Arranged by Pierce Group Benefits
GARMAN HOMES, LLC PLAN YEAR: December 1, 2016 - November 30, 2017
What’s Inside Benefits Plan Overview.................................................................................
Garman Homes, LLC Plan Year December 1, 2016 through November 30, 2017
Health Insurance UnitedHealthcare Silver Choice Plus HSA…………………..…….……
Virtual Visits………………………………………………………………...
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Prescription Drug Savings…………………………………
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UnitedHealthcare Gold Plus 2,000…..………………..………………… myuhc.com Step-By-Step Registration Process……………..………… Generic Medications – Five Things You Need to Know………….…… Getting to know your Prescription Drug List...……………………..…… OptumRx Mail Service Pharmacy……………………….……….……… Health Savings Account (HSA)…………………………………………...
Garman Homes, LLC is offering all eligible employees a Benefits Program.
This booklet highlights the benefits offered through your employer for the current plan year. Some benefits described in this booklet are fully or partially paid by your employer, while others are fully paid by the employee. You have the opportunity to select the benefits in which you wish to participate. Please see the Benefits Plan Overview section of the booklet for more details.
This is neither an insurance contract nor a Summary Plan Description and only the actual policy provisions will prevail.
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Your Combined Medical and Pharmacy Deductible…………………… myHealthcare Cost Estimator……………………………………………. myNurseLine………………………………………………………………..
Dental Benefits Dental Benefits Summary………………………………………… Finding a Dental Provider………………….…………..………….
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Vision Benefits……………………………………………
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Health, Dental & Vision Rates – 2016 - 2017……….………
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Group Term Life Insurance……………….……………….
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Pierce Group Benefits – Website Overview……………………………..……
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COBRA Continuation of Coverage Rights………………………………..…..
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Arranged & Enrolled by
Pierce Group Benefits Rev. 12/15/2016
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GARMAN HOMES, LLC EMPLOYEE BENEFITS PROGRAM Provided by Pierce Group Benefits
Pre-Tax Benefits Health Insurance
UnitedHealthcare
Dental Insurance
Aetna
Vision Insurance
Aetna
Employer-Paid Benefits Group Term Life Insurance
Aetna
Enrollment Period October 17, 2016 through October 28, 2016 Effective Dates December 1, 2016 through November 30, 2017
Qualifications • You must work 30 hours or more per week. • New employees are eligible for benefits the first of the month following 30 days of employment. • New employees must enroll in benefits within the first 30 days of employment. The plan year for UnitedHealthcare Health, Aetna Dental and Aetna Vision lasts from December 1, 2016 through November 30, 2017. Deductions for UnitedHealthcare Health, Aetna Dental and Aetna Vision will begin December 2016. If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when meeting with the Benefits Representative. Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as defined by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse's employment, or the transition of spouse's employment from full-time to part-time or vice-versa.
To enroll or make changes to your Benefits Plan, please speak with the representative while he/she is at your location.
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HEALTH INSURANCE Health Benefits Provided by UnitedHealthcare
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Health Insurance Silver Choice Plus HSA Benefit Highlights
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Health Insurance Gold Plus 2,000 Benefit Highlights
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Health Insurance Gold Plus 2,000 Benefit Highlights
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Health Insurance myuhc.com Step-by-Step Registration Process
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Health Insurance myuhc.com Step-by-Step Registration Process
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Health Insurance Generic Medications – Five Things You Need to Know
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Health Insurance Generic Medications – Five Things You Need to Know
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Health Insurance Getting to Know Your Prescription Drug List
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Health Insurance Getting to Know Your Prescription Drug List
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Health Insurance Getting to Know Your Prescription Drug List
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Health Insurance Getting to Know Your Prescription Drug List
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Health Insurance OptumRx Mail Service Pharmacy
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Health Insurance OptumRx Mail Service Pharmacy
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Health Insurance OptumRx Mail Service Pharmacy
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Health Insurance Health Savings Account (HSA)
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Health Insurance Health Savings Account (HSA)
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Health Insurance Health Savings Account (HSA)
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Health Insurance Health Savings Account (HSA)
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Health Insurance Health Savings Account (HSA)
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Health Insurance Health Savings Account (HSA)
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Health Insurance Your Combined Medical and Pharmacy Deductible
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Health Insurance Your Combined Medical and Pharmacy Deductible
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Health Insurance myHealthcare Cost Estimator
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Health Insurance myHealthcare Cost Estimator
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Health Insurance myHealthcare Cost Estimator
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Health Insurance myHealthcare Cost Estimator
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Health Insurance myNurseLine
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Health Insurance Virtual Visits
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PRESCRIPTION DRUG SAVINGS Mobile Solutions for Prescription Drug Management Provided by OneRx
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DENTAL INSURANCE Dental Benefits Provided by Aetna
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Dental Insurance
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Dental Insurance
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Dental Insurance
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VISION INSURANCE Vision Benefits Provided by Aetna
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Vision Insurance
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HEALTH, DENTAL & VISION RATES Garman Homes December 1, 2016 - November 30, 2017 Rates Health Rates UnitedHealthcare Silver Choice Plus HSA Employee Only
Employee/ Spouse
Employee/ Child(ren)
Employee/ Family
Monthly Contribution
$323.79
$647.58
$599.01
$1,003.74
Less Employer Contribution
$323.79
$422.69
$422.69
$422.69
Employee Monthly Contribution
$0.00
$224.89
$176.32
$581.05
Employee/Deduction (24)
$0.00
$112.45
$88.16
$290.53
UnitedHealthcare Gold Plus 2,000 Employee Only
Employee/ Spouse
Employee/ Child(ren)
Employee/ Family
Monthly Contribution
$422.69
$845.38
$781.98
$1,310.34
Less Employer Contribution
$422.69
$422.69
$422.69
$422.69
Employee Monthly Contribution
$0.00
$422.69
$359.29
$887.65
Employee/Deduction (24)
$0.00
$211.35
$179.65
$443.83
Employee Only
Employee/ Spouse
Employee/ Child(ren)
Employee/ Family
Monthly Contribution
$28.60
$54.40
$69.70
$95.60
Less Employer Contribution
$28.60
$28.60
$28.60
$28.60
Employee Monthly Contribution
$0.00
$25.80
$41.10
$67.00
Employee Per Pay Deduction (24)
$0.00
$12.90
$20.55
$33.50
Employee Only
Employee/ Spouse
Employee/ Children
Employee/ Family
Monthly Contribution
$8.42
$16.00
$16.85
$24.77
Less Employer Contribution
$0.00
$0.00
$0.00
$0.00
Employee Monthly Contribution
$8.42
$16.00
$16.85
$24.77
Employee Per Pay Deduction (24)
$4.21
$8.00
$8.43
$12.39
AETNA DENTAL INSURANCE
AETNA VISION INSURANCE
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GROUP TERM LIFE INSURANCE Group Term Life Benefits Provided by Aetna
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PIERCE GROUP BENEFITS – WEBSITE OVERVIEW
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Website Overview
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General Notice of COBRA Continuation Coverage Rights ** Continuation Coverage Rights Under COBRA** Introduction You are receiving this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
Your spouse dies; Your spouse’s hours of employment are reduced; Your spouse’s employment ends for any reason other than his or her gross misconduct; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a “dependent child.”
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Tyrrell County Government, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:
The end of employment or reduction of hours of employment; Death of the employee; Commencement of a proceeding in bankruptcy with respect to the employer; or The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Nancy Garman. Applicable documentation will be required i.e. court order, certificate of coverage etc.
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General Notice of COBRA Continuation Coverage Rights (continued)
How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months 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.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information: Nancy Garman 3725 Stonegate Drive Durham, NC 27705 P: 919.328.0189 E: nancy@garman.net
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Health Insurance – UnitedHealthcare Please see the inside of your Benefit Booklet for more information myuhc.com – Take advantage of easy, timesaving online tools. You can check eligibility, benefits, claims, claim payments, search for a doctor and hospital and more. 24-hour nurse support – A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Call the number on the back of your ID card. Customer Care telephone support – Call a customer care professional using the toll-free number on the back of your ID card.
Dental Insurance – Aetna
Vision Insurance – Aetna
Customer Service..............................................1-800-872-3862 Internet Address……………..…..…..………...…www.aetna.com Finding a Provider……..………….….…www.aetna.com/docfind
Customer Service..............................................1-877-973-3238 Internet Address……………………...……www.aetnavision.com
To view your benefits online visit www.piercegroupbenefits.com/garmanhomes or for additional information concerning plans offered to employees of Garman Homes, LLC, please contact our North Carolina Service Center at 1-888-662-7500, ext. 100