The Wittern Group

Benefit Summary 

 

 

 

Benefits Overview 

 

The Wittern Group is pleased to offer a comprehensive benefits package to all eligible, full-time employees. The complete benefit package is briefly summarized in this Summary, however, you will receive plan booklets for elected benefits which will provide more detailed information about each of the following programs.  

  

      You will share the costs of some benefits while The Wittern Group provides other benefits at no cost to you. In addition, there are voluntary benefits which you can purchase with reasonable group rates through The Wittern Group payroll deductions. The benefit plans offered are Medical, Dental, Life Insurance, Accidental Death and Dismemberment (AD&D) Insurance, Long-Term Disability, Optional Life and Dependent Life coverage, Voluntary Short Term Disability and Voluntary Vision.  

  

This Summary gives you an overview of the main features of your benefit plan however; the plans are administered according to legal plan documents and insurance contracts. Although we've tried to summarize the provisions clearly and accurately, if any information presented here conflicts with the legal documents, the legal documents will govern. This document does not guarantee any benefits. 

  

Which Employees Are Eligible For Coverage?

  

You are an eligible employee if you are a full-time employee regularly working 40 hours per week. You become eligible for benefit coverage on the first day of the month following 30 days of employment.  Part-time, temporary or seasonal employees are not eligible for coverage. See your insurance plan documents for further information about your eligibility.    

  

Medical Coverage ~ Administered by Wellmark Blue Cross/Blue Shield

  

You will be covered with one of the most widely-recognized worldwide insurance carriers.  Wellmark Blue Cross/Blue Shield is one of the nation's leading providers of medical benefits. They put information and helpful resources to work for millions of members to help them make better informed decisions about their health care and protect their finances against health-related risks. 

  

Wellmark will administer your coverage and provides an extensive provider network system around the country.  In most cases, you should not have to file claim forms or pay anything more than your co-payment(s) or deductible(s) in advance. The Wittern Group offers you a choice of a PPO (the choice of in-network or out-of-network providers) or HMO (all care must be provided or coordinated by the HMO network) medical plans. The following guide highlights your benefits but for more complete information, please references your benefit booklet or contact Wellmark. 

  

How Does Your Medical Program Work?

  

You pay less out-of-pocket if you use the physicians, hospitals, and other healthcare providers that participate in the PPO or HMO networks with Wellmark.  You receive the highest level of benefits when you use Network or Preferred Providers.  To find this these providers: 

·          Visit the Wellmark web site at www.wellmark.com  and look for information regarding Wellmark's   

        Preferred Provider Organization (PPO) network, or Health Maintenance Organization (HMO) or 

·          Call their Customer Service with questions about eligibility, benefits, or providers: 800-526-8995. 

  

Remember, with a Preferred Provider (PPO) you pay more out of your pocket when you use Out-of-Network Providers.  The chart in this booklet shows a comparison between benefits when you use In-Network Providers and benefits when you use Out-of-Network Providers.  The Blue Access Health Maintenance Organization (HMO) provides a high level of benefits by which your care must be provided or coordinated within the Blue Access network of Physicians. Also keep in mind that your health plan pays the Allowed Price for services and supplies.  In-Network Providers agree to accept the Allowed Price as payment in full.  When you use Out-of-Network Providers, you must pay the difference between the usual and customary rate and the provider's charge, in addition to any deductibles and coinsurance amounts that may apply. 

  

Benefits for some services require that you pay a deductible each year for In-Network Providers' services and a higher deductible each year for Out-of-Network Providers' services.  Once you have met your deductible, you share the cost of your care through coinsurance.    

Once again, the coinsurance amount for Out-of-Network Providers is higher than that for In-Network Providers. You need only pay the deductible and coinsurance until you meet your out-of-pocket maximum for the year.  For many services performed in a doctor's office you receive first-dollar coverage.  With first dollar coverage you pay a small co-payment for each visit, but you may not have to pay a deductible or coinsurance. Please review your plan booklet for further information.         

  

SUMMARY OF BENEFITS

Delta Dental Premier~ Administered by Delta Dental  

  

Good oral care enhances overall physical health, appearance and mental and physical well-being. Problems with the teeth  

and gums are common and easily treated. Keep your teeth healthy and your smile bright with  

The Wittern Dental benefit plan. 

  

 

  

  

  

^{LIFE and ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D)}  

^{~ Administered by Sun Life Assurance Co.} 

Life insurance provides financial security for people who depend on you. With Sun Life Assurance Co. Life/AD&D insurance, your family will be protected with benefits and a variety of support services designed to help them cope with both emotional and financial issues. It can help you preserve your dream of a secure lifestyle for your family, even if you can't be there.  

  

Eligible employees will automatically receive a Basic Life and AD&D Insurance benefit equal to 1 x annual salary (up to $105,000). The Wittern Group pays the full cost of this basic coverage.  Benefits will reduce for employees age 65 or older.  See your Human Resources representative for more information. 

  

  

OPTIONAL LIFE and DEPENDENT LIFE BENEFITS ~ Administered by Sun Life Assurance Co. 

You may add to your Basic Life and AD&D Insurance amount by purchasing Optional Life and Dependent Insurance coverage in increments of $10,000 up to a maximum of $500,000 or 3 times your basic annual earnings, whichever is less. 

   

For those employees who enroll in Optional Life Insurance, you may also purchase Dependent Spouse Optional Life Insurance for your spouse in increments of $10,000 to a maximum of $100,000. Additionally, you may purchase Dependent Child Life Insurance coverage (for eligible dependents) in $5,000 increments up to $10,000.    The amount of Dependent Optional Life Insurance cannot exceed 50% of the Employee's amount of Optional Life Insurance. 

  

  

  

VOLUNTARY VISION ~ Administered by Avesis Vision Plan 

 

You have the opportunity to join millions of people who use Avesis to meet their vision care needs. This program has been specifically designed to provide you and your covered family members with quality, professional vision care, all at a tremendous savings to you! 

In-Network Vision Benefits include discounts on vision exams, frames, contact lenses and spectacle lenses. Affordable and easy to use!  

  

IMPORTANT THINGS TO REMEMBER 

 

·          Show your identification card every time you go to the doctor or pharmacy. 

  

·          Be sure that all providers (doctors, labs, x-rays, etc.) participate in-network for the best coverage. 

  

·          If you acquire or lose a dependent during the year, you must notify Human Resources within 30 days of the event.  

 

·          The choices you make now will remain in effect until the next open enrollment period unless you experience a family   

status change.  

                    

All benefit plans are subject to change from time to time and The Wittern Group reserves the right to amend or cancel any benefits described in this Summary, with or without notice. For more detailed information on the plans and your legal rights under the plan,  

be sure to read the summary plan description or request a copy of the plan documents. If you have any questions please contact  

the Human Resources Department at 515-271-8405. 

 

  

 

 

 

 

  

LEGAL UPDATES

What is a Pre-Existing Condition? 

A "pre-existing condition" is an injury or disease for which a person: 

     -   received treatment or services; or 

     -   took prescribed drugs or medicines; 

during the 180 days right before the person's effective date of coverage (or, if the Plan requires you to serve a probationary period, the 180 days right before the first day of the probationary period).  See the Effective Date of Coverage or Late Enrollee section of the Summary of Coverage, whichever applies, to determine a person's effective date of coverage. For the first 365 days following such date, Covered Medical Expenses do not include any expenses for treatment of a pre-existing condition. 

  

Special Rules as To a Pre-existing Condition 

If a person had creditable coverage and such coverage terminated within 90 days prior to the date he or she enrolled (or was enrolled) in this Plan, then any limitation as to a pre-existing condition under this Plan will not apply for that person. Also, if a person enrolls (or is enrolled) in this Plan immediately after any applicable probationary period has been served, and that person had creditable coverage which terminated within 90 days prior to the first day of such probationary period, then any limitation as to a pre-existing condition will not apply for that person. As used above:  "creditable coverage" means a person's prior medical coverage as defined in the Federal Health Insurance Portability and Accountability Act (HIPAA) of 1996.  Such coverage includes the following:  coverage issued on a group or individual basis, Medicare, Medicaid, military-sponsored health care, a program of the Indian Health Service, a state health benefits risk pool, the Federal Employees' Health Benefit Plan (FEHBP), a public health plan as defined in the regulations, and any health benefit plan under Section 5(e) of the Peace Corps Act. 

 

The Women's Health And Cancer Rights Act 

                                                                         

Under this health plan, coverage will be provided to a person who is receiving benefits for a medically necessary mastectomy and who elects breast reconstruction after the mastectomy, for: 

(1)  reconstruction of the breast on which a mastectomy has been performed; 

(2)  surgery and reconstruction of the other breast to produce a symmetrical appearance; 

(3)  prostheses; and 

(4)  treatment of physical complications of all stages of mastectomy, including lymphedemas. 

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 for the mastectomy. If you have any questions about our coverage of mastectomies and reconstructive surgery, please contact the Aetna Member Services number on the back of your ID card. 

  

Making Enrollment Changes During The Year

In most cases, your benefit elections remain in effect for the entire year (January 1 - December 31). During each annual enrollment period, you will have the opportunity to review your benefit elections and make changes for the coming year. 

  

Certain coverages allow limited changes to elections during the year. These benefits include the medical and dental plans. Under these benefits, you may only make changes to your elections during the year if you have a change in family status. Family status changes include: 

  

·          Marriage, divorce or legal separation 

·          Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, marriage,  

         or reaching the dependent child age limit 

·          Changes in your spouse's employment affecting benefit eligibility 

·          Changes in your spouse's benefit coverage with another employer that affects benefit eligibility 

  

The change to your benefit elections must be consistent with the change in family status. You have 30 days from the date of a change in family status to complete an enrollment change form and return it to Human Resources. In most cases your election will become effective the first day of the month following your request. Otherwise, you must wait until the next annual enrollment period to make a change to your elections.  

IMPORTANT:  This Benefit Summary is an outline of the coverages proposed by the carriers, based on information provided by your company.  It does not include all of the terms, coverages, exclusions, limitations, and conditions of the actual contract language..  This document does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts.  Please see your policy or contact us for specific information or further details in this regard.