Employee Benefits - Effective July 1, 2010

Changes scheduled for July 1, 2010.

Is the insurance changing?  Yes.  BlueCross BlueShield (BlueCross BlueShield) will be the new carrier for all lines of coverage effective July 1, 2010. 

What are the medical benefits?  The medical benefits are summarized below.  A full summary is attached. 

Why are we changing medical insurance companies?  BlueCross BlueShield offers comparable coverage, better network coverage, greater stability, and competitive rates. 

Is the provider network changing? Yes.  The new network is named BlueCross BlueShield PPO.  You may search online for BlueCross BlueShield providers at www.bcbstx.com.  Search under the BlueCross BlueShield PPO network.

Are the deductions changing? The 2010 deductions are illustrated below.  NewWave continues to pay the majority of the employee premium.

Does my deductible start over with BlueCross BlueShield? No.  BlueCross BlueShield will credit the deductible paid in 2010.  The deductible credit will automatically be applied by BlueCross BlueShield.

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Coverage

You may select the following coverage(s) for you and your eligible dependents, unless stated otherwise

• Medical Plan with Prescription Drug Coverage
• Dental Insurance with Vision Insurance.
• Basic Group Life and Accidental Death & Dismemberment Insurance
• Voluntary Long Term Disability Insurance
• Voluntary Short Term Disability Insurance
• Voluntary Life Insurance
• Health Care Flexible Spending Account
• Dependent Care Flexible Spending Account

Premium Sharing: Bi-Weekly Deductions*

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Medical  (Medical Providers)

• Calendar Year Deductible: $500 (3 per family)
• Physician Office Visit CoPay: $30
• Prescription Drug CoPays: $15/$35/$60
• Full Medical Summary of Benefits

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Dental  (Dental Providers)

• Calendar Year Benefit Maximum: $1,000
• Calendar Year Deductible Amount: $50 (3 per family)

Preventive Services: Paid at 100%

• Deductible Waived
• Exam and Bitewing X-Rays
• Prophylaxis  (Cleaning)
• Fluoride for Children
• Diagnostic X-Rays

Basic Services: Paid at 80%

• Extraction's, Fillings
• Root Canals, Periodontics
• Periodontal Prophylaxis
• Endodontics, Oral Surgery
• Anesthesia

Major Services: Paid at 50%

• Crowns, Inlays, Onlays
• Dentures, Bridges

Orthodontic Services: Paid at 50%

• $1,000 Lifetime Maximum
• Deductible Waived
• Available to Dependent Children under age 19 only

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Vision Insurance  (VisionProviders)

• $20 Exam Copay
• Discounts on other services

At BlueCross BlueShield Blue Cross and Blue Shield, we understand that vision benefits are essential to maintaining your overall health and well-being. After all, a slight miscorrection in eyesight can reduce productivity by 10% and work accuracy by nearly 40%. Computer eyestrain can reduce productivity between 10 and 50%.1
Blue View Vision, our vision program, provides a cost-effective vision plan. The plan is easy to use and offers savings beyond exam coverage. Blue View Vision provides you with an innovative vision program to meet your unique needs and improve your overall wellness.

Finding a Blue View Vision Provider
Blue View Vision has an extensive national network of participating providers contracted under a vendor agreement with EyeMed Vision Care. You can easily find a provider conveniently located near you. Nationally, we contract with independent optometrists and ophthalmologists as well as retail locations such as LensCrafters®, Target Optical, Sears Optical, JCPenney Optical, and most Pearle Vision locations. Please call Blue View Vision at (866) 723-0515 if you have questions about your vision benefits or need to locate a provider.

Using a Participating Provider
By using a participating provider, you minimize your out-of-pocket expenses and receive the benefits of not having to hassle with paperwork, since the participating provider verifies your eligibility and obtains all the necessary information. You simply pay your copayment and any remaining balance at the time of your appointment.
Blue View Visionprovidersoffer you discount pricing, which is significantly below retail. You receive substantial savings (15%-40% or more) on most eyewear pair purchases, conventional contact lenses, lens treatments, specialized lenses and various sundry items.

Using a Non-Participating Provider
If you choose to go to a non-participating (non-network) provider, you must pay the provider directly at the time of service. Out-of-network claims must be submitted by you. Simply submit a claim for reimbursement. When using a non-participating provider, your coverage may be limited and your out-of-pocket expenses may be greater.

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Basic Group Life and AD&D Insurance

• Employee - $20,000 to all Eligible EmployeesProvided by DunderMifflin
  Benefits reduce by 35% at age 65, and 50% at age 70

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Voluntary Life Insurance

• Employee - $25,000 Increments to $300,000
  Evidence of Insurability is required for amounts above $150,000.
  Benefits reduce by 35% at age 65, and 50% at age 70.
• Spouse - $5,000 Increments to $50,000
  May not exceed 50% of employee amount
  Evidence of Insurability is required for amounts above $25,000
  Benefits reduce by 35% at age 65, and 50% at age 70.
• Children - $5,000 or $10,000.
  Coverage begins at 15-days from birth and ends at age 19, or age 24 if a full-time student.

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Voluntary Long Term Disability

• Elimination Period - 90 Days
• Percentage of Salary - 60%
• Maximum Monthly Benefit - $6,000
• Benefit Duration - To Age 65 (Normal Retirement Age or ADEA)

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Voluntary Short Term Disability

• Elimination Period - 15 Days
• Percentage of Salary - 60%
• Maximum Weekly Benefit - $750
• Benefit Duration - 13 Weeks

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FlexPlan

What is a FlexPlan?

Authorized by Internal Revenue Code Section 125, Cafeteria Plans, also called reimbursement accounts, flexible benefit plans or Flexible Spending Accounts (FSAs), provide a tax-advantaged way to pay certain out-of-pocket health care expenses, and work-related dependent care expenses.

The plans allow you to pay your expenses with “pre-tax” dollars, which means that you get a tax deduction for these expenses before you ever file your tax return.  You don’t pay Federal income or Social Security taxes on this money and, in most states, you don’t pay state taxes either.

Health Care FlexPlan

• Healthcare Contribution Limit: $2,500
• Eligible Health Care Expenses
• Savings Calculator

Dependent Care FlexPlan

• Dependent Care Contribution Limit $2,500 ($5,000 if married filing jointly)
• Dependent Care Calculator

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Eligibility

When Coverage Begins

Eligible employees, and their eligible dependents, are covered on the First of the Month following your waiting period.

Waiting Period

• The waiting period for Commission Sales and Call Center employees is 90-days.
• The waiting period for all other employees is 30-days.

When Coverage Ends

Medical, Dental, and Vision coverage ends on the last day of the month in which you, or your covered dependents, are no longer eligible for coverage under the plan.

Life and Disability coverage ends on your date of termination.

Employees

You are eligible for benefits as a full-time employee if you work at least 30 hours per week, and satisfy the new-hire waiting period.

Dependents

You may also enroll your eligible dependents under plans offered by The plan. Your eligible dependents are

• Your legally-married spouse, or person with whom you have filed a Declaration of Informal Marriage;
• Your unmarried child(ren) under age 26, including
  • Stepchildren, Adopted children, and Children for whom you are the legal guardian.
  • Your unmarried grandchild under age 26, if the child qualifies and is claimed as your dependent for federal tax purposes; and
  • Certain children over age 26, who are determined by the Plan to be medically incapacitated and are unable to provide their own support.


The plan may require supporting documentation when you request to add a dependent.  You may be asked to provide copies of your marriage license, your children’s birth certificate(s), and/or appropriate adoption paperwork.  This paperwork is required not only to support the coverage of eligible dependents but, in the case of marriage or the birth of a new child, to support a mid-year change of status.

• Examples of dependents who are not eligible for coverage include
  • Your common-law spouse, unless you have obtained a Declaration of Informal Marriage;
  • Your same-sex partner;
  • Your former spouse;
  • Your married child;
  • Your child over age 26, if not medically incapacitated and unable to provide their own support;
  • Foster children covered by another government program, unless required by law;
  • Any child for whom you have Power of Attorney only;
  • Any dependent who is active in the Armed Forces of any country.

Initial Period of Eligibility

You have 31 days from your hire date (initial period of eligibility) to complete enrollment in The plan. Employees moving from a non-benefits eligible status to a benefits eligible status also have 31 days from their new benefits eligible status (initial period of eligibility) to complete enrollment in The plan.

If elections are not made within the 31-day initial period of eligibility, you will be considered a "Late Applicant" and required to wait until the next Annual Enrollment or a qualified Change of Status event to make changes, including adding or dropping coverage.

"Late applicants" are required to provide Evidence of Insurability to enroll for Life or Disability coverage.

Change of Status

Changes to your The plan may be made during Annual Enrollment each year or following a qualified Change of Status.  You have 31 days from the date of the Change of Status event to notify your Plan Administrator and change your benefit selections. If you do not make your changes during the 31-day Status Change Period, your changes cannot be made until the next Annual Enrollment in June, to be effective the following July 1.

The list below includes common examples of qualified Changes of Status events:

• Marriage, divorce, annulment, legal separation, or spouse’s death
• Birth, adoption, medical child support order, or dependent’s death
• Significant change in residence if the change affects your or your dependents’ current plan eligibility
• Starting or ending employment, starting or returning from unpaid leave of absence, or a change of job status (e.g., from non-benefits eligible part-time to full-time)
• Change in dependent’s eligibility (e.g., marriage or reaching age 26)
• Change in coverage or cost of other benefit plans available to you and your family

NEW: Effective January 1, 2010, an employee whose dependent loses Medical insurance coverage under the Medicaid or CHIP program as a result of loss of eligibility may enroll the dependent in the Medical plan without Evidence of Insurability, as long as the employee and dependent meet all other The plan eligibility requirements and is enrolled within 60 days from the date coverage was lost.

Your benefit changes must be consistent with your Change of Status event. For questions regarding a qualified Change of Status, please contact your Plan Administrator. Note: Evidence of Insurability may be required for some benefit changes if you wait until Annual Enrollment instead of enrolling during the 31-day Status Change Period.

Evidence of Insurability (EOI)

Evidence of Insurability (EOI) is the record of a person's past and current health events. EOI is used by insurance companies to verify whether a person meets the definition of good health. An EOI form is required to

• Add Life or Disability coverage after your initial 31-day benefit election period, except following a qualified status change during the plan year.

Click here to download the BlueCross BlueShieldLife Evidence of Insurability form.

Continuation of Group Medical and Dental Coverage (COBRA)

If you or your dependents lose eligibility for coverage, you may be eligible to continue your medical and dental coverage, generally for up to 18-months, under COBRA. 

Dependents, losing coverage as a result of the death of an employee, may be eligible to continue medical and dental coverage for up to 36 months, pursuant to applicable COBRA provisions.

HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes certain requirements on group health plans, including

• Limitations on pre-existing condition exclusion periods;
• Special enrollment periods for individuals (and dependents) losing other coverage;
• Prohibitions against discriminating against individual participants and beneficiaries based on health status;
• Standards relating to benefits for mothers and newborns;
• Parity in the application of certain limits to mental health benefits; and
• Protecting your privacy.

For more information, contact your Plan Administrator.