Welcome to Open Enrollment 2014!

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1 Inside this issue: WorkSmart Systems Medical Plan Information Health Savings Account Flexible Spending Accounts Does Cost Comparison Really Matter? -3 FAQs (Medical, 6 Pharmacy, Vision) Basic Life Insurance 6 Lincoln Financial Dental Plan Information & FAQs Employee Assistance Program (EAP) Online Enrollment Instructions Humana Specialty Benefit Products Qualifying Events Lincoln Financial Ancillary Producs Affordable Care Act Privacy Practices Education Meeting and E-Learning Tools 4 Welcome to Open Enrollment 04! Open Enrollment is here! This is your opportunity to review your benefit elections and make new selections for next year. This year s open enrollment period is October 5- November 8, 03. Changes made during this time will have an effective date of January, 04. After November 8, all changes made for 04 coverage will be restricted to Qualifying Events (see page for details). Medical, Dental and Flex payroll deductions for 04 will begin with your first payroll in January. We are pleased to announce that our current vendor partnerships will continue for 04! Anthem Medical and Vision Lincoln Financial Dental, Life Insurance, Short- and Long- Term Disability Coverage Humana Specialty Products Benefit Please review this Guide for details of the 04 open enrollment period. This outlines important plan information. If you do not complete an enrollment, your current 03 medical and/or dental participation will continue for 04. Flexible Spending Accounts (FSAs), however, DO require a response from you. FSAs DO NOT continue automatically year to year, so you must enroll for 04 if you wish to participate. IMPORTANT POINTS: Four medical plans with no change to networks. Medical plans have premium adjustments for 04. Your premium information is available online through myworksmarthr. Online Enrollment via myworksmarthr $5,000 PPO plan s In- Network out-of-pocket maximum will reduce to $6,350 single; $,700 family. Two Lincoln Financial dental plans with no changes to plan design. Dental plans have premium adjustments for 04. Log in to your myworksmarthr portal to view your 04 premium information. Premium decreases for STD and LTD. However, subject to the normal changes as you cross age bands and/or due to salary changes. If you have Open Enrollment questions, please check out the FAQs on page 6 and/or on the WorkSmart Systems HRIS site ( WorkSmart Systems will again have online enrollment this year. The online enrollment will be administered through our HRIS, myworksmarthr. Go to to begin. Your User Name is your WorkSmart Systems Employee Identification number, provided in an message to you. Information regarding your default password is also included in that . Please see pages 8 and 9 of this Guide for instructions on how to complete your 04 enrollment through myworksmarthr. Your online enrollment will provide instant confirmation of your elections. Be sure to print the confirmation page for your records. All 04 enrollment decisions must be in the WorkSmart Systems office by November 8.

2 04 WorkSmart Medical Plans Anthem Website: Traditional PPO $,000 Health Reimbursement Account (HRA) Deductible: Individual $,000 Family $4,000 (IN-NETWORK) Coinsurance: 80% covered by insurance / 0% by member after deductible Out-of-Pocket Maximum: Individual $4,000 Family $8,000 Wellness: Adult physical exam / immunizations 00% by insurance Well child exams / immunizations 00% by insurance Routine GYN care exam 00% by insurance Routine mammogram 00% covered by insurance Routine eye exam (every months) $5 copay Office Visit: Primary Care $5 copay Specialist $50 copay Pharmacy: Generic $5 copay Brand name preferred $35 copay Brand name non-preferred $50 copay Diagnostic Lab and X-Ray: 00% covered by insurance at MidAmerica Labs, LabCorp or Qwest Diagnostics Physician Services: Other Medical Services (Maternity, Hospital, Etc.): Mental Health, Chemical & Alcohol Dependency: Inpatient/Outpatient treatment 80/0 coverage after deductible Office Visit $5 copay Emergency Medical Care: Urgent Care $75 copay Emergency Room $50 copay + 0% coinsurance (copay waived if admitted) (IN-NETWORK) Non-Embedded Deductible: Employee Only $,500 after $500 HRA Employee + Dependent(s) $5,000 after $,000 HRA Dependent coverage requires the Employee + Dependent deductible to be met before coinsurance applies. The Employee Only deductible does not apply to Employee + Dependent coverage. Coinsurance: 80% covered by insurance / 0% by member after deductible Out-of-Pocket Maximum: Employee Only $4,500 after $500 HRA Employee + Dependent(s) $9,000 after $,000 HRA Wellness: Adult physical exam / immunizations 00% by insurance Well child exams / immunizations 00% by insurance Routine GYN care exam 00% by insurance Routine mammogram 00% covered by insurance Routine eye exam (every months) $5 copay Office Visit: Primary Care 80/0 coverage after deductible Specialist 80/0 coverage after deductible Pharmacy: Generic $5 copay after deductible Brand name preferred $35 copay after deductible Brand name non-preferred $50 copay after deductible Diagnostic Lab and X-Ray: Physician Services: Other Medical Services (Maternity, Hospital, Etc.): Mental Health, Chemical & Alcohol Dependency: Emergency Medical Care: Urgent Care 80/0 coverage after deductible Emergency Room 80/0 coverage after deductible Log in to to view your per pay medical premiums for 04. You can review your current benefit enrollment by selecting (Show 03 Current Election) at the top of each enrollment page. Changes made to your benefits for 04 will be accepted once you click Submit at the end of the Enrollment Wizard.

3 04 WorkSmart Medical Plans Anthem Website: High Deductible Health Plan* (HDHP) Traditional PPO $5,000 (IN-NETWORK) (IN-NETWORK) Deductible: Individual $3,500 Family $7,000 Coinsurance: 80% covered by insurance / 0% by member after deductible Out-of-Pocket Maximum: Individual $5,800 Family $,600 Wellness: Adult physical exam / immunizations 00% by insurance Well child exams / immunizations 00% by insurance Routine GYN care exam 00% by insurance Routine mammogram 00% covered by insurance Routine eye exam (every months) $5 copay Office Visit: Primary Care 80/0 coverage after deductible Specialist 80/0 coverage after deductible Pharmacy: Generic $0 copay after deductible Brand name preferred $40 copay after deductible Brand name non-preferred $70 copay after deductible Diagnostic Lab and X-Ray: Physician Services: Other Medical Services (Maternity, Hospital, Etc.): Mental Health, Chemical & Alcohol Dependency: Emergency Medical Care: Urgent Care 80/0 coverage after deductible Emergency Room 80/0 coverage after deductible * HSA COMPATIBLE PLAN (See page 4) Deductible: Individual $5,000 Family $0,000 Coinsurance: 80% covered by insurance / 0% by member after deductible Out-of-Pocket Maximum: Individual $6,350 Family $,700 Wellness: Adult physical exam / immunizations 00% by insurance Well child exams / immunizations 00% by insurance Routine GYN care exam 00% by insurance Routine mammogram 00% covered by insurance Routine eye exam (every months) $5 copay Office Visit: Primary Care $5 copay Specialist $50 copay Pharmacy: Generic $0 copay Brand name preferred $40 copay Brand name non-preferred $70 copay Diagnostic Lab and X-Ray: 00% covered by insurance at MidAmerica Labs, LabCorp or Qwest Diagnostics Physician Services: Other Medical Services (Maternity, Hospital, Etc.): Mental Health, Chemical & Alcohol Dependency: Inpatient/Outpatient treatment 80/0 coverage after deductible Office Visit $5 copay Emergency Medical Care: Urgent Care $75 copay Emergency Room $50 copay + 0% coinsurance (copay waived if admitted) Log in to to view your per pay medical premiums for 04. You can review your current benefit enrollment by selecting (Show 03 Current Election) at the top of each enrollment page. Changes made to your benefits for 04 will be accepted once you click Submit at the end of the Enrollment Wizard.

4 Page 4 WorkSmart Systems, Inc. Health Savings Account: Tower Bank The Health Savings Account (HSA) is your health care spending account option if you enroll in the High Deductible Health Plan. It can be used for medical, dental, vision, prescription and some over-thecounter items. Some things to remember about HSAs: Pre-tax contributions are made to HSAs held by Tower Bank. Start by opening your account online at You will need the WorkSmart company code: The HSA is not an Open Enrollment item, though it may be affected by your medical decision during Open Enrollment. If you have a current HSA deduction and are eligible for the HSA into 04, your deduction will continue at the 03 amount unless and until you advise WorkSmart Systems in writing. You can change your HSA payroll deduction throughout the year. There is no minimum contribution, but there are maximum limits. The 04 IRS limits are: $3,300 for individual coverage; $6,550 for family coverage. If you are 55 years of age or over, you are allowed an additional $,000 annual catch-up contribution. HSA money is not available until it has been deducted from your pay and deposited into your HSA. We transmit funds to Tower Bank twice a week. Your HSA money rolls over from year to year and remains available until you need it. Your HSA is portable and follows you from job to job. We also want you to know about an upcoming enhancement to your HSA. On Tuesday, September 0, 03, a partnership between Tower Bank/The HSA Authority and Old National Bank was announced. The HSA Authority brand, product and service level will remain as is, with the added bonus of providing additional resources and technology enhancements to our HSA clients. The HSA Authority will continue to run all operations from Fort Wayne and The HSA Authority operation will continue to be managed by the existing Fort Wayne Team. When the partnership has been finalized (estimated Spring 04), you will have access to free ATM transactions at Old National Bank centers, expanding your fee-free access to your HSA funds. Flexible Spending Accounts WorkSmart Systems offers three Flexible Spending Accounts (Flex) as your pre-tax spending options. The three Flex Accounts are: Healthcare Flex, which may be used for eligible medical, dental, vision, prescription and some over-the-counter items for yourself and your dependents. Max: $,500/year. Expenses must be incurred between January, 04, and March 5, 05, in order to use your 04 Flex election. Limited Healthcare Flex is available only to HDHP/HSA Participants. Limited Flex may be used for dental and vision expenses only. Max: $,500/year. Expenses must be incurred between January, 04, and March 5, 05, in order to use your 04 Flex election. Dependent Care Flex is for reimbursement of eligible childcare and/or eldercare expenses. Max: $5,000/year. Expenses must be incurred between January, 04, and December 3, 04, in order to use your 04 Flex election. If you enroll in a Flexible Spending Account (Flex), you will make your per pay election for 04 during Open Enrollment. Your election(s) will be set for the entire year and will be deducted from your pay on a pre-tax basis. To calculate your annual amount, multiply your per pay amount by (paid monthly), 4 (paid semimonthly or biweekly) or 48 (paid weekly), depending on your pay cycle. Some things to remember about Flex: Flex requires re-enrollment each year. If a receipt is required, you will receive an reminder on days 7, 4, and. At day, the card is blocked until the outstanding charge is settled. Flex is use-it-or-lose-it. All receipts for reimbursement must be submitted to WorkSmart Systems by April 5, 05, for 04 Flex expenses. Over-the-counter drugs are not eligible for reimbursement from your Healthcare Flex account unless you have a prescription from your doctor. Healthcare Flex and Limited Healthcare Flex elections are front-loaded on a debit MasterCard, giving you access to your full election as of Dependent Care Flex funds are available as funds are deducted from your pay throughout the year.

5 Open Enrollment 04 Page 5 Does Cost Comparison Really Make a Difference? How many of us buy a car without shopping for the best deal? How about a big screen television? And that MRI? Many non-life threatening healthcare services are in the same price range as a car or that awesome TV, but we typically don t consider shopping for the best deal based on price and outcome. Why not? Patient and Consumer: Do you think of yourself merely as a patient, or also as an empowered consumer of healthcare services? Perhaps a combination of the two? Do you know that as a consumer, you have the option of shopping healthcare services? We have been conditioned to think only as a patient do what the doctor, the authority, tells us to do. The average patient is usually scared or at least apprehensive about the condition in question, so the cost component is not typically in the forefront of one s mind. If anything, a patient will usually think only about what will be paid out-of-pocket after insurance pays, not giving any thought to the overall cost of care. Reducing overall healthcare costs, regardless of whether the plan or the participant pays for the service, becomes money saved in the plan. Every dollar that is saved in the plan is ultimately a savings to us in our insurance premiums. Accessibility to Pricing: It is difficult to navigate the labyrinth of physician, lab, hospital and PPO contract pricing to get a straight price for a service. A solution is that there are tools available that can make this process virtually painless. Anthem offers Anthem Care Comparison, which provides accurate pricing information and explanation of these costs to participants. In-Network Does Not Equal Universal Price: Did you know there is a vast pricing disparity from provider to provider? When searching for pricing, outcomes and providers, Anthem Care Comparison gives the low price and high price for a particular healthcare service. Following are a few examples of cost comparisons. These are just a sampling of the typical price disparity for healthcare services: Uncomplicated Birth: Low price = $7,970; High price = $3,99 Neck CT Scan (With Contrast): Low price = $7; High price = $,553 (see example below) Colonoscopy (with biopsy): Low price = $,04; High price = $8,93 WorkSmart data shows that 73% of our healthcare costs are due to claims that are under $5,000. The vast majority of our healthcare claims are for non-life threatening conditions where shopping for cost of service is a valid option. Next time you need a diagnostic test or surgery, take a few minutes to shop online before making your healthcare purchase. Anthem Care Comparison Example: CT Scan Neck with Contrast Anthem Care Comparison is a consumer guide that helps you understand the pricing options for a variety of healthcare services. You have access to Anthem Care Comparison by way of your portal. After you have entered the search criteria, Anthem Care Comparison displays the low and high price in your area for the requested test or procedure. Cost of service can vary quite a bit from one network provider to another, as you can see in this example. It is always up to you where you receive services, but if two providers can offer the very same service, one at a fraction of the price of the other, isn t it worth checking your options?

6 Page 6 WorkSmart Systems, Inc. Medical Insurance and Vision Benefit WorkSmart Systems Plan WorkSmart Systems will continue to sponsor a self-funded medical insurance plan for 04. WorkSmart Systems will maintain our partnership with Anthem BC/BS ( Anthem will continue claims processing, member services, health management tools, network accessibility and problem resolution. MEDICAL INSURANCE FAQs Q. What is our network? A. Anthem Blue Access is the overall network. Go to and select Find a Doctor and then enter your search criteria. You will be able to search for providers by name, specialty, location, etc. You may download a directory if you are interested. You may also call Anthem at the Member Services number on the back of your card. Q. What provider network is utilized for out-of-state services and how do I find out if my provider is In-Network? A. WorkSmart members have access to the Blue Cross/Blue Shield network nationwide. Q. Will I get a new medical insurance card? A. Maybe. If you are electing different medical coverage for 04, you should receive a new Anthem Medical ID card at your home address in December. Your new card will be effective January, 04, for medical, pharmacy and vision benefits. If your coverage will remain the same for 04, you will not receive a new card. If you are new to the WorkSmart medical plan as of January, 04, and need your insurance information before your card arrives in the mail, contact WorkSmart ([email protected]) and request that your Anthem Temp ID card be ed to you. Q. How do I contact Anthem if I have an issue with a claim or another customer service question? A. You may contact Anthem directly by calling the Member Services number on the back of your card, or you may access your claims online at Of course, the WorkSmart Systems Benefits Team is always available to assist you as well. Q. What tools, cost containment and otherwise, are available to me with Anthem? A. Anthem provides many robust and cutting edge web tools on their website at Once you have your Member ID Number, create a Username and Password at by selecting Register Now and following the steps. In addition to your benefit and claim information, each member has access to 360 o Health Program, which includes the 4/7 Nurse- Line, ConditionCare, Future Moms, and Health Risk Assessment tools. You will also have access to Anthem Care Comparison (see page 5). Anthem Care Comparison is a program designed to help you navigate the health care system and help you become a better health care consumer. PHARMACY FAQs Q. How do I find out if my pharmacy is In-Network? A. We utilize Express Scripts (ESI) as the Pharmacy Benefit Manager. ESI has over 65,000 participating pharmacies across the country. The national chain pharmacies participate, as well as most local pharmacies. Log in to and go to Benefits & Claims, then select the Pharmacy Tab, and Click Here which will take you to your pharmacy information at Express Scripts. Q. Will I receive a separate drug card? A. No. Your medical card will also serve as your prescription card. VISION FAQs Q. Is Vision included in my medical plan? A. Yes, one routine eye exam every months is included under the medical plan. You may get your routine exam from any eye doctor in the Blue View Vision network and your cost will be just a $5 copay. Q. Is there a discount on lenses and frames and how do I find providers? A. Blue View Vision is the vision network for discounts on your eye materials. Show your Anthem ID card when you purchase your eyewear to take advantage of the discounted price. Log in at and choose the Vision tab. You will then select the Vision Benefit Details button for more information. Basic Life and AD&D Insurance Lincoln Financial All benefit eligible employees currently have a $5,000 Life and AD&D insurance policy through Lincoln Financial. Basic Life with Lincoln Financial is in addition to any Voluntary Group Term Life Insurance policy you have through Lincoln Financial.

7 Open Enrollment 04 Page 7 Dental Plans Lincoln Financial DENTAL FAQs Q. How do I find out if my dentist is In-Network? A. Visit and select Find a Dentist on the right side of the webpage. Follow the prompts to view participating providers. Q. Will I get a new dental insurance card? A. Maybe. If you are electing different dental coverage for 04, you should Gold receive a new Lincoln Financial Dental ID card at your home address in December. Your new card will be effective January, 04. If your coverage will remain the same for 04, you will not receive a new card. Q. How do I contact Lincoln Financial about dental coverage and claim questions? A. For coverage and/or claim questions, call You may also log on to If you have not yet created a profile, select the Employee/ Insured link at the bottom of the page and it will ask for your social security number and then prompt you to create a profile. Follow the prompts to complete your profile in order to access your information, including claims. You may also contact WorkSmart Systems at with your dental questions. Silver Annual Deductible $50/person; $50/family $50/person; $50/family Annual Maximum per Person $,000 $,000 Preventive Care 00% 00% Basic Services 80% after deductible 50% after deductible Major Services 50% after deductible Not covered Orthodontia (Children under 0) 50% (deductible waived); $,000 lifetime maximum Not covered Employee Assistance Program (EAP) FREE and CONFIDENTIAL BENEFIT: Employees and their immediate family members are eligible for three face-to-face counseling sessions per person per problem per year through Aetna Resources for Living, a nationally recognized leader in the field of EAP services. Toll-Free: Web Access: Login ID: WorkSmart Systems Password: eap Our EAP offers much more than just counseling services! Go to the above website for great articles, newsletters, webinars, helpful information regarding selecting childcare and healthcare providers, shopping and travel discounts available through Aetna Resources for Living and its partners, a concierge service for dining and travel planning! They also offer legal consultation, financial consultation, and consultation for identity theft resolution. Take advantage of the EAP today!

8 Page 8 Instructions for On-line Enrollment Step : Go to to log in Step : Select the Benefits Enrollment Wizard link to begin WELCOME Valued Employee. Select the Benefits Enrollment Wizard link.. Select Employee Login on the welcome screen.. Your User Name and Password are included in the you received from WorkSmart Systems. In the event you currently use myworksmarthr and have a different password, use that unique password. Step 3: Begin your 04 Enrollment. The benefit year will default to 04.. As you complete this page, and then each following page, select the Next button.. The Summary that appears on the right side of the screen shows your eligible benefits for the 04 Plan Year. As you go through the enrollment process, the summary will update with the contribution amounts of your elections.. You will note that some items are locked. These are not open enrollment items. These benefits continue from year to year with no action required by you. In the event you do not have any of these benefits and wish to add them, or to increase your life insurance (if applicable), you may do so at any time throughout the year. Contact WorkSmart Systems to request the necessary Evidence of Insurability form, or to advise if you wish to cancel any of these voluntary benefits. Step 4: Review your dependent information (if applicable) Step 5: Enter Beneficiary Information. To add dependents, select the Add Dependent button and enter the information.. Select the Next button.. Each full-time, benefit eligible employee has a $5,000 Basic Life and AD&D Insurance policy. This beneficiary designation will override any previous beneficiary designation for your Basic Life and AD&D Insurance policy.. FYI...beneficiary information is required before you can complete your medical enrollment or waiver. 3. Select Next.

9 Open Instructions Enrollment 04 for On-line Enrollment Page 9 Step 6: Making Your Benefit Selections Step 7: Consider a Health Savings Account or Flex Spending 3 4. If you are electing a Health Savings Account or Flexible Spending Account, you will elect your PER PAY deduction. The ANNUAL limits for the Health Savings Account are: $3,300 for Employee Only ($4,300 if you are age 55 or over); $6,550 for Employee + Dependent(s) ($7,550 if you are age 55 or over). The ANNUAL amount for Healthcare Flexible Spending must be: Minimum = $00; Maximum $,500 (applies to Healthcare Flex and Limited Healthcare Flex). The ANNUAL amount for Dependent Care Flexible Spending must be: Minimum = $00; Maximum = $5,000.. Select the Next button to proceed to the next benefit option If you need to view the specific medical plan summary, select the appropriate blue Medical link.. The PER PAY deduction for each of the benefit options will be indicated under Cost. 3. Make your plan/coverage election by selecting the appropriate radio button. 4. When you make your selection, the wizard will select the covered dependents for you. Edit as necessary. If you select a plan and do not have the applicable dependents set up, the system will prompt you to go back and make the required changes. 5. Designate the beneficiary distribution for the $5,000 Basic Life and AD&D insurance. Tab to the next beneficiary filed in order to update the Total percentage. 6. Select Next to proceed to Health Savings Account option. Step 8: Election Summary Step 9: Review and Submit 3 3. Review your elections to confirm it reflects the benefit, plan, and level of coverage you need for 04, and that the HSA and Flex deductions make sense.. If you have elected dependent coverage on the medical and/or dental plans, review the dependent(s) listed and the coverage. 3. Select Next to print your election summary and to submit your benefit elections for 04.. Print your Benefit Election Summary, as this will serve as your enrollment confirmation.. Be sure to select the Submit Benefit Election Summary. 3. Your enrollment will be complete once you select Finish. 4. If your printed confirmation does not correspond to what you intended to elect, use the Previous button to go back and make changes, then review your Election Summary again. If you have trouble, contact WorkSmart Systems by phone at or by at [email protected], no later than Friday, November 8, 03.

10 Page 0 WorkSmart Systems, Inc. Humana Supplemental Insurance Products WorkSmart Systems offers Supplemental Insurance products through Humana. These three voluntary plans available are not subject to open enrollment, thus enrollment is ongoing throughout the year. All three plan options provide benefits regardless of other in-force coverage, including medical insurance, so there is no coordination of benefits. Each product offering is independent of the others. You can elect any or all plans that are applicable to you and your family: Accident Plus is supplemental accident insurance that provides you with off-the-job coverage for accident-related expenses such as ambulance services, hospital confinement and medical treatment. Monthly Rates for Accident Plus plan Base (Option $,000) Level Two (Option $,000) Level Four Benefit Employee Only $4.70 $6.56 $8.60 $0.46 Employee + Spouse $9.40 $33. $37.0 $40.9 Employee + Child(ren) (Child = Birth to Age 5, unmarried) $34.40 $36.6 $45.90 $47.76 Family $49.0 $5.8 $64.50 $68. Supplemental Health pays a cash benefit when you are hospitalized. Monthly Rates for Supplemental Health plan Benefit Non-Tobacco User Tobacco User Age Employee $3.9 $3.5 $7.59 $4.67 $6.85 $5.88 $.4 $30.8 Employee + Spouse $5.59 $4.06 $3.93 $47. $9.67 $7.88 $38.8 $54.94 Employee + Child(ren) (Child = Birth to Age 5, unmarrried) $3.4 $.8 $3.04 $9.46 $6.35 $5.55 $6.87 $35.07 Family $3.5 $3.9 $36.96 $50.64 $36.60 $34.99 $4.33 $58.49 Critical Illness Advantage Plus is insurance that helps protect you, your family and your assets in the event of a critical illness such as heart attack, stroke or cancer. It also offers an annual health screening benefit. Monthly Rates for Critical Illness plan Age Employee NTU Employee - TU Spouse - NTU Spouse - TU Benefit: $5,000 $0,000 $0,000 $5,000 $0,000 $0,000 $,500 $5,000 $0,000 $,500 $5,000 $0, $6.68 $9.3 $4.33 $8.03 $.93 $9.73 $3.40 $4.80 $7.60 $4.6 $6.30 $ $9.03 $3.93 $3.73 $.8 $0.43 $36.73 $4.68 $7.35 $.70 $6.48 $0.95 $ $.3 $0.33 $36.53 $8.8 $3.43 $60.73 $6.45 $0.90 $9.80 $9.78 $7.55 $ $7.03 $9.93 $55.73 $7.8 $50.3 $96.33 $9.08 $6.5 $30.30 $4.66 $7.30 $ $0.43 $36.73 $69.33 $33.63 $63.3 $.3 $0.98 $9.95 $37.90 $8.3 $34.45 $ $.88 $39.63 $75.3 $34.43 $64.73 $5.33 $.78 $.55 $4.0 $8.68 $35.35 $68.70 Age Children Benefit: $,500 $5, $.33 $3.65 For specific coverage information or to enroll in these benefits, go to

11 Open Enrollment 04 Page Qualifying Events Outside of Open Enrollment, the only time to make changes to your medical, dental and flex elections during the year is due to a change in family status or a life event. These include: Marriage or divorce Birth, adoption or placement for adoption of a child Death of your spouse or a dependent Significant change in coverage by your spouse s employer Change in your spouse's employment resulting in gain or loss of coverage Change from part-time to fulltime (or vice-versa) by you or your spouse Changes in entitlement to Medicare or Medicaid Dependent satisfies or ceases to satisfy eligibility requirements Qualification by Plan Administrator of a medical child support order Your request for a change in enrollment must be clearly related to the life event change, and is limited to adding or dropping a dependent and/or coverage, as applicable. You are responsible for notifying the Human Resources Department at WorkSmart Systems so that changes can be made with the insurance carrier within 3 days of the life event. By law, changes cannot be made after the 3-day period ends. Your request to change coverage must be datestamped in the WorkSmart Systems office within 3 days of the qualifying event. Lincoln Financial Ancillary Products (Disability and Voluntary Life Insurance) Ancillary products include short-term disability (STD), long-term disability (LTD) and voluntary group term life and AD&D insurance, which are not affected by open enrollment. Your coverage will continue without interruption unless you notify WorkSmart Systems in writing that you wish to cancel your coverage. These products are NOT subject to open enrollment, thus enrollment is ongoing throughout the year. If you are not currently enrolled in STD, LTD, Employee Life, Spouse Life or Child Life (available only with Employee or Spouse Life), but wish to elect the coverage, you may apply for these benefits at any time throughout the year. You need to complete the Evidence of Insurability form required by Lincoln Financial for consideration. This form is available on the WorkSmart Systems website ( Simply complete the form and send it to us at [email protected], or fax it to us at Please note that salary changes affect the volume of life insurance for which you are eligible. Additionally, please be aware that a change in salary and/or an age band change will affect your STD and LTD premiums and an age band change will affect your life insurance premiums for 04. How Is My WorkSmart Systems Coverage Affected by the Affordable Care Act? The Patient Protection and Affordable Care Act (Affordable Care Act) was signed into law in 00 and key aspects will be implemented January, 04. Pre-existing limitation exclusions have been eliminated on medical plans. As of January, 04, health plans cannot limit or deny benefits because you have or have had a pre-existing condition. A pre-existing condition is a health problem found or treated before you signed up for coverage. This provision already applies to individuals under the age of 9 and will take effect January, 04, for those age 9 and older. WorkSmart Systems is continually working with our resources to stay on top of upcoming changes. Any changes will be communicated to you as we receive information. For specific information related to the Affordable Care Act, please visit Privacy Practices The WorkSmart Systems Notice of Privacy Practices is available to you at any time. You have the right to receive a paper copy of this Notice by contacting: Andrea Meyer, Privacy Officer WorkSmart Systems 9957 Crosspoint Blvd Indianapolis IN 4656 You may also obtain a copy on our website:

12 9957 Crosspoint Boulevard Indianapolis, IN 4656 Phone: Toll-free: Fax: Like us on Open Enrollment Education Meeting & E-Learning Tools An Open Enrollment education meeting will be conducted at the WorkSmart Systems office: Date & Time: Wednesday, October 30, 03, at 6:00 PM Location: 9957 Crosspoint Boulevard Indianapolis, IN 4656 Topic: Open Enrollment Overview, Pointers and Assistance If you are unable to attend the education meeting, check out the e-learning tools in the 04 Benefit Resource Center on our website ( which is available 4/7. If you have additional questions about any of the benefits available to you through WorkSmart Systems, review the FAQs on our website or contact our Human Resources Department by phone at (Toll-free: ) or at Open Enrollment is here! (For your 04 Health, Dental and Flexible Spending benefits) October 5 November 8