DENSO Health & Welfare Plan

Transcription

1 DENSO Health & Welfare Plan Attachment F: Healthy Horizons & Chronic Condition Management Program Booklet Although this booklet references DENSO International America, Inc., the benefits and related effective dates, provisions, conditions, limitations and exclusions are identical for the following DENSO Group Companies: American Industrial Manufacturing Services, Inc. (AIMS) DENSO Manufacturing Arkansas, Inc. (DMAR) DENSO Manufacturing Athens Tennessee, Inc. (DMAT) DENSO Manufacturing Michigan, Inc. (DMMI) DENSO Manufacturing Tennessee, Inc. (DMTN) DENSO Sales California, Inc. (DSCA) DENSO Wireless Systems America, Inc. (DWAM) Effective: January 1, 2013

2 DENSO Health and Welfare Plan HEALTHY HORIZONS AND CHRONIC CONDITION MANAGEMENT PROGRAM Table of Contents Page INTRODUCTION... 1 ELIGIBILITY... 1 DEFINITIONS... 2 COVERED BENEFITS... 3 ERISA RIGHTS... 5 COBRA INFORMATION... 5 ADMINISTRATIVE INFORMATION... 6

3 INTRODUCTION This Program Booklet describes the Healthy Horizons benefits and the Chronic Condition Management Program benefits under the DENSO Health and Welfare Plan ( Plan ), as in effect on January 1, The Healthy Horizons benefits and the Chronic Condition Management Program benefits are designed to provide benefits irrespective of, and in addition to, those provided through the self-insured medical benefits provisions of the Plan. This Program Booklet is an attachment to, and is a part of, the main Plan and Summary Plan Description document. Together, this Program Booklet and the main Plan and Summary Plan Description document contain important information on your rights and obligations. This Program is designed to provide Associates and their Eligible Spouses with access to certain education and services. Some of the words in this booklet are Capitalized. This means they have a special definition - see the "Definitions" section. Where the definition provided in this document conflicts with that in the main Plan and Summary Plan Description document, the definition in this document will apply. The Healthy Horizons benefits and the Chronic Condition Management Program benefits under the Plan are paid by the Plan Sponsor rather than an insurance company. Formal claims and appeals will be processed by Viverae, the program s Claims Administrator. The Plan Sponsor reserves the right to change or end all or any portion of the benefits under the Plan at any time with respect to any individual, including Associates, former Associates, and Spouses, in its sole discretion. If the Healthy Horizons benefits and/or Chronic Condition Management benefits under the Plan end, no such benefits will be provided after the date of termination. Your local Human Resources representative and the Plan Administrator are available to answer your questions about your benefits, can assist you in filing formal claims and appeals for benefits not approved by the Claims Administrator, and collecting the benefits to which you are entitled. ELIGIBILITY The Healthy Horizons benefit is available only to eligible individuals. Eligible individuals include only Associates, eligible Spouses, and eligible Domestic Partners. Associates, Spouses, and Domestic Partners are eligible to participate effective as of the Associate s date of hire. 1

4 Additionally, the Chronic Condition Management benefits are available to any Eligible individual and also to any Dependent of an Associate, regardless of whether the individual is enrolled in health benefits under the Plan. DEFINITIONS Associate an individual classified by their Employer as an employee or former employee participating under a COBRA election. Dependent -- an individual who is: your Spouse your or your Spouse's child who is under age 26, including a natural child, stepchild, a legally adopted child, a child placed for adoption or a child for whom you or your Spouse are the legal guardian; or an unmarried child of any age who is or becomes disabled prior to age 26 who is wholly dependent upon you for financial support and is incapable of selfsustaining employment, and who was eligible to be covered under the Plan immediately prior to turning age 26. Domestic Partner -- an individual of the same or opposite sex with whom you have established a domestic partnership as described below. A Domestic Partnership is a relationship between an Associate who is a resident of the State of California and one other person of the same or opposite sex. Both persons must: not be so closely related that marriage would otherwise be prohibited in the State of California; not be legally married to, or the Domestic Partner of, another person under either statutory or common law; be at least 18 years old; live together and share the common necessities of life; be mentally competent to enter into a contract; be financially interdependent; and file a valid Declaration of Domestic Partnership with the California Secretary of State, and a copy of the filing must be provided. For opposite gender couples, one partner must be at least age 62 and at least one partner must be eligible for Social Security Benefits. Please see the Human Resources Department for details regarding enrolling a Domestic Partner. 2

5 Program Benefits the covered education and health-related benefits you are entitled to under the Program. These may change from time to time, and from year to year. Program Year the period from from December 1 st through November 30 th of the following year. Spouse an individual to whom you are legally married, who is of the opposite sex. COVERED BENEFITS Healthy Horizons Benefits. The Plan s benefits include a voluntary wellness program known as Healthy Horizons. The Plan Sponsor has discretion to decide whether to offer a Healthy Horizons benefit in any given year, to determine the period of time during which the Healthy Horizons benefits will be available, and to determine the benefits and incentives, if any, available under the Healthy Horizons portion of the Program. You will be notified of these terms and conditions in advance. The Healthy Horizons benefits generally may include the following features: Eligible individuals earn points through participating in Healthy Horizons activities. Healthy Horizons activities include things such as completing a biometric screening (which may be performed on-site), answering questions on the Member Health Assessment (MHA), participating in scheduled health challenges, taking on-line courses/webinars, completing preventive screenings, or working with a health coach on the phone or by . Points accumulate throughout the Program Year. If an Associate s points reach a pre-specified goal by the end of the Program Year, cash amounts are distributed to the Associate on a per pay-period basis during the following calendar year if the Associate continues to be classified as an active Associate of a Participating Employer. If the Associate s Spouse also reaches the prespecified goal, this cash amount payable to the Associate may be increased. Reaching pre-determined goals throughout the year and/or participating in certain activities may generate individual cash awards, gift cards or entry in drawings for prizes or cash. Chronic Condition Management Benefits. The Plan s benefits include voluntary Chronic Condition Management Benefits. The Plan Sponsor has discretion to decide whether to offer a Chronic Condition Management benefit in any given year, to determine the period of time during which the Chronic Condition Management benefit will be available, and to determine the particular benefits, if any, available under the 3

6 Chronic Condition Management portion of the Program. You will be notified of these terms and conditions in advance. A chronic condition is generally one that is treatable but not curable, such as asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, or diabetes (types I and II), among others. The Chronic Condition Management benefits generally may include the following features: Individuals identified as candidates for the Chronic Condition Management program through data-analytic tools such as Health Risk Assessments, supplemental questionnaires, biometric screening results, or medical or prescription drug claims information are provided with access to clinicians, nurses, dietitians and other medical professionals who coach employees to help them self-manage chronic conditions. Identified individuals are provided with o support for treatment adherence; o support daily self-management of their condition; o support for health behavior choices; o advice on how to reduce disease-related complications; o education on disease condition to enhance self management; o assistance in identifying barriers that impact their ability to improve health outcomes; and o tools to help track outcomes, and identify opportunities to improve their health management. Taxation. The Program s benefits are provided to eligible individuals at no cost. Any Program cash award provided on a per pay-period is taxable income to the Associate. Any other cash awards and prizes will also be taxable. The taxable amount of any cash awards and prizes that are earned from the result of a drawing will be grossed up meaning the value will be increased to generally account for a portion of the resulting tax liability. No gross-up will be provided for amounts that are generally provided to all Participants for participation in the Healthy Horizons benefits. Associates Married to Associates. You cannot receive benefits under the Healthy Horizons portion of the Program as both an Associate and a Spouse. If you enroll in a medical plan as an Associate, you will be treated as an Associate under this program. If you are covered as a Spouse under another Associate s medical plan, you will be treated as a Spouse under the Healthy Horizons portion of the Program. General Information. The Program is voluntary. When you elect to use any of the Program s benefits, you do so voluntarily, and are free at all times to select a different service provider outside of the Program, in your own discretion and at your own cost. However, services provided by an outside service provider may not qualify as documentation of progress toward your goals under the Health Horizons portion of the 4

7 Program. Program benefits are not to be construed as a promise of continued future employment. Limitations and Exclusions. This Program is not designed to provide medical treatment or psychological counseling. ERISA RIGHTS As a participant in the Program, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended ( ERISA ). These rights are described in the ERISA Rights section of the main Plan and Summary Plan Description document. The portions of the Program that do not involve the provision of medical benefits (for example, educational events) are generally not subject to ERISA. COBRA INFORMATION As a participant in the Program, you are entitled to certain rights and protections under the Consolidated Omnibus Budget Reconciliation Act of 1985 ( COBRA ). These rights are described in the COBRA Continuation Coverage section of the main Plan and Summary Plan Description document. The portions of the Healthy Horizons benefits and the Chronic Condition Management benefitsunder the Program that do not involve the provision of medical benefits (for example, educational events, cash rewards, etc.) are generally not subject to COBRA. 5

8 ADMINISTRATIVE INFORMATION Plan Name DENSO Health and Welfare Plan Plan Number 526 Plan Sponsor DENSO International America, Inc Denso Drive Southfield, Michigan (248) Plan Sponsor s Employer Identification Number Agent for Service of Legal Process Sr. Manager of Benefits DENSO International America, Inc Denso Drive Southfield, MI (248) Type of Plan Plan Year The Healthy Horizons and Chronic Condition Management Program is an employee welfare benefit plan making available the following types of benefits: health education and screenings. January 1 through December 31. Type of Administration The Healthy Horizons and Chronic Condition Management Program portion of the Plan is administered by DENSO International America, Inc. ( DIAM ), by the North America Benefits Health & Welfare Committee ( NAB-H&W ), and by 6

9 Viverae. The roles of these entities are also identified in the preceding pages of the Program Booklet and in the Plan and Summary Plan Description. North America Benefits Health & Welfare Denso Drive Southfield, MI (248) Viverae N. Central Expressway, Suite 700 Dallas, TX (888) Requires registration Contributions and Funding Program Benefits are provided by Viverae, pursuant to contracts that are paid for by the Plan Sponsor. Participating Employers The Plan provides benefits to the Associates of the following affiliates of DIAM, which is a Participating Employer: American Industrial Manufacturing Services, Inc.* Corning Place Murrieta, CA DENSO Manufacturing Arkansas, Inc. 100 Denso Road Osceola, AR DENSO Manufacturing Athens Tennessee, Inc Denso Drive Athens, TN DENSO Manufacturing Michigan, Inc. One Denso Road Battle Creek, MI

10 DENSO Manufacturing Tennessee, Inc Robert C. Jackson Drive Maryville, TN DENSO Sales California, Inc.* 3900 Via Oro Avenue Long Beach, CA DENSO Wireless America, Inc Business Park Drive Vista, CA * American Industrial Manufacturing Services, Inc. and DENSO Sales California, Inc. are expected to merge and to be re-named DENSO Products and Services Americas, Inc., on or about April 1, As a result of this change, DENSO Products and Services Americas, Inc., will become a Participating Employer. An updated list of the names, addresses, and phone numbers of the employers participating in the Plan may be obtained, or is available for examination, by Participants and beneficiaries upon written request to the Plan Administrator. NOTE: This document only describes the benefits available to the Associates described in the Eligibility section on pages 1 and 2 of this document. 8