hospital indemnity insurance Effective January 1, 2017, Chevron will offer a new Group Hospital Indemnity* Insurance underwritten by Continental American Insurance Company (CAIC), a wholly-owned subsidiary of Aflac Incorporated (Aflac), and administered by Mercer Voluntary Benefits. Even if you have health insurance, you could face unanticipated out-of-pocket expenses your medical plan doesn t cover with an inpatient hospital stay. Group Hospital Indemnity Insurance with Aflac can help with the out-of-pocket costs associated with a covered hospital stay, including benefits for hospital admission, confinement, and intensive care. It provides financial assistance to enhance your current medical and disability coverage if you are hospitalized due to a covered injury or illness. who can enroll Group Hospital Indemnity Insurance is available to all U.S.-payroll employees eligible for Chevron health benefits. You must enroll to be covered. If you enroll, you can also cover your eligible dependents: Eligible spouse. Eligible domestic partner. Eligible child (under age 26)*. * If you do not have dependent child coverage, a newborn or newly adopted child will be automatically covered for 60 days from the date of birth or placement for adoption. To continue coverage beyond 60 days, you must apply for coverage for the child and pay any required premium. When you enroll, you ll be required to indicate which dependent is receiving coverage. In addition, to be eligible for coverage, when you enroll you ll be required to attest to meeting certain additional eligibility requirements, including but not limited to: That you re actively at work. The person to be insured has comprehensive health benefits from an insurance policy, an HMO plan, or an employer s health benefits. You do not have to be enrolled in Chevron health coverage. This means you can have comprehensive health coverage from another source. how it works The Group Hospital Indemnity Insurance plan pays you, unless otherwise assigned, a cash benefit (Hospital Admission) when you or a covered dependent are admitted as an inpatient for a covered injury or illness, including pregnancy. It then pays additional benefits each day you are confined, as well as for time spent in an intensive care unit (Hospital Confinement, Hospital Intensive Care Unit, and Intermediate Intensive Care Step-Down Unit). To review a complete list of covered injuries or illnesses and the corresponding schedule of benefit payments, see the Certificate of Insurance available on hr2.chevron.com or by contacting Mercer. If you or a covered dependent are admitted as an inpatient for a covered injury or illness, submit a claim for benefits directly to Aflac. Most claims are processed in about four days. Because you receive cash benefits directly, unless otherwise assigned, you have the flexibility to use the money any way that s best for you, even for day-to-day expenses such as mortgage or rent. Benefits are paid to you unless you choose otherwise. There is no coordination with other insurance. benefit amount There are two different levels of coverage you can purchase, Hospital Indemnity High and Hospital Indemnity Low. For complete eligibility rules and details, see the Certificate of Insurance available on hr2.chevron.com or by contacting Mercer. 2017 Hospital Indemnity Low Hospital Admission: $1,500 per confinement, once per covered injury or illness per calendar year for each insured. Hospital Confinement: $150 per day, maximum of 31 days per confinement for each covered injury or illness for each insured. Hospital Intensive Care Unit: $150 per day, maximum of 10 days per confinement for each covered injury or illness for each insured. Intermediate Intensive Care Step-Down Unit: $75 per day, maximum of 10 days per confinement for each covered injury or illness for each insured. U.S. Pay and Benefit News 52
2017 Hospital Indemnity High Hospital Admission: $2,000 per confinement, once per covered injury or illness per calendar year for each insured. Hospital Confinement: $300 per day, maximum of 31 days per confinement for each covered injury or illness for each insured. Hospital Intensive Care Unit: $300 per day, maximum of 10 days per confinement for each covered injury or illness for each insured. Intermediate Intensive Care Step-Down Unit: $150 per day, maximum of 10 days per confinement for each covered injury or illness for each insured. when coverage begins If you enroll during open enrollment, coverage will begin on January 1 of the following year. If you enroll within 31 days of hire or rehire, coverage will begin on the first of the month following enrollment. If you enroll within 31 days of qualifying life event, coverage will begin on the first of the month following enrollment. The Group Hospital Indemnity Insurance plan doesn t have a waiting period for benefits. proof of good health You and covered dependents will not have to answer medical questions or otherwise prove you are in good health if you enroll during Chevron open enrollment, October 17 through October 28, 2016 or within 31 days of hire or rehire or within 31 days of a qualifying life event. The Group Hospital Indemnity Insurance plan doesn t have any pre-existing condition limitations. how you pay for coverage This voluntary coverage is paid entirely by you through after-tax payroll deductions; Chevron does not contribute. You can view premiums online, when you enroll, or you can call the Chevron HR Service Center. If you enroll, your Group Hospital Indemnity Insurance premium is automatically taken through after-tax payroll deductions in 24 equal payments, regardless of your pay frequency. when coverage ends You are not required to re-enroll to continue coverage each year. Participation will end when any of the following occurs: On the date the Group Hospital Indemnity Insurance plan offering is terminated. If an insured s coverage terminates, Aflac will provide benefits for valid claims that were incurred while coverage was active. For further details, see the Certificate of Insurance available on hr2.chevron.com or by contacting Mercer. when you can change coverage You can enroll, discontinue, or change coverage: Within 31 days of a qualifying life event. During Chevron s open enrollment period. when you leave chevron Group Hospital Indemnity Insurance is not eligible for continuation through COBRA if you leave Chevron. Coverage is portable (with certain stipulations). That means you can take it with you, if you change jobs or retire. It s your responsibility to contact Aflac within 31 days of leaving Chevron to move to direct bill. Your premiums may change, and you ll pay Aflac directly for coverage. Aflac will provide written notice at least 31 days before any change is to take effect. how to enroll or ask questions This benefit is insured by Aflac and administered by Mercer Voluntary Benefits. Contact Mercer for information about plan coverage, how the plan works or for payroll deduction inquiries. 1-800-274-4833, 8 a.m. to 7 p.m. Central time, Monday through Friday beginning October 17, 2016. You can also read the Certificate of Insurance for this plan on hr2.chevron.com or request a copy from Aflac. To enroll or change coverage, contact the Chevron HR Service Center. Please note, the HR Service Center is unable to answer questions about this coverage; please contact Mercer at the number above for that information. Benefits Connection website available from hr2.chevron.com 1-888-825-5247 (610-669-8595 outside the U.S.) * *The Aflac coverage described here is subject to plan limitations, exclusions, definitions, and provisions. For detailed information, please see the plan brochures, as this material is intended to provide general summaries of the coverage. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. For groups sitused in California, group coverage is underwritten by Continental American Life Insurance Company. On the date an insured cancels plan coverage or stops making required plan contributions. On the date an insured no longer meets the plan eligibility requirements and is therefore no longer eligible for coverage under the plan. September 2016 53
Human Energy. Yours. TM Update to the Summary Plan Description Effective January 1, 2017 All changes described in this SMM are effective January 1, 2017 unless otherwise indicated. This enclosed newsletter serves as an official summary of material modification (SMM) for the plans referenced herein. Please keep this information with your other plan documents for future reference. This communication provides only certain highlights about changes of benefit provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will prevail to the extent permitted by law. There are no vested rights with respect to Chevron health care plans or any company contributions towards the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to unionrepresented employees. You can access the summary plan descriptions for your benefits on the Internet at hr2.chevron.com or by calling the HR Service Center at 1-888-825-5247 (610-669-8595 if you re outside the U.S.), option 2. This SMM applies to the following summary plan description: January 1, 2017 Group Hospital Indemnity Insurance January 1, 2017
Updates to this Plan Since the printing of the September 2016 U.S. Pay and Benefits newsletter, Prepare to Make Choices 2017 Benefit Changes, several updates regarding this plan have surfaced. Information about the changes are included here, but were also previously provided directly to Group Hospital Indemnity Insurance participants. When Payroll Deductions Begin If you enroll during open enrollment. Your Group Hospital Indemnity Insurance coverage begins on January 1 of the new year. However, due to administrative processes surrounding enrollment and payroll deduction setup, payroll deductions for Group Hospital Indemnity Insurance coverage will occur on your first paycheck in February. The first payroll deduction will be your normal coverage cost; no retroactive deductions for the month of January will be taken. If you enroll mid-year. If you enroll mid-year within 31-days of a qualifying life event or your hire date, your Group Hospital Indemnity Insurance coverage begins on the first of month following the date your enrollment election is made. Your first payroll deduction for Group Hospital Indemnity Insurance coverage will occur on in the month following the date your coverage begins. The first payroll deduction will be your normal coverage cost; no retroactive deductions to your coverage start date will be taken. For example: Enrollment election is made on February 10. Date coverage begins is March 1. First payroll deduction will occur in April. Other Dependents are not Eligible for Coverage The Group Hospital Indemnity Insurance as currently underwritten does not include other dependents in the definition of an eligible dependent. Please note that this eligibility restriction does not apply to Chevron s other health and welfare benefit plans which currently continue to provide access to coverage for other dependents. An other dependent is defined as a dependent who meets all of the following: Not married. Younger than age 26. Is a member of your household. Someone for whom you act as a guardian. Dependent on you (or on your spouse/domestic partner) for more than 50 percent of his or her financial support. Updated Eligibility Attestation To be eligible for coverage, when you enroll you ll be required to attest to meeting certain additional eligibility requirements, including but not limited to: You are actively at work for Chevron at the time of enrollment. The person(s) to be insured has comprehensive health benefits from an insurance policy, an HMO plan, or an employer s health benefits. You do not have to be enrolled in Chevron health coverage. This means you can have comprehensive health coverage from another source. California law prohibits an HIV test from being required or used by health insurance companies as a condition for obtaining health insurance coverage. January 1, 2017
January 1, 2017