Health and Welfare Benefits Handbook CONTENTS
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B enefits Health and Welfare Benefits Handbook CONTENTS 5 General Information 19 Plan Year 6 Introduction 19 Agent for Legal Process 6 How the INTEGRIS Benefit Program 19 How Benefits Are Funded Works 20 Administration of Benefits 7 Other Benefits 22 Your Rights Under ERISA 7 Who Is Eligible to Participate 10 Enrolling in the Plan 23 Your Benefits Medical Plan 11 Changing Your Benefit Options 24 Your Options 12 When Coverage Begins 25 Who Is Eligible to Participate 13 When You Reach Age 65 26 An Overview of the Medical Plan 13 If You Go on Leave of Absence 28 Prescription Drug Benefits 14 When Coverage Ends 29 Save Money with Generics 15 COBRA Continuation of Coverage 17 Coordination of Benefits – Medical Plans 29 Prescription Drug Step Therapy 29 How the Step Therapy Program Works 18 If Your Claim for Benefits Is Denied 18 Third-Party Settlements 30 How the Medical Plan Works 18 Plan Sponsor and Administrator 35 Clinical Management Services 18 Plan Amendment or Termination 36 What the Medical Plan Covers 19 Plan Sponsor Employer Identification Number 45 What the Medical Plan Does Not (EIN) Cover 2 Health and Welfare Benefits Handbook RETURN TO TABLE OF CONTENTS GENERAL INFORMATION 48 How to File a Claim 69 Imputed Income 51 Other Information 69 Accelerated Death Benefit 51 Definitions 70 If You Become Disabled 70 Dependent Life Insurance Options Employee Wellness 71 Proof of Good Health for You and Your 54 A Shared Commitment for Your Health Spouse 71 Employee PAI Options Dental Plan 72 Dependent PAI Options 57 Your Options 72 What PAI Covers BENEFITS YOUR 57 How the Dental Options Work 73 Common Carrier Benefit 58 What the Dental Options Cover 73 Seat Belt Benefit 60 What the Dental Options Do Not Cover 73 Special Higher Education Benefit 61 How to File a Claim 73 If You Are Traveling 61 Other Information 73 What PAI Does Not Cover 74 General Information about Life Insurance Vision Plan and PAI 62 Your Options 74 How to File a Claim 62 How the Vision Plan Works 75 Other Information 63 Laser Surgery Discount What the Vision Plan Covers Short-Term Disability Plan 64 SPECIAL PROGRAMS 65 What the Vision Plan Does Not Cover 76 Your Options 65 How to File a Claim 76 Who Is Eligible to Participate 66 Other Information 76 How Premiums Are Calculated 76 Benefit Waiting Period Voluntary Benefits 76 When You Receive Benefits 67 Hospital Indemnity Insurance 77 Amount of Your Benefit 67 Accident Insurance 77 How Short-Term Disability Works 67 Critical Illness Insurance 67 Whole LIfe Insurance Long-Term Disability Plan 80 Your Options Life Insurance and Personal Accident 80 Who Is Eligible to Participate Insurance (PAI) Plans 80 Benefit Waiting Period AND RESOURCES NOTICES 68 Introduction 80 When You Receive Benefits 68 Employee Life Insurance Options 81 Pre-Existing Condition Limitation 68 What Life Insurance Covers 81 Amount of Your Benefit 69 Annual Base Pay 82 Work Incentive Benefit 69 Benefit Reductions Based on Your Age 82 Maximum Benefit Period 3 Health and Welfare Benefits Handbook 82 Survivor Benefit 83 When the Plan Does Not Pay Benefits Adoption Assistance Program 103 Introduction 83 When the Plan Limits Benefits 103 Who Is Eligible to Participate 83 How to Apply for Benefits 103 How the Adoption Assistance 84 Short-Term Disability and Long-Term Disability Program Works Claims Procedures 104 Payment of Benefits 85 Short-Term Disability and Long-Term Disability Appeal Procedures 104 How to File a Claim 86 Other Information 104 Adoption Assistance Benefit vs. Tax Credit 105 Benefit and Tax Credit Limitations Selling PPL Days 87 Selling PPL Days Severance Plan 106 1.0 Purpose Reimbursement Accounts 106 2.0 Severance Benefits 89 Your Options 110 3.0 Administration 89 How Reimbursement Accounts Save 111 4.0 Amendment and Termination of The You Money Plan 91 How the Health Care Reimbursement 111 5.0 Definitions Account Works 112 6.0 Scope 94 How the Dependent Care Reimbursement 112 7.0 Additional Plan Information Account Works 112 8.0 Statement of ERISA Rights 97 COBRA Continuation of Coverage- Health Care Reimbursement Account Only 114 Notices and Resources 97 How to File a Claim For Your Reference 97 Other Information 115 Notice of Privacy Practices 98 Special Programs 119 Medicare Part D Notice of Creditable Coverage Employee Assistance Program (EAP) 121 Free or Low-Cost Health Coverage for Children 99 Introduction and Families 99 How EAP Works Information Resources Education Reimbursement Program 125 Phone Numbers and Addresses for Plan Claim 101 Introduction Administrators, Insurers and Providers 101 Who Is Eligible to Participate 101 How the Education Reimbursement Program Works 4 Health and Welfare Benefits Handbook general information This section outlines who can participate in INTEGRIS’ benefit plans, how you pay for coverage and when you can make changes. your INTEGRIS benefits Introduction How the INTEGRIS This handbook (Summary Plan Description) summarizes the health and welfare benefits available to eligible employees of INTEGRIS and its participating affiliates Benefit Program Works (“INTEGRIS”). These benefits are collectively called INTEGRIS pays a large portion of the medical premium INTEGRIS’ health and welfare benefit plans. You can for its full-time employees. Additionally, INTEGRIS obtain a list of participating affiliates from INTEGRIS covers the costs for Limited Care dental plan, basic life, Human Resources Customer Service. personal accident and long-term disability insurance at the Employee Only level. INTEGRIS also offers a number If you have any questions about your benefits, please of voluntary benefit programs, including vision, short- call INTEGRIS Human Resources Customer Service at term disability, hospital indemnity, accidental injury, 1-405-949-4045 or toll-free at 1-888-546-8347. critical illness, whole life, identity theft protection and Travelers Auto and Homeowners policies. More About Your INTEGRIS Benefits Your online enrollment form will show the price tags of With the INTEGRIS benefits program, you have a range the benefits that you can elect. of options in several benefit areas. Our program of benefits provides you financial protection during times when you need it the most. Selling PPL Days Each year at annual enrollment, you can sell future Paid INTEGRIS helps employees by providing a Personal Leave (PPL) days to receive additional money comprehensive program with many benefit choices to to help pay for your benefit elections. You can sell each meet diverse needs. As your needs change, you can day at a rate of eight times your base hourly rate. If you change your benefits. choose to sell PPL days, future accrual of PPL days will be reduced throughout the plan year by the amount of PPL you sell. Many benefits offer choice, known as options. Each option has a price tag based on the level of coverage it provides and the cost of providing that coverage. You choose the benefits that are most important to you and your family. 6 Health and Welfare Benefits Handbook RETURN TO TABLE OF CONTENTS GENERAL INFORMATION Tax-free and Taxable Premiums Other Benefits The INTEGRIS benefit program includes tax-free and taxable premiums. Federal laws determine whether a INTEGRIS provides these other benefits at no cost to you: premium is tax-free or taxable. This handbook does • Employee Wellness Program not provide that direction or advice. With “tax-free” premiums, you pay your share of the cost through payroll • Employee Assistance Program deductions before federal, state and Social Security taxes • Educational Assistance and Health Careers are withheld from your paychecks. Programs • Adoption Assistance Program Tax-free Premiums BENEFITS YOUR • Paid Personal Leave (PPL) and Extended Illness • Medical Accrual Bank (EIAB) • Dental • Time-Off Benefit for Organ Donation • Vision • Employee Life Insurance, with certain limitations Who Is Eligible • Employee Personal Accident Insurance • Long-Term Disability to Participate • Health Care Reimbursement Account Employees • Dependent Care Reimbursement Account If you are classified as a full-time employee of INTEGRIS and its participating affiliates, you are eligible to participate in all benefits described in this handbook. As a full-time employee, you must select the benefits you SPECIAL PROGRAMS Taxable Premiums want by your enrollment deadline; otherwise you will be • Dependent Life Insurance enrolled in the default benefits described on page 10. • Dependent Personal Accident Insurance If you are classified as a regular part-time employee of INTEGRIS you are eligible for all benefits except Paid • Short-Term Disability Personal Leave (PPL), Extended Illness Accrual Bank • Hospital Indemnity (EIAB), short-term disability and long-term disability. Certain other benefits may be reduced and are described • Accidental Injury more fully in the applicable sections of this handbook. • Critical Illness • Identity Theft Protection The Affordable Care Act and Medical • Whole Life Plan Eligibility The Affordable Care Act (“ACA”), also known as health Your “tax-free” premiums are like getting your benefits care reform, requires employers with more than 49 NOTICES AND RESOURCES NOTICES on sale. The actual cost of your benefits is reduced by employees to either pay a penalty or offer essential the savings you get from a tax-free benefit. medical coverage to any employee who is hired with the intent of working more than 30 hours per week or who is determined to have worked more than an average of 30 hours per week after a measurement period. 7 Health and Welfare Benefits Handbook INTEGRIS’ Approach to Individual and Annual ACA Compliance Measurement Periods INTEGRIS offers medical plan coverage to all full-time There are two types of measurement periods. There and regular part-time employees. At the time of hire, is an individual measurement period, and an annual coverage is not made available to occasional part-time measurement period. Newly hired employees start what (“OPT”) employees, as they are expected to work less is called an individual measurement period at time of than 20 hours per week on average (or less than 30 hire.