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TRANSCRIPT
Putnam County School District
On Course for a Successful Future
2016 Decision Guide
Active Employees
TableofContentsHealthBenefits 3
WhatisaConsumerDrivenHealthPlan(CDHP) 5
HelpfulMedicalResources 6
DisabilityIncomeProtection 7
BasicLifeInsurance 9
WholeLifeInsurance 10
DentalBenefits 11
VisionBenefits 13
FlexibleSpending&DependentCare 14
CriticalIllness 15
HowtoEnroll 17
EmployeeNotices 19
Wearecommittedtoprovidingemployeeswithabenefits
programthatisbothcomprehensiveandcompetitive.Our
programoffersarangeofplanoptionstomeettheneeds
ofourdiverseworkforce.Weknowthatyourbenefitsare
importanttoyouandyourfamily.Helpingyouunderstand
thebenefitsweofferisimportanttous.
This Decision Guideprovides a general overview of your
benefit choices. It is designed to help you select the
coveragethatisrightforyou.Weencourageyoutoreview
eachsectionandtodiscussyourbenefitswithyourfamily
members.Pleasetaketimetoreadaboutandunderstand
thebenefit.Whenyouareready,youcanenrollon-lineor
bycallingtheEmployeeBenefitAssistanceline.
Thisguideisnotanemployee/employercontractandalso
isnot intendedtocoverallprovisionsofallplans;rather,
thisguideisaquickreferencetohelpanswermostofyour
questions.
For complete details about the benefits described in this
guide,pleasecontactusanytime.
Website:www.myputnambenefits.com
BenefitsChoiceCenter:(844)554-4126
2
UnitedHealthcare-POSMedicalPlan(AHKOwithRx161)
INNETWORK OUTOFNETWORK
DEDUCTIBLE
IndividualFamily
$750
$1,500
$1,500
$3,000
OUTOFPOCKETMAXIMUM
IndividualFamily
$4,000
$8,000
$6,0000
$12,000
DOCTOR’SVISITS
PreventativeServicesVirtualVisits
100%Covered
$25Copay
60%AfterDeductible
60%AfterDeductiblePrimaryCareOfficeVisit $30Copay 60%AfterDeductibleSpecialistOfficeVisit $60Copay 60%AfterDeductible
PhysicalandSpeechTherapyVisit $30Copay,20Visits 60%AfterDeductible,20Visits
ChiropracticVisits $30Copay,20Visits 60%AfterDeductible,20Visits
EMERGENCYCAREUrgentCareFacility $75Copay 60%AfterDeductible EmergencyRoomVisit $350Copay
AmbulanceServices 80%AfterDeductible
OUTPATIENTSERVICES
HomeHealthCare 80%AfterDeductible,60Visits 60%AfterDeductible,60Visits
HospiceCare 80%AfterDeductible 60%AfterDeductible
LabX-RayandMajorDiagnostics-Outpatient�IncludingCT,PET,MRI,MRAandNuclearMedicine
$200Copay $200Copay
MentalHealthServices–Outpatient $60CopayPerVisit 60%AfterDeductible
NeurobiologicalDisorders–AutismSpectrumDisorderServices $60CopayPerVisit 60%AfterDeductible
Surgery 80%AfterDeductible 60%AfterDeductible
INPATIENTSERVICES
Hospital–InpatientStay 80%AfterDeductible 60%AfterDeductible
MentalHealthServices–Inpatient 80%AfterDeductible 60%AfterDeductible
SkilledNursingFacility 80%AfterDeductible,60Days 60%AfterDeductible,60Days
PRESCRIPTIONDRUG
Deductible–DoesNOTApplytoTier1 $100Individual/$200Family
$100Individual/$200Family
Tier1 $15Copay Copay+CostDifference
Tier2 $30Copay Copay+CostDifference
Tier3 $50Copay Copay+CostDifference
MailOrder–Upto90DaySupply 2xCopay NotCovered
DEDUCTIONS
EmployeeOnly $211.49
Employee+Spouse $965.59
Employee+Child(ren) $899.44
Family $1,589.75
3
UnitedHealthcare-CDHPMedicalPlan(AHJCwithRx125)
In-Network Out-of-NetworkDEDUCTIBLE
IndividualFamily
$3,000$6,000
$5,000$10,000
OUTOFPOCKETMAXIMUM
IndividualFamily
$6,550$13,100
$10,000$20,000
DOCTOR’SVISITS
PreventativeServices
VirtualVisits100%Covered
90%AfterDeductible50%AfterDeductible50%AfterDeductible
PrimaryCareOfficeVisit 90%AfterDeductible 50%AfterDeductibleSpecialistOfficeVisit 90%AfterDeductible 50%AfterDeductible
PhysicalandSpeechTherapyVisit 90%AfterDeductible,20Visits 50%AfterDeductible,20VisitsChiropracticVisits 90%AfterDeductible,20Visits 50%AfterDeductible,20Visits
EMERGENCYCARE
UrgentCareFacility 90%AfterDeductible 50%AfterDeductible EmergencyRoomVisit 90%AfterDeductible
AmbulanceServices 90%AfterDeductible
OUTPATIENTSERVICES
HomeHealthCare 90%AfterDeductible,60Visits 50%AfterDeductible,60Visits
HospiceCare 90%AfterDeductible 50%AfterDeductible
LabX-RayandMajorDiagnostics-Outpatient�IncludingCT,PET,MRI,MRAandNuclearMedicine
90%AfterDeductible 50%AfterDeductible
MentalHealthServices–Outpatient 90%AfterDeductible 50%AfterDeductibleNeurobiologicalDisorders–AutismSpectrumDisorderServices 90%AfterDeductible 50%AfterDeductibleSurgery 90%AfterDeductible 50%AfterDeductible
INPATIENTSERVICES
Hospital–InpatientStay 90%AfterDeductible 50%AfterDeductible
MentalHealthServices–Inpatient 90%AfterDeductible 50%AfterDeductible
SkilledNursingFacility 90%AfterDeductible,60Visits 50%AfterDeductible,60Visits
PRESCRIPTIONDRUG
Deductible MedicalDeductible
MedicalDeductible
Tier1 $15Copay Copay+CostDifferenceTier2 $50Copay Copay+CostDifference
Tier3 $80Copay Copay+CostDifferenceMailOrder–Upto90DaySupply 2.5xCopay NotCovered
DEDUCTIONS
EmployeeOnly $73.82Employee+Spouse $670.98Employee+Child(ren) $618.60Family $1,152.90
4
ConsumerDrivenHealthPlan(CDHP)
WhatisaCDHP?ACDHPisatypeofhealthplanthatencouragescoveredindividualstobeinformedandthoughtfulconsumersofhealthcareservices,muchlikeanyotherconsumerwhowouldbeinformedandthoughtfulwhenpurchasingothergoodsandservices.TheCDHPplanstructuremotivatesparticipantstotakeamoreactiveroleinselectingtheirhealthcareproviders,managingtheirhealthexpensesandimprovingtheiroverallhealththroughgoodnutrition,exerciseandotherfactorstheycancontrol.
ACDHPisahealthplanthatallowsindividualstouseaHealthSavingsAccount(HSA)topayhealthcareexpensesdirectly,whileahigh-deductiblehealthcoverageplanprotectstheparticipantfromcatastrophicmedicalexpenses.
PreventiveandWellnessServicesAreCoveredWearecommitted to yourgoodhealth. That’swhy theCDHP—likeallhealthplans—coversmostpreventiveandwellnessservicesat100%.Youhavenoout-of-pocketcosts (noco-payment, co-insuranceordeductible) for eligiblepreventiveandwellnessservices,includingcheckupsandage-appropriatepreventivetesting(suchasroutinebloodtests,mammogramsorPSAtests).StepsYouCanTaketoManageYourHealthExpensesYouhavemorecontroloveryourhealthcareexpendituresthanyoumayrealize.Hereareafewstepsyoucantaketospendlessonhealthcare—withoutcompromisingthequalityofcareyoureceive:
• Fillprescriptionswithgenericmedicationsinsteadofname-brandmedications.Askyourdoctorifagenericisavailableandappropriate.
• Fillmaintenance(long-term)prescriptionsbymailorder,insteadofusingawalk-inpharmacy.• UtilizetheCare24,virtualofficevisits,doctor’sofficeorurgentcarecenter—insteadofahospitalemergencyroom—
whenyoufeelsick,orhavesymptomsoraninjurythatisnotlife-threateningorlimb-threatening.
WhatisanHSA?• Asavingsaccountownedandfundedbyyouwithpre-taxdollarstopayformedical,dental,andvisionexpensesnotcovered
byinsurance.
• HSA’sallowyoutorollovermoneyfromyeartoyear.
• HSAmoneyalwaysbelongstoyouandthereisnota“useitorloseit”rule.
• AllHSAmoneyremainsinyouraccountuntilyouspendit.Youraccountisportable.
• Youcanchangecontributionelectionamountsduringtheplanyear.
• Distributionsforqualifiedexpensesaretaxfree.
5
HelpfulMedicalResources
6
ThefollowingdocumentsareavailableforyouonyourbenefitswebsiteinordertoassistyouwithyourUnitedHealthcare
Coverage.
1. WelcomeNewMembers-ThisguideismeanttotakeyouthroughtheAtoZ’sofUnitedHealthCare,including
butnotlimitedto:a. UnderstandingyourIDcardb. Wheretogoforcarec. HowtofindaPCPd. Howclaimsarepaide. Programsavailabletoyou
2. MyUHC–Summaryofalloftheresourcesavailabletomembersatmyuhc.com
3. HealthCareCostEstimator–Instructionsonhowtoutilizethistoolwhichwillallowyoutobemorepreparedto
decidewhichchoiceisbestforyou,planyourcareandbudgetformedicalexpenses
4. Health4MeApp–HealthcaremanagementresourcesatyourfingertipsspecifictoyouasamemberofUHC
5. Care24Services–Informationonthe24hours,7daysaweek,365daysayearnurselinethatisavailabletoyouatnocost.
6. TransitionofCare–Thisisforanyonewithaneligibleconditiontobeabletoseeyourcurrentdoctorevenifout
ofnetworkwithUHCitreviewstheproceduresandincludesanapplication
7. PharmacyBenefitServices–Aguidetousingyourpharmacyservices
8. OptumRxSpecialtyPharmacyProgram–Animportantreadforanyoneonspecialtymedications
9. PrescriptionDrugList–UnitedHealthCare’sapproved2016PrescriptionDrugListsothatyoucandeterminewhereyourprescriptionsfall
MutualofOmaha-ShortTermDisabilityIncomeProtectionShort-TermDisabilityShort-termDisabilityisintendedtoprotectyourincomeforashortperiodoftimeincaseof injuryorillness.Youareableto
takeadvantageofthiscoveragenowwithoutansweringhealthquestions.Youwillnotbeofferedthisopportunityagainuntil
thenextannualOpenEnrollment.
EliminationPeriod(waitingperiod)…………………14days
MaximumWeeklyBenefit........................…….….60%ofweeklysalary,upto$1,500perweek
MaximumBenefitDuration…………………………….11weeks
MinimumWeeklyBenefit………………………………..$25.00
Basedonyourelection,yourbenefit isequivalentto40%,50%or60%ofyourbefore-taxweeklyearnings,nottoexceedtheplan’smaximumweeklybenefitamountstatedabove.
Pre-ExistingConditionExclusion:Thepre-existingconditionperiodis3/6.Thismeansthatanyresultingconditionfrominjury
orsicknessforwhichtheEmployeereceivedmedicaltreatment,servicesorincurredexpensesfor3monthspriortothedateof
hisorhercoveragethatresultsindisabilitywithinthefirst6monthsofcoveragewillnotbecovered.
DefinitionofWeeklyEarningsWeekly earnings is1/52
ndof thecompensation you receive fromyour employerunderyourannualcontract in effectat the
onsetofdisability,whichisusedtodetermineyourbenefitintheeventofaclaim.
DefinitionofDisabilityDisabilityanddisabledmeanthatbecauseofaninjuryorillness,asignificantchangeinyourmentalorfunctionalabilitieshas
occurred,forwhichyouarepreventedfromperformingatleastoneofthematerialdutiesofyourregularjobandareunableto
generatecurrentearningswhich exceed99%of yourweekly earnings fromyour regular job. You canbe totallyorpartially
disabledduringtheeliminationperiod.
PartialDisabilityIfyoubecomedisabledandcanworkpart-time(butnotfull-time),youmaybeeligibleforpartialdisabilitybenefits,whichwill
helpsupplementyourincomeuntilyouareabletoreturntoworkfull-time.
VocationalRehabilitationBenefitIfyoubecomedisabledandparticipate in thevocationalrehabilitationprogramwhichoffersservicesthathelpyoureturnto
workandability,youwillbeeligibleforaweeklybenefitincreaseof5%.
WaiverofPremiumThepremiumforyourshort-termdisabilitycoverageiswaivedwhileyouarereceivingbenefits.
PortabilityTheportability feature allows you to apply for disability insurance should your employment end,without having to provide
evidenceofinsurability(informationaboutyourhealth).Youwillberesponsibleforthepremiumforthecoverage.
OtherExclusions:Informationaboutotherexclusionsmaybefoundinthecertificatebooklet.
7
MutualofOmaha-LongTermDisabilityIncomeProtection
8
Long-TermDisabilityLong-term Disability insurance is intended to protect your income for a long period of time after you havedepletedshort-termdisability.
• EliminationPeriod(waitingperiod)……….90days• MaximumMonthlyBenefit……………………60%ofmonthlysalaryupto$6,500permonth• MaximumBenefitDuration……………………Priortoage62,benefitsarepayabletoage65orSocialSecurityNormal
RetirementAge.Atage62(andolder),thebenefitperiodwillbebasedonareduceddurationschedule.• MinimumMonthlyBenef………………………$100
DefinitionofMonthlyEarningsMonthlyearnings is1/12thofthecompensationyoureceivefromyouremployerunderyourannualcontract ineffectattheonsetofdisability,whichisusedtodetermineyourbenefitintheeventofaclaim.Pre-Existing Conditions Exclusion:Disabilities that occur during the first 12 months of coverage due to a pre-existingconditionduringthe3monthspriorocoverageareexcluded.DefinitionofDisabilityDisabilityanddisabledmeanthatbecauseofaninjuryorillness,asignificantchangeinyourmentalorfunctionalabilitieshasoccurred,forwhichyouarepreventedfromperformingatleastoneofthematerialdutiesofyourregularoccupationduringthefirst24monthsofdisabilityandafter24monthsareunabletoperformallofthematerialdutiesofanygainfuloccupation;andduringhefirst24monthsofdisabilityareunabletogeneratecurrentearningswhichexceed99%ofyourmonthlyearningsfromyourregularoccupation,andafter24months ifpartiallydisabled,areunabletogeneratecurrentearningswhichexceed85%ofyourmonthlyearningsfromanygainfuloccupation.Youcanbetotallyorpartiallydisabledduringthe90dayeliminationperiod.PartialDisabilityIfyoubecomedisabledandcanworkpart-time(butnotfull-time),youmaybeeligibleforpartialdisabilitybenefits,whichwillhelpsupplementyourincomeuntilyouareabletoreturntoworkfull-time.VocationalRehabilitationBenefitIfyoubecomedisabledandparticipateinthevocationalrehabilitationprogramwhichoffersservicesthathelpyoureturntoworkandability,youwillbeeligibleforaweeklybenefitincreaseof5%.SurvivorBenefitIf youpassawaywhile receiving long-termdisability benefits, yourbenefitswillbeprovided to yourbeneficiaries foraperiodoftimeafteryourdeath.WaiverofPremiumThepremiumforyourlong-termdisabilitycoverageiswaivedwhileyouarereceivingbenefits.Alcohol&DrugAbuseandMentalDisorders:Relateddisabilities;Benefitsareavailableforupto24months.OtherExclusions:InformationaboutotherexclusionsmaybefoundinthecertificatebookletavailablefromPCSD.
MetLife–BasicLifeandSupplementalLife/AD&D
9
Basic,Board-PaidLifeInsuranceYouremployerprovidesyouwithBasicTermLifeandAccidentalDeathandDismemberment(AD&D)insurancecoveragein
theamountof:
CoverageAmounts:ActiveEmployees: Anamountequalto1timesyourannualsalary,roundedtothenexthighest$1,000,
oftermlifeinsuranceatnocosttoyou,theemployee.
MaximumBasicLifeBenefit:$50,000(BasicLifeandOptionalSupplementalTermLifecombinedcannotexceed$50,000).
OptionalSupplementalTermLife/AD&DInsuranceAllemployeesworkingatleast20hoursperweekinactiveemploymentandtheireligiblespousesandchildren,14daysto19
yearsold(uptoage23ifchildisaFull-TimeStudent).
CoverageAmounts:Employee: 1-3timesyourbasicannualearnings,roundedtothenexthigher$1,000,toa
maximumof$200,000
Spouse(uptoage70): Option1=$5,000Option2=$10,000
DependentChild(ren): $5,000–uptoage23withStudentStatus
AD&DBenefitSchedule AdditionalBenefits
Thefullbenefitamountispaidforlossof:
•Life •AcceleratedBenefit
•Anycombinationofahand,afoot,sightofaneye •WaiverofPremium
•Quadriplegia •Conversion
•Speechandhearing •HRI,Inc.-GriefCounseling
•HyattLegalResourceBenefit
•SeatBelt/AirBagBenefit
UNUM–WholeLifeInsurance
10
GetLifetimeCoverageandCashBenefits
WholeLifeInsuranceprovidesmuchmorethanadeathbenefit–italsooffersvaluable“livingbenefits”thatyoucanuseduringtimesofneed.AndyoucankeepyourWholeLifecoverageafteryouretire,makingitanessentialcomplementtoTermLifeInsurance.
Whatfeaturesareavailable?
• Cashvalueatage65.Thispolicyaccumulatescashvalue.Youcanborrowfundsfromthisvalueasneeded• Livingbenefitoptionrider.Ifyouarediagnosedwithaterminalillness,youcanrequestupto100%ofyour
policy’sbenefitamountanduseitforanypurpose.
Howdoesitwork?
• Yourpremiumsarelevelforlife.Premiumswillbeconvenientlydeductedfromyourpaycheck.• Yourdeathbenefitislevel,too.Thebenefitdoesnotdecreasewithage.• Youownthepolicy.Youcankeepthepolicyifyouleaveorretire.You’llpaythesamepremium
ThreereasonstobuyWholeLifeatwork–now!
1. WholeLiferates.Theratesavailablethroughyouremployeraretypicallymoreaffordablethanthoseavailableelsewhere.
2. Age-basedpremiums.Premiumsarebasedonyouragewhenyoupurchase,anddoesn’tincreaseasyougetolder.Sotheearlieryoubuy,theloweryourpremiumwillbeforthelifeofyourpolicy
3. Guaranteedissue.Generallyavailableduringtheinitialenrollmentatyourworkplace.Whenit’sofferedtoyou,youcanpurchasecoverageuptoasetamount,withoutmedicalexamsorhealthquestions.Ifyoudon’tpurchasethemaximumamount,youhavetheoptiontoincreaseituptothatlevelduringfutureenrollmentswithnoquestionsasked!
Coverageisavailabletoyou,yourspouse,childrenandgrandchildren,evenifyouchoosenottoparticipate.Youownthepolicysoitisyourstokeepevenifyouchangejobsorretire.
EmployeeElectionAmountOptions: $15,000,$30,000,$40,000or$50,000
SpouseElectionAmountOptions: $10,000or$15,000
Child(ren)ElectionAmountOptions: $10,000or$15,000
• Guaranteedrenewabletoage120• Non-TobaccoandTobaccoRatesAvailable
FloridaBlue–Dental
11
BlueDentalChoice
CoveredServicesHighOption LowOption
InNetwork OutofNetwork InNetwork OutofNetwork
DeductibleIndividual:$50
FamilyMax:$150Basic&Majoronly
Individual:$50FamilyMax:$150Basic&Majoronly
Individual:$50FamilyMax:$150Basic&Majoronly
Individual:$50FamilyMax:$150Basic&Majoronly
AnnualMaximum $1,000 $750
OrthoMaximum $1,000LifetimeChild(ren)toage19 NONE
PreventiveServices 100%ofNegotiatedFees*
80%ofNegotiatedFees*
100%ofNegotiatedFees*
80%ofNegotiatedFees*
BasicServices 80%ofNegotiatedFees*
60%ofNegotiatedFees*
80%ofNegotiatedFees*
60%ofNegotiatedFees*
MajorServices 50%ofNegotiatedFees*
40%ofNegotiatedFees*
25%ofNegotiatedFees*
25%ofNegotiatedFees*
Orthodontics*** 50%ofNegotiatedFees*
50%ofNegotiatedFees** 0% 0%
Fillings Basic Basic
Endo/Periodontal Basic Basic
ChildEligibilityAges Uptoage26regardlessofstudentstatus Uptoage26regardlessofstudentstatus
SampleNegotiatedFees SampleNegotiatedFees
0120PeriodicOralEvaluation
$27 $27
1110Prophylaxis $59 $59
0272Bitewings(2Films) $26 $26
2140Amalgam(OneSurface) $74 $74
3310RootCanal
$445 $445
2792Crown(FullCast) $638 $638
*NegotiatedFees-Feesthatparticipatingdentistshaveagreedtoacceptaspaymentinfullforservices**R&C-Reasonable&Customary-isbasedonthelowestof(1)thedentist’sactualcharge,(2)thedentist’susualchargeforthesameorsimilar services,or (3)thechargeofmostdentists inthesamegeographicareaforthe sameorsimilarservicesasdeterminedbyFloridaCombinedLife.***Paymentsareissuedoverspecifiedtime,notpaidasalumpsum.WaitingPeriod-Animportantnote:IfyouenrollnewintheDentalplan,youwillhavea12-monthwaitingperiodonMajorandOrthodonticservicesforthePremiumplan,andMajorservicesonlyontheStandardplan.IfyouhavethecurrentdentalplanandmovetotheStandardplan,youwillnothavethis12monthwaitingperiod.
FloridaBlue–DentalFAQ’s
12
DoesthePreferredDentistProgramofferanydiscountsonnon-coveredservices?Negotiated feesmay extend to services not coveredunderyour plan, and for services received after your planmaximum has been met, where permitted by applicablestate law. Ifpermitted,youmayonlyberesponsibleforthenegotiatedfee.
MayIchooseanon-participatingdentist?Yes.Youarealwaysfreetoselectthedentistofyourchoice.However,ifyouchooseanon-participatingdentist,yourout-of-pocket costsmay be higher. He or she hasn’t agreed toacceptnegotiatedfees. Therefore,youmayberesponsibleforanydifferenceincostbetweenthedentist'sfeeandyourplan'sbenefitpayment.
HowdoIfindaparticipatingdentist?There are thousands of general dentists and specialists tochoose from nationwide, so you are sure to find one whomeets your needs. To see a list of these participatingdentists, you can go to MyPutnamBenefits.com under theDental tab. Don’t see a dentist in your network? Send anemail to: [email protected] or fax yournominationto:(904)866-4846.
Howareclaimsprocessed?Dentistsmaysubmitclaimsforyou,whichmeansyouhavelittleornopaperwork.Youcantrackyourclaimsonlineandevenreceivee-mailalertswhenaclaimhasbeenprocessed.Ifyouneedaclaimform,youcangoto:MyPutnamBenefits.comandlookundertheDentaltab.
Can I find out what my out-of-pocket expenses will bebeforereceivingaservice?Yes.Youcanaskforapre-treatmentestimate.Yourgeneraldentist or specialist usually sends the company a plan foryourcareandrequestsanestimateofbenefits.Theestimatehelps you prepare for the cost of dental services. Werecommendthatyourequestapre-treatmentestimateforservicesinexcessof$300.
Simply have your dentist submit a request online. You andyour dentist will receive a benefit estimate for mostprocedureswhileyouarestillintheoffice.Actualpaymentsmay vary depending upon plan maximums, deductibles,frequencylimits,andotherconditionsattimeofpayment.
How does BlueDental Choice coordinate benefits withotherinsuranceplans?The coordination of benefits provision in dental benefitplansarea setof rules followedwhenapatient is coveredby more than one dental benefits plan. These rulesdeterminetheorder inwhich theplanswillpaybenefits. Ifthe BlueDental Choice dental benefit plan is primary,BlueDentalChoicewillpay the fullamountofbenefits thatwouldnormallybeavailableundertheplan.
If the BlueDental Choice dental benefit plan is secondary,most coordination of benefits provisions requires them todetermine benefits after benefits have been determinedunder theprimaryplan.TheamountofbenefitspayablebyFloridaCombinedmaybe reduceddue to thebenefitspaidundertheprimaryplan.
EyeMed–VisionCare
13
CoveredServices
In-Network Out-of-NetworkReimbursement
FrequencyEyeExamLensesFramesContacts
Every12Months
Every12Months
Every24Months
Every12Months
EyeExam $10Copay Upto$40
Spectacle/LensesSingleBifocalTrifocalLenticularLensTreatmentOptionsStandardProgressiveStandardanti-reflectiveUVcoatingTint(solid)Standardscratch-resistanceStandardpolycarbonateAdditionalPairBenefit
$15Copay
$15Copay
$15Copay
$15Copay
Memberpays$80
Memberpays$45
Memberpays$15
Memberpays$15
Memberpays$15
Memberpays$40
$0forKidsunderage19
40%Discountoffcomplete
pair
Upto$30
Upto$50
Upto$70
Upto$70
Upto$50
N/A
N/A
N/A
N/A
Upto$32
Kidsunderage19
NotCovered
Frames NoCopay
$130AllowanceUpto$91allowance
ContactLensesElective*MedicallyNecessary*ContactfittingfeeisnotincludedinAllowanceAdditionalPairBenefit
$130allowance
CoveredInFull
Upto$55feeforFitand
Follow-up
15%Discountoff
conventionalcontactlenses
oncethefundedbenefit
hasbeenused
Upto$130
Upto$210
Lasik15%offRetailPriceor5%
offpromotionalprice
throughUSLaserNetwork
DiscountsDoNotApply
ConsolidatedAdministrativeServices(CAS)-FSA
14
Howmuchwillyoupayout-of-pocketforhealthcareexpensesthisyear?Whether it’shundredsorthousands,youcansavemoneybypayingtheseexpenseswithtax-freemoney.Theseaccountsofferreimbursementforeligiblemedical,dentalandvision expenses not reimbursed by insurance, including deductibles, copays, prescriptions, orthodontic care, glasses,contacts,andevenLasiksurgery.
HealthcareFlexibleSpendingAccount(FSA)andDependentCareFlexibleSpendingAccount
WhatisaHealthcareFlexibleSpendingAccount(FSA)?
• AHealthcareFSAisanemployeebenefitprogramthatallowsyoutosetasidemoneyonapre-taxbasisforcertainkindsofcommon“outofpocket”medicalexpensesforyouandyoureligibledependents
• FSA’sdollarsdonotrolloverfromyeartoyear.Anymoneythatisunusedattheendoftheplanyearwillbeforfeited• YoucanonlychangecontributionelectionamountsduringopenenrollmentorduetoaQualifyingEvent• Distributionsforqualifiedexpensesaretax-freeWhatisaDependentCareFSA?
TheDependentCareFSA isdesignedforspecificsituations.YoucanelectaDependentCareFSAif youandyourspouse(ifmarried)areworkingorinschool,and:• Yourdependentchildrenunderage13attenddaycare,after-schoolcareorsummerdaycamp;or• Youprovidecareforapersonofanyagewhomyouclaimasadependentonyourfederalincometaxreturn,andwhois
mentallyorphysicallyincapableofcaringforhimselforherself.
HealthcareMaximumContribution: $2,550
DependentCareMaximumContribution: $5,000($2,500/eachifyouaremarriedandbothyouandyourspousecontributetoseparately)
DebitCards: ReceiveaplanDebitCardforparticipantand1additionalfamilymember
LostorStolenCardReplacementFee: $10.00percardchargedtoparticipant
AdditionalCardFee: $5.00percardchargedtoparticipant
RushedCardMailing(Overnight): $35.00percard
PlanYear: January1thruDecember31PlanYears
PlanRunOutPeriod: TheRunOutPeriodishowlongyouhavetofileaclaimformedicalcostsincurredduringtheplanyearandduringtheGracePeriodfollowingtheplanyear.TheRunOutPeriodlast90daysaftertheendoftheplanyear.
PlanGracePeriod: TheGracePeriodistheamountoftimeyouhavetoincurexpensesonce
yourplanyearends.Duringthe2-1/2monthGracePeriodclaimswithdatesofservicefromlastyearwillbereimbursedfromlastyear’sunusedbalanceamounts.Claimswithdatesofservicefromthenewplanyearwillbereimbursedfromthenewplanyear’selectedamount.TheGracePerioddoesnotextendthe90dayRunOutPeriod.
MetLife–CriticalIllnessInsurance
15
Insurancedesignedtohelpemployeesoffsetthefinancialeffectsofacatastrophicillnesswithalumpsumbenefitifaninsuredisdiagnosedwithacoveredcriticalillness.
CoverageAmountsEmployee GuaranteedIssueamountupto$20,000
Canelect$10,000or$20,000
Spouse/DomesticPartner GuaranteedIssueamountupto100%ofemployeeGuaranteeIssueCanelect$10,000or$20,000(100%ofemployeeamount).EmployeemustbeenrolledincoveragefortheirSpouse/DomesticPartnertobeenrolled.
Child GuaranteedIssueamountupto100%ofemployeeGuaranteeIssue
Canelect$10,000or$20,000(100%ofemployeeamount).EmployeemustbeenrolledincoveragefortheirdependentChild(ren)tobeenrolled.
CriticalIllnessesCoveredat100%FullBenefitCancer,HeartAttack,Stroke,CoronaryArteryBypassGraft,KidneyFailure,Alzheimer’sdisease,andMajorOrganTransplant.FirstOccurrenceBenefit Theinitialbenefitworksasfollows:
1) ForPartialBenefitCancer;25%oftheBenefitAmountwillbepaid2) ForListedCondition;25%oftheBenefitAmountwillbepaid.3) Forallothercoveredconditions;100%oftheBenefitAmountwillbepaid.
MetLifewillpaybenefitsuntiltheTotalBenefitAmountforeachcoveredpersonisreached.
Re-OccurrenceBenefit IfinsuredisdiagnosedwithanotheroccurrenceofcertaincoveredconditionsandMetLifehasalreadypaidtheInitialBenefitforthatcoveredcondition,aRecurrenceBenefitequalto100%oftheSelectedBenefitAmountwillbepaid.ARecurrenceBenefitpaymentissubjecttoa180-daybenefitsuspensionperiod.MetLifewillnotpayaRecurrenceBenefitforacoveredconditionthatrecursduringthisperiod.MetLifewillpaytheinitialbenefitamountandarecurrencebenefituntiltheTotalBenefitAmountof300%foreachcoveredpersonisreached.
Whentheemployeecoverageterminates,thespouse/domesticpartneranddependentchildrencoverageswillalsoterminate.
HealthScreeningBenefit Afteronemonthofcoverage,eachinsuredhasaHealthScreeningBenefitannually
of$50forthe10,000policyor$100forthe20,000policyCriticalIllnessesCoveredat25%CoronaryArteryBypass,SkinCancer,PermanentParalysis(ifduetostroke),CarcinomainSitu
MetLife–CriticalIllnessInsurance
16
Insurancedesignedtohelpemployeesoffsetthefinancialeffectsofacatastrophicillnesswithalumpsumbenefitifaninsuredisdiagnosedwithacoveredcriticalillness.
WhydoesCriticalIllnessInsurancemakessense?Criticalillnessinsurancecanhelpwithunexpectedexpensesthatmaynotbecoveredbyyourmedicalinsurance.Yourmedicalinsurancehelpscoveryourmedicalbillsifyougetsick.CriticalillnessInsurancecoversspecificconditionssuchascancer,heartattackorstroke.Plus,itprovidesalump-sumpaymentifyouarediagnosedwithacoveredconditionsoyoucanfocusonyourrecoveryinsteadofyourfinances.CriticalIllnessesCoveredat100%oftheInitialBenefitsAmount:FullBenefitCancer,HeartAttack,Stroke,CoronaryArteryBypassGraft,KidneyFailure,Alzheimer’sdisease;andMajorOrganTransplant
CriticalIllnessesCoveredat25%oftheInitialBenefitsAmountfor22conditions:Addison’sdisease(adrenalhypofunction);amyotrophiclateralsclerosis(LouGehrig’sdisease);cerebrospinalmeningitis(bacterial);cerebralpalsy;cysticfibrosis;diphtheria;encephalitis;Huntington’sdisease(Huntington’schorea);Legionnaire’sdisease;malaria;multiplesclerosis(definitivediagnosis);musculardystrophy;myastheniagravis;necrotizingfasciitis;osteomyelitis;poliomyelitis;rabies;sicklecellanemia(excludingsicklecelltrait);systemiclupuserythematosus(SLE);systemicsclerosis(scleroderma);tetanus;andTuberculosis.
TheHealthScreeningBenefitcoveredtestsare:
• Bloodtesttodeterminetotalcholesterol;bloodtesttodeterminetriglycerides;breastNRI;breastsonogram;breastultrasound;carotidDoppler;colonoscopy;digitalrectalexam(DRE);electrocardiogram(EKG);endoscopy;fastingbloodglucosetest;fastingplasmaglucosetest;flexiblesigmoidoscopy;hemocultstoolspecimen;mammogram;papsmearsorthinpreppaptest;testonbicycleortreadmill;twohourpost-loadplasmaglucosetest;orvirtualcolonoscopy.
• MTresidentswillhaveaseparatemammogrambenefit.• Wewillonlypayonehealthscreeningbenefitpercoveredpersonpercalendaryear.
HowToEnroll
17
VisitMyPutnamBenefits.comandClickontheblue“MyPersonalBenefits”portalbutton.
StepONE:
Toaccesstheenrollmentsystemausernameandpasswordwillbeneeded.Username=Uptofirst6lettersoflastname,firstletteroffirstnameandlast4numbersofSocialSecurityNumber(Example–JohnSmith111-22-3333;UserNameissmithj3333)Password=SocialSecurityNumberwithoutdashes(Example–111-22-3333;Passwordis111223333)
StepTWO:
Afterinitialaccess,3securityquestionsmustbeansweredandanewpasswordcreated.
StepTHREE:
HowToEnroll
18
FollowpromptstotheWelcomepageandthentoupdatePersonalInformationandDependents/Beneficiaries.Tocoveraspouseorchild(ren),enterthemasdependents.Next,continuethrougheachbenefit,checkingtheboxtoselectorwaivecoverage.Theboxchangestoorangewhencheckedandsaved.
StepFOUR:
Aftercompletion,theConsolidatedEnrollmentFormwillshowyourcurrentenrollmentelectionsineffectnowfor2015,andyourfuturebenefitselectionseffectiveJanuary1,2016.AtthebottomofthepageyoucanPrintorEmailyourselfacopyoftheenrollmentform.MakesuretoclickFinishtocompleteyourenrollment.
StepFIVE:
EmployeeNotices
19
PutnamCountySchoolDistrict,200ReidStreet,Palatka,FL32177
IMPORTANTINFORMATION
November30,2015
Employee&EligibleBeneficiaries,
AsanemployeeofPutnamCountySchoolDistrictandparticipantinouremployeebenefitprograms,youandyourbeneficiariesmayhavevariousrightsandprivilegesrelatedtotheseprograms.Lawsgoverninghealthcarerequireustoprovideyouwiththesenotifications.Listedbelowareimportantnoticestoretainforyourrecords.Inthepast,manyofthesenoticesweresentindividuallyandarenowgroupedtogethertomoreclearlycommunicateyourrights,andtosimplifydistribution.IfyouhaveanyquestionspleasecontactTammyCollins,BenefitsSpecialist,PutnamCountySchoolDistrict:(386)329-0661
NOTIFICATIONS
HIPAA
TheHealthInsurancePortabilityandAccountabilityActof1996(HIPAA)requiresthatwenotifyyouaboutimportantprovisionsintheplan.Youhavetherighttoenrollintheplanunderits"specialenrollmentprovision"ifyoumarry,acquireanewdependent,orifyoudeclinecoverageundertheplanforaneligibledependentwhileothercoverageisineffectandlaterthedependentlosesthatothercoverageforcertainqualifyingreasons.Specialenrollmentmusttakeplacewithin30daysofthequalifyingevent.Ifyouaredeclinedenrollmentforyourselforyourdependents(includingyourspouse)whilecoverageunderMedicaidorastateChildren'sHealthInsuranceProgram(CHIP)isineffect,youmaybeabletoenrollyourselfandyourdependentsinthisprogramifyouoryourdependentsloseeligibilityforthatothercoverage.However,youmustrequestenrollmentwithin60daysafteryouoryourdependents'MedicaidorCHIPcoverageends.Ifyouoryourdependents(includingyourspouse)becomeeligibleforastatepremiumassistancesubsidyfromMedicaidoraCHIPprogramwithrespecttocoverageunderthisplan,youmaybeabletoenrollyourselfandyourdependents(includingyourspouse)inthisplan.However,youmustrequestenrollmentwithin60daysafteryouoryourdependentsbecomeeligibleforthepremiumassistance.Torequestspecialenrollmentorobtainmoreinformation,contacttheplanadministratorindicatedinthisnotice.
EmployeeNotices
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HIPAANoticeofPrivacyPractices
TheHealthInsurancePortabilityandAccountabilityActof1996("HIPAA")requiresthatwemaintaintheprivacyofprotected
healthinformation,givenoticeofourlegaldutiesandprivacypracticesregardinghealthinformationaboutyouandfollow
thetermsofournoticecurrentlyineffect.
YoumayrequestacopyofthecurrentPrivacyPracticesfromthePlanAdministratorexplaininghowmedicalinformation
aboutyoumaybeusedanddisclosed,andhowyoucangetaccesstothisinformation.
AsRequiredbyLaw.WewilldiscloseHealthInformationwhenrequiredtodosobyinternational,federal,stateorlocallaw.
Youhavetherighttoinspectandcopy,righttoanelectroniccopyofelectronicmedicalrecords,righttogetnoticeofa
breach,righttoamend,righttoanaccountingofdisclosures,righttorequestrestrictions,righttorequestconfidential
communications,righttoapapercopyofthisnoticeandtherighttofileacomplaintifyoubelieveyourprivacyrightshave
beenviolated.
CHIPRANOTICE-PremiumAssistanceUnderMedicaidandtheChildren’sHealthInsuranceProgramReauthorizationAct(CHIPRA)
IfyouoryourchildrenareeligibleforMedicaidorCHIPandyouareeligibleforhealthcoveragefromyouremployer,your
Statemayhaveapremiumassistanceprogramthatcanhelppayforcoverage,usingfundsfromtheirMedicaidorCHIP
programs.Ifyouoryourchildrenaren’teligibleforMedicaidorCHIP,youwillnotbeeligibleforthesepremiumassistance
programsbutyoumaybeabletobuyindividualinsurancecoveragethroughtheHealthInsuranceMarketplace.Formore
information,visitwww.healthcare.gov.
IfyouoryourdependentsarealreadyenrolledinMedicaidorCHIPandyouliveinanyofthestate’slisthere,contactyour
stateMedicaidorCHIPofficetofindoutifpremiumassistanceisavailable.Ifyouliveinoneofthefollowingstates,youmay
beeligibleforassistancepayingyouremployerhealthplanpremiums.
ALABAMA–MedicaidWebsite:http://www.medicaid.alabama.govPhone:1-855-692-5447,ALASKA–MedicaidWebsite:
http://health.hss.state.ak.us/dpa/programs/medicaid/Phone(OutsideofAnchorage):1-888-318-8890Phone(Anchorage):
907-269-6529,
ARIZONA–CHIPWebsite:http://www.azahcccs.gov/applicantsPhone(OutsideofMaricopaCounty):1-877-764-5437Phone
(MaricopaCounty):602-417-5437,
COLORADO–MedicaidWebsite:http://www.colorado.gov/MedicaidPhone(Instate):1-800-866-3513MedicaidPhone
(Outofstate):1-800-221-3943,
FLORIDA–MedicaidWebsite:https://www.flmedicaidtplrecovery.com/Phone:1-877-357-3268,
GEORGIA–MedicaidWebsite:http://dch.georgia.gov/-ClickonPrograms,thenMedicaid,thenHealthInsurancePremium
Payment(HIPP)Phone:1-800-869-1150,
IDAHO–MedicaidWebsite:
http://healthandwelfare.idaho.gov/Medical/Medicaid/PremiumAssistance/tabid/1510/Default.aspxMedicaidPhone:1-800-
926-2588,
EmployeeNotices
21
INDIANA–MedicaidWebsite:http://www.in.gov/fssaPhone:1-800-889-9949,IOWA–MedicaidWebsite:www.dhs.state.ia.us/hipp/Phone:1-888-346-9562,KANSAS–MedicaidWebsite:http://www.kdheks.gov/hcf/Phone:1-800-792-4884,KENTUCKY–MedicaidWebsite:http://chfs.ky.gov/dms/default.htmPhone:1-800-635-2570,LOUISIANA–MedicaidWebsite:http://www.lahipp.dhh.louisiana.govPhone:1-888-695-2447,MAINE–MedicaidWebsite:http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone:1-800-977-6740TTY1-800-977-6741,MASSACHUSETTS–MedicaidandCHIPWebsite:http://www.mass.gov/MassHealthPhone:1-800-462-1120,MINNESOTA–MedicaidWebsite:http://www.dhs.state.mn.us/ClickonHealthCare,thenMedicalAssistancePhone:1-800-657-3629,MISSOURI–MedicaidWebsite:http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone:573-751-2005,MONTANA–MedicaidWebsite:http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtmlPhone:1-800-694-3084,NEBRASKA–MedicaidWebsite:www.ACCESSNebraska.ne.govPhone:1-855-632-7633,NEVADA–MedicaidWebsite:http://dwss.nv.gov/MedicaidPhone:1-800-992-0900,NEWHAMPSHIRE–MedicaidWebsite:http://www.dhhs.nh.gov/oii/documents/hippapp.pdfPhone:603-271-5218,NEWJERSEY–MedicaidandCHIPMedicaidWebsite:http://www.state.nj.us/humanservices/dmahs/clients/medicaid/MedicaidPhone:609-631-2392CHIPWebsite:http://www.njfamilycare.org/index.htmlCHIPPhone:1-800-701-0710,NEWYORK–MedicaidWebsite:http://www.nyhealth.gov/health_care/medicaid/Phone:1-800-541-2831,NORTHCAROLINA–MedicaidWebsite:http://www.ncdhhs.gov/dmaPhone:919-855-4100,NORTHDAKOTA–MedicaidWebsite:http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone:1-800-755-2604,OKLAHOMA–MedicaidandCHIPWebsite:http://www.insureoklahoma.orgPhone:1-888-365-3742,OREGON–MedicaidWebsite:http://www.oregonhealthykids.govhttp://www.hijossaludablesoregon.govPhone:1-800-699-9075,PENNSYLVANIA–MedicaidWebsite:http://www.dpw.state.pa.us/hippPhone:1-800-692-7462,RHODEISLAND–MedicaidWebsite:www.ohhs.ri.govPhone:401-462-5300,SOUTHCAROLINA–MedicaidWebsite:http://www.scdhhs.govPhone:1-888-549-0820,SOUTHDAKOTA–MedicaidWebsite:http://dss.sd.govPhone:1-888-828-0059,TEXAS–MedicaidWebsite:https://www.gethipptexas.com/Phone:1-800-440-0493,UTAH–MedicaidandCHIPWebsite:http://health.utah.gov/uppPhone:1-866-435-7414,VERMONT–MedicaidWebsite:http://www.greenmountaincare.org/Phone:1-800-250-8427,VIRGINIA–MedicaidandCHIPMedicaidWebsite:http://www.coverva.org/programs_premium_assistance.cfmMedicaidPhone:1-800-432-5924CHIPWebsite:http://www.coverva.org/programs_premium_assistance.cfmCHIPPhone:1-855-242-8282,WASHINGTON–MedicaidWebsite:http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspxPhone:1-800-562-3022ext.15473,WESTVIRGINIA–MedicaidWebsite:www.dhhr.wv.gov/bms/Phone:1-877-598-5820,HMSThirdPartyLiability,WISCONSIN–MedicaidWebsite:http://www.badgercareplus.org/pubs/p-10095.htmPhone:1-800-362-3002,WYOMINGWebsite:http://health.wyo.gov/healthcarefin/equalitycarePhone:307-777-7531.ThelistofStatesofferingapremiumassistanceprogramiscurrentasofJuly31,2014.StatesofferingCHIPassistancemaychangewithoutnotice.
EmployeeNotices
22
Formoreinformationonspecialenrollmentrights,ortoverifyifanyotherStatenowofferspremiumassistance,contacteither:U.S.DepartmentofLaborEmployeeBenefitSecurityAdministrationwww.dol.gov/ebsa1-866-444-EBSA(3272),U.S.DepartmentofHealthandHumanServicesCentersforMedicare&MedicaidServiceswww.cms.hhs.gov1-877-267-2323,MenuOption4,Ext.61565
IfyouoryourdependentsareNOTcurrentlyenrolledinMedicaidorCHIP,andyouthinkyouoranyofyourdependentsmightbeeligibleforeitheroftheseprograms,youcancontactyourStateMedicaidorCHIPofficeordial1-877-KIDSNOWorwww.insurekidsnow.govtofindouthowtoapply.Ifyouqualify,askyourStateifithasaprogramthatmighthelpyoupaythepremiumsforanemployer-sponsoredplan.
OnceitisdeterminedthatyouoryourdependentsareeligibleforpremiumassistanceunderMedicaidorCHIP,aswellaseligibleunderyouremployerplan,youremployermustpermityoutoenrollinyouremployerplanifyouarenotalreadyenrolled.Thisiscalleda“specialenrollment”opportunity,andyoumustrequestcoveragewithin60daysofbeingdeterminedeligibleforpremiumassistance.Ifyouhavequestionsaboutenrollinginyouremployerplan,youcancontacttheDepartmentofLaborelectronicallyatwww.askebsa.dol.govorbycallingtoll-free1-866-444-EBSA(3272).
WHCRA
TheWomen'sHealthandCancerRightsAct(WHCRA)of1998,providesbenefitsformastectomy-relatedservicesincludingreconstructionandsurgerytoachievesymmetrybetweenthebreasts,prostheses,andcomplicationsresultingfromamastectomy(includinglymphedema).Callyourhealthinsuranceissuerformoreinformation.
ThisnoticeinformsyouoftheFederalregulationthatrequiresallhealthplansthatcovermastectomiestoalsocoverreconstructionoftheremovedbreast.Ifyouhavehadoraregoingtohaveamastectomy,youmaybeentitledtocertainbenefits.Forindividualsreceivingmastectomy-relatedbenefits,coveragewillbeprovidedinamannerdeterminedinconsultationwiththeattendingphysicianandthepatient,for:
• Allstagesofreconstructionofthebreastonwhichthemastectomywasperformed;• Surgeryandreconstructionoftheotherbreasttoproduceasymmetricalappearance;• Prostheses;and• Treatmentofphysicalcomplicationsofthemastectomy,includinglymphedemas.
NMHPA
Newborns'andMothers'HealthProtectionActrequiresthatgrouphealthplansandhealthinsuranceissuerswhoofferchildbirthcoveragegenerallymaynot,underfederallaw,restrictbenefitsforanyhospitallengthofstayinconnectionwithchildbirthforthemotherornewbornchildtolessthan48hoursfollowingavaginaldelivery,orlessthan96hoursfollowingacesareansection.However,federallawgenerallydoesnotprohibitthemother'sornewborn'sattendingprovider,afterconsultingwiththemother,fromdischargingthemotherorhernewbornearlierthan48hours(or96hoursasapplicable).Inanycase,plansandissuersmaynot,underfederallaw,requirethataproviderobtainauthorizationfromtheplanortheissuerforprescribingalengthofstaynotinexcessof48hours(or96hours).Refertoyourplandocumentforspecificinformationaboutchildbirthcoverageorcontactyourplanadministrator.
EmployeeNotices
23
ForadditionalinformationaboutNMHPAprovisionsandhowSelf-fundednonFederalgovernmentalplansmayopt-outoftheNMHPArequirements,visithttp://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/nmhpa_factsheet.html.
USERRA
TheUniformedServicesEmploymentandReemploymentRightsAct(USERRA),protectsthejobrightsofindividualswhovoluntarilyorinvoluntarilyleaveemploymentpositionstoundertakemilitaryserviceorcertaintypesofserviceintheNationalDisasterMedicalSystem.USERRAalsoprohibitsemployersfromdiscriminatingagainstpastandpresentmembersoftheuniformedservices,andapplicantstotheuniformedservices.
ReemploymentRights
Youhavetherighttobereemployedinyourcivilianjobifyouleavethatjobtoperformserviceintheuniformedserviceand:• Youensurethatyouremployerreceivesadvancewrittenorverbalnoticeofyourservice;• Youhavefiveyearsorlessofcumulativeserviceintheuniformedserviceswhilewiththatparticularemployer;• Youreturntoworkorapplyforreemploymentinatimelymannerafterconclusionofservice;and• Youhavenotbeenseparatedfromservicewithadisqualifyingdischargeorunderotherthanhonorableconditions.
Ifyouareeligibletobereemployed,youmustberestoredtothejobandbenefitsyouwouldhaveattainedifyouhadnotbeenabsentduetomilitaryserviceor,insomecases,acomparablejob.
RightToBeFreeFromDiscriminationandRetaliation
Ifyouareapastorpresentmemberoftheuniformedservice;haveappliedformembershipintheuniformedservice;orareobligatedtoserveintheuniformedservice;thenanemployermaynotdenyyou:initialemployment;reemployment;retentioninemployment;promotion;oranybenefitofemploymentbecauseofthisstatus.Inaddition,anemployermaynotretaliateagainstanyoneassistingintheenforcementofUSERRArights,includingtestifyingormakingastatementinconnectionwithaproceedingunderUSERRA,evenifthatpersonhasnoserviceconnection.
HealthInsuranceProtection
Ifyouleaveyourjobtoperformmilitaryservice,youhavetherighttoelecttocontinueyourexistingemployer-basedhealthplancoverageforyouandyourdependentsforupto24monthswhileinthemilitary.Evenifyoudon'telecttocontinuecoverageduringyourmilitaryservice,youhavetherighttobereinstatedinyouremployer'shealthplanwhenyouarereemployed,generallywithoutanywaitingperiodsorexclusions(e.g.,pre-existingconditionexclusions)exceptforservice-connectedillnessesorinjuries.
Enforcement
TheU.S.DepartmentofLabor,VeteransEmploymentandTrainingService(VETS)isauthorizedtoinvestigateandresolvecomplaintsofUSERRAviolations.Forassistanceinfilingacomplaint,orforanyotherinformationonUSERRA,contactVETSat1-866-4-USA-DOLorvisititswebsiteathttp://www.dol.gov/vets.AninteractiveonlineUSERRAAdvisorcanbeviewedathttp://www.dol.gov/elaws/userra.htm.IfyoufileacomplaintwithVETSandVETSisunabletoresolveit,youmayrequestthatyourcasebereferredtotheDepartmentofJusticeortheOfficeofSpecialCounsel,asapplicable,forrepresentation.YoumayalsobypasstheVETSprocessandbringacivilactionagainstanemployerforviolationsofUSERRA.
EmployeeNotices
24
GINA
TheGeneticInformationNondiscriminationActof2008(GINA)prohibitsemployersandotherentitiescoveredbyGINATitle
IIfromrequestingorrequiringgeneticinformationofanindividualorfamilymemberoftheindividual,exceptasspecifically
allowedbythislaw.Tocomplywiththislaw,weareaskingthatyounotprovideanygeneticinformationwhenresponding
toanyrequestsformedicalinformation,ifapplicable.‘Geneticinformation,’asdefinedbyGINA,includesanindividual’s
familymedicalhistory,theresultsofanindividual’sorfamilymember’sgenetictests,thefactthatanindividualoran
individual’sfamilymembersoughtorreceivedgeneticservices,andgeneticinformationofafetuscarriedbyanindividualor
anindividual’sfamilymemberoranembryolawfullyheldbyanindividualorfamilymemberreceivingassistivereproductive
services.
QMCSO(QualifiedMedicalChildSupportOrder)
QMCSOisamedicalchildsupportorderissuedunderstatelawthatcreatesorrecognizestheexistenceofan“alternate
recipient’s”righttoreceivebenefitsforwhichaparticipantorbeneficiaryiseligibleunderagrouphealthplan.An“alternate
recipient”isanychildofaparticipant(includingachildadoptedbyorplacedforadoptionwithaparticipantinagroup
healthplan)whoisrecognizedunderamedicalchildsupportorderashavingarighttoenrollmentunderagrouphealthplan
withrespecttosuchparticipantisanalternaterecipient.Uponreceipt,theadministratorofagrouphealthplanisrequired
todetermine,withinareasonableperiodoftime,whetheramedicalchildsupportorderisqualified,andtoadminister
benefitsinaccordancewiththeapplicabletermsofeachorderthatisqualified.Intheeventyouareservedwithanoticeto
providemedicalcoverageforadependentchildastheresultofalegaldetermination,youmayobtaininformationfromyour
employer;knowtherulesforseekingtoenactsuchcoverage.Theserulesareprovidedatnocosttoyouandmaybe
requestedfromyouremployeratanytime.
RESCISSIONS
TheAffordableCareActprohibitstherescissionofhealthplancoverageexceptforfraudorintentionalmisrepresentationof
amaterialfact.Arescissionofaperson’shealthplancoveragemeansthatwewouldtreatthatpersonasneverhavinghad
thecoverage.Theprohibitiononrescissionsappliestogrouphealthplans,includinggrandfatheredplans,effectiveforplan
yearsbeginningonorafterSeptember23,2010.
Regulationsprovidethatarescissionincludesanyretroactiveterminationsorretroactivecancellationsofcoverageexceptto
theextentthattheterminationorcancellationisduetothefailuretotimelypaypremiums.Rescissionsareprohibited
exceptinthecaseoffraudorintentionalmisrepresentationofamaterialfact.Forexample,ifanemployeeisenrolledinthe
planandmakestherequiredcontributions,thentheemployee’scoveragemaynotberescindedifitislaterdiscoveredthat
theemployeewasmistakenlyenrolledandwasnoteligibletoparticipate.Ifamistakewasmade,andtherewasnofraudor
intentionalmisrepresentationofamaterialfact,thentheemployee’scoveragemaybecancelledprospectivelybutnot
retroactively.
EmployeeNotices
25
Shouldamember’scoverageberescinded,thenthemembermustbeprovided30daysadvancewrittennoticeofthe
rescission.Thenoticemustalsoincludethemember’sappealrightsasrequiredbylawandasprovidedinthemember’splan
benefitdocuments.Pleasebeawarethatifyourescindamember’scoverage,youmustprovidethepropernoticetothe
member.
TheIFRsonrescissioncanbefoundatthefollowingInternetlink:http://edocket.access.gpo.gov/2010/2010-15278.htm;
withaclarifyingFAQonrescissionsathttp://www.dol.gov/ebsa/faqs/faq-aca2.html.
PREVENTIVECARE
Healthplanswillprovidein-network,first-dollarcoverage,withoutcost-sharing,forpreventativeservicesandimmunizations
asdeterminedunderhealthcarereformregulations.Theseinclude,butarenotlimitedto,cancerscreenings,well-baby
visitsandinfluenzavaccines.Foracompletelistofcoveredservices,pleasevisit:
www.healthcare.gov/law/about/provisions/services/lists.html.
WOMEN'SPREVENTIVEHEALTHSERVICES
Allofthefollowingwomen’shealthserviceswillbeconsideredpreventive(somewerealreadycovered).Theseservices
generallywillbecoveredatnocostshare,whenprovidedin-network:
• Well-womanvisits(annually)
• Prenatalvisits(routinepreventivevisits)
• Screeningforgestationaldiabetes
• Humanpapillomavirus(HPV)DNAtesting
• Counselingforsexuallytransmittedinfections
• Counselingandscreeningforhumanimmunodeficiencyvirus(HIV)
• Screeningandcounselingforinterpersonalanddomesticviolence
• Breastfeedingsupport,suppliesandcounseling
• Genericformularycontraceptives,certainbrandformularycontraceptives,andFDA-approved,over-the-counter
femalecontraceptiveswithprescriptionarecoveredwithoutmembercostshare(forexample,nocopayment).
Certainreligiousorganizationsorreligiousemployersmaybeexemptfromofferingcontraceptiveservices.
MHPA/MHPAEA
MentalHealthParityandAddictionEquityAct(MHPA/MHPAEA)requirethatgrouphealthplansnotunfairlyrestrict
treatmentwithregardstobenefits/servicesapplicabletomentalhealthorsubstanceusedisorders.Additionalinformation
anddetailscanbefoundbyvisitingtheDepartmentofLabor'sMentalHealthParitywebpagelocateat
http://www.dol.gov/ebsa/newsroom/fsmhpaea.html.
EmployeeNotices
26
FMLA
FamilyMedicalLeaveAct(FMLA)entitleseligibleemployeesofcoveredemployerstotakeunpaid,job-protectedleaveforspecificfamilyandmedicalreasonsiftheemployeehasbeenwiththecompanyforoneyear,hasworkedatleast1250hoursduringtheprior12monthsandworksinanareawherethereareatleast50employeeswithin75miles.Publicagenciesaswellaspublicandprivatesecondaryschoolsarecoveredemployerswithoutregardtothenumberofemployeesemployed.Foradditionaldetails,visittheDepartmentofLaborFMLApage.Notifytheorganizationwhenyouhaveaqualifyingleavesuchasbirthoradoptionofachild,aserioushealthcondition,tocareforaspouse,childorparentwithaseriousmedicalconditionorforreservistorNationalGuardprovisionsrelatedtoyouoranimmediatefamilymemberleavingformilitarydutyorbeinginjuredinactiveduty.
COBRANOTICE
ThisnoticehasimportantinformationaboutyourrighttoCOBRAcontinuationcoverage,whichisatemporaryextensionofcoverageunderthecompanyplan.ThisnoticeexplainsCOBRAcontinuationcoverage,whenitmaybecomeavailabletoyouandyourfamily,andwhatyouneedtodotoprotectyourrighttogetit.WhenyoubecomeeligibleforCOBRA,youmayalsobecomeeligibleforothercoverageoptionsthatmaycostlessthanCOBRAcontinuationcoverage.
TherighttoCOBRAcontinuationcoveragewascreatedbyaFederallaw,theConsolidatedOmnibusBudgetReconciliationActof1985(COBRA).COBRAcontinuationcoveragecanbecomeavailabletoyouwhenyouwouldotherwiseloseyourgrouphealthcoverage.ItcanalsobecomeavailabletoothermembersofyourfamilywhoarecoveredunderthePlanwhentheywouldotherwiselosetheirgrouphealthcoverage.FormoreinformationaboutyourrightsandobligationsunderthePlanandunderfederallaw,youshouldreviewthePlan’sSummaryPlanDescriptionorcontactthePlanAdministrator.
Youmayhaveotheroptionsavailabletoyouwhenyoulosegrouphealthcoverage.Forexample,youmaybeeligibletobuyanindividualplanthroughtheHealthInsuranceMarketplace.ByenrollingincoveragethroughtheMarketplace,youmayqualifyforlowercostsonyourmonthlypremiumsandlowerout-of-pocketcosts.Additionally,youmayqualifyfora30-dayspecialenrollmentperiodforanothergrouphealthplanforwhichyouareeligible(suchasaspouse’splan),evenifthatplangenerallydoesn’tacceptlateenrollees.
WhatisCOBRAcontinuationCoverage?
COBRAcontinuationcoverageisacontinuationofplancoveragewhencoveragewouldotherwiseendbecauseofalifeeventknownasa"qualifyingevent."You,yourspouse,andyourdependentchildrencouldbecomequalifiedbeneficiariesifcoverageundertheplanislostbecauseofthequalifyingevent.Undertheplan,qualifiedbeneficiarieswhoelectCOBRAcontinuationcoveragemustpayforCOBRAcontinuationcoverage.EmployeesandtheirqualifieddependentsareresponsiblefornotifyingtheCompanyofanychangeinaddressorstatus(e.g.,divorce,insuranceeligibility,childbecomingineligibleduetoage,etc.)within30daysoftheevent.
Ifapplicable,yourparticipationintheHealthFlexibleSpendingAccountcanalsocontinueonanafter-taxbasisthroughtheremainderofthePlanYearinwhichyouqualifyforCOBRA.Theopportunitytoelectthesamecoveragethatyouhadatthetimethequalifyingeventoccurredextendstoallqualifiedbeneficiaries.
EmployeeNotices
27
IfyoumakecontributionstotheHealthFlexibleSpendingAccountfortheyearinwhichyourqualifyingeventoccurs,youmaycontinuetomakethesecontributionsonanafter-taxbasis.Thisway,youcanbereimbursedforcertainmedicalexpensesyouincurafteryourqualifyingevent,butbeforetheendofthePlanYear.
YoumaybeofferedtocontinueyourcoverageundertheHealthFlexibleSpendingAccountifyouhavenotoverspentyouraccount.Thedeterminationofwhetheryouraccountforaplanyearisoverspentorunderspentasofthedateofthequalifyingeventdependsonthreevariables:(1)theelectedannuallimitforthequalifiedbeneficiaryforthePlanYear(e.g.,$2,550ofcoverage);(2)thetotalreimbursableclaimssubmittedtotheCafeteriaPlanforthatplanyearbeforethedateofthequalifyingevent;and(3)themaximumamountthattheCafeteriaPlanispermittedtorequiretobepaidforCOBRAcoveragefortheremainderoftheplanyear.Theelectedannuallimitlesstheclaimssubmittedisreferredtoasthe“remainingannuallimit.”IftheremainingannuallimitislessthanthemaximumCOBRApremiumthatcanbechargedfortherestoftheyear,thentheaccountisoverspent.Youmaynotre-enrollintheHealthFlexibleSpendingAccountduringanyannualenrollmentforanyPlanYearthatfollowsyourqualifyingevent.
Supportingdocumentationlikeadivorcedecree,deathcertificate,proofofotherinsurancemayberequiredasproofofaqualifyingevent.
ThisgeneralnoticedoesnotfullydescribeCOBRAortheplan.Morecompleteinformationisavailablefromtheplanadministratorandinthesummaryplandocument.
Ifyouareanemployee,youwillbecomeaqualifiedbeneficiaryifyouloseyourcoverageunderthePlanbecauseeitheroneofthefollowingqualifyingeventshappens:
• Yourhoursofemploymentarereduced,or• Youremploymentendsforanyreasonotherthanyourgrossmisconduct.
Ifyouarethespouseofanemployee,youwillbecomeaqualifiedbeneficiaryifyouloseyourcoverageunderthePlanbecauseanyofthefollowingqualifyingeventshappens:
• Yourspousedies;• Yourspouse'shoursofemploymentarereduced;• Yourspouse'semploymentendsforanyreasonotherthanhisorhergrossmisconduct;• YourspousebecomesentitledtoMedicarebenefits(underPartA,PartB,orboth);or• Youbecomedivorcedorlegallyseparatedfromyourspouse.
YourdependentchildrenwillbecomequalifiedbeneficiariesiftheylosecoverageunderthePlanbecauseanyofthefollowingqualifyingeventshappens:
• Theparent-employeedies;• Theparent-employee'shoursofemploymentarereduced;• Theparent-employee'semploymentendsforanyreasonotherthanhisorhergrossmisconduct;• Theparent-employeebecomesentitledtoMedicarebenefits(PartA,PartB,orboth);• Theparentsbecomedivorcedorlegallyseparated;or• Thechildstopsbeingeligibleforcoverageundertheplanasadependentchild.
EmployeeNotices
28
WhenisCOBRACoverageAvailable?
ThePlanwillofferCOBRAcontinuationcoveragetoqualifiedbeneficiariesonlyafterthePlanAdministratorhasbeen
notifiedthataqualifyingeventhasoccurred.Whenthequalifyingeventistheendofemploymentorreductionofhoursof
employment,deathoftheemployee,ortheemployeebecomingentitledtoMedicarebenefits(underPartA,PartB,or
both),theemployeemustnotifythePlanAdministratorofthequalifyingevent.
HowisCOBRACoverageProvided?
OncethePlanAdministratorreceivesnoticethataqualifyingeventhasoccurred,COBRAcontinuationcoveragewillbe
offeredtoeachofthequalifiedbeneficiaries.EachqualifiedbeneficiarywillhaveanindependentrighttoelectCOBRA
continuationcoverage.CoveredemployeesmayelectCOBRAcontinuationcoverageonbehalfoftheirspouses,andparents
mayelectCOBRAcontinuationcoverageonbehalfoftheirchildren.
COBRAcontinuationcoverageisatemporarycontinuationofcoverage.Whenthequalifyingeventisthedeathofthe
employee,theemployee'sbecomingentitledtoMedicarebenefits(underPartA,PartB,orboth),yourdivorceorlegal
separation,oradependentchild'slosingeligibilityasadependentchild,COBRAcontinuationcoveragelastsforuptoatotal
of36months.Whenthequalifyingeventistheendofemploymentorreductionoftheemployee'shoursofemployment,
andtheemployeebecameentitledtoMedicarebenefitslessthan18monthsbeforethequalifyingevent,COBRA
continuationcoverageforqualifiedbeneficiariesotherthantheemployeelastsuntil36monthsafterthedateofMedicare
entitlement.Forexample,ifacoveredemployeebecomesentitledtoMedicare8monthsbeforethedateonwhichhis
employmentterminates,COBRAcontinuationcoverageforhisspouseandchildrencanlastupto36monthsafterthedate
ofMedicareentitlement,whichisequalto28monthsafterthedateofthequalifyingevent(36monthsminus8months).
Otherwise,whenthequalifyingeventistheendofemploymentorreductionoftheemployee'shoursofemployment,
COBRAcontinuationcoveragegenerallylastsforonlyuptoatotalof18months.Therearetwowaysinwhichthis18-month
periodofCOBRAcontinuationcoveragecanbeextended.
Disabilityextensionof18-monthperiodofcontinuationcoverage
IfyouoranyoneinyourfamilycoveredunderthePlanisdeterminedbytheSocialSecurityAdministrationtobedisabled
andyounotifythePlanAdministratorinatimelyfashion,youandyourentirefamilymaybeentitledtoreceiveuptoan
additional11monthsofCOBRAcontinuationcoverage,foratotalmaximumof29months.Thedisabilitywouldhavetohave
startedatsometimebeforethe60thdayofCOBRAcontinuationcoverageandmustlastatleastuntiltheendofthe18-
monthperiodofcontinuationcoverage.DocumentationfromtheSocialSecurityadministrationcertifyingadisabilitywillbe
required.
Secondqualifyingeventextensionof18-monthperiodofcontinuationcoverage
Ifyourfamilyexperiencesanotherqualifyingeventwhilereceiving18monthsofCOBRAcontinuationcoverage,thespouse
anddependentchildreninyourfamilycangetupto18additionalmonthsofCOBRAcontinuationcoverage,foramaximum
of36months,ifnoticeofthesecondqualifyingeventisproperlygiventothePlan.Thisextensionmaybeavailabletothe
spouseandanydependentchildrenreceivingcontinuationcoverageiftheemployeeorformeremployeedies,becomes
entitledtoMedicarebenefits(underPartA,PartB,orboth),orgetsdivorcedorlegallyseparated,orifthedependentchild
stopsbeingeligibleunderthePlanasadependentchild,butonlyiftheeventwouldhavecausedthespouseordependent
childtolosecoverageunderthePlanhadthefirstqualifyingeventnotoccurred.
EmployeeNotices
29
ArethereothercoverageoptionsbesidesCOBRAContinuationCoverage?
Yes.InsteadofenrollinginCOBRAcontinuationcoverage,theremaybeothercoverageoptionsforyouandyourfamilythroughtheHealthInsuranceMarketplace,Medicaid,orothergrouphealthplancoverageoptions(suchasaspouse’splan)throughwhatiscalleda“specialenrollmentperiod.”SomeoftheseoptionsmaycostlessthanCOBRAcontinuationcoverage.Youcanlearnmoreaboutmanyoftheseoptionsatwww.healthcare.gov.
Ifyouhavequestions
QuestionsconcerningyourPlanoryourCOBRAcontinuationcoveragerightsshouldbeaddressedtotheplanadministratorindicatedaboveorinthesummaryplandescription.FormoreinformationaboutyourrightsundertheEmployeeRetirementIncomeSecurityAct(ERISA),includingCOBRA,thePatientProtectionandAffordableCareAct,andotherlawsaffectinggrouphealthplans,contactthenearestRegionalorDistrictOfficeoftheU.S.DepartmentofLabor’sEmployeeBenefitsSecurityAdministration(EBSA)inyourareaorvisitwww.dol.gov/ebsa.(AddressesandphonenumbersofRegionalandDistrictEBSAOfficesareavailablethroughEBSA’swebsite.)FormoreinformationabouttheMarketplace,visitwww.HealthCare.gov.
KeepyourPlaninformedofaddresschanges
Toprotectyourfamily’srights,letthePlanAdministratorknowaboutanychangesintheaddressesoffamilymembers.Youshouldalsokeepacopy,foryourrecords,ofanynoticesyousendtothePlanAdministrator.
MEDICAREPARTDNOTICE
MedicalPlan:UnitedHealthcare
AboutYourPrescriptionDrugCoverageandMedicare
ThisnoticehasinformationaboutyourcurrentprescriptiondrugcoverageandaboutyouroptionsunderMedicare'sprescriptiondrugcoverage.ThisinformationcanhelpyoudecidewhetherornotyouwanttojoinaMedicaredrugplan.Ifyouareconsideringjoining,youshouldcompareyourcurrentcoverage,includingwhichdrugsarecoveredatwhatcost,withthecoverageandcostsoftheplansofferingMedicareprescriptiondrugcoverageinyourarea.Informationaboutwhereyoucangethelptomakedecisionsaboutyourprescriptiondrugcoverageisattheendofthisnotice.
TherearetwoimportantthingsyouneedtoknowaboutyourcurrentcoverageandMedicare'sprescriptiondrugcoverage:
1.Medicareprescriptiondrugcoveragebecameavailablein2006toeveryonewithMedicare.YoucangetthiscoverageifyoujoinaMedicarePrescriptionDrugPlanorjoinaMedicareAdvantagePlan(likeanHMOorPPO)thatoffersprescriptiondrugcoverage.AllMedicaredrugplansprovideatleastastandardlevelofcoveragesetbyMedicare.Someplansmayalsooffermorecoverageforahighermonthlypremium.
2.WehavedeterminedtheprescriptiondrugcoverageofferedbyUnitedHealthcareis,onaverageforallplanparticipants,expectedtopayoutasmuchasstandardMedicareprescriptiondrugcoveragepaysandisthereforeconsideredCreditableCoverage.BecauseyourexistingcoverageisCreditableCoverage,youcankeepthiscoverageandnotpayahigherpremium(apenalty)ifyoulaterdecidetojoinaMedicaredrugplan.
EmployeeNotices
30
WhenCanYouJoinAMedicareDrugPlan?
YoucanjoinaMedicaredrugplanwhenyoufirstbecomeeligibleforMedicareandeachyearfromOctober15thtoDecember7th.Planparticipantsareeligibleiftheyarewithinthreemonthsofturningage65,arealready65yearsoldoriftheyaredisabled.
However,ifyouloseyourcurrentcreditableprescriptiondrugcoveragethroughnofaultofyourown,youwillalsobeeligibleforatwo(2)monthSpecialEnrollmentPeriod(SEP)tojoinaMedicaredrugplan.
WhatHappenstoyourCurrentCoverageifYouDecidetoJoinaMedicareDrugPlan?
IfyoudecidetojoinaMedicaredrugplan,yourcurrentcoveragewillnotbeaffected,andbenefitswillbecoordinatedwithMedicare.Refertoyourplandocumentsprovideduponeligibilityandopenenrollmentorcontactyourproviderortheplanadministratorforanexplanationand/orcopyoftheprescriptiondrugcoverageplanprovisions/optionsundertheplanavailabletoMedicareeligibleindividualswhenyoubecomeeligibleforMedicarePartDIndividuals.Visithttp://www.cms.hhs.gov/CreditableCoverage/whichoutlinestheprescriptiondrugplanprovisions/optionsMedicareeligibleindividualsmayhaveavailabletothemwhentheybecomeeligibleforMedicarePartD.
IfyoudodecidetojoinaMedicaredrugplanandcurrentcoverageisdropped,beawareyouandyourdependentswillbeabletogetthiscoverageback.Refertoplandocumentsorcontactyourproviderortheplanadministratorbeforemakinganydecisions.
Note:Ingeneral,differentguidelinesexistforretireesregardingcancelationofcoverageandtheabilitytogetthatcoverageback.Retireeswhoterminateorlosecoveragewillnotbeabletogetbackontheplanunlessspecificcontractlanguageorotheragreementexists.Contacttheplanadministratorfordetails.
WhenWillYouPayaHigherPremium(Penalty)toJoinaMedicareDrugPlan?
Youshouldalsoknowifyoudroporloseyourcurrentcoverageanddon'tjoinaMedicaredrugplanwithin63continuousdaysafteryourcurrentcoverageends,youmaypayahigherpremium(apenalty)tojoinaMedicaredrugplanlater.
Ifyougo63continuousdaysorlongerwithoutcreditableprescriptiondrugcoverage,yourmonthlypremiummaygoupbyatleast1%oftheMedicarebasebeneficiarypremiumpermonthforeverymonththatyoudidnothavethatcoverage.Forexample,ifyougo19monthswithoutcreditablecoverage,yourpremiummayconsistentlybeatleast19%higherthantheMedicarebasebeneficiarypremium.Youmayhavetopaythishigherpremium(apenalty)aslongasyouhaveMedicareprescriptiondrugcoverage.Inaddition,youmayhavetowaituntilthefollowingOctobertojoin.
Formoreinformationaboutthisnoticeoryourcurrentprescriptiondrugcoverage...
Contactthepersonlistedinthisnotificationsreport.Youwillgetthisnoticeeachyear.YouwillalsogetitbeforethenextMedicarepartDdrugplanenrollmentperiodandifthiscoveragechanges.Youalsomayrequestacopyofthisnoticeatanytime.
EmployeeNotices
31
FormoreinformationaboutyouroptionsunderMedicareprescriptiondrugcoverage...
MoredetailedinformationaboutMedicareplansthatofferprescriptiondrugcoverageisinthe"Medicare&You"handbook.You'llgetacopyofthehandbookinthemaileveryyearfromMedicare.YoumayalsobecontacteddirectlybyMedicaredrugplans.
FormoreinformationaboutMedicareprescriptiondrugcoverage:Visitwww.Medicare.gov
CallyourStateHealthInsuranceAssistanceProgram(seetheinsidebackcoverofyourcopyofthe"Medicare&You"handbookfortheirtelephonenumber)forpersonalizedhelp.
Call800-MEDICARE(800-633-4227).TTYusersshouldcall(877)486-2048.
Ifyouhavelimitedincomeandresources,extrahelppayingforMedicareprescriptiondrugcoverageisavailable.Forinformationaboutthisextrahelp,visitSocialSecurityonthewebatwww.socialsecurity.govorcall(800)772-1213(TTY1-800-325-0778).
RemembertokeepthisCreditableCoveragenotice.IfyoudecidetojoinoneoftheMedicaredrugplans,youmayberequiredtoprovideacopyofthisnoticewhenyoujointoshowwhetherornotyouhavemaintainedcreditablecoverageand,therefore,whetherornotyouarerequiredtopayahigherpremium(apenalty).
Putnam County School District
On Course for a Successful Future