Enrollment Guide. JFC Staffing Companies. For the Employees of. Medical Plan Options and Enrollment Information

Transcription

1 Enrollment Guide For the Employees of JFC Staffing Companies Medical Plan Options and Enrollment Information Administered by Key Benefit Administrators, Inc

2 What is 5M? A choice of options to fit your healthcare needs Minimum Essential Coverage Minimum Essential Coverage (MEC) is designed to satisfy your obligations under PPACA and avoid individual tax penalties. The cost of this insurance is 50% paid by your employer. MEC Heavy is a stronger version of the MEC product that covers a variety of outpatient services. MEC Heavy The Minimum Value Plan is a bronze major medical plan that provides comprehensive coverage for inpatient and outpatient procedures. However, it has a high deductible and out-of-pocket maximum ($6,500 for single coverage, $13,200 for families). Minimum Value Plan

3 Minimum Essential Coverage As outlined under the new healthcare law, ACA, all individuals must have Minimum Essential Coverage (MEC) beginning January 1, 2014, or pay a penalty tax. Employees can prevent being taxed the Individual Mandate penalty tax by purchasing Minimum Essential Coverage through their employer. If you don t purchase Minimum Essential Coverage (MEC) for 2016, you will face a tax of the greater of 2.5% of adjusted household income or $695 per adult plus $ per c h i l d. There are preventive services covered at 100% under the required government list of Preventive and Wellness Benefits when you visit a network provider. The benefits drop to 40% if you use an out-of-network provider. Services covered include immunizations, blood pressure screenings, diabetes and cholesterol screenings, prenatal visits for pregnant women and more. A full list of the covered services is included in this information. Minimum Essential Coverage covers 100% of the government s listed Preventive and Wellness Benefits when you visit a network provider (40% out-of-network). Self-Insured by your employer, this coverage is designed to satisfy your individual mandate under the new healthcare law. Minimum Essential Coverage (MEC) provides first dollar coverage with access to one of the largest national preferred provider organizations (PPO) available with great discount savings for MEC benefits. The network savings can also be used for services not covered by the MEC. You will have access to a simple-to-use web portal for your local or out-of-town provider look up to be sure your provider is in the PPO Network. The MEC comes with a medical ID Card that needs to be presented to your medical provider at your time of service. The cost of this insurance is detailed on page 17 3

4 MEC Covered Preventive Services Covered Preventive Services for Adults (ages 18 and 1. Abdominal Aortic Aneurysm one time screening for age Alcohol Misuse screening and counseling 3. Aspirin use for men ages and women ages to prevent CVD when prescribed by a physician 4. Blood Pressure screening 5. Cholesterol screening for adults 6. Colorectal Cancer screening for adults starting at age 50 limited to one every 5 years 7. Depression screening 8. Type 2 Diabetes screening 9. Diet Counseling older) 10. HIV Screening 11. Immunizations vaccines (Hepatitis A & B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis, Varicella) 12. Obesity screening and counseling 13. Sexually Transmitted Infection (STI) prevention counseling 14. Tobacco Use screening and cessation interventions 15. Syphilis screening 16. Hepatitis B screening for non-pregnant adolescents and adults. 17. Lung Cancer screening years old who smoke 30 packs a year. 18. Fall Prevention Physical therapy and vitamin D for 65 and older at risk for falling 19. Hepatitis C screening for high risk individuals and a onetime screening for HCV infection if born between Covered Preventive Services for Women, including Pregnant Women 1. Anemia screening on a routine basis for pregnant women 2. Bacteriuria urinary tract or other infection screening for pregnant women 3. BRCA counseling and genetic testing for women at higher risk 4. Breast Cancer Mammography screenings every year for women age 40 and over 5. Breast Cancer Chemo Prevention counseling 6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women. 7. Cervical Cancer screening 8. Chlamydia Infection screening 9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs 10. Domestic and interpersonal violence screening and counseling for all women 11. Folic Acid supplements for women who may become pregnant when prescribed by a physician 12. Gestational diabetes screening 13. Gonorrhea screening 14. Hepatitis B screening for pregnant women 15. Human Immunodeficiency Virus (HIV) screening and counseling 16. Human Papillomavirus (HPV) DNA Test: HPV DNA testing every three years for women with normal cytology results who are 30 or older 17. Osteoporosis screening over age Rh Incompatibility screening for all pregnant women and follow-up testing 19. Tobacco Use screening and interventions and expanded counseling for pregnant tobacco users 20. Sexually Transmitted Infections (STI) counseling 21. Syphilis screening 22. Well-woman visits to obtain recommended preventive services 23. Aspirin for Preeclampsia prevention * Includes routine prenatal visits for pregnant women Covered Preventive Services for Children 1. Alcohol and Drug Use assessments 2. Autism screening for children limited to two screenings up to 24 months 3. Behavioral assessments for children limited to 5 assessments up to age Blood Pressure screening 5. Cervical Dysplasia screening 6. Congenital Hypothyroidism screening for newborns 7. Depression screening for adolescents age 12 and older 8. Developmental screening for children under age 3, and surveillance throughout childhood 9. Dyslipidemia screening for children 10. Fluoride Chemo Prevention supplements for children without fluoride in their water source when prescribed by a physician 11. Gonorrhea preventive medication for the eyes of all newborns 12. Hearing screening for all newborns 13. Height, Weight and Body Mass Index measurements for children 14. Hematocrit or Hemoglobin screening for children 15. Hemoglobinopathies or sickle cell screening for newborns 16. HIV screening for adolescents 17. Immunization vaccines for children from birth to age 18; doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella, Haemophilus influenzae type b 18. Iron supplements for children up to 12 months when prescribed by a physician 19. Lead screening for children 20. Medical History for all children throughout development ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 21. Obesity screening and counseling 22. Oral Health risk assessment for young children up to age Phenylketonuria (PKU) screening in newborns 24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents 25. Tuberculin testing for children 26. Vision screening for all children under the age of Skin Cancer Behavioral Counseling age for exposure to sun 28. Tobacco intervention and counseling for children 29. Fluoride varnish for primary teeth through age 5. This list above summarizes some but not all services. Please reference the US Preventative Service Task Force website for the entire list.

5 Optional Hospital Indemnity Insurance Underwritten by Transamerica Life Insurance Company TransChoice Advance: Group Limited Benefit Hospital Indemnity Insurance Plan 1 Daily In-Hospital Indemnity Benefit Pays per day, up to a max of 31 days per confinement Surgical and Anesthesia Indemnity Benefit Pays benefit per day; 1 day per calendar year for Inpatient Surgery, 1 day per calendar year for Outpatient Surgery, 1 day per calendar year for Specified Outpatient Surgeries. Pays additional 20% of the surgical benefit for Anesthesia. Inpatient Outpatient Specified Outpatient $200 $1,000 $500 $100 Outpatient Physician Office Visit Indemnity Benefit Pays per day, up to max days per calendar year per insured person Outpatient Diagnostic X-Ray and Laboratory Indemnity Benefit Pays benefit per day; 2 days per calendar year for Advanced Studies, 2 days per calendar year for Select Diagnostic tests, 3 days per calendar year for Diagnostic Laboratory tests. Advance Studies Select Diagnostic Diagnostic Laboratory $60 6 day max $200 $50 $10 Hospital Confinement 1 day of confinement per year Ambulance Service Daily Indemnity Benefit Per trip in a ground ambulance, 3x benefit for air ambulance, up to 3 days per year Emergency Room Sickness Benefit Per visit up to 4 days per calendar year per insured person Prescription Drug Indemnity Benefit Per day a prescription is filled for up to 36 days per calendar year, per insured person $1,000 $100 $100 $15 Generic $30 Brand Additional Benefits Group Term Life Insurance Policy with Accidental Death and Dismemberment Rider (AD&D) AD&D not available to dependent children Employee Child(ren) $5,000 $2,500 Employee Discount Card - Offered by New Benefits, LTD Provides access to a discount Vision plan, Nurses Hotline, Counseling Services, and discounts on Hearing Aids Patient Advocacy - Offered by The Karis Group Services that provide employees with unparalleled diligence and dedication to find the best solutions for resolving their outstanding medical bills This is a brief summary of TransChoice Advance Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, IA. Policy form series CPGHI400 and CCGHI400. Forms and form numbers may vary. This insurance may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. THIS IS NOT MAJOR MEDICAL INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL INSURANCE. IT DOES NOT QUALIFY AS MINIMUM ESSENTIAL HEALTH COVERAGE UNDER THE FEDERAL AFFORDABLE CARE ACT. The cost of this insurance is detailed on page 17 EBD IB5MEG

6 Optional Hospital Indemnity Insurance Summary of Benefits for TransChoice Advance: Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company Daily In-Hospital Indemnity Benefit When an insured person is confined in a hospital as a result of an accident or sickness, this benefit pays the benefit amount for each day the insured is confined in a hospital, up to a maximum of 31 days per confinement. Surgical and Anesthesia Indemnity Benefit We will pay the inpatient, an outpatient or an outpatient minor surgical benefit described for an insured person when a covered surgery is performed because of an accident or a sickness. The inpatient benefit is payable once per calendar year per insured person for any covered inpatient surgical procedure or for two or more inpatient procedures performed in the same surgical session. The outpatient benefit is payable once per calendar year for any covered outpatient surgical procedure or two or more outpatient procedures performed in the same surgical session. The outpatient minor benefit is payable once per calendar year per insured person for any covered outpatient minor surgical procedure or two or more such procedures performed in the same surgical session. We will also pay the anesthesia benefit when anesthesia is administered during any covered surgery. The indemnity benefit will be a percentage of the amount paid under the surgical indemnity benefit. Please see the certificate for a list of codes that are considered outpatient minor surgical procedures. Ambulance Indemnity Benefit This benefit pays per day of using an air or ground ambulance. Treatment must be received within 72 hours of the accident or onset of sickness, and must be provided by a licensed ambulance company for benefits to be payable. Outpatient Diagnostic X-Ray and Laboratory Indemnity Benefit This benefit pays the amount shown per testing day for tests performed for the purpose of diagnosis of a covered sickness or accident as indicated by symptoms that would suggest an injury or sickness had occurred. The benefit is limited to a number of days of testing per calendar year per covered person and is not payable while the insured is confined in a hospital (i.e. it applies to outpatient services only). Emergency Room Sickness Benefit This benefit will pay for each sickness visit to the emergency room for a number of days per calendar year per insured person. Emergency room visits for accidents are not covered under this benefit, they would be covered under the Off-the-Job Accident Benefit. Hospital Confinement This benefit pays an additional benefit per insured person per calendar year when he/she receives treatment or surgery while confined to a hospital as an inpatient as a result of a covered accident or sickness. Outpatient Physician Office Visit Indemnity Benefit This benefit pays the amount shown for the day of a physician s office visit as a result of a sickness or accident. Benefits are payable for a maximum number of days per calendar year per person. Prescription Drug Indemnity Benefit This benefit pays the amount selected for a day when a prescription is filled for prescription drugs prescribed by a physician as a result of an accident or sickness. There is a maximum of one brand and one generic prescription per day. EBD IB5MEG 0915

7 Optional Hospital Indemnity Insurance Summary of Benefits for TransChoice Advance: Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company Group Term Life Insurance Policy with Accidental Death and Dismemberment Rider Policy Form Series CP and CP This policy pays the benefit amount shown upon the death of the insured, subject to any limitations/exclusions. The AD&D benefit amount will match the amount of group term life insurance. Exclusions We will not pay any benefits if the loss, directly or indirectly, results from any of the following, even if the means or cause of the loss is accidental: - suicide or intentionally self-inflicted injury, while sane or insane; - commission of or attempt to commit an assault or felony; - sickness or mental illness, disease of any kind, or medical or surgical treatment for any sickness, illness or disease; Under the AD&D Rider, when a covered accident results in any of the following losses, benefits are paid for the following specified percentages of the coverage amount subject to any limitations and exclusions. Loss Percentage Paid - injuries received while under the influence of alcohol, a controlled substance or other drugs as defined by the laws of the State where the accident occurs, except as prescribed by a doctor; - any poison or gas voluntarily taken, administered, absorbed, or inhaled (except in the course of employment); Loss of life or loss of two or more members (hand, foot, sight of an eye) Quadriplegia (total and permanent paralysis of both upper and lower limbs) 100% 100% - flight in any kind of aircraft, except as a fare paying passenger on a regularly scheduled commercial aircraft; - any bacterial or viral infection; Loss of speech AND hearing in both ears 100% Paraplegia (loss or paralysis of both lower limbs) 75% - declared or undeclared war, or any act of war; and - taking part in an insurrection. Age Reduction Death benefits automatically reduce to the following percentages, or flat amount, on the Group Master policy Anniversary Date that follows the applicable birthday, as follows: Loss of one member, or loss of speech, or loss of hearing in both ears Hemiplegia (total and permanent paralysis of the upper and lower limbs of one side of the body) Loss of hearing of one ear, or loss of thumb and index finger of same hand 50% 50% 25% Schedule Birthday 65% of pre-age 65 death benefit 65th 50% of pre-age 65 death benefit 70th 25% of pre-age 65 death benefit 75th Only one such amount will be paid as a result of a single covered accident This Rider stops on the Employee s/member s 70th birthday. This is a brief summary of Group Term Life Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa Policy form series CP The lesser of $5,000 or 25% of pre-age 65 death benefit 80th and CC100400; Rider form series CR Forms and form numbers may vary. Coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate, and riders for complete details. EBD IB5MEG

8 Optional Hospital Indemnity Insurance Non-Insurance Benefits Employee Discount Card This discount card is provided by New Benefits, LTD. It offers Employees access to a discount Vision Plan, a Nurses Hotline, Counseling Services and benefits for Hearing Aids. This is not an insurance plan. The discount Vision Plan through the Coast to Coast network allows the Employee to receive discounts of 20% to 60% on eyeglasses, non-prescription sunglasses, contact lenses (including disposables) and frames from over 10,000 independent retail optical locations nationwide. Providers include independent practitioners, regional chains, department store opticals, and the largest chains in the U.S. Some of these providers are LensCrafters, Pearle Vision, Sears Optical and JC Penney Optical (among others).* The Nurses Hotline allows access to experienced registered nurses 24 hours a day, 7 days a week, 365 days a year. These hotline nurses are an immediate, reliable and caring source of health information, education and support. Services provided by this plan include: o General information on all types of health concerns o Information based on physician-approved guidelines o Answers about medication usage and interaction o Information on non-medical support groups o Translation services for non-english speaking callers o Full time medical director on staff The Counseling Services benefit allows the Employee to speak with a counselor 24 hours a day, 7 days a week regarding any personal problems they may be facing. In addition, if the Employee is referred to one of the 27,000 counseling providers nationwide, they will receive discounts of 25% to 30% off the normal billing charges from those providers.* Patient Advocacy Even with exceptional PPO discounts and rich reimbursement schedules, employees of limited benefit medical plans may be left with unpaid medical bills in years when medical bills approach $3,500 or more. For these individuals, Karis Patient Advocacy service becomes the critical missing piece and an invaluable benefit for customers. Since we treat each employee, locality and provider as a unique combination of variables that leads to a customized solution for each employee, Karis delivers a customized and comprehensive solution that goes far beyond the benefits of a one size fits all PPO network discount. When reimbursement limits are reached, our services kick in and provide employees with unparalleled diligence and dedication to find the best solutions for resolving their outstanding medical bills. For employees who find themselves unable to pay bills that exceed Limited Benefit Medical plan reimbursements, Karis can come alongside to advocate on their behalf, working with every provider to find a mutually agreeable solution. Karis highly trained and experienced Employee Advocates guide employees through the tangled maze of medical billing. Initially, we research the availability of entitlement or financial assistance programs in an effort to locate outside funding sources to help pay their bills. If an employee qualifies for such programs, their Employee Advocate will hold their hand throughout what can be a lengthy process and will do everything for the employee from acquiring necessary paperwork to chasing decision makers. If an employee does not qualify for entitlement or financial assistance programs, their Employee Advocate will try to negotiate a reduced settlement or reduced/extended payment plan with providers that is acceptable to all parties. The Hearing Aid benefit provides savings of up to 15% off the retail cost on over 70 models of hearing aids, and a free hearing test when utilizing one of the 1,200 participating Beltone locations nationwide. Or, the Employees can realize savings of up to 50% off suggested retail price on over 90 models of hearing aids in over 1,000 locations nationwide.* Information on how to access the benefits of the Employee Discount card will be included in the fulfillment package that each insured Employee receives from KBA. * Discounts on professional services are not available where prohibited by law. EBD IB5MEG 0915

9 Optional Hospital Indemnity Insurance Limitations and Exclusions for TransChoice Advance: Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company Confinement for the same or related condition within 30 days of discharge will be treated as a continuation of the prior confinement. Successive confinements separated by more than 30 days will be treated as a new and separate confinement. No benefits under this contract will be payable as the result of the following: Suicide or attempted suicide, whether while sane or insane. Intentionally self-inflicted injury. Rest care or rehabilitative care and treatment. Immunization shifts and routine examinations such as: physical examinations, mammograms, Pap smears, immunizations, flexible sigmoidoscopy, prostate-specific antigen tests and blood screenings (unless Wellness Indemnity Benefit Rider is included). Any pregnancy of a dependent child including confinement rendered to her child after birth. Routine newborn care (unless Wellness Indemnity Benefit Rider is included). An insured person s abortion, except for medically necessary abortions performed to save the mother s life Treatment of mental or emotional disorder (unless Inpatient Mental and Nervous Disorder Indemnity Benefit Rider is included). Treatment of alcoholism or drug addiction (unless Inpatient Drug and Alcohol Addiction Indemnity Benefit Rider is included). Participation in a felony, riot, or insurrection. Any accident caused by the participation in any activity or event, including the operation of a vehicle, while under the influence of a controlled substance (unless administered by a physician or taken according to the physician s instructions) or while intoxicated (intoxicated means that condition as defined by the law of the jurisdiction in which the accident occurred). Dental care or treatment, except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly. Sex change, reversal of tubal ligation or reversal of vasectomy. Artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications or physician s services, unless required by law. Committing, attempting to commit, or taking part in a felony or assault, or engaging in an illegal occupation. Traveling in or descending from any vehicle or device for aerial navigation, except as a fare-paying passenger in an aircraft operated by a commercial airline (other than a charter airline) on a regularly scheduled passenger trip. Any loss incurred on active duty status in the armed forces. (If you notify us of such active duty, we will refund any premiums paid for any period for which no insurance is provided as a result of this exception.) An accident or sickness arising out of or in the course of any occupation for compensation, wage or profit or for which benefits may be payable under an Occupational Disease Law or similar law, whether or not application for such benefits has been made. Involvement in any war or act of war, whether declared or undeclared Termination of Insurance The insurance terminates on the earliest of: The insured s death. The premium due date when we fail to receive a premium, subject to the grace period. The date of written notice to cancel insurance. The date the policy terminates, subject to the portability option. The date the insured ceases to be eligible for insurance. Dependent insurance ends on the earliest of: The date the insured s insurance terminates for any of the reasons above. The date the dependent no longer meets the definition of a dependent. The premium due date when we fail to receive a premium, subject to the grace period. The date of written notice to cancel insurance. The date the policy is modified so as to exclude dependent insurance. The insurance company has the right to terminate the insurance of any insured who submits a fraudulent claim. Termination will not impact any claim which begins before the date of termination. Extension of Benefits Whenever termination of insurance under this section occurs due to termination of Your employment or membership, such termination will be without prejudice to: 1. Any Hospital Confinement which commenced while insurance was in force, with respect to Daily In-Hospital Indemnity Benefits; or, 2. Any covered treatment or service for which benefits would be provided and which commenced while insurance was in force; provided, however, that the Insured Person is and continues to be Hospital Confined or Disabled. Such Extension of Benefits will continue for up to the earlier of: days; or 2. The date on which the Insured Person is no longer disabled. Massachusetts Residents: This product DOES NOT MEET MINIMUM CREDITABLE COVERAGE STANDARDS and WILL NOT SATISFY the Massachusetts individual mandate that you have health insurance. EBD IB5MEG

10 MEC Heavy As outlined under the new healthcare law, ACA, all individuals must have Minimum Essential Coverage (MEC) or pay a penalty tax. Employees can prevent being taxed the Individual Mandate penalty tax by purchasing Minimum Essential Coverage through their employer. Because the MEC plan covers specific preventative services we also offer the MEC Heavy plan that provides meaningful benefits for those looking for a more encompassing MEC plan. The MEC Heavy plan covers the required MEC preventative services in addition to Emergency Room Services, Primary Care and Specialist visits, Imaging (CT, PET Scans, MRI s), Laboratory Services, X-Ray and Diagnostic Imaging and Prescription Drugs. The MEC Heavy includes our acclaimed Chronic Disease management program along with the RealTime Health Diabetic Program and the RealTime Choices Price Transparency tool. Covered Benefit Categories for the MEC Heavy Plans: - Emergency Room Services - Primary Care Visit to Treat an Injury or Illness - Specialist Visit - Imaging (CT, PET Scans, MRIs) - Preventative Care, Screening, & Immunization (MEC Services) - Laboratory Outpatient and Professional Services - X-Rays and Diagnostic Imaging - Prescription Drugs - Chronic Disease Services under the AHDI CDM Benefit As a MEC Heavy member, you will receive a medical ID Card that needs to be presented to your medical provider at your time of service. The MEC Heavy offers a Co-Pay plan design with a $2,500 single Out-of-Pocket Maximum. Out-of-Network benefits are covered with a $500 single / $1,000 family deductible with a 40% coinsurance and no out of pocket maximum.

11 MEC Heavy Deductible $0 / $0 $500 / $1,000 Out-of-Pocket Maximum $2,500 / $13,200 Deductible & Coinsurance Covered Benefits In-Network Out-of-Network Emergency Room Services (Facility Charges) Emergency Room Services (Physician Charges) Primary Care Visits to Treat an Injury or Illness $400 copay, then 100% up to $7,500 per day $400 copay, then 100% up to $2,500 per day $400 copay, then 100% up to $7,500 per day $400 copay, then 100% up to $2,500 per day $15 copay Deductible & Coinsurance Specialist Visit $25 copay Deductible & Coinsurance Imaging (CP, PET Scans, MRIs) $400 copay Deductible & Coinsurance Laboratory Outpatient and Professional Services $50 copay Deductible & Coinsurance X-rays and Diagnostic Imaging $50 copay Deductible & Coinsurance Preventative Care, Screening, & Immunization (Minimum Essential Coverage) 100% covered Deductible & Coinsurance Chronic Disease Management (CDM) 100% covered Deductible & Coinsurance Prescription Drugs Generic Drugs $15 copay Deductible & Coinsurance Preferred Brand Drugs $25 copay Deductible & Coinsurance Non-Preferred Brand Drugs $75 copay Deductible & Coinsurance Life Insurance with AD&D $10,000 $10,000 The Following Services are NOT COVERED: Inpatient Hospital Services, Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services, Rehabilitative Speech Therapy, Rehabilitative Occupational and Rehabilitative Physical Therapy, Outpatient Facility Fees, Outpatient Surgery Physician/Surgical Services, Specialty Drugs & Compounds The cost of this insurance is detailed on page 17 11

12 Optional Hospital Indemnity Insurance Underwritten by Transamerica Life Insurance Company TransChoice Advance: Group Limited Benefit Hospital Indemnity Insurance Plan 2 Daily In-Hospital Indemnity Benefit Pays per day, up to a max of 31 days per confinement Surgical and Anesthesia Indemnity Benefit Pays benefit per day; 1 day per calendar year for Inpatient Surgery, 1 day per calendar year for Outpatient Surgery, 1 day per calendar year for Specified Outpatient Surgeries. Pays additional 20% of the surgical benefit for Anesthesia. Hospital Confinement 1 day of confinement per year Intensive Care Indemnity Benefit Pays per day, up to a max of 30 days per year Inpatient Outpatient Specified Outpatient $400 $500 $250 $50 $500 $500 Employee Discount Card - Offered by New Benefits, LTD Provides access to a discount Vision plan, Nurses Hotline, Counseling Services, and discounts on Hearing Aids This is a brief summary of TransChoice Advance Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, IA. Policy form series CPGHI400 and CCGHI400. Forms and form numbers may vary. This insurance may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. THIS IS NOT MAJOR MEDICAL INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL INSURANCE. IT DOES NOT QUALIFY AS MINIMUM ESSENTIAL HEALTH COVERAGE UNDER THE FEDERAL AFFORDABLE CARE ACT. The cost of this insurance is detailed on page 17 EBD IB5MEG 0915

13 Optional Hospital Indemnity Insurance Summary of Benefits for TransChoice Advance: Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company Daily In-Hospital Indemnity Benefit When an insured person is confined in a hospital as a result of an accident or sickness, this benefit pays the benefit amount for each day the insured is confined in a hospital, up to a maximum of 31 days per confinement. Hospital Confinement This benefit pays an additional benefit per insured person per calendar year when he/she receives treatment or surgery while confined to a hospital as an inpatient as a result of a covered accident or sickness. Intensive Care Indemnity Benefit This benefit pays per day for confinement in an intensive care unit, for a maximum of 31 days per insured person per calendar year. This benefit is paid in addition to the Daily In-Hospital Indemnity Benefit. Surgical and Anesthesia Indemnity Benefit We will pay the inpatient, an outpatient or an outpatient minor surgical benefit described for an insured person when a covered surgery is performed because of an accident or a sickness. The inpatient benefit is payable once per calendar year per insured person for any covered inpatient surgical procedure or for two or more inpatient procedures performed in the same surgical session. The outpatient benefit is payable once per calendar year for any covered outpatient surgical procedure or two or more outpatient procedures performed in the same surgical session. The outpatient minor benefit is payable once per calendar year per insured person for any covered outpatient minor surgical procedure or two or more such procedures performed in the same surgical session. We will also pay the anesthesia benefit when anesthesia is administered during any covered surgery. The indemnity benefit will be a percentage of the amount paid under the surgical indemnity benefit. Please see the certificate for a list of codes that are considered outpatient minor surgical procedures. EBD IB5MEG

14 Optional Hospital Indemnity Insurance Non-Insurance Benefits Employee Discount Card This discount card is provided by New Benefits, LTD. It offers Employees access to a discount Vision Plan, a Nurses Hotline, Counseling Services and benefits for Hearing Aids. This is not an insurance plan. The discount Vision Plan through the Coast to Coast network allows the Employee to receive discounts of 20% to 60% on eyeglasses, non-prescription sunglasses, contact lenses (including disposables) and frames from over 10,000 independent retail optical locations nationwide. Providers include independent practitioners, regional chains, department store opticals, and the largest chains in the U.S. Some of these providers are LensCrafters, Pearle Vision, Sears Optical and JC Penney Optical (among others).* The Nurses Hotline allows access to experienced registered nurses 24 hours a day, 7 days a week, 365 days a year. These hotline nurses are an immediate, reliable and caring source of health information, education and support. Services provided by this plan include: o General information on all types of health concerns o Information based on physician-approved guidelines o Answers about medication usage and interaction o Information on non-medical support groups o Translation services for non-english speaking callers o Full time medical director on staff The Counseling Services benefit allows the Employee to speak with a counselor 24 hours a day, 7 days a week regarding any personal problems they may be facing. In addition, if the Employee is referred to one of the 27,000 counseling providers nationwide, they will receive discounts of 25% to 30% off the normal billing charges from those providers.* The Hearing Aid benefit provides savings of up to 15% off the retail cost on over 70 models of hearing aids, and a free hearing test when utilizing one of the 1,200 participating Beltone locations nationwide. Or, the Employees can realize savings of up to 50% off suggested retail price on over 90 models of hearing aids in over 1,000 locations nationwide.* Information on how to access the benefits of the Employee Discount card will be included in the fulfillment package that each insured Employee receives from KBA. * Discounts on professional services are not available where prohibited by law. Limitations & Exclusions Apply. See page 9 for details EBD IB5MEG 0915

15 Minimum Value Plan The Minimum Value Plan (MVP) is a high deductible plan offering very limited coverage. The MVP plan does include the required MEC services and does prevent the employee from being taxed the Individual Mandate penalty tax by purchasing Minimum Essential Coverage through their employer. Unlike the plans being offered on the Exchange and individual market this MVP does have a list of services that are not covered by the plan. The MVP plan covers the following services after your $6,500 deductible is met. Emergency Room Services, Inpatient Hospital Services, Primary Care and Specialist visits, Imaging, Laboratory Services, X-rays and Diagnostic Imaging, and certain Generic and Preferred Brand drugs. Please pay close attention to the list of excluded benefit categories outlined below. The MVP offers a very limited benefit plan design excluding the following major service categories: - Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services - Rehabilitative Speech Therapy - Rehabilitative Occupational and Rehabilitative Physical Therapy - Skilled Nursing Facility - Outpatient Facility Fees. - Outpatient Surgery Physician/Surgical Services - Non-Preferred Brand Drug. - Specialty Drugs (including compound drugs) - Drugs related to mental health such as ADHD The MVP offers a plan design with a $6,500 single deductible and a $13,200 family deductible. The Coinsurance responsibility is 40% paid by the enrolled. The out-of-pocket maximum is $6,500 for single and $13,200 for a family. Note: Because almost every benefit category is subject to the deductible it is important that you budget for the $6,500 deductible which comes out to be $541 a month in addition to your maximum premium contribution. As a MVP member, you will receive a medical ID Card that needs to be presented to your medical provider at your time of service. 15

16 Minimum Value Plan Deductible $6,500 / $13,200 Not Covered Out-of-Pocket Maximum $6,500 / $13,200 Not Covered Covered Benefits Inpatient Hospital Services Deductible & Coinsurance Not Covered Primary Care Visits to Treat an Injury or Illness $50 copay + 40% Coinsurance Not Covered Imaging (CP, PET Scans, MRIs) Deductible & Coinsurance Not Covered X-rays and Diagnostic Imaging Deductible & Coinsurance Not Covered Preventative Care, Screening, & Immunization (Minimum Essential Coverage) Chronic Disease Management (CDM) 100% covered Not Covered 100% covered Not Covered Prescription Drugs Generic Drugs Deductible & Coinsurance Not Covered Preferred Brand Drugs Deductible & Coinsurance Not Covered The Following Services are NOT COVERED: Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services, Rehabilitative Speech Therapy, Rehabilitative Occupational and Rehabilitative Physical Therapy, Outpatient Facility Fees, Outpatient Surgery Physician/Surgical Services, Specialty Drugs & Compounds The cost of this insurance is detailed on page 17

17 Rate Sheet Weekly Cost Employee EE + Child(ren) MEC $8.30 $31.84 Weekly Cost Employee EE + Child(ren) MEC Heavy $34.08 $67.73 Optional TransChoice Advance: Add-on Coverage for MEC & MEC Heavy Plans Group Limited Benefit Hospital Indemnity Insurance underwritten by Transamerica Life Insurance Company Weekly Cost Employee EE + Child(ren) TransChoice Advance Plan 1 $19.45 $32.19 Weekly Cost Employee EE + Child(ren) TransChoice Advance Plan 2 $10.29 $15.62 If you choose to purchase both KeySolution MEC or MEC Heavy and TransChoice Advance Hospital Indemnity Insurance, your total cost will be: MEC + Plan 1 = MEC Plus Weekly Cost MEC+ Employee $27.75 EE + Child(ren) $64.03 MEC Heavy + Plan 2 = MEC Heavy Plus Weekly Cost MEC Heavy+ Employee $44.38 EE + Child(ren) $83.35 MVP Weekly Cost* Employee: 9.5% of Pay Rate EE + Child(ren): 9.5% of Pay Rate + $ MVP *Note: MVP employee premiums are calculated based on the lowest hourly rate of pay as of the first day of coverage, using a 30 hour work week. A 30 hour work week is used regardless of actual hours worked. The calculation is as follows: 9. 5% Hourly Pay Rate 30 Hours = MVP Weekly Premium MVP employee only sample calculation using a $10 per hour pay rate: 9. 5% $10 per Hour 30 Hours = $

18 Notes

19 Notes 19

20 Frequently Asked Questions How Can You Participate? All employees are eligible to enroll on the 1st of the month following 59 days of employment. Eligible dependents include children or stepchildren, under age 26. How Are Premium Payments Made? Premiums will be taken through payroll deduction. If you miss a payroll deduction as a result of absence or lack of work, you risk being terminated from the plan. If terminated you will not be eligible to reenroll until the next open enrollment period unless you experience a qualifying event. When Will My Insurance End? Your insurance will end when you no longer qualify for the insurance or when your premium payments end, whichever comes first. Insurance on dependents ends on either the date they no longer meet the definition of a dependent or, the date your insurance terminates, whichever comes first. What Is An Indemnity Benefit? It means that the insurance company will pay a set amount each time the insured receives a covered service. The same amount is paid regardless of the fees charged by the provider. Is my doctor in the network? To check if your provider is in the network, go to or speak to a representative at What if I do not enroll? If you do not enroll in or decline to opt out of any of the available options by the end of the enrollment period, you will be automatically enrolled in the basic MEC at a weekly deduction of $8.30 per week. The basic MEC provides wellness/preventative coverage only and protects you from the individual penalty (an annual cost of $ compared to the individual penalty of $695. This plan offering prevents an otherwise qualified individual from obtaining a premium tax credit through the HealthCare Marketplace. Can I Sign Up For Insurance At Any Time? No. New employees are eligible for benefits after working long enough to meet the eligibility requirement. JFC Staffing Companies eligibility requirement is the first month after 59 days. If you have worked long enough to be eligible for benefits, and work the required number of 30 hours per week, you are eligible to sign up for this coverage. If you do not elect coverage when eligible, you will not be able to enroll until the next open enrollment period unless you experience a qualifying event. Can I Cancel My Insurance At Any Time? Premiums are paid with pre-tax dollars through payroll deductions as part of a Section 125 Savings Plan. You will not be able to change these elections until the next annual enrollment period, unless you have a qualifying event. When can I expect to receive the Member Kit? The member kit will typically be mailed to you approximately 7-10 business days after your first payroll deduction. Please allow three weeks for this kit to arrive in your mailbox.

21 EBD IB5MEG 0915 Notes