2020 Benefits Guide California...2020 Benefits Guide | California Welcome to Phoenix House Our...

2020 Benefits Guide | California

Welcometo Phoenix House

Our mission is to protect and support individuals, families, and communities affected by substance abuse and dependency. Our unique and holistic approach has helped thousands of people – making us the nation’s leading provider of alcohol and drug abuse treatment and prevention services. We are proud that our employees share our vision and passion – and we recognize that you are an important part of the team!

We hold ourselves to a high standard when it comes to delivering health benefits to our employees. We offer a wide range of employee benefits, from the standard medical and prescription benefits, to retirement benefits and employee recognition opportunities.

This guide is designed to assist you in making benefit choices and provide details about other benefit opportunities. It provides key information on the various aspects of the health plans and helps you sort through your options.

Please review the material, discuss it with your family, and make an informed choice when selecting coverage. Changes are only allowed during open enrollment periods or if you experience a “Qualifying Life Event”.

Phoenix House reserves the right to change the benefits package and/or our pay practices, or any components thereof, at its discretion at any time. Detailed descriptions of each plan are contained in the official plan documents, insurance contracts and trust agreements, which are the legal documents that govern the operation of the plans, rights of employees to benefits, and the calculation and payment of benefits. In the event there is a conflict between the official plan documents and the summaries contained herein, the applicable plan texts/documents, insurance contracts and/or trust agreements will govern.

If you have questions, please contact the Human Resources Department.

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In This Guide....

How to Enroll in Benefits .................. 4Benefits and Eligibility ...................... 6Medical Benefits ............................... 9-10Medical Contributions ...................... 11Wellness Tools and Resources........ 12Dental Benefits ................................. 13Vision Benefits .................................. 14Flexible Spending Accounts ............ 15Life Insurance .................................... 16Short Term Disability......................... 18Long Term Disability ......................... 18Legal & Identity Theft Protection ... 19

403 (b) Retirement Plan........................ 20Employee Assistance ............................. 21Travel Assistance……………...……………... 21Pet Care ................................................... 22Tuition Assistance .................................. 22(COBRA) Rights & Important Notices ....... 23

Carrier Contact Information .................. 31

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How to Enroll in BenefitsStep 1: You will need to login into Datis and click on Open Enrollment “Click Here”

Step 2: You will need to click “Next”

Step 4: Go through each benefit plan being offered and select your desired enrollment option. You will notice the plan options and applicable premium per paycheck listed.

If you select an Anthem HMO plan, you will be required to choose a primary care provider (PCP) and enter the provider’s 6-digit PCP code into the system to enroll. See page 9 for information on how to find a provider.

If you wish to enroll, you will need to select the “Benefit Plan”, and “Coverage Type.” If you are enrolling dependents, you will need to select each dependent you wish to cover.

If you wish to decline coverage, you can select “I decline coverage” at the bottom of the page.

If you want to save your progress and come back at a later time, you can click on the orange button “Save and complete later” that is found at the bottom, left side of the page.

Step 3: You will Add Your Dependents

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Step 5: If you elected Voluntary Life Insurance over the Guaranteed Issue (GI) amount, you will need to submit Evidence of Insurability (EOI) to Anthem for the amount over the GI benefit. Please make sure to download the form from Datis’ portal and submit to the carrier directly. The carrier may take 30-45 days to review. While your EOI is being processed you will only see the GI amount/deductions on the confirmation page. Phoenix House will not deduct the premium amount for coverage over the GI until they receive Anthem’s approval/response. If Anthem Blue Cross approves the additional amount, Phoenix House will deduct the higher amount 1st of the month following the approval. If Anthem Blue Cross denies your request, Phoenix House will continue deducting the premium up the Guaranteed Issue amount.

Step 5: You will need to click “Submit” once you have confirmed all of your elections.

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Benefits and EligibilityNew Hires Have 30 Days to Enroll!If you do not submit your elections within 30 days from your date of hire, you and/or your eligible dependent(s) will not be enrolled in benefits. You will not be able to make plan changes or enroll your dependent(s) until the next open enrollment period, unless you experience a Qualifying Life Event during the year.

Employee EligibilityDifferent benefits are available based on an employee’s tenure, status, and scheduled work hours; full-time (FT) or part-time benefited (PTB). Use the chart below to review eligibility for the Phoenix House benefits. During the year, if you become benefit-eligible by transferring to a FT or PTB position, you have 30 days to elect benefits following the status change. Your benefits will become effective the first of the following month in which the change occurs; so long as you have satisfied the benefit waiting period (for details, see page 7.) The applicable premium will be deducted from your pay accordingly.Benefit enrollment changes are effective on the 1st of the month following the date that the change is made within the Datis portal. This is also applicable for terminations.If you are rehired within 6 months of terminating employment, you will be eligible immediately for the benefits listed below based on your regularly scheduled hours, so long as you have previously satisfied our benefit waiting period. Changes are effective 1st of the month following the date that the change is made within the Datis portal.See next page for details. If you lose your benefit eligibility; i.e. are terminated or transfer to a position working less than 30 hours, any benefits for which you are no longer eligible will terminate at the end of the month of termination.

Medical & Rx (including prescription drug coverage)

Dental

Vision

Life Insurance

CA State Short Term Disability Insurance

Long Term Disability

403(b) Retirement Plan

EAP - Employee Assistance Program

Flexible Spending Accounts

Tuition Reimbursement

Pet Care/Veterinary Insurance

Legal & Identity Theft Insurance

1. Eligibility exclusions apply as per the plan document. 2. Reimbursement limits are one-half the limits set for full-time employees.

No

No

No

No

Yes

No

Yes1

Yes

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes2

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Scheduled to work full-time30 + hours per weekUnder 30 hours per weekBenefit

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Plan YearYour benefit elections for the 2020 plan year will begin effective April 1, 2020 and remain in place through December 31, 2020. Once enrolled, your coverage will remain active through the plan year and cannot be changed unless you experience an IRS-qualified life event. Details on qualifying events found on page 8.

Benefit Eligibility/Waiting PeriodsTo participate in the Phoenix House benefit program you must meet the eligibility criteria found on page 6, and meet the following waiting periods:Medical (including prescription drug coverage): 1st of the month following the 30th day of employmentDental: 1st of the month following the 30th day of employmentVision: 1st of the month following the 30th day of employmentFlexible Spending Accounts: 1st of the month following the 30th day of employmentLife Insurance: 1st of the month following the 30th day of employmentDisability Insurance: 1st of the month following the 30th day of employmentLegal & Identity theft protection: 1st of the month following the 30th day of employmentPet care/veterinary insurance: 1st of the month following the 30th day of employmentVeterinary/Pet Insurance: 1st of the Month following 30th Day of EmploymentEmployee Assistance Plan (EAP): 1st day of employment403b retirement plan: Employee contribution – Eligible 1st day of employment. *The first contribution will be the 1st pay date following receipt of completed employee deferral election. Phoenix House match – Effective the month following 1 year of service (provided that you worked 1,000 hours).

Dependent EligibilityYou may also enroll eligible family members in the Phoenix House benefit plans as outlined below. Dependents are defined as the following:• Your legal spouse

• Your registered domestic partner ONLY IF coverage is required by law of the state in which you reside

• Dependent Children up to age 26 (regardless of school-status):

Taxability of Domestic Partner benefitsFederal law in effect at the time of this publication requires the taxation of health coverage for domestic partners who are not also qualified tax dependents under IRC Section 152. This means that if your domestic partner is not a tax-qualified dependent, you will pay imputed income taxes on the value of the insurance provided to your domestic partner. You will also be required to pay a portion of your contribution on a post-tax basis. In the event your dependent is tax-qualified, you will need to provide this information to Phoenix House; otherwise, imputed income taxes and post-tax contributions will apply.

- Until the end of the month in which the dependent child turns 26 years of age.

- Unmarried children age 26 or older who are physically or mentally incapacitated (if such incapacitation occurs before the age of 26), are not capable of self-support, and are dependent on you for support. (Physician verification will be required on an annual basis and acceptance of documentation is at Phoenix House’s sole discretion.)

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Benefits ChangesDuring the YearA “Qualifying Life Event” is an opportunity to change your benefit enrollment“Qualifying Event” is a term associated with a major life change that enables you to make changes to your benefit elections outside of your initial, new-hire eligibility or an open enrollment period. These life events are good opportunities to review your current enroll-ments, compare them to new needs, and decide on appropriate adjustments.

Procedure for ChangesIf you experience a qualifying event and want to make changes, you must record the change through the Datis portal within 31 days of the event. In addition, you must provide proof of the change, such as a marriage certificate, birth certificate, divorce decree, a letter on company letterhead stating the date that coverage changed (ended or began) listing all coverages effected, or verification of student status. New hires will need to submit documents verifying each dependent who is enrolled under the group plan during their new hire enrollment time frame.

* These qualifying events do not apply to Flexible Spending Accounts

Note: Changes are effective on the 1st of the month following the date that the change is made within the Datis portal; with the excep-tion of birth or adoption; which is effective on the day that the qualifying event occurs.

• Change in legal marital status (marriage, divorce, legal separation, or annulment)

• Birth, adoption, legal guardianship

• Death of an eligible dependent

• Dependent satisfies or ceases to satisfy dependent eligibility requirements

• Change in employment status (you or eligible dependent)

• Change in your residence*

• Significant reduction/restriction of coverage*

• Significant cost increases*

• Addition or elimination of benefit plan option*

• Change in coverage of a spouse or dependent under an employer plan*

• HIPAA special enrollment rights*

• COBRA qualifying even

• COBRA qualifying event

• Loss of group health coverage sponsored by governmental or education institution*

• A judgment, decree or order requiring coverage for a spouse or child

• Medicare or Medicaid entitlement and Employment Assistance under Medicaid or SCHIP

• Termination/loss of eligibility for Medicaid, Medicare, or State Children’s Health Insurance Program (SCHIP) coverage

• Exchange Event - Exchange enrollment during an Exchange open enrollment period or special enrollment period*

• Exchange Event - Exchange enrollment during an Exchange open enrollment period or special enrollment period*

Examples of Qualifying Events:

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HMO Medical

Health Plan Services and CoverageThe information outlines some of the costs you are responsible for.

Preventive Health ServicesCertain preventive health services and contraceptive methods are offered at no cost to you. Please refer to the benefit summary for full details.

Kaiser Permanente HMOPlan Name: Deductible HMO 8821 Plan

Kaiser Permanente HMOPlan Name: Deductible HMO 6215 Plan

Anthem HMO (Base)Plan Name: Value Deductilbe HMO $250Network Name - Select HMO

Anthem HMO (Buy Up)Plan Name: Premier HMO 20/40/250/3 daysNetwork Name - Select HMO

In-Network

In-Network

In-Network In-Network

Out-of-Network Services and Emergency CareHMO plans have no out-of-network coverage. However, under an HMO there is access to emergency care out-of-network. Emergency care is for medical or mental health conditions that require immediate medical attention to prevent serious jeopardy to your health and considered life-threatening.

Find an Anthem providerTo find a provider in the HMO Select network, please visit: www.anthem.com/ca/find-doctor/ Scroll down to “Search as a Guest”. You will need the network name above to complete your search.

• Deductible: The fixed amount of money you pay out of pocket before insurance benefits start. Some services are not subject to the deductible.• Coinsurance: The percentage of the total bill that you are responsible for (after you have paid/met the deductible).• Copay (or Copayment): A fixed dollar amount that you pay for an in-network service; such as an office visit or prescription medicine.

Kaiser Permanente HMO and Anthem Blue Cross HMO options

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Deductible (single/family)


Deductible (single/family) Deductible (single/family)

$2,500 / $5,000

$1,000 / $2,000

$250 per person None

$5,000 / $10,000

$3,000 / $6,000

$3,500 / $ 7,000 $2,500 / $ 5,000

30%

20%

10% $250 per day (3 day max)

30%

20%

10% N/A

$40 PCP / $40 Specialist


$20 PCP / $40 Specialist $20 PCP / $40 Specialist

$40 copay

$20 copay

No Charge

No Charge

$10 copay $10 copay

30%

20%

$20 copay $20 copay

$150 copay + 10% $150 copay

Coinsurance (your portion)


Coinsurance (your portion) Coinsurance (your portion)

Office Visit Copay

Office Visit Copay

Office Visit Copay Office Visit Copay

ER Copay (waived if admitted)


Urgent Care Urgent Care

ER Copay (waived if admitted) ER Copay (waived if admitted)

Out-of-Pocket Maximum (single/family)


Out-of-Pocket Maximum (single/family) Out-of-Pocket Maximum (single/family)

Hospital Admission

Hospital Admission

Hospital Admission Hospital Admission

Urgent Care

Urgent Care

Telehealth “Visit”


Telehealth “Visit” Telehealth “Visit”

PPO & EPOMedicalAnthem PPO and EPO

Anthem PPOPlan Name: Classic PPO 750/30/50/20Network Name - Prudent Buyer PPO

Anthem EPOPlan Name: EPO 1000/20/20Network Name - Prudent Buyer PPO

In-Network

In-Network



Please note: There are NO out-of-network benefits on an EPO plan

$750 / $2,250

$3,000 / $6,000

$5,000 / $10,000

$7,350 / $ 14,700

20%

20%

20%

20%



$10 copay

$10 copay

$150 copay + 20%

$150 copay + 20%

$30 copay

$25 copay

Yes See benefit summary for details

No



Office Visit Copay

Office Visit Copay

Urgent Care

Urgent Care

Out-of-network coverage

Out-of-network coverage



Hospital Admission

Hospital Admission





Health Plan Services and CoverageThe information outlines some of the costs you are responsible for.

Preventive Health ServicesCertain preventive health services are offered at no cost to you:

• Deductible: The fixed amount of money you pay out of pocket before insurance benefits start. Some services are not subject to the deductible.• Coinsurance: The percentage of the total bill that you are responsible for (after you have paid/met the deductible).• Copay (or Copayment): A fixed dollar amount that you pay for an in-network service; such as an office visit or prescription medicine.

• Annual physical exams, such as well woman exams

• HPV, cancer and other screenings based on age and gender (ask your doctor for details)

• Breastfeeding support, counseling, and supplies

• Counseling for sexually transmitted infections, HIV, contraceptive methods, tobacco use-related diseases and others.•Immunizations (e.g. flu shot)

Find an Anthem providerTo find a provider in the EPO and PPO Prudent Buyer network, please visit: www.anthem.com/ca/find-doctor/ Scroll down to “Search as a Guest”. You will need the network name above to complete your search.

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Employee ContributionsPremiumsThe cost of coverage under a health plan is called a “premium”. Your share (the employee’s portion) of the premium is referred to as your contribution. Employee contributions are paid through pre- tax payroll deductions. Employee contributions to the premium are salary-banded, which means that costs are equitably distributed according to an employee’s salary level. Please review the charts on this page to determine what the cost of coverage will be for you and any eligible dependents.

Kaiser Low HMO plan; cost per paycheck

Kaiser High HMO plan; cost per paycheck

Anthem HMO (Base) plan; cost per paycheck

Anthem HMO (Buy-Up) plan; cost per paycheck

$25,000 - $34,999

$25,000 - $34,999

$25,000 - $34,999

$25,000 - $34,999

$50,000 - $74,999

$50,000 - $74,999

$50,000 - $74,999

$50,000 - $74,999

$35,000 - $49,999

$35,000 - $49,999

$35,000 - $49,999

$35,000 - $49,999

$75,000 and over

$75,000 and over

$75,000 and over

$75,000 and over

$17.77

$48.13

$17.66

$41.61

$53.30

$88.99

$52.98

$76.93

$35.54

$68.56

$35.32

$59.27

$62.19

$99.20

$61.81

$85.76

$39.09

$105.89

$38.85

$91.55

$117.26

$195.77

$116.56

$169.25

$31.98

$86.64

$31.79

$74.90

$95.94

$160.18

$95.37

$138.48

$78.17

$150.83

$77.71

$130.40

$136.80

$218.24

$135.98

$188.68

$63.96

$123.41

$63.58

$106.69

$111.93

$178.56

$111.26

$154.38

$27.54

$117.55

$27.37

$101.63

$137.70

$244.20

$136.87

$211.12

$82.62

$180.87

$82.12

$156.38

$165.24

$275.86

$164.24

$238.50

Family

Family

Family

Family

Employee + Spouse/Partner




Employee + Child(ren)




Single

Single

Single

Single

Salary Range

Salary Range

Salary Range

Salary Range

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Anthem EPO plan; cost per paycheck

Anthem PPO plan; cost per paycheck

$25,000 - $34,999

$25,000 - $34,999

$50,000 - $74,999

$50,000 - $74,999

$35,000 - $49,999

$35,000 - $49,999

$75,000 and over

$75,000 and over

$139.15

$199.23

$174.47

$234.55

$156.81

$216.89

$183.30

$243.38

$306.12

$438.30

$383.83

$516.00

$250.46

$358.61

$314.04

$422.18

$344.98

$477.15

$403.26

$535.43

$282.25

$390.40

$329.94

$438.08

$403.98

$590.23

$513.48

$699.72

$458.73

$644.97

$540.85

$727.09

Family

Family





Single

Single

Salary Range

Salary Range

There are no shortcuts to getting healthy. We provide you with the resources you need to reach your goals and make healthy choices. Take advantage of these free apps and member discounts offered with your medical plan

• Kaiser’s ChooseHealthy® program provides discounts on acupuncture, massage therapy, gym memberships and even chiropractic care if you need more visits than the plan includes. • Kaiser’s Active&Fit® Direct program offers Kaiser members access to over 10,000 fitness centers for just $25 a month! (Including LA Fitness, Curves, Anytime Fitness and more).• Manage your care online with interactive tools and reference guides.• Wellness Coaching: whether you want to lose weight, quit smoking or reduce stress, a coach is available for you.• Telephone Appointments: Get care wherever you are for minor health conditions such as a cold or allergies.• Free Flu Shots: to find out where to get your flu shot, visit kp.org/flu.

• Anthem’s new “Get Strong” health rewards program pays members up to $200 for various health related actions. - Tobacco free certification - Health Assessment - Annual wellness exam & flu shot• 24/7 Nurseline: No matter where you are, or what time it is, you can speak with a registered nurse over the phone to find answers for your health questions. (No cost to members!) • LiveHealth Online: If you need to speak with a doctor instead of a nurse, Anthem offers virtual visits with board-certified doctors or therapists through a smartphone, tablet or computer with a webcam. ($10 per visit)• Case Management: nurse care managers assist members after a hospital stay or in the event a long-term/serious health problem has left them in need extra support.•ConditionCare: offers support from a dedicated nurse if you have certain chronic conditions such as: asthma, diabetes, heart disease or heart failure.• Future Moms: one-on-one support from registered nurses to help expecting mothers have a healthy pregnancy, and safe delivery.

Kaiser members, visit kp.org for:

Anthem members, go to anthem.com/ca for:

Enhance your health with Kaiser and Anthem wellness offerings!

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Wellness Tools& Resources

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DentalBenefitsAnthem Blue Cross Dental PPO (DPPO)

Phoenix House offers a flexible dental plan through Anthem. You may receive care from any licensed dentist, but you’ll save money by choosing a dentist within the Anthem Dental Complete network. Dental health is an import-ant part of your fundamental health care and we encourage you to take advantage of this benefit. If you choose not to participate, please make sure you have adequate coverage from other sources.

Some of the services covered by the dental plan are as follows:*Please note that out-of-network services are covered based on Anthem’s maximum allowable charge and are subject to balance billing.

Calendar Year Deductible (single/family)

Waive Deductible for Preventive Care

Annual Maximum

Diagnostic & Preventive Oral Exam & teeth cleaning (2 per 12 months) Bitewing X-rays (1 set per 12 months)

Major Bridge Installation Dentures, Inlays, Onlays, Crowns

Orthodontic Coverage Lifetime Coverage Limit

Basic Fillings: Amalgam and Composite Root canal therapy (Endodontics) Oral surgery: extractions Surgical and Non-surgical Periodontics

In-Network Out-of-Network *

Employee



Family

$50 / $150

$1,500 per insured

Yes

100% Covered

80% Covered

50% Covered

Dependent children only $1,000 Dependent children only $1,000

$50 / $150

$1,500 per insured

No

70% Covered

70% Covered

50% Covered

$15.91

$33.87

$37.20

$53.22

PremiumsThe dental premium cost will depend on which tier of coverage is elected; employee only or employee +dependent coverage. Premiums are paid pre-tax via payroll deductions. In-network providers can be found at www.anthem.com/ca/find-doctor/, by calling the number listed on the back of your Anthem ID card, or via the new Anthem app. “Sydney Health”.

*DPPO Allowed Amount, which is the lesser of the dentist’s submitted fee or the PPO Maximum Allowance. For non-participating dentists, percentages are based on the Anthem Maximum Allowed Coverage.

*Out-of-network services are subject to balance billing. For out-of-network dentists, coverage is based on the Anthem Maximum Allowed Coverage. DPPO Allowed Amount is the lesser of the dentist’s submitted fee or the PPO Maximum Allowance.

Anthem Dental Complete DPPO plan; cost per paycheck

VisionBenefitsAnthem Blue Cross

Vision coverage is a vital piece of the Phoe-nix House benefit package. The plan offered through Anthem Blue Cross provides employ-ees and their families with important preven-tive care coverage. Regardless of whether you have vision correction needs, getting an annual eye exam is crucial for monitoring your eyes for changes and detecting early signs of disease, such as macular degeneration and diabetic retinopathy.

Vision Services

Eye Exam

Eyeglass Frames

Eyeglass Lenses standard, plastic Rx lenses

Contact Lenses instead of eyeglass lensesElective Conventional Elective Disposable

In-Network Out-of-Network Frequency

Employee



Family

$5 copay

$150 allowance + 20% discount on additional balance

$0 copay

$150 allowance + 15% discount on additional balance

$150 allowance (no added discount)

Up to $42 reimbursement Once every calendar year

Up to $45 reimbursement Once every calendar year

Once every calendar yearReimbursement varies

($40 - $80)

Up to $105 reimbursement Once every calendar year(in lieu of eyeglass lenses)

$5.94

$12.18

$11.88

$18.12

Anthem’s Blue View Vision PlanThe Blue View Vision network gives you access to a wide range of in-network professionals, including some of the top optical retailers such as: LensCrafters®, Target Optical®, and most Pearle Vision® locations. You also have in-network benefits when ordering eyewear online from companies such as Glasses.com and ContactsDirect.com.For a list of in-network providers, visit www.anthem.com/ca or call member services at (866) 723-0515.

Out-of-NetworkIf you choose to, you may receive vision services outside of the Blue View Vision network. If you choose to go out-of-network, you pay in full at the time of service, obtain an itemized receipt, and file a claim for reimbursement up to your maximum out-of-network allowance.

PremiumsVision premium cost will depend on which tier of coverage is elected; employee only or employee +dependent coverage. Premiums are paid pre-tax via payroll deductions. In-network providers can be found at www.anthem.com/ca/find-doctor/, by calling the number listed on the back of your Anthem ID card, or via the new Anthem app. “Sydney Health”.

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Anthem Blue View Vision plan; cost per paycheck

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Flexible Spending AccountsUnderstanding Flexible Spending Accounts (FSAs)Flexible Spending Accounts (FSAs) are special accounts that allow you to contribute funds directly from your paycheck on a pre-tax basis into an account to be used for specified expenses. Using these pre-tax dollars to pay for eligible expenses, either healthcare or dependent care, is a strategic way to lower your taxable income. Your elections/contributions are deducted from your paycheck on a bi- weekly basis before Federal, State and Social Security taxes are applied to your earnings.

Terminated EmployeesAll services must have occurred by end of the month of termination. You can only be reimbursed up to the amount that is in the account at termination. Reimbursement claim must be done within 30 days after end of the month of termination. All funds remaining after end of the month will be forfeited.

Healthcare FSAA Healthcare FSA pays for qualified/eligible healthcare expenses not covered or reimbursed by your insurance plans. This includes things such as: medical, dental, and vision deductibles, copays, and coinsurance. You can also pay for orthodontic services, laser eye surgery, doctor-prescribed medications, and more. For a more comprehensive list of eligible expenses, visit www.TASCon-line.com and click the “Resources” tab.

Dependent Care FSAA Dependent Care FSA may be used for qualified/eligible day care expenses for eligible dependents. Your dependent care funds must be used for the care of one or more qualified dependents. Your qualified dependents may include your dependent child(ren) under age 13, and/or dependents of any age who are mentally or physically incapable of caring for themselves. Eligible forms of dependent care include: preschool and afterschool child care, eldercare for an incapacitated adult who lives with you eight or more hours per day, child care at day camp, nursery school or private sitters. For more details about using Dependent Care FSA funds, please visit www.TASConline.com and click the “Resources” tab.

Commuter FSAParking and Transit FSAs cover eligible parking and/or transit expenses incurred for your travel to and from work. Your TASC debit card can be used to pay for eligible parking/commuting expenses. Examples of eligible expenses are: • Public Transportation expenses (mass transit, bus, train, ferry, subway) • Work-Related Parking: Park n’ ride, parking ramps, parking meters The parking and transit contribution maximums are $270 per month. Unlike the Healthcare and Dependent Care FSAs, you may change your contributions to your Commuter FSA from month-to-month during the plan year. Funds in this type of FSA can be rolled over into the next plan year.

Annual ElectionsThe contribution amounts you elect are “locked in” for the duration of the plan year, and cannot be changed except in the event of cer-tain “Qualified Life Events” and for the transit/commuter FSA.

The FSA plan year runs alongside the other benefits offered. For 2020, this will be from April 1, 2020 to December 31, 2020. According to the IRS’s “use-it-or- lose-it” rule, if you do not use all the money in your FSA for expenses incurred during the plan year, you will forfeit the unused balance. Your unused balance cannot be carried over into the next year. Our Healthcare FSA and Dependent Care FSA offer a 2 months and 14-day grace period. This extends your available time to incur claims to March 15, 2021. The plan also includes a “runout period”. The runout period is additional time to submit claims that were incurred between April 1, 2020 and March 15, 2021. The runout period lasts 90 days, meaning that you have until April 15, 2021 to submit a claim.If you enroll in one or more of the FSA’s available to you TASC will send you a debit card free of charge. The FSA debit card allows for easy access to your funds. If you don’t use the debit card provided, you can pay for eligible expenses out of pocket and submit a request for reimbursement to TASC via one of these methods:

Phoenix House offers three types of FSAs:

• Healthcare Flexible Spending Account• Dependent Care Flexible Spending Account • Parking and Transit Flexible Spending Account

• Mobile app

• TASC’s online employee account

Minimum Annual Election for 2020

Maximum Annual Election for 2020

Healthcare FSA Dependent Care FSA

$130

$2,062

$130

$3,749 per household

Life Insurance

Basic Life Insurance

Voluntary Life Insurance

Eligibility and BenefitsLife insurance coverage is available to full-time employees and part-time employees who work 30 hours or more per week on a regularly scheduled basis following waiting period. For basic life insurance, evidence of insurability is not required for coverage up to $425,000. This company-paid life insurance benefit is one times the employee’s annual salary rounded to the next higher $1,000, up to a maximum of $800,000. Reduction schedule applies at age 70.

Eligibility, Benefits and CostEmployees may also elect additional, voluntary life insurance in increments of $10,000, from $10,000 up to $500,000 or 5x the employee’s annual earnings; whichever is less.Any request for life insurance coverage above $300,000 or 2x annual earnings; whichever is less, will require completion of evi-dence of insurability (EOI).

The cost of the voluntary coverage for employee and spouse is based on the employee’s age. Premium is paid by the employee through post-tax payroll deductions. How to calculate cost of voluntary life insurance for 35-year-oldExample per pay period:

The amount of life insurance provided to an employee (both company paid and voluntary) is reduced to 50% of the life insurance benefit at age 70; to 30% at age 75; and to 25% at age 80.

A. List the amount of additional insurance you want: $50,000 Divide B. “A” by $1,000 = 50C. Multiply “B” by Rate in table: 5 x $.0462 = $2.31

Voluntary Life Insurance; cost per paycheck

Additional Benefit Details•You may purchase coverage for your spouse in increments of $5,000 up to $250,000. Guaranteed Issued (GI) amount is $30,000.•You may purchase coverage for your child(ren)- (age 15 days to 26 years) in increments of $1,000 up to $10,000.•You must enroll in coverage to elect dependent coverage. Dependent coverage cannot exceed 50% of the employee’s benefit amount.•Late Entrants: If your application is submitted to Anthem more than 31 days after you became eligible, the Guaranteed Issue amount does not apply, and you must submit evidence of insurability (EOI). Anthem must approve all amounts in writing.

Understanding Imputed IncomeFederal regulations require you to pay imputed income tax on the value of company-provided basic term life insurance in excess of $50,000. This means that if the value of your company-paid basic term life insurance is over $50,000, you will be taxed based on the IRS imputed income tax table. This taxable income will be shown on your W-2 form at the end of the year.

Age Rate per $1,000 of coverage

Under 25

30 to 34

40 to 44

50 to 54

60 to 64

70 and older

25 to 29

35 to 39

45 to 49

55 to 59

65 to 69

$0.0277

$0.0369

$0.0646

$0.1662

$0.4246

$1.3246

$0.0277

$0.0462

$0.0969

$0.2769

$0.8169

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Life insurance eases the financial burden placed upon family members in the event of your premature death. Knowing that your family will be taken care of brings peace of mind and contributes to you and your family’s overall well-being. This is why Phoenix House provides eligible employees with basic life insurance, at no cost to the employee, and the option to purchase additional voluntary life insurance. Both coverages are offered through Anthem Blue Cross.One-Time Open Enrollment Opportunity for 2020!During the 2020 Open Enrollment period employees who previously waived voluntary life insurance have a one-time opportunity to elect coverage up to the Guaranteed Issued (GI) amount without submitting evidence of insurability. Currently enrolled employees have the option to increase their coverage amount up to the GI without EOI, and any previously-declined employees will need to submit EOI on any elected amounts.

The life insurance plans include a “Living Benefit” feature for a covered individual who is terminally ill, and whose life expectancy is 12 months or less. This feature provides advance payment of benefits. A lump sum payment of 75% of the death benefit to amaximum of $250,000.

Life insurance amounts over $50,000 are taxable as imputed income in accordance with IRS regulations given that basic lifeinsurance is provided at no cost.

If more than one beneficiary is named and you do not designate their order or share of benefits, the beneficiaries will share equally. You may change your beneficiaries and their amounts at any time during the year in the Datis portal. It is important to keep your designation(s) current, which is why you are reminded annually during Open Enrollment.

Beneficiary designation in some states may be governed by local community property law, including California, Virginia, and Texas, and may require that the spouse be selected as the primary beneficiary. If an employee in one of these states would like to designate someone other than the spouse as the primary beneficiary, please consult local community property laws.

Remember to Designate a Beneficiary!Designating a beneficiary is very important. When you enroll in Life Insurance benefits, you must name at least one beneficiary to receive the benefits of your life insurance after death. Employees should complete the beneficiary information in the Datis portal and update annually during Open Enrollment.

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Short Term Disability (STD)

Long Term Disability (LTD)

Disability benefits offer you financial support when you’re sick, injured and unable to work and earn an income. Phoenix House does not offer Short Term Disability benefits through our benefits plan. This coverage is provided under California’s state-mandated program.

In California, Short Term Disability Insurance is provided by California State Disability Insurance (SDI). SDI is a partial wage-replacement insurance plan for California workers. The SDI program is state- mandated and funded through employee payroll deductions. SDI provides short-term benefits to eligible workers who suffer a loss of wages when they are unable to work due to a non-work-related illness or injury, or a medically disabling condition from pregnancy or childbirth. The required SDI payroll deductions from an employee’s earnings begin immediately upon employment along with CA state income tax and other federal deductions (e.g. Social Security).

EligibilityLong term disability (LTD) coverage is available to full-time employees and part-time employees who work 30 hours or more per week on a regularly scheduled basis, following your waiting period.

Benefits begin after 180 days of approved, continuous disability. After six months, you are considered disabled if you are unable to perform all material and substantial duties of your regular occupation; resulting in at least a 20% loss of pre-disability earnings. After 24 months, you will still be considered disabled and eligible to receive LTD benefits if you are unable to perform the material and substantial duties of any occupation, which results in at least 40% loss of pre-disability earnings.

LTD BenefitsLong Term Disability Insurance is provided through Anthem Blue Cross at no cost to the employee. This employer-paid benefit covers employees for off-the-job injuries/illnesses. The LTD plan provides an employee with coverage equal to 40% of their basic monthly earnings, minus other disability income benefits from any source, to a maximum of $4,000 per month. Executives and Vice Presidents receive coverage equal to 60% of their basic monthly earnings, minus other disability income benefits from any source, to a monthly maximum of $11,000.

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Legal and Identity Theft ProtectionBenefits OverviewPhoenix House is offering employees the option to purchase legal and/or identity theft protection plans through LegalShield.

LegalShield – Legal PlanParticipants in the LegalShield plan have the ability to choose from a network of dedicated law firms in 50 states. LegalShield does not require claims to be filed. The plan covers the employee (member), their spouse, and dependents up to the age of 26 who are living at home.

LegalShield provides telephone and office consultations with in- network attorneys for a wide variety of matters including: estate planning, will preparation, real estate, family law, traffic offenses, civil law defense, financial issues, immigration, and more.

This benefit also provides IRS Audit Assistance which enables you to take advantage of 25% preferred-member discounts on matters related to bankruptcy, criminal charges, DUI and personal injury.

IDShield – Identity Theft ProtectionIn addition to legal services, LegalShield offers comprehensive identity protection service and financial account number monitoring. Nothing is left to chance by their monitoring of your name, SSN, date of birth, email address (up to 10), phone numbers (up to 10), driver’s license, passport numbers and medical ID numbers. Through IDShield you also have full-service restoration in the event you experience identity theft, social medial monitoring, credit monitoring, credit inquiry alerts, and 24/7 consultations.

To learn more about how the programs work and to enroll, you can go to the Phoenix House LegalShield homepage at: http://www.legalshield.com/info/phoenixhouse

Please note, rates listed online may reflect monthly cost rather than cost per paycheck.

LegalShield plans; cost per paycheckThe employee cost for LegalShield plans is paid via post-tax payroll deductions as follows:

Legal plan only

Legal + Identity theft

IDShield plan only

Employee Only Employee + Family

$9.67

$13.57

$3.90

$9.67

$15.65

$7.36

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Phoenix House 403(b) Retirement PlanBenefits

EnrollingTo enroll and make voluntary contributions to the 403(b) Plan, or to obtain information on investment options, call T. Rowe Price at 1 800 354 2351. Voluntary contributions can be changed at any time during the calendar year.

Vesting ScheduleTo be vested means that you have non-forfeitable ownership of your account balance.•You are always 100% vested in the contributions you make to your account.•Phoenix House Match employer contributions are on a 3-year Cliff schedule.

Company ContributionsEligible employees may receive Phoenix House contributions. It’s a discretionary match of 100% up to 6% of your compensation after completion of the 403(b) plan’s eligibility requirements as further described in the Summary Plan Description.

Phoenix House provides employees with the 403(b) Plan as a way to save towards retirement. Employees are eligible to make voluntary pre-tax contributions into the 403(b) Plan from the first day of employment. The maximum amount that an employee may voluntarily con-tribute to the 403 (b) Plan for 2020 is $19,500. If an employee is age fifty (50), or will reach age fifty by the end of 2020, the em-ployee may contribute an additional $6,500 for a total contribution of $26,000. Contribution limits are subject to change each year, as determined by the IRS.All voluntary contributions are pre-tax contributions and thus, are not subject to Federal, state or local taxes. However, voluntary contribu-tions are subject to Social Security taxes. Contributions are subject to taxation only when withdrawn. In addition, employees are eligible to roll over qualified 401(a), 401(k), and 403(b) funds from other employers into the 403(b) Plan at any time after employment with Phoenix House.

The 403(b) Plan offers employees a variety of different investment options for both employee and Phoenix House contributions. Infor-mation about the various investment options can be accessed via the T. Rowe Price website at rps.troweprice.com.

In accordance with 403(b) Plan provisions, employees can take loans from employee contributions and vested employer contribu-tions. Loans can be made for up to 50% of the vested contribution balance, with $1,000 being the minimum loan and $50,000 being the maximum loan (other loan provisions may apply). If an employee fails to repay the loan in accordance with the terms of the loan, the unpaid balance will be considered a default and will be subject to all applicable taxes and penalties. Hardship withdrawals are available from employee voluntary contributions in accordance with strict IRS guidelines and are subject to all applicable taxes and penalties.

The 403(b) Plan offers benefits to beneficiaries, in case some-thing happens to the employee. In order to ensure that beneficiaries have access to benefits available to them, employees must complete the Beneficiary Information portion of the 403(b) Plan enrollment. Ben-eficiary information should be updated as needed. Beneficiary desig-nation in some states may be governed by local community property law, including California and Texas, and gen erally require that the spouse be selected as the primary beneficiary. If an employee in one of these states would like to designate someone other than the spouse as the primary beneficiary, please consult local communi-ty property laws and/or call T. Rowe Price at 1 800 354 2351 for assistance.

Upon termination of employment, vested balances in the employee’s 403(b) Plan account can be rolled over into other types of pension accounts such as a 403(b), 401(k), or IRA, etc. without any taxes or penalties; alternatively, the employee can withdraw the balance sub-ject to IRS regulations and all applicable taxes and penalties. If the terminated employee does not provide an election, the account may be handled as follows:

•If the former employee’s vested account balance is under $1,000, and absent an election by the employee, the employee will be sent a check by T. Rowe Price for the balance of the account.

•If the former employee’s vested account balance is more than $1,000 but less than $5,000, and absent an election by the employ-ee, the balance will be rolled over to a T. Rowe Price IRA, and they will not remain in the Phoenix House 403(b) Plan.

• If the former employee’s vested account balance is $5,000 or more, the employee can leave the funds in the Phoenix House 403(b) Plan account; can roll the funds over into other types of pension accounts such as a 403(b), 401(k), or IRA, etc. without any taxes or early withdrawal penalties; or can withdraw the funds subject to IRS regulations and all applicable taxes and penalties.

Anthem’s EAP provides you and your dependents with completely confidential, third-party assistance for a variety of work, home, personal, and/or family situations including: • Parenting support• Education and child care resources• Senior care referrals• Financial and legal problems• Emotional support• Depression and stress management• Limited identity monitoring & identity theft victim recovery services

As an employee of Phoenix House, you and your household have access to the work/life resources anytime. This includes face-to-face visits with a counselor (up to 4 visits per issue) or online visits via LiveHealth Online. You can tap into these benefits 24/7 by:• Calling toll-free (800) 999-7222• Visiting www.anthemEAP.com and entering the program name/ company code: Phoenix House.

Anthem’s Travel Assistance program is provided at no cost to employees. The program includes travel assistance if you are traveling more than 100 miles from home for 90 days or less.

You can access Travel Assistance benefits by calling: • US and Canada: 1(866) 295-4890• Other locations, call collect: +1(202) 296-7482

This value-added program gives you access to emergency medical help, travel services and useful tips for your trip. The program can help arrange for 24-hour multilingual service, medical consultation and evaluation, emergency medical evacuation, emergency Rx services, care for minor children, and more. While there is no charge for the benefit, employees may incur costs for the actual services provided by third-party providers contracted to assist.

All services must be arranged in advance by General Global Assistance, Inc., Anthem’s Travel Assistance vendor.

Anthem’s Employee Assistance Program

Anthem’sTravel Assistance Program

To help employees with life’s challenges, Phoenix House provides you with access to a confidential Employee Assistance Program (EAP) through Anthem. The EAP is offered at no cost to the employee and you don’t have to register to access it; you are automatically enrolled in this employer-paid benefit.

As part of your employer-paid basic life insurance, employees can utilize Anthem’s Travel Assistance program through General Global Assistance, Inc. (GGA).

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Pet Care Program

Tuition Assistance

EligibilityYou may enroll your pets in veterinary/pet care through the United Pet Care program at discounted rates. You may enroll only when you are newly eligible for benefits, or during Open Enrollment periods.

EligibilityFull-time employees and part-time employees (30 or more hours per week) that have completed at least six months of service are eligible for pre-approved tuition reimbursement.

EnrollingEmployees can enroll directly through link below. To enroll, select your state, choose your program and then your veterinarian. There are two ways to enroll: • Call 888-781-6622• Visit the United Pet Care Phoenix House website at: www.unitedpetcare.com/phoenixhouse

BenefitsThe United Pet Care program covers preventative, accident and sick care. Unlike traditional insurance, United Pet Care is a membership savings program where employees will save 20-50% off veterinary services. Simply present your card when you visit your veterinarian for instant savings! Available programs vary by state and each program features different savings on office visits, procedures, and medications. Veterinarians also vary by program. Please go online to Phoenix House’s page to find out what programs are accessible to you: http://www.unitedpetcare.com/phoenixhouse. United Pet Care features no claim forms, no deductibles, no waiting period, and no old-age or pre-existing condition exclusions.

BenefitsThe amount of tuition reimbursement available each period (Jan-uary – June and July – December) is dependent on the budgeted amount allocated to tuition reimbursement. A review committee will meet the first week of February and August to review all tuition reimbursement requests to determine how the tuition reimburse-ment funds will be distributed to each employee and will notify each employee by the 15th of the month.

Alcohol and Drug CertificationFull-time employees are eligible for tuition reimbursement for educational courses related to their Alcohol and Drug Certification to a maximum of $2,000 upon hire. Part-time benefited employ-ees (30 or more hours a week) are eligible for reimbursement amounting to a maximum of $1,500 for their Alcohol and Drug Certification courses (75 percent of the full benefit) upon hire.

Alcohol and Drug Testing FeesAlcohol and Drug Certification testing fees are eligible for reimbursement for organizations that are recognized by the State of CA. Testing fees are included in the maximum of $2,000 eligible towards certification for full time employees and $1,500 for part time benefited employees (30 or more hours per week).

To receive reimbursement:• Employees must receive preapproval from the Human Resources department prior to starting their course.• Courses must be taken at an accredited college or university.• The course of study is in a field related to the employee’s current job and/or is for a degree relevant to the needs of Phoenix House.• The student passes the course and/or receives a grade of “C” or better.

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Important NoticesNotice: Special Enrollment RightsIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stopped contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).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. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, see the contact information at the end of these notices.

Notice: The Newborns’ and Mothers’ Health Protection Act (NMHPA)Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Notice: Woman’s Health and Cancer Rights Act (WHCRA)Did you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema)? For more information, see the contact information at the end of these notices.

Notice: Consolidated Omnibus Budget Reconciliation Act (COBRA)IntroductionYou’re getting this notice because you have coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact 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.

What is COBRA Continuation Coverage?COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or• Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your spouse dies;• Your spouse’s hours of employment are reduced;• Your spouse’s employment ends for any reason other than his or her gross misconduct;• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:• The parent-employee dies;• The parent-employee’s hours of employment are reduced;• The parent-employee’s employment ends for any reason other than his or her gross misconduct;

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• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);• The parents become divorced or legally separated; or• The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA Continuation 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. The em-ployer must notify the Plan Administrator of the following qualifying events:

•The end of employment or reduction of hours of employment;•Death of the employee; or•The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all 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 within 60 days after the qualifying event occurs. You must provide this notice to the contact person shown at the end of these notices.

How is COBRA Continuation 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 that generally lasts for 18 months due to employment termination or reduction of hours of work (for fully insured plans issued in California, coverage generally last for 36 months). Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability Extension of 18-Month Period of COBRA Continuation CoverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a 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 COBRA continuation coverage.

Second Qualifying Event Extension of 18-Month Period of Continuation CoverageIf your family experiences another qualifying event during the 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 the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare bene-fits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

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.

If You Have QuestionsQuestions 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 the Employee Retirement Income Security Act (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 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 ChangesTo protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Notice: Uniformed Services Employment and Reemployment Rights Act (USERRA)Under the Uniformed Services Employment Reemployment Rights Act of 1994 (USERRA), employees are provided with broad protection in terms of their reemployment upon completion of military service.

REEMPLOYMENT RIGHTSYou have the right to be reemployed in your civilian job if you leave that job to perform service in the uniformed service and:• You ensure that your employer receives advance written or verbal notice of your service;• You have five years or less of cumulative service in the uniformed services while with that particular employer;• You return to work or apply for reemployment in a timely manner after conclusion of service; and• You have not been separated from service with a disqualifying discharge or under other than honorable conditions.

If you are eligible to be reemployed, you must be restored to the job and benefits you would have attained if you had not been absent due to military service or, in some cases, a comparable job.

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RIGHT TO BE FREE FROM DISCRIMINATION AND RETALIATION

If you:• Are a past or present member of the uniformed service;• Have applied for membership in the uniformed service; or• Are obligated to serve in the uniformed service;then an employer may not deny you:• Initial employment;• Reemployment;• Retention in employment;• Promotion; or• Any benefit of employmentbecause of this status.In addition, an employer may not retaliate against anyone assisting in the enforcement of USERRA rights, including testifying or making a statement in connection with a proceeding under USERRA, even if that person has no service connection.

HEALTH INSURANCE PROTECTION• If you leave your job to perform military service, you 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 without any waiting periods or exclusions (e.g., pre-existing condition exclusions) except for service-connected illnesses or injuries.

ENFORCEMENT • The U.S. Department of Labor, Veterans Employment and Training Service (VETS) is authorized to investigate and resolve complaints of USERRA violations.

• For assistance in filing a complaint, or for any other information on USERRA, contact VETS at (866) 4-USA-DOL or visit its website at http://www.dol.gov/vets. An interactive online USERRA Advisor can be viewed at http://www.dol.gov/elaws/userra.htm.

• If you file a complaint with VETS and VETS is unable to resolve it, you may request that your case be referred to the Department of Justice or the Office of Special Counsel, as applicable, for representation.

• You may also bypass the VETS process and bring a civil action against an employer for violations of USERRA.

Notice: Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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, con-tact your State Medicaid or CHIP office or dial (877) KIDS-NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your State if it has a program that might help you pay the premiums for an employer-sponsored Plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call (866) 444-EBSA(3272).

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2019. Contact your State for more information on eligibility.

Website: http://myalhipp.com/

The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/ Website: https://medicaid.georgia.gov/health-insurance-premi-

um-payment-program-hipp

Phone: (678) 564-1162 ext. 2131

Medicaid Eligibility:Website: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Email: [email protected]

Phone: (866) 251-4861

Website: http://flmedicaidtplrecovery.com/hipp/

PHONE: (855) 692-5447 Phone: (877) 357-3268

ALABAMA – Medicaid

ALASKA – Medicaid

FLORIDA – Medicaid

GEORGIA – Medicaid

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Website: http://www.kdheks.gov/hcf/

Website: http://myarhipp.com/

Health First ColoradoWebsite: HTTPS://HEALTHFIRSTCOLORADO.COM/

Healthy Indiana Plan for Low-Income Adults 19-64Website: http://www.in.gov/fssa/hip

CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plusCHP+ Customer Service: (800) 359-1991 / State Relay 711

Website: http://dhs.iowa.gov/hawki Customer Service: (800) 257-8563

Phone: (800) 403-0864

All other Medicaid Website: http://www.indianamedicaid.com

Health First Colorado Member Contact Center: (800) 221-3943 / STATE RELAY 711

Phone: (877) 438-4479

Website: https://dhcfp.nv.gov/

Phone: (785) 296-3512

Phone: (855) MyARHIPP (692-7447)

Phone: (800) 992-0900

KANSAS – Medicaid

ARKANSAS – Medicaid

COLORADO – Health First Colorado(Colorado’s Medicaid Program) & Child Health PlanPlus (CHP+)

NEVADA – Medicaid

INDIANA – Medicaid

IOWA – Medicaid

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

Website: http://chfs.ky.gov

Website: http://www.mass.gov/eohhs/departments/masshealth/

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

Website: https://www.dhhs.nh.gov/oii/hipp.htm

TTY: Maine Relay 711

Website: http://www.nyhealth.gov/health_care/medicaid/

Website: https://medicaid.ncdhhs.gov/

CHIP Phone: (800) 701-0710CHIP Website: http://www.njfamilycare.org/index.html

Phone: (800) 635-2570 Phone: (603) 271-5218

Toll Free Number for HIPP Program: (800) 852-3345, Ext.. 5218

Phone: (800) 442-6003

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html

Phone: (800) 862-4840

Phone: (800) 541-2831

Phone: (919) 855-4100

Medicaid Phone: (609) 631-2392Phone: (888) 695-2447

KENTUCKY – Medicaid

LOUISIANA – Medicaid

MAINE – Medicaid

MASSACHUSETTS – Medicaid and CHIP

NEW HAMPSHIRE – Medicaid

NEW JERSEY – Medicaid and CHIP

NEW YORK – Medicaid

NORTH CAROLINA – Medicaid

Website: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jsp

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: (800) 657-3739 Phone: (844) 854-4825

MINNESOTA – Medicaid NORTH DAKOTA – Medicaid

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Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Website: http://www.ACCESSNebraska.ne.gov

Website: http://www.insureoklahoma.org

Website: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.html

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthin-surancepremiumpaymenthippprogram/index.htm

Phone: (573) 751-2005

Phone: (800) 694-3084

Phone: (855) 632-7633Lincoln: (402) 473-7000 Omaha: (402) 595-1178

Phone: (888) 365-3742

Phone: (800) 699-9075

Phone: (800) 692-7462

MISSOURI – Medicaid

MONTANA – Medicaid

NEBRASKA –Medicaid

OKLAHOMA – Medicaid and CHIP

OREGON – Medicaid

PENNSYLVANIA – Medicaid

Website: http://www.eohhs.ri.gov/ Website: http://www.scdhhs.gov

Phone: (855) 697-4347, or 401-462-0311 (Direct RIte Share Line) Phone: (888) 549-0820

RHODE ISLAND – Medicaid SOUTH CAROLINA – Medicaid

Website: https://www.hca.wa.gov/

Website: http://dss.sd.gov

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

Medicaid: http://health.utah.gov/medicaid

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm

CHIP: http://health.utah.gov/chip

CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm

Website: http://mywvhipp.com/

Website: http://gethipptexas.com/

Phone: (800) 362-3002

Phone: (877) 543-7669

Medicaid Phone: (800) 432-5924

CHIP Phone: (855) 242-8282

Phone: (307) 777-7531

Phone: (800) 250-8427

Website: https://wyequalitycare.acs-inc.com/

Website: http://www.greenmountaincare.org/

Phone: (888) 828-0059 Phone: (800) 440-0493

Phone: (855) MyWVHIPP (1-855-699-8447)Phone: (800) 562-3022 ext. 15473

SOUTH DAKOTA - Medicaid

WASHINGTON – Medicaid

WISCONSIN – Medicaid and CHIP

UTAH – Medicaid and CHIP

TEXAS – Medicaid

WEST VIRGINIA – Medicaid

WYOMING – Medicaid

VERMONT– Medicaid

VIRGINIA – Medicaid and CHIP

28

To see if any other States have added a premium assistance program since July 31, 2019, or for more information on Special Enrollment Rights, contact either:

OMB Control Number 1210-0137 (Expires: 12/31/2019)

U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa(866) 444-EBSA (3272)

Notice: Patient Protection –Primary Care Designation (HMO)Your group health plan generally requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. Until you make this designation, your health insurer designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, see the contact information at the end of these notices.

Notice: Patient Protection –Obstetrics & Gynecological care (HMO)You do not need prior authorization from your group health plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, see the contact information at the end of these notices.

U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov(877) 267-2323, Menu Option 4, Ext. 61565

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

You have the right to: • Get a copy of your health and claims records • Correct your health and claims records • Request confidential communication • Ask us to limit the information we share • Get a list of those with whom we’ve shared your information • Choose someone to act for you • File a complaint if you believe your privacy rights have been violated

We may use and share your information as we: • Help manage the health care treatment you receive • Tun our organization • Pay for your health services • Help with public health and safety issues • Do research • Comply with the law • Respond to organ and tissue donation requests and work with a medical examiner or funeral director • Address workers’ compensation, law enforcement and other government requests • Respond to lawsuits and legal action

You have some choices in the way that we use and share information as we: • Answer coverage questions from your family and friends • Provide disaster relief • Market our services and sell your information

Your Rights

Our Uses and

Disclosures

Your Choices

Notice: HIPAA Notice of Privacy Practice

29

• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

• You can ask us not to use or share certain health information for treatment, payment or our operations.• We are not required to agree to your request, and we may say “no” if it would affect your care.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with and why.• We will include all the disclosures except for those about treatment, payment and health care operations and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records

Ask us to correct health and claims records

Request confidential communications

Ask us to limit what we use or share

Get a list of those with whom we’ve shared information

Your Rights

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. • We will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel we have violated your rights by contacting us using the information on page 9. • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling (877) 696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.• We will not retaliate against you for filing a complaint.

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

• Share information with your family, close friends, or others involved in payment for your care• Share information in a disaster relief situationIf you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

• Marketing purposes• Sale of your information

For certain health information, you can tell us your choices about what to share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

In these cases we never share your information unless you give us written permission:

Your Choices

• We can use your health information and share it with professionals who are treating you.

Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

How do we typically use or share your health information. We typically use or share your health information in the following ways.

Help manage the health care treatment you receive

Our Uses and Disclosures

30

Example: We use health information about you to develop better services for you.

Example: We share information about you with your dental plan to coordinate payment for your dental work.

Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

• We can use and disclose your information to run our organization and contact you when necessary. • We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.

• We can use and disclose your health information as we pay for your health services.

• We may disclose your health information to your health plan sponsor for plan administration.

Run our organization

Pay for your health services

Administer your Plan

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Our Responsibilities• We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this NoticeWe can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.

Effective date of this NoticeOctober 29, 2019

We can share health information about you for certain situations such as:• Preventing disease• Helping with product recalls• Reporting adverse reactions to medications• Reporting suspected abuse, neglect or domestic partner• Preventing or reducing a serious threat to anyone’s health or safety

• We can share health information about you with organ procurement organizations.• We can share health information with a coroner, medical examiner or funeral director when an individual dies.

• For workers’ compensation claims• For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law• For special government functions such as military, national security and presidential protective services

Help with public health and safety issues

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

Address workers’ compensation, law enforcement and other gov-ernment requests

• We can use or share your information for health research

• We will share information about you if State or Federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with Federal privacy law.

• We can share health information about you in response to a court or administrative order or in response to a subpoena.

Do research

Comply with the law

Respond to lawsuits and legal actions

Benefit & Carrier Email/WebpagePhone Number

Medical & Rx: Kaiser www.kp.org800-464-4000

Medical: Anthem HMO/PPO/EPO www.anthem.com/ca

EAP: Anthem www.anthem.com/ca

800-888-8288

800-999-7222

Rx: Anthem

FSA: TASC

www.anthem.com/ca

www.tasconline.com

Retirement 403(b) www.troweprice.com

800-700-2541

800-422-4661

800-354-2351

Dental: Anthem DPPO

United Pet Care

www.anthem.com/ca

www.unitedpetcare.com

877-567-1804

888-781-6622

Vision: Anthem

Legal Plans

www.anthem.com/ca

www.legalshield.com/

866-723-0515

626-392-1437

Life and Disability: Anthem

COBRA

www.anthem.com/ca

www.tasconline.com

800-552-2137

800-422-4661

Contact Information

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