Benefits Enrollment Guide. January 1, 2016 December 31, 2016 Plan Year. USMS Employees

Transcription

1 Benefits Enrollment Guide January 1, 2016 December 31, 2016 Plan Year USMS Employees

2 Welcome Table of Contents Overview & Eligibility... 3 Dependent Eligibility... 4 Paying for Benefits... 5 Enrolling in Benefits... 6 Major Medical... 7 Dental Vision Life and AD&D Short-Term Disability Critical Illness Accident Benefit Health Reimbursement Commuter & Transit Enrolling in Retirement COBRA Disclaimers & Notices Important Phone Numbers Plan Administrator: The Contractors Plan Inter-Con Member Services: Toll-Free (855) Hours of Operations are Monday through Friday 7 am 7 pm CST. Blue Shield of Northeastern New York: Medical: Toll-Free (800) MetLife: Dental: Toll-Free (800) Vision: Toll-Free (855) Life: Toll-Free (855) Transamerica: Disability & Critical Illness: Toll-Free (855) Standard Security Life Accident Benefit: Toll-Free (855) / Visit or call Toll Free (855) for more information 2 / 2

3 Overview & Eligibility Employees may be eligible for the benefits described in the enrollment guide when they work on average 30 hours or more per week. Those employees who are working on average less than 30 hours per week may not be eligible to enroll. Part-Time eligibility is based on an annual determination from prior year. The table below shows the benefit options that are available to both Full-Time and Part-Time Employees. Employee Status Health Specialty Benefits Optional Coverage Full-Time Part-Time Eligible Blue Shield EPO 8000 Blue Shield EPO 6017 Blue Shield EPO 6000 Minimum Essential Coverage (MEC) MetLife Dental MetLife VSP Vision MetLife Group Term Life/AD&D Transamerica Short Term Disability Transamerica Critical Illness Standard Security Life Accident Coverage Commuter/Parking/Transit Health Reimbursement Account (HRA) - You must be enrolled in one of our Major Medical plans to elect this coverage Part-Time Working an average less than 30 hours per week. Determined by prior year annual calculation. Part-Time not eligible. USMS Share-Time eligible for health coverage. MetLife Dental MetLife VSP Vision MetLife Group Term Life/AD&D Transamerica Short Term Disability Transamerica Critical Illness Standard Security Life Accident Coverage Commuter/Parking/Transit Mandatory Coverage for Full-Time Employees Full-Time employees who do not take action will be automatically enrolled in the following benefits: Blue Shield EPO 8000 Core Medical Plan for employeeonly coverage Nationwide 401(K) Retirement Plan Waiving Major Medical You may waive major medical with proof of other employer-sponsored group major medical or TRICARE coverage. Medicare, Medicaid and Individual coverage are not valid waivers. When processing your enrollments on the portal, you will see a drop down menu that will allow you to confirm your other coverage details and waive coverage. When Coverage Begins and Ends Coverage will begin the first day of the month following your first 30 days of continuous employment. Your coverage will end due to: Non-payment of premium or in the event of insufficient hours. You have 30 days to make a payment for any missed premiums. If you miss two consecutive bi-weekly payments and payment is not received within 30 days, your coverage is cancelled back to the last day of the month that the full premium was received. If your Employment Ends, coverage is effective through the last day of the month in which your employment ends. For example, if your employment ends January 15, your coverage will end January 31. / Visit or call Toll Free (855) for more information 3 / 3

4 Dependent Eligibility Determining Eligibility You may enroll eligible dependents in your benefit coverage. Eligible dependents include: Your legal spouse Your same sex domestic partner Same Sex Domestic Partners must be 18 years of age or older, residing together, unmarried, not related by marriage or blood in way that would bar their marriage to each other; and financially dependent upon each other. Same Sex Domestic Partnership must have existed for a period of at least six (6) months prior to becoming eligible for coverage under this plan. Also, you must submit a signed and notarized BlueShield Medical Affidavit of Domestic Partnership. You may obtain this form by contacting The Contractors Plan. Your children, including step-children, legally adopted children, children who have been placed with you for adoption, or children for whom you have been a court appointed legal guardian. In most cases, your dependent children are eligible until the end of the month in which they turn 26 years of age. Benefits available for dependents include: Blue Shield Medical Plans MetLife Dental Plan MetLife/VSP Vision Plan MetLife Supplemental Life Plans Transamerica Critical Illness Plans Standard Security Accident Plan Dependent Verification: The Contractors Plan requires documentation of a dependent s eligibility at initial enrollment. Proof may include Marriage license, birth certificate, adoption paperwork, or domestic partner affidavit. If documentation is required, you will be given information on what to submit at the time of the request. Making Changes During the Plan Year You can change your dependent(s) coverage during the year, according to IRS rules, only when you experience a qualifying event such as: Marriage, divorce, or legal separation Death of spouse, same sex domestic partner, or dependent Birth or adoption of a new dependent or gaining legal custody of a new dependent A change in a dependent s eligibility status Employment change for a spouse or same sex domestic partner resulting in a loss or gain of employer-sponsored coverage A change in your employment status You must make a coverage change due to a qualifying life event within 30 days of the event, and the election change must be consistent with the event. For example, if your dependent child no longer meets eligibility requirements (if he or she reaches age 26), you can drop coverage only for that dependent. Special Enrollment If you are declining benefit coverage because of other group health plan coverage, you may be able to enroll in this plan if you lose eligibility for the other coverage. However, you must enroll within 30 days after your other coverage ends. 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 your dependents. However, you must request enrollment within 30 days of the marriage, birth, adoption, or placement for adoption. If you miss this 30-day special enrollment window, you will have to wait until Open Enrollment / Visit or call Toll Free (855) for more information 4 / 4

5 Paying For Benefits How H&W Dollars Work Health & Welfare (H&W) dollars also referred to as fringe dollars - are contributed by Inter-Con to help pay for your benefit coverage as required by the Service Contract Act. You earn an H&W allowance for every hour worked as defined by your Wage Determination. This H&W allowance is utilized to pay for employee only benefits with any excess H&W dollars added to a Reserve Account which is set up for each employee. This Reserve Account will accumulate up to one month of employee only premium for all elected benefits ; once full, excess H&W dollars will flow to your retirement account. H&W dollars will be allocated as follows, and in this order: 1. H&W dollars are first used to pay for your first month of employee only benefits. Example: Benefits will begin August 1st, 2015; July hours pay for August benefit. 2. If there are H&W dollars remaining after paying for mandatory employee only benefits, they are added to your reserve account. 3. Once you have a full month s worth of employee only premium in your reserve, any extra H&W dollars will flow into your 401k retirement account. What if I Work Fewer Hours in a Month? If you do not work enough hours to cover the cost of your benefits in a given month, H&W dollars in your reserve account will be used to cover the shortage and keep your coverage active. When you start working enough hours to sufficiently cover the cost of benefits, any extra H&W dollars will be funded back to your reserve account until one month is satisfied again. If in the event that the amount of H&W dollars in your reserve combined with the number of hours worked is not enough to cover the cost of a full month s mandatory employee only benefits, the you will receive a Short Hours Notice from The Contractors Plan listing the amount due to keep your benefits in effect, and instructions for paying that amount. What happens if I have a missed payroll deductions? You have 30 days to pay for the premiums that could not be deducted from your paycheck. If you have missed premium deductions and want to find the balance due or have questions about making a payment, contact Member Services at (855) or go online to H&W dollars can only be used to pay for employee only benefit coverage. If you choose to enroll an eligible dependent, the additional cost to cover your dependent(s) will be paid for with payroll deductions How H&W Dollars Work After the First Month of Coverage After all employee only premiums are paid for each month, any remaining H&W dollars will be funded to your reserve account. Once there is enough H&W dollars to cover one month of mandatory employee only premiums held in your reserve, any left over H&W dollars will then flow to your 401k retirement account. TO PAY MISSED PREMIUMS BY CREDIT CARD OR E-CHECK, GO TO: If this is your first time visiting the site, please use the New User? box and sign in using your Social Security Number and Date of Birth. From there you will be prompted to verify your billing address and contact information (one time process) If you have already created a user account, select the Returning User? box and enter your username and password, The Security Question tool can assist in instances where you cannot remember your username or password. Once logged in, click on the Make a Payment Link. Complete instructions are located on the screen. / Visit or call Toll Free (855) for more information 5 / 5

6 Enrolling in Your Benefits How To Enroll Online 1. Go to 2. For returning users, enter your established user name and password in the appropriate fields at the top of the screen. 3. If you are a new user click the Register Here link, beside New Users to create a new account. Click Social Security # in the New User Field. Then enter your Social Security number and Date of Birth in the fields provided. Click Continue. 4. Create your User Name and Password-keep this password for future use. Setup your security questions and read the Terms of Use. Click Continue. 5. Make your elections for each benefit. Enroll dependents in dependent coverage as you choose. Also, remember to include any beneficiary designations. Note: If you do not make your elections during open enrollment, you will automatically be enrolled in Major Medical and 401K. 6. The enrollment will be summarized for your review and confirmation. If you have made any mistakes and would like to make changes, you may select the My Plans tab or select the shopping car icon to empty or delete your elections and begin again. Once you are satisfied with your elections, click Continue. 7. Once you receive your confirmation number and projected effective date, your enrollment is complete. This confirmation number is for your records only. Note: Receipt of confirmation number Is receipt of a transaction completion. The confirmation number is not confirmation of benefits. Dependent Enrollment When enrolling eligible dependents, please be prepared to provide their name, date of birth, and Social Security Number. Confirmation Number 1. You may still make changes to your benefit elections during Open Enrollment after receiving a confirmation number. 2. Any changes you make, for example, if you originally elected Dental, but after enrolling, you decide to remove Dental coverage, will result in a different confirmation number upon completion. If you do not receive a confirmation number, this means you have not completed your enrollment and should keep clicking the CONTINUE button until you see the confirmation page which includes a confirmation number and effective date. Alternatively, you may enroll by phone: Call (855) Monday through Friday 7:00 AM to 7:00 PM Central Time / Visit or call Toll Free (855) for more information 6 / 6

7 Major Medical EPO Plan 8000-Core Information Available For You Our medical plans are designed to help maintain wellness and protect you and your family from major financial hardship in the event of illness or injury. We offer several medical insurance coverage options, all of which comply with the standards provided by the Patient Protection and Affordable Care Act (Federal Health Care Reform). All include preventative care paid at 100% and we encourage you to get your annual physical as an early detection method. Each health plan provides a comprehensive list of medical providers and access to local, regional and national medical centers to address routine or complex issues of medical care. You must use a network provider. The difference in the plans are the costs you will pay for services. The chart below provides a summary of the costs for some of the covered services. Please refer to the Summary of Benefits and Coverage (SBC) for a complete chart of services and costs associated with these services. Medical information is available whenever you need it via or the BCBS Mobile App. Find a network provider and estimate costs Review your coverage and accounts ID Cards are issued when you first enroll, add dependents or change plans. If ID cards are generated, they should arrive to your home by the 1st week in January. Additionally, you may obtain an ID Cards online or by calling member services. How to Find a Medical Provider How Find a Medical Provider Go to Click on Find a Doctor Icon Click Start Searching Today Click on Blue National Finder Choose Your Network-BlueCard PPO/EPO You can search by Name or by Location BlueShield of Northeastern New York EPO 8000 Plan-Core Services Available to You Your Cost for a Network Provider Primary Care Visit Specialty Care Visit 20% After Deductible 20% After Deductible Preventative Care $0 Outpatient Surgery Inpatient Surgery Emergency Room Urgent Care Deductible (counts towards out-of-pocket costs) 20% After Deductible 20% After Deductible 20% After Deductible 20% After Deductible $5,000 Individually $10,000 For Family Coinsurance-Plan Pays 80% Out-Of-Pocket Costs $6,350 Individually $12,700 For Family Prescription Drug Tier 1: Generic Brand Prescription Drug Tier 2: Brand Name Prescription Drug Tier 3: Non-Formulary Our medical plan includes unlimited access to your own personal health advocate, free of charge. Health Advocate is available 24/7. $15 After Deductible $50 After Deductible 50% After Deductible Call or answers@healthadvocate.com Website: : Click on purple member box. Organization name is Blue Shield NENY. Privacy is protected. Medical and personal information is strictly confidential. / Visit or call Toll Free (855) for more information 7 / 7

8 Major Medical EPO Plan 6017-Buy Up Information Available For You The chart below provides a summary of the costs for some of the covered services. Please refer to the SBC for a complete chart of services and costs. Medical information is available whenever you need it via or the BCBS Mobile App. Find a network provider and estimate costs Review your coverage and accounts Get ID Cards Review claims and treatment history BlueShield of Northeastern New York EPO 6017 Plan-Buy Up Services Available to You Your Cost for a Network Provider Primary Care Visit Specialty Care Visit $30 Copay $30 Copay Preventative Care $0 Outpatient Surgery $50 Inpatient Surgery Emergency Room Urgent Care Deductible 20% after Deductible $50 Copay $35 Copay $2,000 Individually (counts towards out-of-pocket costs) $4,000 For Family Coinsurance-Plan Pays 80% Out-Of-Pocket Costs $4,000 Individually $8,000 For Family Prescription Drug Tier 1: Generic Brand $10 Prescription Drug Tier 2: Brand Name $30 Prescription Drug Tier 3: Non-Formulary 50% / Visit or call Toll Free (855) for more information 8 / 8

9 Major Medical EPO Plan 6000-Buy Up Information Available For You The chart below provides a summary of the costs for some of the covered services. Please refer to the SBC for a complete chart of services and costs. Medical information is available whenever you need it via or the BCBS Mobile App. Find a network provider and estimate costs Review your coverage and accounts Get ID Cards Review claims and treatment history BlueShield of Northeastern New York EPO 6000 Plan-Buy Up Services Available to You Your Cost for a Network Provider Primary Care Visit Specialty Care Visit $25 Copay $25 Copay Preventative Care $0 Outpatient Surgery $50 Inpatient Surgery Emergency Room Urgent Care 10% after Deductible $50 Copay $35 Copay Deductible $1,500 Individually (counts towards out-of-pocket costs) $3,000 For Family Coinsurance-Plan Pays 90% Out-Of-Pocket Costs $3,000 Individually $6,000 For Family Prescription Drug Tier 1: Generic Brand $10 Prescription Drug Tier 2: Brand Name $30 Prescription Drug Tier 3: Non-Formulary 50% / Visit or call Toll Free (855) for more information 9 / 9

10 Minimum Essential Coverage (MEC) Available to Medicare Enrolled Employees Only As mandated by the Affordable Care Act (ACA), all individuals must purchase health insurance that meets curtain requirements, in order to avoid paying a penalty tax. Minimum Essential Coverage (MEC) is the coverage level that is required to avoid the Individual Mandate penalty under the ACA. There are 63 preventative services covered at 100% under the required government list of Preventative and Wellness Benefits when utilizing an in-network provider and are not subject to a deductible. A list of the covered services is included on the next page. What Does This Plan Cover? The Preventative Only Plan covers 63 specific tests and procedures that the government has outlined and requires that all plans cover these at 100% coverage which means there is no cost to you and there are no limits on the coverage. What Doesn t This Plan Cover? This plan won t help you if you are sick or if you ve already been diagnosed with an illness or ailment. We offer other benefit plans that can help you if you get sick or have a chronic condition. Why Should I Enroll? The Preventative Only Plan will help you stay healthy and hopefully will allow you to catch any problems in their early stages, so that there is a greater likelihood of a quick recovery. Procedures are covered at 100% - so there is no cost to you and there is no limit on the number of times the plan can be used. Also it s priced affordably. Can I Use Any Doctor? No, with the Preventative Only plan you are required to see a First Health Network provider. The plan does not cover out of network providers. You can call Member services (800) for assistance in finding a network provider or research for yourself at What Will Happen If I Don t Sign Up? If you TAKE NO ACTION TO Opt Out during your enrollment period, you will be auto enrolled at the employee only tier, unless you have a qualifying event. If you don t get qualifying coverage this year, you may be subject to tax penalties when you file your 2015 taxes. Is This Major Medical Or Similar To Coverage On The Exchange? No, the Preventative only plan is not major medical and only covers 63 procedures. For More Detailed Information Please visit to view more details about the MEC plan and learn more about the 63 tests that are covered. / Visit or call Toll Free (855) for more information 10 / 10

11 MEC Covered Preventive Services For Adults All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven t met your yearly deductible. This applies only when these services are delivered by a network provider. 1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked 2. Alcohol Misuse screening and counseling 3. Aspirin use to prevent cardiovascular disease for men and women of certain ages 4. Blood Pressure screening for all adults 5. Cholesterol screening for adults of certain ages or at higher risk 6. Colorectal Cancer screening for adults over Depression screening for adults 8. Diabetes (Type 2) screening for adults with high blood pressure 9. Diet counseling for adults at higher risk for chronic disease 10. Hepatitis B screening for people at high risk, including people in countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence. 11. Hepatitis C screening for adults at increased risk, and one time for everyone born HIV screening for everyone ages 15 to 65, and other ages at increased risk 13. Immunization vaccines for adults doses, recommended ages, and recommended populations vary: Hepatitis A Herpes Zoster Influenza (Flu Shot) Meningococcal Tetanus, Diphtheria, Pertussis Hepatitis B Human Papillomavirus Measles, Mumps, Rubella Pneumococcal Varicella 14. Lung cancer screening for adults at high risk for lung cancer because they re heavy smokers or have quit in the past 15 years 15. Obesity screening and counseling for all adults 16. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk 17. Syphilis screening for all adults at higher risk 18. Tobacco Use screening for all adults and cessation interventions for tobacco users / Visit or call Toll Free (855) for more information 11 / 11

12 MEC Covered Preventive Services For Women All Marketplace health plans and many other plans must cover the following list of preventive services for women without charging you a copayment or coinsurance. This is true even if you haven t met your yearly deductible. This applies only when these services are delivered by an in-network provider. 1. Anemia screening on a routine basis for pregnant women 2. Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer 3. Breast Cancer Mammography screenings every 1 to 2 years for women over Breast Cancer Chemoprevention counseling for women at higher risk 5. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women 6. Cervical Cancer screening for sexually active women 7. Chlamydia Infection screening for younger women and other women at higher risk 8. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt religious employers. 9. Domestic and interpersonal violence screening and counseling for all women 10. Folic Acid supplements for women who may become pregnant 11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes 12. Gonorrhea screening for all women at higher risk 13. Hepatitis B screening for pregnant women at their first prenatal visit 14. HIV screening and counseling for sexually active women 15. Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older 16. Osteoporosis screening for women over age 60 depending on risk factors 17. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk 18. Sexually Transmitted Infections counseling for sexually active women 19. Syphilis screening for all pregnant women or other women at increased risk 20. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users 21. Urinary tract or other infection screening for pregnant women 22. Well-woman visits to get recommended services for women under 65 / Visit or call Toll Free (855) for more information 12 / 12

13 MEC Covered Preventive Services For Children All Marketplace health plans and many other plans must cover the following list of preventive services for women without charging you a copayment or coinsurance. This is true even if you haven t met your yearly deductible. This applies only when these services are delivered by an in-network provider. 1. Alcohol and Drug Use assessments for adolescents 2. Autism screening for children at 18 and 24 months 3. Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 4. Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 5. Cervical Dysplasia screening for sexually active females 6. Depression screening for adolescents 7. Developmental screening for children under age 3 8. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 9. Fluoride Chemoprevention supplements for children without fluoride in their water source 10. Gonorrhea preventive medication for the eyes of all newborns 11. Hearing screening for all newborns 12. Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 13. Hematocrit or Hemoglobin screening for children 14. Hemoglobinopathies or sickle cell screening for newborns 15. HIV screening for adolescents at higher risk 16. Hypothyroidism screening for newborns 17. Immunization vaccines for children from birth to age 18 doses, recommended ages, and recommended populations vary: Diphtheria Pertussis Hepatitis A Human Papillomavirus Influenza (Flu Shot) Meningococcal Rotavirus Tetanus Haemophilus influenzae type b Hepatitis B Inactivated Poliovirus Measles Pneumococcal Varicella 18. Iron supplements for children ages 6 to 12 months at risk for anemia 19. Lead screening for children at risk of exposure 20. Medical History for all children throughout development at the following 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 Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years. 23. Phenylketonuria (PKU) screening for this genetic disorder in newborns 24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk 25. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 26. Vision screening for all children. / Visit or call Toll Free (855) for more information 13 / 13

14 Dental Coverage Information Available For You As part of the benefits Inter-Con provides you to maintain your health and well-being, dental is provided to full-time and parttime employees through MetLife. Our Preferred Provider Organization(PPO) allows dental services to be provided through Metlife Dental PPO network, or, you can choose any dentist not affiliated with Metlife. Dental information is available whenever you need it via When the website asks for a Company Name, type: The Contractors Plan Trust and you will be directed to the benefit plan home page. Find a dentist near you View your plan Review claims and treatment history No ID card is issued. You can print an ID card from MetLife website. Coverage Type In-Network 1 % of PDP Fee Out-of-Network 1 Based on Maximum Allowed Charge Type A Preventive 100% 100% Type B Basic Restorative 80% 80% Type C Major Restorative 50% 50% Type D Orthodontia 50% 50% Deductible (waived for preventive) Individual $50 $50 Family $150 $150 Annual Maximum Benefits Per Person $1,500 $1,500 Orthodontia Lifetime Maximum $1,000 $1,000 Ortho Applies to Child Only Child to age 19 1 In-Network Benefits means benefits under this plan for covered dental services provided by a MetLife PDP dentist. Out-of-Network Benefits means benefits under this plan for covered dental services that are not provided by a MetLife PDP Dentist. / Visit or call Toll Free (855) for more information 14 / 14

15 Vision Coverage Information Available For You As part of the benefits Inter-Con provides you to maintain your health and well-being, vision coverage is provided to full-time and part-time employees through MetLife. Finding the right eyecare provider for you is important to your eye health and overall wellness. That s why you can choose to see any eyecare provider-a VSP doctor, retail chain affiliate (including Costco or Walmart) or any other provider. The vision plan includes benefits for eye exams, eyeglasses and contact lenses. You may visit a doctor within the VSP network and take advantage of higher benefits coverage, or visit an out-of -network provider of your choice for a reduced benefit. Vision information is available whenever you need it via When the website asks for a Company Name type: The Contractors Plan Trust and you will be directed to the benefit plan home page. Find a vision provider near you View your plan Review claims and treatment history No ID card is issued. You can print an ID card from MetLife website. Coverage Type In-Network Coverage Out-of-Network Coverage Comprehensive Visual Exam Covered after $10 copay Covered up to $45 allowance Base Lenses Single Vision Lined Bifocal Lined Trifocal Lenticular Covered in full Covered up to: $30 Allowance $50 Allowance $65 Allowance $100 Allowance Frame Allowance Covered in full up to $130 Costco: covered in full up to $70 allowance Up to $70 Allowance Contact Lenses (Fitting and Evaluation) Standard or Premium Fit: Member receives 15% off; copay will not exceed $60 Not Covered Contact Lenses (Elective) Covered up to $130 Allowance Covered up to $105 Allowance Vision Exam Lenses Benefit Frequency Every 12 months Every 12 months Either glasses (Base Lenses & Frames) or Contact Lenses allowed per frequency. Not Both. Frames Every 12 months Contacts Every 12 months / Visit or call Toll Free (855) for more information 15 / 15

16 Group Term Life and AD&D Insurance Life insurance and Accidental Death & Dismemberment (AD&D) coverage provides financial security for your family or beneficiary in the event of your death. Your coverage amount will be paid to the beneficiary of your choice, provided a beneficiary is designated. If your death is a result of a covered accident or injury, your beneficiary will receive an additional amount of money through accidental death and dismemberment coverage. AD&D coverage is equal to your basic life insurance coverage amount. AD&D benefits are payable if you pass away, lose a limb, or have a loss of speech, hearing, or eyesight because of a covered accident (either on or off the job) and the loss occurs within one year of the covered accident. Beneficiary Designations A primary beneficiary is defined as the person, organization, trust, or entity you name to receive any benefits in the event of your death. Keep in mind that changes in your family situation (such as marriage, divorce, birth, or adoption) do not automatically alter or revoke your beneficiary designation. Therefore, it is important that you review your beneficiary designation from time to time by visiting mycontractorsplan.com. Basic Life: provides a benefit in the event of death $25,000 Flat Amount Accidental Death & Dismemberment: Provides a benefit in the event of death or dismemberment resulting from a covered accident $25,000 Flat Amount Age Reduction Formula Benefits Reduce 35% at age 65 50% at age 70 / Visit or call Toll Free (855) for more information 16 / 16

17 Supplemental Life Insurance You make a great investment in your family. You spend time with them. You care for them and if you re not there for them, you want them protected. Employees are able to purchase additional Life Insurance coverage through the Supplemental Life plan. You must be enrolled in our MetLife Group Life/AD&D program to take advantage of this Supplemental Life offering. Voluntary supplemental life insurance from Metlife is a simple, easy way to help protect your loved ones. Medical underwriting and acceptance for coverage may be required. Employee / Spouse Employee Employee Employee Employee Age at Enrollment $50K (In addition to $25,000 Basic term life benefit) Spouse ($25K) Child ($5K) Family Less than 30 $ 7.35 $ $ 9.24 $ $ 9.10 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Employee / Spouse Employee Employee Employee Employee Age at Enrollment $75K (In addition to $25,000 Basic term life benefit) Spouse ($25K) Child ($5K) Family Less than 30 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ / Visit or call Toll Free (855) for more information 17 / 17

18 Supplemental Life Insurance Employee / Spouse Employee Employee Employee Employee Age at Enrollment $100K (In addition to $25,000 Basic term life benefit) Spouse ($25K) Child ($5K) Family Less than 30 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Employee / Spouse: No Medical Evidence of Insurability required (at initial eligibility Guaranteed Issue) Waiver of Premium (if employee is disabled prior to 60, coverage continues to 65) No Age Reduction Conversion and Portability are included 100% of the Supplemental Life benefit for AD&D Child Benefit: Child Under 15 days: $100 Child 15 days to 6 months old: $100 Child more than 6 months: $5,000 Child limiting age: % of the Supplemental Life benefit for AD&D / Visit or call Toll Free (855) for more information 18 / 18

19 Short-Term Disability Disability insurance offers financial protection to you and your family in the event that you cannot work due to an illness or accident that did not occur at work. The Contractors Plan offers disability coverage provided by Transamerica. Eligibility Pre-Existing Condition Pre-existing condition means a sickness or accidental injury for which the employee: Received medical treatment, consultation, care, or services in the last 12 months. If you are a full-time or part-time employee, you may choose to enroll into Transamerica s Short-Term Disability benefits plan. Short-Term Disability There is a 14 day elimination period in the event of a sickness or accident. Once you have met this 14 day elimination period the plan will provide: 80% of your earnings up to $600 per week Benefit duration of 6 months Took prescription medication or had medications prescribed in the 12 months before insurance is effective. Pre-Existing conditions are not covered until you have been continuously insured under the short-term disability policy for 12 months. Short-Term Disability only covers illnesses and accidents that occur outside of work. / Visit or call Toll Free (855) for more information 19 / 19

20 Critical Illness Critical Illness provides a benefit in the event you are diagnosed with a covered illness. Diagnosis may occur after death. The plan will pay a lump sum in the event of a diagnosis of a covered illness. What is Covered There are two coverage options available for you to choose from; the Low Option will provide a $5,000 Flat amount and the High Option will provide a $10,000 Flat amount. Please review the table below to see which illnesses are covered and for how much the plan will pay out for each illness. There is a Low Option and a High Option of Critical Illness coverage available for you to choose from. Amount the Plan will Pay $5,000 or $10,000 Flat Amount Family/dependent coverage: 50% of the employee benefit Covered Illnesses: heart attack, stroke, heart and major organ transplants, end of stage renal failure, paralysis of all four limbs, burns, coma, loss of sight, speech or hearing, invasive cancer, bone marrow transplant 100% of the employee benefit Covered Illnesses: Paralysis of three or fewer limbs not due to stroke; recurrent critical illness 50% of the employee benefit Covered Illnesses: Alzheimer s Disease 30% of employee benefit Covered Illnesses: Coronary bypass surgery, carcinoma in situ, prostate cancer with TNM classification of TI 25% of the employee benefit / Visit or call Toll Free (855) for more information 20 / 20

21 Accident Benefit The Accident plan is not a substitute for minimum essential health coverage under the Affordable Care Act (ACA); and does not qualify as minimum essential coverage under the Affordable Care Act (ACA). This plan helps to cover some of the costs associated with being in the hospital. Coverage Hospital Admission Benefit $1,000 Benefit payable only once during any period of confinement. Requires 24 hour hospital stay. Daily In-Hospital Benefit $100 Benefit payable per day. Up to a maximum of 500 days of confinement (except for Substance Abuse, Mental Illness Disorder, and In-patient Skilled Nursing Facility). Requires 24 hour hospital stay. Intensive Care Benefit $200 Double the daily in-hospital benefit will be paid, up to a maximum of 30 days per calendar year. Mental Illness Disorder $50 per day $50 per day will be paid up to a $5,000 calendar year maximum and a lifetime maximum of $30,000 for hospitalization due to Mental Illness Substance Abuse $50 per day Maximum 30 days Inpatient Skilled Nursing Facility $50 per day Maximum 60 days Accident Expense Benefit $1, % of charges incurred within 90 days of a bodily injury. / Visit or call Toll Free (855) for more information 21 / 21

22 Health Reimbursement Account A Health Reimbursement Account (HRA) is an IRS defined tax advantaged savings plan for employees. This program is available to employees who enroll in one of our BSNENY Major Medical Plans. Any uninsured medical expense defined by the IRS may be paid or reimbursed from the plan tax-free and funds accumulate tax-free. Employees with account balances when they terminate employment may continue to submit claims for medical expenses, even if incurred after termination of employment. Employees may also use HRA dollars to pay for COBRA coverage. The HRA is a bona-fide fringe benefit plan for payroll certifications on prevailing wage contracts. All contributions to the plan are 100% vested when made and are funded to a third party trustee. This HRA will apply a $6.50 monthly admin fee against your accumulated fringe dollars. You must allocate a specific amount each pay period to your HRA account. Amounts in the HRA may be used for medical expenses that are not paid by insurance. The payments are tax free. You can designate H&W dollars not utilized for Employee Only Benefit premiums to overflow into your HRA account. Using the Contractors Plan HRA Card The Contractors Plan HRA Card is a type of debit card and will be sent to you in the mail. If you would like a secure pin, you can request one. Once activated, your card can be used just like a typical credit or debit card when you are paying for a covered medical expense. You can also get reimbursed for qualified expenses. For example, you can submit a reimbursement claim form and a copy of your EOB (explanation of benefits). Once reviewed and approved, you will receive a check in the mail with funds drawn on your HRA account. Here is how it works: All contributions are 100% vested (permanently yours) once contributed to your HRA account. You will receive a debit card to pay for qualified expenses. Funds may be used for deductibles, coinsurance, co-pays, prescriptions, and many other qualified expenses for you and/or your spouse or legal dependents. Your card will not work at an ATM or for other non-medical related charges. You may use up to the balance held in your HRA Account, but not over. If purchase exceeds the account balance, you will need to pay the difference using another means of payment. Examples of Medical Qualified Expenses: Insurance deductibles, coinsurance, copays and prescriptions Eye Exam Long Term Care Birth Control Pills Eyeglasses Nursing Services Chiropractor Fertility Enhancement Psychoanalysis Contact Lenses Hearing Aids Dental Expenses Crutches Laboratory Fees Stop Smoking Programs / Visit or call Toll Free (855) for more information 22 / 22

23 Commuter & Transit Benefit Eligible Expenses Expenses that are eligible for reimbursement under the Transit include: Parking your vehicle in a facility at or near your place of employment Parking at a location from where you commute, e.g., a train station Transit passes to and from work, including the cost of tokens, passes, fare cards, vouchers, etc. Mass transit public systems (Mass transit can be a public system, or a private enterprise provided by a company or individual who is in the business for transporting people in a Commuter highway vehicle ) Transportation provided by a qualified, private transportation company. Parking For your parking account, simply submit a claim form with attached documentation (if available) for reimbursement under your eflex transit plan. We can also set up parking claims on a recurring bases. This feature allows you to submit a single claim, while continuing to receive reimbursements throughout the plan year. To set up a recurring claim, simply follow the instructions on the claim form. We ll take care of the rest. You ll receive your parking reimbursement each time there s a payroll deduction. Download the claim form and instructions at How Much Can I Contribute to my Transit Account? You may elect to have any amount up to the monthly pre-tax maximums set by the IRS. In some cases, the monthly maximum may not be enough to cover your transit expenses. Transportation Under the eflex Transit plan, you can pay for your transportation expenses using the eflex card or by submitting a manual claim. The amount you have available in your eflex Transit account is the balance on the eflex Card, which is how much you contribute each month. You may use the eflex Card up to this amount, but never over. Funds are only disbursed as the account is replenished with payroll deductions. You may check your available balance at Because funds are not available prior to the first month s payroll deduction, you'll need to use post-tax dollars for the first month of the plan year. You may contribute any amount up to the pre-tax maximums set by the IRS. / Visit or call Toll Free (855) for more information 23 / 23

24 Enrolling in Your Retirement Plan Once you have finished electing medical benefits online at mycontractorsplan.com, you can click Benefit Center to be directed to your personal home screen. Select the Retirement Icon. The first time you click this icon it will guide you through several questions to set up your retirement account. Summary Tab This is a snapshot of your account balance at a glance. From this page you can select details of your account, current investment fund balances, see a chart of your current investments and more. Investments Tab The Investments tab will provide the following tools you may select: Account Balances: View your investment funds, click on the icon next to the fund name for a detailed report about the fund. Investment Elections: Review or change your investments Investment Profiles: See all the investments available in your plan including detailed reports. Investment Returns: View the latest investment returns for the available funds. Rate of Return: See how your account has done reports your personal rate of return percentage. Tools Tab The Tools tab will provide the following tools you may select: estatements: sign up for estatements and receive automatic delivery of your account statements and view your statements online from anywhere. Reports: Create your own Statement of account for any timeperiod and save it to an Adobe PDF file on your computer Forms: Select a copy of forms available for your plan. Personal Profile Tab The Personal Profile tab will provide the following tools you may select: Personal Info: Keep your contact information up-to-date, including your mailing address, , and alternate or security information. Beneficiaries: Shows the beneficiary of your account in the event of your death. Designate who should receive your account or add additional or contingent beneficiaries. Transactions Tab The Transactions tab will provide the following tools you may select: Investment Elections: Choose where future contribution deposits are invested. Transfer Funds: Change where your existing account balance is invested by transferring money between investment funds. Transaction History: Customize your search for account activity and see detailed reports. Web/VRU Requests: See a complete history of all requests you have made through the website or the telephone system (VRU) and click to see the details. Use your smartphone to get online. Check or update your account anywhere on the go. / Visit or call Toll Free (855) for more information 24 / 24

25 Retirement Plan Nationwide and Nationwide N and Eagle are service marks of Nationwide Mutual Insurance Company. Inter-Con is pleased to offer you a unique investment platform offering investment choices through two investment approaches. You will be asked to make a decision on your investment option during open enrollment and conducting a little research ahead of time will make the process easier. Please note, the Retirement plan is offered through The Contractors Plan. If you have questions regarding your retirement plan, please contact Member Services at Any H&W dollars not used for health benefits or to fund your reserve will be placed into a retirement plan for your future benefit. You can choose your own mix of funds or you can leave the investment allocations to us. IRS Limits Tax law limits the amount you can contribute on a pre-tax basis to the plan each year. Tax law also limits the amount of compensation that is considered eligible for the plan. You cannot defer any portion of your compensation above that limit into the plan. Vesting Vesting refers to the portion of your plan account balance to which you are entitled under the plan rules. Each contribution is 100% vested in the plan. Tax Considerations You pay no taxes on contributions or investment returns until you withdraw funds from the plan. Do-It-For-Me Approach You choose the Target Date fund which corresponds to your expected retirement date. Investment elections are pre-determined based on your expected retirement date. Do-It-Yourself Approach You can make your own selections from among the funds offered, creating your own portfolio and asset allocations. ACCOUNT ACCESS & INVESTMENT BALANCES Once enrolled, you can log in to your account and view your benefits, change information and request information. Please call The Contractors Plan Retirement Member Services at or go online to MyContractorsPlan.com to enroll and for ongoing account access. You will be provided a Nationwide Retirement Plan enrollment kit during open enrollment. / Visit or call Toll Free (855) for more information 25 / 25

26 COBRA INTRODUCTION The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It also can become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan s Summary Plan Description, which will be mailed to you following your enrollment in the plan. WHAT IS COBRA CONTINUATION COVERAGE? COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed below. After a qualifying event, COBRA continuation coverage must be offered to each person who is a qualified beneficiary. You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens: Your hours of employment are reduced Your employment ends for any reason other than your gross misconduct If you are the spouse or same sex domestic partner of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens: Your spouse or same sex domestic partner dies Your spouse s or same sex domestic partner s hours of employment are reduced Your spouse s or same sex domestic partner s employment ends for any reason other than his or her gross misconduct Your spouse or same sex domestic partner s becomes entitled to Medicare benefits (under Part A, Part B, or both) You become divorced or legally separated from your spouse or same sex domestic partner Your dependent children will become qualified beneficiaries if they lose coverage under the plan because any of the following qualifying events happen: The parent/employee dies The parent/ employee s hours of employment are reduced The parent/ employee s employment ends for any reason other than his or her gross misconduct. The parent/ employee becomes entitled to Medicare benefits (Part A, Part B, or both) The parents become divorced or legally separated The child stops being eligible for coverage under the plan as a dependent child WHEN IS COBRA COVERAGE AVAILABLE? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is: the end of employment, a reduction of hours of employment, death of the employee, commencement of a proceeding in bankruptcy with respect to the employer, or the employee s becoming entitled to Medicare benefits (under Part A, Part B, or both); the employer must notify the Plan Administrator of the qualifying event. / Visit or call Toll Free (855) for more information 26 / 26