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TABLE OF CONTENTSELIGIBILITY__________________________________________________________________________- 7 -
MAKING CHANGES_________________________________________________________________- 7 -
SUMMARY OF HEALTH BENEFITS_______________________________________________________- 8 -REWARD PLAN PROTOCOL__________________________________________________________________- 9 -
REWARD PLAN REQUIREMENTS FOR ALL PLAN LEVELS____________________________________- 10 -
KNOW YOUR NUMBERS_____________________________________________________________________- 10 -
COMPLETING YOUR LIFESTYLE WELLNESS AFFIDAVIT ONLINE_____________________________- 11 -
COMPLETING YOUR CHRA ONLINE_________________________________________________________- 12 -
COACHING_________________________________________________________________________________- 13 -
ONLINE ACCESS TO MEDICAL PROVIDERS__________________________________________________- 14 -
IMPORTANT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE_________________________________________________________________________- 15 -
GENETIC INFORMATION NON-DISCRIMINATION ACT OF 2008 (GINA)______- 15 -
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)_- 16 -
SUMMARY OF DENTAL BENEFITS______________________________________________________- 17 -HOW TO FIND A DENTAL PROVIDER________________________________________________________- 19 -
SUMMARY OF VISION BENEFITS_______________________________________________________- 20 -
SUMMARY OF BASIC LIFE & AD&D BENEFITS__________________________________- 24 -
SUMMARY OF VOLUNTARY LIFE BENEFITS____________________________________- 25 -
SUMMARY OF VOLUNTARY AD&D BENEFITS___________________________________- 27 -
SUMMARY OF VOLUNTARY SHORT TERM DISABILITY BENEFITS____________- 30 -
SUMMARY OF VOLUNTARY LONG TERM DISABILITY BENEFITS_____________- 33 -
ONLINE WILL PREPARATION__________________________________________________________- 35 -
SUMMARY OF FLEXIBLE SPENDING ACCOUNT BENEFITS____________________- 36 -
SUMMARY OF HEALTH SAVINGS ACCOUNT BENEFITS___________________________________- 38 -SUMMARY OF HSA/FSA ELIGIBLE EXPENSES________________________________________________- 39 -
SUPPLEMENTAL BENEFITS____________________________________________________________- 41 -ACCIDENT CARE___________________________________________________________________________- 41 -
MEDICAL BRIDGE 3000______________________________________________________________________- 42 -
CRITICAL ILLNESS 1.0______________________________________________________________________- 43 -
CANCER 1000_______________________________________________________________________________- 44 -
SECTION 125__________________________________________________________________________- 45 -
QUALIFYING EVENTS_____________________________________________________________- 46 -
IMPORTANT INFORMATION FOR HEALTHCARE TRANSITION________________- 47 -
YOUR RIGHT TO DOCUMENTATION OF HEALTH COVERAGE_________________- 48 -
THE WOMEN'S HEALTH AND CANCER RIGHTS ACT OF 1998_________________- 48 -
NOTICE IF YOU DECLINE GROUP COVERAGE__________________________________- 48 -
COBRA CONTINUATION____________________________________________________________- 49 -
EMPLOYEE BENEFIT REVIEW
Welcome to INTEGRATED SUPPLY NETWORK, LLC & OMS Insurance Group!
INTEGRATED SUPPLY NETWORK, LLC is committed to sponsoring a comprehensive benefits program for all eligible employees. This booklet describes the benefits available to you, important information pertaining to your enrollment and eligibility, covered services, what the plan pays and amounts that are your responsibility. Please be advised that open enrollment to make changes, enroll or terminate coverage begins at least 30 days prior to the effective date of the plan. Please review your benefits package carefully.
We encourage you to take advantage of the Section 125 pre-tax opportunity that OMS provides. Only through your employment can you take advantage of this benefit, saving as much as 20% off of your benefits. Because your benefits are paid for pre-tax, the IRS Section 125 guidelines mandate that coverage may not be cancelled without a qualifying event or hardship. Once coverage is cancelled, you may not re-enroll until the following open enrollment period.
Should you experience a qualifying event and need to change your dependent status, please notify INTEGRATED SUPPLY NETWORK, LLC and OMS, as soon as possible. Notification with documentation must be provided to the Insurance Carrier within 30 days.
The plans and rates for our plans are enclosed. If you are interested in enrolling in any of these products, please complete the necessary applications, submit to INTEGRATED SUPPLY NETWORK, LLC or fax to:
Benefits DepartmentOMS
PO Box 2Lakeland, FL 33802
Phone – 863-688-1751Fax – 863-683-0521
Thank You!INTEGRATED SUPPLY NETWORK, LLC and OMS
All benefits and provisions are subject to the terms of the policy issued and any state requirements. If the details in this manual or any OMS marketing materials do not agree, the policy provisions will rule.
ELIGIBILITY MAKING CHANGESIf you are a regular, full-time employee working 30 or more hours per week, you are eligible for benefits following a waiting period. You also have the option to enroll eligible dependents for medical and dental benefits. Eligible dependents generally include:
Your legal spouse; or
Your natural, step, adopted, and foster child as well as a child you have legal guardianship for, who is dependent upon you for support may be covered on the medical and dental plans. Dependent children can be covered from birth to age 19 or the end of the calendar year in which they turn 26 if:
Dependent upon you for financial support and living with you in your household; or are attending school, full or part time, if not living in your household. The dependent must be unmarried and not have any dependents of their own. They must also be a resident of this state. They can’t have other coverage provided to them as a named subscriber, insured, enrollee, or covered person under any other group health or individual health plan and not entitled benefits as stated under the Social Security Act.
Dependent children age 25 or
Each year, you have the opportunity to make changes to your benefit elections during the Annual Open Enrollment Period. We typically hold our Annual Open Enrollment Period 30 days prior to your effective date. All elections and changes you make during this period until the same time next year. If you decline coverage when you were initially eligible, some benefits may:
Include a benefit waiting period on certain services; or
You may be subject to Evidence of Insurability.
Your elections will remain in effect for twelve months unless you have a qualifying “change status.” The IRS requires you to have a qualifying change in status in order to make adjustments to your benefit elections outside the initial eligibility period and the Annual Open Enrollment Period.
Events that are considered qualifying changes in status include:
Marriage, legal separation or divorce.
Birth, adoption or custody change of an eligible dependent.
Death of an eligible dependent. Beginning or ending of spouse’
Employment. A change in employment (either
yours or your spouse’s) from part-time to full-time or vice versa.
If you have a qualifying change in status, you can make changes to your benefits by providing Human
older who are incapable of sustaining employment by reason of mental retardation or physical handicap; and are chiefly dependent upon you for support and maintenance. The child must be covered by the medical and/or dental plan provided through the company the day before coverage would otherwise have ended due to age.
WAITING PERIODYou are eligible for benefits the 1st
day of the month following 60 days of continuous employment.
Resources with any applicable documentation within 30 days of the change.
Special Open Enrollment Notes for COBRA BeneficiariesIf you are a COBRA participant, you can make changes to your elections during the Annual Open Enrollment Period. You may change to another medical and/or dental plan offered by the company. You can decline medical and/or dental coverage or you may add or eliminate coverage for family members. Your cost to continue coverage will be made available to you for each line of coverage you are eligible for. All changes will be effective on the effective date. This does not extend the amount of time you are eligible to continue coverage based upon your qualifying event.
SUMMARY OF HEALTH BENEFITS
REWARD PLAN PROTOCOL
REWARD PLAN REQUIREMENTS FOR ALL PLAN LEVELS
*******Employee will LOSE Platinum status if: *******The employee signs the Reward Plan Acknowledgment Form & fails to complete the requirements of the elected plan within the Designated Time Frames. Your premium deductions from your paycheck will then increase & you will be moved down to the next plan level that you qualified for. This will result in higher deductibles, higher Copays, etc.
KNOW YOUR NUMBERSMeasurement Target needed to avoid
coachingBody Mass Index > 35BMI + Blood Sugar BMI > 30 + > 100 (fasting)BMI Hglb A1c > 5.75Nicotine All Tobacco & eCigarettesOther Lifestyle BMI > 30, Pre-Diabetes
COMPLETING YOUR LIFESTYLE WELLNESS AFFIDAVIT ONLINE
COMPLETING YOUR CHRA ONLINE
COACHING
• Coaching Programs For Both Disease And Wellness Improvement
• Coaching sessions last 6 to 8 months, meeting via phone call about every 3 weeks.
• Free Consultation From Nurses & Doctors To:• Improve your health for a healthier lifestyle• Help improve your medical condition • Create goals with your coach
• Being accountable• Track your diet and exercise via coach
• Very important for all employees to return phone calls if asked to participate in a coaching program. You will be required to complete calls next year to qualify for reward
ONLINE ACCESS TO MEDICAL PROVIDERS
The best place for people to find a clinic, walk in clinic or specific provider is to go to the provider search on the UMR website. That is where the most current listing of providers can always be found. Below you will find the instructions on searching for a provider:
Go to www.umr.com On left hand side, select Member On the next page select Find a Provider in the lower left of
the screen On the next screen select medical For the medical provider search/network link on the lower
portion of the page, select “U” and then United HealthCare Choice Plus for the network name
On the next page, scroll down to select “Search for a medical provider”
On the next page you can select any of the following: A starting address Number of miles Specialty Facility Condition If you know the specific name of the provider you would
like to search, you may enter their name and select “Go” and it will appear if they are In the Network (sometimes the provider is listed under the clinic name vs their individual name)
Your selections will then appear
IMPORTANT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE
As part of the Medicare Part D regulations under the Medicare Modernization Act of 2003 (MMA), employer groups are required to notify all Medicare-eligibles covered under their plan, annually and at other specific times, if their pharmacy coverage meets the "creditable coverage" requirements of the Medicare Part D regulations. A pharmacy plan is considered creditable if its benefits are equal to, or better than, a Medicare Part D plan.
This required notice of creditable coverage is intended to assist Medicare-eligible individuals in determining whether they should enroll in a Medicare Part D plan at their initial enrollment period (IEP), or at a later date. For those individuals who do not enroll during the initial enrollment period and do not have creditable coverage under another pharmacy plan (e.g., their employer's coverage), a late enrollment penalty fee (assessed as part of the premium) accrues monthly for each month that the individual delays enrollment in a Medicare Part D plan. If an individual has creditable coverage and enrolls in a Medicare Part D plan at a later date, there are three important things for you to remember:
1. Medicare Part D Prescription Drug coverage is not automatic. You must join for coverage to begin. If you miss the enrollment period, for example October 15th - December 7th, you cannot enroll until the next Annual Election period begins in November of the following year.
If you become eligible for Medicare Part D between annual election periods, you may enroll anytime during the month you become eligible or within the three months that precede or follow this month.
2. You must be eligible to enroll in a Medicare Part D Prescription Drug Plan. To be eligible you must reside in the service area of the Part D plan, be entitled to Medicare benefits under Part A and/or enrolled in Part B, continue to pay the Part B premium - if not otherwise paid for under Medicaid or by another third party - and enroll during the initial, special or annual election periods.
3. Medicare Part D is not free and you could pay a penalty if you delay enrollment. If you choose to enroll in a plan without a delay in your enrollment window, you will pay the plan's applicable monthly premium. Should you delay enrollment in a plan, you could pay a government-imposed penalty of 1 percent of the national base beneficiary premium for every month you remain without effective coverage.
GENETIC INFORMATION NON-DISCRIMINATION ACT OF 2008 (GINA)
The Genetic Information Non-Discrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. Genetic information as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
Offer Free or Low-Cost Health Coverage to Children and Families
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
If you feel you may be eligible for assistance paying your employer health plan premiums contact your state Medicaid office. The following is for the state of Florida:
FLORIDA – MedicaidWebsite: http://www.fdhc.state.fl.us/Medicaid/index.shtml
Phone: 1-866-762-2237
To see other States or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor U.S. Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare & Medicaid Serviceswww.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Ext. 61565
SUMMARY OF DENTAL BENEFITS
CoverageBi-Weekly Deductions
EE $8.69ES $17.93EC $23.61
FAM $36.57
CoverageBi-Weekly Deduction
EE $12.51ES $25.80
EC $32.97FAM $51.37
HOW TO FIND A DENTAL PROVIDER
SUMMARY OF VISION BENEFITS
PAYROLL DEDUCTION NOTICE
Employees are responsible for paying their portion of insurance coverage. You should review the deductions on your paycheck and if you find an error, it is your responsibility to bring it to the attention of your manager immediately. Arrangements will be made to correct the error, however all money owed to the company will be collected.
SUMMARY OF BASIC LIFE & AD&D BENEFITS
SUMMARY OF VOLUNTARY LIFE BENEFITS
SUMMARY OF VOLUNTARY AD&D BENEFITS(included with Voluntary Life for cost shown)
SUMMARY OF VOLUNTARY SHORT TERM DISABILITY BENEFITS
SUMMARY OF VOLUNTARY LONG TERM DISABILITY BENEFITS
ONLINE WILL PREPARATION
SUMMARY OF FLEXIBLE SPENDING ACCOUNT BENEFITS
Integrated Supply Network, LLC provides you the opportunity to pay for out-of-pocket medical, dental, vision, and dependent care expenses with pre-tax dollars through the Flexible Spending Accounts. You can save approximately 25% of each dollar spent on these expenses when you participate in a FSA.
A health care FSA is used to reimburse out-of-pocket medical expenses incurred by you and your dependents. A dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse work.
Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don’t pay federal income tax, Social Security taxes, and state and local income taxes on the portion of your paycheck you contribute to your FSA. You should contribute the amount of money you expect to pay out of pocket for eligible expenses for the plan period. If you do not use the money you contributed it will not be refunded to you or carried forward to a future plan year. This is the use-it-or-lose-it rule.
The maximum that you can contribute to the Health Care Flexible Spending account is $2,500.
The maximum that you can contribute to the Dependent Care Flexible Spending Account is $5,000 if you are a single employee or married filing jointly, or $2,500 if you are married and filing separately.
The following example shows how you can save money with a flexible spending account.
Bob and Jane’s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult orthodontia and $3,300 for day care next plan year, they decide to direct a total of $5,300 into their FSAs.
Without FSAs With FSAsGross income: $30,000 $30,000FSA contributions: 0 -5,300Gross income: 30,000 24,700Estimated taxes:Federal -2,550* -1,755*State -900** -741**FICA -2,295 -1,890After-tax earnings: 24,255 20,314Eligible out-of-pocketMedical and dependent care expenses: -5,300 0Remaining spendable income: $18,955 $20,314Spendable income increase: $1,359
*Assumes standard deductions and four exemptions. ** Varies, assume 3%.
DEPENDENT CARE REIMBURSEMENT
The dependent care reimbursement option under the FSA helps reimburse you for the work-related cost of care for a qualifying dependent. These costs can include adult daycare (subject to IRS Guidelines) and after school care for a dependent child.
Maximum Contribution: $5,000 per plan year
Estimate what your daycare expenses will be for the year, and allocate enough from your pay, up to the allowable contribution limit, to cover them.
Tax Savings A dependent care FSA offers a way to better manage dependent care expenses and gain real tax savings. Your actual savings will depend on several factors, including your:IncomeTax bracket or amount of income taxes you payYearly dependent care expenses
For example, let's say your: Income is $40,000 annuallyTax bracket is 15 percent, andEstimated dependent care expenses are $5,000
Using the numbers in that example, a dependent care FSA offers an estimated yearly tax savings of $1,132.
With FSA Without an FSAAnnual Income $40,000 $40,000Estimated Care Pretax Contributions $5,000 $0Taxable Income $35,000 $40,000Federal Income & Social Security Taxes $7,391 $8,523Dependent Care Expenses $0 $5,000After-Tax Income $27,609 $26,477
Online Website: www.discoverybenefits.com
SUMMARY OF HEALTH SAVINGS ACCOUNT BENEFITS
WHAT IS AN HSA?• A tax-exempt account established primarily for the purpose of paying qualified medical expenses• A valuable tool to help save money for current and future medical expenses• HSA funds can be used for you, your spouse and your dependent children• Most people who are covered under an IRS qualified High-Deductible Health Plan (HDHP/HSA) can open and contribute to an HSA.
THE TAX ADVANTAGES CAN’T BE BEAT!• Contributions into an HSA will reduce taxable income• Withdrawals made for qualified medical expenses are tax-fee• Earnings on HSA funds are tax-free• Maximum contribution for 2014 for an individual is $3,300 and $6,550 for family
Individuals 55 and older, are allowed the opportunity to “catch up”, which means are allowed to contribute up to an additional $1,000 to their HSA account.
HSA funds do not need to be spent by the end of the calendar year. Funds can remain in the account year after year earning interest until you need to use the funds. At the age of 65, the account can be used as retirement savings or continue to be used for medical expenses, you decide!
To open an HSA, you must be enrolled in the High Deductible plan with UMR.
Questions regarding your Health Savings Banking Account should be directed to:
SUMMARY OF HSA/FSA ELIGIBLE EXPENSES
SUPPLEMENTAL BENEFITS
To get exact pricing and to enroll in these plans you will need to reach out to Shaunet Prokuski at OMS Insurance Group at 863-688-1751, x226 as these plans are customized based on your needs and can’t be elected via your new hire enrollment form.
ACCIDENT CARE
Accident Care is available to cover you and your dependent children 24/7 for any type of an accident. Whether it be your children participating in Little League, weekend sports or other leisure hobbies such as chores and fix-up projects around the house, accidents do occur unexpectedly and are a part of everyday life. And often, we don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Designed to supplement your employer-sponsored insurance coverage, accident insurance pays specific benefit amounts for covered accidents. Benefits from a supplemental accidental insurance plan can help pay out-of-pocket expenses related to an accidental injury that your existing coverage would not cover.
On and Off the job coverage available Accidental Death and Dismemberment benefit included Annual Health Screening Rider (if elected) Hospital Admission/ER Benefits for accidents included Follow up treatment care for accidents included
Plan 1: On and Off-job accident coverage with Health Screening RiderCoverage Cost per MonthEmployee $19.75
Employee + Spouse $26.501 Parent Family $31.752 Parent Family $38.50
MEDICAL BRIDGE 3000
Benefits from Medical Bridge are paid in a lump sum benefit to you per covered hospital confinement or outpatient benefit SURGERY, unless you specify otherwise, regardless of any other insurance you may have with other insurance companies.
Medical Bridge provides supplemental benefits for:
Annual Wellness Benefit Confinement to a hospital due to a covered accident or sickness. Outpatient surgical procedures performed by a doctor, using anesthesia
administered by a licensed anesthesiologist in a hospital or ambulatory surgical center.
Rehabilitation Unit Benefit Diagnostic Procedure and ER visit benefits, if elected
Coverage is available to you, your spouse and your dependent children. Plus Medical Bridge offers different benefit amounts so that you can choose the coverage that best meets your individual needs. Medical Bridge is portable, which means you can take your coverage with you if you change jobs or retire.
Medical Bridge 3000 CoverageOption 1
Hospital Confinement Benefit - $500Outpatient Surgical Procedures Benefit - $1,500 Calendar Year Maximum (Tier
schedule applies)Rehabilitation Unit Benefit - $100 per Day up to 15 Days
Wellness Benefit - $50; one per calendar year for employee only coverage; two per calendar year combined for family coverage
You Pay Monthly 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Employee $11.95 $12.00 $12.05 $12.65 $14.25 $15.90 $17.80 $20.95
Employee + spouse $22.25 $22.75 $23.15 $24.70 $27.90 $31.60 $36.20 $42.8
0Employee + Child(ren) $19.50 $19.35 $19.00 $19.60 $20.85 $22.55 $24.70 $28.0
0Employee + Family $27.05 $27.60 $27.95 $29.55 $32.90 $36.55 $41.05 $46.2
5
Option 2Hospital Confinement Benefit - $1,000
Outpatient Surgical Procedures Benefit - $1,500 Calendar Year Maximum (Tier schedule applies)
Rehabilitation Unit Benefit - $100 per Day up to 15 DaysWellness Benefit - $50; one per calendar year for employee only coverage; two
per calendar year combined for family coverage.
You Pay Monthly 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Employee $18.25 $17.65 $17.25 $18.15 $20.40 $22.80 $25.90 $31.00
Employee + spouse $33.60 $33.20 $33.05 $35.35 $40.05 $45.45 $52.60 $63.2
0Employee + Child(ren) $29.45 $28.45 $27.35 $28.05 $29.85 $32.25 $35.65 $40.9
0Employee + Family $41.10 $40.80 $40.60 $42.95 $47.85 $53.15 $60.25 $69.4
0
CRITICAL ILLNESS 1.0
Critical Illness Insurance offers you supplemental benefits if you are diagnosed with one of the following specified disease:
Heart Attack (myocardial infarction) Stroke Major Organ Failure End Stage Renal (Kidney) Failure Coronary Artery Bypass Graft Surgery Blindness Coma Permanent Paralysis due to a Covered Accident Annual Screening Rider ($50) for certain screening tests
Critical Illness Insurance will pay a percentage of the policy face amount upon diagnosis of a covered critical illness. These benefits can be used to help pay the out-of-pocket expenses related to the treatment of a critical illness.
Critical Illness Insurance Monthly Premiums (based on a $15,000 Benefit)Age Non-Tobacco Rates Tobacco Rates25 – 29
$1.95 $3.60
30 – $3.30 $5.70
3435 – 39
$5.10 $9.00
40 – 44
$7.35 $13.20
45 – 49
$10.50 $18.75
50 – 54
$14.10 $25.05
55 – 59
$17.55 $31.35
60 - 64
$22.05 $39.45
65 - 70
$26.85 $47.85
*Spouse and Dependent Children can be added for additional cost.
CANCER 1000
Colonial’s Cancer Insurance provides supplement benefits for you to use where they are needed most. This cancer plan pays specific benefits for cancer diagnosis and treatment.
Upon diagnosis of cancer, his plan provides benefits for procedures and treatments you may require to care for your cancer.
Includes benefits for transportation and lodging This plan pays an annual cancer screening benefit for certain screening tests. Includes a $5,000 Initial Diagnosis Benefit
Cancer 1000 – Monthly PremiumsEmployee Employee &
Dependent Children
Employee, Spouse &
Dependent Children
Level 1 $17.50 $20.50 $29.50Level 2 $26.50 $29.50 $44.00Level 3 $32.50 $37.50 $55.00Level 4 $41.50 $47.00 $68.50
SECTION 125
INTEGRATED SUPPLY NETWORK, LLC allows you the opportunity to pre-tax your benefits. This means you pay for your Insurance Premiums with pre-tax dollars. You must elect this when completing the necessary paperwork. Certain limitations apply regarding dependent status changes if you choose to pre-tax your benefits.
If you decline to participate in the benefit program, you may not enroll until the next open enrollment period. The open enrollment period occurs annually, prior to the plan anniversary dates. You will be advised of the opportunity to enroll during annual open enrollment.
If you pre-tax your benefits, IRS Section 125 guidelines mandate that coverage may not be cancelled without a qualifying event. Once coverage is cancelled, you may not re-enroll until the following open enrollment period.
Your contributions through payroll deduction for Medical, Dental, Vision, the first $50,000 of Term Life, Supplemental Health (including Hospital Indemnity) are covered under the IRS Section 125 Premium Payment Plan. This plan allows this contribution to be taken out of your paycheck before taxes are applied. The example below illustrates what this means to an employee earning $25,000 per year, filing single with zero exemptions. Keep in mind that the tax savings include both federal income tax and social security tax. The example assumes Employee only coverage at a weekly cost of $20.00 and annual cost of $1,040.00.
No Plan With PlanGross Income $25,000 $25,000
Insurance Premiums (before tax) N/A $1,040Taxable Income $25,000 $23,960
Federal Income & Social Security Taxes
$4,970 $4,734
Sub-Total $20,030 $19,226
Insurance Premiums (after tax) $1,040 N/A
Take-Home Pay $18,990 $19,226
Total Savings of $236!As a client of OMS you have access to our corporate rate and VALUED DISCOUNT PROGRAM. Join through the OMS Corporate program and receive a reduced annual fee. Below is a small representation of the discounts and benefits:
QUALIFYING EVENTS
Examples of a qualifying event include: Marriage, Adoption, Birth, Divorce, and Spouse obtaining or losing other group coverage. If you are not sure if you have a qualifying event, please see Human Resources.
Remember, if you change your election your contribution may change. Should you experience one of these qualifying events or have questions regarding your enrollment or dependent status, please contact Human Resources. Failure to notify Human Resources within 30 days will prohibit you from enrolling or making changes until the next annual open enrollment.
EXAMPLES OF QUALIFIED LIFE EVENTS OF FAMILY STATUS CHANGE
Qualified Event Date of Event
Notification Due Date
Required Documentation
Adding Dependent(s)
Marriage January 15 Before February 15 Marriage Certificate
Birth of Child October 6 Before November 6 Birth Certificate
Adoption of Child May 10 Before June 10 Adoption papers/Birth Certificate
Terminating Dependent(s)
Divorce or Legal Separation
July 10 Before August 10 Divorce decree or separation Agreement
Death of dependent April 21 Before May 21 Death certificate
Spouse becomes Insured under his/her Employer sponsored
November 5 Before December 5 Proof of new employment, Eligibility & coverage
Plan
The examples shown illustrate typical qualified life events or family status changes that an employee may experience and are intended for demonstration purposes only. Please refer to your other written material for a detailed list of eligible benefit elections.
IMPORTANT INFORMATION FOR HEALTHCARE TRANSITION
Does the idea of changing Health Insurance Carriers concern you? If you answered yes, it should. Rising healthcare costs are forcing employer’s like yours to make changes to your health plan. Other factors such as Quality, Network Access and ease of Plan administration play key roles in the decision to change. Our goal is to make this transition as painless as possible for you. Outlined below are some suggestions and tips on how to make this a smooth transition for you and your covered family members. Please be sure your enrollment form is complete and is legible. Missing information
such as dates of birth or social security #s will only delay the enrollment process & your I.D. Cards.
DO NOT use your prior ID Card from your prior health carrier after coverage is effective with the new carrier. This will cause significant out of pocket expenses on your behalf.
Pre-fill all prescriptions before your current coverage expires . ID cards could arrive late, making it difficult to fill your prescriptions.
Try not to schedule an office visit during the first 5 - 10 days of coverage with a new carrier.
Although rare, pre-existing condition limitations may apply to your plan. If you have been covered under a plan prior to enrolling in this new program, please provide a copy of the I.D. Card and any applicable paperwork received from the prior Insurance Company (i.e. Certificate of Creditable Coverage). This will eliminate any confusion and claims should be processed timely.
Are you planning to cover your eligible spouse and/or dependent children? If you are not sure, you must make an educated and timely decision. Delays in this decision could post-pone your opportunity to enroll them. Open enrollment occurs annually unless you have experienced a qualifying event.
Do you have a Family Physician? You may also refer to him/her as your Primary Care Physician (PCP). If so, please confirm that your physician participates with your new health insurance carrier. If your physician participates in the new Plan, great! If not, please be sure to:
o Select a new Physician under the new Plan. You may want to ask your current Physician if he/she can recommend someone.
o Set an appointment as soon as possible. It is important that you establish a relationship as soon as possible. This will only benefit you when you need to receive care or treatment and is critical if you are taking medication.
o Have your medical records transferred, especially if you suffer from an ongoing illness.
Are you currently under the care of a Specialist? If so, it is important that you coordinate with your Primary Care Physician and/or the new Plan to be sure proper referral procedures have been followed. While some carriers allow you to self-refer to network specialists, some do not.
Are you or any of your eligible, covered dependents Pregnant, scheduled for surgery within the next 30 days, or currently undergoing physical therapy? If you answered yes to any of these, it will be important for you to complete necessary “Transition of Care” paperwork, which varies by company. While not a guarantee of coverage, this provides the Insurance Carrier with the necessary information to coordinate a smooth transition.
YOUR RIGHT TO DOCUMENTATION OF HEALTH COVERAGE
Recent changes in Federal law may affect your health coverage if you are enrolled or become eligible to enroll in health coverage that excludes coverage for preexisting medical conditions.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) limits the circumstances under which coverage may be excluded for medical conditions present before you enroll. Under the law, pre-existing condition exclusion generally may not be imposed for more than 12 months (18 months for a late enrollee). The 12-month (or 18-month) exclusion period is reduced by your prior health coverage. You are entitled to a certificate that will show evidence of your prior health coverage. If you buy health insurance other than through an employer group health plan, a certificate of prior coverage may help you obtain coverage without pre-existing condition exclusion. Contact your State insurance department for further information.
For employer group health plans, these changes generally take effect at the beginning of the first plan year starting after June 30, 1997. For example, if your employer’s plan year begins on January 1, 1998, the plan is not required to give you credit for your prior coverage until January 1, 1998.
You have the right to receive a certificate of prior health coverage since July 1, 1996. You may need to provide other documentation for earlier periods of health care coverage. Check with your insurance carrier to see if your plan excludes coverage for preexisting conditions and if you need to provide a certificate or other documentation of your previous coverage.
THE WOMEN'S HEALTH AND CANCER RIGHTS ACT OF 1998
The Women's Health and Cancer Rights Act of 1998 (WHCRA) requires all health plans to cover reconstructive surgery following a mastectomy. Your health program currently covers such reconstructive surgery. This law also requires that we provide you with this notice.
Coverage for Reconstructive Surgery Following MastectomyWhen a covered individual receives benefits for a mastectomy and decides to have breast reconstruction, based on consultation between the attending physician and the patient, the health plan must cover:
reconstruction of the breast on which the mastectomy was performed;surgery and reconstruction of the other breast to produce symmetrical appearance; andprosthesis and treatment of physical complications in all stages of mastectomy, including lymph edema.
This coverage must be the same as for any other benefit under the plan.
NOTICE IF YOU DECLINE GROUP COVERAGE
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within
30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth adoption, or placement for adoption.
COBRA CONTINUATION
The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) requires employer-sponsored group plans to allow covered employees and dependents to elect to have their current coverage continued, at group rates, following a qualifying loss of coverage. The law applies to employers who customarily employed 20 or more employees on a typical business day in the preceding year. OMS Cobra Services will notify you of your continuation rights on any OMS Cobra Services sponsored plans that you may elect to participate in. This notice is intended to advise employees and their eligible dependents about their rights and obligations under the law.
GENERAL NOTICE**CONTINUATION COVERAGE RIGHTS UNDER COBRA**
PLEASE READ AND KEEP FOR YOUR RECORDS
Introduction
You are receiving this notice because you have recently been offered coverage under Integrated Supply Network, LLC Group Plan. If you elected coverage, this notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. The right to COBRA continuation coverage was created by a federal law, Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and to other members of your family who are covered under the Plan when you would otherwise lose your group coverage. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. This notice gives only a summary of your COBRA continuation coverage rights. For more information about your rights and obligations under the Plan and under federal law, you should either review the Integrated Supply Network, LLC Summary Plan Description or request a copy of the Plan Document from the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
The Plan Administrator is
Integrated Supply Network, LLC 2727 Interstate DriveLakeland, FL. 33805
The COBRA Administrator is
UMR COBRA ADMINISTRATION
PO BOX 1206WAUSAU WI 54402-1206800-207-1824What is COBRA Continuation Coverage? COBRA continuation coverage is a continuation of Integrated Supply Network, LLC's Group Plan when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” A qualified beneficiary is someone who will lose coverage under Integrated Supply Network, LLC's Group Plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries.
Under the Integrated Supply Network, LLC Group Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage by the due date, subject to a 45-day grace period for the initial payment and a 30-day grace period for subsequent payments.
If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:
(1) Your hours of employment are reduced, or(2) Your employment ends for any reason other than your gross misconduct.
If you are the covered spouse or child of an employee, you will become a qualified beneficiary if you lose your coverage under Integrated Supply Network, LLC's Group Plan because any of the following qualifying events happens:
(3) Employee dies;(4) Employee's hours of employment are reduced;(5) Employee's employment ends for any reason other than his or her gross misconduct;(6) Employee becomes enrolled in Medicare – Part A, Part B, or both
(This is not a qualifying event if the employee is still employed with the company);
(7) You become divorced or legally separated from the employee; or(8) The child stops being eligible for coverage under the plan as a “dependent
child.”
If the Plan provides a health Flexible Spending Account you may be able to continue this coverage to the end of the plan or calendar year, if a balance is in your account at the time of the qualifying event.
If the Plan provides retiree health coverage, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Integrated Supply Network, LLC, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee is a qualified beneficiary with respect to the bankruptcy. The retired employee's spouse, surviving spouse, and dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.
When is COBRA Coverage Available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction in hours of employment, death of the employee, if the Plan provides retiree health coverage: commencement of a proceeding in a bankruptcy with respect to the employer, or enrollment of the employee in Medicare (Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event within 30 days of the qualifying event date or the loss of coverage date, whichever is later.
You Must Give Notice of Some Qualifying Events
For other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for coverage as a dependent child), you must notify the Plan Administrator.
The Plan requires you to provide written notice and any required documentation to the Plan Administrator within 60 days after the qualifying event occurs. You must send the written notice to:
Integrated Supply Network, LLC 2727 Interstate DriveLakeland, FL. 33805
How is COBRA Coverage Provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage.
Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, enrollment of the employee in Medicare (Part A, Part B, or both), your divorce or legal separation, or a dependent child losing eligibility as a dependent child, COBRA coverage may continue up to 36 months for the spouse or child. When the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage lasts for up to 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended:
1) Disability extension of 18-month period of continuation coverageIf you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. The qualified beneficiary must notify the COBRA Administrator in writing and provide documentation of the disability
from the Social Security Administration within 60 days of the later of: (a) the date of the Social Security disability determination, (b) the date the qualifying event occurs, (c) the date the qualified beneficiary loses (or would lose) coverage due to the original 18-month qualifying event, or (d) the date on which the qualified beneficiary is informed of the requirement to notify the COBRA Administrator of the disability by receiving the summary plan description or the general COBRA notice. Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. If the qualified beneficiary is determined by SSA to no longer be disabled, you must notify the COBRA Administrator in writing within 30 days after SSA's determination.
2) Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. In all of these cases, you must make sure that the COBRA Administrator is notified in writing of the second qualifying event within 60 days of the second qualifying event. This notice must be sent to:
UMR COBRA ADMINISTRATION
800-207-1824
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
Early Termination of COBRA Continuation
Continuation coverage under COBRA may terminate before the end of the above maximum coverage periods for any of the following reasons:
(1) This employer ceases to maintain a Group Plan for any employees. (Note that if the employer terminates the Group Plan that you are under, but still maintains another Group Plan for other similarly-situated employees, you will be offered COBRA Continuation coverage under the remaining Group Plan, although benefits and costs may not be the same.
(2) The required premium for the Qualified Beneficiary's coverage is not paid on time.
(3) After electing COBRA continuation, the Qualified Beneficiary becomes enrolled with Medicare.
(4) After electing COBRA continuation, the Qualified Beneficiary becomes covered under another group plan that does not contain any exclusion or limitation with respect to any Pre-Existing Conditions for the beneficiary.
(5) The Qualified Beneficiary is found not to be disabled during the disability extension.
(6) Termination for cause, such as submitting fraudulent claims.If You Have Questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under ERISA, including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa . (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.) For more information about the Marketplace, visit www.HealthCare.gov.
Keep Your Plan Informed of Address and Marital Status Changes
In order to protect you and your family's rights, you should keep the Plan Administrator informed of any address or marital status changes of covered family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator and/or COBRA Administrator.
The Plan Administrator is:
Integrated Supply Network, LLC 2727 Interstate DriveLakeland, FL. 33805
The COBRA Administrator is
UMR COBRA ADMINISTRATION PO BOX 1206WAUSAU WI 54402-1206
Please direct all communications to your Human Resources Department
