2015 Enrollment Guide New Hampshire Employees

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1 You can only enroll once a year, so don t miss your chance! 2015 Enrollment Guide New Hampshire Employees Enroll online at To enroll by phone, call Questions: Call , or ask@myvba.biz This brochure contains a brief summary of benefits and services available to you for purchase through your employer. Limitations and exclusions apply. Refer to your policy, certificate and riders for complete details. If there should be a typo in this brochure, the policy certificate will always prevail.

2 Your Benefits Overview Dear Apple American Employees: Under the new ACA guidelines, you are required to have compliant health insurance coverage or face a tax penalty. How much are the penalties for NOT having compliant coverage? January 1, 2015: 2% of adjusted household income or $325 per adult PLUS $ per child (whichever is greater) January 1, 2016: 2.5% of adjusted household income or $695 per adult PLUS $ per child (whichever is greater) In order to help you avoid these tax penalties and offer you affordable compliant coverage, your employer is making available a menu of new benefit offerings. These new plans provide several levels of coverage based on your individual or family s needs. Minimum Essential Coverage (MEC) (page 3) This plan offers you the minimum coverage required to avoid the new ACA penalties and provides 100% coverage (in network) with no deductibles or co-payments for 63 preventive services including 15 tests for adults, 23 tests for women (including pregnant women) and 26 tests for children. You can purchase this coverage stand alone or combine it with the Hospital Indemnity Benefits for a more comprehensive compliant plan. Enclosed you will find detailed descriptions of these benefit options. For additional assistance and information, please contact Member Services at Representatives are available to assist you Monday through Friday from 7:00 am to 7:00 pm Central Standard Time. Call , today for more information and to enroll, or questions to Ask@myvba.biz. You can also enroll online at: AA-Benefits.com 2

3 NEW Minimum Essential Coverage This coverage is required to satisfy the individual mandate under Health Care Reform. Minimum Essential Coverage (MEC) covers 100% of the 63 CMS-listed Preventative and Wellness benefits when you visit a network provider (including Pap smears, mammograms, contraception, well child visits and much more (See next page for details). As an Employee, you can prevent being taxed the Individual Mandate coverage penalty by purchasing Minimum Essential Coverage through your employer Penalty tax of 2% of adjusted household income or $325 per adult plus $ per child, whichever is greater 2016 and beyond - Penalty tax of 2.5% of adjusted household income or $695 per adult plus $ per child, whichever is greater You can purchase Minimum Essential Coverage (MEC) stand-alone or combine it with your Hospital Indemnity Insurance (explained on page 3 of this brochure) for a more comprehensive and compliant plan. Cost of Coverage Minimum Essential Coverage Weekly Cost EE Only $13.14 EE + Spouse $22.31 EE + Child(ren) $24.09 EE + Family $31.12 Network The MEC plan utilizes the First Health Network. The First Health Network provides access to one of the nation s largest and most respected networks. Access to over 490,000 healthcare provider locations across all 50 states and the District of Columbia. First Health logo on medical ID card for fast and easy recognition by the provider To view a list of network providers, go to or call: for assistance. When making your appointment, verify with the provider that they are part of the First Health Network. This brochure contains a brief summary of benefits and services available to you for purchase through your employer. Limitations and exclusions apply. Refer to your policy, certificate and riders for complete details. If there should be a typo in this brochure, the policy certificate will always prevail. Front of the House Employees If you are a front of the house employee, your benefit premiums will NOT be withheld from your paycheck. Rather, you must establish a direct pay arrangement when enrolling for coverage. You must pay premiums with a credit/debit card. When enrolling, you will be required to set up your payment. Each month, we will charge your card for the monthly premium. The premium will be charged to your card on the last day of each month for coverage for the next month s coverage. If you card is declined, your coverage will be terminated. 3

4 Minimum Essential Coverage 15 Covered Preventive Services for Adults (ages 18 and older) 1. Abdominal Aortic Aneurysm one time screening for ages 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 10. HIV screening 11. Immunizations, vaccines (Hepatitis A & B, Herpes Zoster, Human Papillomavirus, influenza (flu shot), measles, mumps, rubella, Meningococcal, Pneumococcal, Tetanus, Diptheria, Pertussis, Varicella) 12. Obesity screening and counseling 13. Sexually Transmitted Infection (STI) prevention counseling 14. Tobacco use screening and cessation interventions 15. Syphilis screening 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 for women 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 Routine prenatal visits for pregnant women 19. Rh Incompatibility screening for all pregnant women and follow-up testing 20. Tobacco Use screening and interventions and expanded counseling for pregnant tobacco users 21. Sexually Transmitted Infections (STI) counseling 22. Syphilis screening 23. Well-woman visits to obtain recommended preventive services 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 5 4 This brochure contains a brief summary of benefits and services available to you for purchase through your employer. Limitations and exclusions apply. Refer to your policy, certificate and riders for complete details. If there should be a typo in this brochure, the policy certificate will always prevail.

5 Frequently Asked Questions Who is eligible to enroll? All hourly employees and their eligible dependents are eligible to enroll in the MEC. Eligible dependents include spouses and children or step-children up to age 26. Can I enroll at any time? No, you must sign up for coverage during your eligibility period. If you do not elect coverage during this time, you will not be able to enroll until the next open enrollment period, unless you experience a qualifying event. How will my premiums be paid? Benefits will run on a bi-weekly cycle based on your pay check. Premiums are paid through payroll deductions, except for employees who work in the front of the house. Your deductions will be taken from your paycheck which will pay for coverage starting on the first day of that pay period and ending on the last day of the pay period. If you do not have a deduction, you will need to submit a Missed Premium payment. If you do not have a deduction and do not make a Missed Premium payment, you will not be covered for that period. Claims will not be processed until premium is paid for the benefit period. What happens if I am a front of the house employee? Employees who work in the front of the house will be set up on a monthly basis and will have premiums charged to a credit/debit card. You will be asked to set up this information when completing your enrollment. Your card will be charged on the first day of each month for the total monthly premium. A 6% service charge will be added to your credit card. When should I expect my Welcome Packet to arrive? The benefit kit will be mailed to you soon after you have enrolled. Can I make changes or cancel my coverage at any time? Open enrollment is the one time of year to make changes or cancel your plan. Premiums are paid with pre-tax dollars through payroll deductions as part of a Section 125 Savings Plan unless your are a tipped employee. You will not be able to change these elections until the next annual enrollment period, unless you have a qualifying event. Are Medicare/Medicaid recipients eligible for this plan? Please note that the prescription drug coverage under MEC is not considered Creditable Coverage under Medicare Part D regulations. Medicare eligible individuals may have to pay higher costs if they delay enrolling in the Medicare Pharmacy Plan. If you have Medicare/Medicaid it is NOT recommended that you enroll in coverage, which may reduce or discontinue your benefits. What happens if I have a missed payroll deduction? You have 30 days to pay for the premiums that could not be deducted from your paycheck. If you do not pay the missed premiums within 30 days you will be unable to pay for them at a later date. If you have missed premium deductions and want to find the balance due or have questions about making a payment, contact Member Services at or go online to Whom can I contact if I have questions about my plan? Contact Member Services at , and a customer service representative will assist you. You can also questions to ask@myvba.biz or visit on line at AA-Benefits.com. ID cards will be included in your Welcome Packet. This brochure contains a brief summary of benefits and services available to you for purchase through your employer. Limitations and exclusions apply. Refer to your policy, certificate and riders for complete details. If there should be a typo in this brochure, the policy certificate will always prevail. 5

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