Health Benefits Effective January 1, Subject to change.
|
|
- Jerome Harrington
- 5 years ago
- Views:
Transcription
1 Health Benefits Effective January 1, Subject t change. Purpse: T utline the guidelines related t medical, prescriptin, dental and visin benefits. Scpe: All team members f Hackensack Meridian Health. Plicy: Hackensack Meridian Health, HMH, prvides a grup Health Benefits Prgram t eligible team members. Eligibility Team members are eligible fr the Health Benefits Prgram if they are in a regular full-time r regular part-time benefit-eligible psitin, (wrking hurs per week) with standard hurs f 20 hurs r mre per week. Team members whse standard hurs are less than 20 hurs per week, have a status f Per Diem r Temprary are nt eligible fr the prgram. Cverage becmes available effective the first day f the mnth fllwing date f emplyment. Benefit-eligible team members and their cvered dependents may participate in single, emplyee/spuse, emplyee/child(ren), r family medical, prescriptin, dental, r visin cverage. It is the team member's respnsibility t ntify HMH in the event f a change in enrllment status within 31 days f a qualifying life r enrllment event. Failure t d s will result in disciplinary actin, up t and including terminatin f emplyment. (See Qualifying Life Events sectin belw fr mre details) HMH shares a prtin f the cst f cverage fr team members and their cvered dependents fr the medical/rx and dental plans. Team members pay the full cst f any visin electin. Definitin f Eligible Dependents Legal Spuse shall mean the persn recgnized as the cvered team member's husband r wife under the laws f the state where the cvered emplyee lives. Civil Unin is a legally recgnized unin f a same-sex cuple, with rights similar t thse f marriage. Imputed incme applies fr civil unin partners unless he/she meets definitin f dependent as defined under Sectin 152 f the Internal Revenue Cde ( IRC ) Defense f Marriage Act (DOMA) - The IRS ruled that the same-sex cuples, legally married in jurisdictins that recgnize same-sex marriage, will be treated as married fr Federal tax purpses. The ruling's brad impact extends t matters such as: Spusal prtectins and rllver rights in retirement plans Taxatin f grup health benefits COBRA health cverage electins Special enrllment rights under the Health Insurance Prtability and Accuntability Act Leave rights under the Family and Medical Leave Act Grandfathered Dmestic Partners, f the same r ppsite sex, bth f whm are at least 18 years f age, must share a clse persnal relatinship, and have shared the same residence fr n less than six (6) mnths. This is a clsed grup wh must still meet certain eligibility criteria in rder t maintain eligibility. The cst f the benefit is subject t imputed incme unless DP is cnsidered a dependent under IRC Sectin 152. Children wh have nt attained age 26 will be eligible fr cverage under the medical plan regardless f their eligibility fr ther insurance cverage, student status, tax dependency r marital status.
2 Children wh have nt attained age 19, r are full-time cllege students (12 credits fr undergrad, 9 credits fr graduate) age 19-23, will be eligible fr cverage under the dental and visin plans. In rder t maintain eligibility as dependents under the dental r visin plans, student dcumentatin shwing eligibility must be submitted in the Spring and Fall upn request. Dcumentatin must include a bursar's receipt r transcript fr the semester in questin. The term "child" r "children" shall include: natural children adpted children Children placed with a cvered emplyee in anticipatin f adptin. The term "placed" means the assumptin and retentin by such team member f a legal bligatin fr ttal r partial supprt f the child in anticipatin f adptin f the child. Cverage f these pre-adptive children is in accrdance with the requirements f the federal Omnibus Budget Recnciliatin Act f The child must therwise be available fr adptin and the legal prcess must have cmmenced. Step-children If a cvered team member is the legal guardian f an unmarried child r children, these children may be enrlled in the health plan as cvered dependents. Any child wh is an alternate recipient under a qualified medical child supprt rder shall be cnsidered as having a right t dependent cverage under the health plan. Cverage f these children is in accrdance with the requirements f the federal Omnibus Budget Recnciliatin Act f Unmarried dependent children age 19 r ver, unable t earn a living due t mental r physical disability and wh depend n the cvered emplyee fr supprt. Fster children are ineligible t participate. Enrllment Dcumentatin If yu enrll r make changes in ur health benefits plans, Human Resurces may require prf f eligibility upn request thrugh an independent auditing firm, t supprt prf f eligibility. The fllwing dcuments may be requested by the auditing firm t enrll r maintain cverage fr eligible dependents as defined abve: 1. Legal Spuse - certified marriage certificate frm the municipality in which yu were married 2. Dependent Children - certified birth certificate, adptin papers and/r legal dcumentatin frm the curt 3. Scial Security Numbers f all dependents. 4. Prf f ttal disability fr cvered dependent wh is disabled 5. Prf f student status - 12 credits fr undergrad, 9 credits fr graduate fr dependents age 19 and ver fr dental and visin plans 6. Tax Recrds 7. Civil Unin Certificate f Civil Unin, r certified Marriage Certificate T maintain eligibility fr a grandfathered dmestic partner status, all dcumentatin must prve t have been in effect fr a minimum f six (6) mnths prir t the health insurance cverage effective date. All three (3) dcuments prvided as prf must be selected frm the separate grupings belw - (ne selectin per grup). Three f the fllwing dcuments evidencing the cmmitment f the relatinship are required. Jint mrtgage r lease Designatin f the dmestic partner as primary beneficiary in the team member's will, life insurance, r retirement cntract. Durable pwer f attrney fr health care r financial management. Jint wnership f a mtr vehicle, a jint checking accunt r a jint credit card
3 A relatin r chabitatin cntract which bligates each f the parties t prvide supprt fr the ther party State f New Jersey Certificate f Dmestic Partnership T maintain eligibility in the medical plan fr a grandfathered Civil Unin partner status, a Certificate f Civil Unin r marriage license must be submitted as prf evidencing the cmmitment f the relatinship. Please nte: Child(ren) f grandfathered dmestic partners r grandfathered Civil Unin, are eligible dependents cvered under the plans discussed in this plicy. Tax treatment f the team member s cntributin will be dependent upn whether the dependent is cnsidered yur qualified tax dependent under IRC Sectin 152. Yu may be asked t prduce prf f tax dependency at least annually at the end f the plan year. If yur dependent is nt a qualified tax dependent, the value f the HMH prvided medical cverage fr the dependent will be treated as taxable incme t yu, a cncept knwn as imputed incme. Medicare Eligibility Team members wh are eligible fr Medicare, actively wrking with HMH and age 65 r ver, and/r their spuse is eligible fr Medicare and age 65 r ver, bth the team member and the spuse must be aware that their benefits thrugh HMH are their primary health benefits. If team members are eligible fr Medicare, and are nt actively emplyed at age 65 r ver, the benefits will be reduced t the extent that benefits fr the services received are available under Medicare. If team members are under 65 and disabled, the HMH benefits will be primary. Medicare will supplement these benefits. Enrllment/Changes At the time f hire/eligibility, the qualifying team member must access the Team Member Benefits Prtal thrugh MyWay - PepleSft. If the team member enrlls dependents, their cverage will becme effective n the first day f the mnth fllwing date f emplyment. All team members are still required t prvide prf f eligibility upn request. Team members ging frm benefit-ineligible t benefit-eligible will immediately be able t enrll in the apprpriate benefits n the date f the jb change if they have already satisfied the initial waiting perid. Qualifying Life Events Team members wh d nt enrll themselves and/r their eligible dependents at the time f eligibility will nt be eligible fr cverage until a subsequent pen enrllment perid r a qualifying life status event as determined by the IRS ccurs. Qualifying life status events include the fllwing: Changes in the team member's legal marital status (marriage, death f spuse, divrce, legal separatin (under state law), and annulment). Change in the number f team member's dependents (birth, death, adptin, placement fr adptin). Change in the emplyment status f the team member, spuse, r dependent (terminatin/ cmmencement f emplyment, beginning r end f an unpaid leave f absence, change in wrk site. Als included is change in emplyment status that affects plan eligibility, such as changing frm hurly t salaried status). Change in dependent status (dependent reaching cntract terminatin age, marriage f the child). Change in residence f the team member, spuse r dependent. (When team member/dependent mves ut f a plan's service area, i.e. an HMO.) The annual Cafeteria Plan pen enrllment fr a spuse's plan.
4 Human Resurces must be ntified within 31 days f a qualifying event. If yu d nt ntify the Plan within 31 days f the event and yur ineligible dependents cntinue t utilize services under the Plan, this will be cnsidered fraud and will result in the terminatin f the team member's and the dependents' cverage. Enrllment int the benefits plan is nt autmatic; the team member must access the Team Member Benefits Prtal thrugh MyWay - Peplesft. Team members have 31 days t make a change after a qualifying life event. Team members will be mailed identificatin cards fr their medical, dental, visin and prescriptin cverage. These cards shuld be carried at all times and presented t the hspital r physician whenever emplyees r eligible dependent(s) receive medical/prescriptin r dental services. Online Resurces The benefit plan carriers ffer 24/7 nline access t claims statements, Explanatin f Benefits (EOB), prvider selectin infrmatin, and ther member tls. Yu can visit fr mre infrmatin. COVERAGE The health plans ffered are described in detail in the varius Summary Plan Descriptins (SPDs) available n the Team Member Benefits Prtal. Team members are encuraged t review the SPDs t becme familiar with their cverage tiers, deductibles, and c-insurance charges. After reviewing the SPDs, if emplyees still have questins regarding their cverage, they may cntact the plan carriers thrugh the member services cntacts fund n The team member s prtin f the health, dental and visin premiums are deducted bi-weekly, frm their paychecks. Prescriptin Plan HMH ffers nsite pharmacies created s team members can cnveniently fill prescriptins fr themselves and their families. In Huse pharmacies accept OptumRX cards and ther third-party insurance plans. In-huse pharmacies als prvide team members with the pprtunity t btain 90-day supplies f maintenance medicatins. The percentages f csts and maximums fr the 90-day supply f maintenance medicatins are mre favrable ut-f-pcket thrugh In-Huse Pharmacy vs Mail-rder fr 90-day supply. Specifics regarding cverage tiers, deductibles, and c-insurance charges under the prescriptin plan are available at the Team Member Benefits Prtal. Team members must fill their maintenance medicatins thrugh any in-huse pharmacies r thrugh mail rder with OptumRx. If a generic is available and the pharmacy fills it with the brand name drug fr any reasn, the team member will pay the difference between the generic and the brand, as well as the generic c-pay. Dental Plan HMH ffers a cmprehensive dental plan administered by Hrizn Blue Crss Blue Shield f NJ. Eligibility fr the dental plan is n the 1st day f the mnth fllwing date f emplyment. Dependent children are cvered t age 19, 23 if full-time cllege students. Mre specifics regarding dental cverage are available at the Team Member Benefits Prtal.
5 Visin Plan A visin plan thrugh Hrizn Blue Crss Blue Shield f NJ is ffered t benefit eligible team members. NOTE: Prf f full-time student status fr the fall and spring semesters are required t btain r maintain cverage. Failure t submit prf f student status will result in dis-enrllment f the dependent child(ren) frm the dental and visin plans. TERMINATION OF HEALTH COVERAGE When a team member terminates r becmes ineligible due t a reductin f hurs, cverage ceases n the day in which the change ccurs. Cverage ceases fr dependent children the end f the mnth in which they reach the limiting age f 26 fr medical, the actual day yur dependent reach age 19, r 23 if full-time cllege student, fr dental r visin cverage. Excluded frm age limits are children physically r mentally disabled and incapable f earning their wn living. Shuld HMH terminate the benefits plan, cverage fr all team members will end n that date. COBRA With the passage f the Cnslidated Omnibus Recnciliatin Act f 1985, team members are required t ffer frmer team members, retirees, spuses and dependent children the right t cntinue health cverage. HMH is mandated by law t ntify the Plan Administratr (Hrizn BCBS f NJ) f a qualifying event within 30 days f a team member's terminatin, reductin in hurs, death r entitlement t Medicare. Qualified beneficiary must ntify HMH within 60 days f divrce, legal separatin r child ceasing cverage. Under COBRA, team members and their eligible dependents may elect t cntinue grup health cverage if their cverage wuld have therwise ended as a result f the fllwing events: Vluntary r invluntary terminatin Reductin in the number f hurs Medicare entitlement Divrce r legal separatin Death f cverage emplyee Lss f dependent child status Scial Security disability If cverage is t cntinue, the team member and/r eligible dependents will be respnsible fr paying 102% f the premium fr that cverage. Cverage will be identical t the health care cverage fr the grup and wuld be extended as fllws: Qualifying Events Beneficiary Cverage Terminatin Team Member 18 Mnths Reduced hurs Spuse/Dependent Child 18 Mnths Team Member entitled t Medicare, Divrce/Legal Separatin r death f Team Member Spuse/Dependent Child 36 Mnths
6 Lss f Dependent Child Status Dependent Child 36 Mnths Scial Security Disability Team Member/Spuse 29 Mnths HMH expressly reserves the right, in its sle and abslute discretin, t change, mdify r delete the prvisins f this plicy in whle r in part, at any time r fr any reasn withut ntice. The emplyment terms set ut in this plicy wrk in cnjunctin with, and d nt replace, amend, r supplement any terms r cnditins f emplyment stated in any applicable cllective bargaining agreement. Wherever emplyment terms in this plicy differ frm the terms expressed in the applicable cllective bargaining agreement, team members shuld refer t the specific terms f the cllective bargaining agreement, which will cntrl. Any questins regarding this plicy and prcedure may be referred t Human Resurces.
Information Package CAFETERIA 125 PLANS
Infrmatin Package CAFETERIA 125 PLANS Shaffer Insurance Services, Inc. Benefits Divisin 902 E. Ave Q-9 Palmdale Ca. 93550 Tll Free (866) 412-5872 Office Tel (661) 575 9331 Fax (661) 280 2016 Sectin 125
More informationRev. 7/1/11. Sprint Flex Plans Eligibility and Enrollment Section
Rev. 7/1/11 Sprint Flex Plans Eligibility and Enrllment Sectin TABLE OF CONTENTS SPRINT FLEX PLANS 3 WHO IS ELIGIBLE TO PARTICIPATE IN SPRINT FLEX PLANS 3 DUPLICATE COVERAGE.. 7 ENROLLMENT.. 7 ENROLLMENT
More informationMICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS
Seattle, Washingtn 98101 MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS D nt cancel any existing plicies until yu receive cnfirmatin f final rates and/r acceptance f the grup by Regence BlueShield (Regence).
More informationTable of Contents. About Your Benefits 1. Medical Plan 2. Prescription Drugs Plan 3. Vision Plan 4. Dental Plan 5. Employee Assistance Program 6
Table f Cntents Sectin Tab Abut Yur Benefits 1 Medical Plan 2 EPO 2-1-1 PPO 2-2-1 Chice Fund HSA 2-3-1 PPO Cre 2-4-1 PPO Select 2-5-1 Open Access Plus 2-6-1 Indemnity 2-7-1 Prescriptin Drugs Plan 3 Visin
More informationTable of Contents. About Your Benefits 1. Medical Plan 2. Prescription Drugs Plan 3. Vision Plan 4. Dental Plan 5. Employee Assistance Program 6
Table f Cntents Sectin Tab Abut Yur Benefits 1 Medical Plan 2 PGU Chice Fund HSA 2-1-1 PGU PPO Cre 2-2-1 PGU PPO Select 2-3-1 Chice Fund HSA 2-4-1 PPO Cre 2-5-1 PPO Select 2-6-1 Open Access Plus 2-7-1
More informationSteps toward Retirement
Steps tward Retirement Eligibility, Actin Steps, and Benefit Optins fr Faculty and Staff Nearing Retirement Eligibility fr Official University Retiree Status The fllwing jb types f the University are eligible
More informationRev. 1/1/12. Sprint Flex Plans Eligibility and Enrollment Section
Rev. 1/1/12 Sprint Flex Plans Eligibility and Enrllment Sectin What is Inside Sprint Flex Plans... 3 Wh Is Eligible T Participate In Sprint Flex Plans... 3 Duplicate Cverage... 6 Enrllment... 6 Enrllment
More informationHow to Count Employees Determining Group Size Under the Medicare Secondary Payer Regulations
Hw t Cunt Emplyees Determining Grup Size Under the Medicare Secndary Payer Regulatins 1. Wh is an Emplyee? An emplyee is an individual wh wrks fr an emplyer r an individual wh, althugh nt actually wrking
More informationEXTENDED BENEFITS FOR TOTAL DISABILITY & SUCCEEDING CARRIER FOR INPATIENT ADMISSIONS
UnitedHealthcare Oxfrd Administrative Plicy EXTENDED BENEFITS FOR TOTAL DISABILITY & SUCCEEDING CARRIER FOR INPATIENT ADMISSIONS Plicy Number: ADMINISTRATIVE 149.11 T2 Effective Date: December 1, 2017
More informationCONNECTICUT CARPENTERS HEALTH FUND COBRA CONTINUATION COVERAGE ELECTION NOTICE
CONNECTICUT CARPENTERS HEALTH FUND COBRA CONTINUATION COVERAGE ELECTION NOTICE DATE Dear : This ntice cntains imprtant infrmatin abut yur right t cntinue yur health care cverage in the Cnnecticut Carpenters
More informationPreparing for Your Early Retirement
Preparing fr Yur Early Retirement Imprtant Infrmatin fr Railrad Emplyees Eligible fr GA-46000 Eligibility fr Railrad Annuity Railrad Retirement Bard https://secure.rrb.gv/ Call yur lcal Railrad Retirement
More informationMedigap Household Discounts
Medigap Husehld Discunts 7/5/2016 Please nte: Nt all states are listed where discunts are available. Please refer t the Applicatin r Prducer Guide fr the specific carrier and state. Yu may cntact the Carrier
More information(FAMILY NAME) Qualified Small Employer Health Reimbursement Arrangement
(FAMILY NAME) Qualified Small Emplyer Health Reimbursement Arrangement Effective Date: Emplyer / Plan Administratr Emplyer Name: Address: Phne Number: ( ) - Federal Emplyer Identificatin Number: The emplyer
More informationPLAN DOCUMENT TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES. Effective January 1, 2014
DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES PLAN DOCUMENT Effective January 1, 2014 (Replaces January 1, 2013 Plan Dcument) 1 CONTENTS OVERVIEW...
More informationSummary Plan Descriptions (SPD)
Descriptins (SPD) SPDs What Are They and Wh Needs Them? What is an SPD? The DOL defines the SPD as the Primary vehicle fr infrming participants and beneficiaries abut their plan and hw it perates. Must
More informationCOMPREHENSIVE BENEFITS SUMMARY (Health Plan)
2017 COMPREHENSIVE BENEFITS SUMMARY (Health Plan) Health Insurance Health insurance is prvided frm the 1 st f the mnth fllwing yur date f hire. Our current plan fferings are as fllws: HealthyBlue r ActiveUnivera
More informationWhat Can You Expect? The following will be effective Jan. 1, Please refer to the enclosed summary charts for more details.
Merck 1 Merck Drive Whitehuse Statin, NJ 08889 merck.cm February 2012 2013 Retiree Health Care Changes Dear Retiree, Since the merger f Merck and Schering-Plugh, we've been wrking t integrate every aspect
More informationABLE Accounts: 10 Things You Should Know
ABLE Natinal Resurce Center 1667 K Street, NW Suite 640 Washingtn, DC 200006 (202) 296-2040 inf@ablenrc.rg ABLE Accunts: 10 Things Yu Shuld Knw 1. What is an ABLE accunt? ABLE Accunts, which are tax-advantaged
More informationYour Retirement Guide. Employees
Yur Retirement Guide Emplyees Retirement is a big step. Over the next few weeks and mnths yu ll be asked t make many imprtant decisins abut yur New Yrk Life benefits and yur financial security. This easy-t-use
More informationEmployee Benefits Guide. January 1 December 31, 2019
Emplyee Benefits Guide 2019 January 1 December 31, 2019 Medical and Prescriptin Drugs Benefits are insured by: 4 Medical Plan Optins Effective January 1, 2019 Premium Netwrk HDHP 1 Nn-Premium Netwrk Nn-Netwrk
More informationDEPARTMENTAL STAFF: LEAVE GUIDELINES
510C:1 DEPARTMENTAL STAFF: LEAVE GUIDELINES The Department f Athletics, in cncurrence with University plicy, prvides staff members with varius types f leave. The University requires the Directr f Athletics
More informationMemorandum. Employees, Retirees and Survivors. Sarah Kloos, Director of Personnel. Date: September 22, Transition to GIC Health Benefits
Memrandum T: Frm: Emplyees, Retirees and Survivrs Sarah Kls, Directr f Persnnel Date: September 22, 2011 Subject: Transitin t GIC Health Benefits Pursuant t Chapter 67 f the Acts f 2007, and after cnsultatin
More informationEmployee Rights & Responsibilities Page 1 of 4 Traumatic Injury/Form CA-1
Emplyee Rights & Respnsibilities Page 1 f 4 Traumatic Injury/Frm CA-1 The Federal Emplyees Cmpensatin Act (FECA) utlines the benefits fr federal emplyees injured in the perfrmance f their duties. The Office
More informationWhat employers need to know about The Patient Protection and Affordable Care Act (PPACA)
What emplyers need t knw abut The Patient Prtectin and Affrdable Care Act (PPACA) 1. It is nw the law. Dept. f Health & Human Services (HHS) guidance is still needed n pen issues. 2. New state insurance
More informationStaff Separation Checklist
Staff Separatin Checklist Please print and use as a reference guide t cmplete the separatin prcess. Benefits Checklist fr Staff Separatin Health Benefits: COBRA Frms Received Retirement: Received infrmatin
More informationGuide to Young Adult Dependent Coverage
Guide t Yung Adult Dependent Cverage The New Yrk State Legislature passed a law in 2009 which extends the availability f health insurance cverage t yung adults thrugh the age f 29. As a result, Freelancers
More informationCRG PATIENT REGISTRATION FORM
CRG PATIENT REGISTRATION FORM PATIENT INFORMATION Patient s Name: Birth : (Last) (First) (Middle) Scial Security Number: Male: Female: Hme Address: (Street / RR Bx # / Apt. #) (City/State) (Zip) Preferred
More informationHighlights for 2017 Compliance
Prvided by Natinal Insurance Services, Inc. Highlights fr 2017 Cmpliance The Affrdable Care Act (ACA) has made a number f significant changes t grup health plans since the law was enacted in 2010. Many
More informationFrequently Asked Questions for Blue Shield Producers Guarantee Issue for Children Under Age 19 Updated June 7, 2011
Frequently Asked Questins fr Blue Shield Prducers Guarantee Issue fr Children Under Age 19 Updated June 7, 2011 What are the new health refrm requirements fr applicants under age 19? The Affrdable Care
More informationPHILADEPHIA PROMOTING HEALTHY FAMILIES AND WORKPLACES ORDINANCE (PAID SICK LEAVE LAW)
PHILADEPHIA PROMOTING HEALTHY FAMILIES AND WORKPLACES ORDINANCE (PAID SICK LEAVE LAW) Eligibility Wrkers emplyed in Philadelphia fr at least 40 hurs in a calendar year (January 1 t December 31) will accrue
More informationCity of Richmond, Virginia
City f Richmnd, Virginia Richmnd Retirement System NEWS RELEASE Philip R. Langham Executive Directr May 31, 2011 Cntact: Adam C. Austin Marketing and Public Relatins Specialist Email: adam.austin@richmndgv.cm
More informationEMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Box 398 ATT: Human Resources Fort Myers, Florida (239)
PERSONAL INFORMATION EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Bx 398 ATT: Human Resurces Frt Myers, Flrida 33902 (239) 533-2245 http://www.lee-cunty.cm JOB NUMBER: JOB TITLE: EXAM ID#: Received:
More informationPolicy & Procedure Manual
Plicy & Prcedure Manual Agency Vacatin Reviewed Date HR0701 Revised Date May 12, 2014 Apprved Date December 19, 1990 Intrductin The Bard f Health believes in prviding fair and equitable benefits t all
More informationSpecial Conditions Form
2017-18 Special Cnditins Frm Cntact Infrmatin www.twsn.edu/finaid finaid@twsn.edu 410-704-4236 If yur family has experienced a majr reductin in incme, the Financial Aid Office may be able t reevaluate
More informationTable of Contents... i-ii. IMPORTANT Information Plan Sponsor and Participating Employers... 1
This bklet, tgether with the applicable insurance plicies, certificates f cverage r ther cmpnent plan benefit bklets serve as bth the fficial plan dcuments and as the summary plan descriptins fr the benefits
More informationSummary of Material Modification
Summary f Material Mdificatin T: Participants Frm: Human Resurces Re: Amendment t University f the Pacific Self-Funded Medical Plan Effective January 1, 2017, the University f the Pacific has amended its
More informationSummary Plan Descriptions
Summary Plan Descriptins All grup health plans subject t the Emplyee Retirement Incme Security Act (ERISA) are required t prvide participants with a Summary Plan Descriptin (SPD). An SPD must be written
More informationYUM! Brands 401k Plan
YUM! Brands 401k Plan Final Distributin Electin Name: Scial Security #: Address: Daytime Telephne #: Evening Telephne #: Befre yu can prcess a Final Distributin Electin, yur status must be terminated.
More informationCafeteria Plan. Explanation Booklet. For January 1, 2010 through December 31, 2010 Plan Year Elections
Cafeteria Plan 2010 Explanatin Bklet Fr January 1, 2010 thrugh December 31, 2010 Plan Year Electins 1 Table f Cntents Cafeteria Plan Overview 3 Medical Plan Optins. 5 Dental Plan Overview. 7 Flexible Spending
More information2018 Employee Benefits Program (U.S.) Qualified Status Changes
2018 Emplyee Benefits Prgram (U.S.) Qualified Status Changes SUMMARY PLAN DESCRIPTION (SPD) 2018 Emplyee Benefits Prgram (U.S.) Qualified Status Changes TABLE OF CONTENTS WHAT HAPPENS TO YOUR BENEFITS...
More informationJanuary 2017 *Benefits Highlights for Medical Center Employees
January 2017 *Benefits Highlights fr Medical Center Emplyees Health Insurance Plans A Tricare Supplement plan is ffered t Tricare eligible emplyees: all ther emplyees have t the ptin t enrll in the MUSC
More informationSection 125 Flexible Benefit Plan Plan Year Frequently Asked Questions & Answers and 125 Plan Summary of Reimbursement Account Arrangement
PLACER COUNTY OFFICE OF EDUCATION Sectin 125 Flexible Benefit Plan 2015-2016 Plan Year Frequently Asked Questins & Answers and 125 Plan Summary f Reimbursement Accunt Arrangement 800-248-8858, Ext. 251
More informationTown of Palm Beach Retirement System. Deferred Retirement Option Plan (DROP) Policies and Information for Participants
Twn f Palm Beach Retirement System Deferred Retirement Optin Plan (DROP) Plicies and Infrmatin fr Participants Twn f Palm Beach Retirement System Deferred Retirement Optin Plan (DROP) Plicies and Infrmatin
More informationaddress: Driver license number: Date of birth: Occupation:
MEMBERSHIP APPLICATION PRIMARY MEMBER INFORMATION Name: Scial security Member Number: Hme phne: Cell phne: Business phne: Mther s Maiden Name: Security passwrd: Mailing address: City: State: ZIP Cde: Street
More informationCafeteria Plan for the Employees of Central Rivers Area Education Agency. Plan Document and Summary Plan Description
Cafeteria Plan fr the Emplyees f Central Rivers Area Educatin Agency Plan Dcument and Summary Plan Descriptin Originally Effective July 1, 2003 Amended and Restated July 1, 2017 Summary Plan Descriptin
More informationThis Agreement is hereby confirmed to vary Terms & Conditions of employment between The Company and you.
Salary Sacrifice Agreement Terms & Cnditins This Agreement regulates yur participatin in the Simplydriveit prgramme, which has been implemented by Pendragn Cntracts Ltd fr (cmpany name here) Under the
More informationHigh Deductible Health Plan/ Health Savings Account Presentation
High Deductible Health Plan/ Health Savings Accunt Presentatin WHY THE CHANGE? Current plan cannt be sustained inflatin and disease states cmpunding effect n cst fr emplyees and Bard HDHC plan structured
More informationSpecial Conditions Form
2019-2020 Special Cnditins Frm Cntact Infrmatin www.twsn.edu/finaid finaid@twsn.edu 410-704-4236 If yur family has experienced a majr reductin in incme, the Financial Aid Office may be able t reevaluate
More information-r\jotic E. Insurance Marketplace Coverage Options and Your Health Coverage. ..t
-r\jotic E Insurance Marketplace Cverage Optins and Yur Health Cverage..t - 2014 GALLAGHER BENEFIT SERVICES, INC. ARll-IUR J. GAllAGHER & CO. I AJG.COM G-Frms\GBS\Template - Wrd -.5 margis.dcx - Frequently
More informationParent Guide to Financial Aid
Parent Guide t Financial Aid fr the 2019-20 schl year OVERVIEW AND DEADLINES Welcme t the financial aid applicatin seasn fr the 2019-20 schl year. We recgnize that the applicatin prcess can be stressful
More informationVision Service Plan (VSP) New Group Implementation Guide
Visin Service Plan (VSP) New Grup Implementatin Guide Nrth Ranch Benefits Trust (NRBT) Administered by HealthSmart Benefit Slutins, Inc. Agents shuld submit the cmpleted New Grup Implementatin Guide back
More informationPREPARING TO TERMINATE DROP
PREPARING TO TERMINATE DROP If yu wrk until yur riginal Deferred Retirement Optin Prgram (DROP) terminatin date, the Divisin f Retirement will mail yu yur DROP Terminatin Packet apprximately 90 days prir
More informationInstitute For Orthopaedic Surgery (IOS) Subject: Healthcare Financial Assistance Policy
Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual Subject: HealthCare Financial Assistance Plicy Purpse: T establish guidelines fr financial
More informationFinancial Aid Satisfactory Academic Progress Appeal Request Spring 2019 Deadline: January 3, 2019
Financial Aid 2018-2019 Satisfactry Academic Prgress Appeal Request Spring 2019 Deadline: January 3, 2019 Is this yur first appeal? (Currently n Financial Aid Suspensin) Is this yur secnd appeal? (Appeal
More informationFOR PLAN ADMINISTRATORS
QDRO INFORMATIONAL KIT FOR PLAN ADMINISTRATORS T ensure cmpliance with requirements impsed by the IRS, we infrm yu that any infrmatin cntained in this cmmunicatin (including any attachments) was nt intended
More informationQUESTION WE VE BEEN ASKED
Date f issue: 23 February 2018 QUESTION WE VE BEEN ASKED QB 18/05 Incme Tax insurance persnal sickness and accident insurance taken ut by emplyer fr the benefit f an emplyee This Questin We ve Been Asked
More informationCompass Critical Illness Insurance Enrollment at a glance An affordable way to help protect against the financial stress of a serious illness.
Cmpass Critical Illness Insurance Enrllment at a glance An affrdable way t help prtect against the financial stress f a serius illness. Fr the emplyees f: ACME Truck Line, Inc. D yu knw smene wh has had
More informationMedicare Advantage Outreach and Education Bulletin
Medicare Advantage Outreach and Educatin Bulletin Anthem Blue Crss and Blue Shield Changing 2013 Medicare Advantage Plan Update Dear Healthcare Prvider, Annual benefits changes fr Medicare Advantage plan
More informationPG&E's Paid Family Leave & Disability Benefits
PG&E's Paid Family Leave & Disability Benefits Utility IBEW and SEIU--represented emplyees 2017 and 2018 Paid Family Leave and Medical /Disability Benefits Overview PG&E s Paid Family Leave wage cntinuatin
More informationEnding Your Membership in the Plan
Ending Yur Membership in the Plan Yu must be eligible fr a valid disenrllment perid. Yur cverage will end the first day f the mnth after we receive yur request t disenrll. When can yu end yur membership
More informationDear State of Florida Retiree:
Peple First Service Center P.O. Bx 6830 Tallahassee, FL 32314 Tel: 866 663 4735 Fax: 800 422 3128 TTY: 866 221 0268 Dear State f Flrida Retiree: Cngratulatins n yur retirement! As a new retiree, yu need
More informationVOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE
Plan Year 2018 Effective January 1, 2018 t December 31, 2018 VOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE Internatinal Assciatin f Firefighters WHEN TO ENROLL When yu are initially eligible fr cverage.
More informationVOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE
Plan Year 2018 Effective January 1, 2018 t December 31, 2018 VOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE Plumbers Lcal 367 WHEN TO ENROLL When yu are initially eligible fr cverage. Yu have 30 days frm
More informationOFFICE OF THE PRESIDENT HUMAN RESOURCES POLICY MANUAL SECTION 11 JULY 28, 2006 REDUCTION IN FORCE GUIDELINES
Purpse A reductin in frce is an actin t reduce the number f emplyees in a wrk unit r university-wide. A reductin in frce may becme necessary due t reduced funding, rerganizatin, change in wrklad, r ablishment
More informationNewport News Shipbuilding Employee s Hardship Fund
Newprt News Shipbuilding Emplyee s Hardship Fund Executive Summary Missin: The Newprt News Shipbuilding Emplyees Hardship Fund (the "Fund'') will prvide mnetary supprt t assist emplyees fllwing a natural
More informationQuality Assurance Program Independent Student Verification Worksheet
2015-16 Quality Assurance Prgram Independent Student Verificatin Wrksheet QAIVER Yur applicatin was selected fr review in a prcess called verificatin. In this prcess, Temple University will be cmparing
More informationEmployee Hardship Assistance Policy
Emplyee Hardship Assistance Plicy Functinal Area: Human Resurces Applies T: All Faculty and Staff Plicy Reference(s): N/A Number: TBD Date Issued: March 4, 2013 Page(s): 6 Respnsible Persn The Directr
More informationExit Interview Check List
Name: Exit Interview Check List Date Exit Interview Scheduled: Separatin/Retirement Date: Reasn fr Leaving (circle ne): Retirement Resignatin Terminatin Other: Health Benefits (COBRA) Life Insurance Cntinuatin
More informationWV INCOME MAINTENANCE MANUAL. Specific Medicaid Requirements
INTRODUCTION The West Virginia Medicaid Prgram prvides payment fr cvered medical services t certified medical prviders fr eligible individuals wh are aged, blind r disabled and t eligible members f families
More informationInformational Sheet- Application for Pension
33 Plaza La Prensa, Santa Fe, NM 87507 (505) 476-9401 Fax (505)476-9300 Vice (800) 342-3422 Tll-Free www.nmpera.rg Infrmatinal Sheet- Applicatin fr Pensin If yu are cnsidering retiring, PERA requests that
More informationPaid time off is provided to eligible hourly and commissioned associates who need to miss work due to an illness or a personal situation.
Sick Time Plicy Paid time ff is prvided t eligible hurly and cmmissined assciates wh need t miss wrk due t an illness r a persnal situatin. Examples f when an assciate can use sick time include, but are
More information2018 Healthy Boiler Wellness Incentive Program FAQs
2018 Healthy Biler Wellness Incentive Prgram FAQs As healthcare csts cntinue t rise acrss the cuntry, the university s best way t cmbat this is by helping t imprve the verall wellness f ur ppulatin. Therefre,
More informationAssurant Affiliate Benefits Program Health and Welfare Plan 2017 Summary Plan Description
Assurant Affiliate Benefits Prgram Health and Welfare Plan 2017 Summary Plan Descriptin Getting t Knw Yur Assurant Benefits Quality, Prtectin, Value Yur cmpensatin is much mre than yur paycheck. There
More informationIRS Notice CLICK HERE to return to the home page
CLICK HERE t return t the hme page IRS Ntice 2012-9 I. PURPOSE This ntice restates and amends the interim guidance n infrmatinal reprting t emplyees f the cst f their emplyer-spnsred grup health plan cverage
More informationSpecial Circumstance Review
1 f 7 Student s Name: Last First SLU Banner ID Number 2008-2009 Special Circumstance Review Parent(s)/Stepparent(s) and Student/Spuse may use this frm t reprt significant changes that have ccurred since
More informationMedicare Advantage Outreach and Education Bulletin
Medicare Advantage Outreach and Educatin Bulletin Empire Blue Crss Blue Shield 2013 Medicare Advantage Plan Updates Dear Healthcare Prvider, Annual benefits changes fr Medicare Advantage plan members will
More informationSocial Security Administration
1 Scial Security Administratin 1329 S. Divisin St. Traverse City MI 49684 Nvember 17, 2017 December 2017 Clumns & Features 5 WAYS SOCIAL SECURITY PROTECTS YOU AND YOUR FAMILY..2 IS IT MEDICARE OR MEDICAID?..
More informationSuperannuation contributions tax ruling Tax deductibility of superannuation contributions
July 2011 Technical Bulletin Superannuatin cntributins tax ruling Tax deductibility f superannuatin cntributins Wh is impacted? As a result f tax ruling 2010/1 yur clients can n lnger claim a tax deductin
More informationNEWPORT-MESA UNIFIED SCHOOL DISTRICT
NEWPORT-MESA UNIFIED SCHOOL DISTRICT BELIEVE IN YOURSELF. WE DO. Cigna FAQ Belw please find details and frequently asked questins regarding the Cigna Netwrk (HMO), St. Jseph Hag Health (SJHH) Select Netwrk
More informationTo all Members of the Medical Insurance Plan for Retirees:
The Wrld Bank Grup Human Resurces, MSN G2-202 (202) 473-2222 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT Washingtn, D.C. 20433 (202) 522-7026 fax INTERNATIONAL DEVELOPMENT ASSOCIATION U.S.A.
More informationNYTD Survey- 19 year olds
1 The fllwing survey is being dne t recrd yur experience in the West Virginia Fster Care System. Yur respnses are imprtant and we really d want yur input as we try t find ways t imprve Fster Care and create
More informationPrivacy Notice for Applicants and Tenants
Privacy Ntice fr Applicants and Tenants What we need Scttish Brders Husing Assciatin (SBHA) will be a "cntrller" f the persnal infrmatin that yu prvide t us thrugh yur cmpleted Husing Applicatin Frm, and
More informationSpecial School District (SSD) Effective Date: August, Overtime
Luisiana Department f Educatin Emplyee Plicies Special Schl District (SSD) Effective Date: August, 2015 Overtime ************************************************************************ Applicability This
More information5/29/14. Insurance. Health Care Coverage for Baylor College of Medicine Students
Insurance Health Care Cverage fr Baylr Cllege f Medicine Students Baylr Cllege f Medicine (The Cllege) believes student wellness is essential t academic prgress. In rder t supprt this philsphy, Baylr Cllege
More informationWELCOME. to The Orange Life! WORK, HOME and in the COMMUNITY. Benefits Orientation Guide for Permanent U.S. Part-Time Hourly Associates
WELCOME t The Orange Life!» WORK, HOME and in the COMMUNITY Benefits Orientatin Guide fr Permanent U.S. Part-Time Hurly Assciates We re glad yu decided t put n the range aprn and bring yur skills and knw-hw
More informationMAINTENANCE Domestic Relations Law 236-B(5-a) & (6) For divorces filed after January 25, a. Temporary maintenance awards.
MAINTENANCE Dmestic Relatins Law 236-B(5-a) & (6) Fr divrces filed after January 25, 2016 5-a. Temprary maintenance awards. a. Except where the parties have entered int an agreement prviding fr maintenance
More informationTufts Health Plan Policy #
Cverage Highlights Yur Plan Eligibility Cverage Amunts Tufts Health Plan Plicy # 425544 All full-time and part-time emplyees in active emplyment in the United States wrking at least 20 hurs per week. Cverage
More informationFor the employees of: City and County of San Francisco Health Service System
Cmpass Critical Illness Insurance A limited benefit plicy Enrllment at a Glance An affrdable way t help prtect against the financial stress f a serius illness. Fr the emplyees f: City and Cunty f San Francisc
More informationHRA s and HSA s GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. AJG.COM G-FORMS\GBS Forms\Template - Word - 1 margins.
HRA s and HSA s 1. HRA/HSA What Are They? 2. Can I have ther cverage and still cntribute? 3. Can I cntribute t my FSA if s, full r limited? 4. Can I have bth an HRA and an 5. Can I have bth an HSA and
More informationA Guide to Understanding Medicare Benefits
WEALTH SOLUTIONS GROUP A Guide t Understanding Medicare Benefits This cmprehensive guide prvides an verview f the key cmpnents f Medicare, including eligibility requirements, an explanatin f the different
More informationEmployer Shared Responsibility (ESR) Provisions under the ACA Part II
April 1, 2013 Emplyer Shared Respnsibility (ESR) Prvisins under the ACA Part II Treasury and the IRS released prpsed regulatins n the new Emplyer Shared Respnsibility (ESR) prvisins (a/k/a Play r Pay,
More informationUNISYS SUPPLEMENTAL UNEMPLOYMENT BENEFITS PLAN
UNISYS SUPPLEMENTAL UNEMPLOYMENT BENEFITS PLAN Effective January 1, 2009 TABLE OF CONTENTS Page INTRODUCTION...1 WHO IS ELIGIBLE...2 WHO IS NOT ELIGIBLE...4 SPECIAL SITUATIONS THAT ARE NOT COVERED...6
More informationCODE OF CONDUCT AND ETHICS POLICY ON CONFLICTS OF INTEREST
CODE OF CONDUCT AND ETHICS POLICY ON CONFLICTS OF INTEREST Magna Internatinal Inc. Plicy n Gifts & Entertainment 1 POLICY ON CONFLICTS OF INTEREST Magna emplyees have a duty t act in Magna s best interest.
More informationUniversity of Oregon Sponsored Projects Services T32 & IGERT Group Training Grant Charge Guidance. Guidance Purpose and Overview
University f Oregn Spnsred Prjects Services T32 & IGERT Grup Training Grant Charge Guidance Guidance Purpse and Overview The University f Oregn (UO) has been awarded multiple spnsred prjects with the intent
More informationEXXONMOBIL SAVINGS PLAN Hardship Withdrawal Form
EXXONMOBIL SAVINGS PLAN Hardship Withdrawal Frm Name: Sc. Sec #: Wrk Phne: ( ) Hme Phne ( ) Yu may request a hardship withdrawal when yur financial need cannt be met thrugh: Reimbursement r cmpensatin
More informationCaledon Coal Pty Ltd and related entities
Caledn Cal Pty Ltd and related entities Frequently Asked Questins 15 May 2017 Table f Cntents 1. Backgrund 2. Entitlements 3. Supprt 4. Key timeframes and Cntacts 1. Backgrund 1.1. What has happened t
More informationSWEET HOME SCHOOL DISTRICT. SUMMARY PLAN DESCRIPTION Flexible Spending Account
SWEET HOME SCHOOL DISTRICT SUMMARY PLAN DESCRIPTION Flexible Spending Accunt Effective: 10/1/2016 This dcument explains in detail the peratin and rules that gvern yur Plan. Sme features f a Flexible Spending
More informationSTATE OF NEW YORK MUNICIPAL BOND BANK AGENCY
STATE OF NEW YORK MUNICIPAL BOND BANK AGENCY Recvery Act Bnd Prgram Written Prcedures fr Tax Cmpliance and Internal Mnitring, adpted September 12, 2013 PROGRAM OVERVIEW The State f New Yrk Municipal Bnd
More informationUNIVERSITY OF TORONTO TOWN HALL PRESENTATION. on the University Pension Plan (UPP)
UNIVERSITY OF TORONTO TOWN HALL PRESENTATION n the University Pensin Plan (UPP) This is a presentatin prepared by the University f Trnt fr its emplyees and retirees and is based n the University f Trnt
More informationInformation about the Shared Risk Plan for CUPE Employees of New Brunswick Hospitals
Infrmatin abut the Shared Risk Plan fr CUPE Emplyees f New Brunswick Hspitals Shared Risk Plan fr CUPE Emplyees f New Brunswick Hspitals Disclaimer: This bklet is fr infrmatin purpses nly. N rights are
More information