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Putnam County School District

On Course for a Successful Future

2016 Decision Guide

Active Employees

TableofContentsHealthBenefits 3

WhatisaConsumerDrivenHealthPlan(CDHP) 5

HelpfulMedicalResources 6

DisabilityIncomeProtection 7

BasicLifeInsurance 9

WholeLifeInsurance 10

DentalBenefits 11

VisionBenefits 13

FlexibleSpending&DependentCare 14

CriticalIllness 15

HowtoEnroll 17

EmployeeNotices 19

Wearecommittedtoprovidingemployeeswithabenefits

programthatisbothcomprehensiveandcompetitive.Our

programoffersarangeofplanoptionstomeettheneeds

ofourdiverseworkforce.Weknowthatyourbenefitsare

importanttoyouandyourfamily.Helpingyouunderstand

thebenefitsweofferisimportanttous.

This Decision Guideprovides a general overview of your

benefit choices. It is designed to help you select the

coveragethatisrightforyou.Weencourageyoutoreview

eachsectionandtodiscussyourbenefitswithyourfamily

members.Pleasetaketimetoreadaboutandunderstand

thebenefit.Whenyouareready,youcanenrollon-lineor

bycallingtheEmployeeBenefitAssistanceline.

Thisguideisnotanemployee/employercontractandalso

isnot intendedtocoverallprovisionsofallplans;rather,

thisguideisaquickreferencetohelpanswermostofyour

questions.

For complete details about the benefits described in this

guide,pleasecontactusanytime.

Website:www.myputnambenefits.com

BenefitsChoiceCenter:(844)554-4126

2

UnitedHealthcare-POSMedicalPlan(AHKOwithRx161)

INNETWORK OUTOFNETWORK

DEDUCTIBLE

IndividualFamily

$750

$1,500

$1,500

$3,000

OUTOFPOCKETMAXIMUM

IndividualFamily

$4,000

$8,000

$6,0000

$12,000

DOCTOR’SVISITS

PreventativeServicesVirtualVisits

100%Covered

$25Copay

60%AfterDeductible

60%AfterDeductiblePrimaryCareOfficeVisit $30Copay 60%AfterDeductibleSpecialistOfficeVisit $60Copay 60%AfterDeductible

PhysicalandSpeechTherapyVisit $30Copay,20Visits 60%AfterDeductible,20Visits

ChiropracticVisits $30Copay,20Visits 60%AfterDeductible,20Visits

EMERGENCYCAREUrgentCareFacility $75Copay 60%AfterDeductible EmergencyRoomVisit $350Copay

AmbulanceServices 80%AfterDeductible

OUTPATIENTSERVICES

HomeHealthCare 80%AfterDeductible,60Visits 60%AfterDeductible,60Visits

HospiceCare 80%AfterDeductible 60%AfterDeductible

LabX-RayandMajorDiagnostics-Outpatient�IncludingCT,PET,MRI,MRAandNuclearMedicine

$200Copay $200Copay

MentalHealthServices–Outpatient $60CopayPerVisit 60%AfterDeductible

NeurobiologicalDisorders–AutismSpectrumDisorderServices $60CopayPerVisit 60%AfterDeductible

Surgery 80%AfterDeductible 60%AfterDeductible

INPATIENTSERVICES

Hospital–InpatientStay 80%AfterDeductible 60%AfterDeductible

MentalHealthServices–Inpatient 80%AfterDeductible 60%AfterDeductible

SkilledNursingFacility 80%AfterDeductible,60Days 60%AfterDeductible,60Days

PRESCRIPTIONDRUG

Deductible–DoesNOTApplytoTier1 $100Individual/$200Family

$100Individual/$200Family

Tier1 $15Copay Copay+CostDifference



MailOrder–Upto90DaySupply 2xCopay NotCovered

DEDUCTIONS

EmployeeOnly $211.49

Employee+Spouse $965.59

Employee+Child(ren) $899.44

Family $1,589.75

3

UnitedHealthcare-CDHPMedicalPlan(AHJCwithRx125)

In-Network Out-of-NetworkDEDUCTIBLE

IndividualFamily

$3,000$6,000

$5,000$10,000

OUTOFPOCKETMAXIMUM

IndividualFamily

$6,550$13,100

$10,000$20,000

DOCTOR’SVISITS

PreventativeServices

VirtualVisits100%Covered

90%AfterDeductible50%AfterDeductible50%AfterDeductible

PrimaryCareOfficeVisit 90%AfterDeductible 50%AfterDeductibleSpecialistOfficeVisit 90%AfterDeductible 50%AfterDeductible

PhysicalandSpeechTherapyVisit 90%AfterDeductible,20Visits 50%AfterDeductible,20VisitsChiropracticVisits 90%AfterDeductible,20Visits 50%AfterDeductible,20Visits

EMERGENCYCARE

UrgentCareFacility 90%AfterDeductible 50%AfterDeductible EmergencyRoomVisit 90%AfterDeductible

AmbulanceServices 90%AfterDeductible

OUTPATIENTSERVICES

HomeHealthCare 90%AfterDeductible,60Visits 50%AfterDeductible,60Visits

HospiceCare 90%AfterDeductible 50%AfterDeductible

LabX-RayandMajorDiagnostics-Outpatient�IncludingCT,PET,MRI,MRAandNuclearMedicine

90%AfterDeductible 50%AfterDeductible

MentalHealthServices–Outpatient 90%AfterDeductible 50%AfterDeductibleNeurobiologicalDisorders–AutismSpectrumDisorderServices 90%AfterDeductible 50%AfterDeductibleSurgery 90%AfterDeductible 50%AfterDeductible

INPATIENTSERVICES

Hospital–InpatientStay 90%AfterDeductible 50%AfterDeductible

MentalHealthServices–Inpatient 90%AfterDeductible 50%AfterDeductible

SkilledNursingFacility 90%AfterDeductible,60Visits 50%AfterDeductible,60Visits

PRESCRIPTIONDRUG

Deductible MedicalDeductible

MedicalDeductible

Tier1 $15Copay Copay+CostDifferenceTier2 $50Copay Copay+CostDifference

Tier3 $80Copay Copay+CostDifferenceMailOrder–Upto90DaySupply 2.5xCopay NotCovered

DEDUCTIONS

EmployeeOnly $73.82Employee+Spouse $670.98Employee+Child(ren) $618.60Family $1,152.90

4

ConsumerDrivenHealthPlan(CDHP)

WhatisaCDHP?ACDHPisatypeofhealthplanthatencouragescoveredindividualstobeinformedandthoughtfulconsumersofhealthcareservices,muchlikeanyotherconsumerwhowouldbeinformedandthoughtfulwhenpurchasingothergoodsandservices.TheCDHPplanstructuremotivatesparticipantstotakeamoreactiveroleinselectingtheirhealthcareproviders,managingtheirhealthexpensesandimprovingtheiroverallhealththroughgoodnutrition,exerciseandotherfactorstheycancontrol.

ACDHPisahealthplanthatallowsindividualstouseaHealthSavingsAccount(HSA)topayhealthcareexpensesdirectly,whileahigh-deductiblehealthcoverageplanprotectstheparticipantfromcatastrophicmedicalexpenses.

PreventiveandWellnessServicesAreCoveredWearecommitted to yourgoodhealth. That’swhy theCDHP—likeallhealthplans—coversmostpreventiveandwellnessservicesat100%.Youhavenoout-of-pocketcosts (noco-payment, co-insuranceordeductible) for eligiblepreventiveandwellnessservices,includingcheckupsandage-appropriatepreventivetesting(suchasroutinebloodtests,mammogramsorPSAtests).StepsYouCanTaketoManageYourHealthExpensesYouhavemorecontroloveryourhealthcareexpendituresthanyoumayrealize.Hereareafewstepsyoucantaketospendlessonhealthcare—withoutcompromisingthequalityofcareyoureceive:

• Fillprescriptionswithgenericmedicationsinsteadofname-brandmedications.Askyourdoctorifagenericisavailableandappropriate.

• Fillmaintenance(long-term)prescriptionsbymailorder,insteadofusingawalk-inpharmacy.• UtilizetheCare24,virtualofficevisits,doctor’sofficeorurgentcarecenter—insteadofahospitalemergencyroom—

whenyoufeelsick,orhavesymptomsoraninjurythatisnotlife-threateningorlimb-threatening.

WhatisanHSA?• Asavingsaccountownedandfundedbyyouwithpre-taxdollarstopayformedical,dental,andvisionexpensesnotcovered

byinsurance.

• HSA’sallowyoutorollovermoneyfromyeartoyear.

• HSAmoneyalwaysbelongstoyouandthereisnota“useitorloseit”rule.

• AllHSAmoneyremainsinyouraccountuntilyouspendit.Youraccountisportable.

• Youcanchangecontributionelectionamountsduringtheplanyear.

• Distributionsforqualifiedexpensesaretaxfree.

5

HelpfulMedicalResources

6

ThefollowingdocumentsareavailableforyouonyourbenefitswebsiteinordertoassistyouwithyourUnitedHealthcare

Coverage.

1. WelcomeNewMembers-ThisguideismeanttotakeyouthroughtheAtoZ’sofUnitedHealthCare,including

butnotlimitedto:a. UnderstandingyourIDcardb. Wheretogoforcarec. HowtofindaPCPd. Howclaimsarepaide. Programsavailabletoyou

2. MyUHC–Summaryofalloftheresourcesavailabletomembersatmyuhc.com

3. HealthCareCostEstimator–Instructionsonhowtoutilizethistoolwhichwillallowyoutobemorepreparedto

decidewhichchoiceisbestforyou,planyourcareandbudgetformedicalexpenses

4. Health4MeApp–HealthcaremanagementresourcesatyourfingertipsspecifictoyouasamemberofUHC

5. Care24Services–Informationonthe24hours,7daysaweek,365daysayearnurselinethatisavailabletoyouatnocost.

6. TransitionofCare–Thisisforanyonewithaneligibleconditiontobeabletoseeyourcurrentdoctorevenifout

ofnetworkwithUHCitreviewstheproceduresandincludesanapplication

7. PharmacyBenefitServices–Aguidetousingyourpharmacyservices

8. OptumRxSpecialtyPharmacyProgram–Animportantreadforanyoneonspecialtymedications

9. PrescriptionDrugList–UnitedHealthCare’sapproved2016PrescriptionDrugListsothatyoucandeterminewhereyourprescriptionsfall

MutualofOmaha-ShortTermDisabilityIncomeProtectionShort-TermDisabilityShort-termDisabilityisintendedtoprotectyourincomeforashortperiodoftimeincaseof injuryorillness.Youareableto

takeadvantageofthiscoveragenowwithoutansweringhealthquestions.Youwillnotbeofferedthisopportunityagainuntil

thenextannualOpenEnrollment.

EliminationPeriod(waitingperiod)…………………14days

MaximumWeeklyBenefit........................…….….60%ofweeklysalary,upto$1,500perweek

MaximumBenefitDuration…………………………….11weeks

MinimumWeeklyBenefit………………………………..$25.00

Basedonyourelection,yourbenefit isequivalentto40%,50%or60%ofyourbefore-taxweeklyearnings,nottoexceedtheplan’smaximumweeklybenefitamountstatedabove.

Pre-ExistingConditionExclusion:Thepre-existingconditionperiodis3/6.Thismeansthatanyresultingconditionfrominjury

orsicknessforwhichtheEmployeereceivedmedicaltreatment,servicesorincurredexpensesfor3monthspriortothedateof

hisorhercoveragethatresultsindisabilitywithinthefirst6monthsofcoveragewillnotbecovered.

DefinitionofWeeklyEarningsWeekly earnings is1/52

ndof thecompensation you receive fromyour employerunderyourannualcontract in effectat the

onsetofdisability,whichisusedtodetermineyourbenefitintheeventofaclaim.

DefinitionofDisabilityDisabilityanddisabledmeanthatbecauseofaninjuryorillness,asignificantchangeinyourmentalorfunctionalabilitieshas

occurred,forwhichyouarepreventedfromperformingatleastoneofthematerialdutiesofyourregularjobandareunableto

generatecurrentearningswhich exceed99%of yourweekly earnings fromyour regular job. You canbe totallyorpartially

disabledduringtheeliminationperiod.

PartialDisabilityIfyoubecomedisabledandcanworkpart-time(butnotfull-time),youmaybeeligibleforpartialdisabilitybenefits,whichwill

helpsupplementyourincomeuntilyouareabletoreturntoworkfull-time.

VocationalRehabilitationBenefitIfyoubecomedisabledandparticipate in thevocationalrehabilitationprogramwhichoffersservicesthathelpyoureturnto

workandability,youwillbeeligibleforaweeklybenefitincreaseof5%.

WaiverofPremiumThepremiumforyourshort-termdisabilitycoverageiswaivedwhileyouarereceivingbenefits.

PortabilityTheportability feature allows you to apply for disability insurance should your employment end,without having to provide

evidenceofinsurability(informationaboutyourhealth).Youwillberesponsibleforthepremiumforthecoverage.

OtherExclusions:Informationaboutotherexclusionsmaybefoundinthecertificatebooklet.

7

MutualofOmaha-LongTermDisabilityIncomeProtection

8

Long-TermDisabilityLong-term Disability insurance is intended to protect your income for a long period of time after you havedepletedshort-termdisability.

• EliminationPeriod(waitingperiod)……….90days• MaximumMonthlyBenefit……………………60%ofmonthlysalaryupto$6,500permonth• MaximumBenefitDuration……………………Priortoage62,benefitsarepayabletoage65orSocialSecurityNormal

RetirementAge.Atage62(andolder),thebenefitperiodwillbebasedonareduceddurationschedule.• MinimumMonthlyBenef………………………$100

DefinitionofMonthlyEarningsMonthlyearnings is1/12thofthecompensationyoureceivefromyouremployerunderyourannualcontract ineffectattheonsetofdisability,whichisusedtodetermineyourbenefitintheeventofaclaim.Pre-Existing Conditions Exclusion:Disabilities that occur during the first 12 months of coverage due to a pre-existingconditionduringthe3monthspriorocoverageareexcluded.DefinitionofDisabilityDisabilityanddisabledmeanthatbecauseofaninjuryorillness,asignificantchangeinyourmentalorfunctionalabilitieshasoccurred,forwhichyouarepreventedfromperformingatleastoneofthematerialdutiesofyourregularoccupationduringthefirst24monthsofdisabilityandafter24monthsareunabletoperformallofthematerialdutiesofanygainfuloccupation;andduringhefirst24monthsofdisabilityareunabletogeneratecurrentearningswhichexceed99%ofyourmonthlyearningsfromyourregularoccupation,andafter24months ifpartiallydisabled,areunabletogeneratecurrentearningswhichexceed85%ofyourmonthlyearningsfromanygainfuloccupation.Youcanbetotallyorpartiallydisabledduringthe90dayeliminationperiod.PartialDisabilityIfyoubecomedisabledandcanworkpart-time(butnotfull-time),youmaybeeligibleforpartialdisabilitybenefits,whichwillhelpsupplementyourincomeuntilyouareabletoreturntoworkfull-time.VocationalRehabilitationBenefitIfyoubecomedisabledandparticipateinthevocationalrehabilitationprogramwhichoffersservicesthathelpyoureturntoworkandability,youwillbeeligibleforaweeklybenefitincreaseof5%.SurvivorBenefitIf youpassawaywhile receiving long-termdisability benefits, yourbenefitswillbeprovided to yourbeneficiaries foraperiodoftimeafteryourdeath.WaiverofPremiumThepremiumforyourlong-termdisabilitycoverageiswaivedwhileyouarereceivingbenefits.Alcohol&DrugAbuseandMentalDisorders:Relateddisabilities;Benefitsareavailableforupto24months.OtherExclusions:InformationaboutotherexclusionsmaybefoundinthecertificatebookletavailablefromPCSD.

MetLife–BasicLifeandSupplementalLife/AD&D

9

Basic,Board-PaidLifeInsuranceYouremployerprovidesyouwithBasicTermLifeandAccidentalDeathandDismemberment(AD&D)insurancecoveragein

theamountof:

CoverageAmounts:ActiveEmployees: Anamountequalto1timesyourannualsalary,roundedtothenexthighest$1,000,

oftermlifeinsuranceatnocosttoyou,theemployee.

MaximumBasicLifeBenefit:$50,000(BasicLifeandOptionalSupplementalTermLifecombinedcannotexceed$50,000).

OptionalSupplementalTermLife/AD&DInsuranceAllemployeesworkingatleast20hoursperweekinactiveemploymentandtheireligiblespousesandchildren,14daysto19

yearsold(uptoage23ifchildisaFull-TimeStudent).

CoverageAmounts:Employee: 1-3timesyourbasicannualearnings,roundedtothenexthigher$1,000,toa

maximumof$200,000

Spouse(uptoage70): Option1=$5,000Option2=$10,000

DependentChild(ren): $5,000–uptoage23withStudentStatus

AD&DBenefitSchedule AdditionalBenefits

Thefullbenefitamountispaidforlossof:

•Life •AcceleratedBenefit

•Anycombinationofahand,afoot,sightofaneye •WaiverofPremium

•Quadriplegia •Conversion

•Speechandhearing •HRI,Inc.-GriefCounseling

•HyattLegalResourceBenefit

•SeatBelt/AirBagBenefit

UNUM–WholeLifeInsurance

10

GetLifetimeCoverageandCashBenefits

WholeLifeInsuranceprovidesmuchmorethanadeathbenefit–italsooffersvaluable“livingbenefits”thatyoucanuseduringtimesofneed.AndyoucankeepyourWholeLifecoverageafteryouretire,makingitanessentialcomplementtoTermLifeInsurance.

Whatfeaturesareavailable?

• Cashvalueatage65.Thispolicyaccumulatescashvalue.Youcanborrowfundsfromthisvalueasneeded• Livingbenefitoptionrider.Ifyouarediagnosedwithaterminalillness,youcanrequestupto100%ofyour

policy’sbenefitamountanduseitforanypurpose.

Howdoesitwork?

• Yourpremiumsarelevelforlife.Premiumswillbeconvenientlydeductedfromyourpaycheck.• Yourdeathbenefitislevel,too.Thebenefitdoesnotdecreasewithage.• Youownthepolicy.Youcankeepthepolicyifyouleaveorretire.You’llpaythesamepremium

ThreereasonstobuyWholeLifeatwork–now!

1. WholeLiferates.Theratesavailablethroughyouremployeraretypicallymoreaffordablethanthoseavailableelsewhere.

2. Age-basedpremiums.Premiumsarebasedonyouragewhenyoupurchase,anddoesn’tincreaseasyougetolder.Sotheearlieryoubuy,theloweryourpremiumwillbeforthelifeofyourpolicy

3. Guaranteedissue.Generallyavailableduringtheinitialenrollmentatyourworkplace.Whenit’sofferedtoyou,youcanpurchasecoverageuptoasetamount,withoutmedicalexamsorhealthquestions.Ifyoudon’tpurchasethemaximumamount,youhavetheoptiontoincreaseituptothatlevelduringfutureenrollmentswithnoquestionsasked!

Coverageisavailabletoyou,yourspouse,childrenandgrandchildren,evenifyouchoosenottoparticipate.Youownthepolicysoitisyourstokeepevenifyouchangejobsorretire.

EmployeeElectionAmountOptions: $15,000,$30,000,$40,000or$50,000

SpouseElectionAmountOptions: $10,000or$15,000

Child(ren)ElectionAmountOptions: $10,000or$15,000

• Guaranteedrenewabletoage120• Non-TobaccoandTobaccoRatesAvailable

FloridaBlue–Dental

11

BlueDentalChoice

CoveredServicesHighOption LowOption

InNetwork OutofNetwork InNetwork OutofNetwork

DeductibleIndividual:$50

FamilyMax:$150Basic&Majoronly

Individual:$50FamilyMax:$150Basic&Majoronly



AnnualMaximum $1,000 $750

OrthoMaximum $1,000LifetimeChild(ren)toage19 NONE

PreventiveServices 100%ofNegotiatedFees*

80%ofNegotiatedFees*



BasicServices 80%ofNegotiatedFees*




MajorServices 50%ofNegotiatedFees*




Orthodontics*** 50%ofNegotiatedFees*

50%ofNegotiatedFees** 0% 0%

Fillings Basic Basic

Endo/Periodontal Basic Basic

ChildEligibilityAges Uptoage26regardlessofstudentstatus Uptoage26regardlessofstudentstatus

SampleNegotiatedFees SampleNegotiatedFees

0120PeriodicOralEvaluation

$27 $27

1110Prophylaxis $59 $59

0272Bitewings(2Films) $26 $26

2140Amalgam(OneSurface) $74 $74

3310RootCanal

$445 $445

2792Crown(FullCast) $638 $638

*NegotiatedFees-Feesthatparticipatingdentistshaveagreedtoacceptaspaymentinfullforservices**R&C-Reasonable&Customary-isbasedonthelowestof(1)thedentist’sactualcharge,(2)thedentist’susualchargeforthesameorsimilar services,or (3)thechargeofmostdentists inthesamegeographicareaforthe sameorsimilarservicesasdeterminedbyFloridaCombinedLife.***Paymentsareissuedoverspecifiedtime,notpaidasalumpsum.WaitingPeriod-Animportantnote:IfyouenrollnewintheDentalplan,youwillhavea12-monthwaitingperiodonMajorandOrthodonticservicesforthePremiumplan,andMajorservicesonlyontheStandardplan.IfyouhavethecurrentdentalplanandmovetotheStandardplan,youwillnothavethis12monthwaitingperiod.

FloridaBlue–DentalFAQ’s

12

DoesthePreferredDentistProgramofferanydiscountsonnon-coveredservices?Negotiated feesmay extend to services not coveredunderyour plan, and for services received after your planmaximum has been met, where permitted by applicablestate law. Ifpermitted,youmayonlyberesponsibleforthenegotiatedfee.

MayIchooseanon-participatingdentist?Yes.Youarealwaysfreetoselectthedentistofyourchoice.However,ifyouchooseanon-participatingdentist,yourout-of-pocket costsmay be higher. He or she hasn’t agreed toacceptnegotiatedfees. Therefore,youmayberesponsibleforanydifferenceincostbetweenthedentist'sfeeandyourplan'sbenefitpayment.

HowdoIfindaparticipatingdentist?There are thousands of general dentists and specialists tochoose from nationwide, so you are sure to find one whomeets your needs. To see a list of these participatingdentists, you can go to MyPutnamBenefits.com under theDental tab. Don’t see a dentist in your network? Send anemail to: [email protected] or fax yournominationto:(904)866-4846.

Howareclaimsprocessed?Dentistsmaysubmitclaimsforyou,whichmeansyouhavelittleornopaperwork.Youcantrackyourclaimsonlineandevenreceivee-mailalertswhenaclaimhasbeenprocessed.Ifyouneedaclaimform,youcangoto:MyPutnamBenefits.comandlookundertheDentaltab.

Can I find out what my out-of-pocket expenses will bebeforereceivingaservice?Yes.Youcanaskforapre-treatmentestimate.Yourgeneraldentist or specialist usually sends the company a plan foryourcareandrequestsanestimateofbenefits.Theestimatehelps you prepare for the cost of dental services. Werecommendthatyourequestapre-treatmentestimateforservicesinexcessof$300.

Simply have your dentist submit a request online. You andyour dentist will receive a benefit estimate for mostprocedureswhileyouarestillintheoffice.Actualpaymentsmay vary depending upon plan maximums, deductibles,frequencylimits,andotherconditionsattimeofpayment.

How does BlueDental Choice coordinate benefits withotherinsuranceplans?The coordination of benefits provision in dental benefitplansarea setof rules followedwhenapatient is coveredby more than one dental benefits plan. These rulesdeterminetheorder inwhich theplanswillpaybenefits. Ifthe BlueDental Choice dental benefit plan is primary,BlueDentalChoicewillpay the fullamountofbenefits thatwouldnormallybeavailableundertheplan.

If the BlueDental Choice dental benefit plan is secondary,most coordination of benefits provisions requires them todetermine benefits after benefits have been determinedunder theprimaryplan.TheamountofbenefitspayablebyFloridaCombinedmaybe reduceddue to thebenefitspaidundertheprimaryplan.

EyeMed–VisionCare

13

CoveredServices

In-Network Out-of-NetworkReimbursement

FrequencyEyeExamLensesFramesContacts

Every12Months

Every12Months

Every24Months

Every12Months

EyeExam $10Copay Upto$40

Spectacle/LensesSingleBifocalTrifocalLenticularLensTreatmentOptionsStandardProgressiveStandardanti-reflectiveUVcoatingTint(solid)Standardscratch-resistanceStandardpolycarbonateAdditionalPairBenefit

$15Copay

$15Copay

$15Copay

$15Copay

Memberpays$80

Memberpays$45

Memberpays$15

Memberpays$15

Memberpays$15

Memberpays$40

$0forKidsunderage19

40%Discountoffcomplete

pair

Upto$30

Upto$50

Upto$70

Upto$70

Upto$50

N/A

N/A

N/A

N/A

Upto$32

Kidsunderage19

NotCovered

Frames NoCopay

$130AllowanceUpto$91allowance

ContactLensesElective*MedicallyNecessary*ContactfittingfeeisnotincludedinAllowanceAdditionalPairBenefit

$130allowance

CoveredInFull

Upto$55feeforFitand

Follow-up

15%Discountoff

conventionalcontactlenses

oncethefundedbenefit

hasbeenused

Upto$130

Upto$210

Lasik15%offRetailPriceor5%

offpromotionalprice

throughUSLaserNetwork

DiscountsDoNotApply

ConsolidatedAdministrativeServices(CAS)-FSA

14

Howmuchwillyoupayout-of-pocketforhealthcareexpensesthisyear?Whether it’shundredsorthousands,youcansavemoneybypayingtheseexpenseswithtax-freemoney.Theseaccountsofferreimbursementforeligiblemedical,dentalandvision expenses not reimbursed by insurance, including deductibles, copays, prescriptions, orthodontic care, glasses,contacts,andevenLasiksurgery.

HealthcareFlexibleSpendingAccount(FSA)andDependentCareFlexibleSpendingAccount

WhatisaHealthcareFlexibleSpendingAccount(FSA)?

• AHealthcareFSAisanemployeebenefitprogramthatallowsyoutosetasidemoneyonapre-taxbasisforcertainkindsofcommon“outofpocket”medicalexpensesforyouandyoureligibledependents

• FSA’sdollarsdonotrolloverfromyeartoyear.Anymoneythatisunusedattheendoftheplanyearwillbeforfeited• YoucanonlychangecontributionelectionamountsduringopenenrollmentorduetoaQualifyingEvent• Distributionsforqualifiedexpensesaretax-freeWhatisaDependentCareFSA?

TheDependentCareFSA isdesignedforspecificsituations.YoucanelectaDependentCareFSAif youandyourspouse(ifmarried)areworkingorinschool,and:• Yourdependentchildrenunderage13attenddaycare,after-schoolcareorsummerdaycamp;or• Youprovidecareforapersonofanyagewhomyouclaimasadependentonyourfederalincometaxreturn,andwhois

mentallyorphysicallyincapableofcaringforhimselforherself.

HealthcareMaximumContribution: $2,550

DependentCareMaximumContribution: $5,000($2,500/eachifyouaremarriedandbothyouandyourspousecontributetoseparately)

DebitCards: ReceiveaplanDebitCardforparticipantand1additionalfamilymember

LostorStolenCardReplacementFee: $10.00percardchargedtoparticipant

AdditionalCardFee: $5.00percardchargedtoparticipant

RushedCardMailing(Overnight): $35.00percard

PlanYear: January1thruDecember31PlanYears

PlanRunOutPeriod: TheRunOutPeriodishowlongyouhavetofileaclaimformedicalcostsincurredduringtheplanyearandduringtheGracePeriodfollowingtheplanyear.TheRunOutPeriodlast90daysaftertheendoftheplanyear.

PlanGracePeriod: TheGracePeriodistheamountoftimeyouhavetoincurexpensesonce

yourplanyearends.Duringthe2-1/2monthGracePeriodclaimswithdatesofservicefromlastyearwillbereimbursedfromlastyear’sunusedbalanceamounts.Claimswithdatesofservicefromthenewplanyearwillbereimbursedfromthenewplanyear’selectedamount.TheGracePerioddoesnotextendthe90dayRunOutPeriod.

MetLife–CriticalIllnessInsurance

15

Insurancedesignedtohelpemployeesoffsetthefinancialeffectsofacatastrophicillnesswithalumpsumbenefitifaninsuredisdiagnosedwithacoveredcriticalillness.

CoverageAmountsEmployee GuaranteedIssueamountupto$20,000

Canelect$10,000or$20,000

Spouse/DomesticPartner GuaranteedIssueamountupto100%ofemployeeGuaranteeIssueCanelect$10,000or$20,000(100%ofemployeeamount).EmployeemustbeenrolledincoveragefortheirSpouse/DomesticPartnertobeenrolled.

Child GuaranteedIssueamountupto100%ofemployeeGuaranteeIssue

Canelect$10,000or$20,000(100%ofemployeeamount).EmployeemustbeenrolledincoveragefortheirdependentChild(ren)tobeenrolled.

CriticalIllnessesCoveredat100%FullBenefitCancer,HeartAttack,Stroke,CoronaryArteryBypassGraft,KidneyFailure,Alzheimer’sdisease,andMajorOrganTransplant.FirstOccurrenceBenefit Theinitialbenefitworksasfollows:

1) ForPartialBenefitCancer;25%oftheBenefitAmountwillbepaid2) ForListedCondition;25%oftheBenefitAmountwillbepaid.3) Forallothercoveredconditions;100%oftheBenefitAmountwillbepaid.

MetLifewillpaybenefitsuntiltheTotalBenefitAmountforeachcoveredpersonisreached.

Re-OccurrenceBenefit IfinsuredisdiagnosedwithanotheroccurrenceofcertaincoveredconditionsandMetLifehasalreadypaidtheInitialBenefitforthatcoveredcondition,aRecurrenceBenefitequalto100%oftheSelectedBenefitAmountwillbepaid.ARecurrenceBenefitpaymentissubjecttoa180-daybenefitsuspensionperiod.MetLifewillnotpayaRecurrenceBenefitforacoveredconditionthatrecursduringthisperiod.MetLifewillpaytheinitialbenefitamountandarecurrencebenefituntiltheTotalBenefitAmountof300%foreachcoveredpersonisreached.

Whentheemployeecoverageterminates,thespouse/domesticpartneranddependentchildrencoverageswillalsoterminate.

HealthScreeningBenefit Afteronemonthofcoverage,eachinsuredhasaHealthScreeningBenefitannually

of$50forthe10,000policyor$100forthe20,000policyCriticalIllnessesCoveredat25%CoronaryArteryBypass,SkinCancer,PermanentParalysis(ifduetostroke),CarcinomainSitu

MetLife–CriticalIllnessInsurance

16

Insurancedesignedtohelpemployeesoffsetthefinancialeffectsofacatastrophicillnesswithalumpsumbenefitifaninsuredisdiagnosedwithacoveredcriticalillness.

WhydoesCriticalIllnessInsurancemakessense?Criticalillnessinsurancecanhelpwithunexpectedexpensesthatmaynotbecoveredbyyourmedicalinsurance.Yourmedicalinsurancehelpscoveryourmedicalbillsifyougetsick.CriticalillnessInsurancecoversspecificconditionssuchascancer,heartattackorstroke.Plus,itprovidesalump-sumpaymentifyouarediagnosedwithacoveredconditionsoyoucanfocusonyourrecoveryinsteadofyourfinances.CriticalIllnessesCoveredat100%oftheInitialBenefitsAmount:FullBenefitCancer,HeartAttack,Stroke,CoronaryArteryBypassGraft,KidneyFailure,Alzheimer’sdisease;andMajorOrganTransplant

CriticalIllnessesCoveredat25%oftheInitialBenefitsAmountfor22conditions:Addison’sdisease(adrenalhypofunction);amyotrophiclateralsclerosis(LouGehrig’sdisease);cerebrospinalmeningitis(bacterial);cerebralpalsy;cysticfibrosis;diphtheria;encephalitis;Huntington’sdisease(Huntington’schorea);Legionnaire’sdisease;malaria;multiplesclerosis(definitivediagnosis);musculardystrophy;myastheniagravis;necrotizingfasciitis;osteomyelitis;poliomyelitis;rabies;sicklecellanemia(excludingsicklecelltrait);systemiclupuserythematosus(SLE);systemicsclerosis(scleroderma);tetanus;andTuberculosis.

TheHealthScreeningBenefitcoveredtestsare:

• Bloodtesttodeterminetotalcholesterol;bloodtesttodeterminetriglycerides;breastNRI;breastsonogram;breastultrasound;carotidDoppler;colonoscopy;digitalrectalexam(DRE);electrocardiogram(EKG);endoscopy;fastingbloodglucosetest;fastingplasmaglucosetest;flexiblesigmoidoscopy;hemocultstoolspecimen;mammogram;papsmearsorthinpreppaptest;testonbicycleortreadmill;twohourpost-loadplasmaglucosetest;orvirtualcolonoscopy.

• MTresidentswillhaveaseparatemammogrambenefit.• Wewillonlypayonehealthscreeningbenefitpercoveredpersonpercalendaryear.

HowToEnroll

17

VisitMyPutnamBenefits.comandClickontheblue“MyPersonalBenefits”portalbutton.

StepONE:

Toaccesstheenrollmentsystemausernameandpasswordwillbeneeded.Username=Uptofirst6lettersoflastname,firstletteroffirstnameandlast4numbersofSocialSecurityNumber(Example–JohnSmith111-22-3333;UserNameissmithj3333)Password=SocialSecurityNumberwithoutdashes(Example–111-22-3333;Passwordis111223333)

StepTWO:

Afterinitialaccess,3securityquestionsmustbeansweredandanewpasswordcreated.

StepTHREE:

HowToEnroll

18

FollowpromptstotheWelcomepageandthentoupdatePersonalInformationandDependents/Beneficiaries.Tocoveraspouseorchild(ren),enterthemasdependents.Next,continuethrougheachbenefit,checkingtheboxtoselectorwaivecoverage.Theboxchangestoorangewhencheckedandsaved.

StepFOUR:

Aftercompletion,theConsolidatedEnrollmentFormwillshowyourcurrentenrollmentelectionsineffectnowfor2015,andyourfuturebenefitselectionseffectiveJanuary1,2016.AtthebottomofthepageyoucanPrintorEmailyourselfacopyoftheenrollmentform.MakesuretoclickFinishtocompleteyourenrollment.

StepFIVE:

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19

PutnamCountySchoolDistrict,200ReidStreet,Palatka,FL32177

IMPORTANTINFORMATION

November30,2015

Employee&EligibleBeneficiaries,

AsanemployeeofPutnamCountySchoolDistrictandparticipantinouremployeebenefitprograms,youandyourbeneficiariesmayhavevariousrightsandprivilegesrelatedtotheseprograms.Lawsgoverninghealthcarerequireustoprovideyouwiththesenotifications.Listedbelowareimportantnoticestoretainforyourrecords.Inthepast,manyofthesenoticesweresentindividuallyandarenowgroupedtogethertomoreclearlycommunicateyourrights,andtosimplifydistribution.IfyouhaveanyquestionspleasecontactTammyCollins,BenefitsSpecialist,PutnamCountySchoolDistrict:(386)329-0661

NOTIFICATIONS

HIPAA

TheHealthInsurancePortabilityandAccountabilityActof1996(HIPAA)requiresthatwenotifyyouaboutimportantprovisionsintheplan.Youhavetherighttoenrollintheplanunderits"specialenrollmentprovision"ifyoumarry,acquireanewdependent,orifyoudeclinecoverageundertheplanforaneligibledependentwhileothercoverageisineffectandlaterthedependentlosesthatothercoverageforcertainqualifyingreasons.Specialenrollmentmusttakeplacewithin30daysofthequalifyingevent.Ifyouaredeclinedenrollmentforyourselforyourdependents(includingyourspouse)whilecoverageunderMedicaidorastateChildren'sHealthInsuranceProgram(CHIP)isineffect,youmaybeabletoenrollyourselfandyourdependentsinthisprogramifyouoryourdependentsloseeligibilityforthatothercoverage.However,youmustrequestenrollmentwithin60daysafteryouoryourdependents'MedicaidorCHIPcoverageends.Ifyouoryourdependents(includingyourspouse)becomeeligibleforastatepremiumassistancesubsidyfromMedicaidoraCHIPprogramwithrespecttocoverageunderthisplan,youmaybeabletoenrollyourselfandyourdependents(includingyourspouse)inthisplan.However,youmustrequestenrollmentwithin60daysafteryouoryourdependentsbecomeeligibleforthepremiumassistance.Torequestspecialenrollmentorobtainmoreinformation,contacttheplanadministratorindicatedinthisnotice.

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HIPAANoticeofPrivacyPractices

TheHealthInsurancePortabilityandAccountabilityActof1996("HIPAA")requiresthatwemaintaintheprivacyofprotected

healthinformation,givenoticeofourlegaldutiesandprivacypracticesregardinghealthinformationaboutyouandfollow

thetermsofournoticecurrentlyineffect.

YoumayrequestacopyofthecurrentPrivacyPracticesfromthePlanAdministratorexplaininghowmedicalinformation

aboutyoumaybeusedanddisclosed,andhowyoucangetaccesstothisinformation.

AsRequiredbyLaw.WewilldiscloseHealthInformationwhenrequiredtodosobyinternational,federal,stateorlocallaw.

Youhavetherighttoinspectandcopy,righttoanelectroniccopyofelectronicmedicalrecords,righttogetnoticeofa

breach,righttoamend,righttoanaccountingofdisclosures,righttorequestrestrictions,righttorequestconfidential

communications,righttoapapercopyofthisnoticeandtherighttofileacomplaintifyoubelieveyourprivacyrightshave

beenviolated.

CHIPRANOTICE-PremiumAssistanceUnderMedicaidandtheChildren’sHealthInsuranceProgramReauthorizationAct(CHIPRA)

IfyouoryourchildrenareeligibleforMedicaidorCHIPandyouareeligibleforhealthcoveragefromyouremployer,your

Statemayhaveapremiumassistanceprogramthatcanhelppayforcoverage,usingfundsfromtheirMedicaidorCHIP

programs.Ifyouoryourchildrenaren’teligibleforMedicaidorCHIP,youwillnotbeeligibleforthesepremiumassistance

programsbutyoumaybeabletobuyindividualinsurancecoveragethroughtheHealthInsuranceMarketplace.Formore

information,visitwww.healthcare.gov.

IfyouoryourdependentsarealreadyenrolledinMedicaidorCHIPandyouliveinanyofthestate’slisthere,contactyour

stateMedicaidorCHIPofficetofindoutifpremiumassistanceisavailable.Ifyouliveinoneofthefollowingstates,youmay

beeligibleforassistancepayingyouremployerhealthplanpremiums.

ALABAMA–MedicaidWebsite:http://www.medicaid.alabama.govPhone:1-855-692-5447,ALASKA–MedicaidWebsite:

http://health.hss.state.ak.us/dpa/programs/medicaid/Phone(OutsideofAnchorage):1-888-318-8890Phone(Anchorage):

907-269-6529,

ARIZONA–CHIPWebsite:http://www.azahcccs.gov/applicantsPhone(OutsideofMaricopaCounty):1-877-764-5437Phone

(MaricopaCounty):602-417-5437,

COLORADO–MedicaidWebsite:http://www.colorado.gov/MedicaidPhone(Instate):1-800-866-3513MedicaidPhone

(Outofstate):1-800-221-3943,

FLORIDA–MedicaidWebsite:https://www.flmedicaidtplrecovery.com/Phone:1-877-357-3268,

GEORGIA–MedicaidWebsite:http://dch.georgia.gov/-ClickonPrograms,thenMedicaid,thenHealthInsurancePremium

Payment(HIPP)Phone:1-800-869-1150,

IDAHO–MedicaidWebsite:

http://healthandwelfare.idaho.gov/Medical/Medicaid/PremiumAssistance/tabid/1510/Default.aspxMedicaidPhone:1-800-

926-2588,

EmployeeNotices

21

INDIANA–MedicaidWebsite:http://www.in.gov/fssaPhone:1-800-889-9949,IOWA–MedicaidWebsite:www.dhs.state.ia.us/hipp/Phone:1-888-346-9562,KANSAS–MedicaidWebsite:http://www.kdheks.gov/hcf/Phone:1-800-792-4884,KENTUCKY–MedicaidWebsite:http://chfs.ky.gov/dms/default.htmPhone:1-800-635-2570,LOUISIANA–MedicaidWebsite:http://www.lahipp.dhh.louisiana.govPhone:1-888-695-2447,MAINE–MedicaidWebsite:http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone:1-800-977-6740TTY1-800-977-6741,MASSACHUSETTS–MedicaidandCHIPWebsite:http://www.mass.gov/MassHealthPhone:1-800-462-1120,MINNESOTA–MedicaidWebsite:http://www.dhs.state.mn.us/ClickonHealthCare,thenMedicalAssistancePhone:1-800-657-3629,MISSOURI–MedicaidWebsite:http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone:573-751-2005,MONTANA–MedicaidWebsite:http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtmlPhone:1-800-694-3084,NEBRASKA–MedicaidWebsite:www.ACCESSNebraska.ne.govPhone:1-855-632-7633,NEVADA–MedicaidWebsite:http://dwss.nv.gov/MedicaidPhone:1-800-992-0900,NEWHAMPSHIRE–MedicaidWebsite:http://www.dhhs.nh.gov/oii/documents/hippapp.pdfPhone:603-271-5218,NEWJERSEY–MedicaidandCHIPMedicaidWebsite:http://www.state.nj.us/humanservices/dmahs/clients/medicaid/MedicaidPhone:609-631-2392CHIPWebsite:http://www.njfamilycare.org/index.htmlCHIPPhone:1-800-701-0710,NEWYORK–MedicaidWebsite:http://www.nyhealth.gov/health_care/medicaid/Phone:1-800-541-2831,NORTHCAROLINA–MedicaidWebsite:http://www.ncdhhs.gov/dmaPhone:919-855-4100,NORTHDAKOTA–MedicaidWebsite:http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone:1-800-755-2604,OKLAHOMA–MedicaidandCHIPWebsite:http://www.insureoklahoma.orgPhone:1-888-365-3742,OREGON–MedicaidWebsite:http://www.oregonhealthykids.govhttp://www.hijossaludablesoregon.govPhone:1-800-699-9075,PENNSYLVANIA–MedicaidWebsite:http://www.dpw.state.pa.us/hippPhone:1-800-692-7462,RHODEISLAND–MedicaidWebsite:www.ohhs.ri.govPhone:401-462-5300,SOUTHCAROLINA–MedicaidWebsite:http://www.scdhhs.govPhone:1-888-549-0820,SOUTHDAKOTA–MedicaidWebsite:http://dss.sd.govPhone:1-888-828-0059,TEXAS–MedicaidWebsite:https://www.gethipptexas.com/Phone:1-800-440-0493,UTAH–MedicaidandCHIPWebsite:http://health.utah.gov/uppPhone:1-866-435-7414,VERMONT–MedicaidWebsite:http://www.greenmountaincare.org/Phone:1-800-250-8427,VIRGINIA–MedicaidandCHIPMedicaidWebsite:http://www.coverva.org/programs_premium_assistance.cfmMedicaidPhone:1-800-432-5924CHIPWebsite:http://www.coverva.org/programs_premium_assistance.cfmCHIPPhone:1-855-242-8282,WASHINGTON–MedicaidWebsite:http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspxPhone:1-800-562-3022ext.15473,WESTVIRGINIA–MedicaidWebsite:www.dhhr.wv.gov/bms/Phone:1-877-598-5820,HMSThirdPartyLiability,WISCONSIN–MedicaidWebsite:http://www.badgercareplus.org/pubs/p-10095.htmPhone:1-800-362-3002,WYOMINGWebsite:http://health.wyo.gov/healthcarefin/equalitycarePhone:307-777-7531.ThelistofStatesofferingapremiumassistanceprogramiscurrentasofJuly31,2014.StatesofferingCHIPassistancemaychangewithoutnotice.

EmployeeNotices

22

Formoreinformationonspecialenrollmentrights,ortoverifyifanyotherStatenowofferspremiumassistance,contacteither:U.S.DepartmentofLaborEmployeeBenefitSecurityAdministrationwww.dol.gov/ebsa1-866-444-EBSA(3272),U.S.DepartmentofHealthandHumanServicesCentersforMedicare&MedicaidServiceswww.cms.hhs.gov1-877-267-2323,MenuOption4,Ext.61565

IfyouoryourdependentsareNOTcurrentlyenrolledinMedicaidorCHIP,andyouthinkyouoranyofyourdependentsmightbeeligibleforeitheroftheseprograms,youcancontactyourStateMedicaidorCHIPofficeordial1-877-KIDSNOWorwww.insurekidsnow.govtofindouthowtoapply.Ifyouqualify,askyourStateifithasaprogramthatmighthelpyoupaythepremiumsforanemployer-sponsoredplan.

OnceitisdeterminedthatyouoryourdependentsareeligibleforpremiumassistanceunderMedicaidorCHIP,aswellaseligibleunderyouremployerplan,youremployermustpermityoutoenrollinyouremployerplanifyouarenotalreadyenrolled.Thisiscalleda“specialenrollment”opportunity,andyoumustrequestcoveragewithin60daysofbeingdeterminedeligibleforpremiumassistance.Ifyouhavequestionsaboutenrollinginyouremployerplan,youcancontacttheDepartmentofLaborelectronicallyatwww.askebsa.dol.govorbycallingtoll-free1-866-444-EBSA(3272).

WHCRA

TheWomen'sHealthandCancerRightsAct(WHCRA)of1998,providesbenefitsformastectomy-relatedservicesincludingreconstructionandsurgerytoachievesymmetrybetweenthebreasts,prostheses,andcomplicationsresultingfromamastectomy(includinglymphedema).Callyourhealthinsuranceissuerformoreinformation.

ThisnoticeinformsyouoftheFederalregulationthatrequiresallhealthplansthatcovermastectomiestoalsocoverreconstructionoftheremovedbreast.Ifyouhavehadoraregoingtohaveamastectomy,youmaybeentitledtocertainbenefits.Forindividualsreceivingmastectomy-relatedbenefits,coveragewillbeprovidedinamannerdeterminedinconsultationwiththeattendingphysicianandthepatient,for:

• Allstagesofreconstructionofthebreastonwhichthemastectomywasperformed;• Surgeryandreconstructionoftheotherbreasttoproduceasymmetricalappearance;• Prostheses;and• Treatmentofphysicalcomplicationsofthemastectomy,includinglymphedemas.

NMHPA

Newborns'andMothers'HealthProtectionActrequiresthatgrouphealthplansandhealthinsuranceissuerswhoofferchildbirthcoveragegenerallymaynot,underfederallaw,restrictbenefitsforanyhospitallengthofstayinconnectionwithchildbirthforthemotherornewbornchildtolessthan48hoursfollowingavaginaldelivery,orlessthan96hoursfollowingacesareansection.However,federallawgenerallydoesnotprohibitthemother'sornewborn'sattendingprovider,afterconsultingwiththemother,fromdischargingthemotherorhernewbornearlierthan48hours(or96hoursasapplicable).Inanycase,plansandissuersmaynot,underfederallaw,requirethataproviderobtainauthorizationfromtheplanortheissuerforprescribingalengthofstaynotinexcessof48hours(or96hours).Refertoyourplandocumentforspecificinformationaboutchildbirthcoverageorcontactyourplanadministrator.

EmployeeNotices

23

ForadditionalinformationaboutNMHPAprovisionsandhowSelf-fundednonFederalgovernmentalplansmayopt-outoftheNMHPArequirements,visithttp://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/nmhpa_factsheet.html.

USERRA

TheUniformedServicesEmploymentandReemploymentRightsAct(USERRA),protectsthejobrightsofindividualswhovoluntarilyorinvoluntarilyleaveemploymentpositionstoundertakemilitaryserviceorcertaintypesofserviceintheNationalDisasterMedicalSystem.USERRAalsoprohibitsemployersfromdiscriminatingagainstpastandpresentmembersoftheuniformedservices,andapplicantstotheuniformedservices.

ReemploymentRights

Youhavetherighttobereemployedinyourcivilianjobifyouleavethatjobtoperformserviceintheuniformedserviceand:• Youensurethatyouremployerreceivesadvancewrittenorverbalnoticeofyourservice;• Youhavefiveyearsorlessofcumulativeserviceintheuniformedserviceswhilewiththatparticularemployer;• Youreturntoworkorapplyforreemploymentinatimelymannerafterconclusionofservice;and• Youhavenotbeenseparatedfromservicewithadisqualifyingdischargeorunderotherthanhonorableconditions.

Ifyouareeligibletobereemployed,youmustberestoredtothejobandbenefitsyouwouldhaveattainedifyouhadnotbeenabsentduetomilitaryserviceor,insomecases,acomparablejob.

RightToBeFreeFromDiscriminationandRetaliation

Ifyouareapastorpresentmemberoftheuniformedservice;haveappliedformembershipintheuniformedservice;orareobligatedtoserveintheuniformedservice;thenanemployermaynotdenyyou:initialemployment;reemployment;retentioninemployment;promotion;oranybenefitofemploymentbecauseofthisstatus.Inaddition,anemployermaynotretaliateagainstanyoneassistingintheenforcementofUSERRArights,includingtestifyingormakingastatementinconnectionwithaproceedingunderUSERRA,evenifthatpersonhasnoserviceconnection.

HealthInsuranceProtection

Ifyouleaveyourjobtoperformmilitaryservice,youhavetherighttoelecttocontinueyourexistingemployer-basedhealthplancoverageforyouandyourdependentsforupto24monthswhileinthemilitary.Evenifyoudon'telecttocontinuecoverageduringyourmilitaryservice,youhavetherighttobereinstatedinyouremployer'shealthplanwhenyouarereemployed,generallywithoutanywaitingperiodsorexclusions(e.g.,pre-existingconditionexclusions)exceptforservice-connectedillnessesorinjuries.

Enforcement

TheU.S.DepartmentofLabor,VeteransEmploymentandTrainingService(VETS)isauthorizedtoinvestigateandresolvecomplaintsofUSERRAviolations.Forassistanceinfilingacomplaint,orforanyotherinformationonUSERRA,contactVETSat1-866-4-USA-DOLorvisititswebsiteathttp://www.dol.gov/vets.AninteractiveonlineUSERRAAdvisorcanbeviewedathttp://www.dol.gov/elaws/userra.htm.IfyoufileacomplaintwithVETSandVETSisunabletoresolveit,youmayrequestthatyourcasebereferredtotheDepartmentofJusticeortheOfficeofSpecialCounsel,asapplicable,forrepresentation.YoumayalsobypasstheVETSprocessandbringacivilactionagainstanemployerforviolationsofUSERRA.

EmployeeNotices

24

GINA

TheGeneticInformationNondiscriminationActof2008(GINA)prohibitsemployersandotherentitiescoveredbyGINATitle

IIfromrequestingorrequiringgeneticinformationofanindividualorfamilymemberoftheindividual,exceptasspecifically

allowedbythislaw.Tocomplywiththislaw,weareaskingthatyounotprovideanygeneticinformationwhenresponding

toanyrequestsformedicalinformation,ifapplicable.‘Geneticinformation,’asdefinedbyGINA,includesanindividual’s

familymedicalhistory,theresultsofanindividual’sorfamilymember’sgenetictests,thefactthatanindividualoran

individual’sfamilymembersoughtorreceivedgeneticservices,andgeneticinformationofafetuscarriedbyanindividualor

anindividual’sfamilymemberoranembryolawfullyheldbyanindividualorfamilymemberreceivingassistivereproductive

services.

QMCSO(QualifiedMedicalChildSupportOrder)

QMCSOisamedicalchildsupportorderissuedunderstatelawthatcreatesorrecognizestheexistenceofan“alternate

recipient’s”righttoreceivebenefitsforwhichaparticipantorbeneficiaryiseligibleunderagrouphealthplan.An“alternate

recipient”isanychildofaparticipant(includingachildadoptedbyorplacedforadoptionwithaparticipantinagroup

healthplan)whoisrecognizedunderamedicalchildsupportorderashavingarighttoenrollmentunderagrouphealthplan

withrespecttosuchparticipantisanalternaterecipient.Uponreceipt,theadministratorofagrouphealthplanisrequired

todetermine,withinareasonableperiodoftime,whetheramedicalchildsupportorderisqualified,andtoadminister

benefitsinaccordancewiththeapplicabletermsofeachorderthatisqualified.Intheeventyouareservedwithanoticeto

providemedicalcoverageforadependentchildastheresultofalegaldetermination,youmayobtaininformationfromyour

employer;knowtherulesforseekingtoenactsuchcoverage.Theserulesareprovidedatnocosttoyouandmaybe

requestedfromyouremployeratanytime.

RESCISSIONS

TheAffordableCareActprohibitstherescissionofhealthplancoverageexceptforfraudorintentionalmisrepresentationof

amaterialfact.Arescissionofaperson’shealthplancoveragemeansthatwewouldtreatthatpersonasneverhavinghad

thecoverage.Theprohibitiononrescissionsappliestogrouphealthplans,includinggrandfatheredplans,effectiveforplan

yearsbeginningonorafterSeptember23,2010.

Regulationsprovidethatarescissionincludesanyretroactiveterminationsorretroactivecancellationsofcoverageexceptto

theextentthattheterminationorcancellationisduetothefailuretotimelypaypremiums.Rescissionsareprohibited

exceptinthecaseoffraudorintentionalmisrepresentationofamaterialfact.Forexample,ifanemployeeisenrolledinthe

planandmakestherequiredcontributions,thentheemployee’scoveragemaynotberescindedifitislaterdiscoveredthat

theemployeewasmistakenlyenrolledandwasnoteligibletoparticipate.Ifamistakewasmade,andtherewasnofraudor

intentionalmisrepresentationofamaterialfact,thentheemployee’scoveragemaybecancelledprospectivelybutnot

retroactively.

EmployeeNotices

25

Shouldamember’scoverageberescinded,thenthemembermustbeprovided30daysadvancewrittennoticeofthe

rescission.Thenoticemustalsoincludethemember’sappealrightsasrequiredbylawandasprovidedinthemember’splan

benefitdocuments.Pleasebeawarethatifyourescindamember’scoverage,youmustprovidethepropernoticetothe

member.

TheIFRsonrescissioncanbefoundatthefollowingInternetlink:http://edocket.access.gpo.gov/2010/2010-15278.htm;

withaclarifyingFAQonrescissionsathttp://www.dol.gov/ebsa/faqs/faq-aca2.html.

PREVENTIVECARE

Healthplanswillprovidein-network,first-dollarcoverage,withoutcost-sharing,forpreventativeservicesandimmunizations

asdeterminedunderhealthcarereformregulations.Theseinclude,butarenotlimitedto,cancerscreenings,well-baby

visitsandinfluenzavaccines.Foracompletelistofcoveredservices,pleasevisit:

www.healthcare.gov/law/about/provisions/services/lists.html.

WOMEN'SPREVENTIVEHEALTHSERVICES

Allofthefollowingwomen’shealthserviceswillbeconsideredpreventive(somewerealreadycovered).Theseservices

generallywillbecoveredatnocostshare,whenprovidedin-network:

• Well-womanvisits(annually)

• Prenatalvisits(routinepreventivevisits)

• Screeningforgestationaldiabetes

• Humanpapillomavirus(HPV)DNAtesting

• Counselingforsexuallytransmittedinfections

• Counselingandscreeningforhumanimmunodeficiencyvirus(HIV)

• Screeningandcounselingforinterpersonalanddomesticviolence

• Breastfeedingsupport,suppliesandcounseling

• Genericformularycontraceptives,certainbrandformularycontraceptives,andFDA-approved,over-the-counter

femalecontraceptiveswithprescriptionarecoveredwithoutmembercostshare(forexample,nocopayment).

Certainreligiousorganizationsorreligiousemployersmaybeexemptfromofferingcontraceptiveservices.

MHPA/MHPAEA

MentalHealthParityandAddictionEquityAct(MHPA/MHPAEA)requirethatgrouphealthplansnotunfairlyrestrict

treatmentwithregardstobenefits/servicesapplicabletomentalhealthorsubstanceusedisorders.Additionalinformation

anddetailscanbefoundbyvisitingtheDepartmentofLabor'sMentalHealthParitywebpagelocateat

http://www.dol.gov/ebsa/newsroom/fsmhpaea.html.

EmployeeNotices

26

FMLA

FamilyMedicalLeaveAct(FMLA)entitleseligibleemployeesofcoveredemployerstotakeunpaid,job-protectedleaveforspecificfamilyandmedicalreasonsiftheemployeehasbeenwiththecompanyforoneyear,hasworkedatleast1250hoursduringtheprior12monthsandworksinanareawherethereareatleast50employeeswithin75miles.Publicagenciesaswellaspublicandprivatesecondaryschoolsarecoveredemployerswithoutregardtothenumberofemployeesemployed.Foradditionaldetails,visittheDepartmentofLaborFMLApage.Notifytheorganizationwhenyouhaveaqualifyingleavesuchasbirthoradoptionofachild,aserioushealthcondition,tocareforaspouse,childorparentwithaseriousmedicalconditionorforreservistorNationalGuardprovisionsrelatedtoyouoranimmediatefamilymemberleavingformilitarydutyorbeinginjuredinactiveduty.

COBRANOTICE

ThisnoticehasimportantinformationaboutyourrighttoCOBRAcontinuationcoverage,whichisatemporaryextensionofcoverageunderthecompanyplan.ThisnoticeexplainsCOBRAcontinuationcoverage,whenitmaybecomeavailabletoyouandyourfamily,andwhatyouneedtodotoprotectyourrighttogetit.WhenyoubecomeeligibleforCOBRA,youmayalsobecomeeligibleforothercoverageoptionsthatmaycostlessthanCOBRAcontinuationcoverage.

TherighttoCOBRAcontinuationcoveragewascreatedbyaFederallaw,theConsolidatedOmnibusBudgetReconciliationActof1985(COBRA).COBRAcontinuationcoveragecanbecomeavailabletoyouwhenyouwouldotherwiseloseyourgrouphealthcoverage.ItcanalsobecomeavailabletoothermembersofyourfamilywhoarecoveredunderthePlanwhentheywouldotherwiselosetheirgrouphealthcoverage.FormoreinformationaboutyourrightsandobligationsunderthePlanandunderfederallaw,youshouldreviewthePlan’sSummaryPlanDescriptionorcontactthePlanAdministrator.

Youmayhaveotheroptionsavailabletoyouwhenyoulosegrouphealthcoverage.Forexample,youmaybeeligibletobuyanindividualplanthroughtheHealthInsuranceMarketplace.ByenrollingincoveragethroughtheMarketplace,youmayqualifyforlowercostsonyourmonthlypremiumsandlowerout-of-pocketcosts.Additionally,youmayqualifyfora30-dayspecialenrollmentperiodforanothergrouphealthplanforwhichyouareeligible(suchasaspouse’splan),evenifthatplangenerallydoesn’tacceptlateenrollees.

WhatisCOBRAcontinuationCoverage?

COBRAcontinuationcoverageisacontinuationofplancoveragewhencoveragewouldotherwiseendbecauseofalifeeventknownasa"qualifyingevent."You,yourspouse,andyourdependentchildrencouldbecomequalifiedbeneficiariesifcoverageundertheplanislostbecauseofthequalifyingevent.Undertheplan,qualifiedbeneficiarieswhoelectCOBRAcontinuationcoveragemustpayforCOBRAcontinuationcoverage.EmployeesandtheirqualifieddependentsareresponsiblefornotifyingtheCompanyofanychangeinaddressorstatus(e.g.,divorce,insuranceeligibility,childbecomingineligibleduetoage,etc.)within30daysoftheevent.

Ifapplicable,yourparticipationintheHealthFlexibleSpendingAccountcanalsocontinueonanafter-taxbasisthroughtheremainderofthePlanYearinwhichyouqualifyforCOBRA.Theopportunitytoelectthesamecoveragethatyouhadatthetimethequalifyingeventoccurredextendstoallqualifiedbeneficiaries.

EmployeeNotices

27

IfyoumakecontributionstotheHealthFlexibleSpendingAccountfortheyearinwhichyourqualifyingeventoccurs,youmaycontinuetomakethesecontributionsonanafter-taxbasis.Thisway,youcanbereimbursedforcertainmedicalexpensesyouincurafteryourqualifyingevent,butbeforetheendofthePlanYear.

YoumaybeofferedtocontinueyourcoverageundertheHealthFlexibleSpendingAccountifyouhavenotoverspentyouraccount.Thedeterminationofwhetheryouraccountforaplanyearisoverspentorunderspentasofthedateofthequalifyingeventdependsonthreevariables:(1)theelectedannuallimitforthequalifiedbeneficiaryforthePlanYear(e.g.,$2,550ofcoverage);(2)thetotalreimbursableclaimssubmittedtotheCafeteriaPlanforthatplanyearbeforethedateofthequalifyingevent;and(3)themaximumamountthattheCafeteriaPlanispermittedtorequiretobepaidforCOBRAcoveragefortheremainderoftheplanyear.Theelectedannuallimitlesstheclaimssubmittedisreferredtoasthe“remainingannuallimit.”IftheremainingannuallimitislessthanthemaximumCOBRApremiumthatcanbechargedfortherestoftheyear,thentheaccountisoverspent.Youmaynotre-enrollintheHealthFlexibleSpendingAccountduringanyannualenrollmentforanyPlanYearthatfollowsyourqualifyingevent.

Supportingdocumentationlikeadivorcedecree,deathcertificate,proofofotherinsurancemayberequiredasproofofaqualifyingevent.

ThisgeneralnoticedoesnotfullydescribeCOBRAortheplan.Morecompleteinformationisavailablefromtheplanadministratorandinthesummaryplandocument.

Ifyouareanemployee,youwillbecomeaqualifiedbeneficiaryifyouloseyourcoverageunderthePlanbecauseeitheroneofthefollowingqualifyingeventshappens:

• Yourhoursofemploymentarereduced,or• Youremploymentendsforanyreasonotherthanyourgrossmisconduct.

Ifyouarethespouseofanemployee,youwillbecomeaqualifiedbeneficiaryifyouloseyourcoverageunderthePlanbecauseanyofthefollowingqualifyingeventshappens:

• Yourspousedies;• Yourspouse'shoursofemploymentarereduced;• Yourspouse'semploymentendsforanyreasonotherthanhisorhergrossmisconduct;• YourspousebecomesentitledtoMedicarebenefits(underPartA,PartB,orboth);or• Youbecomedivorcedorlegallyseparatedfromyourspouse.

YourdependentchildrenwillbecomequalifiedbeneficiariesiftheylosecoverageunderthePlanbecauseanyofthefollowingqualifyingeventshappens:

• Theparent-employeedies;• Theparent-employee'shoursofemploymentarereduced;• Theparent-employee'semploymentendsforanyreasonotherthanhisorhergrossmisconduct;• Theparent-employeebecomesentitledtoMedicarebenefits(PartA,PartB,orboth);• Theparentsbecomedivorcedorlegallyseparated;or• Thechildstopsbeingeligibleforcoverageundertheplanasadependentchild.

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28

WhenisCOBRACoverageAvailable?

ThePlanwillofferCOBRAcontinuationcoveragetoqualifiedbeneficiariesonlyafterthePlanAdministratorhasbeen

notifiedthataqualifyingeventhasoccurred.Whenthequalifyingeventistheendofemploymentorreductionofhoursof

employment,deathoftheemployee,ortheemployeebecomingentitledtoMedicarebenefits(underPartA,PartB,or

both),theemployeemustnotifythePlanAdministratorofthequalifyingevent.

HowisCOBRACoverageProvided?

OncethePlanAdministratorreceivesnoticethataqualifyingeventhasoccurred,COBRAcontinuationcoveragewillbe

offeredtoeachofthequalifiedbeneficiaries.EachqualifiedbeneficiarywillhaveanindependentrighttoelectCOBRA

continuationcoverage.CoveredemployeesmayelectCOBRAcontinuationcoverageonbehalfoftheirspouses,andparents

mayelectCOBRAcontinuationcoverageonbehalfoftheirchildren.

COBRAcontinuationcoverageisatemporarycontinuationofcoverage.Whenthequalifyingeventisthedeathofthe

employee,theemployee'sbecomingentitledtoMedicarebenefits(underPartA,PartB,orboth),yourdivorceorlegal

separation,oradependentchild'slosingeligibilityasadependentchild,COBRAcontinuationcoveragelastsforuptoatotal

of36months.Whenthequalifyingeventistheendofemploymentorreductionoftheemployee'shoursofemployment,

andtheemployeebecameentitledtoMedicarebenefitslessthan18monthsbeforethequalifyingevent,COBRA

continuationcoverageforqualifiedbeneficiariesotherthantheemployeelastsuntil36monthsafterthedateofMedicare

entitlement.Forexample,ifacoveredemployeebecomesentitledtoMedicare8monthsbeforethedateonwhichhis

employmentterminates,COBRAcontinuationcoverageforhisspouseandchildrencanlastupto36monthsafterthedate

ofMedicareentitlement,whichisequalto28monthsafterthedateofthequalifyingevent(36monthsminus8months).

Otherwise,whenthequalifyingeventistheendofemploymentorreductionoftheemployee'shoursofemployment,

COBRAcontinuationcoveragegenerallylastsforonlyuptoatotalof18months.Therearetwowaysinwhichthis18-month

periodofCOBRAcontinuationcoveragecanbeextended.

Disabilityextensionof18-monthperiodofcontinuationcoverage

IfyouoranyoneinyourfamilycoveredunderthePlanisdeterminedbytheSocialSecurityAdministrationtobedisabled

andyounotifythePlanAdministratorinatimelyfashion,youandyourentirefamilymaybeentitledtoreceiveuptoan

additional11monthsofCOBRAcontinuationcoverage,foratotalmaximumof29months.Thedisabilitywouldhavetohave

startedatsometimebeforethe60thdayofCOBRAcontinuationcoverageandmustlastatleastuntiltheendofthe18-

monthperiodofcontinuationcoverage.DocumentationfromtheSocialSecurityadministrationcertifyingadisabilitywillbe

required.

Secondqualifyingeventextensionof18-monthperiodofcontinuationcoverage

Ifyourfamilyexperiencesanotherqualifyingeventwhilereceiving18monthsofCOBRAcontinuationcoverage,thespouse

anddependentchildreninyourfamilycangetupto18additionalmonthsofCOBRAcontinuationcoverage,foramaximum

of36months,ifnoticeofthesecondqualifyingeventisproperlygiventothePlan.Thisextensionmaybeavailabletothe

spouseandanydependentchildrenreceivingcontinuationcoverageiftheemployeeorformeremployeedies,becomes

entitledtoMedicarebenefits(underPartA,PartB,orboth),orgetsdivorcedorlegallyseparated,orifthedependentchild

stopsbeingeligibleunderthePlanasadependentchild,butonlyiftheeventwouldhavecausedthespouseordependent

childtolosecoverageunderthePlanhadthefirstqualifyingeventnotoccurred.

EmployeeNotices

29

ArethereothercoverageoptionsbesidesCOBRAContinuationCoverage?

Yes.InsteadofenrollinginCOBRAcontinuationcoverage,theremaybeothercoverageoptionsforyouandyourfamilythroughtheHealthInsuranceMarketplace,Medicaid,orothergrouphealthplancoverageoptions(suchasaspouse’splan)throughwhatiscalleda“specialenrollmentperiod.”SomeoftheseoptionsmaycostlessthanCOBRAcontinuationcoverage.Youcanlearnmoreaboutmanyoftheseoptionsatwww.healthcare.gov.

Ifyouhavequestions

QuestionsconcerningyourPlanoryourCOBRAcontinuationcoveragerightsshouldbeaddressedtotheplanadministratorindicatedaboveorinthesummaryplandescription.FormoreinformationaboutyourrightsundertheEmployeeRetirementIncomeSecurityAct(ERISA),includingCOBRA,thePatientProtectionandAffordableCareAct,andotherlawsaffectinggrouphealthplans,contactthenearestRegionalorDistrictOfficeoftheU.S.DepartmentofLabor’sEmployeeBenefitsSecurityAdministration(EBSA)inyourareaorvisitwww.dol.gov/ebsa.(AddressesandphonenumbersofRegionalandDistrictEBSAOfficesareavailablethroughEBSA’swebsite.)FormoreinformationabouttheMarketplace,visitwww.HealthCare.gov.

KeepyourPlaninformedofaddresschanges

Toprotectyourfamily’srights,letthePlanAdministratorknowaboutanychangesintheaddressesoffamilymembers.Youshouldalsokeepacopy,foryourrecords,ofanynoticesyousendtothePlanAdministrator.

MEDICAREPARTDNOTICE

MedicalPlan:UnitedHealthcare

AboutYourPrescriptionDrugCoverageandMedicare

ThisnoticehasinformationaboutyourcurrentprescriptiondrugcoverageandaboutyouroptionsunderMedicare'sprescriptiondrugcoverage.ThisinformationcanhelpyoudecidewhetherornotyouwanttojoinaMedicaredrugplan.Ifyouareconsideringjoining,youshouldcompareyourcurrentcoverage,includingwhichdrugsarecoveredatwhatcost,withthecoverageandcostsoftheplansofferingMedicareprescriptiondrugcoverageinyourarea.Informationaboutwhereyoucangethelptomakedecisionsaboutyourprescriptiondrugcoverageisattheendofthisnotice.

TherearetwoimportantthingsyouneedtoknowaboutyourcurrentcoverageandMedicare'sprescriptiondrugcoverage:

1.Medicareprescriptiondrugcoveragebecameavailablein2006toeveryonewithMedicare.YoucangetthiscoverageifyoujoinaMedicarePrescriptionDrugPlanorjoinaMedicareAdvantagePlan(likeanHMOorPPO)thatoffersprescriptiondrugcoverage.AllMedicaredrugplansprovideatleastastandardlevelofcoveragesetbyMedicare.Someplansmayalsooffermorecoverageforahighermonthlypremium.

2.WehavedeterminedtheprescriptiondrugcoverageofferedbyUnitedHealthcareis,onaverageforallplanparticipants,expectedtopayoutasmuchasstandardMedicareprescriptiondrugcoveragepaysandisthereforeconsideredCreditableCoverage.BecauseyourexistingcoverageisCreditableCoverage,youcankeepthiscoverageandnotpayahigherpremium(apenalty)ifyoulaterdecidetojoinaMedicaredrugplan.

EmployeeNotices

30

WhenCanYouJoinAMedicareDrugPlan?

YoucanjoinaMedicaredrugplanwhenyoufirstbecomeeligibleforMedicareandeachyearfromOctober15thtoDecember7th.Planparticipantsareeligibleiftheyarewithinthreemonthsofturningage65,arealready65yearsoldoriftheyaredisabled.

However,ifyouloseyourcurrentcreditableprescriptiondrugcoveragethroughnofaultofyourown,youwillalsobeeligibleforatwo(2)monthSpecialEnrollmentPeriod(SEP)tojoinaMedicaredrugplan.

WhatHappenstoyourCurrentCoverageifYouDecidetoJoinaMedicareDrugPlan?

IfyoudecidetojoinaMedicaredrugplan,yourcurrentcoveragewillnotbeaffected,andbenefitswillbecoordinatedwithMedicare.Refertoyourplandocumentsprovideduponeligibilityandopenenrollmentorcontactyourproviderortheplanadministratorforanexplanationand/orcopyoftheprescriptiondrugcoverageplanprovisions/optionsundertheplanavailabletoMedicareeligibleindividualswhenyoubecomeeligibleforMedicarePartDIndividuals.Visithttp://www.cms.hhs.gov/CreditableCoverage/whichoutlinestheprescriptiondrugplanprovisions/optionsMedicareeligibleindividualsmayhaveavailabletothemwhentheybecomeeligibleforMedicarePartD.

IfyoudodecidetojoinaMedicaredrugplanandcurrentcoverageisdropped,beawareyouandyourdependentswillbeabletogetthiscoverageback.Refertoplandocumentsorcontactyourproviderortheplanadministratorbeforemakinganydecisions.

Note:Ingeneral,differentguidelinesexistforretireesregardingcancelationofcoverageandtheabilitytogetthatcoverageback.Retireeswhoterminateorlosecoveragewillnotbeabletogetbackontheplanunlessspecificcontractlanguageorotheragreementexists.Contacttheplanadministratorfordetails.

WhenWillYouPayaHigherPremium(Penalty)toJoinaMedicareDrugPlan?

Youshouldalsoknowifyoudroporloseyourcurrentcoverageanddon'tjoinaMedicaredrugplanwithin63continuousdaysafteryourcurrentcoverageends,youmaypayahigherpremium(apenalty)tojoinaMedicaredrugplanlater.

Ifyougo63continuousdaysorlongerwithoutcreditableprescriptiondrugcoverage,yourmonthlypremiummaygoupbyatleast1%oftheMedicarebasebeneficiarypremiumpermonthforeverymonththatyoudidnothavethatcoverage.Forexample,ifyougo19monthswithoutcreditablecoverage,yourpremiummayconsistentlybeatleast19%higherthantheMedicarebasebeneficiarypremium.Youmayhavetopaythishigherpremium(apenalty)aslongasyouhaveMedicareprescriptiondrugcoverage.Inaddition,youmayhavetowaituntilthefollowingOctobertojoin.

Formoreinformationaboutthisnoticeoryourcurrentprescriptiondrugcoverage...

Contactthepersonlistedinthisnotificationsreport.Youwillgetthisnoticeeachyear.YouwillalsogetitbeforethenextMedicarepartDdrugplanenrollmentperiodandifthiscoveragechanges.Youalsomayrequestacopyofthisnoticeatanytime.

EmployeeNotices

31

FormoreinformationaboutyouroptionsunderMedicareprescriptiondrugcoverage...

MoredetailedinformationaboutMedicareplansthatofferprescriptiondrugcoverageisinthe"Medicare&You"handbook.You'llgetacopyofthehandbookinthemaileveryyearfromMedicare.YoumayalsobecontacteddirectlybyMedicaredrugplans.

FormoreinformationaboutMedicareprescriptiondrugcoverage:Visitwww.Medicare.gov

CallyourStateHealthInsuranceAssistanceProgram(seetheinsidebackcoverofyourcopyofthe"Medicare&You"handbookfortheirtelephonenumber)forpersonalizedhelp.

Call800-MEDICARE(800-633-4227).TTYusersshouldcall(877)486-2048.

Ifyouhavelimitedincomeandresources,extrahelppayingforMedicareprescriptiondrugcoverageisavailable.Forinformationaboutthisextrahelp,visitSocialSecurityonthewebatwww.socialsecurity.govorcall(800)772-1213(TTY1-800-325-0778).

RemembertokeepthisCreditableCoveragenotice.IfyoudecidetojoinoneoftheMedicaredrugplans,youmayberequiredtoprovideacopyofthisnoticewhenyoujointoshowwhetherornotyouhavemaintainedcreditablecoverageand,therefore,whetherornotyouarerequiredtopayahigherpremium(apenalty).

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On Course for a Successful Future

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