WILLCARE BENEFITS OVERVIEW GUIDE

2015-2016
Plan Year
WILLCARE
BENEFITS OVERVIEW GUIDE
Benefit Outlines shown are for illustration purposes only.
This is intended for information and your convenience only
and is not to be construed as a Summary Plan Description.
The information in this package is not a complete list of
features of limitations or exclusions. If there is any
discrepancy between the information in the Summary Plan
Description and this, the Summary Plan Description shall
prevail. You may request a Summary Plan Description
from our Corporate Human Resources department at 716856-7500.
Rev. January 2015 (POS)
INTRODUCTION
As part of the WILLCARE family of companies, full time and part time employees are eligible to participate in our
excellent benefit programs.
At WILLCARE, we know that your employee benefits are important to you. Our goal is to offer a package that
will mark us as an "employer of choice" and affirm to each of you your value as an employee with our company. It
is our goal to be competitive in our industry and local business marketplace. We are confident in our choices and in
our commitment to you that we will continue to provide the level and types of benefits you request. As we build our
company in scope and profitability, we are committed to building our benefit packages for you.
We strive to offer the best possible value and the lowest reasonable cost. When you are covered by a WILLCARE
health plan, you and WILLCARE share the cost of health care. The amount you pay includes your payroll
contributions and any coinsurance, copayments or deductibles that the plan you choose requires. In order to keep
costs down, both you and WILLCARE need to be wise consumers of health care. WILLCARE’S premiums continue
to increase each year, and we have made, and will continue to make, every attempt to keep your costs as low as
possible.
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This booklet is designed to briefly describe the benefits, the costs, and the options of each plan.
Details of the benefits are available through the Enrollment Packets from the individual providers of
benefits.
Enrollment brochures are available in your branch HR office.
We encourage you to read the complete details prior to making your benefit election decisions.
Please feel free to ask for assistance in your HR office when filling out any forms. Our goal is to help you know,
understand, and participate in WILLCARE's benefit plans.
Please use care in determining your family's needs in electing to participate in the medical plan since you will
be unable to make changes or enroll until the next Open Enrollment period, which occurs in February of
every calendar year. EXCEPTION: IF you experience a "change in life" status, (a divorce, an adoption or birth, a
loss of your current health insurance through the loss of your spouse's job if you are covered under that plan), you
would be eligible to enroll outside of the Open Enrollment period. Notify your HR office immediately for assistance.
Rev. January 2015
2
ELIGIBILITY REQUIREMENTS
The chart below outlines eligibility requirements that must be met in order to participate in certain benefits.
Eligibility requirements vary by coverage.
Benefit
Eligibility Requirements
Eligibility Date
Medical Insurance
Dental Insurance
Vision Insurance
Supplemental Short Term Disability Ins
Full Time or Part Time
(min 20 hours week)
Critical Illness Insurance
1st of the month following
30 days of Full Time /
Part Time employment
Accident Insurance
Health Savings Account (HSA)
Flexible Spending Account (FSA)
Life and AD&D Insurance
Supplemental Life and AD&D Insurance
Full Time
(40 hours week)
Employee Assistance Plan (EAP)
1 year of Full Time
employment
Tuition Assistance Plan
Full Time or Part Time
(min 20 hours week)
1 year of Full or Part
Time employment
401k Retirement Plan
See pages 17 & 18
1st calendar quarter
following 90 days of
employment
Paid Time Off (PTO)
Full Time or Part Time
(min 20 hours week)
Continuing Education Unit Reimbursement
90 days of Full Time /
Part Time employment
30 days of Full Time /
Part Time employment
Holidays / Bereavement / Jury Duty
Rev. January 2015
3
MEDICAL INSURANCE
WILLCARE offers a comprehensive health insurance plan in each of the regions we operate in. We are pleased to
announce that we make a fairly large contribution to the cost of your health care premiums. Below are the four plan
options that are available to you through Blue Cross Blue Shield (BCBS). All four of these options cover
dependents up to age 26.
The plan options that are available to you are as follows:
1) Co-Pay Option
This type of plan design allows for the member to pay a designated co-pay for services. For example, a
Physician’s Office visit is generally a specific dollar amount, and the plan pays for the rest of the cost.
Employees enrolled in this option may NOT enroll in an HSA, however, they may enroll in an FSA.
2) Hybrid Plan Option
This type of plan design allows the member to pay a designated co-pay for some services, but then pay a
deductible for other services. For example, a Physician’s Office visit would require a specific co-pay, but a
hospitalization will require the member to pay the full cost of the visit, up to the deductible. Employees
enrolled in this option may NOT enroll in an HSA, however, they may enroll in an FSA.
3) High Deductible Plan Option (HDHP)
A health insurance plan that has a high minimum deductible, which does not cover the initial costs or all of
the costs of medical expenses. The deductible forces the insurance holder to pay the first portion of a
medical expense before the insurance coverage kicks in. The term "high deductible health plan" is almost
always used in the context of health savings accounts (HSAs). HSAs are a special kind of tax-advantaged
savings account used to accumulate funds for medical expenses (see below).
a. Health Savings Account (HSA) (only to be used in conjunction with a HDHP)
An HSA is a tax-advantaged medical savings account available only to participants who are enrolled in a
High Deductible Health Plan (HDHP). The funds contributed to the account are taken via payroll
deduction, and are not subject to federal income tax at the time of deposit. Unlike a flexible spending
account (FSA), funds roll over and accumulate year over year if not spent. HSAs are owned by the
individual. Funds may only be used to pay for qualified medical expenses such as co-pays and
deductibles. If you enroll in the HDHP, you cannot enroll in an FSA plan. The maximum HSA
contributions for 2015 are $3,350for a single plan and $6,650for a family plan. If you are over age 55,
you can contribute an additional $1,000 for 2015.
Below are some helpful definitions that may be used in the summary of benefits listed on the next page.
Co-Pays:
This is a flat dollar amount that a health plan member has to pay for specific health services, such as visits to a
physician.
Deductible:
The amount the health plan member must pay for covered services before BCBS will assume liability for all or part of the
remaining costs for covered services.
Co-Insurance:
The portion of the cost for covered services which is the responsibility of the subscriber. In the case of the High
Deductible Option benefit that we offer, BCBS will pay 80% and the subscriber is responsible for 20% of the
allowance for any given service. This arrangement is after any applicable deductible amount is met.
Out-of-Pocket Maximums:
The total amount you must pay before your benefits are paid at 100%.
Rev. January 2015
4
HEALTH INSURANCE
Below is a brief summary of the benefits offered through Blue Cross Blue Shield. For a more in-depth list of
coverage, please refer to a Blue Cross Blue Shield enrollment book available in your office.
BCBS
Co-Pay Option
BCBS
Hybrid Option
BCBS
HDHP Option #1
BCBS
HDHP Option #2
In-Network Benefits*
In-Network Benefits*
In-Network Benefits*
In-Network Benefits*
DEDUCTIBLE
N/A
$500 Individual / $1,000
Family
$1,500 Individual / $3,000
Family
$5,000 Individual /
$10,000 Family
CO-INSURANCE
N/A
20%
20%
20%
OUT-OF-POCKET
MAXIMUM
N/A
$1,000 Individual / $2,000
Family
$3,000 Individual / $6,000
Family
$6,350 Individual /
$12,700 Family
Preventative PCP Visit
(eg. Annual Physical)
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Primary Care Physician
(PCP) Visit
$30 co-pay
$30 co-pay
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
Well Baby / Child Visits
(up to age 19)
Covered in Full
Covered in Full
Covered in Full
Covered in Full
$50 co-pay
$30 co-pay
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
$10 / $30 / $50
$10 / $30 / $50
subject to deductible,
then: $10 / $30 / $50
subject to deductible,
then: $10 / 50% / 50%
$500
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
$100 co-pay
$100 co-pay, after
deductible is paid
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
$100 co-pay
$100 co-pay, after
deductible is paid
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
$100 co-pay
N/A
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
$35 co-pay
$30 co-pay
covered at 80%, after
deductible is paid
covered at 80%, after
deductible is paid
SERVICES
PHYSICIAN SERVICES
Specialist Visit
PRESCRIPTIONS
HOSPITALIZATION
EMERGENCY SERVICES
Emergency Room /
Ambulance
Ambulance – Ground
Ambulance – Air
Urgent Care Centers
*Please refer to full benefit summary for out-out-network benefits.
Rev. January 2015
5
DENTAL INSURANCE
WILLCARE offers the Guardian Dental Plan to all eligible employees. We believe this is one of the best dental
plans available, and we are very pleased to present it to you.
The Guardian plan gives you the ability to select any dentist you wish. There is one low deductible. The
deductible is waived for preventative services, up to 3 individual deductibles per family. If you are anticipating any
work that will exceed $300, you need to have your dentist submit a Pre-Determination of Benefits prior to the start
of any procedure.
Out-of-Network dental service coverage and payments are based on the Usual, Customary and Reasonable fees in a
geographic area. If your Out-of-Network dentist's fees are higher than the UCR, the plan will pay benefits based on
the UCR and you will be responsible for any amount above that limit. In some cases it will result in your paying
higher than the indicated co-payment.
In-Network dentist’s fees are based on a reduced fee schedule. Guardian allows you to select a dentist IN or OUT of
the Guardian Network of participating providers. Maximum benefit is achieved by choosing to get your care IN the
network.
Employees who do not participate in the medical insurance plans are eligible to receive a large portion of the
company’s contribution towards their dental. This is not an option, however, IF YOU ARE COVERED BY
ANOTHER PRIMARY DENTAL PLAN.
Policy Options
Calendar Year Deductible / Per person/family
Annual Maximum /per person
Children Covered up to age
Special Limitations: Replacement of teeth lost or missing before a covered
person becomes insured by this plan UNLESS loss occurred during prior dental
plan coverage.
Preventative Services:
Emergency Palliative Treatments
Oral Examination / Teeth Cleaning every 6 months
X-rays: 4 bitewings every 12 months
Full mouth series every 5 years
Fluoride Treatments for Children: every 6 months under age 14
Space Maintainers for Children: under 16
Topical Sealants for unrestored molars:
1 treatment for child(ren) under 16 w/i a3 year period.
Basic Services
Laboratory Test
Periodontics: Gum Disease
Diagnostic Consult: 1 per year
Fillings: Amalgam, Silicate & Acrylic
Oral Surgery – extractions
Root Canal Therapy
Repair of Dentures, Crowns & Bridges
Gen. Anesthesia: surgical procedures only
Injectable Antibiotics - dental procedures
Major Services
Fillings: Porcelain
Bridges Install: fixed and removable
Dentures: Full & Partial
Inlays, On lays, Crowns & Posts
Orthodontics
Braces - $1,000 lifetime benefit for children under age 19
Rev. January 2015
6
In-Network
Out-of-Network
$50/$150
$1,000
20/26 if student
$50/$150
$1,000
20/26 if student
Not covered unless the dental
prosthesis also replaces an eligible
natural tooth lost after coverage
Not covered unless the dental
prosthesis also replaces an eligible
natural tooth lost after coverage
Percentages Paid
100%
Percentages Paid
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Percentages Paid
90%
90%
90%
90%
90%
90%
90%
90%
90%
Percentages Paid
60%
60%
60%
60%
Percentages Paid
50%
Percentages Paid
80%
80%
80%
80%
80%
80%
80%
80%
80%
Percentages Paid
50%
50%
50%
50%
Percentages Paid
50%
VISION
Vision coverage is provided by some of the health plans on a limited basis. Carefully review the comparisons in this
booklet.
WILLCARE also offers the Guardian Vision Plan to all eligible employees.
A benefit chart is printed below, which will provide you with a brief overview of the plan.
In-Network
Out-of-Network
EYE EXAMS
Frequency
12 months
Co-Pay
$10 co-pay
12 months
$46 maximum allowance
after $10 co-pay
LENSES
Frequency
12 months
Single
$20 co-pay
Bifocal
$20 co-pay
Trifocal
$20 co-pay
Lenticular
$20 co-pay
CONTACT LENSES (in lieu of complete set of glasses)
12 months
Frequency
Medically Necessary
Elective
FRAMES
Frequency
Co-Pay
MATERIALS
Co-Pay
Child Age limit
$20 co-pay
From formulary, $20 co-pay. Not
from formulary, $135 max (co-pay
waived)
24 months
$135 retail after $20 co-pay
$20
20 (26 FT Student)
12 months
$47 maximum allowance
after $20 co-pay
$66 maximum allowance
after $20 co-pay
$85 maximum allowance
after $20 co-pay
$125 maximum allowance
after $20 co-pay
12 months
$210 maximum allowance
after $20 co-pay
$105 max (co-pay waived)
24 months
$47 maximum allowance
after $20 co-pay
$20
20 (26 FT Student)
Plan limitations & Exclusions:
 Coverage is limited to those charges that are necessary to prevent, diagnose, and treat a vision condition.
 Eye examination or corrective eyewear required by an employer as a condition of employment.
 Lenses or frames furnished under this plan, which are lost or broken (except when services are otherwise
available).
 The plan does not pay for:
O Orthoptics or vision training and any associated supplemental testing.
O Medical or surgical treatment of the eye
 See Summary Plan Description for entire list of services, exclusions and limitations.
Rev. January 2015
7
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Your work-life balance is very important to us. It can be difficult to balance the demands of work with those of your
personal life. The WorkLifeMatters EAP is here to help. This program provides unlimited telephone consultations
with EAP Counselors, web-based tools and online information for you and anyone in your family who needs help.
Visit the website or call a counselor if you need help and information with issues such as:
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Childcare and/or eldercare referrals;
Personal relationship information;
Health information and online tools;
Legal consultations with licensed attorneys;
Financial planning assistance;
Stress management;
Career development
Counselors can help you work through your concerns and develop a plan to address your problems. Calls are
confidential*; no one will know you use this service unless you tell them. Our WorkLifeMatters EAP is the
comprehensive resource available to help you face life’s everyday challenges.
*The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the
counselor may be mandated to report a situation to the appropriate authority
LIFE / AD&D INSURANCE
No one likes to think about dying. The time to plan for such an event is now – while you’re healthy. WILLCARE
helps you and your family by providing a life insurance benefit of $20,000. This benefit is available to Full-time
Employees only.
100% of the premium for this Employer-Sponsored Benefit will be paid by WILLCARE.
Insurance Coverage is through Guardian. Group Plan Policy # 369895
Coverage starts the first day of the month following eligibility.
A word about AD & D Insurance: In addition, this insurance provides coverage called Accidental Death and
Dismemberment. If you die accidentally (some exclusions apply, see enrollment book for list), your family will
receive twice the face value of the death benefit, or $40,000. If you experience a loss of eye(s) or limb(s), there
would also be a full or partial payment to you dependent upon the extent of the loss.
Beneficiary: You must name your beneficiary in the on-line enrollment system--spouse, child, other relations,
friends, etc. It is important that this information be kept current as circumstances change. Notify your HR
Representative if a change is needed.
Rev. January 2015
8
SUPPLEMENTAL LIFE / AD&D INSURANCE
WILLCARE has offers Supplemental Life and AD&D Insurance to help protect you and your family against the
unexpected. Because WILLCARE offers Life and AD&D Insurance to Full-time employees without charge, this
gives you (the employee) the option to buy up more insurance for yourself AND it also gives you the option to
purchase coverage for your spouse and/or children. This is available through Guardian.
Employee Eligibility – Coverage can be purchased in increments of $10,000 to a maximum of $450,000. You
must be a Full-time employee to purchase Supplemental Life and AD&D Insurance.
Spousal/Domestic Partner Eligibility* – Coverage can be purchased in increments of $10,000 to a maximum
of $100,000. In order to elect the spousal benefit, you must be legally married or be able to provide proof of
domestic partnership. Spousal premium rates are on based on employee’s age.
Child Eligibility* – Coverage can be purchased in increments of $1,000 to a maximum of $4,000. In order to
be eligible, children must be unmarried and at least 2 weeks old but less than 20 years of age (or 26 years if a Fulltime student). Unmarried children over the age of 19 who are disabled may also be eligible if certain conditions are
met.
*Please Note: Spousal and Dependent coverage is only available to you when you elect coverage for yourself.
Guaranteed Issue Amount: The guaranteed issue amount is the amount of insurance that you may elect without
providing evidence of good health. Employees are only eligible for the guaranteed issue amount at hire. The
guaranteed issue amount is $150,000 for employees, $30,000 for spouses and $4,000 for dependent children. If
you elect these amounts or less, no medical information is required. If you do not enroll in this benefit at hire,
evidence of good health will be required for all coverage amounts you elect at Open Enrollment.
Supplemental Life and AD&D Rates:
Please see the Guardian Enrollment Kit for rates and biweekly premium calculations
Rev. January 2015
9
FLEXIBLE SPENDING ACCOUNT (FSA)*
A Flexible Spending Account provides a tax-advantaged way to pay for certain out-of-pocket health care expenses,
and work-related dependent care expenses. The money you put in these accounts is deducted from your earnings
prior to computing your taxes. This money is set aside in your account from which you will be reimbursed when
your have a qualifying expense. The plan allows you to pay your expenses with pre-tax dollars, which means that
you get a tax deduction for these expenses before you file your tax return. You don’t pay Federal income or Social
Security taxes on this money.
Each year on March 1st, you decide which plan(s) you wish to enroll in. You should then estimate how much you
think your health care and/or dependent care out-of-pocket costs will be for the coming 12 months. Contributions
are deducted from your paycheck in equal installments. If you enroll, you must enroll for the entire year. The IRS
intends that you set aside what you need and no more. Money in reimbursement accounts not used during the
plan year will not be carried over to the next year. They will be forfeited. Plan your contributions
realistically.
Plan Administrator:
Independent Health/NOVA, Buffalo, NY
Eligibility:
All regular full or part-time employees who have worked past their 30th day. The
benefit must start on the first day of the month following their eligibility date.
Contribution Limits:
Healthcare Reimbursement Account: Up to $2,000 pre-tax dollars
Dependent Care Reimbursement Account: Up to $5,000 pre-tax dollars
HEALTH CARE Reimbursement Account: Although our medical and dental plans cover a majority of your
health care bills, you are likely to incur a certain amount of out-of-pocket expenses each year. A FSA allows you to
set aside Pre-tax dollars from your paycheck to assist in covering these out-of-pocket costs.
Examples of out of pocket expenses you may pay with pre-taxed dollars from your account*:
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Deductibles
Co-Pays for Prescriptions
Co-Pays for Services
Payments in Excess of Plan Limits
DEPENDENT CARE Reimbursement Account: This account allows you to use payroll deducted, pre-taxed
dollars to pay for eligible dependent care that you need in order to continue working.
Examples of out of pocket expenses you may pay pre-taxed dollars from your account*:
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After school programs – YMCA, recreational
programs, latch-key programs
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Babysitting (only while at work or attending
school full time)
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Daycare, Pre-school and Nursery School
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Elderly care
*See the complete list in the Independent Health/NOVA Enrollment Info. You must be able to provide an Employer
Tax ID number or a Social Security number for the dependent care provider, along with receipts showing requested
date ranges.
How do you get money from your Account? With the PowerPay debit card, you will have immediate access to
your FSA account and you will not have to wait for a reimbursement check. You just use the card at qualifying
merchant locations, wherever MasterCard is accepted. Although there is no requirement for you to complete claim
forms with the PowerPay debit card, additional documentation may be required in some cases in order to meet IRS
guidelines. Therefore, you must keep copies of all receipts and itemized statements (not the credit card receipt) for
each purchase.
Rev. January 2015
10
Claims/Expenses may be submitted to the FSA up to 90 days after the plan year ends.
You must have a contribution balance greater than or equal to the claim amount to be reimbursed for qualified
expenses
Reimbursement checks are issued twice per month. If you have to submit a paper claim in Independent
Health/NOVA, reimbursements are issued twice per month through your payroll. Each reimbursement check you
receive will include an account summary. As you incur expenses throughout the year, you submit a Reimbursement
Form along with documentation of the expense. Reimbursement forms will be available on the Plan Administrator's
web site, on the Willcare Intranet (see Documents/Forms/HR Forms) and at your branch office.
You may set up one or both FSA options.
If you qualify for Child Care tax credits, consult a tax advisor. Generally, you are not eligible to receive both tax
benefits.
FSA TAX SAVINGS Demonstration Chart
TAX ADVANTAGES
Annual Wages
HCRA
DCRA
Taxable Income
$
$
Fed Income estimated @ 15%
State Income taxes @ est. 5%
Soc. Sec. Tax @ 7.65%
Net Income
$
HCRA reimbursement
DCRA reimbursements
Spendable Income
$
FSA Pre Tax
After-Tax
Contribution
Contribution
25,000
1,000
5,000
19,000
(2,850)
(950)
(1,454)
13,747
1,000
5,000
19,747
$
$
$
$
25,000
25,000
(3,750)
(1,250)
(1,913)
18,088
18,088
See NOVA Enrollment information and fill out the applicable enrollment form in the NOVA packet.
* PLEASE NOTE THAT YOU MAY NOT ENROLL IN AN FSA IF YOU CHOOSE TO ENROLL IN THE HDHP
& HSA.
Rev. January 2015
11
HEALTH SAVINGS ACCOUNT (HSA)
A Health Savings Account (HSA) is a tax-advantaged medical savings account available only to participants who are
enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account are taken via payroll
deduction, and are not subject to federal income tax at the time of deposit.
Employees who participate in this benefit receive an HSA Debit Card that they can use to pay for expenses. Unlike
an FSA, the balance in the HSA account must be able to cover the payment being made for the service.
Also, unlike a flexible spending account (FSA), funds roll over and accumulate year over year if not spent. HSAs are
owned by the individual. Funds may only be used to pay for qualified medical expenses such as co-pays and
deductibles. If you enroll in the HDHP, you cannot enroll in an FSA plan. The maximum HSA contributions for
2015 are $3,350 for a single plan and $6,650 for a family plan. If you are over age 55, you can contribute an
additional $1,000 for 2015.
Plan Administrator:
Wells Fargo
Eligibility:
All regular full-time employees who have worked past their 30th day. The benefit
must start on the first day of the month following their eligibility date.
Contribution Limits:
Set annually by the IRS.
2015 Single Plan Limit:
$3,350
2015 Family Plan Limit:
$6,650
Eligible Expenses:
Examples of out of pocket expenses you may pay with pre-taxed dollars from your account:
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Plan deductibles
Laboratory Fees
Physician Visit Fees
Over-the-Counter Medicines (Not Preventatives like vitamins)
Rev. January 2015
12
ACCIDENT INSURANCE
Trustmark’s Accident insurance helps pay for unexpected healthcare expenses due to accidents that occur
every day – from the soccer field to the ski slop and the highway in-between. Accident insurance provides
benefits due to covered accidents for initial care, injuries and follow-up care. Benefits are paid directly to
the employee, in addition to any other coverage they have.
Rev. January 2015
13
SUPPLEMENTAL SHORT-TERM DISABILITY BENEFIT
This plan will replace a portion of your income if you become unable to work because of an off/job covered accident
or illness. WILLCARE has Workers’ Compensation insurance for injuries that occur in the workplace.
The plan helps employees provide financial security for their family and lifestyle. It may help you pay your
mortgage or rent, utility bills and other household expenses in the event of an off/job accident or illness.
Plan Administrator: Trustmark
What’s covered? Total Disability due to:
 Non-occupational sickness
 Non-occupational injury
 Pregnancy (10 months after effective date)
 Complications of pregnancy
CRITICAL ILLNESS INSURANCE
Trustmark’s Critical Illness benefit, including Cancer insurance, offers a lump-sum benefit payment upon
diagnosis of a covered critical illness including invasive cancer, stroke, heart attack, major organ failure,
renal failure or ALS (Lou Gehrig’s disease). This benefit offers immediate financial relief from the
overwhelming expenses of a serious illness.
Rev. January 2015
14
401(K) RETIREMENT SAVINGS PLAN
With Social Security income accounting for only 25-50% of retirement income, WILLCARE offers our employees a
401(k) Retirement Plan to supplement retirement savings. 401(k) is a simple, automatic, payroll-deduction savings plan
that allows you to set aside some of your earnings on a "pre-taxed" basis for retirement. The tax on this income is
"deferred", meaning it is paid when you take your savings out of the Plan. This money has the added advantage of being
eligible to be invested in several mutual fund investment options ranging from conservative to aggressive.
PLAN HIGHLIGHTS
Eligibility:
Age 21, 90 days of service
The following employee classifications are EXCLUDED from participation in the plan:
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Per Diem PCA's
Per Diem HHA's
Per Diem CNA's
Highly Compensated Employees (HCEs)
Entry Dates:
Quarterly on January 1, April 1, July 1 and October 1
Deferral Contributions:
100% of your compensation may be contributed to a maximum IRS limitation of $18,000
in 2015. If you are if you are age 50 or older, then you may elect to defer additional
amounts (called "catch-up contributions") to the Plan. The additional amounts may be
deferred regardless of any other limitations on the amount that you may defer to the Plan.
The maximum "catch-up contribution" that you can make in 2015 is $6,000.
Stop Contributions:
Payroll Deferrals may be stopped at any point; however, you may not restart contributing
until the next Quarterly Open Enrollment Period. If you stop your payroll contribution
while employed, you must leave your money in your account. It may not be taken out
unless you retire, terminate your employment, or die.
Company Contributions:
WILLCARE may contribute a discretionary matching contribution.
Hardships / Loans:
Hardship withdrawals are not permitted. Loans are not permitted.
Vesting Schedule:
Vesting Applies to employer contributions only. Employee deferrals are 100% vested
immediately. If you terminate your WILLCARE employment prior to reaching your 6th
year of service, the following percentage of the employer contributions will be yours as
you leave the 401(k) Plan



< 2 years
=
2 years of service =
3 years of service =
0%
20%
40%



4 years of service =
5 years of service =
6 years of service =
60%
80%
100%
You are 100% vested at Normal Retirement Age (65), regardless of years of service.
Investment Fund Options:
See Enrollment Kit for Investment Options
Telephone / Web Access:
1-866-809-8146 / https://myaccount.ascensus.com/rplink
Telephone and Internet access is available to you 24 hours a day, 7 days a week.* This allows you to monitor your
savings, change funds, and redirect future fund electives. Transfers between any funds may be made anytime
without a charge. *You will need your SSN, date of birth and zip code to access.
Rev. January 2015
15
TUITION ASSISTANCE PLAN
The “WILL*LEARN” Tuition Assistance Plan supports further education for full time WILLCARE employees by
providing assistance with tuition costs for approved courses of study.
Full time employees whom have completed a minimum of one (1) year of service may be eligible for Tuition
Reimbursement. Employees must seek prior approval from their Branch Administrator to confirm that the coursework is
related. The following conditions will also apply:




50% of total tuition cost reimbursement for business or health related courses of study, up to $2,500 maximum
annually per employee
Reimbursement occurs at end of completion of course work
Grade level must be a “B” or higher
Six-month work commitment to WILLCARE upon completion of course work
CONTINUING EDUCATION UNIT (CEU) REIMBURSEMENT
The CEU Reimbursement program supports the continuing education of employees as it relates to maintaining jobrequired licensure and / or job-related certification. WILLCARE has two levels of reimbursement:
Level 1:
This benefit will provide assistance toward the cost of Continuing Education Units (CEU) for
maintaining job-related certifications. The benefit amount is 50% of the cost, up to $300 per calendar
year. This benefit is meant for Full Time staff only; there is no pro-rated reimbursement rate for part time
employees. Reimbursement for conferences and/or seminars as it relates to a professional certification
such as WOCN, PHR, CPA, etc would fall under this level. Reimbursement will cover the cost of the
course only. The cost for travel and meals are not subject to reimbursement.
Level 2:
This benefit will provide assistance toward the cost of Continuing Education Units (CEU) for
maintaining required licensure as it relates to an individual’s job. The benefit amount for Full Time
employees is 100% of the cost, up to $1,000 per calendar year. There is a pro-rated reimbursement rate
for part time employees (20+ hours weekly) in the amount of $600. Reimbursement for conferences
and/or seminars as it relates to a professional licensure that is required for an individual’s employment
fall into this category. An example of a position that requires CEUs to maintain licensure for their
continued employment as a Physical Therapist. Reimbursement will cover the cost of the course only.
The cost for travel and meals are not subject to reimbursement.
Level 3:
This benefit will provide 100% reimbursement for the cost of Cardiopulmonary Resuscitation (CPR)
certification for Full Time and Part Time Direct Care employees. Reimbursement will be for up to $30
annually for recertification, and up to $60 for a first time certification in CPR. Course must be conducted
by an accredited agency certified by American Heart Association or Red Cross in order to be eligible for
reimbursement.
The following conditions will also apply:

One year of full time service prior to eligibility for Level 1 reimbursement; or one year of full or part time service
prior to eligibility for Level 2 reimbursement

Full or part time work commitment to WILLCARE of at least 6 months after reimbursement is required. Failure
to honor this work commitment will result in repayment to WILLCARE in fill.
Rev. January 2015
16
PAID TIME OFF (PTO)
Paid time off (PTO) provides employees with paid time away from work that can be used for vacation, personal time,
personal illness or time off to care for dependents. PTO must be scheduled in advance and have supervisory approval,
except in the case of illness or emergency. All time away from work will be deducted from the employee’s PTO bank
in hourly increments with the exception of fixed company holidays, the floating holiday, and time off in accordance
with company policy for jury duty, military duty or bereavement.
Eligibility:
All full and part-time (minimum of 20 hours per week) employees are eligible to earn PTO right away; however, PTO
cannot be accessed until 90 days of employment have been completed. PTO is not earned for months when unpaid
leave is taken or during periods in which short or long term disability benefits are paid. PTO does not accrue on PTO
cash outs (such as upon termination). PTO is not earned by temporary or contract employees.
Accrual Process:
PTO is earned on an hourly basis and credited to an employee’s PTO bank on a biweekly basis following the
biweekly pay period in which the PTO was earned. Accruals are based upon paid hours up to 2080 hours per year,
excluding overtime. PTO accrues on a “rolling calendar method” meaning PTO will continue to accrue up to the limit
based on your length of service (see table below). If the Maximum Rolling Accrual Limit is met, you will not accrue
PTO time until PTO has been taken.
Length of service determines the rate at which the employee will accrue PTO. Employees become eligible for the
new higher accrual rate on the first day of the pay period in which the employee’s anniversary date falls. PTO is
earned on the following schedule:
Length of
Employment
Hire
1st Anniversary
2nd Anniversary
5th Anniversary
10th Anniversary
Administrative Staff,
LPNs, PTAs, OTAs, & Staff Aides
Maximum Rolling
Hourly PTO
Accrual Limit*
Accrual
112 Hrs (14 Days)
0.0538
152 Hrs (19 Days)
0.0538
152 Hrs (19 Days)
0.0730
192 Hrs (24 Days)
0.0923
232 Hrs (29 Days)
0.1115
Registered Nurses & Therapists
Maximum Rolling
Accrual Limit*
152 Hrs (19 Days)
192 Hrs (24 Days)
192 Hrs (24 Days)
232 Hrs (29 Days)
240 Hrs (30 Days)
Hourly PTO
Accrual
0.0730
0.0730
0.0923
0.1115
0.1153
* The Maximum Rolling Accrual Limits listed in the chart above are based upon working 40 hours per week. If you are working
less than 40 hours per week, your Maximum Rolling Accrual Limit will be prorated based upon the number of hours you are
scheduled to work.
Administration:
You may use “Paid Time Off” in half hour, hourly or daily increments. You must use PTO for whole or half days
off. Make-up time may be used up to one half day of work and with supervisory approval only. Make-up time must
be worked in the same pay week.
Unpaid time off will only be granted if all of your PTO has been used. Please keep in mind that time off without pay
is granted on an exception basis only and requires pre-approval from the Branch Manager/Administrator. In addition,
PTO will not accrue during time off without pay. If more than a week is needed, see the Leave of Absence section of
this handbook.
Employees who separate from employment or who move to per diem status will receive a cash out of their unused,
accrued PTO, provided that proper notice was given. See the “Resignation Notice” section of the Employee
Handbook for information on time off benefits upon separation from WILLCARE.
See Employee Handbook for further guidelines on the use of Paid Time Off (PTO).
Rev. January 2015
17
SICK BANK PROGRAM
Employees are eligible to convert up to one week (40 hours) of PTO days into their Sick Bank per calendar year. The
employee’s PTO will be reduced by the amount of time that they elect to convert into the Sick Bank, and this time will be
moved to a separate Sick Bank. The maximum amount of time that can be converted into the Sick Bank at any given time
during employment is 30 days (up to 240 hours). This total amount is based upon a full time (40 hours per week) work
schedule and this amount will be prorated for those who work part time. The Sick Bank was established to provide
income to participants in the plan who have an extended, serious health condition. An employee who is out on an
intermittent leave or a worker's compensation may not draw from the Sick Bank.
An extended, serious health condition means an illness, injury impairment, or condition that involves inability to
work beyond 7 calendar days AND one of the following:
1. Requires Hospital Care - Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical
care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such
inpatient care.
2. Absence Plus Treatment - A period of incapacity of seven (7) or more calendar days (including any subsequent
treatment or period of incapacity relating to the same condition), that also involves:
(1) Treatment two or more times by a health care provider, by a nurse or physician’s assistant under direct
supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under
orders of, or on referral by, a health care provider; or (2) Treatment by a health care provider on at least one
occasion which results in a regimen of continuing treatment under the supervision of the health care provider.
3. Pregnancy - Any period of incapacity due to pregnancy, or for prenatal care.
4. Permanent / Long Term Conditions Requiring Supervision - A period of incapacity which is permanent or
long-term due to a condition for which treatment may not be effective. The employee must be under the
continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include
Alzheimer’s, a severe stroke, or the terminal stages of a disease.
5. Multiple Treatments (Non-Chronic Conditions) - Any expanded period of absence to receive multiple
treatments (including any period of recovery there from) by a health care provider or by a provider of health care
services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident
or other injury, or for a condition that would likely result in a period of incapacity of more than seven (7)
consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy,
radiation, etc.), severe arthritis (physical therapy), and kidney disease (dialysis).
An FMLA / MLOA Physician Certification must be submitted to support the diagnosis before any Sick Bank Days may
be withdrawn. Employees should contact Corporate Human Resources for the applicable paperwork.
In order to convert PTO time to your sick bank, please complete the Sick Bank Conversion request on the Intranet which
will be submitted to Payroll for processing.
The Sick Bank expires upon separation of employment and / or conversion to per diem status. In addition, the
Sick Bank has no cash value upon separation of employment and / or conversion to per diem status.
Rev. January 2015
18
HOLIDAYS
Employees are eligible for seven (7) paid holidays per year. WILLCARE observes the following holidays. When these
holidays fall on a weekend, an alternative weekday will be designated for this holiday for office staff.







New Year’s Day
Memorial Day
Independence Day
Labor Day
Thanksgiving Day
Christmas Day
Floating Holiday - You may choose one day per calendar year
New full and part-time employees are entitled to holiday pay after their first thirty days of employment. Employees
working part time receive pro-rated paid holiday time off. Holiday hours paid and not worked will not be included in the
calculation of overtime
To be eligible for holiday pay, you must work the regularly scheduled day before and day after the holiday. Pre-approved
time off is allowed on the day before and after a holiday and will be considered as a “regularly scheduled day”. If an
unscheduled absence is warranted, you must have Branch Administration approval for it to be allowed to be considered a
“regularly scheduled day”. If a holiday falls within a period where you have scheduled PTO, it will be considered as
holiday and not PTO pay.
WILLCARE recognizes the importance of your desire to spend the holidays with family and friends and will make every
effort to avoid scheduling clinical personnel on rotation two holidays in a row. Clinical employees are required to discuss
this with their supervisor in advance of scheduling the work time. If business conditions require it, management may
request that you work a holiday. You may be requested to select an alternative day off during the holiday week. If no
alternative is taken, the holiday will be paid according to the table in the Employee Handbook.
JURY DUTY
In the event you are required to fulfill your civic obligation to serve as a jury member, WILLCARE will pay your
regularly scheduled straight-time earnings up to a maximum of three (3) days within any twenty-four month period.
At least 50% of your time off beyond three days should be covered by your available PTO.
BEREAVEMENT LEAVE
If there is a death in your immediate family or step family (parent, parent-in-law, sibling, spouse, child, grandparent or
domestic partner) WILLCARE will provide you three days off with pay.
In the event there is a death in your extended family (aunt, uncle, niece, nephew, cousin or in-laws), WILLCARE will
provide you one day off with pay. If more time is needed, please request PTO.
Eligibility:
Employees are eligible for bereavement pay after completing 30 days of employment.
Part-time regular employees will be paid their regular part-time daily pay for bereavement time off.
Rev. January 2015
19
EMPLOYEE DISCOUNT PROGRAMS
WILLCARE has arranged for several discounts for its employees. Below is a listing of the discounts you are
eligible to participate in.
WILLCARE
Perks Program
Verizon Wireless
Land's End Clothing
Discount site especially for WILLCARE employees. Best pricing on
Electronic Devices / Computers, Call Phones, Restaurants and Travel.
Go to http://willcare.corporateperks.com
Login / Register at
Willcare Perks
Company Code:
willcare46
Discount (22%) on eligible cell phone and data plans, as well as some
phones and accessories. In order to access, employees must login to the
Willcare Intranet (http://intranet.willcare.com/) and click on “Verizon
Discounts” under MyWillnet.
Great deals on Land's End apparel with the WILLCARE Logo!
Visit: http://ces.landsend.com/willcare
Hertz Automotive
& Rentals
To make a reservation, simply call 1-800-654-3131 or book on line at
www.hertz.com. To join the Hertz #1 Club Gold:
Visit: http://bapgold.hertz.com & Click "Fee-Waived Hertz #1 Club Gold
Application"
Enter Company Name: WILLCARE
Enter CDP#:
1848568
Pin-Code:
bapgold
Dell Computers
Save on Dell Computers when you purchase directly through Dell using
their Employee Purchase Program (EPP).
Visit: www.dell.com/epp
Or, call: 1-800-695-8133
You will need Member ID: HS75889615
Schmidt’s Auto
Body & Glass
Discounts offered on a variety of services including mechanical, glass
and collision. See the HR Department for a VIP card and take your car in
to one of their 5 locations for a quote.
Visit: www.schmidtsautobody.com
Liberty Mutual Insurance
Dunn Tire
A group discount on auto and home insurance, including renters’
insurance. Contact our local representative for a free quote:
Contact: Valarie DiRienzo
400 Essjay Road, Suite 300
Williamsville, NY 14221
(P) 716-631-9140 x 51778
5% discount offered on major name brand tires.
See the HR department for a VIP Card and take your car into one of their
many shops located throughout WNY.
Kissing Bridge
Discounts on skiing (lift tickets, rentals & lessons).
Customer password is: WC541
Charles Dickhut - Kissing Bridge Group Sales
(P) 716-592-4963, ext. 2237 / (F) 716-954-3406
(E) [email protected]
Visit: http://corporate.kbski.com/
AT&T Wireless
Discount (up to 20%) on eligible cell phone and date plans. To access,
visit www.att.com/wireless/Willcare and use code 2765355.
Rev. January 2015
20
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) AND MEDICAID
Free or Low-Cost Health Coverage to Children And Families
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 www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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 1-877-KIDS NOW or
www.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 www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan
premiums. The following list of states is current as of July 31, 2014. Contact your State for more information on
eligibility –
ALABAMA – Medicaid
COLORADO – Medicaid
Website: http://www.medicaid.alabama.gov
Medicaid Website: http://www.colorado.gov/
Phone: 1-855-692-5447
Medicaid Phone (In state): 1-800-866-3513
Medicaid Phone (Out of state): 1-800-221-3943
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
ARIZONA – CHIP
FLORIDA – Medicaid
Website: http://www.azahcccs.gov/applicants
Website: https://www.flmedicaidtplrecovery.com/
Phone (Outside of Maricopa County): 1-877-764-5437
Phone (Maricopa County): 602-417-5437
Phone: 1-877-357-3268
GEORGIA – Medicaid
Website: http://dch.georgia.gov/ - Click on Programs, then
Medicaid, then Health Insurance Premium Payment (HIPP)
Phone: 1-800-869-1150
IDAHO – Medicaid
Medicaid Website:
http://healthandwelfare.idaho.gov/Medical/Medicaid/Premiu
mAssistance/tabid/1510/Default.aspx
MONTANA – Medicaid
Website: http://medicaidprovider.hhs.mt.gov/clientpages/
clientindex.shtml
Phone: 1-800-694-3084
Medicaid Phone: 1-800-926-2588
Rev. January 2015
21
INDIANA – Medicaid
NEBRASKA – Medicaid
Website: http://www.in.gov/fssa
Website: www.ACCESSNebraska.ne.gov
Phone: 1-800-889-9949
Phone: 1-855-632-7633
IOWA – Medicaid
NEVADA – Medicaid
Website: www.dhs.state.ia.us/hipp/
Medicaid Website: http://dwss.nv.gov/
Phone: 1-888-346-9562
Medicaid Phone: 1-800-992-0900
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
NEW HAMPSHIRE – Medicaid
Website:
http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 603-271-5218
LOUISIANA – Medicaid
Website: http://www.lahipp.dhh.louisiana.gov
Phone: 1-888-695-2447
NEW JERSEY – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
MAINE – Medicaid
Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
Phone: 1-800-977-6740
TTY 1-800-977-6741
MASSACHUSETTS – Medicaid and CHIP
NEW YORK – Medicaid
Website: http://www.mass.gov/MassHealth
Website: http://www.nyhealth.gov/health_care/medicaid/
Phone: 1-800-462-1120
Phone: 1-800-541-2831
MINNESOTA – Medicaid
Website: http://www.dhs.state.mn.us/
Click on Health Care, then Medical Assistance
NORTH CAROLINA – Medicaid
Website: http://www.ncdhhs.gov/dma
Phone: 919-855-4100
Phone: 1-800-657-3629
MISSOURI – Medicaid
NORTH DAKOTA – Medicaid
Website:
http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Website:
http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 573-751-2005
Phone: 1-800-755-2604
OKLAHOMA – Medicaid and CHIP
UTAH – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Website: http://health.utah.gov/upp
Phone: 1-888-365-3742
Phone: 1-866-435-7414
Rev. January 2015
22
OREGON – Medicaid
Website: http://www.oregonhealthykids.gov
http://www.hijossaludablesoregon.gov
VERMONT– Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid
Website: http://www.dpw.state.pa.us/hipp
Phone: 1-800-692-7462
VIRGINIA – Medicaid and CHIP
Medicaid Website:
http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website:
http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
RHODE ISLAND – Medicaid
Website: www.ohhs.ri.gov
Phone: 401-462-5300
WASHINGTON – Medicaid
Website:
http://www.hca.wa.gov/medicaid/premiumpymt/pages/index
.aspx
Phone: 1-800-562-3022 ext. 15473
SOUTH CAROLINA – Medicaid
WEST VIRGINIA – Medicaid
Website: http://www.scdhhs.gov
Website: www.dhhr.wv.gov/bms/
Phone: 1-888-549-0820
Phone: 1-877-598-5820, HMS Third Party Liability
WISCONSIN – Medicaid
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov
Website: http://www.badgercareplus.org/pubs/p-10095.htm
Phone: 1-888-828-0059
Phone: 1-800-362-3002
TEXAS – Medicaid
WYOMING – Medicaid
Website: https://www.gethipptexas.com/
Website: http://health.wyo.gov/healthcarefin/equalitycare
Phone: 1-800-440-0493
Phone: 307-777-7531
To see if any other states have added a premium assistance program since July 31, 2014, or for more information on
special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Rev. January 2015
23
HELPFUL CONTACT INFORMATION
Insurance
Health
Insurance
Dental Insurance /
Vision Insurance
Company
Address
Phone / Web
Blue Cross Blue
Shield of WNY
PO Box 80
Buffalo, NY 14240-0080
716-884-2800 / 800-888-0757
www.bcbswny.com/willcare
Guardian
PO Box 2459
Spokane, WA 99210-2459
888-600-1600
www.guardiananytime.com
PO box 2459
Spokane, WA 99210-2459
General: 888-600-1600
EAP: 800-3867055
www.guardiananytime.com
www.ibhworklife.com
Life & AD&D / EAP
Guardian
401k Plan
Ascensus
Plan Administration:
Corporate HR WILLCARE
https://myaccount.ascensus.com/rplink
Flexible Spending
Account
Independent
Health
511 Farber Lakes Drive
Buffalo, NY 14221
Attn: FSA Department
800-258-3348 / 716-504-1468
www.independenthealth.com
Health Savings Account
Wells Fargo
NYS Disability
Disability (NYS)
Guardian
888-262-5670
www.guardiananytime.com
Trustmark
400 Field Drive, Lake
Forest, IL 60045
trustmarksolutions.com
Supplemental Disability,
Critical Illness &
Accident Insurance
866-809-8146
www.wellsfargo.com/hsa
Rev. January 2015
24
Women’s Health Act
The Women’s Health and Cancer Rights Act of 1998 required that all health insurance plans that cover mastectomy also
cover the following medical care:
• 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 at all stages of the mastectomy, including lymphedemas,
and mastectomy bras and external prostheses limited to the lowest cost alternative available that meets the
patient’s physical needs.
Continuation of Coverage Required by Federal Law
The Continuation of coverage 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 a termination of employment due to your
gross misconduct). Federal law also enables your Dependents to continue health insurance if their coverage ceases due to
your death, divorce or legal separation (if a legal separation triggers a loss of coverage), or with respect to a Dependent
child, failure to continue to qualify as a Dependent. Continuation coverage 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.
Mental Health Parity Act
According to the Mental Health Parity Act of 1996, the lifetime maximum and annual maximum dollar limits for mental
health benefits under the WILLCARE medical plan are equal to the lifetime maximum and annual maximum dollar limits
for medical and surgical benefits under this plan. However, mental health benefits may be limited to a maximum number
of treatment days per year or series per lifetime.
Newborns’ and Mothers’ Health Protection Act
Federal law (Newborns’ and Mothers’ Health Protection Act of 1996) prohibits the plan from limiting a mother’s or
newborn’s length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean deliver or from
requiring the provider to obtain preauthorization for a stay of 48 or 96 hours, as appropriate. However, federal law
generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her
newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery.
Health Insurance Portability and Accountability Act (HIPAA)
WILLCARE, in accordance with the HIPAA, protects your Protected Health Information (PHI). WILLCARE 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 Notice of Privacy Practices
is available upon request in the Human Resources department.
Patient Protection and Affordable Care Act
The Plans shall comply with the provisions of the Patient Protection and Affordable Care Act, the Reconciliation Act
(hereinafter both are collectively referred to as “PPACA”) and certain other provisions of applicable law and the
applicable regulations that are generally effective after December 31, 2009. The Plans intend good faith compliance with
the requirements of the PPACA and other applicable laws and are to be construed in accordance with same.
This brochure summarizes the health care and income protection benefits that are available to WILLCARE employees
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 Resources
Department.
Information provided in this brochure is not a guarantee of benefits.
Rev. January 2015
25