit options that best suit Fontainebleau Team Members ƒ Offer plans to provide long-term financial security for you and your family
Copayment – A flat dollar amount that you pay for medical or prescription drug services, regardless of the actual amount charged by your doctor or another provider.
The ability to make individual choices regarding your coverage is an important aspect of your Fontainebleau benefits program. However, it is not always easy to make decisions about your health and financial benefits. It is natural to review the cost of each benefit, but it is also important to think through other issues. With choice comes responsibility. So, take the time to educate yourself on the specifics of Fontainebleau’s benefits plan. We want you to understand all your options and make informed decisions. Only you can determine which benefits best fit you and your family. You are eligible for the benefits program if you are a Non-Union Full-Time Team Member working at Fontainebleau at least 30 hours per week. Benefits are available to newly hired team members on the first of the month following 60 days of employment from the date of hire. Your eligible dependents include: ƒ Your legally married spouse or domestic partner ƒ Dependent child(ren) to age 26; to age 30*. Definition of child is birth child, adopted child, step child and foster child ƒ Adult child(ren) with a disability ƒ Domestic Partner – refer to page 13 for details (Certification form required)
Benefit Basics Once you elect your benefit options for 2016, your elections remain in effect from August 1, 2016 through July 31, 2017. You may only change coverage during Open Enrollment for the next plan year or due to a qualified “lift event.” If a qualifying life event should occur, you must log on to bswift and initiate the change within 30 days of the event date. You will be required to upload supporting documentation to finalize the change.
Enrollment You must enroll or waive/decline coverage. Log on to myFB.bswift.com for more information and to submit your enrollment or waiver form. If you do not plan to enroll in any benefits, you still must log on to complete the waiver of coverage and the beneficiary information for the Basic Life Employer-Paid benefit. *Unmarried; live in FL or a full-time/part-time student; have no dependents; have no coverage elsewhere; have no gap in
02 LI V E YOUR LIF E FA MOUS LY
Life Events ƒ Marriage ƒ Divorce or legal separation ƒ Birth of your child ƒ Death of your spouse or dependent child ƒ Adoption of/placement for adoption of your child ƒ Termination or commencement of your spouse’s employment ƒ Change of employment status by you or your spouse qualification by the Plan Administrator of a Medical Child Support Order ƒ A significant change in your or your spouse’s health coverage due to your spouse’s employment ƒ Entitlement to Medicare or Medicaid ƒ A participating Team Member’s hours of service are reduced so that the Team Member is expected to average less than 30 hours of service per week but for whom the reduction does not affect the eligibility for coverage under Fontainebleau’s group health plan ƒ A Team Member participating in Fontainebleau’s group health plan who would like to cease coverage under the group health plan and purchase coverage through a marketplace without that resulting either in a period of duplicate coverage under Fontainebleau’s group health plan and the coverage purchased through a Marketplace or in a period of no coverage
Deductible – The amount you pay towards medical and dental expenses each calendar year before the plan begins paying benefits.
Coinsurance – The percentage of the total bill that you pay after you pay the deductible. In-Network – Use of a health care provider that participates in the plan’s network. For access to the most savings visit an in-network provider. Out-of-Network – Use of a health care provider that is not in the plan’s provider network. The medical plans generally pay reduced benefits for out-of-network services, except in the event of an emergency. Explanation of Benefits (EOB) – A statement sent to you by the health/dental carrier explaining what treatment and/or services were paid for by the carrier. An EOB typically describes: ƒ The service performed including date, description, name of provider and name of the patient. ƒ The doctor’s fee, and what the insurer allows—the amount initially claimed by the doctor/provider minus any payments made by the insurer. ƒ The amount the patient is responsible for payment. Guaranteed Issue (GI) – The maximum amount of coverage provided without completing a Statement of Health. Statement of Health (SOH) – Additional medical information will be required for any amount above the Guarantee Issue amount, for late enrollees or increase in insurance.
Accelerated Death Benefit – This provides an option to withdraw a percentage of your life insurance coverage when diagnosed as terminally ill (as defined by policy). The death benefit will be reduced by the amount withdrawn. To qualify, you must have satisfied the Active Work rule and have been covered under this policy for the required amount of time as defined by the policy. Portability – If Life coverage has been in force for at least 12 months, you may continue your coverage for a specified period of time after your employment ends by paying the required premium. Portability is available if your employment ends for a reason other than total disability. Conversion – If you terminate or become ineligible for Life coverage, you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination. HSA – A Health Savings Account (HSA) is a tax-exempt trust or custodial account you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be an eligible individual to qualify for an HSA. Contracted Rates – The amounts that health insurance companies will pay to healthcare providers in their networks for services. These rates are negotiated and established in the insurers’ contracts with in-network providers. Team Members on the Select Plan will pay the contracted rate for In-Network Services. Out of Pocket Maximum – The maximum amount you will pay in coinsurance during the calendar year.
TIPS FOR MEMBERS Make sure you always review your CIGNA “Explanation of Benefits” (EOB) What if I receive an invoice from a provider or a facility and I verified they were contracted with CIGNA? ƒ Retrieve your EOB from CIGNA for that specific claim/ date of service. ƒ If the amount that you owe on the EOB is equal to the amount on the invoice, then the invoice should be paid. ƒ If the amount that you owe on the EOB is less than the amount on the invoice (the invoice is greater) and you are certain you went to a contracted CIGNA provider, send a copy of your EOB with the invoice and the amount that CIGNA states you owe to your CIGNA contracted provider/facility. ƒ Please contact PatientCare, your dedicated benefits advocates at 1-800-640-1898.
When you visit your Contracted CIGNA provider for your Annual Physical/Exam make sure you’re stating that this is your “Preventive Visit” so that you are not charged. (Remember, if you are treated for an illness during this visit it will no longer be considered a preventive visit and you will be charged the applicable copay/coinsurance). If you DO NOT have a life threatening emergency, you have the option to contact Teladoc or visit an Urgent Care Center or a Contracted Convenience Care Center for Medical services. ƒ CVS Minute Clinics ƒ Walgreens Take Care Clinics Do not forget about the Generic Drug Discount programs that are available at most retail chains. ƒ Publix-free antibiotics ƒ Walmart ƒ Target
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OUR COMMITMENT TO YOU
LOGGING INTO BSWIF T You can access Fontainebleau’s enrollment website at www.myFB.bswift.com. Once you reach the log in page follow the instructions below to enter your username and password.
U S ER N A ME: Team Member Number IN IT IA L PA SS WO R D : Last 4 digits of your SSN You will be required to change your password after your initial login.
P L AY YO U R PA RT… G ET TING STARTED There are a few simple steps to enroll in your benefits:
E N G AG E Utilize this guide to understand your benefits to build the best benefit package for you.
ADD-ON Enroll eligible dependents in your benefit plans. Due to Healthcare Reform Provisions, you are able to enroll your child to age 26 regardless of tax-dependency status or to age 30*. Be prepared with all Social Security numbers and dates of birth for enrollments.
COM PA R E Compare each benefit plan design to determine details such as deductibles, copays and coinsurance. Please read carefully to determine which plan is best for you and your family.
BU D G E T Review your benefit cost options and determine your budget for health and welfare benefits. Please notice the rates and budget accordingly.
FI ND It is important to find a doctor or dentist that participates in your plan for cost savings. It is necessary to identify a dentist facility number when electing SafeGuard SGX245.
E N RO L L Once you have built your benefits package, complete the enrollment materials and return to the Benefits Office within Human Resources. * Unmarried; live in FL or a full-time/part-time student; have no dependents; have no coverage elsewhere; have no gap in coverage of more than 63 days.
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FONTAINEBLE AU BENEFITS EFFECTIVE DATES
MEDICAL BENEFITS understanding your medical plan options with CIGNA We need health care that protects our physical health as much as healthcare that protects our financial well-being. That is why Fontainebleau believes it is important to invest in quality plans that are cost effective, easy to use and valuable to you. Fontainebleau provides the following options:
Medical Standard (CIGNA OA PS ) The CIGNA Open Access Plus Standard (OAPS) Plan allows you to see doctors who are in the CIGNA Open Access Plus network. The OAPS Plan provides the ability to use the network without certain restrictions. Specifically, you do not have to elect a primary care physician and you do not need a referral to see an in-network specialist. This plan does not cover the cost of care you receive from a non-Open Access Plus provider.
Medical Deluxe (CIGNA OAPD) The CIGNA Open Access Plus Deluxe (OAPD) Plan allows members to see any licensed provider they choose, though benefits are less costly when they receive care from a provider in the Open Access Plus network. You have the flexibility to go to any doctor or to any hospital you wish, and no referral is required.
If you are a New Hire, please note your Insurance Effective dates below:
If you were hired this year in: January February March April May June July August September October November December
Your insurance effective date is: April 1 May 1 June 1 July 1 August 1 September 1 October 1 November 1 December 1 January 1 February 1 March 1
Turn in your enrollment forms no later than: March 5 April 5 May 5 June 5 July 5 August 5 September 5 October 5 November 5 December 5 January 5 February 5
IMPORTANT INFORMATION Enrollments and Waivers must be submitted on-line via bswift by the above dates as indicated. If you choose not to enroll in Fontainebleau benefits, we still require a waiver of coverage to be submitted via bswift before the enrollment effective date. The Employer Health Coverage offered by Fontainebleau does meet the “minimum value” standard of coverage as defined by the Affordable Care Act; therefore, you would not be eligible for coverage through the Health Insurance Marketplace.
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Medi ca l S elect P la n ( CIGN A H S A) The CIGNA Select HSA Plan allows members to see any licensed provider they choose and pay the contracted rate for In-Network Services. Members on this plan will be able to contribute to the HSA, which provides a tax-advantaged way to save for future medical expenses and greater flexibility over how their healthcare dollars are used.
Ma ke S u re Yo u A re A lways S eei n g Co n t rac ted P rov i ders ! How do I locate a CIGNA Contracted provider? Online: Register on MyCigna.com 1. Go online to www.mycigna.com 2. Under the Welcome Tab, select “Find a Doctor” 3. Select Health Care Professional Type (Physician, Pharmacy, Hospital) 4. If you are selecting a facility, enter in the facility type (Urgent Care, MRI Center, etc.) 5. Enter your location criteria 6. Select your plan/network which is (Open Access Plus) then click “Search” and your provider/facility listing will populate. Phone: 1. Call 1-800-244-6224 2. PatientCare 1-800-640-1898
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MEDICAL BENEFITS
HE ALTH SAVINGS ACCOUNT (HSA) Fo r m e m b e rs e n ro l le d i n C I G N A S e le c t P la n o n ly L oweri n g yo u r t a xes wi t h rei m bu rsem en t acco u n t s U s i n g yo u r HS A
Benefit
Benefits Highlights HSA Funding Single Family Deductible Embedded or Non-Embedded Single Family Coinsurance Out-of-Pocket Limit Single Family Out-of-Pocket Includes Lifetime Maximum Physician Services PCP Office Visits Specialist Visits Preventive Care Well Child Care Routine Adult Physical Exam Well Woman/GYN Exam Mammograms Hospital Services
Standard CIGNA OAPS (In-Network Only) Out of Network
In Network
Deluxe CIGNA OAPD (In/Out of Network)
N/A N/A Embedded $500 $1,000 10%
Out of Network
In Network
N/A N/A Embedded $250 $750 0%
$1,500 $3,000 30%
Select CIGNA (HSA)
Out of Network In Network $250 per Team Member N/A N/A Non-Embedded $3,000 $1,500 $6,000 $3,000 30% 10%
$8,000 $8,000 $6,350 $6,350 $4,000 $16,000 $16,000 $12,700 $12,700 $8,000 Deductible, Copays, Coinsurance, Rx Deductible, Copays, Coinsurance, Rx Deductible, Copays, Coinsurance, Rx Unlimited Unlimited Unlimited $25 $50
$40 $50
30% after ded 30% after ded
10% after ded 10% after ded
30% after ded 30% after ded
Covered in full Covered in full Covered in full Covered in full
Covered in full Covered in full Covered in full Covered in full
30% after ded 30% after ded 30% after ded 30% after ded
Covered in full Covered in full Covered in full Covered in full
30% after ded 30% after ded 30% after ded 30% after ded
Inpatient
10% after ded
$250 per day, max $1,000 per
30% after ded
10% after ded
30% after ded
Outpatient
10% after ded
$300 per visit, then 100% after ded
30% after ded
10% after ded
30% after ded
$200 30% after ded
10% after ded 10% after ded
10% after ded 30% after ded
30% after ded 30% after ded 30% after ded
10% after ded 10% after ded 10% after ded
30% after ded 30% after ded 30% after ded
Emergency Services Emergency Room Urgent Care Center Diagnostic X-ray/Lab Diagnostic Lab Facility Diagnostic X-ray Facility Major Services - PET Scans, MRI, CT Scans Prescription Drugs Retail - 30 day supply Tier 1 Tier 2 Tier 3 Tier 4 Mail Order - 90 day supply
$200 $50 $0 $0 10% after ded
$10 $35 $60 30% coinsurance 2x retail
$200 $50 $0 $0 $250 after ded
$15 $35 $55 25% 2x Retail
30% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance
10% after ded 10% after ded 10% after ded 10% after ded 10% after ded
30% after ded 30% after ded 30% after ded 30% after ded 30% after ded
ƒ When you open an HSA, you may contribute to your account which is established through JPMorgan Chase. ƒ You can choose to pay for your share of the costs (deductible and coinsurance) for eligible services up to your plan’s out-of-pocket maximum by using your HSA, other personal funds or both. ƒ The amount used from your account for services covered under the health plan helps you meet your annual deductible. ƒ You can also use your HSA to pay for qualified expenses not covered through your medical plan, such as dental and vision expenses. Visit Cigna.com/expenses for more information. ƒ The money you don’t use earns interest tax-free.* You can save for future medical costs and have the option to open an investment account when your balance reaches $2,000. ƒ You may take the account with you when you leave the plan, change jobs or retire. If you enroll in the CIGNA Select Plan (HSA), you can set aside money in a Health Savings Account (HSA) before taxes are deducted to pay for eligible medical, dental and vision expenses. The HSA will be administered by JP Morgan Chase. Other significant key advantages: ƒ Your account balance in an HSA can be carried forward from one year to the next. ƒ If you have any money remaining in your HSA after your retirement, you may withdraw the money as cash. ƒ A debit card is available for convenient payment of your eligible expenses including doctor visits.
N o U se It o r L ose It feat u re! The IRS Amounts for 2016 are $3,350 for individual coverage and $6,750 for family coverage. The IRS Amounts for 2017 are $3,400 for individual coverage and $6,750 for family coverage.
Wh en ca n I m a ke “catch -u p” co n t ri bu t i o n s to a n HS A ? If you are 55 or older, or turning 55 during the calendar year, you can make additional “catch-up” contributions to your HSA. The “catch-up” contribution is $1,000. If you have high deductible health plan (HDHP) coverage for the full year, you can make the full catch-up contribution regardless of when your 55th birthday falls during the year. If you do not have HDHP coverage for the full year, you must prorate your catch up contribution for the number of full months you were eligible, i.e., had HDHP coverage. However, if you are covered on December 1, you’re treated as an eligible individual for that entire year and can make the full contribution, provided you also elect the HDHP for the following year.
Which services are covered by my plan, and which will I have to pay for out of my own pocket? Covered services vary depending on your plan, so visit myCigna.com or check your plan materials for specific information. In addition, you’ll pay: ƒ Any health care service or costs not covered by your plan. ƒ Costs for any services you receive until you meet your deductible. ƒ Your share of the cost for your covered health care expenses (coinsurance), after you meet the deductible and your medical plan coverage begins, and up to your plan’s out-of-pocket maximum.
Important HSA Fees to keep in Mind! HSA Monthly Fee= $1.85 Monthly Paper Statements = $1.25 (You have the option to choose paper or online statements) Online Paper Statements = No charge ** There may be additional standard banking fees such as check and overdraft fees. This information will be included in your CIGNA packets** Additional questions regarding the CIGNA Select (HSA) Plan? Contact Patient Care at 1-800-640-1898 OR CIGNA at 1-800-244-6224 and reference Group #3337185.
Important Note: While the plan you select may not require you to use a primary care physician; it remains your responsibility to make sure you are using In-Network providers in order to enjoy the benefits of the plan’s In-Network benefit schedule.
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TEL A DOC
DENTAL BENEFITS
CONSULT WITH A DOCTOR 24/7/365 Fontainebleau now provides members with access to Teladoc, giving you 24/7 access to board-certified physicians. Teladoc allows you to resolve your routine medical issues anytime you need care. It’s healthcare made simple!
Taking care of your teeth is as important as taking care of the rest of your body. That’s why Fontainebleau offers dental plans that cover routine check-ups and additional services needed for your health through MetLife.
WHAT IS TELADOC? Teladoc is a national network of board-certified physicians who provide quality healthcare through the convenience of phone or online video consultations for members of any age. Teladoc physicians can diagnose, treat, and write prescriptions, when necessary for routine medical conditions, including: ƒ Sore throat and stuffy nose. ƒ Sinus infection ƒ Bronchitis ƒ Allergies ƒ Pink eye ƒ Urinary tract infection WHEN SHOULD YOU USE IT? ƒ If you’re considering the ER or urgent care center for a non-emergency medical issue. ƒ When you can’t reach your primary care physician due to time, weather, remote location, or a disability ƒ When you’re on vacation or a business trip ƒ For short-term prescription refills The cost for TelaDoc services is $15 per call if you are on the Open Access and Open Access Plus plans. If you are on the HSA plan the cost is $40 per call. Payment information will need to be provided at the time of the call. Take a doctor with you Teladoc.com 1-800-Teladoc (835-2362)
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Dental Health Maintenance Organization Plan (DHMO) The DHMO gives you access to the MetLife DHMO through the SafeGuard network of providers. The DHMO covers costs for services rendered by providers within the network. The costs of any services performed by an out-of-network provider will not be covered by the DHMO plan. You must choose your dentist and list the facility number on the enrollment form. A Safeguard Dental card will be mailed to your address. Your dentist can be changed by contacting SafeGuard Dental directly.
Dental Preferred Provider Organization Plan (DPPO) The DPPO plan gives you the freedom to access both in-network and out-of-network providers. In a DPPO plan, costs are typically reduced when you receive covered care from network providers. Also, dental specialists can be chosen from the network without a referral for covered services. You will not receive a Dental Card if you choose this plan. Please advise your Dentist that your coverage is through MetLife.
Compare the following Fontainebleau Dental options through MetLife:
Dental Benefit
DHMO
DPPO
In-Network
In-Network
Out-of-Network
Annual Deductible Single Family
$0 $0
$50 $150
$50 $150
Preventive and Diagnostic
100%/ Copays
100%
80%
Basic Treatment
100%/ Copays
Ded & 80%
Ded & 50%
Major Treatment
Copays
Ded & 50%
Ded & 50%
Orthodontia
Copays
50% Lifetime Max $1500
50% Lifetime Max $1500
Annual Maximum Benefit
N/A
$5000
$5000
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VISION BENEFITS
PATIENT CARE At no cost to you, Fontainebleau provides this advocacy program to assist you in locating specialists, resolving with claim issues, and providing clear, objective health information so that you can make informed decisions. A Personal Advocate will assist you with clinical and insurance-related issues, serve as a liaison with healthcare providers, insurance plans and health-related community services. Contact Patient Care at 1-800-640-1898. Patient Care’s services are available to all eligible employees enrolled in a Fontainebleau Medical plan. Services are also available to employees and their dependents What are the features of the Core Advocacy service?
A dvo cacy
It is proven that routine vision check-ups and care are not only beneficial to your eyes but are crucial to your long-term health. That is why Fontainebleau offers vision coverage.
E ye M e d V i s i o n C are Plan Your vision benefit is a voluntary plan offered by Fontainebleau through EyeMed Vision Care. This program allows you to access care from participating providers for a greater level of benefit and no claim forms. You may also access care from non-participating providers and receive reimbursement for your exam and/or supplies by filing a claim form.
E x t ra V i s i o n Be ne fi t s You receive 20% savings on numerous lens options and 15% savings on retail price of Laser Vision Correction or 5% savings on promotional pricing. Visit www.enrollwitheyemed.com for more information.
Fontainebleau offers the fo llowing Vision options through EyeMed Vision Care: Vision Benefit
EyeMed
Exams (every 12 months)
$10 Copay
Lenses (every 12 months)
$10 Copay
Frames (every 12 months)
$130 Allowance then 20% off balance over $130
Contacts (every 12 months)
$0 Copay; $120 Allowance then 15% off balance over $120
Medically Necessary
$0 Copay; Paid-in-Full
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ƒ
Travel expenses to and from treatment centers
ƒ
Answer benefit questions
ƒ
Resolve claims and billing issues
ƒ
Clarify out-of-pocket costs for services
ƒ
Assist with referrals and prior authorization
ƒ
Coordinate appeals
ƒ
Research in-network physicians/facilities
ƒ
Identify a primary care physician (PCP)
ƒ
Make doctor’s appointments
ƒ
Explain pharmacy benefits
ƒ
Arrange for mail order prescription services
Tra n s p a ren cy ƒ
Review benefits for a health care test/procedure
ƒ
Research in-network physicians and facilities
ƒ
Compare cost and quality between providers
ƒ
Explain impact (savings) for member choices
ƒ
Educate members about their options
ƒ
Track decisions made by members
ƒ
Report member and plan savings
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LIFE AND AD&D BENEFITS
LIFE AND AD&D BENEFITS
U n d ers ta n d in g Yo ur L i fe a n d A cc ide n t Cove rage W it h M e t Life L ife a nd AD&D Life insurance can provide valuable financial protection. Fontainebleau offers you a choice of different levels of coverage to meet your needs. The Life Insurance Plans are insured and administered by MetLife. In addition to the Basic Life and AD&D insurance that is provided to you at no cost by Fontainebleau, you can purchase Supplemental Life Insurance for yourself and Dependent Life for your spouse or domestic partner and dependent children.
Fontainebleau covers 100% of the cost for following Basic Life and AD&D benefit through MetLife:
How Coverage Wor k s The Life Insurance Plans pay a lump sum benefit to your beneficiary in the event of your death while actively employed by Fontainebleau. The Plan can also pay a living benefit (Accelerated Death Benefit). If you become terminally ill, the Plan will pay out a benefit while you are still living. Any amount you receive will reduce the benefit paid to your beneficiary. The Dependent Life Insurance Plan pays a lump sum benefit to you in the event of your spouse or child’s death while you are actively employed by Fontainebleau.
Provisions
Benefit Amount
Benefit Amount
2 times your base annual salary
Maximum Issue
$500,000
Guaranteed Issue Amount
$500,000
Waiver of Premium
Included if disabled before age 60
Airbag Benefit
5% up to $10,000
Seat Belt Benefit
10% up to $25,000
Common Carrier Benefit
100% or full amount
(No SOH required)
For supplemental Life and AD&D coverage, Fontainebleau offers the following options for Team Member, spouse, domestic partner and/or child(ren) through MetLife:
S U P P L EMEN TA L L IFE: Statement of Health (SOH) You must provide a Statement of Health, which is a statement of your medical history, to determine if you are approved for coverage when the amount of requested life insurance is in excess of the Guaranteed Issue Amount. You will be asked to complete a SOH if: ƒ You are a late enrollee, ƒ You are increasing your original life coverage amount; or ƒ You are age 60 or above The SOH must be completed entirely and approved by MetLife before the coverage will take effect. All SOHs must be submitted to the Benefits Office within Human Resources.
Provisions
Detail
Optional Life Insurance for you
Up to 5 x base annual salary in $10,000 increments (GI- $100,000) Above GI requires SOH
Dependent Life Insurance for your spouse/ domestic partner
Up to 50% of Team Member election in $5,000 increments (GI- $25,000) Above GI requires SOH
Dependent Life Insurance for your child(ren)
$10,000; if 14 days to 6 months old- $250 (GI- $10,000)
WIL L P R EPA R AT IO N S ERVICE: By enrolling in Supplemental Term Life coverage, you will have access to Hyatt Legal Plans’ network of 11,500+ participating attorneys. Services include Wills (Simple, Complex or Living) along with a Power of Attorney. When you use a participating plan attorney there will be no charge for the services.
S U P P L EMEN TA L A D & D : Conversion & Portability Your Life Insurance Plan through MetLife provides Conversion and Portability Options. Conversion is the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without a SOH. Portability is available for coverage that has been in force for a minimum of 12 months and is the option to continue your coverage for a specified period of time after your employment by paying the required premium. You must provide a written application to MetLife for Conversion or Portability within 31 days of your termination.
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Provisions
Detail
Rate
Optional AD&D Insurance for you
Amount equal to Supplemental Life
$0.02 per $1,000 of elected coverage
Dependent AD&D Insurance for your spouse
Amount equal to Supplemental Life
$0.02 per $1,000 of elected coverage
Dependent AD&D Insurance for your child(ren)
Amount equal to Supplemental Life
$0.05 per $1,000 of elected coverage
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LIFE INSURANCE BENEFIT RATES
AD&D SUPPLEMENTAL RATES
Monthly Costs for Supplemental Term Life Insurance With MetLife You have the option to purchase Supplemental Term Life Insurance. Listed below are your monthly rates as well as those for your spouse (based on your age and the amount of coverage). Rates to cover your child(ren) are also shown. The premiums are paid 100% by you and deducted from your paycheck after taxes. Please refer to the table below to estimate your monthly premiums.
Employee Age Under 25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 + Cost for your Child(ren)*
Your Monthly Cost per $1,000 of Term Life Coverage $0.06 $0.06 $0.08 $0.09 $0.10 $0.16 $0.26 $0.44 $0.66 $1.27 $2.14 $0.11
Spouse/Domestic Partner Monthly Cost Per $1,000 of Term Life Coverage $0.06 $0.06 $0.08 $0.09 $0.10 $0.16 $0.26 $0.44 $0.66 $1.27 $2.14
* Covers all eligible children
Use the above table to calculate your premium based on the amount of life insurance you choose:
Example: $100,000 Supplemental Coverage Enter the rate from the table above (example: age 36) Enter the amount of insurance in thousands of dollars (example: for $100,000 of coverage, enter 100) Monthly premium = Line 1 x Line 2 Bi-Weekly Payroll Deduction = Line 3 x 12 divided by 26
Your Estimated Coverage Cost $0.09 100 $9.00 $4.15
Repeat the four easy steps above to determine the cost for the coverage selected. RESTRICTIONS: 1. 2.
3.
4.
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YOU must be enrolled in Supplemental Life Insurance in order to enroll your spouse or domestic partner. If you or your spouse/domestic partner were previously eligible to enroll and declined, you must now complete the MetLife Statement of Health (SOH) form and submit it to HR Benefits Office. The application must be approved by MetLife before the Supplemental benefits become effective or before payroll deductions begin. If you or your spouse/domestic partner are newly eligible to enroll and are applying for an amount that is greater than the GTD issue amount, you must complete the MetLife Statement of Health (SOH) form. The application must be approved by MetLife before your Supplemental benefits become effective or before payroll deductions begin. If employee is age 60 or above, there is no guarantee issue for spouse coverage. A Statement of Health must be submitted for any coverage requested for spouse. See benefit administrator for additional restrictions due to age.
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Monthly Costs for Accidental Death & Dismemberment (AD&D) Insurance With MetLife To purchase Supplemental AD&D coverage, you and your dependants must also be enrolled in Supplemental Life coverage.
Supplemental AD&D Coverage
Monthly Cost Per $1,000 of AD&D Coverage
Employee
$0.020
Dependant Spouse/Domestic Partner
$0.020
Dependant Child
$0.050
Example: $100,000 AD&D Insurance
Your Estimated Coverage Cost
Enter the rate from the table above (example “Employee�)
$0.020
Enter the amount of insurance in thousands of dollars (Example: for $100,000 of coverage enter 100)
100
Monthly premium = Line 1 x Line 2
$2.00
Bi-Weekly Payroll Deduction = Line 3 x 12 divided by 26
$0.92
Repeat the four easy steps above to determine the cost for the coverage selected.
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DISABILIT Y BENEFITS
VOLUNTARY PL ANS
U n d ers ta n d in g Vo l un t a r y ST D & Volu n t ar yLT D I n su ran ce t h rou g h M etLife Fontainebleau offers a Voluntary Short Term Disability and Long Term Disability plan. These benefits replace a portion of your pre-disability earnings*, less the income that was actually paid to you for the same disability from other sources.
A et n a A cc id e n t Plan The Aetna Accident Plan pays cash benefits directly to you when you have a covered accident. You can use the money to pay for everyday expenses like mortgage payments, day care or utility bills. Or you can use the cash for expenses like coinsurance or to help cover your medical plan’s deductible. It’s up to you. Benefits are payable no matter what other medical coverage you might have.
Vo l u n t a r y S h o r t -Te r m D i s a b i l i t y ( V ST D ) There is a 14 day waiting period for illness. Pre-existing condition restrictions may affect the benefits paid to you. The benefit amount is 60% of your pre-disability weekly earnings up to a maximum weekly benefit of $1,000.
Vo lu n t a r y Lo ng-Te rm Di s ab i l i t y (V LTD) If you are disabled due to a qualified non work-related accident or sickness lasting more than 90 days, your long-term disability coverage provides for tax-advantaged payments. This benefit pays you 60% of your defined monthly earnings* up to $6,000 per month. *Definition of Earnings: Disability coverage is determined by the average weekly or average monthly earnings based on the prior 52 weeks of earnings (or a pro-ration if applicable) at the time of initial enrollment and updated at each Annual Open Enrollment.
RESTRICTIONS: 1.
If you were previously eligible to enroll and declined, you must now complete the MetLife SOH form. The application must be approved by MetLife before your Voluntary STD and/or LTD benefits become effective or payroll deductions begin.
Rate / $10 of weekly benefit coverage 0.245
For VoluntarySTD Premium Rates Example
Your Estimated Coverage Cost
A. Annual Earnings
30,000
B. Weekly Earnings = A divided by 52
576.92
C. Weekly Benefit Coverage = B x 60%
346.15
D. Value per $10 = C divided by 10
34.62
E. Estimated Monthly Contribution = (D multiplied by 0.245)
8.48
F. Estimated Bi-Weekly deduction =
3.91
Example 30,000
B. Monthly Earnings = A divided by 12
2,5000
C. Value per $100 of earnings = (Bdivided by 100)
25.00
D. Estimated Monthly Contribution = (C multiplied by 0.418)
10.45
E. Estimated Bi-Weekly deduction = (C multiplied by 12 divided by 26)
4.82
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Pays fixed cash benefits when you are in the hospital.
Your Estimated Coverage Cost
A. Annual Earnings
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The Aetna Critical Illness Plan pays cash benefits directly to you when you are diagnosed with a covered condition. You can use the money to pay for everyday expenses like mortgage payments, day care or utility bills. Or you can use the cash for expenses like coinsurance or to help cover your medical plan’s deductible. It’s up to you. Benefits are payable no matter what other medical coverage you might have.
Aetna Hospital Plan Rate / $100 of monthly earnings 0.418
For VoluntaryLTD Premium Rates
Critical Illness
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OTHER EMPLOYEE BENEFITS
DOMESTIC PA RTNER COVERAGE
B en efi ts th at h e l p yo u a n d you r fa m ily
Domestic Partner benefits coverage is available to Fontainebleau Team Members.
Employee Assistance Program (E AP) Many of life’s problems can grow into major issues that can disrupt an employee’s life and their ability to function at work, at home and in their personal relationships. Fontainebleau now provides an Employee Assistance Program (EAP) through MetLife free of charge to all employees and their dependents for confidential support and direction.
EL IG IB IL IT Y
We A ll N e e d He l p Eve ry Now and Then
1. 2. 3. 4. 5. 6. 7.
Problems are just a part of everyday life. In addition to the benefits provided under your MetLife Group Insurance coverage, you and your household members now have access to MHN’s Employee Assistance Program (EAP) to help with the everyday challenges of life that may affect your health, family life and desire to excel at work. (EAP services provided through an agreement with MHN, Inc. MHN is not a subsidiary or affiliate of MetLife and the services provided are separate and apart from the insurance and services provided by MetLife.)
Consultation and Support
To be eligible for Domestic Partner benefits, you and your Domestic Partner must meet the following eligibility requirements: Are each 18 years of age or older; Live together in a serious, committed relationship and are responsible for each other’s common welfare; Are each other’s sole domestic partner; Are not legally married to anyone and/or have not had another domestic partner within the prior 12 months; Have shared the same regular and permanent residence for at least 6 months, with the intent to continue doing so indefinitely; Share “basic living expenses,” defined as the basic cost of food, shelter and medical expenses; and Are not related by blood to a degree of closeness, which would prohibit legal marriage in the state in which we reside.
You and the members of your household are entitled to up to 3 consultations with a licensed clinician per incident, per individual, per calendar year. You choose between telephone consultations, for maximum convenience and anonymity, or web-video consultations, for convenience with the warmth of a face-to-face conversation. Please call 1-800-511-3920 anytime to speak with a clinician or schedule an appointment.
A Declaration of Domestic Partnership form is required before enrollment is approved and processed. See the Human Resources Benefits Office for forms.
Wo r k a n d Li fe S e rvi ce s
Additional taxation may be imposed as a result of Domestic Partner Coverage. See processed. See the Human Resources Benefits Office for more information.
Telephone consultations are available in the following areas: Financial Services: Budgeting, credit and financial guidance (investment advice, loans and bill payments not included), retirement planning and assistance with tax issues. Childcare and Eldercare Assistance: Needs assessment plus referrals to childcare and eldercare providers. Identity Theft Recovery Services: Information on ID theft prevention, plus an ID theft emergency response kit and help from a fraud resolution specialist if you are victimized. Legal Services: Consultations for issues relating to civil, consumer, personal and family law, financial matters, business law, real estate, estate planning and more (excluding disputes or actions between you and MetLife or MHN). Daily Living Services: Referrals to consultants and businesses that can help with event planning, transportation services, pet services and more (does not cover the cost nor guarantee delivery of vendors’ services). Online Member Services: MHN’s EAP member website features a wide range of tools and information to help you take charge of your well-being and simplify your life. Log on to members.mhn.com and enter the following company code: metlifeeap1
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401 (K) RETIREMENT
PRESCRIPTION DRUG COVERAGE Important Notice from Fontainebleau Florida Hotel, LLC Regarding Your Prescription Drug Coverage under the CIGNA Medical Plans and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Fontainebleau and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription 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. Fontainebleau has determined that the prescription drug coverage offered by the CIGNA Medical Plans are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage. Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15th through December 7th. Beneficiary’s leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan.
Fontainebleau understands that retirement is probably your most important financial goal.
We lco m e to Trans am e ri ca 4 01(k) Adva ntage As you probably already know, saving for retirement takes you down one of two paths…saving on your own, or participating in a pension or retirement savings plan through Fontainebleau. The 401(k) Advantage Plan is an important benefit available to Team Members to save for retirement on a pre-tax basis with the added feature of employer matching!
40 1 ( k) Fontainebleau gives you the option to enroll in the 401(k) Advantage Plan through Transamerica/TAG to make saving for retirement easy and painless. There are many different investments available within the 401(k) Advantage Plan for you to choose from. Best of all, you do not pay any taxes today on your deferrals. You will receive an enrollment information packet at your home address prior to meeting your eligibility requirements. All enrollments are done online or via telephone. Please choose a deferral percentage, do not choose a flat dollar amount for your biweekly payroll contributions.
A m o u n t to S ave Amount to Save – Save up to 75% of your gross earnings per pay period up to the IRS limit of $18,000 in the tax year of 2016. Participants over 50 years of age can contribute an additional $6,000 for the 2016 tax year.
Ve s t i n g Your contributions as well as the Fontainebleau’s matching contributions to the plan are immediately 100% vested.
Catc h- u p Co nt ri b ut i o ns If you are 50 or older, you may qualify to make additional before-tax “Catch-up” contributions as a flat dollar amount. (Do not select a catch-up %). The Federal limit for the 2015 tax year is $6,000.00.
You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. If you do decide to enroll in a Medicare prescription drug plan and drop your Fontainebleau prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan. You should also know that if you drop or lose your coverage with Fontainebleau and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. If you go 63 days or longer without prescription drug coverage, that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to enroll. For more information about this notice or your current prescription drug coverage… Contact Fontainebleau for further information. NOTE: You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Fontainebleau changes. You also may request a copy. For more information about your options under Medicare prescription drug coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans: ƒ Visit www.medicare.gov ƒ Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help. ƒ Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you call them at 1-800-772-1213 (TTY 1-800-325-0778).
E l i g i b i l i t y R e q u i re m e n t You are eligible to participate in the 401(k) plan if you are a Non-Union Team Member over 18 years of age, have completed 6 months of service, and have worked 500 hours within the 6 months of service.” Your plan entry date will be the first day of any month after meeting the eligibility requirements.
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Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare, which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount.
Date: Name of Entity/Sender: Contact-Position/Office: Address: Phone Number:
August 1, 2016 Fontainebleau Florida Hotel, LLC Human Resources Benefits Office 4441 Collins Avenue, Miami Beach, FL 33140 (305) 535-3224
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REQUIRED DISCLOSURE NOTICES HIPAA Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be eligible to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage.) However, you must request enrollment within 30 days after yours or your dependent’s 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. However, you must enroll within 30 days after the marriage, birth, adoption, or placement for adoption. Effective April 1, 2009 special enrollment rights exist in the following circumstances: If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program (SCHIP) coverage; or
N o t i ce o f Wo m en’s Hea l t h a n d Ca n cer R i gh t s A ct o f 1 9 9 8 The Women’s Health and Cancer Rights Act (WHCRA) requires group health plans to provide participants with notices of their rights under WHCRA, to provide certain benefits in connection with a mastectomy, and to provide other protections for participants undergoing mastectomies. If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: ƒ All stages of reconstruction of the breast on which the mastectomy was performed; ƒ Surgery and reconstruction of the other breast to produce a symmetrical appearance; ƒ Prostheses’; and ƒ Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and Fontainebleau coinsurance amounts applicable to other medical and surgical benefits provided under the health plan offered by your employer. Please keep this information with your other group health plan documents. If you have any questions about the Plan’s coverage of mastectomies and reconstructive surgeries, please contact the Human Resource Department.
Met L i fe
If you or your dependents become eligible for premium assistance under an optional state Medicaid or SCHIP program that would pay the Team Member’s portion of the health insurance premium.
Our Privacy Notice We know that you buy our products and services because you trust us. This notice explains how we protect your privacy and treat your personal information. It applies to current and former customers. “Personal information” as used here means anything we know about you personally.
Note: In the two above listed circumstances only, you or your dependents will have sixty (60) days to request special enrollment in the group health plan coverage. An individual must request this special enrollment within sixty (60) days of the loss of coverage described at bullet one, and within sixty (60) days of when eligibility is determined as described at bullet two.
Plan Sponsors and Group Insurance Contract Holders This privacy notice is for individuals who apply for or obtain our products and services under an employee benefit plan, or group insurance or annuity contract. In this notice, “you” refers to these individuals.
To request special enrollment or obtain more information, contact your Human Resources Department.
Protecting Your Information We take important steps to protect your personal information. We treat it as confidential. We tell our employees to take care in handling it. We limit access to those who need it to perform their jobs. Our outside service providers must also protect it, and use it only to meet our business needs. We also take steps to protect our systems from unauthorized access. We comply with all laws that apply to us.
No t i ce o f Avai lab i l i t y: HIPA A P ri vacy Prac tices This communication is intended to alert you to the availability of our notice of privacy practices as required by the HIPAA Privacy Rule of 2003. You can obtain a copy of this notice by contacting the Fontainebleau plan administrator at (305) 674-4719. Should you have any questions regarding this notice, please contact the Human Resource Department.
N o t i ce L i fe t i m e L i m i t N o L o n ge r A p p l i e s a n d E n ro l l m e n t O p p o r t u n i t y The lifetime limit on the dollar value of benefits under Independent Health no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For more information contact the Fontainebleau plan administrator at (305) 674-4719.
Fa m i ly a n d Me d i cal Leave A ct o f 1 993 You are eligible for leave under the Family and Medical Leave Act (FMLA) if you have been employed for a total of 12 months and worked at least 1,250 hours during the 12 months preceding the leave. Eligible employees will receive up to 12 weeks of leave within any rolling 12 month period for the birth or adoption of a child, for the employee’s own serious health condition, or to care for a child, spouse, or parent with a serious health condition. Eligible employees may also be eligible for FMLA leave to care for a family member who is a member of the Armed Forces under certain circumstances.
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Co l le c t i n g Yo u r I n fo r m at i o n We typically collect your name, address, age, and other relevant information. We may also collect information about any business you have with us, our affiliates, or other companies. Our affiliates include life, car, and home insurers. They also include a bank, a legal plans company, and securities broker-dealers. In the future, we may also have affiliates in other businesses.
How We G et Yo u r In fo rm at i o n We get your personal information mostly from you. We may also use outside sources to help ensure our records are correct and complete. These sources may include consumer reporting agencies, employers, other financial institutions, adult relatives, and others. These sources may give us reports or share what they know with others. We don’t control the accuracy of information outside sources give us. If you want to make any changes to information we receive from others about you, you must contact those sources.
U s i n g Yo u r In fo rm at i o n We collect your personal information to help us decide if you’re eligible for our products or services. We may also need it to verify identities to help deter fraud, money laundering, or other crimes. How we use this information depends on what products and services you have or want from us. It also depends on what laws apply to those products and services. For example, we may also use your information to: ƒ Administer your products and services ƒ Process claims and other transactions ƒ Perform business research ƒ Confirm or correct your information ƒ Market new products to you ƒ Help us run our business ƒ Comply with applicable laws
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Sh a r i n g Yo u r Info rm at i o n W i t h Other s
N ewbo rn’s a n d Mo t h ers’ Hea l t h P ro tect i o n A ct o f 1 9 9 6
We may share your personal information with others with your consent, by agreement, or as permitted or required by law. For example, we may share your information with businesses hired to carry out services for us. We may also share it with our affiliated or unaffiliated business partners through joint marketing agreements. In those situations, we share your information to jointly offer you products and services or have others offer you products and services we endorse or sponsor. Before sharing your information with any affiliate or joint marketing partner for their own marketing purposes, however, we will first notify you and give you an opportunity to opt out.
The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery to less than 48 hours; and (2) following a cesarean section, to less than 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards, an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay.
Other reasons we may share your information include: ƒ Doing what a court, law enforcement, or government agency requires us to do (for example, complying with Search warrants or subpoenas) ƒ Telling another company what we know about you if we are selling or merging any part of our business ƒ Giving information to a governmental agency so it can decide if you are eligible for public benefits ƒ Giving your information to someone with a legal interest in your assets (for example, a creditor with a lien on your account) ƒ Giving your information to your health care provider ƒ Having a peer review organization evaluate your information, if you have health coverage with us ƒ Those listed in our “Using Your Information” section above
Further, a health insurer or health maintenance organization may not: ƒ Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage. ƒ Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage. ƒ Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage. ƒ Require a mother to give birth in a hospital. ƒ Restrict benefits for any portion of a period within a hospital length of stay described in this notice. These benefits are subject to the plan’s regular deductible and copay. For further details, refer to you (SPD) Summary Plan Description.
H I PA A We will not share your health information with any other company – even one of our affiliates – for their own marketing purposes. If you have dental, long-term care, or medical insurance from us, the Health Insurance Portability and Accountability Act (“HIPAA”) may further limit how we may use and share your information.
A cce ss i n g a n d Co r re c t i n g Yo u r I n fo r m at i o n You may ask us for a copy of the personal information we have about you. Generally, we will provide it as long as it is reasonably retrievable and within our control. You must make your request in writing listing the account or policy numbers with the information you want to access. For legal reasons, we may not show you anything we learned as part of a claim or lawsuit, unless required by law. If you tell us that what we know about you is incorrect, we will review it. If we agree, we will update our records. Otherwise, you may dispute our findings in writing, and we will include your statement whenever we give your disputed information to anyone outside MetLife.
G e n e t i c I n fo r m at i o n N o n d i sc r i m i n at i o n A c t 2 0 0 8 ( G I N A ) Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. GINA also restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants, employees, or their family members. Our Plan complies with these requirements.
Offer Free Or Low-Cost Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, Florida has premium assistance programs that can help pay for coverage. Florida uses 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.
Questions We want you to understand how we protect your privacy. If you have any questions about this notice, please contact us. When you write, include your name, address, and policy or account number.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in Florida, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.
Send privacy questions to: MetLife Privacy Office P. O. Box 489 Warwick, RI 02887-9954 privacy@metlife.com
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your Florida 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 employer-sponsored plan.
We may revise this privacy notice. If we make any material changes, we will notify you as required by law. We provide this privacy notice to you on behalf of these MetLife companies:
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the Medicaid or CHIP plan – as long as you and your dependents are eligible. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
Metropolitan Life Insurance Company General American Life Insurance Company SafeHealth Life Insurance CompanyInsuran
For further information on eligibility contact; www.flmedicaidtplrecovery.com/ 1-877-357-3268
MetLife Insurance Company of Connecticut SafeGuard Health Plans, Inc.
CPN-Inst-Ann-2009v2
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MEDICARE PART D NOTICE This notice applies to employees and covered dep en den t s wh o a re el i gi ble fo r M e d i ca re Par t D. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with CIGNA 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. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
M i c h e l le’s L aw The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010 If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary.
P re m i u m A ssi st ance Und e r Me d i ca id a nd the Children’s Hea lth Insura nce Prog ra m ( CHIP ) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
FLO R I DA – Me d i cai d Website: www.flmedicaidtplrecovery.com Phone: 1-877-357-3268
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1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. CIGNA has determined that the prescription drug coverage offered by CIGNA is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You should also know that if you drop or lose your coverage with CIGNA and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later..
Wh en Ca n Yo u Jo i n A Medi ca re D ru g P la n ? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable coverage, through no fault of your own, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
Wh at Ha p p en s To Yo u r Cu rren t Coverage If Yo u D eci de to Jo i n A Medi ca re D ru g P la n ? If you decide to join a Medicare drug plan, your current CIGNA coverage will not be affected. You can keep this coverage if you elect Part D and this plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current CIGNA coverage, be aware that you and your dependents will be able to get this coverage back.
Wh en wi l l yo u p ay a h i gh er p rem i u m (p en a l t y) to j o i n a Medi ca re dru g P la n ?
later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up 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.
Fo r Mo re In for m at ion Ab ou t T h is N ot ice O r Your Current Prescription Drug Coverage… Contact our office for further information (see contact information below) 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 CIGNA changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: ƒ Visit www.medicare.gov ƒ 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 ƒ 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 1-800-3250778).
R EMEMB ER : Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. Name of Entity/Sender: Miami Fontainebleau, LLC Contact-Position/Office: Human Resources Benefits Office Address: 4441 Collins Ave, Miami Beach, FL 33140 Phone Number: (305) 535-3224
You should also know that if you drop or lose your current coverage with CIGNA 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
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VENDOR CONTACTS
NOTES
Plan
Administrator
Website
Phone Numbers
Patient Care
Patient Care
www.patientcare4u.com
800-640-1898
Teladoc
Teladoc
www.teladoc.com
800-Teladoc (835-2362)
Medical Benefits
CIGNA
www.mycigna.com
800-244-6224
Dental Benefit PPO
MetLife
www.metlife.com/mybenefits
800-438-6388
Dental Benefit DMO
SafeGuard
www.safeguard.net
800-880-1800
Vision Benefits
Eyemed
www.eyemedvisioncare.com
866-939-3633
Life and AD&D Plan
MetLife
For filing claims see Human Resources
800-638-6420
Short/ Long Term Disability
MetLife
For filing claims see Human Resources
For existing claims 800-300-4296
Will Preparation through Hyatt Legal
Hyatt Legal
Must have voluntary supplemental life insurance
800-821-6400
401 (k) Advantage Plan
Transamerica/TAG
www.TA-RETIREMENT.com
800-401-8726
Compass EMP
Mike Organ
Individual investment advice, regardless of 401k asset balance, at no additional fee.
866-376-7890
Employee Assistance Program Available 24 hours 7 days a week
MetLife
Members.mhn.com Company code: metlifeeap1
800-511-3920 TDD callers on call: 800-327-0801
Voluntary Benefits
Aetna
www.aetna.com
1-888-772-9268
This guide describes the benefit plans available to you as a Team Member of Fontainebleau. The details of these plans are contained in the official Plan documents, including some insurance contracts. This guide is meant only to cover the major points of each plan. It does not contain all of the details that are included in your Summary Plan Description (SPD) (as described by the Employee Retirement Income Security Act). If there is ever a question about one of these plans, or if there is a conflict between the information in this guide and the formal language of the Plan documents, the formal wording in the Plan documents will govern. Note that the benefits described in this guide may be changed at any time and do not represent a contractual obligation on the part of Fontainebleau.
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