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2023 - Rogers - New Hire Guide Flipbook PDF
2023 - Rogers - New Hire Guide
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2 0 2 3│EMPLOYEE BE N E F I T S
IMPORTANT NOTICE: READ CAREFULLY This benefits guide briefly describes your benefit choices and your options to enroll. All benefits, and your eligibility for benefits, are subject to the terms and conditions of the benefit plans, including group insurance contracts. This guide is not intended to be a complete description of the benefit plans and it is not a summary plan description or plan document. In the event of any conflict or discrepancy between this guide and the plan documents, the plan documents will govern. The Plan Sponsor reserves the right to modify or terminate any of the described benefits at any time and for any reason. This guide is not a guarantee of current or future employment or benefits.
A MESSAGE FROM ROGERS MACHINERY Dear Valued Employee, Rogers Machinery knows that our most important asset is the dedicated employees that work hard to deliver the quality service that our clients have come to expect. Knowing that, we are committed to providing quality health benefits to our valued employees and eligible dependents. As you are aware, the cost of healthcare has continued to rise at double digit levels over the past decade. It is now one of the nation’s largest issues. Rogers Machinery has worked hard to create a solution that will control the rising cost to the company as well as our employees. We urge you to read this benefit guide carefully and keep it for future reference. When you are well informed, you are in a better position to make the appropriate choices and take full advantage of your benefits as a valued member of our team. We encourage you to contact Human Resources or the SolV Independent Insurance Associates’ Benefits Advocacy Line at 833.4.SolVIT or [email protected] if you should have any questions regarding your employee benefits package. Sincerely, Rogers Machinery
2023 BENEFITS GUIDE
TABLE OF CONTENTS
4
Eligibility and Enrollment
5
Eligibility and Changes
6
Medical
7
Medical: Network & Other Information
8
HST
9
Prescription
10
Dental
11
Vision
12
Contributions
13
Flexible Spending Accounts
14
Colonial Life: Group Life Insurance & Voluntary Benefits
15
Retirement
16
Other Benefits
17
Glossary of Terms
18
Benefit Plan Contact Information
19
Healthcare Notices
2023 BENEFITS GUIDE
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ELIGIBILITY & ENROLLMENT
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ELIGIBLITY All your healthcare benefits become available to you on the 1st of the month following your date of hire. In order to be eligible for company benefits you must work a minimum of 30 hours per week on a regular basis and be hired into a regular position. If you are not currently eligible for benefits, but in the future your employment status changes to an eligible class, you will be allowed to join the plan on the first of the month following your change in eligibility.
HOW TO ENROLL New employees will have the opportunity to request benefits information at the time of hire when completing their new employee paperwork. All enrollment elections and changes must be completed online through Paycom’s Employee Self-Service Center. Step 1: Visit www.paycom.com Step 2: Click LOG IN and then select EMPLOYEE From the Paycom portal, you will be able to: • Review detailed information about the available benefit plan options • View your paychecks • Request time off • Review your costs • Enroll in benefits • And more!
ELIGIBLE DEPENDENTS Our benefit plans are available to you and your family members. You can enroll yourself, your spouse, and eligible children of you or your spouse. Eligible children under the plan include biological, adopted, or children of whom you have legal custody, up to the age of 26. If your child is disabled before the age of 26, they may be eligible for continued coverage while disabled beyond age 26.
2023 BENEFITS GUIDE
ELIGIBILITY & CHANGES
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WAIVING COVERAGE If you elect to waive your coverage options through your employer, you still must act. You must decline benefits online in Paycom during your 30-day enrollment window. Please keep in mind that you will not be allowed to enroll in any of the offered plans if you later change your mind unless you experience a qualified event (see the following paragraphs). You will be allowed to enroll during the next Open Enrollment period if you are still eligible. Please note that you must provide a reason for declining coverage.
MAKING CHANGES If you experience a qualifying event such as marriage, divorce, birth/adoption of a child or you lose other group coverage you have 31 days to notify the Benefits Administrator and make changes to your elections.
HIPAA SPECIAL ENROLLMENT RIGHTS The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides employees additional opportunities to enroll in a group health plan if they experience a loss of other coverage or certain life events. If you are declining coverage at this time for either yourself or your eligible dependents, you may be able to enroll yourself and/or your eligible dependents in coverage at a later date if there is a loss of other coverage. You must enroll and provide the required supporting documentation within 31 days of the date your other coverage ends. In addition, you may be able to enroll yourself and your eligible dependents if you have a qualifying life event (e.g., change in your marital status, birth or adoption of a child, death of dependent or change in employment status.) You must enroll and provide the applicable required supporting documentation within 31 days of the qualifying life event. For additional information regarding your rights under HIPAA, please visit the US Department of Labor website at: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
REDUCTION OF HOURS If you experience a loss in hours and you are not regularly working the required 30 hours per week to maintain eligibility, you will lose coverage. You will be eligible for continuation of coverage when applicable.
IF YOU LEAVE YOUR JOB If your employment with Rogers Machinery ends, qualified beneficiaries will be offered COBRA continuation coverage. You will receive election paperwork and be given the opportunity to continue to cover yourself or your previously enrolled dependents on the plan. COBRA can be costly; you may also visit your state’s Exchange to find alternative options. 2023 BENEFITS GUIDE
MEDICAL
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The Health Plan (THP) / HST PPO
GENERAL PLAN PROVISIONS
In Network
Out of Network
Deductible Individual/Family
$500/$1,500
Calendar Year Out-of-Pocket Limit Individual/Family
$3,000/$6,500 Unlimited
Lifetime Maximum
OUTPATIENT SERVICES
In Network
Out of Network
$20, deductible waived
$20 + balance bill
Routine Adult Physical Exams
No cost, deductible waived
50%, deductible waived
Well-Baby & Well Child Care
No cost, deductible waived
50%, deductible waived
20% after deductible
50% after deductible
$75, deductible waived
$75, deductible waived
Office Visit
Diagnostic Lab & X-Ray Urgent Care INPATIENT SERVICES
Any Licensed Provider
Hospitalization
20% after deductible
Emergency Room
20% after deductible
Outpatient Surgery in Facility
20% after deductible
Pharmacy Pharmacy Network
In Network
Out of Network
Southern Scripts
Not Covered
www.southernscripts.net
To find a pharmacy: PRESCRIPTION DRUGS
Retail (30-day supply)
Mail Order (90-day supply)
Generic
$5
$10
Brand – Formulary
$40
$80
Brand – Non-Formulary
$80
$160
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NETWORK & OTHER INFORMATION
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NETWORK & PROVIDER SEARCH INSTRUCTIONS To find providers participating in the MultiPlan network, visit www.multiplan.com/VDHP and click on “Find a Provider.” Before beginning your search, you must acknowledge that you have read the notice at the bottom of the screen. To begin your search, follow these four steps: 1. Select Network (PHCS) This information can be found on your health plan’s ID card; the on-screen selection uses the same wording as the network logos on the cards. Select the network name and based on your selection you may be prompted to answer additional questions, like whether the logo includes additional wording or whether it is located on the front or back of the ID card. Once you’ve made your selection, follow the prompts on the next few screens. 2. Use the search field to specify what you are searching for. Enter a practitioner’s name, specialty, facility type, NPI # or license #. As you begin to type your selection, you may be prompted with suggestions. Please note that you cannot leave the search field empty. 3. Set your location and begin your search. If your settings allow your browser to detect your location, you can begin the search by clicking on the magnifying glass. However, if your settings don’t allow the browser to detect your location, you will need to enter the zip code of the area you want to search. By default, the search pulls results within 20 miles of the zip code you enter. 4. Receive your search results and refine as desired. Before your search results are presented, you will need to acknowledge reading another notice. After you click OK, a list of providers matching the criteria you entered will be presented. To narrow your results, you can apply filters including gender, languages spoken, hospital affiliation, whether the provider is accepting new patients, and wait time for appointments. A Printer Friendly icon is available for easy viewing of your search results on a printed page. You may print the listed providers or the details for a specific provider. Simply click on the Printer Friendly icon, send the results to your printer, and then close the window.
98point6 Get 24/7, on-demand diagnosis and treatment for 400+ common conditions through 98point6, included with our medical plan, and available to all participating members. Enrolled members will have access to free text-based doctors’ appointments, including behavioral health (ages 18+). 98point6 members have free access to U.S. board-certified doctors who can resolve many of your medical issues, including writing prescriptions, via mobile app consults. Available 24/7/365, from wherever you happen to be. Save yourself some time and an office visit copay. Pre-register for telemedicine through 98point6 app today! Apple App Store
Google Play Store
866.657.7991│ www.98point6.com 2023 BENEFITS GUIDE
HST, THP & the SolV Benefits Advocacy Team
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It is important that you understand your medical plan and resources available to help you navigate your benefits and member experience. By using HST we make sure the amount charged by providers, and paid by you, is fair and reasonable. Balance billing is when a healthcare provider accepts the "plan allowed" amount and then bills the patient for the difference between the billed charges and the "plan allowed" amount (the amount paid by the plan). IMPORTANT: If you receive a balance bill, do not pay it. Contact The Health Plan (THP) at 888.816.3096 immediately.
2023 BENEFITS GUIDE
Download the HST Connect app today! Newly integrated features include: • Provider Search • Navigation • Price Comparison • Member Information • Prescription Pricing • Procedure Information • HST Acceptance Rating • And more!
PRESCRIPTION DRUGS
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Included with the medical plan is coverage for prescription drugs. Rogers Machinery and The Health Plan partner with a pharmacy benefit management company called Southern Scripts.
HOME DELIVERY Use the Southern Scripts Home Delivery for safe and reliable prescription delivery direct to your home, through Postal Prescription Services.
Please make sure the pharmacy has a copy of your updated ID card each time you pick up a prescription.
Cost Savings: You pay less for your medications when receiving a 90-day supply.
Southern Scripts has a number of cost savings programs and coupons available that are automatically built into your plan if you qualify. If they reach out to you related to cost savings programs, please engage them. It will help save you money.
Convenient: Get standard free shipping on medications delivered to your mailbox. Reminders & 24/7 Access: Speak to a pharmacist who can answer your questions any day, any time. Sign up now at https://ppsrx.com or call 800.552.6694.
Rogers Machinery has engaged the services of RxCompass, a prescription advocacy program that assists employees and their family members with medications, which includes those that are or may have been utilized by you or a member of your family. These medications are typically very high cost. By using this program, Rogers Machinery will be able to reduce the cost of these medications and use those savings to keep employee premium contributions at a minimum. If you are currently taking an eligible medication or are prescribed one in the future, a representative from RxCompass will contact you to enroll you in drug savings program. You may contact them at 318.652.8379 if you have questions about the program. There is also an International Mail program that provides access to medications through International pharmacies. This program is offered to provide financial relief for our members who end up paying the most for their medications each year. With RxCompass, members pay nothing for their high-cost medications each month plus the convenience of the medications delivered to your home. Please visit myrxcompass.com for more information. You may also call them at 318.652.8379.
2023 BENEFITS GUIDE
DENTAL
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In a continued effort to promote good oral health, Rogers Machinery offers two robust dental plans. It is advantageous to seek services in-network whenever possible to stretch your benefits. To locate a participating Cigna provider, visit www.cignadentalsa.com. The network is Dental PPO Shared Administration Plus (Cigna DPPO SA Plus), and dental members will receive an ID card in the mail.
The Health Plan (THP) / Cigna Dental PPO GENERAL PLAN PROVISIONS
Base PPO In Network
Out of Network
In Network
Out of Network
$100/$300
$50/$150
$1,500
$2,500
Not Covered
$2,500
Deductible (Individual/Family) Calendar Year Max Lifetime Ortho Maximum
Enhanced PPO
PREVENTIVE CARE (DEDUCTIBLE WAIVED) Cleanings, X-Rays, Exams
100%
100%
100%
100%
80%
70%
90%
80%
50%
40%
60%
50%
50%
50%
BASIC SERVICES Fillings, Extractions, Sealants, Periodontics & Endodontics MAJOR SERVICES Crowns, Bridges & Dentures ORTHODONTIC SERVICES
Child Only
Not Covered
USING YOUR DENTAL PLAN To fully utilize your benefit, request that your dentist obtain a pre-determination of benefits for any for any service exceeding $500.00. You and your dentist will be advised what the insurance company will pay, including what will be your responsibility. We suggest you discuss with your dentist the difference that may not be covered by the insurance company and request that the amount be written off.
OUT OF NETWORK BENEFITS Using an out of network provider will greatly increase your costs. Out of network claims will be processed based on Usual, Customary, and Reasonable (UCR), which means you may be charged the difference. Using an in-network provider will maximize your savings. 2023 BENEFITS GUIDE
VISION
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YOUR VISION PLAN Rogers Machinery has partnered with The Health Plan to offer a comprehensive vision plan. Plan features are listed below. The vision plan is an open-network plan, meaning you can go to any provider you choose. You are provided a per year allowance for each of the services listed below. You can obtain an ID card by visiting myplan.healthplan.org.
The Health Plan (THP) Vision GENERAL PLAN PROVISIONS
OPEN ACCESS
COPAYMENTS Eye Exam
$10
Materials
$25
BENEFITS Exams
Up to $150
Frames
Up to $130
Lenses Single Vision
Up to $40
Bifocal
Up to $60
Trifocal
Up to $65
Progressive
Up to $90
Contact Lenses (in lieu of frames) Safety Glasses
Up to $130 Up to $75
FREQUENCY Exams
One every 12 months
Lenses
One pair every 12 months
Frames
One frame every 24 months
2023 BENEFITS GUIDE
2023 Contributions
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PRE-TAX RATES (Per Pay Period) Medical
Non-Tobacco Users
Tobacco Users
$32.00
$45.50
$86.50
$107.00
$78.50
$92.00
$108.00
$120.00
$113.00
$133.50
Base PPO
Enhanced PPO
Employee Only
$0.00
$5.00
Employee + Spouse
$6.00
$11.00
Employee + Child
$6.00
$10.00
Employee + Children
$10.00
$17.50
Employee + Family
$10.00
$17.50
Employee Only Employee + Spouse Employee + Child Employee + Children Employee + Family Dental
Vision
PPO
Employee Only
$1.00
Employee + Spouse
$2.00
Employee + Child
$1.50
Employee + Children
$3.50
Employee + Family
$3.50
2023 BENEFITS GUIDE
FLEXIBLE SPENDING ACCOUNTS
Rogers Machinery’s Health and Dependent Care Flexible Spending Accounts (FSAs) allow you to use pre-tax dollars to reimburse yourself for a wide variety of health and/or dependent care expenses that are not covered through your other benefit plans. The annual amount you elect to contribute to each account will be divided into equal amounts and deducted from your paycheck before federal, state and local income taxes are withdrawn.
HEALTH CARE SPENDING ACCOUNT Out-of-pocket healthcare expenses for yourself and your dependents, including medical, dental and/or vision deductibles, coinsurance, and copays, are eligible for reimbursement from your Healthcare FSA.
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IMPORTANT! If you incur fewer expenses than expected please contact The Health Plan before the end of the plan year to help find ways to spend your unused dollars. You can visit www.fsastore.com to purchase qualified products too!
The annual Healthcare FSA maximum contribution is $3,050.
DEPENDENT CARE SPENDING ACCOUNT Expenses for dependent care services for children under age 13, a disabled spouse, or incapacitated parent are eligible for reimbursement from your Dependent Care FSA if you incur them while you and your spouse work or attend school full-time. The annual maximum contribution is $5,000 ($2,500 if you are married and filing a separate income tax return).
HOW TO USE YOUR FSA AND FILE CLAIMS FOR REIMBURSEMENT Using your THP Debit Card is as easy as 1-2-3!
1. Simply swipe your FSA Debit Card like any other card for eligible medical, dental or vision charges. 2. Funds are immediately transferred from your FSA, on the spot. 3. Track your card balance on the THP mobile app. 4. Save your receipts and EOBs in case you receive a substantiation request. If you forget to use your Debit Card, you may still submit manual claims for reimbursement. Simply complete an FSA claim form with a copy of the Explanation of Benefits (EOB) or itemized receipt from your provider showing the total incurred out-of-pocket expenses. The FSA Reimbursement Claim Form can also be found online in Paycom.
2023 BENEFITS GUIDE
Colonial Life
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BASIC LIFE AND AD&D INSURANCE Rogers Machinery provides all full-time employees with employer paid life/AD&D benefits on the first of the month following 60 days from date of hire. The life insurance benefit pays your designated beneficiary(ies) $20,000 in the event of your death. This benefit is doubled if your death is the result of an accident. Benefits are also payable in the case of dismemberment. See contract for benefit details and exclusions.
Colonial Life Insurance – Group Life/AD&D BENEFITS Life Insurance AD&D Insurance Conversion/Portability
$20,000 $20,000 Available within 31 days from termination of group plan
AGE REDUCTIONS At Age 70 At Age 75
Reduced by 35% of original benefit Reduced by an additional 15%
VOLUNTARY BENEFITS Rogers Machinery offers a wide variety of supplemental plans for you and your dependents through Colonial Life via payroll deduction. Disability Insurance: Replaces a portion of your income to help make ends meet if you become disabled from a covered accident or covered sickness. Accident Insurance: Helps offset the unexpected medical expenses, such as emergency room fees, deductibles and copayments, that can result from a fracture, dislocation or other covered accidental injury. Hospital Confinement Insurance: Provides a lump-sum benefit for a covered hospital confinement and a covered outpatient surgery to help offset the gaps caused by copayments and deductibles that are not covered by most major medical plans.
2023 BENEFITS GUIDE
Critical Illness Insurance: Complements your major medical coverage by providing a lumpsum benefit that you can use to pay the direct and indirect costs related to a covered critical illness, which can often be expensive and lengthy.
Supplemental Life Insurance: Enables you to tailor coverage for your individual needs and helps provide financial security for your family members. If you are interested in more information about the available plans and pricing, please contact our Colonial Life Benefit Counselor: Don Brink E: [email protected] P: 503.504.8347
RETIREMENT PLANS
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401(K) SAVINGS PLAN As a new hire at Rogers, you are auto-enrolled into an individual 401k account with a pre-tax deduction of 3% of your gross wages automatically deducted from your paycheck and funded to your account. You may elect to contribute a different percentage or flat amount in either the traditional 401K or post-tax Roth 401K. You may also opt out entirely. To make changes you must go online to the NW Plan Services website https://www.yourplanaccess.net/nwps/. Your account will be set up for you after your first paycheck. The default username and password will be: Username - your social security number
Password - the last four digits of your social security number
PROFIT SHARING
All Rogers employees are eligible to participate in the profit-sharing plan. Profit sharing contributions are made directly to employees’ accounts. To receive a company profit sharing contribution an employee must work 1000 hours prior to the fiscal year end (March 31st) and be employed on the last day of the fiscal year. Profit-sharing contributions are not guaranteed but are generally 3% - 15% of each employees’ total compensation. Vesting of the employees share of the fund is as follows: • • • • •
2 years’ participation = 20% 3 years’ participation = 40% 4 years’ participation = 60% 5 years’ participation = 80% 6 years’ participation = 100%
The Summary Plan Description (SPD) provides greater detail and is available from Human Resources.
HUMAN INVESTING
Human Investing is the advisor on the Rogers Machinery 401(k) and Profit-Sharing Plan. Rogers Machinery employees can utilize Human Investing’s services to provide advice on investments, savings rate, savings type, rollovers, and other investment/planning strategies. Feel free to reach out to Human Investing at 503.905.3100 or via email at [email protected].
2023 BENEFITS GUIDE
OTHER BENEFITS
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EMPLOYEE ASSISTANCE PLAN (EAP) No matter what life throws your way, there’s someone there to help you through it. A compassionate ear, expert advice, professional support. It’s all just a call away if you need it. The EAP is a free and confidential resource provided by Rogers Machinery, through Colonial Life and Health Advocate, to help assist you and your immediate family members manage life’s daily challenges – ranging from personal relationships to legal and financial resources. The EAP can help you and your family find solutions and restore your peace of mind.
24/7 Live Support │ Toll Free: 888.645.1772 │ http://ColonialLife.com/EAP
LIFE PLANNING SERVICES Rogers Machinery has partnered with Colonial Life and Health Advocate to offer a helping hand to an insured terminally ill employee or spouse, or designated beneficiaries of an employee or spouse. Life Planning Services can provide guidance when you may have many financial and legal decisions to make and are not sure where to begin. Toll Free: 800-422-5142 │ http://HealthAdvocate.com/members (Colonial Life - Life Planning)
TOBACCO CESSATION BENEFITS Rogers Machinery provides tobacco cessation assistance for employees who want to quit the habit. Education and up to 3 counseling session are covered at a 100% under our group medical plan’s Preventive Care benefits. Some physician prescribed tobacco cessation products are covered under our prescription drug benefit along with other prescription drugs used to encourage you or your loved ones to stop smoking. Please also see our EAP plan for additional resources.
COBRA ADMINISTRATION The Consolidated Omnibus Budget Reconciliation Act (COBRA) became law in 1985. It requires companies with twenty or more employees to offer employees and their dependents the opportunity to continue health benefits should they no longer be eligible for coverage. If you become eligible to continue benefits under COBRA you will receive a notice in the mail at your home of your rights. Please make sure Human Resources Department always has your most current address.
MEDICARE ASSISTANCE For anyone needing advice regarding their Medicare rights and options, our employee benefits consultants recommend Willamette Valley Benefits. Please contact Willamette Valley Benefits at 888.944.4644 to review the options available and to help make the choice that’s right for you. 2023 BENEFITS GUIDE
GLOSSARY OF TERMS AD&D (Accidental Death & Dismemberment)
A plan that provides benefits in the event of an accidental death or dismemberment (generally, an accident that results in death, loss of part of the body, or the loss of the use of part of the body).
Beneficiary
A person designated by a participant, or by the terms of an employee benefit plan, which is or may become entitled to a benefit under the plan.
COBRA
Federal law (Consolidated Omnibus Budget Reconciliation Act of 1985) requiring certain employers that offer group health plans to provide continuation coverage to employees and their dependents who incur certain qualifying events.
Co-Insurance or Cost Sharing
The portion of covered health care costs for which you are financially responsible. Coinsurance does not include deductibles or copays.
Co-Payment or Copay
A set amount you pay out of pocket for a particular service. The plan pays the balance.
Deductible
The out-of-pocket amount you must pay each plan year before the plan pays for eligible benefits.
Evidence of Insurability
Many insurance companies require prospective clients/ individuals to prove that they are in good health and are therefore good insurance risks before the company will cover them.
Explanation of Benefits (EOB)
A statement from a plan explaining what portion of a claim was paid.
Generic
Your prescription drug copay depends on the class or group of your prescribed medication. A generic drug generally has the lowest copay level. A generic drug is one that is no longer produced only under a brand name. Once a drug’s patent expires, many companies can begin to manufacture “generic” versions of a previously brandname-only drug. Generic drugs are identical to brand-name drugs in chemical makeup (“active ingredients”), usage, strength and dosage. They are regulated and approved by the FDA just like brand-name drugs; however, they are much less expensive.
HIPAA Authorization
Under HIPAA, a document that authorizes the use or disclosure of an individual’s Protected Health Information by a Covered Entity for any purpose described in the document and meets specific requirements.
In-Network Provider
A provider who has contracted with a health care plan (a medical, dental or vision plan) and agreed to certain rates. In most cases, you pay less and receive a higher benefit when you use in- network providers. Check with your plan for coverage details.
Negotiated rates
The costs for health care services negotiated between the insurance carrier and innetwork health care providers. Negotiated rates are usually less than usual, customary and reasonable (UCR) charges.
Non-preferred brand
Your prescription drug copay depends on the class or group of your prescribed medication. A non- preferred brand-name drug generally has the highest copay level because it is not on the plan’s list of preferred drugs. You can find out how different drugs are classified by your plan by visiting the plan’s Web site.
Out-of-Pocket Expenses
Copays, deductibles, and other expenses that are not covered by the health plan.
Out-of-Network Provider
A state-licensed health care provider who has not contracted with a health care plan (medical, dental or vision plan) and has not agreed to certain rates. In most cases, you pay more and receive a lower level of benefits when you use out-of-network providers. See your plan for coverage details.
Qualifying Life Event
Certain events which may allow you to make allowable changes to your benefits. Qualifying events include: marriage, divorce, death, birth, adoption or placement for adoption, and significant change in employment.
Reasonable and Customary (R&C) or Usual, Reasonable & Customary (UCR)
A term used in many health plans, defined as the price at or below which the majority of health- care professionals of similar expertise charge for similar procedures within a specific geographic area.
2023 BENEFITS GUIDE
BENEFIT PLAN CONTACT INFORMATION
Plan
Group #
Telephone #
Website
0180982901
888.816.3096
myplan.healthplan.org
800.710.9341
southernscripts.net
RxCompass
800.710.9341
myrxcompass.com
98point6
866.657.7991
98point6.com
HST Patient Advocacy Center (PAC)
888.837.2237
[email protected]
888.816.3096
www.cignadentalsa.com
888.816.3096
myplan.healthplan.org
888.816.3096
myplan.healthplan.org
800.325.4368
www.coloniallife.com
503.504.8347
[email protected]
888.645.1772
ColonialLife.com/EAP
(Colonial Life – Life Planning)
800.422.5142
HealthAdvocate.com/members
Rogers Machinery
833.4.SolVIT (765848)
www.SolVins.com [email protected]
MEDICAL The Health Plan (THP) Southern Scripts
DENTAL Cigna PPO Plan
Base: 0180982903 Enhanced: 0180982904
VISION The Health Plan (THP)
0180982902
OTHER BENEFITS FLEXIBLE SPENDING ACCOUNTS The Health Plan (THP) Colonial Life Group Life/AD&D and Voluntary Benefits For plan information, cost, and to enroll:
Don Brink
Health Advocate Employee Assistance Program Health Advocate Life Planning Benefit Advocacy Team (BAT)
2023 BENEFITS GUIDE
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HEALTHCARE NOTICES
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HIPAA PRIVACY INFORMATION A portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses the protection of confidential health information. It applies to all health benefit plans. In short, the idea is to make sure that confidential health information that identifies (or could be used to identify) you is kept completely confidential. This individually identifiable health information is known as “protected health information” (PHI), and it will not be used or disclosed without your written authorization, except as described in the Plans HIPAA Privacy Notice or as otherwise permitted by federal and state health information privacy laws. A copy of the Plan’s Notice of Privacy Practices that describes the Plan’s policies, practices and your rights with respect to your PHI under HIPAA is available from your medical plan provider. For more information regarding this Notice, please contact Roger Machinery’s Human Resources or the medical plan directly. HIPAA SPECIAL ENROLLMENT RIGHTS If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself and your dependents in the Rogers Machinery health plan as follows: Loss of Other Coverage If an employee is declining coverage (for self and/or dependents) because of other health insurance or group health plan coverage, the employee may be able to enroll (self/dependents) in this plan if the employee /dependents lose eligibility for that other coverage (or if the employer stops contributing toward the employee/dependents’ other coverage). However, the employee must request enrollment within 31 days after the other coverage ends (or after the employer stops contributing toward the other coverage). Marriage, Birth, or Adoption If an employee has a new dependent as a result of a marriage, birth, adoption, or placement for adoption, the employee may be able to enroll himself/herself and his/her dependents. However, the employee must request enrollment within 31 days after the marriage, birth, or placement for adoption. Medicaid or CHIP If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy. NOTICE OF PRESCRIPTION DRUG CREDITABLE COVERAGE Rogers Machinery provides a “Notice of Prescription Drug Creditable Coverage” to all Medicareeligible participants on an annual basis. This notice states that under Roger Machinery’s medical plan, you have prescription drug coverage that is, on average, as generous as the standard Medicare prescription Drug Coverage. If you or an enrolled dependent becomes eligible for Medicare, you will need this notice for your records.
2023 BENEFITS GUIDE
HEALTHCARE NOTICES
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WOMEN’S HEALTH AND CANCER RIGHTS ACT Rogers Machinery, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services. These services include: • All stages of reconstruction of the breast on which the mastectomy was performed • Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses and treatment of physical complications resulting from mastectomy (including lymphedema) This coverage will be provided in consultation with the attending physician and the patient and will be subject to the same annual deductibles and coinsurance provisions that apply to the mastectomy. For more information, contact your medical plan provider. NEWBORNS & MOTHERS HEALTH PROTECTION ACT The Newborns’ Act and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier. The Newborns’ Act, and its regulations, prohibits incentives (either positive or negative) that could encourage less than the minimum protections under the Act as described above. A mother cannot be encouraged to accept less than the minimum protections available to her under the Newborns’ Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery. In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing the length of stay not in excess of 48 hours or 96 hours, as the case may be. THE MENTAL HEALTH PARITY & ADDICTION EQUITY ACT The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans to apply the same treatment limits on mental health or substance-related disorder benefits as they do for medical and surgical benefits. The MHPAEA also extends this parity requirement to inpatient and outpatient services, whether in-network or out-of-network, and to emergency care services and prescription drugs. MHPAEA revised the definition of “mental health benefits” to include substance use disorder benefits. The MHPAEA also requires group health plans to apply the same beneficiary financial requirements to mental health or substance use disorder benefits as they apply for medical and surgical benefits, including limits on deductibles, co-payments and out-of-pocket expenses. Plan administrators are also required to make the criteria for “medical necessity” determinations with respect to mental health and substance use disorder benefits available to plan participants, beneficiaries or providers upon request.
2023 BENEFITS GUIDE
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A 4170 Douglas Blvd #100, Granite Bay, CA 95746
P 833.476.5848
F 916.891.0123