2015/2016 benefits enrollment guide
Transcription
2015/2016 benefits enrollment guide
IBEW LOCAL UNION 716 ELECTRICAL MEDICAL TRUST 2015/2016 BENEFITS ENROLLMENT GUIDE ELIGIBILITY AND ENROLLMENT Initial Eligibility ▪ 375 hours during a period of 3 consecutive months, eligible for benefits the 1st day of the 2nd calendar month following that 3-month period; or ▪ Total of at least 500 hours are contributed during a period of 6 consecutive months, eligible 1st day of the 2nd calendar month following that 6month period. ▪ You and your eligible dependents will become initially eligible on the 1st day of the 2nd month following any 3 consecutive calendar months in which you have worked at least 375 hours for Contributing Employers. ▪ You must enroll your dependents or they will lose their eligibility to participate in the health plan. Maintenance of Eligibility Reserve Account (Hour Bank) – hours worked in excess of 140 per month will be credited to the Reserve Account with a maximum of 560 Reserve hours. Monthly Deductions from Reserve Account 140 hours are deducted from the Active Member’s Reserve Account for each month of coverage. A lag month will be used in determining continuing eligibility, i.e., June hours are worked for August eligibility. Termination for Active Members ▪ Last day of the month member has less than 140 hours in Reserve Account ▪ 31st day Collective Bargaining Agreement no longer provides continued remittance of employer contributions Reinstatement Member must post 140 hours within a 6-month period immediately following such termination. Reinstatement will take place on the 1st day of the month following the month requirement is met. If Reserve Account does not show 140 hours within such 6-month period all hours will be forfeited unless coverage is continued through selfpayment. Once a Reserve Account has been forfeited for this reason Active Member will have to meet the Initial Eligibility requirements again. Continuation During Total Disability With prior approval total disability continuing for 30 days or more will not have any hours deducted from the Member’s Reserve Account from the 1st day of the month disability commences. Coverage will be continued up to 3 consecutive months. After that 3 month period the Reserve Account will be used. Once the Reserve Account is depleted, the Member may then continue coverage through self-pay provisions. Eligibility for Dependents Your lawful spouse and eligible children up to age 26. Non-Bargaining Employees Employer must contribute 173 hours per month for each Non–Bargaining Employee. Non-Bargaining Employees Loss of Eligibility for Insufficient Hours Once a Non-Bargaining Employee loses eligibility due to a reduction or insufficient hours, coverage may be continued through the self-pay provisions of COBRA. Enrollment for the Newly Eligible: ▪ You will need Social Security Number and Date of Birth for all covered family members. ▪ You should confirm your health care providers participate in the insurance plan before making an appointment. ▪ You will receive a detailed benefit booklet and ID card at your home after you have enrolled. ▪ If you have become eligible for the first time and are enrolling in the medical plan, you may be asked to send a HIPAA Certificate of Creditable Coverage to Cigna from your prior insurance carrier. The plan may impose a pre-existing condition limitation if there is more than a 63day gap from your prior carrier or if you have not had coverage previously for 12 consecutive months. ▪ Member will automatically receive the option to choose between any of the 2 lower deductible plans highlighted in red until they are given the opportunity to participate in the wellness program. Members who completed both the biometric screening as well as the Health Assessment during the Spring of 2015 will receive the option to choose between any of the 2 plans marked "Wellness Participant." Those who did not complete both portions will choose between the plans listed as "Non-Wellness Participant. Any newly eligible member who does not make their plan election will be automatically placed into the “Kelsey Care HMO” plan based on their wellness participation. *At time of hire, or if you are already employed, please notify your employer of your plan election.* 2 MEDICAL GROUP #3335042 800-CIGNA24 WWW.MYCIGNA.COM Those who participated in and completed the Health Assessment and biometric screening are eligible to elect one of the two enhanced benefit options, indicated as “Wellness Participant” plans. Those who did not complete both portions may select from the “Non-Wellness Participant” plans. Lifetime Maximum Annual Deductible Individual Family Out of Pocket Maximum Individual Family Hospital Services Inpatient Outpatient Emergency Room Physician Services Primary Care Physician Specialist Urgent Care Diagnostic X-Ray & Lab Physician’s Office Facility Maternity Initial OB visit Hospital, OB visits Wellness Participant Non-Wellness Participant KELSEY HMO - $500 DED KELSEY HMO - $750 DED coverage is effective 8/1/2015 coverage is effective 8/1/2015 In Network In Network Unlimited Unlimited $500 $1,500 $750 $2,250 $5,000 $10,000 $5,000 $10,000 90% after deductible 90% after deductible 90% after deductible 90% after deductible $150 copay $200 copay $25 copay $35 copay $50 copay $25 copay $35 copay $75 copay No charge 100% No charge 100% $35 copay 90% after deductible $35 copay 90% after deductible Therapy Services Speech, Physical, Occupational - 60 visit limit combined; Primary Care Physician $25 copay Specialist $35 copay Chiropractic - 20 visit limit $35 copay Mental Health and Chemical Dependency Inpatient 90% after deductible - unlimited visits Outpatient $35 copay - unlimited visits Participating Pharmacies Only Prescription Drugs $15 Generic Drugs Brand Name $35 Non-Formulary $55 1.5x applicable copay Mail Order Pharmacy Out of Pocket Maximum Individual $1,350 Family $2,700 Eye Exam $35 copay* 1 per calendar year Hearing Test $35 copay 1 per calendar year * Routine eye exams available through Cigna providers - see www.cigna.com. No referral needed. $25 copay $35 copay $35 copay 90% after deductible - unlimited visits $35 copay - unlimited visits Participating Pharmacies Only $20 $40 $70 1.5x applicable copay $1,350 $2,700 $35 copay $35 copay This is a partial comparison of plan benefits. Refer to the Master Contract/Summary Plan Description for plan details. 3 MEDICAL GROUP #3335042 1-800-CIGNA24 WWW.MYCIGNA.COM Those who participated in and completed the Health Assessment and biometric screening are eligible to elect one of the two enhanced benefit options, indicated as “Wellness Participant” plans. Those who did not complete both portions may select from the “Non-Wellness Participant” plans. Wellness Participant Non-Wellness Participant CIGNA OAP - $750 DED CIGNA OAP - $1,250 DED coverage is effective 08/01/2015 coverage is effective 08/01/2015 In Network Lifetime Maximum Annual Deductible Individual Family Out of Pocket Maximum Individual Family Hospital Services Inpatient Outpatient Emergency Room Physician Services Primary Care Physician Specialist Urgent Care Diagnostic X-Ray & Lab Physician’s Office Facility Maternity Initial OB visit Hospital, OB visits Therapy Services Speech, Physical, Occupational60 visit limit combined; Chiropractic - 20 visit limit Mental Health and Chemical Dependency Inpatient Outpatient Prescription Drugs Generic Drugs Brand Name Non-Formulary Mail Order Pharmacy Out of Pocket Maximum Individual Family Eye Exam 1 per calendar year Hearing Test 1 per calendar year Out of Network In Network Unlimited Out of Network Unlimited $750 $2,250 $2,000 $6,000 $1,250 $3,750 $3,000 $9,000 $5,000 $10,000 $10,000 $20,000 $5,000 $10,000 $10,000 $20,000 75% after deductible 50% after deductible 75% after deductible 50% after deductible $150 copay 75% after deductible 50% after deductible 75% after deductible 50% after deductible $200 copay $35 copay $45 copay 50% after deductible 50% after deductible $50 copay $45 copay $55 copay 50% after deductible 50% after deductible $75 copay OV copay 100% 50% after deductible 50% after deductible OV copay 100% 50% after deductible 50% after deductible $45 copay 75% after deductible 50% after deductible 50% after deductible $55 copay 75% after deductible 50% after deductible 50% after deductible 75% after deductible 50% after deductible 75% after deductible 50% after deductible $45 copay 50% after deductible $55 copay 50% after deductible 75% after deductible 50% after deductible unlimited visits unlimited visits $45 copay 50% after deductible unlimited visits unlimited visits Participating Pharmacies Only $15 $35 $55 1.5x applicable copay 75% after deductible 50% after deductible unlimited visits unlimited visits $55 copay 50% after deductible unlimited visits unlimited visits Participating Pharmacies Only $20 $40 $70 1.5x applicable copay $1,350 $2,700 $45 copay $1,350 $2,700 50% after deductible $1,350 $2,700 $55 copay $1,350 $2,700 50% after deductible $45 copay 50% after deductible $55 copay 50% after deductible This is a partial comparison of plan benefits. Refer to the Master Contract/Summary Plan Description for plan details. 4 HAVE YOU MET BEN-IQ? Inside the Ben-IQ™ app 24/7 access to your health plan highlights Store and organize your plan ID cards Nurse line numbers an helpful contact information Cost of care info at your fingertips Get Ben-IQ today! Download the free app with your Android or iPhone. Enter this username: EMT IBEW 716 Read the Terms and Conditions, then tap the Sign In button. PUT BEN-IQ TO WORK FOR YOU. SMARTER IS BETTER. 5 6 7 8 9 10 11 USE YOUR CIGNA ID CARD FOR DISCOUNTS ON SERVICES AND PRODUCTS 24/7 Hour Customer Service We have extended Customer Service hours to include Weekdays, Saturdays, Sundays and holidays, 24 hours a day, 7 days a week. Convenience Care Clinics When you need treatment for common ailments and injuries, you have more choices. Open 7 days a week with evening weekday hours, the clinics offer convenient, professional walk-in care for common ailments. You can get highquality, affordable services for a wide variety of routine medical conditions through Convenience Care Clinics located throughout the country. You can find locations near you by going to myCIGNA.com or calling the number on your ID card. 24 Hour Health Information Line – Call a nurse anytime. Day or Night. The 24 hr Health information line assists individuals in understanding the right level of treatment at the right time. Trained nurses are available 24 hours a day, 7 days a week, 365 days a year to provide health and medical information and direction to the most appropriate resource for you. Just call the number on your ID card. CIGNA Healthy Rewards® Member Discounts Just Walk 10,000 Steps-A-Day Walking Program 8-week online program allows you to log your daily steps, track your progress and receive coaching tips and fun facts. Members receive pedometer and related materials ($23.95). Option to extend online program by purchasing the 52-week step-up maintenance program. Weight Management Discount Programs On-line, at home, telephone-based & traditional meeting options Fitness Club Memberships American Specialty Health Networks and ChooseHealthy provide access to over 15,000 fitness clubs, including Yoga and Pilates studios Tobacco Cessation Discounts Telephonic based Employee-pay cessation program. Other discounts through drugstore.com, Eyeglasses & Contacts Reduced rates at over 15,000 participating retailers and providers. Discounts on eyeglasses, contact lenses, prescription sunglasses and vision exams. Complementary & Alternative Medicine Reduced rates from over 22,000 participating providers including chiropractics, acupuncturists, massage therapists & registered dieticians. Health & Wellness Products 5% off every order at drugstore.com, including weight management scales and blood pressure monitors. And the ChooseHealthy Store offers discounts on vitamins & supplements, herbal products, dental products, homeopathic remedies, natural products, diet & sports nutrition, yoga & fitness activities, personal body care, books, audio, video & DVDs. Laser Vision Correction (LASIK) Reduced rates at over 240 participating facilities 12 RETIREE MEDICAL Retiree Rates: Please call the Trust Office at 713-869-8900 for information regarding retiree rates. SHORT TERM DISABILITY COVERAGE 877-672-1648 WWW.AGEMPLOYEEBENEFITS.COM Once you have met your initial eligibility requirements you will automatically be enrolled in the Short Term Disability program. In order to maintain your coverage under the Short Term Disability program, all members must work 140 hours or more per month. After being totally disabled for 7 days due to a non-work related covered accident or sickness, and if your disability is approved by the insurance company, you will be eligible to receive a weekly benefit of up to $250, (not to exceed 70% of weekly salary). This benefit could last for up to 26 weeks as long as you continue to meet the definition of disabled. The benefit reduces to 50% at age 70. You may be considered totally disabled if you are unable to perform each of your main duties of your occupation. If you are unable to perform one or more of your main full-time duties, you may be eligible for a partial disability benefit. Short Term Disability is not available to Retirees. Disability Claims Address: Disability Claims Phone: AG Benefit Solutions Connecticut Claims Center P.O. Box 387 Farmington, CT 26034 888-762-2250 13 New Health Insurance Marketplace Coverage Options and Your Health Coverage Form Approved OMB No. 1210-0149 (expires 1-31-2017) PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employmentbased health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact . The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs cove red by the plan is no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986) 14 PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. Employer Name Electrical Medical Trust Local 716 Employer Address 1475 North Loop West City Houston Who can we contact about employee health coverage at this job? Benefit Resources, Inc. Phone number (if different from above) (713) 643-9300 Employer Identification Number (EIN) 74-1621269 Employer phone number State TX ZIP Code 77008 Email address Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to: All employees. Eligible employees are: x Some employees. Eligible employees are: Have worked 375 hours during 3 consecutive months are eligible for benefits the 1 st day of the 2nd calendar month following that 3 month period. OR If at least 500 hours are contributed during a period of 6 consecutive months, they are eligible the 1st day of the 2nd calendar month following that 6 month period. With respect to dependents: x We do offer coverage. Eligible dependents are: Your lawful spouse and eligible children to age 26. We do not offer coverage. x If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums. The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers, but will help ensure employees understand their coverage choices. 11. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in the next 3 months? Yes (Continue) 13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the employee eligible for coverage? __________________ (mm/dd/yyyy) (Continue) No (STOP and return this form to employee) 12 Does the employer offer a health plan that meets the minimum value standard*? Yes (Go to question 13) No (STOP and return form to employee) For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don’t include family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/she received the maximum discount for any tobacco cessation programs, and didn’t receive any other discounts based on wellness programs. How much would the employee have to pay in premiums for this plan? $_____________________ How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don't know, STOP and return form to employee. 14. What change will the employer make for the new plan year? _____________ Employer won't offer health coverage Employer will start offering health coverage to employees or change the premium for the lowest-cost plan available only to the employee that meets the minimum value standard.* (Premium should reflect the discount for wellness programs. See question 15.) a. How much would the employee have to pay in premiums for this plan? $ ___________ b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly 15 MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the following page, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 877KIDS NOW or insurekidsnow.gov to find out how to apply. If you qualify, ask your State if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at askebsa.dol.gov or call 866-444-EBSA (3272). If you live in one of the States listed on the following page, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2015. Contact your State for more information on eligibility. To see if any other States have added a premium assistance program since January 31, 2015, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services dol.gov/ebsa cms.hhs.gov 866-444-EBSA (3272) 877-267-2323, Menu Option 4, Ext. 61565 16 ALABAMA – Medicaid Website: www.myalhipp.com Phone: 1-855-692-5447 ALASKA – Medicaid Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529 COLORADO – Medicaid Medicaid Website: http://www.colorado.gov/hcpf Medicaid Customer Contact Center: 1-800-221-3943 FLORIDA – Medicaid Website: https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268 GEORGIA – Medicaid Website: http://dch.georgia.gov/ Click on Programs > Medicaid > Health Insurance Premium Payment (HIPP) Phone: 1-800-869-1150 INDIANA – Medicaid Website: http://www.in.gov/fssa Phone: 1-800-889-9949 IOWA – Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 KANSAS – Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884 KENTUCKY – Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUISIANA – Medicaid Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447 MAINE – Medicaid Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741 MASSACHUSETTS – Medicaid and CHIP Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120 NEW JERSEY – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK – Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA – Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-800-755-2604 OKLAHOMA – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON – Medicaid Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075 PENNSYLVANIA – Medicaid Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462 RHODE ISLAND – Medicaid Website: www.ohhs.ri.gov Phone: 401-462-5300 SOUTH CAROLINA – Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS – Medicaid Website: https://www.gethipptexas.com/ Phone: 1-800-440-0493 UTAH – Medicaid and CHIP Medicaid: http://health.utah.gov/medicaid CHIP: http://health.utah.gov/chip Phone: 1-866-435-7414 VERMONT– Medicaid Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427 MINNESOTA – Medicaid Website: http://www.dhs.state.mn.us/id_006254 Click on Health Care > Medical Assistance Phone: 1-800-657-3739 MISSOURI – Medicaid VIRGINIA – Medicaid and CHIP Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Phone: 573-751-2005 Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282 MONTANA – Medicaid WASHINGTON – Medicaid Website: http://medicaid.mt.gov/member Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/ index.aspx Phone: 1-800-694-3084 Phone: 1-800-562-3022 ext. 15473 NEBRASKA – Medicaid WEST VIRGINIA – Medicaid Website: www.ACCESSNebraska.ne.gov Website: www.dhhr.wv.gov/bms/ Phone: 1-855-632-7633 Phone: 1-877-598-5820, HMS Third Party Liability NEVADA – Medicaid WISCONSIN – Medicaid and CHIP Medicaid Website: http://dwss.nv.gov/ Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Medicaid Phone: 1-800-992-0900 Phone: 1-800-362-3002 NEW HAMPSHIRE – Medicaid WYOMING – Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Website: http://health.wyo.gov/healthcarefin/equalitycare Phone: 603-271-5218 Phone: 307-777-7531 effective: January 31, 2015 17 Important Notice from Electrical Medical Trust About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Electrical Medical Trust and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Electrical Medical Trust has determined that the prescription drug coverage offered by the Express Scripts Pharmacy Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. ______________________________________________________________________________ When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your Electrical Medical Trust coverage will not be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan. Since the existing prescription drug coverage under Express Scripts Pharmacy Plan is creditable (e.g. as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage. If you do decide to join a Medicare drug plan and drop your Electrical Medical Trust prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. 18 When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Electrical Medical Trust and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Electrical Medical Trust changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: Name of Entity/Sender: Contact--Position/Office: Address: Phone Number: 08/01/2015 Electrical Medical Trust Local 716 Cory Crandell – Benefit Resources, Inc. 8441 Gulf Freeway, Suite 304, Houston, TX 77017 (713) 643-9300 19 NOTICES Women’s Health and Cancer Rights Act Notice 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 this plan. Therefore, the following deductibles and coinsurance apply. Continuation Required by Federal Law for You and Your Dependents The Continuation Required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your Dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than for gross misconduct). Federal law also enables your Dependents to continue health insurance if their coverage ceases due to your death, divorce or legal separation, or with respect to a Dependent child, failure to continue to qualify as a Dependent. Continuation must be elected in accordance with the rules of your Employer’s group health plan(s) and is subject to federal law, regulations and interpretations. Newborns’ and Mothers’ Health Protection Act Notice 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). If you would like more information on maternity benefits, call your plan administrator. Health Insurance Portability and Accountability Act (HIPAA) IBEW Union 716 Electrical Medical Trust, in accordance with HIPAA, protects your Protected Health Information (PHI). IBEW Union 716 Electrical Medical Trust will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides you your medical, dental, and vision benefits or as mandated by law. A copy of the IBEW Union 716 Electrical Medical Trust Notice of Privacy Practices is available upon request in the Human Resources department. Summary of Material Modification (SMM) This enrollment guide constitutes a Summary of Material Modifications (SMM) to the Electrical Medical Trust Health & Welfare Fund 2015-2016 summary plan description (SPD). It is meant to supplement and/or replace certain information in the SPD, so retain it for future reference along with your SPD. Please share these materials with your covered family members. This brochure summarizes the health care and income protection benefits that are available to IBEW Union 716 Electrical Medical Trust members and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through the Human Re sources Department. Information provided in this brochure is not a guarantee of benefits. © 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861 Rev. 7-15-15 Alliant Insurance Services