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9.1.2020 Benefit Guide Flipbook PDF
9.1.2020 Benefit Guide
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YOUR HEALTH
|
YOUR FAMILY
|
YOUR LIFE
BENEFITS ENROLLMENT GUIDE September 1, 2020 through August 31, 2021
WELCOME
Your benefits are an important part of your overall compensation. We are pleased to offer a comprehensive array of quality benefits to protect your health, your family and your way of life. This brochure was designed to answer some of the basic questions you may have about your benefits. Please read it carefully along with any supplemental materials you receive.
Eligibility
Choose Carefully!
You are eligible for benefits if you work 30 or more hours per week. You may also enroll your eligible family members under certain plans you choose for yourself. Eligible family members include:
Due to IRS regulations, you cannot change your elections until the next annual Open Enrollment period, unless you have a Qualifying Event during the year. The following are examples of the most common Qualifying Events:
Your legally married spouse
Your children who are your natural children, stepchildren, adopted children, or children for whom you have legal custody (age restrictions may apply). Disabled children age 26 or older who meet certain criteria may continue on your health coverage.
When Coverage Begins You must complete the enrollment process within 30 days of your date of hire. Your benefits are effective the 1st of the month following 30 days of full time employment. If you fail to enroll on time, you will not have benefits coverage (except for Company paid benefits).
Marriage or divorce Birth or adoption of a child Child reaching age 26 Death of a spouse or child Change in child custody Change in coverage election made by your spouse during his/her employer’s Open Enrollment period You lose coverage under your spouse’s plan
To make changes to your benefit elections, you must contact Human Resources within 30 days of the Qualifying Event (including newborns). Be prepared to show documentation of the event such as a marriage license, birth certificate, or divorce decree. If changes are not submitted on time, you must wait until the next Open Enrollment period to make your election changes. See inside to learn more about your benefits.
Medical Plans Cust-O-Fab is proud to offer you a choice of two PPO plans. Key Medical In-Network Benefits Deductible (per calendar year) Individual
PPO 1000
PPO 3000
$1,000
$3,000
Family
$2,000
$6,000
Out-of-Pocket Maximum (per calendar year) Individual
$4,500
$6,000
Family
$9,000
$12,000
Summary of Covered Services Physician Office Visit Specialist Office Visit Routine Preventive Care Outpatient Diagnostic Lab & X-ray Emergency Room Urgent Care Facility Inpatient Hospital Stay Outpatient Surgery Prescription Drugs (Tier 1 / Tier 2 / Tier 3) Retail Pharmacy (30-day supply) Mail Order (90-day supply)
Covered person