2014 Enrollment Guide

Transcription

1 M e d i c a l D e n t a l V i s i o n L i f e L o n g t e r m d i s a b i l i t y r e t i r e m e n t for your well-being 2014 Enrollment Guide

2 Contents About Us... 1 Your C&MA Benefits Program... 2 What s New for Benefits Effective Dates... 4 Benefits At-a-Glance Chart... 4 Enrolling with Alliance Benefits... 5 Medical and Prescription Comparison Charts... 9 Your Dental Plan Benefit Your Vision Plan Benefit Your Life Insurance and Accidental Death & Dismemberment (AD&D) Options Your Long Term Disability Benefit Colonial Life Products Helpful Contact Information... 14

3 About Us Celebrating 20 Years of Service The Christian and Missionary Alliance (C&MA) developed a self-funded Health Plan in 1994 in order to provide competitive and affordable health plans for its pastors, missionaries, and employees of supporting organizations. Alliance Benefits became responsible for administration of the plan in January 1998 and in 1999 restructured to incorporate additional professionals to further serve the needs of the ministry. Alliance Benefits operates under the authority of the Benefit Board, established by General Council in The Benefit Board governs both the Health and Retirement Plans. Currently, we serve more than 2,300 active and retired employees enrolled in our health and life insurance plans. SELF-FUNDED The C&MA Health Plan is a self-funded church plan, whereby the Plan pays the claims with its own funds. We have contracted with several vendors to administer the processing of claims. Alliance Benefits then pays the claims processed through the vendor from the monthly premiums collected from Plan participants. MULTI-EMPLOYER Alliance Benefits serves many different employers who participate in the C&MA Health Plan. These employers include: the National Office, the Orchard Foundation, the Alliance Development Fund, Crown College, and hundreds of churches nationwide. Our Mission To serve The Christian and Missionary Alliance churches, supporting organizations, employees, and retirees by designing, implementing, and administering competitive, cost-effective group insurance and retirement programs. We honor God and achieve our mission by guiding our services with the following principles: COMPASSION RESPECT INTEGRITY 1

4 Your C&MA Benefits Program The Christian and Missionary Alliance is committed to providing benefits for your well-being. We understand the well-being of our workers is a vital component of achieving the Great Commission. Alliance Benefits plays a role by providing a range of health plans designed to fit the unique needs of those working in ministry needs that include affordable yet comparable rates with the ability to transfer your enrollment when you relocate to a new employer. Our health plans are designed with you in mind. WHY YOU ARE RECEIVING THIS GUIDE The purpose of this guide is to give you a summary view of the various health plans offered. It is designed to make it easy for you to: Learn about benefits offered Determine which benefits are right for you Take action by enrolling in a plan or make changes to the benefits you select WHAT YOU CAN DO Open enrollment is the period of time set up to allow employees to choose from the plans available to them. Typically, it is held at the end of each year. However, you must make your new elections no later than November 15, Any changes will take effect January 1, You may choose to: Start coverage if you don t have any Change from one plan to another per your employer s choices Choose which member tier to enroll in Add eligible family members to your plan AVAILABILITY OF PLANS This booklet is a summary of all plans offered through Alliance Benefits. Your employer may choose one or all of the plans to make available to you. I DO NOT IGNORE THIS WARNING Due to all the changes that have been made this year, every employee MUST re-enroll this year even if you are satisfied with your current plan. To avoid having your enrollment terminated you must have your reenrollment completed before November 15. See What s New for The annual open enrollment period is October 28 November 15. Your new plan enrollment elections will become effective on January 1. 2

5 What s New for 2014 To comply with Affordable Care Act (ACA), effective 2014, there are several changes to our plan design. Please read the information below to familiarize yourself with these changes. Due to the changes, every employee MUST re-enroll this year before November 15. PLAN Medical Plans HIGHLIGHTS Elimination of Plan A due to lower enrollment and added plans, Plan A is no longer available. Those currently enrolled in Plan A must choose another plan. Creation of two new plans we have created two new plan choices. One is a new HDHP plan to comply with the basic requirements for all health plans. The second is a new PPO plan to provide another affordable option. Plan name changes to make it easier to compare with the Federal and/or State exchanges, all plan names are changed. The new names are Gold PPO; Silver PPO; Silver HDHP; and Bronze HDHP. Every employee must choose a plan. Added tier rate option currently employees are offered tiers of: Employee; Employee+1; and Family. The new choices are: Employee; Employee+child(ren); Employee+spouse; and Family. For some enrolled in the Family tier, the Employee+child(ren) may be a better fit. No pre-existing conditions effective January 1, 2014 there are no pre-existing condition requirement and no need to show proof of Credible Coverage. Late enrollment changed from 6 months to 1 st of the month following 60 days from date of hire. Transplant surgery participants are required to go to a Blue Center for Quality Transplant facility. The plan will pay up to $10,000 to cover travel and lodging for the patient and spouse or companion. Transplants performed at any hospital other than an approved hospital will not be covered. THIS IS MANDATORY. See Blues Centers of Distinction for certain surgeries there is a lower percent of cost for the participant if performed in a Center of Distinction. THIS IS NOT MANDATORY. For detailed information please see the full Plan Document on Physical/Occupational therapy visits are now combined for a total of 60 visits per calendar year. Speech therapy visits are increased from 20 visits per calendar year to 30 visits. Adjust Hearing Test and Equipment Coverage The equipment coverage changed to $750 maximum per ear every two years with the cost not affecting the deductible. Prescriptions No deductible the $50/$100 deductible is eliminated for the PPO plans. Specialty medications specialty drugs must be purchased through mail order and use a specialty pharmacies. This is for Medco/ESI and NPS. 3

6 Benefit Effective Dates BENEFIT PLAN YEAR: The Benefit plan year begins on January of every year and ends in December. NEW EMPLOYEE: You are eligible for benefits on the first day of the month following your hire date. If your hire date is the first day of the month, you are eligible for benefits on that day. SPECIAL ENROLLMENT: When an eligible employee or dependent has an event that causes him/her to gain or lose eligibility for coverage outside of the Benefit Plan year, it is considered a special enrollment. The health insurance portability and Accountability Act (HIPAA) provides for special enrollment within 30 days after the qualifying event. Some examples of Qualifying Events include marriage, birth or adoption, and involuntary loss of other coverage. OPEN ENROLLMENT: Typically in the fall, Alliance Benefits begins its Open enrollment period. During this time you can enroll and make changes to your benefits. The changes will begin on January 1 of the new year. Benefits At-a-Glance TRADITIONAL PPO PLANS Gold PPO Plan the old Plan B is now called the Gold PPO Plan. It has the same deductibles, out-of-pocket, and co-pays as Plan B did. Pays 80% after deductible with $25 and $35 co-pays. Silver PPO this is a brand new PPO plan designed to provide another option for those desiring a traditional PPO plan with deductibles, out-of-pocket, and co-pays. Pays 75% after deductible with $35 and $45 co-pays. HDHP PLANS Silver HDHP comparable to the old HDHP plan with slightly higher deductible and out-of-pocket. Pays 90% after deductible. If enrolled in any tier except Employee only the family deductible and out-of-pocket (OOP) must be met. The total family deductible and OOP can be met by one or more family members. There are no co-pays and prescription drugs count towards the deductible and OOP. Bronze HDHP this is a brand new HDHP plan. This plan meets the coverage that ACA requires for all health plans. Pays. If enrolled in any tier except Employee only the family deductible and out-ofpocket (OOP) must be met. The total family deductible and OOP can be met by one or more family members. There are no co-pays and prescription drugs count towards the deductible and OOP. Health Savings Account (HSA) To make the most of the HDHP plans you might consider enrolling in the HSA an account where you can set aside tax-free money to pay for anticipated medical expenses during the year, or to accumulate for future medical expenses. ALL MEDICAL PLANS You receive higher levels of coverage when you use in-network doctors and hospitals and lower levels of coverage when you use out-of-network providers. Plan Options all four plan designs are offered with Premium or Standard options. o Premium includes Medical, Prescription, Dental, Vision, Basic Life, and Long Term Disability o Standard includes Medical, Prescription, and Basic Life only 4

7 Enrolling with Alliance Benefits WHO MAY PARTICIPATE DISTRICTS For a district to be eligible, they must maintain enrollment of 50% of official workers in the C&MA Health Plan. To determine the 50%, you do not need to include: Retired workers Those who work less than 20 hours per week Volunteer workers Those who are covered under their spouse s employer plan EMPLOYERS Churches that are C&MA affiliated, accredited, or developing District offices of the C&MA National Office, Alliance Development Fund, Inc., and The Orchard Foundation Other C&MA affiliated entities such as colleges, camps, schools, etc. For employers to be eligible, they must maintain enrollment of 100% of official workers employed 20 hours or more a week. To determine the 100%, you do not need to include: Official workers covered by Medicare or Medicaid Official workers covered by a spouse s employer health plan Official workers covered by a second employer Official worker under 26 years old covered by parent s plan WHO MAY ENROLL EMPLOYEES Must be employed by an eligible employer within a participating district Must be active, full-time employees and paid to work 20 hours or more a week May be either an official worker or another employee such as an assistant, janitor, church school worker, etc. FAMILY MEMBERS Your spouse Not divorced from you Not legally separated from you Not a domestic partner Your dependent children* Your biological children, adopted children (including child placed for adoption) stepchildren, and foster children Under the age of 26 *For disabled children, contact Alliance Benefits, 5

8 Enrolling with Alliance Benefits WHEN MAY I ENROLL? When eligible employers decide to participate in the Health Plan During annual Open Enrollment Within 30 days of hire date Within 30 days of employment status change to 20 hours or more a week Within 30 days of loss of other coverage Within 60 days of the date on which you lose Medicaid or Children s Health Insurance Program coverage as a result of loss of eligibility WHEN MAY I ENROLL MY FAMILY? When you enroll During annual Open Enrollment Within 30 days of marriage (spouse and stepchildren only) Within 30 days of birth, adoption, or placement for adoption (new child only) Within 30 days of a dependent s loss of other coverage (affected dependent only) Within 60 days of the date on which a spouse or dependent child loses Medicaid or Children s Health Insurance Program coverage as a result of loss of eligibility (affected spouse or dependent child only) I NOTE: Open Enrollment is the only time a participant may change plan options. LATE ENROLLMENT Late enrollment means your completed enrollment/change form was not received within 30 days of eligibility. if you enroll more than 30 days later than qualifying event, a 2+ month waiting period begins when all completed paperwork is received. Health coverage begins for you (and/or your family) the first day of the month following the end of the waiting period. MEDICARE AND OTHER COVERAGE When you have two insurance plans, specific rules apply for coordination of benefits between the plans. You must inform us within 30 days before starting or ending any other coverage on any covered family member. This includes Medicare, Medicaid, a spouse s employer plan, or any other coverage. MEDICARE Becoming Medicare eligible may significantly change your coverage. Contacting Alliance Benefits at least four months prior to you or your spouse turning 65 will better prepare you for important decisions affecting your well-being. If your local employer (church) has fewer than 20 employees, Medicare will be the primary claims preparer for the participant who is turning

9 Enrolling with Alliance Benefits (continued) ENDING COVERAGE EMPLOYEES Coverage for you and your dependents will end on the last day of the month in which you are no longer for coverage. Some reasons for losing eligibility are: You choose to discontinue participation in the Your work hours drop below 20 hours per week Health Plan (may not violate rules of participation You take a leave of absence from employment for district or church) Your employer has failed to make premium Your employment with the sponsoring church payments ends Your employer or you may cancel your enrollment by completing the form to end Active Coverage and sending to Alliance Benefits by , fax, or postal mail. If an employer/employee chooses to end participation in the C&MA health plan, they will only be eligible to participate again by completing a waiting period of 12 months. If end of coverage notification is more than 30 days, Alliance Benefits can only refund one month premium. SPOUSE AND DEPENDENTS Coverage for your dependents will end on the last day of the month in which they are no longer eligible for coverage. Some reasons for losing eligibility are Your eligibility ends Your child reaches the age of 26 Divorce or legal separation COVERAGE EXTENSION As a church plan, the C&MA health plan is not governed by ERISA laws; therefore, we do not provide COBRA coverage. We do offer Coverage Extension, which is not the same as COBRA. If you have lost your employment and are not eligible to enroll in another plan, you may elect to continue your coverage for up to an additional 18 months after your employment has ended. Another eligible plan is a new employer s plan, your spouse s employer plan, or Medicare/Medicaid. If at any time during the 18 months of coverage extension you become eligible for another plan, your coverage extension will end. Coverage extension premiums are paid by the employee. If a church/employer wishes to offer the former employee a severance package, they may pay the premiums for the first 3 months. The total months of coverage extension will be reduced by the number of months paid by the church/employer. The employee will pay the months remaining Coverage extension cannot be terminated retroactively CHURCH TRANSFER/DEDUCTIBLE CARRYOVER If you remain enrolled in the same medical plan, your deductible will not start over in that calendar year, even if you change between participating C&MA employers or have Coverage Extension, as long as there is no gap in coverage. 7

10 Medical & Prescription Comparison Chart GOLD PPO (formerly Plan B) Premium or Standard 8 Traditional PPO Plans SILVER PPO Premium or Standard BENEFITS NETWORK OUT-OF-NETWORK NETWORK OUT-OF-NETWORK Deductible (per calendar year) Individual/Family $700/$1,400 $1,400/$4,200 $1,500/$3,000 $3,000/$9,000 Benefits begin for one member once individual deductible is met. They begin for other family members once family deductible is met by one or more members Plan Payment Level 80% after deductible 75% after deductible 55% after deductible Out-of-Pocket (OOP)Max (includes deductible) Individual/Family $4,700/$9,400 $9,400/$28,200 $6,350/$12,700 $12,700/$38,100 Plan pays 100% for one member once individual OOP max is met. Plan pays 100% for other family members once family deductible is met by one or more members Lifetime Maximum Unlimited Unlimited Physician Services 1 PCP Office Visit Specialist Office Visit Urgent Care Deductible does not apply 100% after $25 copay 100% after $35 copay 100% after $35 copay Deductible does not apply 100% after $35 copay 100% after $45 copay 100% after $45 copay 55% after deductible 55% after deductible 55% after deductible Preventive Services 2 Routine annual exams and wellness exams per preventive schedule Adult and pediatric immunizations Diagnostic Services Basic diagnostic (Lab, x-ray, allergy testing, etc.) 100% deductible does not apply 100% deductible does not apply Not covered 100% deductible does not apply 100% deductible does not apply Not covered 55% after deductible Advanced Imaging (MRI, Cat scan, etc.) 80% after deductible 75% after deductible 55% after deductible Colorectal Cancer Screening 100% every 10 years beginning at age 50; deductible does not apply 100% every 10 years beginning at age 50; deductible does not apply 55% after deductible Hospital Services3 Outpatient/Inpatient Emergency Room Inpatient precertification 80% after deductible 80% after $100 copay & deductible $500 less in benefits 80% after $100 copay & deductible $500 less in benefits 75% after deductible 75% after $100 copay & deductible $500 less in benefits 55% after deductible 75% after $100 copay & deductible $500 less in benefits Maternity (all services) 80% after deductible 75% after deductible 55% after deductible Mental Health/Substance Abuse Outpatient (includes marital counseling) Deductible does not apply 100% after $25 copay Deductible does not apply 100% after $35 copay 55% after deductible Inpatient 80% after deductible 75% after deductible 55% after deductible PRESCRIPTION DRUGS (through NPS) RETAIL PHARMACY MAIL ORDER RETAIL PHARMACY MAIL ORDER Deductible None None Days Supply Generic 25% or copay max of $10 25% or copay max of $20 25% or copay max of $10 25% or copay max of $20 Brand 25% or copay max of $40 25% or copay max of $80 25% or copay max of $40 25% or copay max of $80 Brand with generic available 25% or copay max of $40+ cost difference 25% or copay max of $80+ cost difference 25% or copay max of $40+ cost difference Non-Formulary Brand 25% or copay max of $60 25% or copay max of $120 25% or copay max of $60 Non-Formulary Brand with generic available 25% or copay max of $60+ cost difference 25% or copay max of $120+ cost difference 25% or copay max of $60+ cost difference 25% or copay max of $80+ cost difference 25% or copay max of $120 25% or copay max of $120+ cost difference Specialty Drugs 25% or copay max of $200. Must be purchased through mail order PLAN COVERAGE/RATES PREMIUM STANDARD PREMIUM STANDARD Coverage Included = Yes Medical Prescription Dental Vision Basic Life ($30,000) Long Term Disability Active Employee Monthly Rates Employee Only Employee+ Child(ren) Employee+ Spouse Family $504 $782 $914 $1,344 $443 $692 $809 $1,194 $452 $695 $811 $1,187 $391 $605 $706 $1,037 1 Some services performed in the doctor s office are subject to a deductible or are not covered. 2 Preventive Care: In order for your claim to be paid as Preventive or Wellness, you must use PPO provider(s) and the service must conform to the Preventive Schedule available by logging in at or call the member service number on your I.D. card. The provider(s) must code the claim as Wellness or Routine Preventive. 3 You are required to contact Highmark Healthcare Management Services prior to a planned inpatient admission or within 48 hours of an emergency or maternity-related admission. If this does not occur or is later determined that all or part of the inpatient stay was not medically necessary or appropriate, the patient will be responsible for payment of any costs not covered.

11 Medical & Prescription Comparison Chart SILVER HDHP (formerly HDHP Plan) Premium or Standard High Deductible Health Plans (HDHP) BRONZE HDHP Premium or Standard BENEFITS NETWORK OUT-OF-NETWORK NETWORK OUT-OF-NETWORK Deductible (per calendar year) Individual/Family $2,150/$4,300 $4,300/$12,900 $3,000/$6,000 $6,000/$18,000 Benefits begin for one member once individual deductible is met. They begin for other family members once family deductible is met by one or more members Plan Payment Level 80% after deductible 75% after deductible 55% after deductible Out-of-Pocket (OOP)Max (includes deductible) Individual/Family $5,600/$11,200 $11,200/$33,600 $6,350/$12,700 $12,700/$38,100 Plan pays 100% for one member once individual OOP max is met. Plan pays 100% for other family members once family deductible is met by one or more members Lifetime Maximum Unlimited Unlimited Physician Services 1 PCP Office Visit Specialist Office Visit Urgent Care Preventive Services 2 Routine annual exams and wellness exams per preventive schedule Adult and pediatric immunizations Diagnostic Services Basic diagnostic (Lab, x-ray, allergy testing, etc.) 90% after deductible 90% after deductible 90% after deductible 100% deductible does not apply 100% deductible does not apply Not covered 100% deductible does not apply 100% deductible does not apply 40% after deductible 40% after deductible 40% after deductible Not covered 40% after deductible Advanced Imaging (MRI, Cat scan, etc.) 90% after deductible 40% after deductible Colorectal Cancer Screening 90% after deductible 40% after deductible Hospital Services3 Outpatient/Inpatient Emergency Room Inpatient precertification 90% after deductible 90% after deductible $500 less in benefits $500 less in benefits $500 less in benefits 40% after deductible 40% after deductible $500 less in benefits Maternity (all services) 90% after deductible 40% after deductible Mental Health/Substance Abuse Outpatient (includes marital counseling) 90% after deductible 40% after deductible Inpatient 90% after deductible 55% after deductible PRESCRIPTION DRUGS (through Medco/ESI) RETAIL PHARMACY MAIL ORDER RETAIL PHARMACY MAIL ORDER Deductible None None Days Supply Generic 90% after deductible 90% after deductible Brand 90% after deductible 90% after deductible Brand with generic available 90% after deductible 90% after deductible Non-Formulary Brand 90% after deductible 90% after deductible Non-Formulary Brand with generic available 90% after deductible 90% after deductible Specialty Drugs 90% after deductible. Must be purchased through mail order. Must be purchased through mail order PLAN COVERAGE/RATES PREMIUM STANDARD PREMIUM STANDARD Coverage Included = Yes Medical Prescription Dental Vision Basic Life ($30,000) Long Term Disability Active Employee Monthly Rates Employee Only Employee+ Child(ren) Employee+ Spouse Family $548 $859 $1,007 $1,488 $487 $769 $902 $1,338 $425 $654 $762 $1,115 $364 $564 $657 $965 1 Some services performed in the doctor s office are subject to a deductible or are not covered. 2 Preventive Care: In order for your claim to be paid as Preventive or Wellness, you must use PPO provider(s) and the service must conform to the Preventive Schedule available by logging in at or call the member service number on your I.D. card. The provider(s) must code the claim as Wellness or Routine Preventive. 3 You are required to contact Highmark Healthcare Management Services prior to a planned inpatient admission or within 48 hours of an emergency or maternity-related admission. If this does not occur or is later determined that all or part of the inpatient stay was not medically necessary or appropriate, the patient will be responsible for payment of any costs not covered. 9

12 Your Dental Plan Benefit for Premium Plan participants only With the Delta Dental of Colorado PPO Plan, you have the freedom to choose any dentist, but you will pay less if you use an in-network provider. For a list of network providers, visit Benefit In-Network Coverage Out of Network Coverage Preventive Care (annual cleanings) Preventive care will not subtract from annual maximum. Annual Deductible (applies to Basic and Major Services) Basic Services (fillings, root canals, and periodontics) Major Services (crowns, bridges, partials, and dentures) 100% 100% of R&C 1 $50 individual $150 family $50 individual $150 family 70% 70% of R&C 1 50% 50% of R&C 1 Annual Maximum $1,250 per person $1,250 of R&C 1 per person Orthodontics (braces for dependents under the age of 19) 50% 40% of R&C 1 Orthodontic Lifetime Maximum (combination of in and out-of-network) $1,000 per person $1,000 of R&C 1 per person 1 R&C is Reasonable and Customary, or the maximum amount allowed under the Plan. You would be responsible for paying any amount above R&C. Your Vision Plan Benefit for Premium Plan participants only The Superior Vision plan has a network of over 35,000 providers, including more than 5,000 ophthalmologists. For a list of providers, visit Benefit In-Network Coverage Out of Network Coverage Eye Examination Every 12 months 100% Eyeglasses 1 Standard Lenses: Every 12 months Frames: Every 24 months Contact Lenses Every 12 months (in lieu of eyeglasses) 100% after a $15 copay for materials: Single Vision Bifocals Trifocals Lenticular Reimbursed up to $34 at an Ophthalmologist, or $26 at an Optometrist Reimbursed up to: $35 Single Vision $50 Bifocals $60 Trifocals $95 Lenticular 100% coverage up to $125 Reimbursed up to $50 100% after a $15 copay Medically necessary contact lenses Reimbursed up to $120 Cosmetic lenses $25 copay Lens fitting exam fee 1 Contact Superior Vision about optional frames, lens types, and coatings available at discounted fees. Reimbursed up to $210 Medically necessary contact lenses Reimbursed up to $100 Cosmetic lenses Lens fitting exam Not covered 10

13 Your Life Insurance Death & Dismemberment (AD&D) Options BASIC LIFE AND AD&D To help give you and your family extra peace of mind, the C&MA provides you with the following coverage as part of your medical plan package: $30,000 Basic life insurance $30,000 AD&D Reduction in Coverage, Beginning at 65 There are reductions in life insurance amounts, beginning at age 65 for Basic Life and 70 for Voluntary Life. VOLUNTARY LIFE If you choose you may choose additional life insurance coverage for yourself up to $250,000, for your spouse up to $50,000, and for your child(ren) up to $10,000. OPEN ENROLLMENT BUY-UP OPPORTUNITY If you previously purchased voluntary life on yourself, spouse, and children, but have less than the maximum, you may buy-up one increment during Open Enrollment without providing evidence of insurability. One increment is $10,000 on yourself, $5,000 on your spouse, and $1,000 on your children. Maximum amounts are $250,000 for employee, $50,000 for spouse, and $10,000 for child coverage Evidence of Insurability If you apply for Voluntary Life coverage more than 30 days after enrollment, coverage is usually subject to approval with Evidence of Insurability. There are a few exceptions: you may be able to add coverage within 30 days of family changes such as marriage or birth. All life insurance coverage ends when active employment ends and cannot be continued during a severance or coverage extension period. Conversion may be available for purchase within 30 days. Contact Alliance Benefits for details. Retiree Life Insurance Alliance Benefits offers $7,500 retiree life insurance to C&MA life insurance participants who retire at age 65 or older with 20 or more years of service. You must inform Alliance Benefits within 30 days. Monthly Rates for Voluntary Life Insurance (Per $1,000 of coverage) Age Employee Rate Spouse Rate $10,000-$250,000 in $10,000 increments <30 $0.091 $ Monthly Rates for Dependent Children (Per $1,000 of coverage) Children Rates $5,000-$50,000 in $5,000 increments, up to 50% of employee s coverage $2,000-$10,000 in $1,000 increments One cost per household regardless of the number of children; all eligible children are insured for the same amount $0.112 per $1,000 of coverage Children s voluntary life covers dependents only up to age 23, even if the dependent continues to be eligible for the C&MA health plan beyond that 11

14 Your Long Term Disability Benefit for Premium Plan Participants only Alliance Benefits offers a safety net in the event you are unable to work due to a serious illness or injury. If you become disabled and you are a U.S. citizen, subject to approval, the C&MA Long Term Disability plan will pay you 60 percent of your salary up to $5,000 per month (including ministerial housing allowance, if applicable). You first must satisfy a 90 day waiting period before benefits will begin. Preexisting condition limitations may apply. Definition of Disability You are considered disabled if, because of sickness or injury, you are unable to perform all the material duties of your regular occupation or unable to earn more than 80% of your annual salary (including housing allowance) that was in effect on the date you were disabled. Generally, Long Term Disability benefits are paid until age 65 if you continue to qualify. However, if you are disabled after age 62, the following schedule of benefits applies. HORIZONCARE EMPLOYEE ASSISTANCE PROGRAM (for Premium Plan Participants only) Good mental health includes your emotional wellbeing. Standard Life Insurance Company offers an Employee Assistance program (EAP) through Horizon Health that can help you maneuver life s challenges. As a participant in the Long Term Disability plan, you can obtain confidential support, guidance, and resources for the following: Difficulties in relationships Stress and anxiety with work or family Depression Grief and loss Alcohol and drug abuse Life improvement Personal achievement Emotional well-being Financial and legal concerns Child care and elder care HorizonCare services are available at no cost to you, 24 hours a day. You can reach them toll free at or log on to Age Maximum Benefit Period 65 or under Until your 65 th birthday or 42 months, whichever is longer 63 36,months months months months months months 69 or older 12 months Benefits paid under an approved Long Term Disability claim may be taxable income. Check with your financial advisor for IRS rules. 12

15 VOLUNTARY SUPPLEMENTAL BENEFIT OPTIONS AVAILABLE THROUGH COLONIAL LIFE Colonial life s products, which are offered in addition to qualified health insurance, will not be affected by health care reform. These products offer you solutions to help pay for what is not covered by your health plan. Medical Gap Coverage An individual, hospital confinement indemnity plan that complements your core medical coverage, offering benefits for hospital confinement, wellness, rehabilitation confinement, and more. Accident Insurance Protection Designed to help you fill some of the gaps caused by increasing deductibles, co-payments and out of pocket costs related to an accidental injury. Short Term Disability Income Replacement An individual, STD product that replaces a portion of income if someone becomes disabled due to a covered accident or sickness. Cancer Supplemental Insurance Plans A guaranteed renewable, individual cancer product that helps pay some of the direct and indirect costs related to cancer diagnosis and treatment. Helpful Contact Information Keep this information handy for finding answers to your benefit questions. Topic Whom should I contact? Hours of Operations Phone Number Web Site (24 hours a day) Medical Plans & Claims Group #CQM363 Highmark BC/BS 6am - 3pm MT, Mon - Fri Pre-Certification Highmark BC/BS 6am - 3pm MT, Mon - Fri hour Nurse Line Highmark Blues on Call 24/ BLUE PPO Prescriptions NPS 24/ HDHP Prescriptions Medco/Express Scripts 24/ Dental Plan Group #7789 Delta Dental of Colorado 8am - 6pm MT, Mon - Fri Vision Plan # Group Life Insurance Group # Long Term Disability Group # Superior Vision Alliance Benefits Alliance Benefits 6am - 7pm MT, Mon Fri 9am 2pm MT, Sat 8am - 5pm MT, Mon Fri 8am - 5pm MT, Mon Fri Benefit Claims Alliance Benefits 8am - 5pm MT, Mon Fri Benefit Enrollment Alliance Benefits 8am - 5pm MT, Mon Fri press 1 then press 1 then press 1 then press 1 then This summary contains highlights and is subject to change. The specific terms of coverage, exclusions, and limitations are contained in the summary plan description or insurance certificate. If there is any conflict between this guide and the plan documents, the plan documents will govern. To view a copy of the plan documents, visit. If you have benefit questions, call Alliance Benefits at

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