2016 Benefits and Enrollment Guide - Explain My Benefits€¦ · 2016 Benefits and Enrollment Guide...

2016 Benefits and Enrollment Guide

Health | Dental | Vision | Life | Disability | FSA

January 1, 2016 to December 31, 2016

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see pages 21-23 for more details.

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2016 Benefit Summary Guide Overview

Annual Enrollment: Enrollment is only available from November 16, 2015 through November 22, 2015. FPG will enroll using the self-service on-line enrollment tool through EMB; you will be able to access the system using any computer or mobile device with internet access at http://www.explainmybenefits.biz/fpg

ALL benefit eligible employees MUST complete all their enrollment through the Explain My Benefits self service system, even if not making changes or declining, by the deadline of Nov 22, 2015. If enrolling dependents, make sure to have their social security number and date of birth.

This is the only opportunity you will have this year to make changes to your benefit elections. During this period you may add, drop, or modify coverage. You will be locked into the plan selections until December 31, 2016, unless there is a qualifying event (marriage, divorce, birth, adoption/change in custody of a child, death of a dependent, change in employment status). All changes must be made within 30 days of the event.

Following are the changes to our current benefit plans:

Healthcare & Vision: United Healthcare

Dental, Life & Disability: Mutual of Omaha

Voluntary Benefits: Trustmark

Hospital Indemnity: American Public Life

Employee Contributions: Employees will be asked to share the cost of their insurance benefits. Your contribution amounts are outlined throughout this guide and in the enrollment materials provided through the Explain My Benefits website. Family Physicians Group has invested significantly to keep your payroll deductions affordable.

3 Eligibility

4 Healthcare Benefits

5 Employee Contributions

6 Choosing the Right Care Facility

7 Tips for a Successful Healthcare Experience

8 Voluntary Dental

9 Voluntary Vision

10 Employer Paid Life

11 Voluntary Term Life Insurance

12 Voluntary Short Term Disability

13 Base & Voluntary Long Term Disability

14 Flexible Spending Account (FSA)

15 Medical FSA Overview

16 Dependent FSA Eligible Expenses

17 Additional Voluntary Benefits & EAP

18-19 401K Plan Highlights

20 Important Disclosures & Notices

24 Availability of SBC’s

28 Contact Information

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern. Family Physicians Group reserves the right to change or terminate at any time, in whole or in part, the employee benefit package, with respect to all or any class of employees, former employees and retirees.

Family Physicians Group offers eligible employees a variety of benefits that can provide you and your fam-ily with health care coverage, financial protection and more, tailored to best fit your needs. Our benefits program is an important part of your overall compensation and with the assistance of HYLANT, we are regularly assessing the quality and cost of the benefits to ensure we offer the most competitive package possible. Changes and relevant new information are highlighted below, however, we encourage you to review this guide in its entirety.

Contents

Customer Service Hotline: In order to help you with your benefit questions, claim issues, and gen-eral inquiries, you and your dependents may con-tact HYLANT. HYLANT is a one-source helpline for all of your benefit questions. Please call the toll-free number (1.866.740.5550) and speak to a cus-tomer service specialist who knows your benefit plan and can help with any questions.

3 2016 Benefits and Enrollment Guide

Family Physicians Group is pleased to offer its employees an excellent benefit program. These health and welfare benefits are designed to protect you and your family while you are an active employee.

Eligibility: Health and welfare plans are available to all employees who work 30 or more hours per week.

Dependent Eligibility: If you wish, your dependents may also be covered under the medical, dental and vision plans. Eligible dependents include:

Legal spouse; and

Your children up to age 26 regardless of marital sta-tus, financial dependency, residency with the Eligible Employee, student status, employment status, or eli-gibility for other coverage. For Medical, in the state of Florida dependent coverage is available up to age 30 if the dependent is unmarried, a Florida resident (or full-time student) and uninsured. The dependent must maintain continuous service.

New Hire Coverage: As a new hire, your plan eligibility date is the first day of the month following 60 calendar days of service with Family Physicians Group. Once the necessary enrollment process has been completed, bene-fits are effective on your plan eligibility date.

New employees have up to 30 days after their eligibility date to enroll. If you do not enroll by that deadline, you will not be eligible for coverage until the following annual enrollment period.

Annual Elections: It is important that you make your choices carefully, since changes to those elections can generally only be made during the annual open enrollment period. Exceptions will be made for changes in family status during the year, allowing you to make a mid-year benefit change. A family status change includes:

Marriage

Divorce

Birth or adoption

Death of a dependent

Change in your spouse’s employment or

Loss of coverage by a spouse

Eligibility

If you have a family status change, you must change your benefit elections within 30 days of the qualifying event, or you will need to wait until the next annual open enrollment period.

COBRA Continuation Coverage: When you or any of your dependents no longer meet the eligibility require-ments for health and welfare plans, you may be eligible for continued coverage as required by the Consolidated Om-nibus Budget Reconciliation Act (COBRA) of 1986.

Affordable Care Act IRS Reporting

Just a heads up…

We value our employees and are committed to providing you and your family with affordable, substantial health benefits that meet the requirements of “minimum essential coverage” under the Affordable Care Act (ACA).

After January 1, 2016, IRS Form 1095-B will be provided to employees as proof of the health coverage we offer you and your family. It will contain information about who pro-vides your health insurance, as well as which members of your family are covered by the policy and the months of the year each person was covered in 2015.

You will be able to use Form 1095-B to help report your insurance coverage when filing your tax return. Only one form is provided for all the individuals listed on your policy; you may need to provide copies to your spouse or de-pendents, as necessary.

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Healthcare benefits are one of the most important and necessary parts of your benefit package. The following is a sum-mary of your three benefit options offered through United Healthcare. For a more detailed explanation of benefits, please refer to your certificate of coverage.

You may access a list of participating providers at www.myuhc.com.

Base Plan (Choice 5QF MOD)

Mid Plan (Choice OKU-MOD2)

High Plan (Choice Plus OLU-MOD3)

In-Network What you pay

Out-of-Network What you pay





Doctors Office Visits Primary Care Physician*

Specialist* Preventive Care Services

Convenience Care (i.e. Clinics at CVS & Walgreens)

Urgent Care* (i.e. Centra Care)

30% after CYD 30% after CYD Covered in Full 30% after CYD

30% after CYD

Not covered Not covered Not covered Not covered

Not covered

$45 copay $45 copay

Covered in Full $45 copay

$50 copay

Not covered Not covered Not covered Not covered

Not covered

$30 copay $50 copay

Covered in Full $30 copay

$50 copay

Emergency Room 30% after CYD $300 copay $200 copay

Prescription Drugs Pharmacy Filled

(up to 30 day supply)

Mail Order (up to 90 day supply)

Tier I: $10 Tier II: $35 Tier III: $60

Tier IV: $100

Tier I: $25 Tier II: $87.50 Tier III: $150 Tier IV: $250

Not covered

Not covered


Tier IV: $100


Not covered

Not covered


Tier IV: $100


Not covered

Not covered

Diagnostics Labs @ LabCorp

X-rays

30% after CYD

30% after CYD

Not covered

Not covered

$0 copay

$0 copay at Independent Facilities

Not covered

Not covered

$0 copay

$0 copay at Independent Facilities

30% after CYD

30% after CYD

Major Diagnostics (i.e. MRI, PET/CT Scans)

30% after CYD Not covered 30% after CYD Not covered 10% after CYD 30% after CYD

Deductible/Basis ~January to December~

Calendar Year Deductible (CYD)

Not covered Calendar Year Deductible (CYD)

Not covered Calendar Year Deductible (CYD)

Individual

Family

$2,000

$4,000

Not covered

Not covered

$1,000

$2,000

Not covered

Not covered

$500

$1,000

$1,000

$2,000

Co-Insurance 30% Not covered 30% Not covered 10% 30%

Out of Pocket Maximum Includes Deductible, Coinsurance & Copays

Not covered Includes Deductible, Coinsurance & Copays

Not covered Includes Deductible, Coinsurance & Copays

Individual

Family

$6,000

$12,000

Not covered

Not covered

$4,500

$9,000

Not covered

Not covered

$2,000

$4,000

$4,000

$8,000

Outpatient Hospital Services

30% after CYD Not covered $250 Copay + 30%

after CYD Not covered 10% after CYD 30% after CYD

Inpatient Hospital Services

30% after CYD Not covered $500 Copay + 30%

after CYD Not covered 10% after CYD 30% after CYD

Lifetime Maximum Benefit

Unlimited Not covered Unlimited Not covered Unlimited

30% after CYD 30% after CYD 30% after CYD 30% after CYD

30% after CYD

Healthcare Benefits At-a-Glance

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

* In addition to the visit Copayment, the applicable Copayment and any Deductible/Coinsurance may apply when these services are done: CT, PET, MRI, Nuclear Medicine; Scopic Procedures; Surgery; Therapeutic Treatments.



Employee Contributions (Payroll Deductions for Medical)

Bi-Weekly Deductions

Employee Employee +

Spouse Employee +

Children Employee +

Family

Healthcare

Base Plan $57.23 $248.77 $209.08 $326.77

Mid Plan $92.77 $280.62 $236.31 $368.77

High Plan $164.77 $438.92 $369.23 $480.92

Prescription Savings

Many pharmacies now offer discount prescriptions—often even lower than your copay. Below are just a few of the current discounts offered:

Publix: a variety of oral antibiotics for FREE

Target: over 300 generics for only $4

Wal-Mart: $4 for a 30-day supply and $10 for a 90-

day supply of some generic medications

Walgreens: Over 300 generics for $12.99 for a 90-

day supply

Lab Facility:

We highly recommend that for lab work, you go to an In-Network standalone facility to minimize your expenses. If your doctor’s office sends out labs, you run the risk of them being sent to an Out-of-Network facility. If that happens, you will be responsible for the Out-of-Network charges which can be significant!

Your In-Network National Lab Facility is:

Family Physician Group Office Visit Co-pay Waiver Program:

If you enroll in an FPG Medical plan, you will be entitled to all medical services provided by FPG, up to two (2) visits per month, as follows:

For each FPG team member who is enrolled in the United Healthcare plan, your co-pay will be waived for FPG provided services.

~ You can use one or both of these visits for any covered dependents on the FPG medical plan ~

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Choosing the Right Care Facility

With the rise of convenience care and urgent care clin-ics, and varying healthcare plans, it can be confusing untangling the web of care options available to you. The following should serve as a guide to help you suc-cessfully choose the right healthcare facility for your condition.

Primary Care Physician (PCP) When you or a loved one is ill or needs medical care, but it is not an emergency situation, it is best to visit your primary care physician. Your PCP knows you and your health history and has access to your medical rec-ords. In addition, you most likely will pay the least amount of out of pocket when visiting your PCP versus a convenience care or emergency room facility.

Convenience Care Clinics Located in retail stores such as CVS, Walgreens and Target, convenience care clinics are staffed by medical professionals and do not require an appointment. These clinics are best utilized when you have a non-emergency condition and you are not able to get an appointment with your primary care physician. Ser-vices are often provided at a lower out of pocket cost than an urgent care clinic or emergency room visit. Typical conditions that may be treated at a Conven-ience Care Clinic include:

Common infections (e.g.: bronchitis, bladder infec-tions, ear infections, pink eye, strep throat)

Minor skin conditions (e.g.: athlete’s foot, cold sores; minor sunburn, poison ivy)

Flu shots This is a sample list and not all-inclusive. For a full list-ing of services please visit each clinic’s website. To find an in-network Convenience Care Clinic near you visit your medical carrier website.

Urgent Care Clinics Urgent care clinics are a good option when you require urgent care outside your doctor’s regular office hours or you are unable to be seen by your doctor immediately. Typical conditions that may be treated at an urgent care clinic include:

Sprains

Small cuts

Strains

Sore throats

Mild asthma attacks

Rashes

Minor infections Services vary per clinic. If you choose to visit an urgent care clinic, visit your medical carrier website or call the toll-free number on the back of your medical card to ensure the clinic is in-network.

Emergency Room If you or your loved one is experiencing an emergent medical condition you should go to the nearest emer-gency room or call 911. In an emergency, all facilities are considered in-network. An emergent medical condition is any condition (including severe pain) which you believe that without immediate medical care may result in:

Serious jeopardy to you or your loved one’s health, including the health of a pregnant woman or her unborn child

Serious impairment to you or your loved one’s bodily functions

Serious dysfunction of any of you or your loved one’s bodily organs or parts

Some examples of emergent conditions may include the following:

Heavy bleeding

Large open wounds

Sudden change in vision

Chest pain

Sudden weakness or trouble walking

Major burns

Spinal injuries

Severe head injuries

Difficulty breathing

This list only provides examples and is not intended as an exclusive list. If you believe you or your loved one is experiencing an emergent medical condition, you should go to the nearest emergency room or call 911, even if your symptoms are not described here. We rec-ommend that you seek routine medical care from your primary care physician whenever possible.


Tips for a Successful Healthcare Experience

Use the following tips to ensure you have a successful healthcare experience:

Set yourself up for a successful healthcare experi-ence by taking the time to find a family physician in your network that you and your family trust. Do this before a health concern arises.

Did you know that doctors base up to 80% of their diagnoses on what patients tell them about their symptoms, history, and lifestyle? Preparing for a trip to the doctor not only helps you to get your thoughts in order, but also helps you better under-stand what your doctor is talking about.

Bring a list of any and all medications, al-lergies, and other doctors you might see.

Be prepared to help the physician answer questions about your ailment, such as how, what, when, and where the symptoms are occurring in the body.

Register with your health insurance carrier’s website for online claim tracking and review.

Periodically review your personal information to ensure your claims are being processed accurately and timely. Consider taking a Health Risk Assess-ment and creating a Personal Health Record.

Ensure you have proper documentation before you see your physician. This includes your proper medical insurance card printed with your carri-er name, policy number, claims address, and co-payment amounts. It’s also helpful to bring your benefit plan summary with you just in case there is a question about copays, deductibles, or coinsur-ance. Pay the correct copayment every time you see your physician. (temporary cards are avail-able online)

When seeing your physicians, confirm that they have your updated information on file. This includes:

Group policy number

Individual identification number

If receiving a routine physical examination, remind your physician to file it as routine preventive care instead of with a medical diagnosis.

If you encounter a problem regarding eligibility make sure the provider is using your most up to date policy and individual identification num-bers; old information can cause unnecessary confusion. These problems are often easily re-solved over the phone.

Contact the insurance company if you believe your claim has not been paid properly or in a timely manner. Contact your health provider if you find the insurance carrier does not have the claim in question. For claim questions, please call the insurance carrier at the number on your card.

Keep a record of all communication with your

insurance carrier or healthcare provider. Include the date and time of any conversation and the name of the person with whom you spoke.

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Dental coverage is provided by Mutual of Omaha. With Mutual of Omaha you have access to an extensive network of dentists utilizing the PPO network. With the flexibility of a PPO you have the option of visiting any provider, however, by choosing a network provider you’ll receive the highest level of benefit and save on out of pocket costs. When utilizing out-of-network providers remember that benefits will be reimbursed at the in-network discounted reimbursement level. For example, if you have a procedure done that costs $80 and the in-network reimbursement level is $60, your reimbursement will be based on $60, and you will be responsible for the difference (in this case, $20).

To see a list of participating providers go to: www.mutualofomaha.com/dental.

Base PPO Plan High PPO Plan In-Network

What you pay Out-Of-Network What you pay


Out-Of-Network What you pay

Preventive Services

Oral examination, cleanings, x-rays

Covered In Full Covered In Full* Covered In Full Covered In Full**

Basic Services

Root canal, fillings, simple extractions, periodontics

20% after deductible 50% after deductible* Covered In Full 20% after deductible**

Major Services

Inlays, onlays, crowns, dentures 50% after deductible 70% after deductible* 40% after deductible 40% after deductible**

Deductible Calendar Year Deductible Calendar Year Deductible

Individual

Family

$50

$150

$100

$300

$50

$150

$50

$150

Maximum Annual Benefit Per Person

$1,000 combined $1,000 combined $1,000 combined $1,000 combined

Orthodontics 50%

Lifetime maximum: $1,000

Ortho for children up to age 19

50%

Lifetime maximum: $1,000

Ortho for children up to age 19

Waived for Preventative Yes Yes Yes Yes

Voluntary Dental

Employee Contributions (Payroll Deductions for Dental)


Employee Employee + Spouse

Employee + Children

Employee + Family

Dental

Base Plan

High Plan

$4.62

$8.77

$14.08

$27.23

$15.46

$31.15

$24.23

$46.85


*Out of Network reimbursed on a Fee Schedule **Out of Network reimbursed at 90th percentile


Vision coverage is provided by United Healthcare. The United Healthcare network consists of private practicing optometrists, ophthalmologists, opticians and optical retailers.

You have the option of visiting any provider, however, by choosing a network provider you’ll receive the highest level of benefit and save on out-of-pocket costs.

To see a list of participating providers go to: www.myuhcvision.com

Voluntary Vision

Employee Contributions (Payroll Deductions for Vision)


Employee Employee + Spouse

Employee + Children

Employee + Family

Vision

$2.42 $4.61 $4.86 $7.13


In-Network Benefits Exam Copay ~covered once every 12 months

$20 copay

Lenses ~covered once every 12 months

$20 copay for Single $20 copay for Bifocal $20 copay for Trifocal $20 copay for Lenticular

Frames ~covered once every 24 months

$100 allowance towards frames in covered selection, 20% off balance over allowance

Contact Lenses ~covered once every 12 months in lieu of eyeglasses

$105 allowance for Elective lenses, additional 15% off balance over allowance

Medically Necessary covered in full

Out-of-Network Benefits

Reimburses up to $40

Reimburses up to:

$40 for Single $60 for Bifocal $80 for Trifocal $80 for Lenticular

Reimburses up to $50

Reimburses up to:

$105 for Elective $210 for Medically Necessary

Discounts may be available for materials NOT listed

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Life and Accidental Death & Dismemberment (AD&D) Insurance is provided by Mutual of Omaha at no cost to the em-ployee.

Life Insurance provides a monetary benefit to your beneficiary in the event of your death while you are employed at Family Physicians Group. AD&D Insurance is equal to your Life Insurance benefit amount and is payable to your benefi-ciary in the event of your death as a result of an accident and may also pay benefits in certain injury instances.

It is important to keep your beneficiary information up-to-date. Please refer to your benefit booklet for more details.

Plan Features Benefit Amount

Life Insurance Class 1: $250,000 (Owners, CEO, CFO, Senior Executives) Class 2: $150,000 (All Eligible Physicians) Class 3: $150,000 (Physician’s Assistants, Pharmacists, Nurse Practitioners, Directors) Class 4: $50,000 (All Eligible Employees OTHER THAN Physicians, Physicians' Assistants, Pharmacists, Nurse Practitioners, Directors, Executives, Officers or Chief Level Positions)

Accidental Death and Dismemberment

Matches Life benefit

Benefit Reduction Schedule

Benefits begin reducing at age 65 by 35% of the original amount & at age 70 by an additional 15% of the original amount

Life and Accidental Death & Dismemberment (AD&D)


Employees have the opportunity to elect voluntary Life Insurance through Mutual of Omaha. This will provide a Life In-surance benefit for yourself. If you elect voluntary life insurance for yourself, you also have the opportunity to elect cov-erage for your spouse and/or your dependent child(ren). Contributions for these premiums are 100% employee paid.

If you waived voluntary life coverage when you were initially eligible you will be required to provide Evidence of Insurability (EOI) when enrolling at a later date. Please allow 4 to 6 weeks for underwriting review. Claims in-curred prior to the approval of your coverage will not be covered. Benefits may be limited and/or denied based on the EOI results.

IF CURRENTLY ENROLLED, employees may increase the employee term life insurance benefit by $10,000 without EOI during annual open enrollment.

Plan Features Benefit Amount

Employee Life Insurance Increments of $10,000 to a maximum of $500,000; not to exceed 5x your annual earnings Guarantee Issue Amount: The lesser of $100,000 or 5x annual salary (only at time of initial hire)

Spouse Life Insurance Increments of $5,000 to a maximum of $250,000; not to exceed 100% of employee elected amount Guarantee Issue Amount: The lesser of $50,000 or 100% of employee elected amount (only at time of initial hire)

Dependent Child(ren) Life Insurance

$10,000 flat benefit Guarantee Issue Amount: The lesser of $10,000 or 100% of employee elected amount

Benefit Reduction Schedule

Benefits begin reducing at age 65 by 35% of the original amount and at age 70 by an additional 15% of the original amount. Coverage terminates for dependents when the FPG team member reaches age 70.

Voluntary Term Life Insurance


Rates for Voluntary Term Life Insurance

AGE

Employee & Spouse Rate per $1,000

~Spouse rates based on employee age~

Under 24 $ .06

25 – 29 $ .08

30 – 34 $ .13

35 – 39 $ .15

40 – 44 $ .20

45 – 49 $ .30

50 – 54 $ .41

55 – 59 $ .65

60 – 64 $ 1.01

65 – 69 $ 1.81

70 – 74 $ 3.25

75 – 79 $ 5.35

80 – 100 $ 10.84

All children for benefit of $10,000

$ 2.00

Example Voluntary Term Life Cost Calculation

A 36 year old employee wants to purchase $50,000 of term life insurance:

.15 x 50 = $7.50 x 12/26 = $3.46

Monthly rate # of units/$1,000 monthly rate Payroll per $1,000 deduction

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Voluntary Short Term Disability


Employees have the opportunity to purchase Voluntary Short Term Disability Insurance (STD) provided by Mutual of Omaha. Short Term Disability Insurance provides income protection in the event you become disabled and are unable to work due to sickness or non-occupational injury, including pregnancy, for a short period of time.

Short Term Disability Benefit Summary

Benefit Amount 60% of weekly salary

Benefit Maximum $2,000 weekly

Benefit Duration 11 weeks

Elimination Period 14 days accident 14 days sickness

Pre-Existing Condition Limitations

3/6 ~For a sickness or injury for which the insured received medical treatment (i.e. consultation, care, services, medication) in the 3 months prior to the effective date will not be covered for 6 months from their effective date.

Monthly Rate $0.60 per $10 of weekly benefit

If you waived voluntary short term disability when you were initially eligible you will be required to provide Evidence of Insurability (EOI) when enrolling at a later date. Please allow 4 to 6 weeks for underwriting re-view. Claims incurred prior to the approval of your coverage will not be covered. Benefits may be limited and/or denied based on the EOI results.

Example STD Cost Calculation

STD cost is based on weekly benefit (up to the plan maximum).

STD Rate is .60 cents per $10 of weekly covered benefit

1. To get the weekly benefit amount: divide annual income by 52 and multiply by .60

Example for employee with annual salary of $30,000: ($30,000/52 x .60 = $346.15 weekly benefit

2. Formula to calculate STD monthly premium: (“weekly benefit” x “rate”) ÷ 10 = monthly STD premium

Using the employee example above: “$346.15” x “.60” /10 = $20.77 monthly STD premium

3. To calculate your payroll deduction: multiply the monthly STD premium by 12 and divide by 26 (payroll cycle)

Using the employee example above: “$20.77” x 12/26 = $9.59 STD payroll deduction


FPG pays for Base Long Term Disability Insurance (LTD), provided by Mutual of Omaha, with a benefit amount of 40% of your monthly income. Long Term Disability Insurance provides income protection in the event you become disabled and are unable to work for an extended period of time.

You are able to purchase additional Voluntary LTD insurance coverage and BUY-UP TO 60% of your monthly income.

Long Term Disability Benefit Summary

Benefit Amount Base provided by FPG: 40% of basic monthly earnings Voluntary LTD BUY-UP available: increases coverage to 60% of your basic monthly earnings

Benefit Maximum

$5,000 monthly ~If you are a physician, physician’s assistant, pharmacist, nurse practitioner, director, executive or officer you can buy up to a maximum of $15,000 per month

Benefit Duration To age 65 or to Normal Retirement Age

Elimination 90 days

Pre-Existing Condition Limitations

3/12 ~For a sickness or injury for which the insured received medical treatment (i.e. consultation, care, services, medication) in the 3 months prior to the effective date will not be covered for 12 months from their effective date.

Voluntary LTD Buy-Up Monthly

$0.50 per $100 of monthly covered payroll

Base & Voluntary Long Term Disability


If you waived voluntary long term disability coverage when you were initially eligible you will be required to provide Evidence of Insurability (EOI) when enrolling at a later date. Please allow 4 to 6 weeks for underwrit-ing review. Claims incurred prior to the approval of your coverage will not be covered. Benefits may be lim-ited and/or denied based on the EOI results.

Example Voluntary LTD Buy-Up Cost Calculation

LTD cost is based on monthly earnings (up to the plan maximum).

LTD Rate is .50 cents per $100 of monthly covered payroll

1. Formula to calculate LTD monthly premium: (“monthly earnings” x “rate”) ÷ 100 = monthly LTD premium

Example for employee with annual salary of $30,000/12 months = $2,500 monthly earnings

“$2,500” x “.50” /100 = $12.50 monthly LTD premium

2. To calculate your payroll deduction: multiply the monthly LTD premium by 12 and divide by 26 (payroll cycle)

Using the employee example above: “$12.50” x 12/26 = $5.77 LTD payroll deduction

14


Without Flex With Flex

Salary $700 $700

FSA Election $0 $25

Taxable Income $700 $675

Income Tax $105 $101

State Tax $56 $54

Social Security Tax

$53 $51

Income After Taxes

$486 $469

Medical Premium $10

Medical Expenses $5

Dependent Care $10 $0

Take Home Pay $461 $469

Net Increase $8

Pay Periods x 52

Annual Increase $416

Flexible Spending Accounts (FSA)

All eligible employees will have the opportunity to participate in a Flexible Spending Account (FSA) program administered through United Healthcare.

What is a Flexible Spending Account?

A Flexible Spending Account, also known as Section 125 Cafeteria Plan, allows participants to set aside pre-tax dollars to be used to pay for various out of pocket medical expenses, and dependent care expenses.

What are the types of FSAs?

There is one for medical expenses. You can use this account to pay for medical expenses that you or your dependents incur even if they are not enrolled in the company sponsored medical plan. You also have access to a Dependent Care flexible spending account. This account is for Child Care or Elder Care expenses ONLY & cannot be used for medical expenses.

How Does an FSA work?

First, you must estimate the amount of out-of-pocket expenses you feel you may incur in the upcoming year. This amount will be your election amount. Your election amount is divided by the frequency of pay periods. This amount is then deducted from your paycheck each pay period on a pre-tax basis. When you incur expenses during the plan year, simply swipe your FSA debit card at your providers office, pharmacy, hospital, etc. at time of service and your claim will be paid instantly. The amount of your expense will be deducted from your account balance.

What is the Plan year?

January 1, 2016 through December 31, 2016.

The Use It or Lose It Rule

Section 125 Plans are governed by the "use it or lose it" rule, whereby, any amounts remaining at the end of the plan year are forfeited due to IRS regulations. However, our flex plan allows for a 2 1/2 month grace period following the end of the plan year. As a result, if you do not use your entire FSA amount during the normal plan year, you can be reimbursed for expenses incurred during the 2 1/2 month period following the end of the plan year. All claims must be submitted no later than 90 days after the end of such grace period.

How Much Can I Contribute to the FSA Plan?

Medical Flexible Spending: $2,550 Maximum.

Dependent Care Flexible Spending: $5,000 married couple filing jointly ($2500 per person if filing separate returns).


Medical FSA Overview

There are at least two significant ways to benefit from a Flexible Spending Account. The first is by taking advantage of the tax savings. By reducing your gross income, you pay less in taxes and have the freedom to choose how your money is used.

The second benefit is the “cash flow” increase built into the medical FSA (not the dependent day care FSA). This means that no matter how much money you have actually contributed to the plan at any given point, you can still be reimbursed up to your entire annual election. So a major medical expense at the beginning of the claim period can be reimbursed even though few, if any, deposits have been made into the account at that time. This applies to the medical FSA only.

Medical FSA Claims Reimbursement

Through myuhc.com, you have a variety of ways to choose from to get reimbursed for your claims: debit card, online submission, fax or mail.

Debit Card

You will receive a MasterCard debit card, which is the most convenient way to receive reimbursement. Simply swipe your debit card at your providers office, pharmacy, hospital, etc., at time of service and your claim will be paid instantly. It is important when you are utilizing the debit card to still ask for and keep an itemized receipt on file. You may still receive a letter from myuhc.com requesting this receipt for IRS documentation purposes. Even if you use the debit card, YOU are ultimately responsible to the IRS for documentation (i.e. a receipt). YOU are required to keep it and submit it so the plan is compliant with government regulations.

Please be advised that if you do not respond to UHC’s request for an itemized receipt, your card and your account will be suspended.

Online

You can submit your claims online at www.myuhc.com. To register your account, go to www.welcometouhc.com/fsa. Once you are registered and logged in, you can view your account balance(s) and see the status of any claims you have submitted.

Mail, Fax

You are also able to submit your claims via mail to: Health Care Account Service Center P.O. Box 981506 El Paso, TX 79998-1506 or you can fax at: 915-231-1709 or toll free fax: 1-866-262-6354

Sample Medical Eligible Expenses

The following is a partial list of expenses that are reimbursable tax-free with a Medical Expense FSA. For a complete list, visit the IRS’s website at www.irs.gov and search for Section 213 expenses.

Acupuncture (if medically necessary)

Ambulance service

Chiropractic care

Contact lenses (corrective)*

Diagnostic tests

Doctor’s fees

Drugs (prescription only**)

Experimental medical treatment (only if referred by a physician)

Eyeglasses

Hearing aids & exams

Injections and vaccinations

Optometrist fees

Orthodontic treatment*

Prescription drugs to alleviate nicotine withdrawal symptoms

Smoking cessation programs/treatments

Transportation for local medical care

Wheelchairs

X rays

*To be eligible for reimbursement, some treatments, prescription drugs, or services deemed cosmetic in nature require written proof of medical necessity from your health care provider.

**Not all drugs requiring a prescription are approved by the IRS as eligible for reimbursement.

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Below is a list of expenses that qualify for reimbursement from the Dependent Care Account. Generally, eligible expenses include the cost of childcare for dependents under age 13 or care for a disabled spouse or dependent that allows you – or you and your spouse – to work. You’ll also find examples of expenses that do not qualify for reimbursement because they are not considered legitimate deductions for federal income tax purposes. To make sure your situation and the type of care being provided meet IRS requirements, refer to IRS Publication 503.

Eligible Expenses

Fees paid to a child care center or day care camp that complies with all applicable state and local reg-ulations if providing care for more than six children

Full amount paid to a nursery school, even though the cost may include lunch and education services

Fees paid to a babysitter in or outside your home

Fees paid to a relative who provides dependent care services, other than your spouse, your child under age 19 or a dependent you claim for federal income tax purposes

Fees paid to a housekeeper or cook who also is responsible for providing care for an eligible de-pendent

Fees paid to a nurse or home health care agency for care for your spouse or legal dependent who is physically or mentally incapable of self-care

Legally mandated amounts paid on behalf of the provider – Social Security (FICA), federal (FUTA) and state (SUTA) unemployment taxes

Ineligible Expenses

Food, clothing and education

Transportation to and from the place where de-pendent care services are provided

Fees paid for a child care center that provides care for more than six children but does not comply with all applicable laws

Expenses for which a federal child care tax credit is taken or which are claimed under the Health Care Account

Search fees for a dependent care provider

Dependent FSA Eligible Expenses

Section 125 Cafeteria Plan The Section 125 - Cafeteria Plan allows you to contribute “before-tax” dollars to pay for your coverage under a portion of the Company’s Benefit Plans (e.g. medical, dental and vision coverage). By paying your premiums with “before-tax” dollars, you generally may reduce the amount of income and social security taxes that you otherwise would be required to pay. The elections you make during the Cafeteria Plan enrollment period are effective for the entire 12-month Plan Year. You generally cannot change your elections during the year unless you experience a change in status event (refer to your Plan Document for the definition of a “change in status”). The circumstances that permit a change of election vary from one benefit to another. If you believe you have experienced a change in status event and you wish to change your elections, notify HR within 30 days of the change.


Additional Voluntary Benefits

You have the option of purchasing additional individual voluntary products and customize the benefits based on need and affordability. These plans provide cash benefits paid directly to you. These policies are portable and belong to you if you leave your employer.

Three voluntary benefits are available through Trustmark:

Universal Life Insurance: is a permanent life insurance

policy designed to match your needs throughout your lifetime and builds cash value over time; it includes both a death benefit and a living benefit. A Long Term Care Accelerated Death Benefit Rider is available to accelerate part of your death benefit to help pay for home healthcare, assisted living, nursing care if you are chronically ill.

Critical Illness/Cancer Plan: pays a specific benefit amount for expenses related to diagnosis of certain critical illnesses such as invasive cancer, heart attack, stroke, organ transplants and kidney failure. This plan includes a health screening benefit that can pay up to $100 to insured for health screenings such as Pap smear, colonoscopy, stress test, low dose mammography and prostate specific antigen.

Accident Plan: pays specific amounts for expenses

related to the treatment of injuries suffered as the result of a covered accident. After 60 days from enrollment, this plan includes a wellness benefit of up to $100 for routine physicals, immunizations and health screening tests, twice per year (maximum of $200 annually per insured).

You are also able to purchase an additional Individual plan through American Public Life for:

Hospital Indemnity: pays specific benefit amounts for

expenses related to inpatient and outpatient services as a result of covered accidents and sickness that can help offset your out of pocket expenses such as deductibles, co-insurance and copays.

Please be sure that you review these plans carefully when making your choices. These voluntary benefits are individual plans, therefore rates vary, and pre-existing conditions, limitations and exclusions may apply.

You may review the detailed brochures and costs online in the EMB self-service enrollment website at:

http://www.explainmybenefits.biz/fpg


Employee Assistance Program (EAP)

Life’s not always easy. Sometimes a personal or professional issue can get in the way of maintaining a healthy, productive life. Through Mutual of Omaha, your Employee Assistance Program (EAP) can be the answer for you and your family.

Experience EAP Staff

Master’s level professionals who can provide assistance for a variety of personal and professional matters.

Emotional well-being

Family and relationships

Legal and financial

Healthy lifestyles

Work and life transitions

EAP Benefits

Unlimited telephone access to EAP Professionals 24 hours a day, seven days a week

Telephone assistance and referral

Service for employees and eligible dependents

Legal assistance and financial services

Will preparation

Legal library & online forms

Resources for:

Work/Life balance

Substance abuse

Dependent and elder care assistance & referral services

Access to a library of educational articles, handouts and resources via website.

What to Expect

Information gathered by the EAP is confidential – the EAP does not communicate with your employer about your situation unless there is a risk of harm to you or others.

Your EAP benefits are provided through your employer. There is no cost to you for utilizing EAP services. If additional resources are needed, your EAP will help locate appropriate providers in your area.

Don’t delay if you need help. Visit mutualofomaha.com/eap or call 1-800-316-2796 for confidential consultation and resource services.

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401K Plan Highlights

Hylant accepts no responsibility for information provided

Please note: This plan is not serviced by Hylant. Please direct questions to Human Resources.


Hylant accepts no responsibility for information provided

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Important Disclosures & Notices

NOTE TO ALL EMPLOYEES:

Certain State and Federal Regulations require employers to provide disclosures of these regulations to all employ-ees. The remainder of this document provides you with all of the required disclosures related to our employee benefits plan. If you have any questions or need further assistance please contact your Plan Administrator as follows:

Family Physicians Group Human Resources 6416 Old Winter Garden Road Orlando, FL 32835 407-253-3535

THIS DOCUMENT IS FOR INFORMATION PURPOSES ONLY

This communication is intended for illustrative and infor-mation purposes only. The plan documents, insurance certificates, and policies will serve as the governing docu-ments to determine plan eligibility, benefits, and payments.

LIMITATIONS AND EXCLUSIONS

Insurance and benefit plans always contain exclusions and limitations. Please see benefit booklets and/or contracts for complete details of coverage and eligibility.

ALL RIGHTS RESERVED

Family Physicians Group reserves the right to amend, mod-ify, or terminate its insurance and benefit plans at any time, including during treatment.

NOTICE REGARDING SPECIAL ENROLLMENT RIGHTS

If you do not timely or properly complete the enrollment process, you and your Eligible Dependents generally will not be covered under the applicable Plan, except as de-scribed below. Also, if you fail to specifically enroll your Eligible Dependents on the enrollment form, your Eligible Dependents will not be covered under the applicable Plan, except as otherwise provided below.

(a.) If you decline enrollment because you or your depend-ent had other group health plan coverage, either through COBRA or otherwise, you may enroll yourself and Eligible Dependents in the Medical Program within 30 days of the loss of that coverage. Your enrollment will become effec-tive on the date your prior coverage terminates. For this purpose, “loss of coverage” will occur if the other group health plan coverage terminates as a result of: (i) termina-tion of employer contributions for the other coverage; (ii) exhaustion of the maximum COBRA period; (iii) legal sepa-ration or divorce; (iv) death; (v) termination of employment;

(vi) reduction in hours of employment; or (vii) failure to elect COBRA coverage.

However, a loss of coverage will not be deemed to occur if the other coverage terminates due to a failure to pay premiums or termination for cause. At the time you enroll in the Employer’s Plan, you must provide a written statement from the administra-tor of the other medical plan that you no longer have that cover-age.

(b.) You are eligible to enroll yourself and your Eligible Depend-ent in the Medical Program within 30 days of the date you ac-quire a new Eligible Dependent through marriage, birth, adop-tion or placement for adoption. Your enrollment will become effective on the date of marriage, birth, adoption or placement for adoption.

(c.) You are eligible to enroll yourself and your Eligible Depend-ent in the Plan within 60 days after either:

(1.) Your or your Eligible Dependent’s Medicaid cover-age under title XIX of the Social Security Act or CHIP coverage through a State child health plan under title XXI of the Social Security Act is terminated as a result of loss of eligibility for such coverage; or

(2.) You or your Eligible Dependent is determined to be eligible for employment assistance under Medicaid or CHIP to help pay for coverage under the Plan.

(d.) You are eligible to enroll yourself and your Eligible Depend-ents in the Plan during an Open Enrollment Period. Your en-rollment will become effective on the 1st day of the Plan Year following the Open Enrollment Period.

(e.) You may enroll in the Plan an Eligible Dependent child for whom you are required to provide medical coverage pursuant to a Qualified Medical Child Support Order (as defined under ERISA Section 609). This enrollment of an Eligible Dependent will become effective as of the Plan Administrator’s qualification and acceptance of the Qualified Medical Child Support Order.

(f.) You are eligible to enroll yourself and your Eligible Depend-ents in the Plan under any other special circumstances permit-ted under the applicable Benefits Guide (and subject to the Cafeteria Plan rules outlined in Section 125 of the Internal Rev-enue Code).

NOTE: You will not be allowed to enroll yourself and/or Eligible Dependents for coverage in the Plan for a Plan Year unless you timely and affirmatively complete the enrollment process by the deadlines set forth above (i.e. within 30 days for loss of coverage or new dependents; within 60 days for Medicaid or CHIP circumstances; within 30 days of receipt of this notice for a dependent under the age of 26; or within the deadline estab-lished by the Plan Administrator for Open Enrollment Period).



Should you have any questions regarding this information or require additional details, please contact the Plan Administra-tor at the address or phone number below.

Family Physicians Group Human Resources 6416 Old Winter Garden Road Orlando, FL 32835 407-253-3535

NOTICE REGARDING WOMEN’S HEALTH AND CANCER RIGHTS ACT (JANET’S LAW)

On October 21, 1998, Congress passed a Federal Law known as the Women’s Health and Cancer Rights Act. Under the Women's Health and Cancer Rights Act, group health plans and insurers offering mastectomy coverage must also provide coverage for:

Reconstruction of the breast on which the mastectomy was performed;

Surgery and reconstruction of the other breast to pro-duce a symmetrical appearance; and

Prostheses and treatment of physical complications at all stages of the mastectomy, including lymph edemas

These services are payable to a patient who is receiving ben-efits in connection with a mastectomy and elects reconstruc-tion. The physician and patient determine the manner in which these services are performed.

The plan may apply deductibles and copayments consistent with other coverage within the plan. This notice serves as the official annual notice and disclosure of that the fact that the company’s health and welfare plan has been designed to comply with this law. This notification is a requirement of the act.

The Women’s Health and Cancer Rights Act (Women’s Health Act) was signed into law on October 21, 1998. The law includes important new protections for breast cancer patients who elect breast reconstruction in connection with a mastec-tomy. The Women’s Health Act amended the Employee Re-tirement Income Security Act of 1974 (ERISA) and the Public Health Services Act (PHS Act) and is administered by the Departments of Labor and Health and Human Services.

NOTICE REGARDING MICHELLE’S LAW

On Thursday, October 9, 2008, President Bush signed into law H.R. 2851, known as Michelle’s Law. This law requires employer health plans to continue coverage for employees’ dependent children who are college students and need a medically necessary leave of absence. This law applies to both fully insured and self-insured medical plans.

The dependent child’s change in college enrollment must meet the following requirements:

The dependent is suffering from a serious illness or inju-ry.

The leave is medically necessary. The dependent loses student status for purposes of cov-

erage under the terms of the plan or coverage.

Coverage for the dependent child must remain in force until the earlier of: One year after the medically necessary leave of absence

began. The date the coverage would otherwise terminate under

the terms of the plan.

A written certification by the treating physician is required. The certification must state that the dependent child is suffer-ing from a serious illness or injury and that the leave is medi-cally necessary. Provisions under this law become effective for plan years beginning on or after October 9, 2009.

NOTICE REGARDING NEWBORNS AND MOTHERS HEALTH PROTECTION ACT

Group health plans and health insurance issuers offering group health insurance may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child for less than 48 hours following normal vaginal delivery, or less than 96 hours following a cesarean section, or require that a provider obtain authorization from the plan or insurance issuer to prescribe a length of stay not in excess of the above periods.

MEDICARE NOTICE

You must notify Family Physicians Group when you or your dependents become Medicare eligible. Family Physicians Group is required to contact the insurer to inform them of your Medicare status. Federal law determines whether Medicare or the group health plan is the primary payer. You must also notify Medicare directly that you have group health insurance coverage. Privacy laws prohibit Medicare from discussing coverage with anyone other then the Medicare beneficiary or their legal guardian. The toll free number to Medicare Coordi-nation of Benefits is 1-800-999-1118.

If you have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices in your prescription drug plan. Please see the complete Medi-care Part D Non-Creditable Coverage Notice.

Should you have any questions regarding this information or require additional details, please contact the Plan Administra-tor at the following address or phone number.

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Date: January 1, 2016 Plan Administrator: Family Physicians Group Contact: Human Resources Address: 6416 Old Winter Garden Road Orlando, FL 32835 Phone Number: 407-253-3535

NOTICE REGARDING PATIENT PROTECTION RIGHTS

The Family Physicians Group health plan does not require members to designate a Primary Care Physician. The follow-ing paragraphs outline certain protections under the PPACA and only apply when the Plan requires the designation of a Primary Care Physician.

One of the provisions in the PPACA of 2010 is for plans and insurers that require or allow for the designation of primary care providers by participants to inform the participants of their rights beginning on the first day of the first plan year on or after September 23, 2010.

You will have the right to designate any primary care provider who participates in the Plan’s network and who is available to accept you and/or your Eligible Dependents. For children, you may designate a pediatrician as the primary care provid-er. You also do not need prior authorization from the Plan or from any other person (including your primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the Plan’s network. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authoriza-tion for certain services, following a pre-approved treatment plan or procedures for making referrals or notifying primary care provider or Plan of treatment decisions.

If you do not make a provider designation, the Plan may make one for you. For information on how to select or change a primary care provider, and for a list of the participat-ing primary care providers, pediatricians, or obstetrics or gy-necology health care professionals, please contact the insur-er.

Should you have any questions regarding this information or require additional details, please contact the Plan Administra-tor at the address or phone number below.

Date: January 1, 2016 Plan Administrator: Family Physicians Group Contact: Human Resources Address: 6416 Old Winter Garden Road Orlando, FL 32835 407-253-3535

IMPORTANT INFORMATION ABOUT YOUR PRESCRIP-TION DRUG COVERAGE AND MEDICARE

Please note that the following notice only applies to indi-viduals who are eligible for Medicare.

Medicare eligible individuals may include employees, spous-es or dependent children who are Medicare eligible for one of the following reasons.

Due to the attainment of age 65

Due to certain disabilities as determined by the Social Security Administration

Due to End Stage Renal Disease (ESRD)

If you are covered by Medicare, please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Family Physicians Group and about your options un-der Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Med-icare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medi-care Advantage Plan (like an HMO or PPO) that offers pre-scription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Family Physicians Group has determined that the prescrip-tion drug coverage offered by their carrier’s Benefits Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. If your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penal-ty) if you later decide to join a Medicare drug plan.



When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current cover-age will not be affected. Your current coverage pays for other health expenses in addition to prescription drugs. The prescrip-tion drug coverage is part of the Group Health Plan and cannot be separated from the medical coverage. If you enroll in a Med-icare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health and pre-scription drug benefits. You have the option to waive the cover-age provided under the Group Health plan due to your eligibility for Medicare. If you decide to waive coverage under the Group Health Plan due to your Medicare eligibility, you will be entitled to re-enroll in the plan during the next open enrollment period.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current cov-erage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug cov-erage. In addition, you may have to wait until the following Octo-ber to join.

For More Information About This Notice or Your Current Prescription Drug Coverage…

Contact your HR Representative. You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through your company changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medi-care Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” hand-book. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medi-care drug plans. For more information about Medicare pre-scription drug coverage:

Visit www.medicare.gov

Call your State Health Insurance Assistance Pro-gram (see the inside back cover of your copy of the “Medicare & You” handbook for their tele-phone number) for personalized help

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For in-formation, visit Social Security at www.socialsecurity.gov, or call 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained credita-ble coverage and, therefore, whether or not you are re-quire to pay a higher premium (penalty).

Date: January 1, 2016 Name of Entity/Sender: Family Physicians Group Contact: Human Resources Address: 6416 Old Winter Garden Road Orlando, FL 32835 6320 Phone Number: 407-253-3535 FAMILY MEDICAL LEAVE ACT/MILITARY FAMILY LEAVE

Federal law requires that Eligible Employees be provided a continuation period in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA). The details of this law are provided in your Summary Plan Description (SPD). If you would like more information regarding FMLA, contact your HR Department.


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UNIFORMED SERVICES EMPLOYMENT AND REEMPLOY-MENT RIGHTS ACT OF 1994

The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) is a federal law intended to ensure that persons who serve or have served in the Armed Forces, Re-serves, National Guard or other “uniformed services”:

1. Are not disadvantaged in their civilian careers because of their services;

2. Are properly reemployed in their civilian jobs upon their return from duty; and

3. Are not discriminated against in employment based on past, present, or future military service.

If you leave your job to perform military service, you will have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. Even if you don’t elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally with-out any waiting periods or exclusions (e.g. pre-existing condition exclusions) except for service-connected illnesses or injuries.


Availability of Summary Health Information

As an employee, the health benefits available to you repre-sent a significant component of your compensation pack-age. They also provide important protection for you and your family in the case of illness or injury.

Your plan offers a series of health coverage options. Choosing a health coverage option is an important deci-sion. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.

The SBC is available on online in the EMB self-service enrollment website at:

http://www.explainmybenefits.biz/fpg

A paper copy is also available, free of charge, by con-tacting Human Resources.

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Health Care United Healthcare

Member Services

1-800-996-0271

Policy Number: 906617

www.myuhc.com

Network: Base & Mid Plans = Choice

High Plan = Choice Plus

Dental Mutual of Omaha

Member Services

1-877-999-2330

Policy Number: G000AK75

www.mutualofomaha.com/dental

Dentist Search: Select “My dental benefits” and look for the link to “Find a dentist”

Vision United Healthcare

Member Services

1-800-996-0271


www.myuhcvision.com

Life, Short & Long Term Disability

Mutual of Omaha 1-800-228-7104

www.mutualofomaha.com

Employee Assistance Program (EAP)

Mutual of Omaha 1-800-316-2796 www.mutualofomaha.com/eap

Voluntary Benefits Trustmark 1-800-918-8877 www.trustmarksolutions.com

Hospital Indemnity American Public Life 1-866-874-5725 www.ampublic.com

[email protected]

Flexible Spending Account (FSA)

United Healthcare

Member Services

1-800-331-0480


www.myuhc.com

Broker Hylant

Customer Service Hotline & Claims Assistance

1-866-740-5550

407-740-5550

Confidential eFax:

1-407-540-9380

www.hylant.com

Benefits

Human Resources

FPG 407-253-3535 [email protected]

[email protected]

Contact Information

When contacting any of the companies above it is important to have the Insurance card or I.D. number (s) of the subscriber for the coverage you are calling about as well as any appropriate paperwork, i.e. Explanation of Benefits, denial letter, receipts, etc.

2016 Benefits and Enrollment Guide - Explain My Benefits€¦ · 2016 Benefits and Enrollment Guide...

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