UFLAC BENEFITS Here for You and Your Family Active Member Brochure

Transcription

1 UFLAC BENEFITS Here for You and Your Family 2017 Active Member Brochure

2 INTRODUCTION UFLAC Benefits Plans At-A-Glance UFLAC offers our members over a dozen different healthcare and benefit plans to suit every member s unique needs To jump to that chapter please click on the title. OVERVIEW GYM MEMBERSHIP ONLINE ENROLLMENT MEDICAL/VISION BODY SCAN DENTAL UFLAC Benefits Here for You and Your Family LIFE/AD&D LTD CRITICAL ILLNESS ACCIDENT NOTICES 1

3 UFLAC Benefits Here for You and Your Family Dear Brothers and Sisters: Look what s new for the 2017 Open Enrollment! UFLAC is excited to announce changes to our current HMO plan and introduce a new HMO option for In order to keep our member s costs down, UFLAC has transitioned our current HMO plan to the Anthem Blue Cross Select HMO network! The Select HMO network includes over 27,000 California Select HMO doctors and specialists and more than 390 hospitals. For our members whose Primary Care Physician (PCP) is outside of the Select HMO network, UFLAC is excited to introduce our new Vivity HMO plan as well. The Vivity HMO plan is smaller than a traditional HMO network, but includes the top 7 hospital systems in Southern California. These premier hospital systems include: Cedars-Sinai, Good Samaritan Hospital, and UCLA Health and provide access to some of the best doctors in all of Los Angeles. The Vivity HMO plan is offered through Anthem Blue Cross and serves as a cutting-edge solution for UFLAC members to access high-quality medical care at lower costs. To check if your PCP is a member of the Select or Vivity networks please visit UFLAC is pleased to continue to offer our members the HSA PPO plan in which members can contribute TAX-FREE money into their individual Health Savings Accounts (HSAs). The UFLAC HSA PPO plan is only available to our members and is the only HSA plan available to Los Angeles firefighters and Los Angeles City employees. For 2017, the City of Los Angeles will continue to contribute $100 per month towards each enrolled members HSA. Effective July 1st, 2016 UFLAC has enhanced its Long Term Disability (LTD) plan as well. The Monthly Benefit is now based off your prior year s W-2 earnings and includes overtime! So even if you are injured on-duty and receiving state-rate, you may still be eligible for an additional benefit from Reliance Standard. These enhancements far exceed the old CAPF LTD policy. You can sign-up for the UFLAC LTD plan anytime without a medical exam! UFLAC will hold a fall open enrollment each year and during this time you can make changes to your Medical and Dental plans. UFLAC will also hold a mid-year open enrollment in April and its during this time you can make changes to your Medical and Life insurance plans. To learn more about UFLAC s plans visit us on the UFLAC Benefits customized enrollment website, where you are able to view your current benefit elections, learn about other plans, change dependents, and much more! Visit or contact the Benefits office by phone at (213) , extension 2 if you have any questions. Very Truly Yours, Tony Gamboa President - Local 112 UFLAC Trustees: David N. Pimentle, Chairman Rigo Arellano, Trustee Edmundo Elguea, Trustee Frank Lima, Trustee David Riles, Trustee David Sifuentes, Trustee 1571 Beverly Boulevard, Suite 101, Los Angeles, CA Benefits (800) ext. 2 2

4 OVERVIEW Overview To jump to that chapter please click on the title. MEDICAL/VISION NEW! UFLAC now offers 2 HMO plans! NEW! Free gym membership for members and dependents over age 18, enrolled in a UFLAC medical plan! DENTAL UFLAC continues to offers four different types of dental plans to meet every member s needs, including a $0 monthly premium cost DHMO with MetLife. LIFE/AD&D Our comprehensive and affordable Life and AD&D insurance, available for members up to $650K, and spouses up to $300K! LTD NEW ENHANCEMENTS! UFLAC s fully-insured Long-Term Disability Plan, now covers overtime! CRITICAL ILLNESS and ACCIDENT Two plans designed specifically for our firefighters and families to protect against unexpected medical costs. 3 Back to Index ENROLL ONLINE HERE

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6 GYM MEMBERSHIP New For 2017! Healthy Lifestyles Gym Membership UFLAC members enrolled in one of our Anthem Blue Cross medical plans will receive a free gym membership. This new benefit is offered to enrolled UFLAC members and your enrolled dependents over age 18. Healthy Lifestyles Gym Membership includes: Over 9,000 fitness centers, across the country Popular fitness centers such as: LA Fitness Anytime Fitness Curves And many more! Open access to any of the 9,000 health clubs To search for gyms near you visit: All you and your family will need is the Healthy Lifestyles membership card to access any gym in the network at any time! 5

7 CLICK CLICK HERE HERE TO FIND TO FIND A GYM A OR HMO HEALTH PROVIDER CLUB 6

8 ONLINE ENROLLMENT Online Open Enrollment UFLAC members will continue to have online access to a fully customized website that will allow you to enroll, make changes and/or learn about all available benefits, 24 hours a day, 7 days a week. You can also verify and enroll your dependents in dependent coverage as well. For ONLINE ENROLLMENT Click below ENROLL ONLINE HERE 7

9 With Online Enrollment, You Can: Get help deciding which medical plan is best for you Change your plans Change your dependents Verify your dependents Estimate your costs View plan details And more! Back to Index 8

10 MEDICAL/VISION UFLAC Medical Plans UFLAC sponsors FOUR different medical plans through Anthem Blue Cross, including our HSA PPO! HSA PPO The health savers plan PPO The freedom and flexibility option HMO The low-cost, managed care option Vivity HMO The NEW HMO option All medical plans include Body Scan! Anthem Blue Cross Click here to find a doctor now! 9

11 MEDICAL/VISION UFLAC HSA PPO The medical plan option for our members with special tax benefits! The benefits of the HSA PPO are simple! New! Free gym membership! ZERO monthly premium $100 tax-free monthly contribution from the City into your Health Savings Account Your contributions reduce your federal income tax Tax-free interest on your contributions and tax-free withdrawls for qualified medical withdrawls Utilizes Anthem PPO Network! This is the only plan of its kind available to LA City Firefighters! You may also want to consider enrolling in UFLAC s Accident & Critical Illness plans for additional coverage 10

12 MEDICAL/VISION UFLAC HSA PPO The plan that combines freedom & flexibility with the lowest monthly cost. The ONLY HSA PPO plan for LA City Firefighters! Active Member HSA PPO Rates Tier Monthly Rate City Subsidy Member Cost Per Pay Period Member Only $ $ $0 2-Party $1, $1, $0 Family $1, $1, $0 *UFLAC Medical subsidies and payroll deductions effective 7/1/2017 $100 per month into your HSA FREE from the City! 11

13 HSA PPO Plan Design Benefit In-Network Deductible Annual Out-of-Pocket Maximum Office Visit * Lab and X-Ray* Hospital Inpatient* LASIK Body Scan Chiropractic/Acupuncture* Prescription Drugs* $1,500 single $2,600 individual on a family plan/ $3,000 family $2,600 single $2,600 indivdual on a family plan/ $5,000 family 10% 10% 10% $1,500 lifetime benefit per eye Once every 24 months, member and spouse only 10% $10 for generics Back to Index *After deductible has been met CLICK HERE TO FIND A HMO PPO PROVIDER ENROLL ONLINE HERE Anthem Blue Cross 12

14 MEDICAL/VISION UFLAC HMO The managed care option for members looking to maintain their health through a network of providers with low monthly premium costs! Active Member HMO Rates Tier Monthly Rate City Subsidy Member Cost Per Pay Period Member Only $ $ $0 2-Party $1, $1, $41.31 Family $1, $1, $63.46 *UFLAC Medical subsidies and payroll deductions effective 7/1/2017 New for 2017: FREE gym membership! Smaller Network- Now SELECT HMO Network Click below to see if your doctor is still in-network CLICK HERE TO FIND A SELECT HMO PROVIDER 13

15 Benefit HMO Plan Design Copay Deductible $0 Annual Out-of-Pocket Maximum Office Visit Copay Lab and X-Ray Copay Hospital Inpatient Copay LASIK Body Scan Prescription Drugs $500 per person (Maximum of 3 per family) $10 $10 $500 $1,500 lifetime benefit per eye Once every 24 months, member and spouse only $10 for generics CLICK HERE TO FIND A SELECT HMO PROVIDER Anthem Blue Cross Back to Index ENROLL ONLINE HERE 14

16 MEDICAL/VISION UFLAC Vivity HMO The cutting edge solution for members looking to maintain their health through a network of premier providers with low monthly premium costs! Active Member Vivity HMO Rates Tier Monthly Rate City Subsidy Member Cost Per Pay Period Member Only $ $ $ Party $1, $1, $57.81 Family $1, $1, $81.51 *UFLAC Medical subsidies and payroll deductions effective 7/1/2017 Vivity includes the following hospital systems: Cedars-Sinai Good Samaritan Hospital Huntington Memorial Hospital MemorialCare Health System New for 2017! PIH Health Torrance Memorial Medical Center UCLA Health Click below to see if your doctor is in the premier Vivity Network 15 CLICK HERE TO FIND A VIVITY HMO PROVIDER

17 Vivity HMO Plan Design Benefit Copay Deductible $0 Annual Out-of-Pocket Maximum Office Visit Copay Lab and X-Ray Copay Hospital Inpatient Copay LASIK Body Scan Prescription Drugs $2,500 per person (Maximum of 2 per family) $20 $100 $250 per day (three day copay maximum) $1,500 lifetime benefit per eye Once every 24 months, member and spouse only $15 for generics CLICK HERE TO FIND A VIVITY HMO PROVIDER Back to Index ENROLL ONLINE HERE 16

18 MEDICAL/VISION UFLAC PPO For more freedom and flexibility in choosing your preferred medical providers and facility locations Active Member PPO Rates Tier Monthly Rate City Subsidy Member Cost Per Pay Period Member Only $ $ $ Party $1, $1, $ Family $2, $1, $ *UFLAC Medical subsidies and payroll deductions effective 7/1/

19 Benefit PPO Plan Design In-Network Deductible Annual Out-of-Pocket Maximum Office Visit Copay Lab and X-Ray* Hospital Inpatient* LASIK Body Scan Prescription Drugs $300 per person (Maximum of 3 per family) $1,000 per person (Maximum of 3 per family) $15 (deductible waived) 0% 10% $1,500 lifetime benefit per eye Once every 24 months, member and spouse only $10 for generics *After deductible has been met Back to Index CLICK HERE TO FIND A PPO PROVIDER ENROLL ONLINE HERE Anthem Blue Cross 18

20 MEDICAL/VISION Vision Our comprehensive vision plan is included in all UFLAC medical plans Coverage provided through VSP with the largest network in California Frame allowance is $130 and may also be used for contacts 19

21 Now includes Costco! New frames and lenses, or contact lens allowance, is available every 24 months Vision exams are available every 12 months with NO COPAY Back to Index CLICK HERE TO FIND A VSP PROVIDER ENROLL ONLINE HERE 20

22 Body Scan Body Scan The Body Scan is available with all UFLAC medical plans 2 yrs. Scan covered once every 24 months 3-Dimensional non-invasive scan for early disease detection and an overall health consultation 21

23 Both members and spouses are eligible Call to schedule your Body Scan 22

24 DENTAL UFLAC Dental Plans Four unique options are available under UFLAC s dental plan. Members can select the option that best fits their needs. UFLAC DR The UFLAC signature dental plan NETWORK DR The newest dental plan option DHMO The low-cost, managed care option DPPO The freedom and flexibility option COMPARE PLANS 23

25 CLICK HERE TO FIND A METLIFE PROVIDER UFLAC Benefits Here for You and Your Family Back to Index ENROLL ONLINE HERE 24

26 DENTAL UFLAC Dental Plans A wide variety of choices to fit you and your family UFLAC DR The UFLAC signature dental plan Is freedom and flexibility most important? With the UFLAC DR plan you can see any dentist, and pre-authorizations aren t required Network DR The newest dental plan option Do you value freedom and savings? MetLife s Network DR plan offers the flexibility of the traditional UFLAC DR plan, with additional savings when you visit a MetLife provider, and no need to pay up front 25

27 MetLife DHMO The low-cost, managed care option Is cost your priority? MetLife DHMO coverage is NO COST for the whole family, for active members MetLife DPPO The freedom and flexibility option Is a rich benefit what matters most? MetLife DPPO offers a $3,000 annual maximum per member UFLAC Benefits Here for You and Your Family Back to Index ENROLL ONLINE HERE 26

28 UFLAC vs. LA City Dental Comparison In-Network Benefits UFLAC DR (Plan pays) UFLAC MetLife Network DR (Plan pays) UFLAC MetLife DHMO (Member copay) UFLAC MetLife DPPO (Plan pays) Calendar Year Deductible $0 $0 $0 $0 Diagnostic & Preventive Services Percentage of dental charges reimbursable*: $0 to $ % $500 to $900-80% $900 to $4,260-50% Percentage of dental charges reimbursable*: $0 to $ % $500 to $900-80% $900 to $4,260-50% $0 100% Basic Services Copay Varies 100% Major Services Copay Varies 80% Orthodontia Annual Plan Maximum 50% ($2,000 lifetime max) 50% ($2,000 lifetime max) $0 for 24 months of treatment, $250 copay for records, $265 copay for retention 50% ($1,500 lifetime max) $2,500/person $2,500/person None $3,000/person *Per calendar year Active Member Cost Per Pay Period 2017 UFLAC Rates Member Only $0.00 $0.00 $0.00 $4.06 Member + Spouse $15.00 $15.00 $0.00 $21.04 Member + Child $15.00 $15.00 $0.00 $21.04 Family $40.50 $40.50 $0.00 $51.73 *UFLAC Dental subsidies and payroll deductions effective through 6/30/2017 **LA City rates assume full-time status and Member + Child rate includes Member + Children 27

29 UFLAC vs. LA City Dental Comparison LA City** Delta Dental Preventive Only (Plan pays) LA City** DeltaCare USA DHMO (Member copay) $0 $0 100% $0 LA City** Delta Dental PPO (Plan pays) $25/person, $75/family (paid by member) 100% (ded waived) Not covered Copay Varies 80% (includes crowns) Not covered Copay Varies 50% Not covered $1,000-$1,350 plus start up fees of $300 (varies by age of child/adult) 50% child only coverage ($1,500 lifetime max) N/A None $1,500/person Active Member Cost Per Pay Period 2016 LA City Rates -$2.50 $0.00 $3.81 $3.29 $7.25 $26.04 $4.17 $5.64 $27.80 $7.78 $9.73 $

30 DENTAL UFLAC and Network DR Dental Plans The UFLAC Signature DR Dental Plan and the Network DR Dental Plan are the most flexible dental plan options! SAME BENEFITS FOR BOTH PLANS: No deductibles No limitations on any covered dental service No pre-authorizations required Coverage for implants and night guards $2,500 annual maximum benefit No fee schedule Orthodontics covered at 50% with $2,000 lifetime maximum 29

31 DIRECT REIMBURSTMENT Administered by UFLAC Example of how it works: 1. Have $100 of dental work done 2. You pay dentist $ Submit claim to UFLAC for reimbursement Why it s different: 1. Any dentist, anywhere 2. You pay dentist directly 3. Administered by UFLAC NETWORK DIRECT REIMBURSTMENT Administered by MetLife Example of how it works: 1. Have $100 of dental work done 2. MetLife Network dentists apply MetLife discount and bill MetL ife directly Why it s different: 1. MetLife dentists have discounted rates and bill MetLife directly 2. Out-of-Network claims sent to MetLife SAME PLAN DESIGN FOR BOTH DIRECT REIMBURSTMENT PLANS Diagnostic, Preventive, Basic, and Major Services Percentage of dental charges reimbursable per calendar year for each enrolled: $0 to $ % $500 to $900-80% $900 to $4,260-50% DR Plans Active Member Rates Tier Monthly Rate City Subsidy Member Cost Per Pay Period Member Only $80.00 $80.00 $0 2-Party $ $80.00 $15.00 Family $ $80.00 $40.50 *UFLAC Dental subsidies and payroll deductions effective 7/1/2017 CLICK HERE TO FIND A METLIFE PROVIDER Back to Index ENROLL ONLINE HERE 30

32 DENTAL DHMO Dental Plan The managed care option available at NO COST to members and their families! Active Member DHMO Rates Tier Monthly Rate City Subsidy Member Cost Per Pay Period Composite $80.00 $80.00 $0 *UFLAC Dental subsidies and payroll deductions effective 7/1/

33 DMHO Plan Design Services Copay Annual Exam & Cleaning $0 Fillings Varies, usually $0 Crowns Orthodontia Varies, usually $0 $0 for 24 months of treatment, $250 copay for records and $265 copay for retention CLICK HERE TO FIND A METLIFE PROVIDER Back to Index ENROLL ONLINE HERE 32

34 DENTAL DPPO Dental Plan The freedom and flexibility option, with the HIGHEST ANNUAL MAXIMUM BENEFIT. See any dentist that you want but receive discounts when you see a MetLife dentist. Tier Active Member DPPO Rates Monthly Rate City Subsidy Member Cost Per Pay Period Member Only $88.12 $80.00 $ Party $ $80.00 $21.04 Family $ $80.00 $51.73 *UFLAC Dental subsidies and payroll deductions effective 7/1/

35 DPPO Plan Design Benefit Deductible Diagnostic and Preventive Services Basic Services Major Services Orthodontia Annual Maximum Benefit In-Network $0 100% 100% 80% 50% ($1,500 lifetime max) $3,000 CLICK HERE TO FIND A METLIFE PROVIDER Back to Index ENROLL ONLINE HERE 34

36 LIFE/AD&D Life and Accidental Death & Dismemberment Insurance Life insurance is an added layer of protection for your family when you expect it the least and they need it the most. UNIQUE PLAN ENHANCEMENTS New Retirees can elect up to $600,000 of coverage! (Subject to EOI) Active member spouses can have up to $300,000 in coverage! Dependents have AD&D insurance to match their Life insurance, at no additional cost! 35

37 WHY HAVE LIFE AND AD&D INSURANCE WITH UFLAC? Provide for your families in the event of an unexpected accident or passing Covers any end of life costs Plan for funeral expenses or estate taxes Up to $650k of coverage for yourself without a medical exam Group rate savings through UFLAC SEE NEXT PAGE FOR MORE INFORMATION Back to Index ENROLL ONLINE HERE 36

38 LIFE/AD&D Life and Accidental Death & Dismemberment Insurance Highlights of the UFLAC Life and AD&D Plans Basic coverage of $50,000 is available at NO COST for active members Up to $600,000 of supplemental coverage is available, for $650,000 total maximum coverage Active members already enrolled in supplemental can increase their coverage by $50,000 each year without a medical exam* Dependent coverage is available, up to $300,000 for spouses and $40,000 for children Convenient payroll deduction New retirees can retain coverage after retirement, up to $600,000 (with EOI for amounts over $200,000) Waiver of Premium is available to members who become disabled For information and to calculate your rates visit: *Members must be active at work to increase coverage MEMBERS CAN ENROLL AT ANY TIME! (a medical exam may be required) 37

39 SUPPLEMENTAL LIFE AND AD&D MONTHLY MEMBER RATES Age Rate per $ $0.050 $0.054 $0.060 $0.066 $0.070 $0.092 $0.124 $0.218 $0.304 $0.592 $0.638 Back to Index ENROLL ONLINE HERE 38

40 LIFE/AD&D RELIANCE STANDARD ACTIVE MEMBER COVERAGE SUPPLEMENTAL LIFE AND AD&D RATES PER PAY PERIOD MEMBER RATES EFFECTIVE 1/1/2015 (FIRST $50K PAID BY SUBSIDY, RATE INCLUDES AD&D) Age: $100,000 $1.25 $1.35 $1.50 $1.65 $1.75 $150,000 $2.50 $2.70 $3.00 $3.00 $3.50 $200,000 $3.75 $4.05 $4.50 $4.95 $5.25 $250,000 $5.00 $5.40 $6.00 $6.60 $7.00 $300,000 $6.25 $6.75 $7.50 $8.25 $8.75 $350,000 $7.50 $8.10 $9.00 $9.90 $10.50 $400,000 $8.75 $9.45 $10.50 $11.55 $12.25 $450,000 $10.00 $10.80 $12.00 $13.20 $14.00 $500,000 $11.25 $12.15 $13.50 $14.85 $15.75 $550,000 $12.50 $13.50 $15.00 $16.50 $17.50 $600,000 $13.75 $14.85 $16.50 $18.15 $19.25 $650,000 $15.00 $16.20 $18.00 $19.80 $

41 RELIANCE STANDARD ACTIVE MEMBER COVERAGE SUPPLEMENTAL LIFE AND AD&D RATES PER PAY PERIOD MEMBER RATES EFFECTIVE 1/1/2015 (FIRST $50K PAID BY SUBSIDY, RATE INCLUDES AD&D) $2.30 $3.10 $5.45 $7.60 $14.80 $15.95 $4.60 $6.20 $10.90 $15.20 $29.60 $31.90 $6.90 $9.30 $16.35 $22.80 $44.40 $47.85 $9.20 $12.40 $21.80 $30.40 $59.20 $63.80 $11.50 $15.50 $27.25 $38.00 $74.00 $79.75 $13.80 $18.60 $32.70 $45.60 $88.80 $95.70 $16.10 $21.70 $38.15 $53.20 $ $ $18.40 $24.80 $43.60 $60.80 $ $ $20.70 $27.90 $49.05 $68.40 $ $ $23.00 $31.00 $54.50 $76.00 $ $ $25.30 $34.10 $59.95 $83.60 $ $ $27.60 $37.20 $65.40 $91.20 $ $

42 LTD Long Term Disability Benefits Are Fully Insured Long Term Disability (LTD) insurance protects your income if you are disabled and unable to work. LTD coverage offered through UFLAC is provided through Reliance Standard with enhancements effective July 1, LONG TERM DISABILITY NEW in 2016! Monthly benefit NOW includes overtime! Rate is $12.50 per pay period Maximum benefit of $10,000 per month Includes survivor benefit 24 month own occupation coverage 90 day waiting period Coverage is fully insured 41

43 We designed this plan to protect our members, which is why we decided to partner with an insurance company with an A+ financial rating. Being insured by a company in good financial standing means that there are reserves available to pay member claims, even in the case of a large-scale disaster. UFLAC has designed a plan with LA City firefighters in mind, taking into account income offsets such as sick and vacation time, and other disability plans. Our plan coordinates with common sources of disability income, such as: Other group plans, Workers Compensation, Sick pay, Social Security and Disability pensions. This means that your benefit payment from Reliance Standard may be reduced if you are receiving any of these types of income. Back to Index 42

44 CRITICAL ILLNESS Critical Illness Plan This benefit protects your family against unexpected costs due to illness, when you need it the most. This pays above and beyond your medical coverage and can be used at your own discretion. CRITICAL ILLNESS Covered illnesses include: Cancer Heart Attack Stroke Paralysis Organ Transplants and others Coverage available in $10k, $15k, or $25k amounts* Lump-sum benefit paid upon diagnosis Annual wellness benefit of $50 For more information visit: *EOI may be required 43

45 CRITICAL ILLNESS MONTHLY RATES Member Age $10,000 Coverage 0-29 $5.60 $15,000 Coverage $8.40 $25,000 Coverage $ $8.00 $12.00 $ $9.60 $14.40 $ $14.40 $21.60 $ $23.20 $34.80 $ $34.60 $51.90 $ $48.80 $73.20 $ $65.80 $98.70 $ $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ Back to Index ENROLL ONLINE HERE 44

46 ACCIDENT Accident Insurance Plan This benefit provides lump sum payments for accidents. This pays above and beyond your medical coverage and can be used at your own discretion. This plan may help offset your deductible on the HSA PPO medical plan! ACCIDENT INSURANCE Covered accidents include Dislocations Fractures Burns Hospital Confinement ER treatment and others Two coverage levels available Plan C pays higher benefits than Plan A, for example: If you are admitted to the hospital, Plan A pays you $500 and Plan C pays you $1,500 You can cover the whole family For more information visit: 45

47 ACCIDENT INSURANCE MONTHLY RATES Member Only Plan A $13.88 Plan C $25.26 Member and Spouse $22.46 $41.58 Member and Child(ren) $33.80 $62.88 Family $42.58 $79.44 Back to Index ENROLL ONLINE HERE 46

48 NOTICES Notices Important information for you and your families HIPAA - Special Enrollment Notice 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. Finally, you and/or your dependents may have special enrollment rights if coverage is lost under Medicaid or a State health insurance ( SCHIP ) program, or when you and/or your dependents gain eligibility for state premium assistance. You have 60 days from the occurrence of one of these events to notify the company and enroll in the plan. Newborn and Mothers Health Protection Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother s or newborn s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). 47

49 Women s Health and Cancer Rights Act If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under each plan. If you would like more information on WHCRA benefits, call your plan administrator at , extension 2. Patient Protection Disclosure Anthem Blue Cross generally requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. Until you make this designation, Anthem designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the UFLAC Benefits Office at extension 2. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from Anthem Blue Cross or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the UFLAC Benefits Office at extension 2. Back to Index 48

50 UFLAC UFLAC Benefits - Here for you and your family Trustees and Special Thanks Here are your UFLAC Trustees: David N. Pimentle, Chairman Rigo Arellano, Trustee Edmundo Elguea, Trustee Frank Lima, Trustee David Riles, Trustee David Sifuentes, Trustee 49

51 Special thanks to MetLife, our partner for DHMO and DPPO, and our Network DR dental provider, and to Reliance Standard Life Insurance, our partner for Life, AD&D, Critical Illnesses, Accident, and LTD insurance. Also, we thank Anthem Blue Cross for the many years of excellent service they have provided to UFLAC members and their families. Additional Thanks to: Marilyn Alvarado, Benefits Supervisor, UFLAC Fickewirth Benefits Advisors Faye Business Systems Group, Inc. Businessolver If you have questions or need to make changes to your Benefit Plans, please call the UFLAC Benefits office at: , extension , extension uflacbenefits@uflac.org Open Enrollment website: To view your plan s Benefit Summary, Evidence of Coverage, Summary of Benefits and Coverage, or other plan materials, please visit and click on Reference Center. BENEFITS ADVISORS Fickewirth Benefits Advisors 60 S. California St., 4 th Floor Ventura, CA Telephone: (805) Fax: (805) Back to Index ENROLL ONLINE HERE CA Insurance License:

52 UFLAC Benefits Here for You and Your Family UNITED FIREFIGHTERS OF LOS ANGELES CITY 1571 Beverly Boulevard, Suite 101, Los Angeles, CA UFLAC Benefits Office: (800) , extension 2