2015 t & o refrigeration benefit guide v2.pdf

8/9/2019 2015 T & O Refrigeration Benefit Guide V2.pdf

1/36

2015

This Plan YearMarch 1, 2015 – February 29, 2016

Plan Administrator& O Refrigeration

70 Walter WayFayetteville, Georgia 30214

770-461-5217

Benefit Guide

Our benefits are offered as a ‘World of Thanksand can keep what’s most important

to you in good health.


2/36

2 |Printed 2/12/15 The Benefit Guide© Copyright 2013-15. Benevestco. All rights reserved.

Our benefits

give you

something to

smile about!

Welcome – This Year’s Benefit HighlightsWe offer you a wide menu of ala carte choices. Plus, you’ve got access to the

ools, information and resources to help you decide what’s right for you! Theperks of our company benefits are gifted to you in addition to your normal payand include:

Tax savings & other incentives

Group rates & guarantee issue

Convenience of payroll deduction

Up to $10,462 in company contributions each year

Employee & dependent coverage available Free preventative care & access to big discounts

Plus, this enrollment guide contains most everything you need to know to getyou through the plan year. An electronic copy of it is also available – with all

of the forms, benefit summaries and hotlinks to make accessing your importantbenefit information easy!

You can also request (free) copies of important plan information, employeenotices, Plan Summary Documents (and much more) by making a writtenequest to the Plan Administrator (see ‘Contacts’).

We help you know and enroll - easily 24/7Log into: https://resourceseven.easyappsonline.com

Our benefits aredesigned to help keep youand your bank account healthy.

BenefitEligibilityAll benefits are offered ala carte. In order to be eligi

participate in the benefits offered, you must maintain all following:

Employees Dependents• W2 employees employed 90

days (eligible as of the firstday following theprobationary period)

Legal spouse, or

• A resident alien or citizen Legal dependentchildren up to age 1

for all benefits and t

age 26 for certain

health benefits. Som

children may qualify

for extended eligibildue to disability or

impairment.

• Reside in the continental US,and

• Work 30 or more hours perweek,

Some plans may impose additional eligibility requireme

see plan details, contact the plan or Plan Administraconfirm your eligibility.

When can you Enroll?You or your dependents have up to 30 days to enroll or changes when you:

• Become newly eligible;

• Experience a Qualified Life Event (Status Change);• Participate in our Annual Open Enrollment (usually h

February each year)

Make your decisions wisely – they can affect you for the

plan year! Use our Counselors at the Resource Center fo

https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/


3/36

& O REFRIGERATION BENEFIT GUIDE


Benefit&CostInfo ContactInfoOur plan year starts March 1 & ends February 29 . We’ve brought the best resources together for you -Many plan benefits are based on a calendar year (not plan year) - check plan info carefully. their knowledge and powerful tools are available to yo

Safeguard Your Finances Plan Administrator T & O Refrigeration170 Walter Way

BCBS Guardian Fayetteville, Georgia 30214Base Life & AD&D Accident Benefit 770-461-5217We provide you with up to $15,000 Cash benefit by reimbursement www.torefrig.com

Resource Center 770-716-3200 Guardian Guardian www.resourceseven.com

Supplemental Life Employee up to $100,000

Critical Illness + Cancer Benefits Use our Resource Center for

Spouse up to $50,000 Employee $10,000 technical benefit, insuranceChild/ren up to $10,000 Spouse & Children up to $2,500 financial planning questions

get personal claims assistancGuardian T & O Refrigeration

Employee Assistance Program (EAP) Pre-Tax Plan 24/7 help to you & your family with life’s issues Sponsored by the company to help you save taxes

Safeguard Your Health Plan ContactsNeed an ID card, provider o

website assistance?

Blue Cross Blue Shield of GA My Ideal Doc InfiniSource………………. 800-300-3838

Health Plan Options Telemedicine Benefits www.infinisource.com Offers members Access basic medical care 24/7/365 from the

free preventative & other member benefits convenience of anywhere in the US Blue Cross Blue Shield…. 800-441-2273www.bcbsga.com

Guardian Guardian

Vision Benefits Dental Benefits Guardian……….………… 800-541-7846Low copays for exams, lens & frames; discounts Access to free preventative benefits, discounted www.guardiananytime.comfor upgrades, additional hardware & Lasik services & benefits to cover your oral health needs

My Ideal Doc……………. 855-879-4332www.myidealdoctor.com

MedicalSurcharge

Rates shown Dental* Vison TeleMed Accident

Child $59.62 Are weekly EE $6.57 $3.28 $2.31 $5.30

Spouse $34.52 Rate tables EE+SP $15.32 $12.03 $2.31 $8.96

provided for all EE+CH $15.11 $11.82 $2.31 $9.33

other benefits Family $23.85 $20.57 $2.31 $12.99

http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/www.torefrig.comhttp://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/www.torefrig.comhttp://www.resourceseven.com/http://www.resourceseven.com/http://www.infinisource.com/http://www.infinisource.com/http://www.bcbsga.com/http://www.bcbsga.com/http://www.guardiananytime.com/http://www.myidealdoctor.com/http://www.myidealdoctor.com/http://www.myidealdoctor.com/http://www.guardiananytime.com/http://www.bcbsga.com/http://www.infinisource.com/http://www.resourceseven.com/http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/www.torefrig.com


4/36 |Printed 2/12/15 The Benefit Guide© Copyright 2013-15. Benevestco. All rights reserv

Table of Contentsind your topic and the corresponding page.

Viewing this electronically? Double click the page #.

Benefit Eligibility ............................................................ 2

Benefit & Cost Info ........................................................ 3

Contact Info .................................................................... 3

Decline, Enroll or Change ............................................. 5 Newly Eligible? ............................................................... 5

When You Can Enroll .................................................... 6

Be Savvy – Know Your Freebies ................................... 7

ntro to Using our Company Portal ............................. 8

Pre-Tax Highlights .......................................................... 9

Know Your #s – Our Wellness Plan ........................... 10

Health Plan Highlights ................................................. 11

Telemedicine Benefits ................................................. 12

HRA Plan for Our Health Plan Members................... 13

Dental Plan Highlights ................................................. 14

Vision Plan Highlights .................................................. 15

Health Plan Basics ........................................................ 16

mportant Information ................................................ 18

Life Benefits .................................................................. 19

Employee Assistance Plan .......................................... 20

Accident Benefits ......................................................... 21

Critical Illness & Cancer Benefits ............................... 22

We Need Your Help to Make it Work at Work! ....... 23

After Enrollment – What’s Next? .............................. 23 Need Help with Claims Issues? .................................. 24

Continue, Convert or Port? ........................................ 25

Self-Care Tips Save You $ ............................................ 26

Preventative Benefits .................................................. 26

On Medicare & Working? ........................................... 28

Be a Savvy Healthcare Consumer .............................. 29

Notices .......................................................................... 33

Privacy Practices & Policies ........................................ 33

Common Insurance Terms ......................................... 35 Document Disclosure .................................................. 36 Our people are our best

resources – thank you forthe good things you do foT & O Refrigeration.

http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745894http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745894http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745894http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745906http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745906http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745906http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745906http://e/Documents/Shared/ER%20files/T&O/2015MAR%20T&O/R7%20Implementation/2015%20T%20&%20O%20Refrigeration%20Benefit%20Guide.docx%23_Toc410745894



Decline,EnrollorChangeAll benefit eligible employees will be required to elect or

decline all of the benefits available within 30 days of youreligibility or qualifying event date.

forms are required - double click on the thumbtack icon

below or refer to the hard copy provided.

CompleteWhat?

Login to our portal athttps://resourceseven.easyappsonline.com

New Hire Event,

Change Request,

Address or Dependent

Update or Open

Enrollment

Premium Only (Pre-Tax)Authorizes us to convert your deferralsto a pre-tax status.

This form.

Life Beneficiary Form.

Use to update abeneficiary(s) any

time.

DependentEligibility Cert FormHealth Plan Eligibility

Employees electing

health plan coverage

for a dependent

spouse and/or child.

Health ReimbursementAccount Claim FormRequest Reimbursement for CoveredExpenses.

Yes.

Complete (timely) to

request

reimbursement for a

covered health claim.

HIPAA Authorization FormAuthorizes assistance with medical

claims.

Yes.To authorize anyone

to help you or another

family member with

claims issues.

When you complete your enrollment, you may also need

o provide additional information in order for your request

o be considered. You will be notified, in writing, if any

documentation is required from you.

NewlyEligible?To protect your rights, we are required to obtain yo

acknowledgement to decline or enroll in any bene

available to you within 30 days of your eligibility date

A newly benefit eligible employee or dependent m

also be given special ‘guarantee issue’ privileges benefits that would otherwise require approval bas

on health status. In these instances, often, electing

lowest level of coverage may secure your ability

increase coverage in the future, should the need aris

If you attempt to elect coverage that you previou

declined, you may:

Be turned down,

Have to wait until open enrollment,

Have a delay or reduction in benefits for a time.

Review the terms of the benefits offered befo

declining coverage.

Questions?For more details about eligibility, look to the pla

Insurance Certificates, Summary Plan Descriptio

benefit summaries or visit www.irs.gov for Publicat

969.

We Take Our Role SeriouslyWe offer free tools and lots of resources to keep y

informed. This Benefit Guide© is intended as a summ

only and does not replace or supplement a

Certificate of Insurance, Summary Plan Descript

Summary of Benefits & Coverage, law or regulation

addition, each of our benefit plans produce Certifica

of Insurance and/or Summary Plan Descriptions (a

known as SPD’s).

These documents outline, in detail, plan provisi

benefit eligibility, limitations and exclusions. It a

informs participants of their rights and responsibilit

These documents are provided &/or made availa

within 60 days of the effective date. Copies

provided at no charge, by requesting a copy, in writi

from your Plan Administrator.

It’s T & O Refrigeration’s intent to act in the best inte

of our employees and plan participants. And, it’s intent to comply with federal and state requireme

and ensure the welfare of plan participants is protect

We take care to protect personal information. Cop

of privacy policies are included in the appropriate p

information.

Resource Center – 770.716.3200

https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/http://www.irs.gov/http://www.irs.gov/http://www.irs.gov/publications/p969/ar02.html#en_US_2014_publink1000204020http://www.irs.gov/publications/p969/ar02.html#en_US_2014_publink1000204020http://www.irs.gov/publications/p969/ar02.html#en_US_2014_publink1000204020http://www.irs.gov/publications/p969/ar02.html#en_US_2014_publink1000204020http://www.irs.gov/publications/p969/ar02.html#en_US_2014_publink1000204020http://www.irs.gov/https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/



WhenYouCanEnrollenefit eligible employees have multiple opportunities

isted below) to enroll or make changes to your elections.

As a condition of employment, your Plan Administrator

equires that you formally acknowledge your decision to

enroll or decline in the benefits available when initially

eligible and during our annual Open Enrollment.

Newly Eligible EmployeeWhen newly benefit eligible, your request to enroll or

participate must be made on or prior to your benefit

eligibility date. If you choose to decline any of the benefits

when first eligible to enroll, you will be required to wait until

Open Enrollment to make any election changes, unless

ou experience a ‘Qualifying Life Event’ (see below).

Annual) Open EnrollmentRe-enrollment or Open Enrollment is held once each year,

prior to your plan’s anniversary (start) date. Educational

opportunities and individual benefits counseling areavailable during our annual Open Enrollment. Spouse

and adult children (over age 18) inquiries are also

welcome.

Qualifying Life (Mid-Year) EventsQualifying Life Events, are also called ‘Lifestyle’ or ‘Status’

changes, allow you to make changes to your elections

outside of open enrollment.

you experience a qualifying life event, you have 30 days

rom the date of the event to make the written request (or

electronic, whichever method is made available to you)

o your Plan Administrator indicating your intent to

change your elections. The change in coverage request

must be consistent with the qualifying event. Information

proof of the change) may be required for the plan to

consider and approve a request.

he effective date of any change will be: the date of the

event retroactively or the date the change request is

made – depending on the benefit and the reason for the

change (check each plan!). If you fail to notify your Plan

Administrator accordingly, you’ll have to wait until the

next Open Enrollment.

HSA or Retirement Plan Deferralsarticipants are allowed to stop deferrals (deductions) at

any time. However, re-entering the plan or making

changes may be limited by the plan’s rules. Ask your Plan

Administrator for more details. A Summary Plan

Description outlining the benefits, rights and restrictions of

he plan is provided and/or made available within 60 days

of the effective date of coverage to all participants.

Copies are available, at no charge, by requesting a copy,

n writing, from the Plan Administrator.

Qualifying LifeEvent(s)

DocumentationExample(s)

Birth, adoption or

gain of legalguardianship

Birth Certificate, the

Hospital Certificate ma

be used or Adoption o

Legal Guardianship

Papers.

Dependent DeathDeath Certificate.

Dependent

Loss of Eligibility

Proof of Full-Time Studen

Status or physical

impairment may be

required. Check with yo

Plan Administrator.

Dependent

Qualified Minor

Support Order

(QMSO)

We will comply

appropriately with any

court order received.

Divorce orAnnulment

Finalized Divorce Decre

or Certificate of

Annulment.

Employee changein employment

status that affectseligibility

N/A. Your Plan

Administrator will help yo

facilitate the changes

Judgment or CourtOrder

A copy of the judgmen

decree or court order

Loss or Gain ofeligibility for medicalprograms funded by

state or federalassistance

Check with your Plan

Administrator.

MarriageMarriage Certificate o

Affidavit of Marriage.

Spouse change in

employment and

loses coverage

HIPAA Certificate of

Credible Coverage from

your Spouse’s (QualifiedGroup Health Plan.

Spouse change inemployment and

gains coverage

Proof of Enrollment und

your Spouse’s (Qualified

Group Health Plan.



BeSavvy– KnowYourFreebiesAs with all insurance benefits, there are always some perks and

ways to save money for your wellbeing that people don’typically think or know about. Below are some freebies (or really

ow cost benefits) that can help you take advantage of the perks

offered to plan members throughout the year.

Dental

One (1) free cleaning each 6 months

Dental rewards

Discounts for using network providers

Additional cleanings for members

with certain health conditions

$360 Per person

Vision

Low cost comprehensive eye exam

Free contact lens

Discounts for using network providers

Hardware upgrade discounts

Lasik surgery discounts

$210Per person

TeleMed No or low cost primary care needs Save time and hassle associated with

traveling

Health records portal

$114-1500Per Visit

HRA Generous employer reimbursements

for in network hospital or outpatient

facility services

Up to $2500Per person

EAP

24/7 counseling Concierge services for personal needs

Free face to face counseling services

Travel assistance

Will preparation

$500 ++Per Year

Critical

Illness

Benefits

Free wellness benefits

Easy to make claim – no keeping

track of expenses

$75-5,000Per Person/

Incident

Pre-Tax

Save 15-25% by pre-taxing premiums

Save by contributing to your account

15-45%Per Year

Our

Resource

Center

1 Stop Shop

Private Exchange (24/7/365) Professional benefits guidance

Open enrollment decision support

Claims assistance Benefits & financial education

Priceless


Description

of Membership Benefits Min Valueof Benefits

Health Plan Membership ‘FreebieBelow are some common freebies. Check yo

plan for details.

Network Providers DiscountsNetwork providers offer substantial discounts for coveservices. Discounts can range from 10-80% and help make

of pocket expenses more affordable.

Health Screenings & Educational CounseliDiabetes, high blood pressure, high cholesterol, breast, cerv

and colon cancer screenings are all important to good heaThese are examples of some of the preventative benefits t

are covered at no cost to you.

Knowledge is power. Your health plan provides you with tand resources to become more informed about your gohealth. Want to quit smoking but don't know how? Concer

about bone loss or obesity? Health counseling can help learn how to improve your health and treat depression. Ta

your physician and check with your insurance plan to see wis covered.

Routine Vaccines & Flu Shots

You don't have to pay anything out of pocket to get your immunized, except perhaps a copay for an office visit if immunizations are billed separately. Routine vaccines for adare also covered. As well as, the CDC recomme

vaccination for everyone 6 months and older during theseason.

Pregnancy, Well-Baby & Well-Child VisitsMaking sure your baby arrives safely and remains well gives y

child a great start to a good healthy life.

Health Assessment ToolsTake a Health Assessment (HA), a brief online questionnabout your medical history and current lifestyle.

With the HA, you'll get a report with steps you can takeimprove your health. Your personal health information whave an impact on your benefits coverage. But, with so

plans you can earn points for taking a health assessment. Thpoints can be redeemed for cash prizes! And, with a few pl

you can actually pay a lower rate for taking an HA.

Membership DiscountsWith your health plan membership, you may have free accto discounted services and programs typically not cove

under your benefit plan. You are also able to nominate servproviders in your area that you would like to see included indiscount program.

The following is a list of discounts, services, and progra

commonly available:

Acupuncture, Chiropractic Services & Massage Therapi

Audiology & Vision Care Services

Day Spas, Health Clubs & Wellness Centers

Minimum Value Per Person: $350-Millio

Questions? Contact the Plan Administrator

or our Resource Center



IntrotoUsingourCompanyPortal In an effort to streamline our processes and provide you with easy acces

important benefit and Human Resources related information, our advoc

Resource Seven, has provided us with a portal known

https://resourceseven.easyappsonline.com.

All employees will access the portal to complete a pre-screen exercise

underwriting purposes – when prompted) or to complete an enrollment ev

or to decline benefits.

We keep you plugged in

to the information you need 24/7.

1st Time Users

Go to

https://resourceseven.easyappsonline.com

Click 'First Time User'

Enter your last name, birthmonth (MM) & year (YYYY)

Click 'Find Me'

Enter your SSN# to create a username &password then click Save'

Review & Agree to theSecurity & Online Agreement

You will be prompted to create a newpassword

Then follow the Steps for 'All Users'

Returning Users

Go to

https://resourceseven.easyappsonline.com

Select 'I Agree - Let's Get Started'

Complete the enrollment pages &Elect employer paid ( free to you) benefits

You will elect or waive - decline all of thebenefits available

Follow the instructions on each screen

Provide health history information whenrequested

Using your mouse (hold the left click) sign inthe signature box

Once you click 'I Agree' - congrats - you'vecompleted the event

Log off & close the browser to protect yourpersonal data

Before Logging InYou need basic information about

yourself and your dependents:

Social Security Number

Date of Birth

Address Info

User TipsRefresh your screen often or keepmoving. The system times-out to

protect your privacy after 14 minutes

of inactivity.

Any enrollment, declination or

change requires an

acknowledgement and e-signature.

Please note, the portal is unable to

manage all of the rules associated

with eligibility.

To prevent payroll deduction issues

or the need for corrections, please

ensure you request only those

benefits that you or your dependents

are eligible for when navigating

through the enrollment pages in the

portal.

Forget Your Password?1.Login to our portal:

resourceseven.easyapps.com

2.Click 'Forgot Login Info'

3.Enter your last name, birth month

(MM) & year (YYYY)

4.Click 'Find Me'

5.Enter your SSN to receive (2) emails

that contain your login instructions

Need Help?

Please visit our help desk at:www.easyappsonline.com/employe

ehelp.asp


https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/http://www.easyappsonline.com/employeehelp.asphttp://www.easyappsonline.com/employeehelp.asphttp://www.easyappsonline.com/employeehelp.asphttp://www.easyappsonline.com/employeehelp.asphttp://www.easyappsonline.com/employeehelp.asphttps://resourceseven.easyappsonline.com/https://resourceseven.easyappsonline.com/



Pre-TaxHighlightsre-tax plans convert taxable dollars into tax free dollars.

axes and healthcare are a huge cost to you.

aving money is good. Saving tax money is even better.

re-tax plans save you money.

he IRS Section 125 refers to these plans as ‘Premium Onlylans,’ ‘Cafeteria Plans’ or as ‘Flexible Spending

Accounts’ (FSA).

Any of these pre-tax plans allow premiums to be pre-

axed for health, dental, vision and most accident

benefits.

Savings account’ pre-tax plans, if available, allow you to

contribute to them to pay for certain out of pocket

eligible expenses with the tax free dollars available in your

account.

lus, you cannot pre-tax outside of work!

Pre-Tax Works – but… Pre-Tax Works Only at Your Work!

No

Pre-Tax Pre-Tax

W2 Pay (Income) $31,000 $31,000

Pre-Tax Elections N/A ($ 2,400)

Taxable Income $31,000 $27,600

Est. Taxes (20%)* ($ 6,000) ($ 5,520)

Elections Not Pre-Taxed

($ 2,400) --

Take-Home Pay $21,600 $22,080

Pre-Tax Savings(Results)

N/A(Bad)

$480*(Good)

*Actual tax savings vary by individual’s tax rate.

Pre-Tax Plan Rules & InfoIn order to offer and maintain a favorable tax status

employer is required to follow IRS Code consistently

to impose these rules upon you. For information, you

also visit www.irs.gov/publications/p15b/ar02.html.

You are not obligated to pre-tax contributions

premiums or participate in a pre-tax benefit.

However, if you want to pre-tax any benefits, the

requires that you make the election within 30 days of eligibility date. You are eligible to pre-tax elections

pay period after you make your pre-tax elections.

If you miss your eligibility window, you’ll have to wait

the company’s next open enrollment period.

Once made, you cannot change or cancel pre

elections (or declinations) during the plan year unless

experience a ‘qualifying life event.’

A Summary Plan Description outlining the benefits, ri

and restrictions of the plan is provided and/or m

available within 60 days of the effective date of cover

to all participants. Copies are available, at no cha

by requesting a copy, in writing, from the

Administrator.

Use your benefits wisely to…

stay healthy,

be happy,

live long and be wise.

http://www.125plan.com/#Estimated%20taxes%20(30.65%)http://www.irs.gov/publications/p15b/ar02.htmlhttp://www.irs.gov/publications/p15b/ar02.htmlhttp://www.irs.gov/publications/p15b/ar02.htmlhttp://www.125plan.com/#Estimated%20taxes%20(30.65%)


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10 |Printed 2/12/15 The Benefit Guide© Copyright 2013-15. Benevestco. All rights reser

KnowYour#s– OurWellnessPlan& O Refrigeration is implementing a Wellness Initiative known as ‘Know Your

Numbers’ in order to promote a corporate culture of health. Good health is

about a journey of a lifetime!

Healthy people are happier, live longer, are more confident and productive.

As an added benefit, healthy people spend less on health plan insurance

premiums, out of pocket (health related) expenses and are less likely tobecome disabled.

To participate in ourhealth plan this year:

Complete our normal healthbenefits eligibility requirements.

Employees are also required tocomplete an on-line health

assessment.

Have your ‘7 Numbers’ before you

begin taking the free (on-line)health assessment.

It usually takes less than 30 minutesto learn how you can improve

your health!

A completion confirmation willappear at the end of the

assessment.

Print the confirmation page at theend of your health assessment.

Provide a copy (not the results) ofthe confirmation to the

Administrator.

Complete theHealth Assessment:

Within 30 days of your health planeffective date, log in and take the

health assessment.

Health Assessment Tips Results are confidential.

Results don’t affect your premiums

Key Health Indicators1. Body Mass Index (BMI)

2. Blood Pressure Reading

3. Cholesterol (Total & HDL)

4. Glucose Level

5. Height

6. Waist Circumference

7. Weight

Get Your 7 Numbers If you've had a wellness exam (wit

the last 90 days) – get your numb

from your physician!

Schedule a wellness visit with y

health plan network primary ca

physician.

Contact the health plan to obtain

voucher for ‘biometric screen

only’ lab work at a contracted lab

Your screening requires you to fa

schedule it early in the day!

Follow these tips when getting

preventative exam:

No eating 12 hours prior.

Only drink black coffee or water

hours prior.

Avoid alcohol and strenuous activ

or exercise 12-24 hours prior.

Remember …preventative benefits a

covered at no cost to you.

When you receive the results of yo

biometric or wellness exam – yo

have your numbers handy to take y

Health Assessment!

To learn more,

please visit --https://www.bcbsga.health-

and-wellness.

https://www.bcbsga.com/health-insurance/health-and-wellness/hw-overviewhttps://www.bcbsga.com/health-insurance/health-and-wellness/hw-overviewhttps://www.bcbsga.com/health-insurance/health-and-wellness/hw-overviewhttps://www.bcbsga.com/health-insurance/health-and-wellness/hw-overviewhttps://www.bcbsga.com/health-insurance/health-and-wellness/hw-overview


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1 |Printed 2/12/15 The Benefit Guide© Copyright 2013-15. Benevestco. All rights reserv

HealthPlanHighlightsIn NetworkPlan Highlights

Option 1BCBSGA OAP5 3.5K/0 6.6K B

Health Plan Summary of Benefits & Coverage Not viewing the doc electronically?Refer to printed materials

Double Click to Open Here

Additional

Health Plan EligibilityRequirements

EMPLOYEES MAY BE REQUIRED TO PAY FOR A SPOUSE OR CHILD/REN

THAT DO NOT QUAILFY FOR FREE DEPENDENT COVERAGE. REFER TOOUR DEPENDENT ELIGIBILITY (SEE FORMS SECTION) FOR MORE DETAILS.

Network Name (& Link) Blue Open Access POS

Type of Health Plan POS

Medical Deductible Plan Year

Embedded

Individual $3,500Family $10,500

After the Deductible,The Plan Pays (Co-Insurance %)

100%

Out of

Pocket Max

Individual $6,600

Family $13,200Misc Info All Co-Pays Do Apply

Primary Care Office Visit $25Specialist Office Visit $50

RX Deductible Per Person $200 (Non Tier 1 Rx)

Prescriptions by Tier $15/40/75/20% to $300

Urgent Care $60

Emergency Room $150

Health Plan Extras

• 24 Hour nurse line

• Health coaching

• Member discounts

• Free quit smoking resources

• Health & wellness resources

• Mail order Rx savings

• Special care for pregnant members

•

Special care for chronic medical conditions

Tips to Lower Healthcare Expenses

Be proactive

Make healthy choices

Get preventative exams

Be informed about your health

Be Well With Our Health Plan Tips

Your health plan has free preventative benefits.

Emergency room coverage is available for a life or

limb threatening injury or illness at any ER in the US.

4th quarter carryover is included (Non-QHDHPs).

Mail order RX can save money on maintenance

meds.

If you get a brand name RX when a generic isavailable, you’ll pay the difference between the two.

http://www.bcbsga.com/http://www.bcbsga.com/http://www.bcbsga.com/


12/36


TelemedicineBenefitsOur Telemedicine benefit compliments any health plan. It’s a physician

owned company that offers members with 24/7-365 on demand access toboard certified physicians for diagnosis and prescriptions. What’s even better

s the visit is free!

elemedicine is provided via telephone, video, text or secure email, forcommon and acute illnesses, offering members and their families with

nlimited access to basic healthcare without the typical hassle or expense ofraditional medicine.

Easy, Effective & FastCommon ailments can be treated by TeleMed physicians such as:

Acid Reflux

Acne

Allergies

Asthma

acterial Infections

ronchitis

urnsCellulitis

Cold & Flu

Cold Sores

Cough & Congestion

Constipation

Diabetes

Diarrhea

ar Pain & Infection

ever

lu

Meds that can bePrescribedhe list includes:

Antibiotics & Antihistamines)

Augmentin

Amoxicillin

actrium

Cephalexin

CiproGuaifenesin

ndomethacin

Fungal Infection

Gout

Headache

Heartburn

High Blood PressureInfections

Insect Bites

Joint Aches

Migraines

Nausea

Pink Eye

Rashes & Hives

Runny Nose

Sinus Conditions

Sore Throat

Stomach Virus

Urinary Tract Infections

Vomiting

Levaquin

Lisinopril

Macrobid

PrednisoneZ-Pak

Telemed is Smart Care

The AMA (American Medical Assorecently stated that 70% of doctor viand 40% of emergency room visits cbe avoided with the use telemedicine?

Many simple short-term and long-te

illnesses can be treated effectivwith telemedicine.

Benefits of TeleMed

• Avoid costly ER or urgent care vifor non-emergency medical issue

• Access care at a moment’s noticewhen traveling easily.

• Get care when your primary cadoctor isn’t available.

• Obtain care when you simply fetoo bad to get out of bed.

• Request prescriptions or get refills.

• Escape long wait times at a doctooffice.

• Avoid travel time for simple issues.

• Maintain personal health records the whole family in a secure on-li

portal.

• Find easy to use health tools on-lin

Using Telemed can lower health pl

claims, which means lower health p

increases!


13/36


HRAPlanforOurHealthPlanMembers

Our HRA is a Generous Benefit!A Health Reimbursement Account (HRA) compliments ourhealth plans and makes our health benefits more

affordable when you use them.

& O Refrigeration sets aside company funds to reimburse ou for certain healthcare expenses.

he plan is designed to reimburse eligible individuals who

ncur qualified expenses identified for reimbursement

during the HRA plan year.

here is no cost for your HRA benefits.

Any benefits received are tax free reimbursements.

Our HRA makes using our health plan for big stuff more affordable.

If you elect one of ourhealth plans

Option 1BCBS OAP5 3.5K/0 6.6KB

These expenses maybe eligible forreimbursement

In Network hospital or facility claims applied to the deductible and

co-insurance only. Does NOT include copays.

After you spend First $1000 of the calendar year deductible per member

(to a max of 3 per family).

Then, you maybe reimbursed for

Last $2500 of deductible per member (to a max of 3 per family).

Max calendar yearreimbursement perEmployee/Family

$2500 per insured person to a max of $7500 each calendar year.

Tips to Using Your HRA BenefitYou must submit a claim to be reimbursed for

eligible expenses.

To get your claim processed quickly, submit:

A completed, signed, paper claim form timely

Backup documentation with the claim

Back up documents verify an eligible member has

incurred qualified reimbursable expenses during the

year.

The Summary Plan Description (SPD) and claim form

outlining the benefits, rights and restrictions of the

plan is provided and/or made available within 60

days of the effective date of coverage to all

participants. Copies of plan documents and claim

forms are available, at no charge, by requesting a

copy, in writing, from the Plan Administrator.

Review your SPD and/or HRA claim form for more

details.


14/36


Keep Smiling

with Our Dental Plan Tips

Rollover benefits are included!

Your plan includes no cost preventative benefits.

Certain health conditions may qualify for more preventative

benefits.

Network providers make your dental benefit dollars go farther.

Preventative benefits don’t count towards the annual max

benefit.

Your dental plan has a missing tooth exclusion limitation.

Cleanings are covered once each 6 months. (Not any sooner!)

A late entrant penalty applies if you decline the coverage

initially.

DentalPlanHighlights

In Network PlanHighlights

GuardianValue Plan

GuardianNAP Plan

Dental Plan Benefits Not viewing the doc electronically?Refer to printed materials

Double Click to

Open Here

Double Click to

Open Here

Type of Dental Plan

OPEN ACCCESS

POS

Primary Dentist

Referral Required

Network Name & Link DentalGuard

Preferred (PPO)

DentalGuard

Preferred (PPO)

Deductible CALENDAR YEAR CALENDAR YEAR

Individual $50 $50

Family $150 $150

Deductible Applies to NON-

PREVENTATIVE

ONLY

NON-

PREVENTATIVE

ONLY

Max AnnualBenefit/Member

$1,500++ $1,500++

Type I Preventative 100% 100%

Type II Basic 100% 80%

Type III Major 60% 50%

Type IV Child OnlyOrtho

50% to

$1500 Lifetime Max

50% to

$1500 Lifetime Ma

The mouth is the gateway to the body – keep it healthy! Remember, go

oral health is critical for good overall health.

People who access affordable preventative dental benefits regularly are

likely to need expensive, invasive procedures in the future.

Frequency Limitations Be familiar with frequency limitations

most commonly found in dental, vision

and/or prescription plans.

Common examples of benefit

provisions that have frequency

limitations include:

Dental Vision Rx Cleanings Exams Dosage

X-Rays Lenses Pills

Materials Frames

Pre-Treatment EstimateA pre-treatment estimate is a written

estimate of your share of the cost and

how much the plan will pay for a

dental treatment plan.

Request your dental provider to submit(on your behalf) a ‘pre-treatment

estimate’ to the dental plan for any

dental services that are likely to

exceed $250.

Getting a pre-treatment estimate

allows you to budget for out of pocket

dental expenses in advance.

Your dentist may also be able to

present alternative treatment options

that will lower your share of the bill,

while still meeting your basic dentalcare needs.

Got a DHMO?A DHMO (dental health maintenance

organization) is a discount plan that

offers unlimited dental benefits.

However, there’s a tradeoff – a fairly

restrictive provider network.

A DHMO also requires you to elect a

Primary Care Dentist.

A DHMO plans only cover services

performed by your Primary Care

Dentist or by a referred network

specialist.

You can change your primary care

dentist by calling the dental plan.


http://www.guardiananytime.com/http://www.guardiananytime.com/http://www.guardiananytime.com/http://www.guardiananytime.com/http://www.guardiananytime.com/http://www.guardiananytime.com/http://www.guardiananytime.com/http://www.guardiananytime.com/


15/36


VisionPlanHighlights

Getting a routine eye exam at least once a year ensures

our vision is maintained and it helps maintain good

overall health.

ome of the benefits of getting preventative eye exams:

Maintain good eyesight and health.

Catch illnesses early.

Identify early learning or developmental issues.

In NetworkPlan Highlights

Guardian Vision

Vision Plan Benefits Not viewing the doc electronically?Refer to printed materials

Double Click to Open

Here

Provider NetworkPlan Name & Link

Davis Network

PreventativeExam Co-Pay

$10

Material Co-Pay (Lens or Frames)

$20

Elective Contact LensAllowance Per Year

$120

Benefit Frequency

Exam12 MONTHS

Lens 12 MONTHS

Frames 24 MONTHS

Our Tips Make It Clear

Purchase contact lenses from any provider.

Lens benefits are either for your eyes or frames.

Contact lens fitting fees may not be covered – ask!

Spend 100% of your contact lens benefit at once.

Your plan offers access to discounts, such as Lasik.

Network providers make benefit dollars go further.

Healthy Body – Healthy MindMental health disorders are the leading cause

disability in the United States. The resulting disea

burden of mental illness is among the highest of

diseases.

Mental health disorders account for 25% of all years

life lost to disability and premature mortality. Men

health plays a major role in people’s ability to maintagood physical health.

Mental illnesses, such as depression and anxiety, affe

people’s ability to participate in health-promoti

behaviors. In turn, problems with physical health, su

as chronic diseases, can have a serious impact

mental health and decrease a person’s ability

participate in treatment and recovery.

The tools and resources are virtually unlimited. Use yo

plan resources and what’s provided by public hea

and non-profit organizations to stay on top your heal

Feed your mind & soul with good things –

your health shows it.

Healthy $ Habits – Be Wise & Beware

This table shows howthe average

American spendsmore than $0.75 of

every $1.00 he or shemakes!

Food & Housing:36.34%

Transportation12.29%

Healthcare5.05%

Personal Insurance & Retirement8.6%

Income Taxes15.02%

Taxes are a large part of your expenses. Our pre-t

plans help you pay less taxes.

Insurance is a necessity and essential to a sou

financial plan. However, when you can – buy as little

possible – but always as much as necessary.

Finally, the best way to spend less on healthcare is

need it less – being heathy is the best way to sa

yourself some money and heartache.

Little improvements = big impacts!

http://www.guardiananytime.com/http://www.guardiananytime.com/


16/36


When you use it, youcost share to a cap!The cap is called the out ofpocket maximum. It startsover when your plansrenews or Jan 1. Even whenyou’re meeting your

deductible – you’ve gotcoverage!

Use your benefits!

Preventative care iscovered at 100%. Plus, youcan receive medical carefrom in-network doctors andhospitals and getprescription coverage usingsignificant memberdiscounts!

Start by SHOPPING!!! Our dedicated team is here to assistyou with finding the best plan for you,

your family and your company!

You pay each monthto belong!By paying your monthlypremium, you have manybenefits of membership!

Review Your PlanPeriodically!Let us help you review yourplan every year or if youhave a life change to makesure you’ve got the right

plan for your situation.

ealthPlanBasicsth the cost of delivering high tech medical and pharmacy care and an

ging population, health plans continue to increase in cost. It pays to pick

e right plan for you! We can help!

he Life Cycle of a Member

The Building Blocks of Health PlansDeductibles, co-insurance and co-pays are ways members’ cost shathe insurance company for the high cost of medical care.

In most instances, all three apply to the annual ‘out of pocket maximu

The out of pocket maximum limits what the member pays in a (calen

plan) year.

You’ve got coverage during the time you are meeting the annual dedu

and you still receive the value of significant negotiated (discountedwhen using network providers. Network discounts can range from 10-

The cost of your plan (monthly premium) is based on the benefi

purchase. The richer the plan – the more expensive the premium – as

below.

TraditionalHealth Plans

HDHPs(H.S.A. Eligib

Annual DeductibleCalendar or plan year

Usually applies to servicesother than doctor’s visits

or prescriptions.

You may have a smallseparate Rx deductible

for expensive meds.

Applies to all coveexpenses.

The family deductibembedded (per pe

– or – unembedded (shar

Co-Insurance %After you have met your plan’s deductible, the p

begins to cost share with you in the form of coinsurance.

Co-PaysFixed or flat dollar expenses

Usually, you will have co-pays for things like docvisits and prescriptions.

You may have co-pas a form of cost shafter you have met

deductible.

Free Preventative

Covered at 100% - Waive Deductible


17/36

|Printed 2/12/15 The Benefit Guide© Copyright 2013-15. Benevestco. All rights reserved.

zing it Up & Adding It Up Comparing Different Health Plans – What it MeaThere’s pros and cons to every plan. It’s important to pick the right pyou. When it makes sense, keep as much $ in your pocket as possible

buy the right amount of insurance – not too little and not too much.

Doc Visits &Prescriptions

The plan cost shares withyou for day to dayexpenses for things likedoc visits and meds. Inreturn, you pay a higher

premium or have ahigher out of pocket limit.

For a lower premiuout of pocket limit,pay for day to dayexpenses for thingsdoc visits and

prescriptions up toplan’s deductible.

Annual Deductible

(Can be calendaror plan year)

The plan applies the

deductible to most all

other covered benefits

aside from doc visits and

medications. Some plansdo have prescription

deductibles for

expensive meds.

The plan applies th

deductible to all

covered benefits.

PreventativeBenefits

Covered at 100% - waive deductible.

Premiums &Renewal Increases

Traditionally higher

premiums and renewalincreases.

Traditionally lower

increases and lowe

renewal increases.

The idea is to fund pre-tax Health SavAccount to pay fo

of pocket expense

a tax free basis fro

the premium savin

Typically, this planis ideal for

Those with moderate

health or who need help

with the cost of everydaycare (doc & Rx) or who

are over age 65.

Those who are rea

sick or really health

TraditionalCo-Pay Plans

QHDHP’s (HSA Eligibl

Benefits are paid onyour behalf if you use theplan.

The lower the price, themore you pay if you usethe plan.

Remember – all planshave an annual cap(called an out ofpocket maximum) of what you may pay touse the plan.

rice (Premium)a promise to pay

hether you use it or not.

In the end, you add the premium to the total you spend (or couldspend) to determine your true cost for the plan.

Opt 1 Opt 2 Opt 3

Total Premium for the year _______ _______ _______

+ (add) Out of Pocket _______ _______ _______

- (less) Tax benefits, If any _______ _______ _______

= Real cost for the year _______ _______ _______


18/36

|Printed 2/12/15 The Benefit Guide© Copyright 2013-15. Benevestco. All rights reserved.

ImportantInformationThe plans provide documents including Summaries of Benefits &

Coverage, Insurance Certificates. As well as, Summary PlanDescriptions (also known as SPD’s) outline, in detail, plan provisions

such as benefit eligibility, limitations and exclusions and your rights and

responsibilities as a plan participant.

These documents are provided &/or made available within 60 days of

the effective date of coverage to participants. Copies are available,at no charge, by requesting a copy, in writing, from your Plan

Administrator.

Get Your SBCs In an effort to comply with Affordable Care Act (Healthcare Reform),a copy of the Summary of Benefits & Coverage (SBC) for our health

plan(s) is provided and available to you.

The SBC is designed to help you better understand and evaluate your

health insurance choices and includes:

Short, plain language explaining benefits & coverage

A uniform glossary of health insurance terms

Coverage details which are comparison tools

You may also request a copy of the glossary of terms from your health

insurance company or group health plan. To learn more, contact the

health plan, the Plan Administrator or our Resource Center.

Finally, if you don’t speak English, you may be entitled to receive the

SBC and uniform glossary in your native language upon request to your

health insurance company or group health plan.

The Plan AdministratorT & O Refrigeration 170 Walter WayFayetteville, Georgia 30214770-461-5217


Health Plan Tips

Always present your insurance ID card.

Your health plan negotiates discounts with network providers (physclinics and pharmacies, etc). Use network providers - network discoun

be substantial!

Only pay what the insurance company tells you to pay. You can g

information from an Explanation of benefits (EOB). The EOB shows you

you owe for each covered claim.

Deductibles are based on a ‘calendar’ or ‘plan’ year. Know which applie

to your plan! A health plan deductible is also described as:

Un-Embedded Deductible:

A combined deductible shared by the employee & dependents. IE. a

family members' deductible expenses apply to the shared fami

deductible. This deductible is always associated with a H.S.A. eligib

health plan.

Embedded:A per person deductible applies. Any per person deductible incurre

applies to the maximum family deductible.


19/36


LifeBenefitsife insurance is an important and basic tool in any

nancial plan. Chances are, if someone will suffer

nancially when you die, chances are…you need or don’t

have enough life insurance!

& O Refrigeration helps you by providing (at no cost to

ou) base life benefits and offering supplemental life

benefits that are easy to get. And, the amount of basefe provided, has no impact on the amount of

upplemental life benefits you can elect.

Other Life Plan Highlights

lease note, in subsequent years, the rate is based on your

age as of the plan year anniversary (beginning) date. Use

he rate table to calculate the rates or our portal will do it

or you. Age reductions and/or limitations apply to our life

benefits.

And, remember, life insurance at work should supplement

our personal life insurance.

BASELIFE

SUPPLEMENTALLIFE

Life Benefit InfoClick on the icon toview more plan info

Double Click to

Open Plan Info

Double Click to

Open Plan/Rate

Info

Max Amt of Benefit

employee Up to $15K Up to $100KSpouse N/A

100% of EE to

$50k

Children N/A50% of EE to

$10k

Accidental Death

&

Dismemberment

Benefits

Included Included

Living Benefits Included Included

Benefits may be

continued if youleave the Co?

Yes Yes

Waiver

of PremiumIncluded Included

Rates are

determined by

amount of

coverage plus:

N/A- Your

Employer Pays

for this

Coverage

You:

Your age

Your Spouse:Your age

Your Children:One rate covers

all children!

Money Matters & Life TipsYour benefits at work can help you bridge gaps in yo

personal financial plan! A sound financial plan –

matter your financial status – includes every aspect

your finances. Be determined to make heal

progress – mind, body & bank account! You’re m

likely to succeed if you commit to your plan in writing

• Make sure you are properly insured (not too muchnot too little!).

• Pay debt down (& keep it down!).• Plan for the future - save and invest!• Take advantage of freebies & tax savings strateg

offered.

• Ensure you have adequate insurance & emergensavings that provide a safety net for you and yfamily.

• Keep a valid will, living will and estate plan in plaand review them periodically to ensure they contin

to meet your needs.

• Use advice from experts who have your best interes

mind.

7 Life Insurance Beneficiary Tips1. Naming a minor child or forgetting a spouse

If you haven't created a trust or made any le

arrangements for someone to manage the mon

the court will appoint a guardian, a costly proce

to handle the proceeds until a minor child reach

18 or 21, depending on the state. And, if you live

a community property state, your spouse must s

a waiver to relinquish rights to your life insuran

proceeds.

2. Failing to keep it up to dateReview your policy every few years and after ma

life events to ensure coverage and beneficiaries

up to date.

3. Only naming a primary beneficiary

Always name a contingent or second

beneficiary.

4. Making a dependent ineligible for gov’t benefitsNaming a lifelong dependent, such as a child w

special needs, as beneficiary can put him/her at

for losing eligibility for government assistance.

5. Falling into a tax trapMost often, life insurance proceeds are tax fre

but, naming the wrong beneficiary can create

taxable event.

6. Assuming your will trumps the policyA life insurance policy is a contract. Regardless

what your will says, the life insurance money will

paid to the beneficiary listed on the policy.

7. Not telling someone who’s in charge Tell someone so they know you have a life insuran

policy, where it is and how to (easily) find it.


20/36


EmployeeAssistancePlanveryone needs a little help in dealing with life’s

challenges from time to time. Our Employee Assistance

lan (EAP) can help with many important real life issues!

Using an EAP can save time and money and gives access

o free benefits regardless of health plan coverage. Use

our EAP for help with:

Substance abuse

Emotional distress

Financial needs

Major life events & health care

concerns

Personal or work relationship issues

EAP

BenefitHighlights

Double click to open plan infoNot viewing the doc electronically?

Refer to the printed materials provided

Benefits are extended to all family

members.

Unlimited 24/7 telephonic & on-line

services.

There’s no cost to use the benefit.

3 free face to face counseling

sessions per year. All other benefits

are unlimited.

Identity Theft benefits are included.

Will preparation services areincluded.

o learn more, contact the EAP plan or visit our EAP plan’s

member home page:

AP plan member home web page.

Username – MattersPassword- wlm70101

7 Facts You Should Knowabout Buying Health Insurance Toda

1. You can only buy it during certain times of the yea. Annual Open Enrollment, or

b. If you become newly eligible to a plan, or

c. If you experience a Qualifying Life Event

2.

You can buy it from 3 sources: a. At work (if offered)

b. Individual/Medicare Market**

c. Healthcare.gov**

3. Most must have coverage or pay a penalty. (Sompeople qualify for an exemption based on incom

or other factors.)

4. You aren’t eligible for a subsidy if you: a. Make too much or make too little;

b. Or your spouse have access to qualified

coverage available at work or government

sponsored coverage (Medicare, Tricare,

Medicaid); or

c. Aren’t a legal citizen (or haven’t filed your

federal income taxes)

5. You don’t have to buy health plan coverage athealthcare.gov (the Marketplace). In fact, youshould only buy it there if you’re subsidy eligible adependent on the subsidy to get coverage.

6. Buying health insurance at work is usually the mocost effective way to do so because of pre-tax.

(Thank your employer!)

7. If you change health plans midyear you may loseall of the money you have paid towards your heaplan’s deductible and out of pocket limit. Checkwith your health plan for more details.

**These plans renew January 1 annually.

Know What it Costs?

U.S. U.S.: Private

EmployerU.S.: Public

Employer

Total $4,939 $5,222 $6,157

Average 'Employee Only'

Healthcare Costs in the U.S.

http://www.ibhworklife.com/http://www.ibhworklife.com/


21/36


AccidentBenefitsAccidents happen to all kinds of people every day.

Accident benefits are ideal for those who have an active lifestyle or

who play sports.

Accident benefits are designed to provide cash benefits by reimbur

an insured throughout different stages of care, regardless of the severi

the injury.

Benefit Highlights Accident Benefits

AccidentPlan BenefitsNot viewing the doc electronically?Refer to printed materials

Double Click to Open the Plan

Summary

Wellness Incentive$100 each year for employee only

for simply for getting a wellness

exam – even if the exam is ‘free

Benefits are forTreatment received for covered o

and on the job accidents.

Benefits Begin 1st day of coverage for any cover

accident.

Other Perks

Benefits are paid regardless of oth

coverage.

Plus, benefits are paid directly to y

- tax free.

Accidents happen…. When they do – they don’t have to wreck your life.

Planning AheadReality is…death is a real fact of life and

disability can be.

Both carry harsh consequences if not

planned for properly. In fact, most

Americans admit they:

Wouldn’t be able to meet expenses if

they couldn’t work for a period of

time; and

Don’t have enough life insurance.

Insurance provides peace of mind. And,

while you have a budget, insurance has

to be on the list.

Basic Financial Tips The average person needs 7-12 times

his/her annual income in life insurance

coverage. If your family depends on your income,

protect it with disability.

Set aside 3-6 months of income for

emergency savings.

Be prepared for the unexpected.

Have adequate savings to protect your

finances or insure them with disability.

Ask Yourself What are my biggest assets?

Do I have adequate insurance to

protect my biggest assets?

Have I planned properly?

Insure the things you cannot afford to lose

- get as much coverage as necessary and

yet as little as possible.

Plus, if you’re married and/or have kids,

you need to make sure you have the

proper wills and healthcare documents in

place.

Having a valid will gives you the ability to

have a final say in what happens to your

assets when you die.


22/36


CriticalIllness&CancerBenefitsCritical illness benefits can provide a lump sum cash payment to help

deal with the unexpected costs of a serious illness.

Benefits are paid regardless of other coverage.

Benefit HighlightsTax free cash benefits are paid directly to you upon the diagnosis o

(covered) critical illness or occurrence of cancer.

Critical

Illness Plan BenefitsNot viewing the doc electronically?Refer to printed materials

Double Click to Open Here

Reoccurence Benefits Included.

Wellness Incentives

$100 each year for employee only for simply getting a wellness o

preventative exam – even if the

wellness or preventative exam i

‘free’!

Rates are Determinedby…

The Amount

of Coverage Plus

You:Your age

Your Spouse:

Your spouse’s age

Your Children:

One flat rate covers all children!

Rates ChangeWhen you hit a new age bracket aanniversary.

Age reductions and restrictions apply to this benefit.

Kicking CancerGetting diagnosed with cancer

changes your life – but, it doesn’t have

to end it!

Staying positive, living healthy and

being financially able to fight the

disease can make all the difference in

the outcome.

Learn about your condition.

Seek care from the best practioners

avaialble in treating your disease. Stick

to your guns – rely on people who care

about your health.

Seek natural foods and activities to

compliment medical treatment.

And…if you’re lucky enough to have

never had the diagnosis, try to helpyour body keep it that way!

Healthy living is simple…eat fresh

vegetables and fruits. Lean meats and

good fats.

Stay active.

And, most of all, keep a positive

attitude – knowing that your…attitude

is a little thing that makes a big

diference.

The heart of any battlestarts in the mind – stay strong.


23/36


WeNeedYourHelptoMakeit

WorkatWork!t’s no surprise that insurance and healthcare costs

continue to escalate at an alarming rate.

Creative plans, rate reviews and partnering with our

Consultant/Broker, Resource Seven, helps us avoid

nreasonable cost increases.

you want to have the best plans at the lowest cost, you

must also take responsibility in the process by actively

managing your health, even if by small improvements!

he truth is – we’re in this together.

ach of us can do our part so that together we are a

healthy, happy and safe workplace!

And, please remember, to respond to HR timely – you are

a critical part of any process!

AfterEnrollment– What ’ sNext

Please notify your Plan Administrator immediately if

discrepancy(s) exists.

Whether you’re new to the plan, have ha

a qualifying event or just completed opeenrollment – take note:

Make sure all of your dependents ar

enrolled correctly – before you need to us

the coverage! Call or log into the plan tconfirm enrollment today.

Get your Health, Dental & Vision ID Cards

make sure they reflect the correct pla

and dependent coverage.

Check payroll deductions – they shou

coincide with your elections.

Get the information you need about th

plans elected – Summary Plan Description

and Certificates of Insurance providimportant plan details to plan participant

Information is available &/or distribute

within 60 days of enrollment or if bene

plan changes occur by accessing th

corresponding plan’s ‘Member Hom

Page’ or by requesting, in writing, a cop

of plan documents from your Pla

Administrator.

If you had to apply (provide health histor

for any (non-health) plan, you will b

notified of approval or denial. You will no

have coverage until/if approved.

The underwriting process involve

collecting health history from you, yo

Medical Information Bureau profile, and/

physician’s records.

http://www.mib.com/http://www.mib.com/http://www.mib.com/


24/36


Before Calling on a Claims IssuePlease Take These Few Steps…

You do not havethe EOB(s)

If you have not receivedan EOB from the plan

that corresponds to thedate and/or charges

billed by the provider,contact the plan toconfirm that the claimhas been received and

processed.

If the plan has notreceived the claim, stophere - you do not have aclaims issue - the claimmust be submitted to

the plan.

Contact the billingprovider and requestthem to file the claim.

You do have theEOB(s)

Match provider (doctodentist, hospital, etc.statements received tthe EOB’s (Explanatioof Benefits) sent by th

plan.

Check your EOB todetermine if the plan

has received the claim

Has the plan asked youprovider for additiona

information necessary process the claim?

Stop here - you do not hava claims issue - this is provider problem.

Please contact thprovider to request thathey comply with thinsurance company

request for additioninformation required by thplan to process the claim

NeedHelpwithClaimsIssues? you need help with a health, dental or vision claim,

before contacting our Resource Center take the simple

teps below to help determine the best and most efficient

course of action to help you resolve your issue.

n most instances, you need the Explanation of Benefits

EOBs) that corresponds to the claim in question.

OBs are generated by the plan when a claim ispresented for payment. EOBs identify how the claim is

paid and the amount you owe, if any.

After taking the steps above, if you determine:

Claim has been received by the plan,

Provider has provided all of the required info to the

plan, and,

Plan is refusing to pay the claim properly,

Call our Resource Center so that they can assist you

with your claims problem!

After taking the steps above, if you

determine:

Claim has been received by the plan,

Provider has provided all of the required

info to the plan, and,

Plan is refusing to pay the claim properly,

Call our Resource Center so that they can assistyou with your claims problem!


25/36


Continue,ConvertorPort?An employee or dependent must remain ‘eligible’ as defined by

rules of the plan(s) in order to maintain coverage. However, if yo

your dependents fail to meet the eligibility requirements, you may

able to keep your benefits at your own expense without regard to y

health status.

The chart below describes the different ways you can retain cover

outside of work.

Specific rules determine your ability to continue, convert or

coverage. These rules can be found in each plan’s Insura

Certificate or Summary Plan Description document.

In any instance, you or your covered dependents must be acti

participating in the benefit(s) the day prior to loss of ‘eligible statu

order to continue, convert or port coverage. You must also reque

retain your coverage &/or make payment arrangements withindays of losing benefits eligibility status.

To determine eligibility rules, conversion, portability or continua

options, review your Insurance Certificate or SPD or contact the pla

your Plan Administrator.

Summary Plan Descriptions (SPD’s) and Insurance Certificates

available &/or distributed within 60 days of enrollment or if benefit p

changes occur. All plan information is available to you by acces

the corresponding plan’s ‘Member Home Page’ or by requestin

writing, a copy of plan documents from your Plan Administrator.

Questions?To obtain information about your COBRA rights, please contactCOBRA Administrator, Aetna, 866-472-0897. To obtain informa

about portability or conversion, please contact the Plan Administra

When one door closes,So another opens…

Keeping Coverage on Your Own with...

Conversion

The ability toconvert group life

insurance toindividually owned

life coverage

(typically convertedto a form of

permanent life).

Continuation

The ability tocontinue Health &Welfare benefits atthe same cost andcoverage offered

to activeemployees.

Portability

The ability forcertain individualsto elect coverageon an individual

basis at the same

rate structure.

Loss of Benefits EligibilityBelow are examples of events that can

trigger a loss of eligibility for:

You (the Employee):• Fail to maintain an 'Actively at Work' status.

• No longer work the required # of hours.

•

Resign, retire or are terminated.• Are on an extended absence (beyond 30

days).

• Exhaust FMLA, if available.

• Exceed the age limitations of the plan.

• Permanently move out of the health plan's

network service area.

Your Dependents:• Exceed the age limitations of the plan.

• Lose eligibility b/c employee loses eligibility.

•

Death of a covered employee.• Lose eligibility due to a divorce.

• Permanently move out of the health plan's

network service area of the plan.

When Benefits EndIf you or your dependents fail to meet the

eligibility requirements of the plan, your

benefits will end the date you or yourdependents are no longer eligible.

However benefits end the last day of themonth after a loss of eligibility for thefollowing:

• Health & RX

• Dental & Vision

• HRA Benefits

No worries! –

Many of your benefits can be retained by

paying for them outside of work – contact

the Administrator or Resource Center for help

and more information.

When You Have a Life Change– Consider All OptionsWhen you lose coverage, have a life change

or just have a birthday - it’s the perfect time

to consider all of your options. Our Resource

Center Can help.

Resource Center 770.716.3200

http://localhost/var/www/apps/conversion/tmp/scratch_2/It%E2%80%99s%20important%20to%20know%20when%20these%20options%20apply%20to%20you%20and%20your%20rights.


26/36


Self-CareTipsSaveYou$Below are a few tips: Take personal responsibility for your health & finances.

Avoid unnecessary stress in your personal or work life.

Look for ways to become less dependent on sickness related healthcare.

Utilize your plan’s ‘freebies’ and member resources – your plan might also offer member discounts – ask!

Make healthier choices: exercise, rest, nutrition, etc. – progress not perfection is something you can achieve

Be informed and make wise use of time. For example,make a list of your questions in advance of an

appointment or trip to the pharmacy. Research your

situation to get an idea of common questions.

Live a lifestyle that keeps you out of the doctor’s

office.

Use preventative benefits – for your eyes, teeth and

body! If you elect the coverage, preventativebenefits are free (health and dental) or just a small co-

pay (vision).

Life is full of nice

surprises -

PreventativeBenefitsPreventive care helps you stay healthy.

Use preventative benefits – for your eyes, teeth and bo

If you elect the coverage, preventative benefits are

(health and dental) or just a small co-pay (vision).

With the advent of Healthcare Reform, most plans m

cover the following list of preventive services at no when these services are delivered by a network provi

Preventive Services for Adults1. Abdominal Aortic Aneurysm one-time screening

specific age men who have smoked

2. Alcohol Misuse screening & counseling

3. Aspirin use to prevent cardiovascular disease for m

& women of certain ages

4. Blood Pressure screening for all adults

5. Cholesterol screening for adults of certain ages o

higher risk

6. Colorectal Cancer screening for adults over 50

7.

Depression screening for adults

8. Diabetes (Type 2) screening for adults with high bl

pressure

9. Diet counseling for adults at higher risk for chr

disease

10. HIV screening for everyone ages 15 to 65 & other a

at increased risk

Self care is key in health promotion,decisions and actions that allow you tobetter cope with or prevent a health

problem.

Remember, when it comes to aserious health condition, earlydetection is the key to success.

Most importantly, being wise aboutyour health will save you money

and can save your life.

https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1http://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/talk-to-your-doctor-about-abdominal-aortic-aneurysmhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/drink-alcohol-only-in-moderationhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/talk-with-your-doctor-about-taking-aspirin-every-dayhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/talk-with-your-doctor-about-taking-aspirin-every-dayhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-blood-pressure-checkedhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-blood-pressure-checkedhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-cholesterol-checkedhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-cholesterol-checkedhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancerhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancerhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/talk-with-your-doctor-about-depressionhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/take-steps-to-prevent-type-2-diabeteshttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/take-steps-to-prevent-type-2-diabeteshttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/eat-healthyhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/eat-healthyhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hivhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hivhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hivhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hivhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/eat-healthyhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/take-steps-to-prevent-type-2-diabeteshttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/talk-with-your-doctor-about-depressionhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancerhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-cholesterol-checkedhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-blood-pressure-checkedhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/talk-with-your-doctor-about-taking-aspirin-every-dayhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/drink-alcohol-only-in-moderationhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/talk-to-your-doctor-about-abdominal-aortic-aneurysmhttps://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1


27/36


1. Immunization vaccines for adults--doses,

recommended ages & populations vary:

2. Obesity screening & counseling for all adults

3. Sexually Transmitted Infection (STI) prevention

counseling for high risk adults4. Syphilis screening for all adults at higher risk

5. Tobacco Use screening for all adults & cessation

interventions for tobacco users

Covered Preventive Services for Women. Anemia screening on a routine basis for pregnant

women

. Breast Cancer Genetic Test Counseling (BRCA) for

women at higher risk for breast cancer

. Breast Cancer Mammography screenings every 1 to 2

years for women over 40. Breast Cancer Chemoprevention counseling for

women at higher risk

. Breastfeeding comprehensive support & counseling

from trained providers, & access to breastfeeding

supplies, for pregnant & nursing women

. Cervical Cancer screening for sexually active women

. Chlamydia Infection screening for younger women &

other women at higher risk

. Contraception: Food & Drug Administration-

approved contraceptive methods, sterilization

procedures, & patient education & counseling, as

prescribed by a health care provider for women with

reproductive capacity (not including abortifacientdrugs). Does not apply to health plans sponsored by

certain exempt “religious employers.”

. Domestic & interpersonal violence screening &

counseling for all women

0. Folic Acid supplements for women who may become

pregnant

1. Gestational diabetes screening for women 24 to 28

weeks pregnant & those at high risk of developing

gestational diabetes

2. Gonorrhea screening for all women at higher risk

13. Hepatitis B screening for pregnant women at thei

prenatal visit

14. HIV screening & counseling for sexually active wom

15. Human Papillomavirus (HPV) DNA Test every 3 year

women with normal cytology results who are 3

older

16. Osteoporosis screening for women over age

depending on risk factors

17. Rh Incompatibility screening for all pregnant wom

& follow-up testing for women at higher risk18. Sexually Transmitted Infections counseling for sexu

active women

19. Syphilis screening for all pregnant women or o

women at increased risk

20. Tobacco Use screening & interventions for all wom

& expanded counseling for pregnant tobacco us

21. Urinary tract or other infection screening for pregn

women

22. Well-woman visits to get recommended service

women under 65

Covered Preventive Services for Childr1. Autism screening for children at 18 & 24 months2. Behavioral assessments for children at the follow

ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 1

14 years, 15 to 17 years.

3. Blood Pressure screening for children at the follow

ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 1

14 years, 15 to 17 years.

4. Cervical Dysplasia screening for sexually ac

females

5. Depression screening for adolescents

6. Developmental screening for children < age 3

7.

Dyslipidemia screening for children at higher rislipid disorders at the following ages: 1 to 4 years,

10 years, 11 to 14 years, 15 to 17 years.

8. Fluoride Chemoprevention supplements for child

without fluoride in their water source

9. Gonorrhea preventive medication for the eyes o

newborns.

10. Hearing screening for all newborns

11. Height, Weight & Body Mass Index measurement

children at the following ages: 0 to 11 months, 1

years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 12. Hematocrit or Hemoglobin screening for children

13. Hemoglobinopathies or sickle cell screening

newborns

14. HIV screening for adolescents at higher risk

15. Hypothyroidism screening for newborns

Hepatitis A

Measles Mumps, Rubella

Hepatitis B

Meningococcal

Herpes Zoster

Pneumococcal

Human Papillomavirus

Tetanus, Diphtheria, Pertussis

Influenza (Flu Shot)

Varicella

http://healthfinder.gov/HealthTopics/Category/doctor-visits/shotsvaccines/get-important-shotshttp://healthfinder.gov/HealthTopics/Category/doctor-visits/shotsvaccines/get-important-shotshttp://healthfinder.gov/HealthTopics/Category/doctor-visits/shotsvaccines/get-important-shotshttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/watch-your-weighthttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/watch-your-weighthttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilisht