Frequently Asked Questions (FAQ) For Full-Time Employees Working 30 or More Hours Weekly

Transcription

1 Frequently Asked Questions (FAQ) For Full-Time Employees Working 30 or More Hours Weekly Disclaimer: This information is intended for general reference and is not a substitute for your responsibility to read and understand the Summary Plan Description. Any conflict between this information and the terms of the plan document will be resolved in favor of the plan document. Nurses Etc. Staffing (NES) has partnered with FCE Benefits, Inc. to administer your Service Contract Act (SCA) employee benefits. FCE is a national provider in the delivery of health and welfare programs for government contractors. 1. When are my benefits effective? Benefits are effective the first of the month following one full month of continuous employment on a fringe paid contract. 2. Is it mandatory that all employees enroll in the plan? Yes. NES pays the required fringe rate for all SCA covered employees through participation in the benefit plan administered by FCE to meet the insurance underwriter s requirements that benefits be provided for all eligible employees. 3. If I already have Medical coverage through another plan, can I waive or decline the coverage on this plan? Yes, provided you have comparable, current and effective coverage through another employer-sponsored group plan or through the military s TRICARE program. Participation in Medicare, Medicaid, VA or any individually obtained insurance plan are not considered qualifying coverage as a basis to waive or decline coverage. 4. If I have Qualifying Medical Coverage, how do I waive or decline benefits? You must complete and sign the waiver form included in your enrollment kit and provide a front and back copy of your medical ID card evidencing current and effective coverage under an employer-sponsored group health plan. It is important to note that you may only decline the Medical Benefits portion of the plan. Those Health & Welfare Fringe dollars in excess of the cost of Core Benefits (such as, Life, AD& D, Dental, Vision) and not used to pay Medical Coverage will be contributed into NES s qualified retirement plan. Please refer to the Plan Waiver Form and Waiver Schedule of Benefits for more details. 5. TRICARE does not issue health ID cards. How can I get evidence current and effective coverage under that program? You can generate an Eligibility Letter that shows proof of health care coverage if you are currently in the TRICARE system.

2 Visit and sign in. Then choose the "Health Care" menu item, and click "Proof of Insurance." Follow the directions to generate and print the letter. You will need a Common Access Card (CAC), DoD Self- Service Logon or Defense Finance Accounting System (DFAS) Pin to access this website. 6. I am concerned that enrollment into this plan will jeopardize eligibility under the Medicare, Medicaid, or VA programs? Enrollment in this plan will not affect your eligibility for any of these programs. This plan may be considered Primary to those programs. Be sure to disclose your enrollment into this plan to your health care provider and they will bill according to the program rules. 7. I noticed there are four classes of benefits listed. Which one will I be in? As a full-time NES employee, you will be placed in Class IV based on the 13 week rolling average of your weekly paid hours, including paid federal holidays and paid vacation up to 40 hours a week and 2,080 hours annually. 8. My hours vary from week to week and from month to month. Wouldn t my class level change all the time? No, not necessarily. Your paid hours are reported to our Third Party Administrator, FCE Benefits, and they calculate your weekly average hours on a rolling 13-week average. Over time, this proves to be a very effective way of stabilizing your class of benefits. It is important to know that most companies in our industry do not provide medical benefits to part-time employees. 9. I am a full-time employee, which means I work at least 30 hours per week. What happens if I drop below 30 hours per week? In order to remain eligible for Class IV Major Medical benefits for the remainder of 2013, you must work a minimum of 30 rolling fringe-paid hours per week on average. The Plan calculates the 30 rolling average of fringe paid hours on the basis of a 13-week look back period. This period consists of reported hours and will, therefore, inevitably lag behind real time. In the event your weekly average over the whole look-back period falls below 30 hours, you will become automatically enrolled in the scheduled portion of the Plan set forth for part-time employees. In the event you become ineligible for Class IV Major Medical benefits, you will have the option to buy back your Major Medical benefits by electing COBRA continuation coverage. An election notice explaining COBRA rights and procedures would arrive in the mail. Starting January 1, 2014, if you become classified as a Class IV employee during the PPACA-mandated Measurement Period, you will retain Class IV status during the entire Employer-determined Stability Period, regardless of any drop in actual measured hours.

3 Please refer to the NES SCA Schedule of Benefits to review levels of coverage for each employee class. 10. How will I be notified if I move to a different benefits package because my average hours worked has been reduced? If your hours worked place you in a different employee class, FCE will send out a COBRA notification that will advise you of the options you have available. You can either pay the COBRA premium to maintain your level of benefits or you can choose to stay in the lower level benefit class. 11. What is the cost for me to enroll into this plan? Nothing, if you are in the plan. NES pays for your coverage utilizing the hourly Health & Welfare Fringe Rate required by the contract. 12. What is the cost to enroll my Eligible Dependents in the plan? There is no cost. If you select the Waived Medical Plan, NES pays for the Core Benefits (such as Life, Dental, and Vision) for your eligible dependents utilizing the hourly Health & Welfare Fringe Rate required by the contract on which you are working. However, by electing Family Coverage you will get slightly less benefits than those employees enrolling as a single or EE Only. 13. What is the cost to enroll my Eligible Dependents in the Major Medical Plan? The monthly cost can be found on the Major Medical benefits highlight sheet. The cost per paycheck can be found on the NES Payroll Deduction Form in your enrollment kit. 14. What if I can t afford the Major Medical Insurance for my eligible Dependents? NES has made available a low cost Indemnity Medical Plan in which you may elect to cover either a Spouse, a Child/Children, or a Family. Refer to the Full-Time Dependent Health & Welfare Plan for Monthly Rates and the NES Dependent Payroll Deduction Form for the cost per paycheck. 15. Which of my Dependents would be eligible to enroll in the Plan? The definition of an Eligible Dependent is fully described in your plan Summary Plan Description (SPD), but generally it includes your legal spouse (not divorced or separated) as defined by the state in which you established such relationship, Domestic Partners both same-sex and opposite sex, and Children who are not yet 26 years old. It is important to note that non-medical benefits may have different age limits and requirements for dependent eligibility. Refer to your plan Certificate of Insurance or Summary Plan Description for details.

4 16. Which of the non-medical benefits have a dependent age limit of less than 26 years old? The Life Insurance dependent age limit is 26 years old. However, if the dependent is age 21 or older then evidence of enrollment in a college, university, or trade school on fulltime basis at the time of death would be needed to pay a death claim. 17. Will my elected dependent coverage start on the same date as my own coverage? Yes, if you ve completed your own enrollment within 31 days of hire and your required verification of dependent eligibility documents reach FCE no later than four business days before the end of your month of hire. Otherwise, the required documentation must reach FCE no later than 31 days from your date of hire and your elected dependent coverage will start on the first of the month following your coverage start date. If you fail to submit the required documentation within 31 days of your date of hire, your elected dependents will not be eligible to enter the plan until the next annual Open Enrollment period. In the case of newborns, the employee may make arrangements for payroll deductions following the birth event so long as two full pay periods of deductions are retroactively captured. 18. Why must I contribute two full pay periods worth of benefit deductions before my dependent s coverage is effective? The Plan requires that you contribute two full pay periods of deductions before coverage can be effective. This is in place to ensure that when coverage ends, you have contributed enough funds to the plan to continue your coverage through the end of the month. 19. If I elect dependent coverage, will my dependent(s) receive medical, dental, and vision insurance cards? No. Dependents do not receive separate insurance cards imprinted with their names. However, you can request additional insurance cards by calling FCE at Can I add or remove dependents or change my elections at any time? Changes may only be made during the initial enrollment eligibility period, the annual benefits Open Enrollment period, or if you experience a Qualifying Life Event such as marriage, birth or adoption. For more information on Qualifying Life Events, please contact FCE at to discuss your specific situation. Customer Service Representatives are available Monday through Friday from 7:30am to 6:30pm CST for assistance.

5 21. What is a Qualifying Life Event (QLE)? A Qualifying Life Event (QLE) is a personal change in status which may allow you to change your benefit elections mid-year. Examples of qualifying events include, but are not limited to, the following: Change in legal marital status such as marriage, divorce, legal separation, annulment, or death of a spouse Change in number of dependents such as birth, death, adoption, placement for adoption, award of legal guardianship Change in employment status of the employee s spouse or employee s dependent such as switching from part-time to full-time employment status or from full-time to part-time, termination or commencement of employment, a strike or lockout, or commencement of or return from an unpaid leave of absence which results in employee or dependent becoming ineligible for coverage Dependent satisfies or ceases to satisfy an eligibility requirement 22. How do I change my benefits when I experience a QLE? If you experience a QLE, please log on to the Online Web Enrollment website at to submit the change. Be sure to have your unique user ID and password handy to log in. You can also call FCE s Customer Service team at They are available Monday through Friday from 7:30am to 6:30pm CST for assistance. 23. When I experience a QLE and add dependent coverage, when is that coverage effective? The effective date of dependent coverage is the first of the month following the date of the event and two full payroll deductions. In the case of birth or adoption, the effective date is the date of the birth or adoption. In this case, you will have double payroll deductions for two pay periods to provide for coverage following the birth or adoption. 24. Can I elect to purchase Life, Dental, Vision and Disability separately? No, the plan offerings are packaged together as core set of benefits and cannot be purchased separately. 25. Can I buy-up the Life, Dental, Vision and Disability to a higher level of coverage? No, the core benefits were negotiated and priced with the insurance carriers to maximize the value to the NES Employees.

6 26. I noticed there is a six-month waiting period for Basic and Major Dental Services under the Dental Benefit, does that apply to everyone? Yes, however you may reduce or eliminate the six-month waiting period by evidencing the period of time you were covered under a creditable plan prior to your effective date of coverage under this plan. 27. How do I provide evidence of creditable dental coverage to reduce or eliminate the dental waiting period? You will need to obtain a Certificate of Creditable Coverage from the prior insurance carrier and provide it to FCE Benefits Administrators. Note that no credit for coverage can be given if there more than 63 days lapse in coverage between the prior plan and this plan. 28. Does the Weekly Disability Benefit coverage extend to my eligible dependents as well? No. Like most Weekly Disability programs, coverage extends to NES Employees only. 29. Does the Weekly Disability Benefit cover me for all disabilities? The Weekly Disability Benefit only covers you for non-work related injuries and illness. 30. If I already have some combination of the Life, Dental, Vision, or Disability, can I waive or decline the duplicate coverage under this plan? No. Those coverage types are part of the core benefits package and cannot be split up. 31. What about Retirement; does NES provide that type of benefit? Yes. A portion of the required hourly Health & Welfare Fringe dollars are contributed to your Qualified Retirement Account. Please refer to the Qualified Retirement Plan on the Schedule of Benefits for the current hourly contribution amount to the plan. Please note that if you are in the Waived Medical Benefit Plan, the contribution to your Qualified Retirement Plan is calculated after the cost of all Core Benefits have been paid. 32. What are Major Medical benefits? Coverage of this type is different from the Indemnity Medical Benefit for part-time employees in that most claims are subject to some combination of Annual Deductibles, co-insurance, out-of-pocket maximums, and per visit co-payments. Once these items are paid, the plan covers all of the eligible expenses and there all no Lifetime Maximums.

7 33. I noticed there are Calendar Year Maximums listed in both the Core Benefits Package coverage as well as the Optional Dependent Indemnity Medical Benefits section. What does that mean and how does it affect me? Like many insurance coverage plans there are stated limits of coverage and those limits are set based on the overall budget allowed for benefits for the contract you are working on. You will notice there are no co-payments or Annual Deductibles associated with those covered expenses, thereby making the cost for you to access health care very affordable. NES wants you to be aware of those Calendar Limits so that you can plan and utilize those benefits to the benefit of both you and your eligible dependents. 34. I noticed there are Per Visit Benefit amounts listed in both the Core Benefits Package coverage as well as the Optional Dependent Indemnity Medical Benefits section. What does that mean and how does it affect me? Per Visit Benefit amounts are the amount the Insurance Plan will pay when you or your enrolled dependents incur a covered expense. You will notice there are no co-payments or Annual Deductibles associated with those covered expenses, thereby making the cost for you to access health care very affordable. The plan will pay will pay out no more or less than the stated Per Visit Benefit Amount shown regardless of the cost of the benefit. In those instances where the cost of the covered expense is less than the Per Visit Benefit Amount, that difference will be sent to you in the form of a check. Conversely, if the cost of the covered expense is more than the Per Visit Amount, you will be responsible for that amount. 35. If I don t utilize all of my Calendar Year Core or Indemnity Benefits do they roll over to the next Calendar year? No. The benefits reset to the Calendar Year Maximum on January 1 st of each calendar year. 36. Where can I find a list of participating network providers for my Dependents Low Cost Medical Indemnity Plan? You can locate a provider or print a network directory online at firsthealth.com. For Customer Service assistance, you may also call First Health s Customer Service Representatives at directly at Where can I find a list of participating providers for the Major Medical Plan? You can locate a provider or print a network directory online at For Customer Service assistance, you may also call FCE s Customer Service Representatives at directly at

8 38. My physicians and hospitals are not listed in the First Health Network will the eligible expense still be covered? Yes, so long as your provider is licensed to provide coverage in your state. However, the provider is not obligated to accept the ID card in lieu of payment or discount the rate of the services provided. You may also nominate your non-network physician or health care facility for membership into the First Health Network and First Health will contact them about membership into the network. However, you should note that this process can takes weeks to accomplish. 39. Will I receive a separate ID cards for my Medical and Prescription Drug coverage? No, your Medical and Prescription Drug coverage is combined into one card. 40. What if I forget my ID card and have to pay full retail price for my prescription(s)? If you forget your ID card and are charged the full retail price for your prescription at the time of purchase, please return to the pharmacy as soon as possible with your ID card to have your purchase reprocessed and to obtain a refund if you overpaid. Alternatively, you may file a claim for reimbursement. Contact FCE s Customer Service team at for a claim form or you can obtain one online at Simply click on the Members tab and then click on Claim Forms. 41. Where can I get a detailed description of my benefit plan? Please refer to your Summary Plan Description (SPD) for a comprehensive summary of your plan within your FCE Enrollment Kit. 42. Where can I access the medical, dental and vision claim forms? Medical, dental and vision claim forms are available for download on the FCE website, Click on the Members tab and then click on Claim Forms on the left side navigation bar. 43. What happens to my benefits if I go out on leave (FMLA or LOA)? SCA employees on FMLA leave have the same obligations and entitlements as non-sca employees. First, you must apply with NES and be authorized for leave. Once approved for Leave under FMLA Federal law requires that NES continue your health benefits under the same cost share arrangement in place before you went out on FMLA leave. NES will continue to contribute the hourly fringe amount towards your benefit plan at the same rate you enjoyed prior to applying for FMLA leave. NES has no obligation to continue benefits coverage for employees on LOA. NES will stop funding the fringe rate for your benefits coverage when you stop recording hours worked. You will have the ability to elect COBRA coverage if you wish to continue your benefits coverage. Once you return to an active work status and record hours paid, NES will resume funding the fringe rate and your benefits will become effective after any applicable waiting period has been satisfied. Your waiting period will be waived on an

9 initial LOA should you return to work within a rolling year period. For example, if you go out on LOA on December 12, 2013 and return to work on January 10, 2014, your waiting period will be waived. 44. What happens to my dependent s benefits if I go out on leave (FMLA or LOA)? If you wish to continue dependent benefits while out on FMLA, you must make arrangements with NES to pre-pay payroll deductions. Otherwise, on notice of failure to make such arrangements, FCE will notify you that dependent benefits are scheduled to end and will provide a COBRA notice on your dependent coverage. If you wish to continue dependent benefits while out on LOA, your dependents must elect COBRA coverage. Otherwise, on notice of failure to make such arrangements, FCE will notify you and your dependent that dependent benefits are scheduled to end. 45. What happens when my employment ends with NES? Should your employment with NES end, your coverage ends at midnight on the last day of the month in which your employment terminates. Please refer to your Summary Plan Description (SPD) or contact FCE at for details or for information about continuation of coverage under COBRA. 46. If I am rehired by NES, am I still subject to the waiting period? Yes. Should you terminate employment with NES, your benefits will end at midnight on the last day of the month of termination. Should you be rehired by NES, it will be treated as an entirely new employment relationship from a benefits perspective and as such, the eligibility waiting period will apply. 47. If I am rehired by NES, are my dependents still subject to the waiting period? Yes. Your dependents would be subject to the waiting period if you leave and are rehired by NES.