Open Enrollment...1 What s New For 2011?...1 Important! Be Sure To Verify And Update...1 If You Do Not Take Action...1

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2 Table of Contents What You Should Know First...1 Open Enrollment...1 What s New For 2011?...1 Important! Be Sure To Verify And Update...1 If You Do Not Take Action...1 Take Action! Log On And Sign In Make Your Choices And Enroll Confirm Your Elections And Enrollment...2 Important Information...3 About This Guide...3 Plan Summaries...3 Misrepresentation...3 Your Choices...4 Anthem BCBS Medical Complete Plan...5 Delta Dental and VSP Vision D&V Plan...6 Prudential Insurance Coverages...7 Contact Information...8 Disclosure Information...9

3 What You Should Know First Open Enrollment Akima s 2011 Open Enrollment period runs from Friday, June 24th and ends at midnight Central Time on Monday, July 18th. You must enroll during this period to be sure to receive the benefits coverage of your choice. Your new benefit choices become effective August 1, Important! Open Enrollment this year will be an active enrollment. This means every employee, including employees on any leave of absence (i.e. military, FMLA, LOA, etc.) must participate in Open Enrollment. This Benefits Guide and the tools and plan summaries you will find on the Akima Benefits web site at are designed to help you make informed decisions about your health and welfare benefits and enroll in the choices that are right for you. If you cannot find the answers to your questions in this guide or online at Akima s Benefit Center, representatives are available to assist you Monday through Friday, between the hours of 7 a.m. and 7 p.m. Central Time, excluding holidays. Important! Be sure to verify and update Verify dependents It is your responsibility to verify that the dependents you plan to cover are, in fact, eligible. Because ineligible dependents can significantly increase the cost of health care coverage for all employees, audits of randomly selected participants whose current benefit coverage includes at least one dependent are routinely conducted. Dependents determined ineligible will not be covered. Update beneficiaries When you enroll online, an important step is updating your beneficiary designations. Current, accurate information is critical to ensuring that proper payment is made to your beneficiary designation(s) in the unfortunate event of your death. What s New for 2011? Enrollment is via the Internet. You can access the website at 24 hours a day/7 days a week. See page 3 of this guide if you do not have Internet access. There is a new D&V Benefits Bundle that provides dental and vision coverage only for employees who are eligible to waive medical coverage. Dependent children up to age 26 can now be enrolled. Individuals whose coverage ended, or who were denied coverage, or were not eligible for coverage because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in Akima s Health Plan. Individuals have the opportunity to enroll during open enrollment. The lifetime limit on the dollar value of benefits under Akima s Health Plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to re-enroll in the plan. Individuals have the opportunity to enroll during open enrollment. Enrollment elections will be effective August 1, If You Do Not Take Action If you fail to submit your benefit choices by the end of the open enrollment period, you could be automatically enrolled in ( defaulted into) coverage that you do not want for the next 12 months, along with any associated cost to you. So, even if you do not want to enroll in benefits, you must go online and waive coverage. Page 1

4 Take Action! Online enrollment is convenient and secure. The Akima Benefits Center is available online from any computer with Internet access 24 hours a day/7 days a week. Enroll online in three easy steps. 1. Log on and sign in Log on to: On the Welcome page select Click Here to create a User ID and Password. When you access the secure website for the first time, you must create a new account. You will be prompted to set up your user profile by entering identifying information in order to access the Open Enrollment page. Once you are registered and have a User ID and Password, the next time you visit the website simply enter them to sign on. 2. Make your choices and enroll You will be able to select from the left navigation bar to make your benefit choices. Add the dependents you wish to enroll, and be prepared to enter their birth dates and social security numbers. Select a benefit to enroll in, such as Medical; then choose coverage levels. Navigate to the previous page or proceed to the next page of each record by selecting PREVIOUS or NEXT. 3. Confirm your elections and enrollment Once you have completed your enrollment and you are satisfied with your enrollment selections, click PRINT CONFIRMATION STATEMENT at the bottom of the page to retain a copy of your elections for your records. Be sure to review your confirmation statement carefully. If your confirmation statement shows that you enrolled yourself or your dependents incorrectly, you may make changes online up to the end of the enrollment period (i.e. midnight on July 18th). Important! You may change your enrollment choices any time up to the end date of your enrollment period. Page 2

5 Important Information About this Guide This guide highlights the plans that are part of Akima s 2011 Benefits program. If there is a conflict between this guide or the information at and the official Plan Documents, the Plan Documents will govern. Akima reserves the right to amend, modify, or terminate its plans and change costs at any time and without prior notice. Your participation in the 2011 Benefits Plan does not give you the right to continued or future employment. Plan Summaries Plan summaries are located in this guide and in the Forms Library at Reviewing the summaries and utilizing the other open enrollment resources listed here, will help you make informed decisions about your 2011 benefits. Enrolling by telephone The easiest, most convenient way to enroll in your 2011 benefits is through the Akima Benefits Center at However, if you do not have Internet access, you can also enroll by calling the Benefits Center at Representatives are available to assist you and answer your questions Monday through Friday, between 7 a.m. and 7 p.m. Central Time, excluding holidays. Misrepresentation It is a crime to knowingly and with intent to injure, defraud, or deceive the plan or your employers or provide any false information, including filing a claim that contains any false, incomplete, or misleading information. These actions will result in denial of your claims, and you may be subject to criminal and/or civil prosecution and punishment under state and/or federal law. The plans reserve the right to pursue all appropriate legal remedies in the event of fraud. Any material misrepresentation on the part of you and/ or your dependents in making application for coverage, or any application for reclassification, or any application for service, will render the coverage under this plan null and void. Page 3

6 Your Choices... Health Plans If you are an Akima full time employee working 32 hours or more, you have two Akima benefit plans to choose from. The Akima Complete Plan, offering medical, dental and vision coverage and the Akima D&V Plan, offering dental and vision coverage only. Pages 5 and 6 of this guide provide summary information on these plans. Visit the Akima Benefits Center on line at for complete Summary Plan Descriptions. Akima Complete Plan Anthem Blue Cross Blue Shield (BCBS) Medical Plan Prescription drug plan Delta Dental Plan VSP Vision Plan Akima D&V Plan Delta Dental Plan VSP Vision Plan No medical or prescription drug plan If you wish to enroll in the D&V Plan only you must provide proof that you have medical coverage under another carrier (generally a copy of the front and back of your insurance card, i.e. Tricare, CHAMPVA, etc.). You will be prompted for this proof when you enroll online at You must complete, sign and return a Benefits Waiver Form which can be found in the Forms Library on the website. The form will need to be submitted to Akima s Benefits Center via fax Attn: Akima Benefits Center or akimabenefits@boongroup.com, along with a copy of proof of other medical coverage. Life and Disability Plans In addition to the Akima Complete and Akima D&V Plans, all full time Akima employees who work 32 hours or more per week are eligible to receive life and disability benefits depending upon the Akima Company and the project they support. Please note that union employees benefits may vary by CBA (Collective Bargaining Agreement). When you enroll online you will be able to see your eligibility for these benefits and the associated costs. Basic Life and Accidental Death and Dismemberment (AD&D) Supplemental Life (for Employee, Spouse, Children) Short Term Disability Long Term Disability Business Travel Accident (BTA) Insurance Page 4

7 Anthem BCBS Medical Plan Calendar Year Deductible Calendar Year Out of Pocket Maximum MEDICAL PPO PLAN IN NETWORK OUT-OF-NETWORK $500 per individual $1,500 per family $2,000 per individual $6,000 per family $1,000 per individual $3,000 per family $5,500 per individual $16,500 per family Lifetime Maximum Unlimited Unlimited Physician Office Visit $20 copay then 100% 70% Preventive Care 100% 70% Allergy Injections $5 copay 70% Allergy Testing 90% 70% Hospital Care (Inpatient and Outpatient Professional Services) 90% 70% Inpatient Facility Services 90% 70% Outpatient Surgery Hospital/ Alternative Care Facility 90% 70% Emergency Room Services (copay at hospital waived if admitted) $75 copay $75 copay Urgent Care Center Services $50 copay 70% Chemical Dependency Hospital Based 90% 70% Outpatient Services 90% 70% Hearing Exam Hearing Hardware Not covered; except for initial screening for newborn Not covered; discounts available through discount providers Home Health Care - 90 visits per year (in network and out-of-network combined) 100% 70% Durable Medical Equipment 90% 70% Mental Health Treatment Inpatient 90% 70% Office visits $20 copay 70% Rehabilitation Therapy Inpatient (Facilities & Professionals) and Outpatient 90% 70% Spinal Manipulations $20 copay (26 visits per Not Covered calendar year) Prosthetics 90% 70% PRESCRIPTION DRUGS IN NETWORK OUT-OF-NETWORK Participating Retail Pharmacies - 30 day supply $15 Generic $25 Preferred Brand $45 Non-Preferred Brand 50% (minimum $45) Mail Order Pharmacy - 90 day supply $30 Generic $50 Preferred Brand $90 Non-Preferred Brand Mail Order not covered Specialty Medications - Specialty Medications must be obtained via Anthem s Specialty Pharmacy Network in order to receive network level benefits. Member may be responsible for additional cost when not selecting an available generic drug. 25% up to $2,500 per year, out-of-pocket maximum then 100%, retail (30 day supply) or mail (90 day supply) Page 5

8 Delta Dental and VSP Vision Plan DELTA DENTAL PPO AND PREMIER PROVIDER AND OUT-OF-NETWORK Annual Maximum (per calendar year) $1,500 Annual Deductible (per calendar year). No deductible for diagnostic, preventive services, or orthodontic Diagnostic and Preventive Coverage (Exams & cleanings, x-rays, fluoride treatments, sealants) Basic and Major 1 Coverage (Amalgam fillings, extractions, periodontal, scaling, oral surgery, root canal) Major 2 Coverage (Crowns, inlays, onlays, dentures, restoration, implantology) Orthodontic Coverage (dependent children - ages 8-25 only) $25 individual/$75 family 100% of maximum allowable fee 80% of maximum allowable fee 50% of maximum allowable fee 50% of maximum allowable fee Orthodontic Maximum Lifetime Coverage per eligible child (ages 8-25 only) $1,500 VISION SERVICE PLAN VSP PROVIDER OUT-OF-NETWORK REIMBURSEMENTS Annual Eye Exam $15 copay - every 12 months Lenses and Frames $25 copay Lenses (single vision, lined bifocal and lined trifocal) Limited to once every 12 months Up to $44 Up to $32 single vision Up to $48 lined bifocal Up to $64 lined trifocal Frames Limited to once every 24 months Up to $45 Select Frames Covered in full up to $130 Contact Lenses (in lieu of lenses/frames) Limited to $130 which includes exam and fitting Up to $100 Additional pair of Prescription Glasses or Sunglasses 20% discount Additional Contact Lenses 15% discount Laser Surgery Discounts are available Page 6

9 Prudential Insurance Coverages Basic Life Insurance and AD&D When you visit be sure to review your life insurance and disability coverage carefully to determine the options and coverages that best meet your needs. This will help you decide whether you wish to take out additional coverage for you, your spouse and your children. Voluntary Life Insurance for you You may be able to purchase additional life insurance coverage for yourself in increments of $10,000 up to $500,000, not to exceed 5 times your covered annual earnings. Your eligibility may be subject to Evidence of Insurability. Note, voluntary life insurance coverage will be reduced as you age by 35% at age 65 and by 50% at age 70. Ages Monthly rate per $1,000 of coverage Under 25 $ $ $ $ $ $ $ $ $ $ $ $2.324 Voluntary Dependent Life Insurance for your spouse You may be able to purchase coverage for your spouse in increments of $5,000 up to $100,000; limited to 50% of employee voluntary supplemental life amount. Ages Monthly rate per $1,000 of coverage Under 25 $ $ $ $ $ $ $ $ $ $ $ $2.324 Voluntary Dependent Life Insurance for your child(ren) You will be able to purchase coverage for your child in $2,000 increments up to $10,000; limited to 50% of employee voluntary supplemental life amount; all Guarantee Issue [no Evidence of Insurability (EOI) is required for child coverage]. Monthly rate per $1,000 of coverage Child Life $0.054 At some locations life, AD&D and disability are provided through the compulsory state plan. Business Travel Accident (BTA) All full time Akima employees who work 32 hours or more are covered up to $100,000 by BTA insurance in the event of loss of life while travelling on company business. Page 7

10 Contact Information COMPANY COVERAGE GROUP NUMBER CUSTOMER SERVICE Akima Benefits Enrollment Benefits Assistance Client Services *Anthem Blue Cross Blue Shield Medical Enrollment Wells Fargo Medical Medical Precertification 360 Health/Nurse line Rx Provider Services Group # Plan 248 RxBIN RxPCN Delta Dental Dental # Vision Service Plan (VSP) Prudential Vision # Life and AD&D Short Term Disability Long Term Disability #49466 *Mail claims to: P.O. Box Louisville, KY Call For questions about enrolling in benefits. Call East Region Call West Region Call For questions about your medical claims. Call To receive prior approval for medical services. Call To speak with a nurse 24 hours a day 7 days a week. Call For questions about your prescriptions. Call For questions about your dental plan. Call For questions about your vision coverage. Life Claims Call Disability Claims Call Page 8

11 Disclosure Information Fraud Statement: All enrollees certify that any persons on their applications for coverage are their dependents, as defined under the Plan. They agree that falsification of any statement in their application may bar the right to coverage under the Plan. They certify that the information they have provided is complete, accurate and true. Enrollees must notify their employer when their child(ren), spouse or domestic partner NO longer meet the eligibility requirements as defined under the plan. If a child(ren), spouse or domestic partner no longer meet the plan s definition of eligible they will be no longer eligible for the benefits. If inaccurate or false information is furnished on the application and/or failure to notify the employer that dependent(s) are longer eligible the result could be termination of coverage, non-payment of benefits, recovery of ineligible benefit payments, termination of employment and/or legal action. Patient Protection: Akima s Medical Plan generally does not require the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Anthem Blue Cross Blue Shield of Missouri at You do not need prior authorization from Anthem Blue Cross Blue Shield or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact Anthem Blue Cross Blue Shield of Missouri at Summary of Material Modification (SMM): Please note that this benefit summary is intended to serve as a Summary of Material Modification (SMM), as described in the Employee Retirement Income Security Act (ERISA). Please keep this information with your Certificate of Coverage provide by the carrier. Pre-Existing Condition: The Akima s Health Plan has no pre-existing condition clause. Special Enrollment: HIPAA (Health Insurance Portability and Accountability Act) requires that you are made aware regarding special enrollment period. If you acquire a new dependent or decline coverage under the plan while other coverage is in effect and later you lose that coverage for qualifying reasons you have the right to enroll in this plan. Loss of Coverage for Medicaid or a State Children s Health Insurance Program (SCHIP): If you decline to enroll yourself or an eligible dependent (including a spouse) while Medicaid coverage or coverage under a state children s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. You must request to be enrolled within 60 days after you or your dependents coverage ends under Medicaid or the state children s health insurance program. New Dependent by Birth, Adoption or Marriage: If you have a new dependent you may be able to enroll yourself and your new dependents on to this plan. You must request enrollment within 60 days after the birth, adoption or marriage. Eligibility for Medicaid or State Children s Health Insurance Program (SCHIP): If you or your dependents become eligible for a state premium assistance subsidy through state s children s health insurance program or Medicaid you may be able to enroll yourself and your dependents in this plan. You must request enrollment within 60 days after you or your dependents determination of eligibility for such assistance is approved. Women s Health and Cancer Rights Act of 1998 Annual Notice: Under Federal law, group health plans and health insurance issuers providing benefits for a mastectomy must also provide, in connection with the mastectomy for which the participant or beneficiary is receiving benefits, coverage for: all stages of reconstruction of the breast on which the mastectomy was performed surgery and reconstruction of the other breast to produce a symmetrical appearance prostheses and physical complications of mastectomy, include lymph edemas in a manner determined in consultation between the attending physician and the patient. These benefits may be subject to annual deductibles and coinsurance provisions that are appropriate and consistent with other benefits under the coverage. Newborns and Mothers Health Protection Act: Under Federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery or less than 96 hours following a Cesarean section delivery. However, the plan or issuer may pay for a shorter stay if the attending physician, nurse midwife or physician assistant, after consultation with the mother, discharges the mother or newborn earlier. Plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour for normal delivery, or 96-hour stay for Cesarean delivery, is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not require that a physician or health care provider obtain authorization for prescribing a length of stay of up to 48-hour for normal delivery, or 96-hour stay for Cesarean delivery. However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain pre-certification. For information on pre-certification, contact your plan administrator. For coverage that is insured, if your state has a law that meets certain criteria, state law applies to your coverage rather than the Newborns Act. A list of states in which the federal Newborns Act requirements apply as of July 1, 1998 can be found in the booklet Questions and Answers: Recent Changes in Health Care Law. Page 9

12 June 2011 MANAGEMENT SERVICES, LLC Ballantyne Corporate Place Suite 400 Charlotte, NC Telephone: (704)