2015 non-union team member benefits booklet
DESCRIPTION
Fontainebleau Miami BeachTRANSCRIPT
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY 2527
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,
LIVE YOUR L IFE FAMOUSLY
FONTAINEBLEAU’S VIEW
Phil Goldfarb
President and Chief Operating Officer
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
PLAY YOUR PART. . . . KNOW YOUR BENEFITSThe Fontainebleau benefits program is designed to recognize the diverse needs of our Team Members. Our plan strives to:
Provide competitive and comprehensive benefit options that allow you to design your own plan based on your individual needs
Maintain benefit options that best suit Fontainebleau Team Members
Offer plans to provide long-term financial security for you and your family
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:
Your legally married spouse or domestic partner
Dependent child(ren) to age 26; to age 30*. Definition of child is birth child, adopted child, step child and foster child
Adult child(ren) with a disability
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.
Life Events
Marriage
Divorce or legal separation
Birth of your child
Death of your spouse or dependent child
Adoption of/placement for adoption of your child
Termination or commencement of your spouse’s employment
Change of employment status by you or your spouse qualification by the
Plan Administrator of a Medical Child Support Order
A significant change in your or your spouse’s health coverage due to your
spouse’s employment
Entitlement to Medicare or Medicaid
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
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
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
Deductible – The amount you pay towards medical and dental
expenses each calendar year before the plan begins paying benefits.
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.
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:
The service performed including date, description,
name of provider and name of the patient.
The doctor’s fee, and what the insurer allows—the amount
initially claimed by the doctor/provider minus any payments
made by the insurer.
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.
KEY DEFINITIONS
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?
Retrieve your EOB from CIGNA for that specific claim/
date of service.
If the amount that you owe on the EOB is equal to the
amount on the invoice, then the invoice should be paid.
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.
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.
CVS Minute Clinics
Walgreens Take Care Clinics
Do not forget about the Generic Drug Discount programs that
are available at most retail chains.
Publix-free antibiotics
Walmart
Target
TIPS FOR MEMBERS
0302
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
There are a few simple steps to enroll in your benefits:
ENGAGEUtilize this guide to understand your benefits to build the best benefit package for you.
ADD-ONEnroll 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.
COMPARECompare 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.
BUDGETReview your benefit cost options and determine your budget for health and welfare benefits.
Please notice the rates and budget accordingly.
FINDIt 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.
ENROLLOnce you have built your benefits package, complete the enrollment materials and return to the Benefits Office
within Human Resources.
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.
USERNAME: Team Member Number
INITIAL PASSWORD: Last 4 digits of your SSN
You will be required to change your password after your initial login.
* 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.
OUR COMMITMENT TO YOU LOGGING INTO BSWIF T
PLAY YOUR PART…GETTING STARTED
04 05
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
FONTAINEBLEAU BENEFITS EFFECTIVE DATES
If you are a New Hire, please note your Insurance Effective dates below:
If you were hired this
year in:
Your insurance effective
date is:
Turn in your enrollment forms no later than:
January April 1 March 5
February May 1 April 5
March June 1 May 5
April July 1 June 5
May August 1 July 5
June September 1 August 5
July October 1 September 5
August November 1 October 5
September December 1 November 5
October January 1 December 5
November February 1 January 5
December March 1 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.
06
MEDICAL BENEFITS
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:
understanding your medica l p lan opt ions with CIGNA
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.
Medical Select P lan (CIGNA HSA)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.
Medical Standard (CIGNA OAPS)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.
Make Sure You Are Always Seeing Contracted Providers !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
07
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
MEDICAL BENEFITS
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.
Benefit Standard CIGNA OAPS(In-Network Only)
Embedded or Non-EmbeddedSingle
Single
Benefits Highlights
Family
Family
HSA Funding
Coinsurance
SingleFamily
Out-of-Pocket Includes
Lifetime Maximum
PCP Office Visits
Specialist Visits
Well Child Care
Routine Adult Physical Exam
Well Woman/GYN Exam
Mammograms
Outpatient
Inpatient
Emergency Room
Urgent Care Center
Diagnostic Lab Facility
Diagnostic X-ray Facility
Major Services - PET Scans, MRI, CT Scans
Tier 1
Tier 2
Tier 3
Tier 4
Mail Order - 90 day supply
Embedded
N/AN/A
N/AN/A
N/A
$250 per Team Member
N/A
$500$1,00010%
$6,350$12,700
Deductible, Copays, Coinsurance, Rx
Unlimited
$25
$50
Covered in fullCovered in full
Covered in full
Covered in full
10% after ded
10% after ded
$200
$50
$0$0
10% after ded
$10
$35
$60
30% coinsurance
2x retail
In NetworkIn Network In Network
Embedded$250 $1,500$750 $3,0000% 10%
$6,350 $4,000$12,700 $8,000
Unlimited Unlimited
$40
$50
Covered in full Covered in fullCovered in full Covered in full
Covered in full Covered in full
Covered in full Covered in full
$250 per day,
max $1,000 per
$300 per visit,
then 100% after ded
$200
$50
$0$0
$250 after ded
$15
$35
$55
25%
2x Retail
Out of NetworkOut of Network Out of Network
$1,500 $3,000$3,000 $6,00030% 30%
$8,000 $8,000$16,000 $16,000
30% after ded 30% after ded10% after ded10% after ded30% after ded 30% after ded
30% after ded 30% after ded
30% after ded 30% after ded
30% after ded 30% after ded
30% after ded 30% after ded
30% after ded 30% after ded
30% after ded
30% after ded 30% after ded
30% after ded 30% after ded
30% after ded30% after ded
30% after ded
30% after ded
30% after ded
30% coinsurance
30% coinsurance
30% coinsurance
30% coinsurance30% coinsurance
30% after ded
30% after ded
30% after ded
30% after ded
10% after ded
10% after ded
10% after ded 10% after ded
10% after ded
10% after ded
10% after ded
10% after ded
10% after ded
10% after ded
10% after ded10% after ded
10% after ded
$200
30% after ded
DeluxeCIGNA OAPD(In/Out of Network)
Select CIGNA (HSA)
Emergency Services
Diagnostic X-ray/Lab
Prescription Drugs
Hospital Services
Preventive Care
Physician Services
Out-of-Pocket Limit
Retail - 30 day supply
Deductible, Copays, Coinsurance, Rx Deductible, Copays, Coinsurance, Rx
Non-Embedded
08
HEALTH SAVINGS ACCOUNT (HSA)
Lower ing your taxes with re imbursement accounts
Using your HSAWhen you open an HSA, you may contribute to your account which is established through JPMorgan Chase.
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.
The amount used from your account for services covered under the health plan helps you meet your annual deductible.
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.
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.
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:
Your account balance in an HSA can be carried forward from one year to the next.
If you have any money remaining in your HSA after your retirement, you may withdraw the money as cash.
A debit card is available for convenient payment of your eligible expenses including doctor visits.
No Use I t or Lose I t feature!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.
When can I make “catch-up” contr ibut ions to an HSA? 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 wil l 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:
Any health care service or costs not covered by your plan.
Costs for any services you receive until you meet your deductible.
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.
For members enrol led in CIGNA Select P lan only
09
Deductible
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
TELADOC
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!
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:
Sore throat and stuffy nose.
Sinus infection
Bronchitis
Allergies
Pink eye
Urinary tract infection
WHEN SHOULD YOU USE IT?
If you’re considering the ER or urgent care center for a non-emergency medical issue.
When you can’t reach your primary care physician due to time, weather, remote location, or a disability
When you’re on vacation or a business trip
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)
10
DENTAL BENEFITS
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.
Dental Health Maintenance Organizat ion P lan (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 Organizat ion P lan (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
Basic Treatment 100%/ Copays Ded & 80% Ded & 50%
Major Treatment Copays Ded & 50% Ded & 50%
Annual Maximum Benefit N/A $5000 $5000
Orthodontia Copays 50% Lifetime Max $1500 50% Lifetime Max $1500
Preventive and Diagnostic 100%/ Copays 100% 80%
Annual Deductible Single Family
$0
$0
$50
$150
$50
$150
In-Network In-Network Out-of-Network
1 1
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
VISION BENEFITS
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.
EyeMed Vis ion Care P lanYour 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.
Extra Vis ion Benef itsYou 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.
Fonta inebleau offers the fol lowing Vis ion opt ions through EyeMed Vis ion Care :
Vision Benefit
Lenses (every 12 months)
Contacts (every 12 months)
Medically Necessary
Exams (every 12 months)
Frames (every 12 months)
EyeMed
$10 Copay
$0 Copay; $120 Allowance then 15% off balance over $120
$0 Copay; Paid-in-Full
$10 Copay
$130 Allowance then 20% off balance over $130
12
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?
Advocacy
Travel expenses to and from treatment centers
Answer benefit questions
Resolve claims and billing issues
Clarify out-of-pocket costs for services
Assist with referrals and prior authorization
Coordinate appeals
Research in-network physicians/facilities
Identify a primary care physician (PCP)
Make doctor’s appointments
Explain pharmacy benefits
Arrange for mail order prescription services
Transparency
Review benefits for a health care test/procedure
Research in-network physicians and facilities
Compare cost and quality between providers
Explain impact (savings) for member choices
Educate members about their options
Track decisions made by members
Report member and plan savings
13
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
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.
How Coverage WorksThe 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.
Life and AD&DLife 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.
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:
You are a late enrollee,
You are increasing your original life coverage amount; or
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.
LIFE AND AD&D BENEFITSUnderstanding Your L i fe and Acc ident Coverage With MetL i fe
14
LIFE AND AD&D BENEFITS
For supplemental Life and AD&D coverage, Fontainebleau offers the following options for Team Member, spouse, domestic partner
and/or child(ren) through MetLife:
WILL PREPARATION SERVICE: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.
Fontainebleau covers 100% of the cost for following Basic Life and AD&D benefit through MetLife:
SUPPLEMENTAL AD&D:
SUPPLEMENTAL L IFE :
Provisions
Dependent Life Insurance for your spouse/
domestic partner
Optional Life Insurance for you
Dependent Life Insurance for your child(ren)
Detail
Up to 50% of Team Member election in $5,000
increments (GI- $25,000) Above GI requires SOH
Up to 5 x base annual salary in $10,000 increments (GI- $100,000)
Above GI requires SOH
$10,000; if 14 days to 6 months old- $250 (GI- $10,000)
Provisions
Dependent AD&D Insurance for your spouse
Optional AD&D Insurance for you
Dependent AD&D Insurance for your child(ren)
Detail Rate
Amount equal to Supplemental Life
Amount equal to Supplemental Life $0.02 per $1,000 of elected coverage
$0.02 per $1,000 of elected coverage
$0.05 per $1,000 of elected coverageAmount equal to Supplemental Life
Provisions
Maximum Issue
Waiver of Premium
Seat Belt Benefit
Benefit Amount
Guaranteed Issue Amount
Airbag Benefit
Common Carrier Benefit
Benefit Amount
$500,000
Included if disabled before age 60
5% up to $10,000
10% up to $25,000
2 times your base annual salary
$500,000 (No SOH required)
100% or full amount
15
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
LIFE INSURANCE BENEFIT RATESMonthly Costs for Supplementa l Term L i fe Insurance With MetL i fe
You have the option to purchase Supplemental Term Life Insurance. L isted 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
chi ld(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 est imate your monthly premiums.
Employee Age Your Monthly Cost per $1,000 of
Term Life Coverage
Spouse/Domestic Partner Monthly Cost
Per $1,000 of Term Life Coverage
Under 25 $0.06 $0.06
25 - 29 $0.06 $0.06
30 - 34 $0.08 $0.08
35 - 39 $0.09 $0.09
40 - 44 $0.10 $0.10
45 - 49 $0.16 $0.16
50 - 54 $0.26 $0.26
55 - 59 $0.44 $0.44
60 - 64 $0.66 $0.66
65 - 69 $1.27 $1.27
70 + $2.14 $2.14
Cost for your Child(ren)* $0.11* 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 Your Estimated Coverage Cost
Enter the rate from the table above (example: age 36) $0.09
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 $9.00
Bi-Weekly Payroll Deduction = Line 3 x 12 divided by 26 $4.15
Repeat the four easy steps above to determine the cost for the coverage selected.
RESTRICTIONS:
1. YOU must be enrolled in Supplemental Life Insurance in order to enroll your spouse or domestic partner.
2. 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.
3. 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.
4. 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.
16
AD&D SUPPLEMENTAL RATES
Monthly Costs for Acc identa l Death & Dismemberment (AD&D) Insurance
With MetL i fe
To purchase Supplemental AD&D coverage, you and your dependants must also be enrolled in Supplemental Life coverage.
Supplemental AD&D Coverage
Dependant Spouse/Domestic Partner
Dependant Child
Employee
Monthly Cost Per $1,000 of AD&D Coverage
$0.020
$0.020
$0.050
Example: $100,000 AD&D Insurance
Monthly premium = Line 1 x Line 2
Bi-Weekly Payroll Deduction = Line 3 x 12 divided by 26
Enter the rate from the table above (example “Employee”)
Your Estimated Coverage Cost
100
$0.020
$2.00
$0.92
Enter the amount of insurance in thousands of dollars
(Example: for $100,000 of coverage enter 100)
Repeat the four easy steps above to determine the cost for the coverage selected.
17
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
DISABIL ITY BENEFITS
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.
Understanding VoluntarySTD & VoluntaryLTD Insurance through MetL i fe
Voluntary Long-Term Disabi l i ty (VLTD)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.
Voluntary Short-Term Disabi l i ty (VSTD)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.
For VoluntarySTD Premium Rates
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.
Example
B. Weekly Earnings = A divided by 52
C. Weekly Benefit Coverage = B x 60%
D. Value per $10 = C divided by 10
A. Annual Earnings
576.92
346.15
34.62
8.48
30,000
E. Estimated Monthly Contribution =
(D multiplied by 0.245)
3.91F. Estimated Bi-Weekly deduction =
Your Estimated Coverage Cost
For VoluntaryLTD Premium Rates Rate / $100 of monthly earnings
0.418
Example
B. Monthly Earnings = A divided by 12
C. Value per $100 of earnings =
(Bdivided by 100)
A. Annual Earnings
2,5000
25.00
10.45
4.82
30,000
D. Estimated Monthly Contribution =
(C multiplied by 0.418)
E. Estimated Bi-Weekly deduction =
(C multiplied by 12 divided by 26)
Your Estimated Coverage Cost
Rate / $10 of weekly benefit coverage
0.245
18
VOLUNTARY PLANS
19
Aetna Accident P lan
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.
Crit ica l I l lness
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 Hospita l P lan
Pays fixed cash benefits when you are in the hospital.
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
We Al l Need Help Every Now and ThenProblems 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.)
Employee Ass istance Program (EAP)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.
OTHER EMPLOYEE BENEFITS
Benef i ts that he lp you and your fami ly
Consultation and SupportYou 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.
Work and L i fe Serv icesTelephone 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
20
DOMESTIC PARTNER COVERAGE
ELIGIBIL ITYTo be eligible for Domestic Partner benefits, you and your Domestic Partner must meet the following eligibility requirements:
1. Are each 18 years of age or older;
2. Live together in a serious, committed relationship and are responsible for each other’s common welfare;
3. Are each other’s sole domestic partner;
4. Are not legally married to anyone and/or have not had another domestic partner within the prior 12 months;
5. Have shared the same regular and permanent residence for at least 6 months, with the intent to continue doing so indefinitely;
6. Share “basic living expenses,” defined as the basic cost of food, shelter and medical expenses; and
7. Are not related by blood to a degree of closeness, which would prohibit legal marriage in the state in which we reside.
A Declaration of Domestic Partnership form is required before enrollment is approved
and processed. See the Human Resources Benefits Office for forms.
Additional taxation may be imposed as a result of Domestic Partner Coverage. See processed. See the Human Resources Benefits
Office for more information.
Domestic Partner benefits coverage is avai lable to Fontainebleau Team Members .
21
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
401 (K ) RETIREMENT
Fontainebleau understands that retirement is probably your most important financial goal.
Welcome to Transamer ica 401 (k) Advantage
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!
401 (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.
Amount to SaveAmount 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.
Vest ingYour contributions as well as the Fontainebleau’s matching contributions to the plan are immediately 100% vested.
Catch-up Contr ibut ionsIf 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.
El ig ib i l i ty RequirementYou 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.
22
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.
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:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone
number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
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).
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.
PRESCRIPTION DRUG COVERAGE
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
23
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
HIPAA Specia l Enrol lment R ightsIf 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
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.
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.
To request special enrollment or obtain more information, contact your Human Resources Department.
Notice of Avai labi l i ty : HIPAA Pr ivacy Pract icesThis 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.
Notice L i fet ime L imit No Longer Appl ies and Enrol lment OpportunityThe 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.
Fami ly and Medica l Leave Act of 1993You 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.
REQUIRED DISCLOSURE NOTICES
24
Notice of Women’s Health and Cancer R ights Act of 1998The 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:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance;
Prostheses’; and
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.
MetLifeOur 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.
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.
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.
Col lect ing Your Informat ionWe 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 Get Your Informat ionWe 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.
Using Your Informat ionWe 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:
Administer your products and services
Process claims and other transactions
Perform business research
Confirm or correct your information
Market new products to you
Help us run our business
Comply with applicable laws
25
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
Shar ing Your Informat ion With OthersWe 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.
Other reasons we may share your information include:
Doing what a court, law enforcement, or government agency requires us to do (for example, complying with Search warrants
or subpoenas)
Telling another company what we know about you if we are selling or merging any part of our business
Giving information to a governmental agency so it can decide if you are eligible for public benefits
Giving your information to someone with a legal interest in your assets (for example, a creditor with a lien on your account)
Giving your information to your health care provider
Having a peer review organization evaluate your information, if you have health coverage with us
Those listed in our “Using Your Information” section above
HIPAAWe 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.
Access ing and Correct ing Your Informat ionYou 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.
Quest ionsWe 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.
Send privacy questions to:
MetLife Privacy Office
P. O. Box 489
Warwick, RI 02887-9954
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:
Metropolitan Life Insurance Company MetLife Insurance Company of Connecticut
General American Life Insurance Company SafeGuard Health Plans, Inc.
SafeHealth Life Insurance CompanyInsuran
CPN-Inst-Ann-2009v2
26
Newborn’s and Mothers ’ Health Protect ion Act of 1996The 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.
Further, a health insurer or health maintenance organization may not:
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.
Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage.
Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such
length of stay coverage.
Require a mother to give birth in a hospital.
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.
Genet ic Informat ion Nondiscr iminat ion Act 2008 (GINA) 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 Chi ldren And Fami l ies 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.
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.
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.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employ-
er’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.
For further information on eligibility contact; www.flmedicaidtplrecovery.com/ 1-877-357-3268
27
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
Michel le’s Law
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.
Premium Ass istance Under Medica id and the Chi ldren’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a
premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t
eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance
coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP
office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for
either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to
apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your
employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and
you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your
employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
FLORIDA – Medica id
Website: www.flmedicaidtplrecovery.com
Phone: 1-877-357-3268
28
This not ice appl ies to employees and
covered dependents who are e l ig ib le for
Medicare Part 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.
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..
When Can You Jo in A Medicare Drug P lan?
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.
What Happens To Your Current Coverage I f
You Decide to Jo in A Medicare Drug P lan?
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.
When wi l l you pay a h igher premium (penalty)
to jo in a Medicare drug P lan?
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
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.
For More Informat ion About This Not ice Or
Your Current Prescr ipt ion 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 Informat ion About Your Options
Under Medicare Prescr ipt ion 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:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see
the inside back cover of your copy of the “Medicare & You”
handbook for their telephone number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
If you have limited income and resources, extra help paying for
Medicare prescription drug coverage is available. For information
about this extra help, visit Social Security on the web at www.
socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-
0778).
REMEMBER : Keep this 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
MEDICARE PART D NOTICE
29
FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY
VENDOR CONTACTS
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.
Plan Administrator Phone NumbersWebsite
Medical Benefits CIGNA 800-244-6224www.mycigna.com
Dental Benefit DMO SafeGuard 800-880-1800www.safeguard.net
Vision Benefits Eyemed 866-939-3633www.eyemedvisioncare.com
Life and AD&D Plan MetLife 800-638-6420For filing claims see Human Resources
Short/ Long Term Disability MetLife For existing claims800-300-4296
For filing claims see Human Resources
401 (k) Advantage Plan Transamerica/TAG 800-401-8726www.TA-RETIREMENT.com
Will Preparation through Hyatt Legal
Hyatt Legal 800-821-6400Must have voluntary supplemental life insurance
Compass EMP Mike Organ 866-376-7890Individual investment advice, regardless of 401k asset balance, at no additional fee.
Patient Care Patient Care
Teladoc Teladoc
800-640-1898
800-Teladoc (835-2362)
www.patientcare4u.com
www.teladoc.com
Dental Benefit PPO MetLife 800-438-6388www.metlife.com/mybenefits
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
30
NOTES
31