WHO TO CONTACT. UNITED HEALTHCARE Customer Service UNITED HEALTHCARE DENTAL Customer Service

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2 TABLE OF CONTENTS Benefits at a Glance... 3 MySCOBenefits.com... 4 Medical Plan... 5 Dental Plan... 6 Flexible Spending Accounts... 7 Critical Illness Plan... 8 Accident Plan... 9 Term Life, Voluntary Life, Dependent Life Plans WHO TO CONTACT UNITED HEALTHCARE Customer Service UNITED HEALTHCARE DENTAL Customer Service MUTUAL OF OMAHA (to file a life claim) MUTUAL OF OMAHA (to file a disability claim) CORPORATE PLANNING NETWORK ALLSTATE BENEFITS Customer Service ENROLLMENT ASSISTANCE (BenefitHelp) , Option 2 Every reasonable effort has been made for the information provided in this booklet to be accurate. It is intended to provide the employees with Southern College of Optometry an overview of the coverages offered. It is in no way a guarantee or offer of coverage. Each carrier has the ability to underwrite based on its contract with Southern College of Optometry or its employees. Each carrier s contract, underwriting, and policies will supersede this document. Please be aware that each carrier may have exclusions or limitations and you must consult your summary plan description and/or policies for details. 2

3 BENEFITS AT A GLANCE Medical Insurance Coverage is provided through United Healthcare. Eligible employees may choose from 3 plan options. The BRONZE plan has an annual, individual deductible of $2,000 with 80% coverage when using network providers. The GOLD plan deductible is $500 for an individual and coverage is 80% when network providers are used. The PLATINUM plan does not have an annual deductible and coverage is 100% after plan copayments. Dental Insurance Eligible employees are offered dental coverage also provided through United Healthcare. Eligible employees my choose from two options. When using the BASE plan, coverage is only provided when using a dentist within the UHC network. The BUY-UP plan allows you to see the provider of your choice, however, benefits are greater when you remain in the UHC network. Flexible Spending Accounts Flexible Spending Accounts enable you to put aside money for important expenses, while helping to reduce your taxable income at the same time. Southern College of Optometry offers you both a HealthCare FSA and a Dependent Care FSA. The HealthCare FSA can be used for eligible expenses that your insurance does not cover. For example, copayments, deductibles and coinsurance, as well as unreimbursed dental and vision expenses. A Dependent Care FSA can be used for childcare or eldercare services. Be sure to calculate your expenses wisely, monies deposited into these accounts do not rollover from year to year. Supplemental Plans Supplemental Plans are designed to help protect your health and savings by paying a cash benefit directly to you to use as you need it. Some things to consider when deciding if you need supplemental coverage are your health risk factors, your savings, and how much you can afford. The Critical Illness and Accident are offered through Allstate Benefits. Premiums are calculated based upon your age and the coverage level you select and are deducted from your paycheck. Life and AD&D Insurance Southern College of Optometry provides eligible faculty and staff with basic life and AD&D insurance coverage. Coverage is equal to 2.5 times your annual income, not to exceed $300,000 in coverage and is offered through Mutual of Omaha. Employees may also purchase additional life insurance for themselves and their dependents through Mutual of Omaha. During Open Enrollment you are given the opportunity to increase your Voluntary Term Life election by $10,000 without providing evidence of insurability, as long as your total election amount does not exceed the Guaranteed Issue limit. If you choose to increase coverage by more than $10,000 or you exceed the Guaranteed Issue amount you will be required to complete a medical questionnaire. 3

4 MYSCOBENEFITS.COM Where online can I get more information about my benefits? Have you ever had trouble locating information about your benefits? What about trying to remember how to find a participating doctor or dentist? Not to worry, with MySCOBenefits.com you are just an internet connection away from... Important Phone Numbers Employee Benefit News Carrier Information Important Plan Documents Provider & Facility Searches Plan documents can be accessed without having to log in. 4

5 You are eligible for Medical coverage on the first day of the month following your date of hire. MEDICAL PLANS SOUTHERN COLLEGE OF OPTOMETRY MEDICAL PLANS (in network benefits) BRONZE GOLD PLATINUM Deductible Individual/Family $2,000 / $4,000 $500 / $1,000 $0 / $0 Out of Pocket Maximum $6,000 / $12,000 $2,500/$5,000 $6,250/$12,500 Office Visit Copay $25 Primary Care $50 Specialist $20 Primary Care $40 Specialist $20 Primary Care $40 Specialist Preventive Care 100%, no deductible 100%, no deductible 100%, no deductible Outpatient Services 80% coverage, after deductible 80% coverage, after deductible 100% Urgent Care Services $75 copay $75 copay $50 copay Emergency Room Visit $250 copay $250 copay $250 copay Inpatient Services 80% coverage, after deductible 80% coverage, after deductible $250 copay per admission Virtual Office Visits Unlimited visits, $15 copay applies Unlimited visits, $15 copay applies Unlimited visits, $15 copay applies Retail Pharmacy 31 day supply $10/$35/$60 copay $10/$30/$50 copay $10/$25/$50 copay Mail Order Pharmacy 90 day supply $25/$87.50/ $150 copay $25/$75/$125 copay $25/$62.50/ $125 copay Medical Plan - Semi-Monthly Payroll Deduction Who to Cover? BRONZE GOLD PLATINUM Employee $26.50 $42.50 $65.00 Employee + 1 Dependent $ $ $ Family $ $ $

6 DENTAL PLANS You are eligible for Dental coverage on the first day of the month following your date of hire. Southern College of Optometry offers 2 Dental plan options through United Healthcare for all eligible faculty and staff. With the BASE dental plan you must use a provider in the UHC network to receive coverage. If you use a provider that is not in the network, your dental work will not be covered.. The BUY-UP Dental plan gives you the ability to obtain dental care services from the dentist of your choice (contracted or not). The BUY-UP dental plan also provides a higher level of benefit if you choose to use an in-network provider. Please note: It is recommended that when a course of treatment is expected to cost $300 or more, and is of a non-emergency nature, your dentist should submit a treatment plan before work begins. This enables you to see what your out-of-pocket expenses will be so you are not surprised and can budget accordingly. There is also a possibility that suggested procedures may be denied, and alternative procedures approved based upon X-rays and supporting documentation. BASE DENTAL PLAN BUY-UP DENTAL PLAN Annual Deductible Individual/Family Annual Maximum Benefit Preventive Care Services Basic Services Major Services In-network Benefits ONLY In-network Benefits Out-of-network Benefits $50/$150 $50/$150 $50/$150 $1,500 $1,000 $1, % 100% 100% 50% 90% 80% 50% 60% 50% Dental Plan - Semi-Monthly Payroll Deduction Who to Cover? BASE Plan BUY-UP Plan Employee $ 8.82 $ Employee + Spouse $ $ Employee + Child(ren) $ $ Family $ $

7 You must re-enroll each year FLEXIBLE SPENDING ACCOUNTS Southern College of Optometry provides you the opportunity to pay for out-of-pocket medical, dental, vision, and dependent care expenses with pre-tax dollars through the Flexible Spending Accounts. A health care FSA is used to reimburse out-of-pocket medical expenses incurred by you and your dependents. The maximum allowable contribution for a health care (medical) FSA is $2,550. A dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse work. The maximum allowable contribution amount for a dependent care FSA is $5,000. Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you do not pay federal income tax, Social Security taxes, and state and local income taxes on the portion of your paycheck that you contribute to your FSA. You should contribute the amount of money you expect to pay out of pocket for eligible expenses* for the plan period. If you do not use the money you contributed it will not be refunded to you nor carried forward to a future plan year. This is known as the use-it-or-lose-it rule. If your elected annual contribution amount is not evenly divisible by the number of pay periods (24), your contribution amount may be reduced to allow for even installments. The following example shows how you can save money with a flexible spending account: Without FSAs With FSAs Gross Income $30,000 $30,000 FSA Contributions $0 - $5,300 Gross Income $30,000 $24,700 Estimated taxes After-tax earnings: Eligible out-of-pocket Federal - $2,550** - $1,755** State - $900*** - $741*** FICA - $2,295 - $1,890 Medical and dependent care expenses - $5,300 $0 Remaining spendable income $18,955 $20,314 Spendable income increase $1,359 *A full list of FSA eligible expenses is available at **Assumes standard deductions and four exemptions ***Varies, assume 3% The example above is for illustrative purposes only. Every situation varies and it is recommended that you consult a tax advisor for all tax advice. 7

8 CRITICAL ILLNESS PLANS Critical Illness benefits help families pay off debts and other expenses not covered by medical insurance such as a loss of income, childcare services, and travel to treatment centers. These benefits are paid directly to you. Eligibility All active faculty and staff working.75 FTE. Benefit Amount Select a lump sum benefit of either $10,000 or $20,000 Guaranteed Issue Covered Conditions Who to cover? Portability Policies are Guaranteed Issue for New Hires; Current employees who did not elect when first eligible may apply for coverage by answering a few questions. Heart Attack, Stroke, Coronary Artery Disease, End Stage Renal Failure, Paralysis, Major Organ Transplant, Cancer (this list is not all inclusive, refer to the plan documents for additional covered conditions and any limitations) Coverage is available for employee, spouse and children Yes, coverage is portable. Critical Illness Plan SAMPLE Rates Semi-Monthly Payroll Deduction Sample Rates are based on a $10,000 policy - non-tobacco user Age Named Insured Family $ 2.10 $ $ 4.60 $ $ 9.40 $ $ $ $ $ $ $

9 ACCIDENT PLAN Accidents can happen anytime, anywhere and can often lead to medical care. Accident coverage provides cash benefits to help cover out-of-pocket medical costs and other incidental expenses. Accident plan benefits pay directly to you and can serve as a compliment to your major medical and disability coverage. Eligibility Benefit Amount Guaranteed Issue Covered Services and Conditions Who to cover? Portability All active faculty and staff working.75 FTE. Select from the Basic or Enhanced plan. A full description of covered services is available at Policies are Guaranteed Issue Emergency Room, Ambulance, Hospitalization, Radiology, Broken Bones, Burns, Concussions, Lacerations, and Paralysis (this list is not all inclusive, refer to the plan documents for additional covered treatments and any limitations) Coverage is available for employee, spouse and children Yes, coverage is portable. Accident Plan Rates Semi-Monthly Payroll Deduction Who to Cover? Basic Plan Enhanced Plan Employee $ 5.95 $ 9.26 Employee + Spouse $ 8.82 $ Employee + Child(ren) $ $ Family $ $

10 LIFE INSURANCE Basic Term Life Insurance and AD&D All active, full-time faculty and staff employees receive Life and Accidental Death & Dismemberment coverage equal to 2.5 times their salary, to a maximum benefit of $300,000. Coverage is provided for you by Southern College of Optometry after one year of employment and is through Mutual of Omaha. Eligibility All active faculty and staff working.75 FTE. Benefit Amount 2.5 Salary to maximum of $300,000 Guaranteed Issue Additional Benefits Up to $300,000 for New Hires 75% Accelerated Death Benefit, Waiver of Premium Benefit Reduction 65% at 70 50% at 75 Termination At retirement or other end of employment. Voluntary Term Life Insurance and AD&D Employees who want to supplement their group life insurance benefits may purchase additional coverage. When you enroll yourself and/or your dependents in this benefit, you pay the full cost through payroll deductions. You can purchase coverage on yourself in $10,000 increments. Minimum coverage is $10,000 and maximum coverage is $250,000 ($100,000 Guaranteed Issue). Spouse amounts may be purchased in $5,000 increments up to $50,000, not to exceed the employees benefit amount. $35,000 in coverage is Guaranteed Issue for the spouse of a new hire. You may purchase $10,000 in coverage on your dependent child(ren). NOTE: If you do not elect voluntary life insurance when you first become eligible, you will need to complete an Evidence of Insurability form to obtain approval for coverage. If you are currently enrolled in voluntary life insurance, you have the ability to increase your coverage during you each open enrollment by $10,000 without providing medical evidence of insurability. If your open enrollment increase is more than $10,000 or exceeds the Guaranteed Issue amount, you will be required to complete an Evidence of Insurability (EOI) form. 10

11 LEGAL NOTICES New and Your OMB No. Form Approved PART A: General When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. For more information about your coverage offered by your employer, please check your summary plan description or contact Human Resource Dept, Ann Fields The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. 1 An if the share of by is no less of 11

12 Legal Notices PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. Here is some basic information about health coverage offered by this employer: As X your employer, we offer a health plan to: All employees. Eligible employees are: Full time Faculty employees working 30 hours per week, Full time Staff employees working hours per week Full time students, actively enrolled in College courses Some employees. Eligible employees are: With respect to dependents: X We do offer coverage. Eligible dependents are: Spouse Dependent Children to age 26 We do not offer coverage. X If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. 12 ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed midyear, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov

13 Legal Notices The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers, but will help ensure employees understand their coverage choices. 13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in the next 3 months? Yes (Continue) 13a. If the employee is not eligible today, including as a result of waiting or probationary period, when is the employee eligible for coverage? 90 Days fro date of hire No (STOP and return this form to employee) 14. Does the employer offer a health plan that meets the minimum value standard*? X Yes (Go to question 15) No (STOP and return form to employee) 15. For the lowest-cost plan (BRONZE PLAN) that meets that minimum value standard* offered only to the employee (don t include family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/she received the maximum discount for any tobacco cessation programs, and didn t receive any other discounts based on wellness programs. a. How much would the employee have to pay in premiums for this plan? $ 53 b. How often? Weekly Every 2 weeks Twice a month X Monthly Quarterly Yearly If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don t know, STOP and return form to employee. 16. What change will the employer make for the new plan year? Employer won t offer health coverage Employer will start offering health coverage to employees or change the premium for the lowest-cost plan available only to the employee that meets the minimum value standard.* (Premium should reflect the discount for wellness programs. See question 15.) a. How much would the employee have to pay in premiums for this plan? $ b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly 13

14 Legal Notices Important Legal Notices & Annual Disclosures Medicare Part D This notice applies to employees and covered dependents who are eligible for Medicare Part D. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with United Healthcare and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. United Healthcare has determined that the prescription drug coverage offered by the Health and Welfare Plan for employees of Southern College of Optometry is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare prescription drug plan. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15 th to December 7 th. However, if you lose your current creditable prescription drug coverage, through no fault of you own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. If you do decide to join a Medicare drug plan, your current United Healthcare drug coverage will not be affected. You can keep this coverage if you elect Part D and the United Healthcare plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current United Healthcare coverage, be aware that you and your dependents will be able to get this coverage back with a qualifying event. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current prescription drug coverage Contact our office for further information (see contact information below). NOTE: You will receive this notice annually and before the next period you can join a Medicare drug plan, and if this coverage through United Healthcare changes. You may also request a copy of this notice at any time. 14

15 Legal Notices For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: > Visit > Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help. > Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit the Social Security Administration on the web at or you call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Name of Entity/Sender: Human Resources, Southern College of Optometry, Ann Fields, The Newborns and Mothers Health Protection Act of 1996 The Newborns and Mothers Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less than 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. Further, a health insurer or health maintenance organization may not: 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage; 4. Require a mother to give birth in a hospital; or Restrict benefits for any portion of a period within a hospital length of stay described in this notice. These benefits are subject to the plan s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. 15

16 Legal Notices HIPAA Privacy Policy for Fully-Insured Plans with no Access to PHI The group health plan is a fully-insured group health plan sponsored by the Plan Sponsor. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R (k) so that the group health plan is not subject to most of HIPAA s privacy requirements I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / disenrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information. II. Insurer for group health plan will provide privacy notice The insurer for the group health plan will provide the group health plan s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor. III. No intimidating or retaliatory acts IV. No Waiver The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights, filing a complaint, participating in an investigation, or opposing any improper practice under HIPAA. The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor s employees, the action shall not be attributed to the group health plan. Children s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children s Health Insurance Program Reauthorization Act (CHIPRA) of If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer s health plan is required to permit you and your dependents to enroll in the plan as long as you and your dependents are eligible, but not already enrolled in the employer s plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. To see if your state has assistance, or for more information on special enrollment rights, you can contact either: 16

17 Legal Notices U.S. Department of Labor Employee Benefits Security Administration U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services EBSA (3272) , Ext Notice of Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents other coverage). However, you must request enrollment within 30 days after your or your dependents other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your dependents in this plan if: coverage is lost under Medicaid or a State CHIP program; or you or your dependents become eligible for a premium assistance subsidy from the State. In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. To request special enrollment or obtain more information, contact the person listed at the end of this summary: Name of Entity/Sender: Attn: Southern College of Optometry, Ann Fields - Human Resources, Statement of ERISA Rights As a participant in the Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 ( ERISA ). ERISA provides that all participants shall be entitled to: Receive Information about Your Plan and Benefits Examine, without charge, at the Plan Administrator s office and at other specified locations, the Plan and Plan documents, including the insurance contract and copies of all documents filed by the Plan with the U.S. Department of Labor, if any, such as annual reports and Plan descriptions. Obtain copies of the Plan documents and other Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies. Receive a summary of the Plan s annual financial report, if required to be furnished under ERISA. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report, if any. 17

18 Legal Notices Continue Group Health Plan Coverage If applicable, you may continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You and your dependents may have to pay for such coverage. Review the summary plan description and the documents governing the Plan for the rules on COBRA continuation of coverage rights. If you have creditable coverage from another plan, you may be entitled to a reduction or elimination of exclusionary periods (if applicable) of coverage for preexisting conditions under your group health plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to COBRA continuation of coverage, when COBRA continuation of coverage ceases, if you request before losing coverage or if you request it up to 24 months after losing coverage. Without evidence of prior creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage. Prudent Actions by Plan Fiduciaries In addition to creating rights for participants, ERISA imposes duties upon the people who are responsible for operation of the Plan. These people, called fiduciaries of the Plan, have a duty to operate the Plan prudently and in the interest of you and other Plan participants. No one, including the Company or any other person, may fire you or discriminate against you in any way to prevent you from obtaining welfare benefits or exercising your rights under ERISA. Enforce your Rights If your claim for a welfare benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have a right to have the Plan review and reconsider your claim. Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from the Plan Administrator and do not receive them within 30 days, you may file suit in federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent due to reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, and you have exhausted the available claims procedures under the Plan, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose (for example, if the court finds your claim is frivolous) the court may order you to pay these costs and fees. Assistance with your Questions If you have any questions about your Plan, this statement, or your rights under ERISA, you should contact the nearest office of the Employee Benefits and Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits and Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C Name of Entity/Sender: Attn: Human Resources, Southern College of Optometry, Ann Fields

19 Legal Notices Health Care Reform and You The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create the most comprehensive health insurance reform ever under taken in recent history by our Country. Many of the new law s required changes have already been incorporated into company health plans across the country since the effective date in September of However, there will be many more changes taking place in the months to come, as more guidance is issued by the government to employers, insurance carriers and individuals. One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each year thereafter. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule: In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2016, the greater of $695 or 2.5% of taxable income; and After 2016, the penalty is indexed for inflation. However, there are two ways to avoid the tax penalty: You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered affordable (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of your W-2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000. Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility. If you obtain coverage through an Exchange: The Exchange will eventually sell insurance policies at certain levels of coverage: - Bronze level a medical plan designed to pay 60% of covered medical benefits; - Silver level a medical plan designed to pay 70% of covered medical benefits; - Gold level a medical plan designed to pay 80% of covered medical benefits; - Platinum level a medical plan designed to pay 90% of covered medical benefits; - Catastrophic available to young adults up to age 30 or those exempt from the individual mandate (additional requirements may apply) You may only obtain coverage through an Exchange if you are not participating in your employer s plan. If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer-provided coverage that is considered unaffordable or pays benefits that are below the Bronze plan discussed above, there are tax credits available to help you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and copays. More information on these credits will be provided to you later. If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid. Other changes that took effect in 2014: - The health plan may no longer exclude coverage of a pre-existing condition; - The health plan may not impose more than a 90-day waiting period for coverage; - Your plan may no longer place an annual limit on key benefits in the plan; - Your health plan must allow dependent children up to age 26 to enroll in coverage, regardless of the availability of employer-sponsored coverage where they work. 19

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