Administration Manual for Employers

Transcription

1 Administratin Manual fr Emplyers Grup Plans GROUP PLANS 6/13 Page 1

2 Table f Cntents HOW TO USE THIS MANUAL... 3 HOW TO GET HELP... 5 ADMINISTRATIVE RESPONSIBILITIES... 9 GENERAL ADMINISTRATIVE GUIDELINES MINIMUM PARTICIPATION REQUIREMENTS WAITING PERIOD IMPORTANT TERMS HOW TO PROCESS MONTHLY BILLING STATEMENTS HOW TO PROCESS ENROLLMENTS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION HOW TO PROCESS CHANGES HOW TO PROCESS A CHANGE OF BENEFICIARY HOW TO PROCESS TERMINATIONS LEAVING ACTIVE EMPLOYMENT LIFE, PERSONAL ACCIDENT AND DISABILITY CLAIMS HOW TO PROCESS MEDICAL AND DENTAL CLAIMS BASIC MEDICARE INFORMATION EMPLOYER ACCESS FLEXIBLE SPENDING ACCOUNT ADMINISTRATIVE FORMS GROUP PLANS 6/13 Page 2

3 HOW TO USE THIS MANUAL HOW TO USE THIS MANUAL Purpse This manual is intended t help each Emplyer participating in the Grup Plans effectively and efficiently administer the benefit plans ffered t its Emplyees. Specific plans and cverage may vary by Emplyer. This manual describes the imprtant Administrative prvisins f these plans and sets frth the step-bystep prcedures that each Emplyer must fllw in rder fr GuideStne Financial Resurces t prperly recrd new Emplyees, make subsequent changes t master recrds and accunt fr Emplyer payments. This manual serves as a training tl fr new Administrative persnnel wh becme respnsible fr the administratin f the plans. The manual als serves as a reference guide fr persnnel wh are already familiar with the peratin f the plans. This manual des nt cntain prcedures which are specific fr each Emplyer such as an Emplyer s internal prcedures fr recnciling payments against payrll recrds. We recmmend that each Emplyer maintain a set f detailed internal prcedures that perate in cnjunctin with the prcedures utlined in this manual t effectively administer these plans. Organizatin and cntents Many f the chapters cntained in this manual are rganized t present infrmatin n an events basis. Fr example, HOW TO PROCESS ENROLLMENTS describes what must be dne t handle the enrllment event. The HOW TO PROCESS TERMINATIONS chapter explains the infrmatin yu shuld give an Emplyee leaving yur emplyment, as well as hw and when yu must cmmunicate this infrmatin t GuideStne. Other chapters deal with medical claims and ther claims events. We think yu will find this rganizatin helpful in explaining what yu must d when a particular event ccurs. A few f the chapters in the manual are nt event-riented, but cntain imprtant infrmatin abut the plans and hw they perate. Fr example, the manual cntains a glssary f defined terms which are capitalized and used thrughut this manual. It is imprtant t be familiar with these terms and their definitins. Als in this manual is a chapter titled HOW TO GET HELP. This chapter lists infrmatin yu may require fr administratin f the plan and enables yu t identify a cntact wh can supply this infrmatin. GROUP PLANS 6/13 Page 3

4 HOW TO USE THIS MANUAL Anther chapter includes instructins fr rerdering frms by mail r dwnlading them thrugh GuideStne Financial Resurces internet website. Revisins GuideStne Financial Resurces reviews and makes revisins t this manual frm time t time. The effective date f each page is in the lwer left crner f the page, after the cde GROUP PLANS. While every effrt is made t maintain accurate infrmatin in the manual, changes in plicy that ccur between revisins will nt be reflected until the next revisin date. Emplyers are typically ntified by mail r f changes in plicy in the interim and are respnsible fr administering their plans in accrdance with the new plicies. Since this manual is maintained n the GuideStne Financial Resurces website, hard cpies are nt prvided. As situatins arise that are nt cvered by this manual, it is imprtant t knw where t get help. As a general rule, yur questins r prblems shuld be directed t the department at GuideStne Financial Resurces respnsible fr handling that aspect f the Prgram, r yu may call the Insurance Slutins and Services department. Sme questins will need t be directed t an utside agency, such as Highmark Blue Crss Blue Shield fr medical plan benefit infrmatin r Express Scripts fr prescriptin drug infrmatin. GROUP PLANS 6/13 Page 4

5 HOW TO GET HELP HOW TO GET HELP This sectin helps yu direct yur questins and prblems t the apprpriate agency r individual. The fllwing pages cntain a listing f sme areas where these questins can be addressed and a list f imprtant phne numbers. Since persnnel assignments may change, yu may print the Imprtant Numbers page in this sectin and use the blank lines t list the names f yur usual cntacts. Fr infrmatin r questins n: Age reductin and retirement effect n benefits Cntact: Insurance Operatins, Grup Plans Appeal f denied Medical benefits claims Insurance Operatins, Claims Unit Highmark BCBS Appeal f denied Dental claims Cigna Dental Beneficiary designatin Insurance Operatins, Claims Unit Benefit interpretatin fr Medical Highmark BCBS Billing Statements Insurance Operatins, Grup Plans Claim submissin prcedures fr Dental benefits Cigna Dental Claim submissin prcedures fr PPO Medical Plans, Senir Plan r Senir Plus Plan, Care Basic Plan, Care Plus Plan r Care Tday Plan Highmark BCBS GROUP PLANS 6/13 Page 5

6 HOW TO GET HELP Fr infrmatin r questins n: Cntact: Claim submissin prcedures fr Term Life, Disability, Accidental Death and Dismemberment r Persnal Accident benefits Insurance Operatins, Claims Unit Cnversin f Term Life cverage Insurance Operatins, Grup Plans Crdinatin f Benefits prcedures fr Medical Highmark BCBS Eligibility f Emplyees r dependents fr benefits Insurance Operatins, Grup Plans Enhanced Benefits prvider verificatin PPO Member Services number listed n the ID card Enrllment prcedures Insurance Operatins, Grup Plans ID cards Request new Dental ID cards Cigna Dental ID cards Request new Medical/prescriptin drug ID cards fr PPO Highmark BCBS (fr Medical) Express Scripts (fr prescriptins) Leave f absence infrmatin Insurance Operatins, Grup Plans Plan Administratin Insurance Operatins, Grup Plans Prtability f Term Life cverage Insurance Operatins, Grup Plans GROUP PLANS 6/13 Page 6

7 HOW TO GET HELP Fr infrmatin r questins n: Cntact: Preauthrizatin fr PPO Medical Plans Highmark BCBS Prescriptin drug infrmatin fr PPO Medical Plans Express Scripts Upgrading Emplyer cverage r adding new Emplyer benefits Insurance Slutins and Services GROUP PLANS 6/13 Page 7

8 HOW TO GET HELP Imprtant numbers GuideStne Financial Resurces phne numbers: Main number: GUIDE ( ) Internet address: Department Cntact address Phne number Insurance Operatins, Grup Plans Insurance Operatins, Claims Insurance Slutins and Services Outside agencies: Agency Internet address Phne number Highmark BCBS Prvider Search Explanatin f Benefits and Claims Express Scripts Cigna Dental Premier Dental Care Plan Chice Dental Care Plan Guided Dental HMO Plan GROUP PLANS 6/13 Page 8

9 ADMINISTRATIVE RESPONSIBILITIES ADMINISTRATIVE RESPONSIBILITIES Emplyer respnsibilities Explaining the Grup Plans t new Emplyees Offering new Emplyees wh are eligible fr Participatin in Grup Plans the pprtunity t enrll in the Prgram s Plan(s) within 31 days f initial eligibility Verifying that all Emplyees and dependents enrlled in Grup Plans meet the eligibility rules fr the Plan(s). Failure t adhere t the eligibility rules will result in the terminatin f cverage fr the affected enrllee(s) and reimbursement t GuideStne, at its sle discretin, may be required fr claims paid n behalf f ineligible enrllees Offering enrllment in Cntributry medical plans t Emplyees wh previusly declined cverage fr themselves and/r their Eligible Dependents when they becme eligible as Special r Late Enrllees Enrlling Emplyees and submitting their enrllment frms t GuideStne Financial Resurces Distributing apprpriate benefit materials t new participating Emplyees Maintaining mnthly earnings recrds fr each participating Emplyee Maintaining cpies f enrllment frms, Beneficiary designatin frms and ther imprtant papers relating t an Emplyee s Participatin in the Prgram Verifying the mnthly billing statement and remitting the mnthly payments due t GuideStne Financial Resurces. Nn-payment culd result in terminatin f cverage Submitting changes t GuideStne Financial Resurces in a timely manner Initial filing f Term Life, Persnal Accident and Disability claims Instructing Emplyees and Retirees abut Medical and Dental claim filing prcedures Reprting changes that affect an Emplyee s r Retiree s grup benefits r cverage status t GuideStne Financial Resurces Cunseling Emplyees wh are appraching retirement cncerning the effect retirement will have n their cverage Registering with and reprting t gvernment agencies, when and if required Prviding GuideStne Financial Resurces with Emplyee and Retiree infrmatin and any statistical data needed fr GuideStne Financial Resurces t prperly administer the Prgram Ntifying Emplyees and Retirees f their rights and bligatins under the Prgram Maintaining the minimum Participatin requirements f the Grup Plans. If these requirements are n lnger met, it must be reprted t the Grup Plans Accunt Administratr GROUP PLANS 6/13 Page 9

10 ADMINISTRATIVE RESPONSIBILITIES Distributing Summaries f Benefits and Cverage (SBCs) yu currently ffer t all eligible Emplyees, including emplyees wh have waived ut f Medical cverage, new emplyees and enrlled Emplyees. Yu may find SBCs fr all GuideStne health plans at Distributing the Cntraceptives Ntice and Certificatin t currently enrlled Emplyees GuideStne Financial Resurces respnsibilities Establishing and maintaining Emplyee and Retiree cverage recrds Submitting the Grup Plans Administrative payments t the Claims Administratrs Prviding Emplyers with technical Administrative assistance and benefit plan infrmatin Interpreting plan prvisins Serving as liaisn n escalated claim situatins Preparing and distributing cmmunicatin materials cvering Prgram benefits and claim prcedures Crdinating the verall administratin f the Prgram between participating Emplyers and the Claims Administratrs Designing and instituting Prgram benefits and Administrative changes Reviewing Prgram renewal terms and mdifying rates, when applicable Cntrlling all accunting, statistical and csting functins as they pertain t the financial success f the Prgram GROUP PLANS 6/13 Page 10

11 GENERAL ADMINISTRATIVE GUIDELINES GENERAL ADMINISTRATIVE GUIDELINES General infrmatin This chapter f the manual discusses many f the general plan prvisins and Administrative guidelines that apply t an Emplyer s Participatin in Grup Plans. This chapter des nt discuss specific benefit prvisins r cverage since this infrmatin will vary depending n plan electins made by each participating Emplyer. Fr specific benefit and cverage infrmatin, cnsult the crrespnding Emplyee Bklet. Plan Participatin requirements Minimum Participatin requirements An Emplyer eligible t participate in Grup Plans is: Any church, cnventin, bard, agency, cmmissin, rganizatin r unit affiliated with the Suthern Baptist Cnventin. Or, Nn-Suthern Baptist Cnventin churches and evangelical ministries wh are nt in cnflict with the Suthern Baptist Cnventin and wh, n an n-ging basis, maintains a minimum Participatin requirement f 10 r mre full-time Emplyees. Nte: The minimum Participatin requirement applies t any new Emplyer effective n r after January 1, 1994, fr all churches regardless f their effective date. An Emplyer falling belw the minimum Participatin requirement shwn abve will be given until January 1, fllwing the end f a 12-mnth perid t achieve the necessary Participatin levels. The 12- mnth perid begins n the first mnth the Emplyer falls belw the minimum Participatin requirement. If the Participatin requirement is nt met, cverage will autmatically terminate fr all Emplyees participating in Grup Plans. If a Grup Plan s Emplyer lses eligibility t participate in Grup Plans and cverage is terminated, participating Emplyees may have the ptin f transferring their Term Life, Accident, Medical, Dental, Shrt-Term Disability and Lng-Term Disability cverage int GuideStne Financial Resurces Persnal Plans. Emplyees wh transfer int Persnal Plans will receive benefits and rates accrding t plan prvisins f the Persnal Plans. An Emplyer falling belw the minimum Participatin requirement shwn abve will nt be eligible t upgrade r add cverage until the Participatin requirement has again been met. In rder t transfer back t Grup Plans frm Persnal Plans at a future date, an Emplyer must maintain a minimum f 10 fulltime emplyees in Persnal Plans fr six mnths. The Emplyer wuld then need t g thrugh the grup underwriting prcess and be apprved in rder t be eligible t transfer back t Grup Plans. GROUP PLANS 6/13 Page 11

12 GENERAL ADMINISTRATIVE GUIDELINES Nn-cntributry plans When the full cst f a plan is paid by an Emplyer (Nn-cntributry plans), the same cverage must be prvided t all eligible Emplyees with n individual selectin with regard t any plans. 100% f all eligible Emplyees and dependents must participate in Nn-cntributry plans. If Emplyee and/r dependent cverages are prvided by an Emplyer n a Nn-cntributry basis, and a new Emplyee and/r Eligible Dependent is nt enrlled at the time f his r her initial eligibility, it will be treated as an Administrative errr. The Emplyee and/r Eligible Dependent will be enrlled as f the date f eligibility with the apprpriate back charges. Waiver f Medical and Dental An Emplyee may waive ut f Medical r Dental cverage when the cverage is paid 100% by the Emplyer. A Grup Plans Waiver f Medical/Dental Cverage Frm must be cmpleted, which can be lcated n the website at The waiver allws the Emplyee t pt ut f Nn-cntributry Medical and Dental cverage. The fllwing criteria apply in rder fr the waiver t be apprved: A waiver may be used fr the Emplyee, all dependents r the entire family. An Emplyee may waive cverage nly if the Emplyee/dependent has Medical/Dental cverage elsewhere. If the Emplyee waives cverage, the Emplyee s dependents are nt eligible fr cverage. Emplyers may nt ffer any financial r ther incentives in exchange fr the Emplyee waiving cverage. The Emplyee wh waives cverage des nt cunt fr the 10 Emplyee minimum that the Emplyer must maintain t participate in Grup Plans. The Emplyee/dependent may enrll in the Medical plan later if the requirements fr a Special r Late Enrllee f the plan are met. See the Special and Late Enrllment sectin f this manual. The Emplyee/dependent may enrll in the Dental Plan at any time accrding t the guidelines fr the effective date. The Dental Plan limits benefits fr sme initial perids f cverage. When a waiver frm is submitted t GuideStne and apprved, the date cverage will end will be determined accrding t the Rescissin rules. Refer t the HOW TO PROCESS TERMINATIONS chapter. GROUP PLANS 6/13 Page 12

13 GENERAL ADMINISTRATIVE GUIDELINES Cntributry Plans If the Emplyer s Grup Plans require Emplyees t pay a prtin f the cst (Cntributry plans), 75% f all eligible Emplyees must participate in the plans. The Emplyer must pay at least 50% f the cst f any Cntributry Emplyee cverage. (Participatin requirements and Emplyer cntributin requirements d nt apply t Emplyee and Spuse Persnal Accident Insurance.) If the Emplyer ffers Medical r Dental benefits t Emplyees, the Emplyer must ffer dependent cverage as well. At least 50% f all Eligible Dependents must participate in the Medical and Dental plans. The Emplyer is nt required t pay any f the cst f dependent cverage. If Emplyee and/r dependent cverage is prvided by an Emplyer n a Cntributry basis, and a new Emplyee and/r Eligible Dependent is nt enrlled within 31 days f the Eligibility Date, that Emplyee and/r Eligible Dependent must prvide satisfactry Evidence f Gd Health befre Term Life r Disability cverage will becme effective. The Emplyee and/r Eligible Dependent will nt be able t enrll in a Medical plan until the fllwing January 1 unless Special Enrllment Requirements are met. (See the Special and Late Enrllment sectin f this manual.) Emplyees and Eligible Dependents can enrll in Premier Dental Care Plan, Chice Dental Care Plan r the Guided Dental HMO Plan at any time. Eligible Emplyees All Salaried, full-time Emplyees, (as defined by the Emplyer), that wrk at least the number f hurs that the Emplyer requires t be cnsidered a full-time Emplyee, but nt less than 20 hurs a week, are cnsidered eligible t participate in the Grup Plans. The fllwing classes f Emplyees are nt eligible fr cverage under the plans: Temprary Emplyees Emplyees wh wrk less than 20 hurs per week Waiting Perid This is the perid f time an Emplyee must cmplete t be eligible fr Grup Plans cverage. An Emplyer may elect t have n Waiting Perid. If an Emplyer elects t have a Waiting Perid, the usual Waiting Perid is ne t three mnths f emplyment. The Waiting Perid may be different fr separate Classificatins f Emplyees. (See the Emplyee Classificatins sectin f this chapter.) The Waiting Perid may be waived in cases f a rehired Emplyee if he r she returns t wrk within ne year f his r her riginal terminatin date r fr an Emplyee transferring frm anther Emplyer where the Emplyee had GuideStne Financial Resurces cverage. GROUP PLANS 6/13 Page 13

14 GENERAL ADMINISTRATIVE GUIDELINES Emplyee Classificatins An Emplyer may designate Classificatins f Emplyees. Cntributin arrangements, benefits and Waiting Perids may vary amng these Classificatins. Fr example, an Emplyer may divide Emplyees int Administrative and Nn-administrative Classificatins. The Emplyer may elect t ffer dependent Medical cverage n a Nn-cntributry basis fr Administrative Emplyees and n a Cntributry basis fr Nn-administrative Emplyees. The Emplyer may als elect t have n Waiting Perid fr Administrative Emplyees and a ne mnth Waiting Perid befre cverage becmes effective fr Nnadministrative Emplyees. In rder t prtect against discriminatin n the plans ffered, the Waiting Perid and any cntributin requirements under the Emplyer s Prgram must be applied cnsistently and unifrmly t all Emplyees within the same Emplyee Classificatin. Emplyers with 10 t 24 Emplyees are requested t limit the number f Emplyee Classificatins t tw. Dependent cverage An Emplyee is eligible fr dependent cverage if ne f these is true: The Emplyee has Emplyee cverage under this Plan. The Emplyee used t have Emplyee cverage under this Plan but is nw cvered under ne f GuideStne Financial Resurces plans fr Medicare-eligible Emplyees, Retirees and dependents. Eligible Dependents under the Grup Plans are: The spuse f the Emplyee The Emplyee s Child under age 26 The Emplyee s Child wh was cvered under the Plan and is incapacitated, prvided the fllwing requirements are met: The Child must be develpmentally disabled r physically handicapped and incapable f earning a living. The Child must have been incapacitated when his r her Plan cverage wuld have ended because f age. Prf f incapacitatin must be sent t GuideStne Financial Resurces at least 31 days befre the Child s Plan cverage is scheduled t end. Additinal prf must be sent whenever asked t shw that the Child is still incapacitated under this prvisin. GROUP PLANS 6/13 Page 14

15 GENERAL ADMINISTRATIVE GUIDELINES Children under GuideStne Grup Plans can be any f the fllwing: An Emplyee s r spuse s natural (bilgical) child An Emplyee s r spuse s legally adpted child r a child placed in the hme fr adptin An Emplyee s r spuse s stepchild r fster child An Emplyee s r spuse s unmarried grandchild wh resides with the Emplyee and is dependent n the Emplyee fr supprt and maintenance A child fr whm the Emplyee r spuse must prvide health care by curt rder r rder f a state agency authrized t issue Natinal Medical Supprt Ntices under federal law A child fr whm the Emplyee r spuse is a legal guardian r managing cnservatr The Emplyee s spuse r child is nt an Eligible Dependent while: On active duty in the armed frces f any cuntry Cvered fr health care expenses under the Emplyer s Plan as an Emplyee (N ne can have bth Emplyee cverage and dependent cverage under the Plan thrugh the same Emplyer.) Eligible fr Medicare, and Medicare pays benefits befre this Plan Incapacitated children The Term Life, Medical and Dental benefits f a child apprved as fully incapacitated will nt be terminated when the child reaches the maximum age fr dependent cverage if the child cntinues t be incapacitated and prvided cverage des nt terminate fr any ther reasn. Generally, a child is cnsidered fully incapacitated if he r she is unable t earn a living because f a develpmental disability r physical handicap. Prf that a child is fully incapacitated must be submitted t the Claims Administratr fr apprval 31 days prir t the date the child reaches age 26. The Claims Administratr may peridically request the Emplyee t submit subsequent prf f a child s incapacitating cnditin. GROUP PLANS 6/13 Page 15

16 GENERAL ADMINISTRATIVE GUIDELINES Plan Administrative changes Certain plan administratin infrmatin and recrds n the peratin f an Emplyer s Prgram must be accurately maintained by GuideStne Financial Resurces Insurance Operatins, Grup Plans. This infrmatin includes: Emplyee Classificatins Waiting Perid Cntributins required fr Participatin This infrmatin is determined by the Emplyer when they elect t participate in Grup Plans and is maintained by GuideStne Financial Resurces Insurance Operatins, Grup Plans. T change any f the infrmatin listed abve, cntact GuideStne Financial Resurces Insurance Operatins, Grup Plans, in advance f the change. Yu will be sent an Emplyer Acceptance Agreement n which t recrd the changes and the effective date f change. The cmpleted Emplyer Acceptance Agreement shuld then be returned t GuideStne Financial Resurces fr the change t be prcessed and recrded in the Prgram s master recrds. Refer all questins cncerning Emplyee Classificatins, Waiting Perids and cntributin amunt changes t GuideStne Financial Resurces Insurance Operatins, Grup Plans. GROUP PLANS 6/13 Page 16

17 IMPORTANT TERMS IMPORTANT TERMS This chapter cntains sme f the imprtant terms that are used in cnnectin with the Grup Plans administratin. These terms have a particular and definite meaning. It is imprtant t becme familiar with these terms and t knw hw t use them in cnnectin with the Prgram peratin. Terms Active Disabled An Emplyee wh is disabled but is cnsidered t have current emplyment status. See the Disabled Medicare Beneficiaries sectin f the BASIC MEDICARE INFORMATION chapter f this manual fr mre details. Allwable Expenses The necessary and reasnable Medical and Dental benefits, part r all f which are cvered by the benefit plans cvering the claimant under the Prgram. Annual Re-enrllment Perid The perid each year when participating Emplyees and their Eligible Dependents may transfer between Medical plans ffered by the Emplyer. Or, fr eligible Emplyees and their Eligible Dependents wh did nt elect t enrll in a GuideStne Financial Resurces Medical plan when they first became eligible, the perid when the Emplyee r Eligible Dependent(s) may enrll as a Late Enrllee in a Medical plan. Cverage becmes effective the January 1 fllwing the request fr Emplyers wh have a standard renewal perid. Assignment With respect t Medical and Dental benefits an electin by an Emplyee t have benefits payable frm the plan made directly t the prvider f a service (the hspital, dctr, dentist, etc.). With respect t Term Life and Persnal Accident benefits the right exercised by an Emplyee, in which he r she delivers ver t anther individual all incidents f wnership f cverage, including the right t name r change a Beneficiary. GROUP PLANS 6/13 Page 17

18 IMPORTANT TERMS Beneficiary The persn r persns named by a participating Emplyee t receive the prceeds frm the Term Life, Accidental Death and Dismemberment r Persnal Accident benefit plans in the event f the Emplyee s death. If an Emplyee dies and des nt have a valid Beneficiary designatin(s) n file with GuideStne Financial Resurces, payment will be made in the fllwing rder: The estate f the deceased Emplyee The surviving Spuse The surviving children, in equal shares The surviving parents, in equal shares Care Basic Plan Care Plus Plan Care Tday Plan Certificate f Creditable Cverage The surviving sibling(s), in equal shares A Medicare-crdinating plan ffered t Emplyees, Retirees r cvered dependents fr whm Medicare is the primary payer f claims. The plan prvides benefits fr Medicare Part A services nly and includes Part D prescriptin drug cverage with generic c-pays in the Medicare-designed cverage gap. A Medicare-crdinating plan ffered t Emplyees, Retirees r cvered dependents fr whm Medicare is the primary payer f claims. The plan prvides benefits fr Medicare Part A and B services and includes Part D prescriptin drug cverage with generic c-pays in the Medicare-designed cverage gap. A Medicare-crdinating plan ffered t Emplyees, Retirees r cvered dependents fr whm Medicare is the primary payer f claims. The plan prvides benefits fr bth Medicare Part A and Part B services and Part D prescriptin drug cverage with a Medicare-designed cverage gap. Certificatin prvided t a Participant f a Medical plan by the Medical plan prvider when cverage ends. The certificate may be used by the individual when enrlling int a new Medical plan t reduce the Pre-existing Cnditin Limitatin perid f the new plan. GROUP PLANS 6/13 Page 18

19 IMPORTANT TERMS Claims Administratr Highmark Blue Crss Blue Shield fr the PPO Medical plans Cigna Dental fr the Premier Dental Care Plan, Chice Dental Care Plan and Guided Dental HMO Plan Prvident Life and Accident Insurance Cmpany, a part f Unum Prvident Crpratin fr the Persnal Accident Plan Unum Life Insurance Cmpany f America fr the Term Life, Accidental Death and Dismemberment plans, and Lng- and Shrt-Term Disability Plans Cnversin Privilege An Emplyee s right t cnvert terminated grup Term Life t individual direct payment plicies administered by the Claims Administratr withut being required t furnish Evidence f Gd Health. Plan benefits must be cnverted and paid fr within 31 days after grup cverage stps. Crdinatin f Benefits (COBs) Cntraceptives Ntice and Certificatin The prvisin that guarantees that Emplyees receive all the benefits they shuld, but nt mre than the actual csts f the Medical care received. If tw r mre grup Medical plans cver expenses, ne f the plans is called Primary and the ther(s) Secndary, the primary plan will pay first and will pay the maximum benefit prvided by the plan. The rules fr determining the Primary and Secndary Medical plan may be fund in the Emplyee Bklet. Specifically, ur Medical and Dental benefit plans will pay either benefit in full, r a reduced amunt, which, when added t the benefit paid by anther plan, will equal 100% f the Allwable Expenses incurred by the claimant. GuideStne is wrking with legislatrs and regulatrs t determine hw the cntraceptives part f the wmen s preventive health expansin mandate des and shuld apply t church plans. The White Huse has issued an exemptin fr religius rganizatins that bject t the cntraceptives mandate n religius grunds. GuideStne is invking the Religius Organizatin Temprary Enfrcement Safe Harbr while we wrk with the U.S. Department f Health and Human Services and legislatrs t gain additinal clarity n GROUP PLANS 6/13 Page 19

20 IMPORTANT TERMS hw this t-narrwly defined exemptin applies t church plans. A Ntice and Certificatin is evidence f ur qualificatin fr the Temprary Enfrcement Safe Harbr. C-payment Under the Medical and Dental benefit plans, the part f the Allwable Expenses paid by the participating Emplyee. Cvered Dental Expenses Cvered Medical Expenses The usual charges f a dentist. Supplies which are necessary fr treatment f a Dental cnditin, but nly t the extent that such charges are within reasnable and custmary fees fr services and supplies custmarily emplyed fr treatment f that cnditin, and nly if rendered in accrdance with accepted standards f Dental practice. The expenses fr certain hspital and ther Medical services and supplies incurred by a claimant in cnnectin with treatment f an injury r disease. Creditable Cverage Fr Medical cverage, the amunt f previus cverage (measured in mnths) used t reduce the Pre-existing Cnditin Limitatin perid. Deductible Dental Health Maintenance Organizatin (DHMO) The amunt an Emplyee must pay each calendar year befre benefits are payable under the PPO Medical Plans, the Premier Dental Care Plan r Chice Dental Care Plan. A managed Dental Care Plan ffered by Emplyers t Emplyees wh reside in a service area established by the Dental insurance prvider. Netwrk prviders must be used t receive benefits frm the plan. The Guided Dental HMO Plan ffered thrugh Cigna Dental ffers Dental cverage thrugh a Dental HMO Plan. GROUP PLANS 6/13 Page 20

21 IMPORTANT TERMS Disability Shrt-Term Any sickness r injury that limits a cvered Emplyee frm perfrming the material and substantial duties f his/her regular ccupatin fr a perid f time established by the plan, and the Emplyee has a 20% r mre lss in weekly earnings. Sme disabilities may nt be cvered. Lng-Term Fr the initial perid defined by the plan, any sickness r injury that limits a cvered Emplyee frm perfrming the material and substantial duties f his/her regular ccupatin and results in a 20% r mre lss in mnthly earnings. After the initial perid, due t the same sickness r injury, the Emplyee is unable t perfrm the material and substantial duties f any gainful ccupatin fr which he r she is reasnably fitted by educatin, training r experience. Sme disabilities may nt be cvered. Effective Date The date the Emplyer enters the Grup Plans and the date an Emplyee s cverage begins under the Prgram. Eligible Dependents Emplyee s spuse: A spuse is a persn f the ppsite sex t whm the Emplyee is married at the relevant time by a religius r civil ceremny effective under the laws f the state in which the marriage was cntracted. Emplyee s Child under age 26 fr Medical and Dental cverage. Fr Child life cverage, the dependent must be at least 14 days ld. A Child is defined as: An Emplyee s r spuse s natural (bilgical) Child An Emplyee s r spuse s legally adpted Child r a Child placed in the hme fr adptin An Emplyee s r spuse s stepchild r fster Child An Emplyee s r spuse s unmarried grandchild wh resides with the Emplyee and is dependent n the Emplyee fr supprt GROUP PLANS 6/13 Page 21

22 IMPORTANT TERMS and maintenance A child fr whm the Emplyee r spuse must prvide health care by curt rder r rder f a state agency authrized t issue Natinal Medical Supprt Ntices under federal law A child fr whm the Emplyee r spuse is a legal guardian r managing cnservatr Fr Medical expenses prvided the newbrn child is under 31 days ld and incurs charges fr treatment f a disease, injury r cngenital abnrmality. Eligibility Date Emplyee Emplyee s Child wh was cvered under the Plan and is incapacitated. The Child must meet all f these rules: The Child must be develpmentally disabled r physically handicapped and incapable f earning a living. The Child must have been incapacitated when his r her Plan cverage wuld have ended because f age. The Emplyee must send GuideStne Financial Resurces prf f incapacitatin at least 31 days befre the Child s plan cverage is scheduled t end. The Emplyee must send additinal prf whenever asked t shw that the Child is still incapacitated under this prvisin. The Term Life, Medical and Dental benefit f a fully incapacitated Child will nt be terminated when the Child reaches the maximum age fr dependent cverage if the Child cntinues t be incapacitated and prvided cverage des nt terminate fr any ther reasn. The date an Emplyee meets the requirements fr Participatin in the plans prvided under the Grup Plans. A persn emplyed by the Emplyer. Emplyee Classificatin The grup r grups f Emplyees the Emplyer includes as being eligible fr cverage under the Grup Plans. All Emplyees f the Emplyer may belng t the same grup GROUP PLANS 6/13 Page 22

23 IMPORTANT TERMS r be divided int tw r mre grups such as Administrative and Nn-administrative, etc. T prtect against discriminatin, the plans ffered, the Waiting Perid and any cntributin requirements under the Emplyer s Prgram must be applied cnsistently and unifrmly t all Emplyees within the same Emplyee Classificatin. Emplyers with 10 t 24 Emplyees are requested t limit the number f Emplyee Classificatins t tw. Emplyer Emplyer Acceptance Agreement (EAA) Emplyer Access Emplyer Base Plan Enrllment Date Expanded Ministry Any eligible church, agency r institutin affiliated with, r sharing cmmn religius bnds with, the Suthern Baptist Cnventin are eligible t participate in a church plan as defined under the Emplyee Retirement Incme Security Act (ERISA) f 1974, as amended. Emplyers must cntinue t meet certain Participatin requirements n an nging basis. See Plan Participatin Requirements in the GENERAL ADMINISTRATIVE GUIDELINES chapter f this manual fr specific infrmatin. A dcument that is used when an Emplyer enrlls in Grup Plans r makes changes t their existing cverage. The dcument utlines Participatin requirements, rates, benefits, terms and cnditins, and ther critical data and is signed by the Emplyer s authrized representative. An nline service available t Emplyers at n cst. Allws Emplyers t view plan and filing infrmatin fr their insurance prgram, make certain changes fr Emplyees nline, submit ther types f changes nline, pay bills nline, view payment histry and run billing inquiries and reprts. Emplyer Access is designed t save bth time and mney. Cverage elected by the Emplyer thrugh Grup Plans and prvided r ffered t Emplyees. The date a new Emplyee meets the requirements fr Participatin in the plans prvided under Grup Plans and elects t enrll him r herself and his r her dependent(s) in the plan(s). Fr a Special Enrllee, the date the Emplyee and/r his Eligible Dependent(s) becme eligible due t a Qualifying Event. Fr a Late Enrllee, the January 1 fllwing the request fr cverage fr Emplyers wh have a standard renewal perid. Nn-SBC churches and ministry rganizatins wh are generally regarded as evangelical ministries and wh are nt GROUP PLANS 6/13 Page 23

24 IMPORTANT TERMS in cnflict with the Suthern Baptist Cnventin. Express Scripts Grup Plans Health Care Prvider Health Care Refrm HIPAA Late Enrllee Administers the Hme Delivery Pharmacy Service prescriptin drug prgram fr prescriptin maintenance medicatins (drugs taken n an n-ging basis) and the retail netwrk pharmacy service (drugs taken n a shrt-term basis). A multiple-emplyer grup health plan made available by GuideStne Financial Resurces f the Suthern Baptist Cnventin t eligible Emplyers with 10 r mre eligible Emplyees and their dependents, and is intended t be a church plan as defined in 3(33) f ERISA and 414(e) f the Internal Revenue Cde. A physician, hspital r Medical facility that prvides health care services. A general term that encmpasses the changes t health care plans resulting frm passage f the 2010 Patient Prtectin and Affrdable Care Act (PPACA). Examples f the changes include extending the maximum age fr dependents t age 26 and remving Pre-existing Cnditin Limitatins fr any Participant under the age f 19. The Health Insurance Prtability and Accuntability Act f 1996 (HIPAA) and its regulatins (the Privacy Rule and the Security Rule ) prtect the privacy f an individual s health infrmatin and gvern the way certain Health Care Prviders and benefits plans cllect, maintain, use and disclse Prtected Health Infrmatin (PHI). An individual wh requests enrllment in a Medical plan mre than 31 days after his r her initial eligibility. Cverage becmes effective n the January 1 fllwing the request fr Emplyers wh have a standard renewal perid. Lk Back Perid Medicare Fr Medical cverage, the six-mnth perid f time prir t a new Emplyee s hire date that is used t determine preexisting cnditins. Fr a Special r Late Enrllee, the date used fr the lk back perid is the cverage effective date. Medical benefits prvided by Scial Security when a persn reaches age 65 r is disabled. Part A is hspital cverage and pays fr Medical inpatient care and, in sme circumstances, pst-hspital services in a nursing facility r GROUP PLANS 6/13 Page 24

25 IMPORTANT TERMS the patient s hme. Part B is supplemental Medical cverage (i.e., dctr s csts, utpatient hspital services, etc.) and ther services and supplies nt cvered by Part A f Medicare. Medicare-crdinating Plan MHPA NMHPA Nn-cntributry Plans PAID Prescriptins, L.L.C. Participant Participatin A Medical plan designed t crdinate with Medicare and pay sme Medical and prescriptin drug csts nt paid by Medicare. The Mental Health Parity Act f 1996 is a federal law affecting cverage limits fr mental health benefits. The Newbrns and Mthers Health Prtectin Act f 1996 is a federal law which gverns hw lng health plans must permit a mther and newbrn t spend in the hspital fllwing birth. Under these plans, the entire cst f cverage is paid by the Emplyer. Since n Emplyee cntributins are required fr Participatin, all Emplyees and dependents meeting the eligibility requirements f the plans must be included fr cverage. A divisin f Express Scripts prvides acute prescriptin drugs, taken n a shrt-term basis, with a small c-payment fr each prescriptin filled at a participating pharmacy. An Emplyee r Eligible Dependent wh is enrlled in any plan(s) in Grup Plans. Membership in Grup Plans. Payment Management A way f mving mney electrnically withut the use f paper. The Emplyer may make a ne-time payment nline using Emplyer Access r set up a recurring mnthly payment fr their insurance billing. Prtability Pst-retirement A prvisin that allws Participants, with evidence f insurability, t cntinue Term Life and Accidental Death and Dismemberment cverage directly with the Term Life carrier at grup rates when the cverage wuld therwise end. Cverage cntinued int retirement. PPO Health Plans Health Plans ffered which may require an annual deductible and annual c-payment amunt. GROUP PLANS 6/13 Page 25

26 IMPORTANT TERMS Preauthrizatin A determinatin made by Highmark BCBS f the medical necessity f a PPO Medical Plan Participant s admissin t a hspital r treatment facility: Services include: Preauthrizatin fr inpatient hspital stays r inpatient treatment f substance abuse and mental illness. Preauthrizatin is nly a determinatin that an admissin r prcedure is medically necessary and des nt guarantee autmatic payment f claims. Emplyees must cmply with these prvisins in rder t receive maximum benefits under the Medical plan. (See bklet fr details.) Pre-existing Cnditin Discharge Planning This prcess keeps track f a hspitalized Participant s recvery prcess. Medical review specialists cntact the patient s dctr t determine if an extensin f stay is needed and wrks with the patient and his r her dctr t arrange fr hme health care, rehabilitatin r ther services when apprpriate. This applies t illnesses r injuries fr which Medical advice, diagnsis, care r treatment was recmmended r received during the six mnths prir t the hire date f a new Emplyee r effective date f a current Emplyee fr Medical cverage. Pre-existing cnditins d nt apply t any Participant under the age f 19. Pre-existing Cnditin Limitatin Perid Preferred Prvider Organizatin (PPO) This is the 12-mnth perid during which benefits fr preexisting cnditins are limited r excluded fr Medical cverage. This perid begins with the hire date fr new hires. This perid begins with the cverage effective date fr Special r Late Enrllees. Pre-existing cnditins d nt apply t any Participant under the age f 19. A netwrk f lcal physicians, hspitals and ther Health Care Prviders wh have agreed t prvide quality health care at discunted prices. Under the PPO Medical Plans, Emplyees and their dependents have the ptin t access PPO prviders and receive an increased level f benefits. GROUP PLANS 6/13 Page 26

27 IMPORTANT TERMS Emplyees f Emplyers lcated utside the PPO service area may travel t a PPO service area and receive a higher level f benefits. Premium Waiver If a participating Emplyee under age 60 becmes permanently and ttally disabled, and has been ttally disabled fr nine mnths, Term Life, Accidental Death and Dismemberment and Persnal Accident cverage may be cntinued, withut payment f charges, during the perid f Disability up t age 70. Prf f Disability must be submitted t and apprved by the Claims Administratr befre the extensin f cverage takes effect. Pretreatment Review f Dental Benefits Prtected Health Infrmatin (PHI) Prgram Prvider f Service Qualifying Event Reasnable and Custmary A system that allws a Participant and his r her Dental Care Prvider t knw in advance what estimated benefits wuld be payable under the Premier Dental Care Plan and Chice Dental Care Plan fr a prpsed curse f treatment. Any infrmatin abut an individual s health that reveals (r can be used as a reasnable basis t reveal) the identity f the individual. This infrmatin can relate t the past, present r future physical r mental health cnditin f an individual, infrmatin abut the health care services prvided t an individual r payment fr health care services prvided t an individual. The cverage r benefits prvided under Grup Plans t a participating Emplyer and ffered t the Emplyees f an Emplyer. The plans may differ amng participating Emplyers. Any accredited Medical facility, licensed physician, licensed qualified dentist r labratry that prvides Medical services r supplies. An event which allws an eligible Emplyee wh elected nt t enrll himself r his r her Eligible Dependent(s) in a GuideStne Financial Resurces Medical plan when the Emplyee r his r her dependent(s) first became eligible, t enrll him r herself and/r his r her Eligible Dependent(s) in the plan as a Special Enrllee. This is the amunt that is cvered under the PPO Medical Plans, Premier Dental Care Plan r Chice Dental Care Plan fr a Medical r Dental service r supply. This amunt is the lesser f: GROUP PLANS 6/13 Page 27

28 IMPORTANT TERMS The charge usually made by the prvider wh furnishes it. Rescissin The custmary charge made by thse f similar prfessinal standing in the same gegraphic area. Under the Health Care Refrm rules, any retractive cancellatin (Rescissin) f a Participant s Medical cverage is prhibited except in certain situatins: fraud r intentinal misrepresentatin f a material fact r nn-payment f premiums. Salary Salary means yur grss annual incme frm services frm Suthern Baptist Emplyment r apprved Expanded Ministries grup. It may include yur ttal incme just befre taxes and befre any deductins made fr pretax cntributins t a qualified deferred cmpensatin plan, Sectin 403(b) annuity, Sectin 125 plan, r flexible spending accunt. It may include incme actually received frm bnuses, vertime pay, husing allwance r any ther extra cmpensatin, r incme received frm surces as last reprted t GuideStne Financial Resurces. Nte: This definitin must be used unifrmly fr all Emplyees in determining amunts f Term Life cverage and Disability benefits. Senir Plan Senir Plus Plan Service Area A Medicare-crdinating plan ffered t Emplyees, Retirees r cvered dependents fr whm Medicare is the primary payer f claims. The plan prvides benefits fr Medicare Part A services nly. A Medicare-crdinating plan ffered t Emplyees, Retirees r cvered dependents fr whm Medicare is the primary payer f claims. The plan prvides benefits fr bth Medicare Part A and Part B services. The gegraphical area serviced by a PPO r Dental HMO. Special Enrllee An individual wh enrlls in a Medical plan after meeting Special Enrllment Requirements. GROUP PLANS 6/13 Page 28

29 IMPORTANT TERMS Special Enrllment Requirement Summary f Benefits and Cverage (SBC) Surviving Spuse When an individual is allwed t enrll him r herself and/r his r her dependents in a Medical plan within the specified time frame f a Qualifying Event, such as acquiring a dependent thrugh marriage, birth, adptin, r placement fr adptin r lss f ther cverage. The Summary f Benefits and Cverage (SBC) was created t help cnsumers mre easily understand their insurance benefits and cmpare plans apples-t-apples. The Health Care Refrm law requires all health plan spnsrs t prvide SBCs t participants. The spuse wh was a cvered dependent n the Emplyee s Grup Plan cverage and therefre eligible t cntinue certain cverage as a Surviving Spuse after the Emplyee s death. Waiting Perid The perid f time an Emplyee must be emplyed in rder t becme eligible fr benefits under the Prgram prvided by the Emplyer. Waiver f Medical/Dental Cverage Fr the Premier Dental Care Plan and Chice Dental Care Plans, the perid f time a Participant must be cvered under the Plan befre benefits are paid fr certain services. A prvisin that allws an Emplyee t waive ut f Medical/Dental cverage when the cverage is paid 100% by the Emplyer and certain requirements are met. Waiver f Payment A prvisin allwing an Emplyee wh becmes ttally disabled prir t age 60 t cntinue Term Life, Persnal Accident and Accidental Death and Dismemberment cverage at n cst t the Emplyee up t age 70. See Premium Waiver. GROUP PLANS 6/13 Page 29

30 HOW TO PROCESS MONTHLY BILLING STATEMENTS HOW TO PROCESS MONTHLY BILLING STATEMENTS General infrmatin On apprximately the 9th day f each mnth, GuideStne Financial Resurces Insurance Operatins, Grup Plans will send yu a billing statement fr payments due under Grup Plans. The statement will be fr cverage in frce during the next mnth. The statement shws the name and basic cverage rate infrmatin fr each Emplyee participating in Grup Plans. This cverage varies accrding t yur particular Prgram. The mnthly billing statement must be PAID AS BILLED. Please d nt make changes t the statement r adjust the charged amunts shwn. If a change shuld be made that affects Emplyee rates, d nt reprt changes with yur payment. Reprt changes t GuideStne Financial Resurces Insurance Operatins, Grup Plans. If received by the 1st f the mnth, the change will be reflected n yur next billing statement, alng with any adjustment due. Payment fr the mnthly charges due and the detachable prtin f the recap page f yur statement shuld be received by GuideStne Financial Resurces by the 1st f the mnth fr which cverage is being billed. GROUP PLANS 6/13 Page 30

31 HOW TO PROCESS MONTHLY BILLING STATEMENTS Past due accunts Grup Plans limit the number f mnths an accunt may remain in a past due status t tw mnths. If yur accunt becmes tw mnths past due, yu will be given until the end f the mnth t bring yur accunt payments up-t-date. If GuideStne Financial Resurces has nt received payment by the end f the mnth, and n payment arrangements have been made, yur grup s cverage will be canceled. Fr example: Calendar Aug. 9 Current statement is created fr September cverage. Sept. 9 Past due statement is created fr September n the Octber billing statement. Sept. 1 September payment is due. Oct. 1 September and Octber payments are nw due. Past due letter will be sent t the Emplyer. Oct. 31 September and Octber payments must be received by GuideStne Financial Resurces t avid cancellatin. Descriptin f plan names Listed belw are descriptins f the plan names that appear n the Grup Plans billing statement. Billing Cde ABASIC ABSRW ABSR+W AD&D APLUS ATODAY CHLTD CHSTD CLIFE DENT DENTCH DENTPR DENTMO Plan Descriptin Care Basic Plan fr active Emplyees and their dependents Senir Plan fr active Emplyees and their dependents Senir Plus Plan fr active Emplyees and their dependents Emplyee Accidental Death and Dismemberment Plan Care Plus Plan fr active Emplyees and their dependents Care Tday Plan fr active Emplyees and their dependents Chice Lng-Term Disability Chice Shrt-Term Disability Child Term Life Plan Cmbinatin Premier Dental, Chice Dental and Guided Dental HMO plans Chice Dental Care Plan Premier Dental Care Plan Guided Dental HMO Plan GROUP PLANS 6/13 Page 31

32 HOW TO PROCESS MONTHLY BILLING STATEMENTS DIS ECLTD ECSTD ELIFE EPAI EXC50 EXC70 EXP50 EXP70 HHC0500 HHC1000 HHC2000 HHC3000 HHC5000 HHL0200 HDHP26 HDHP28 HDHP30 HH Medical HHT0080 LTED LTSD OLIFE PLIFE PRLTD PRSTD RBASIC Cmbinatin f Premier, Chice and Ecnmy Lng-Term Disability Plans, Premier, Chice and Ecnmy Shrt-Term Disability Plans and Executive Lng-Term Disability Plan Ecnmy Lng-Term Disability Ecnmy Shrt-Term Disability Emplyee Term Life Emplyee Persnal Accident Plan Executive Chice 50 Lng-Term Disability Executive Chice 70 Lng-Term Disability Executive Premier 50 Lng-Term Disability Executive Premier 70 Lng-Term Disability Highmark Blue Crss Blue Shield Health Chice 500 Highmark Blue Crss Blue Shield Health Chice 1000 Highmark Blue Crss Blue Shield Health Chice 2000 Highmark Blue Crss Blue Shield Health Chice 3000 Highmark Blue Crss Blue Shield Health Chice 5000 Highmark Blue Crss Blue Shield Health Legacy 200 Highmark Blue Crss Blue Shield Health Saver 2600 Highmark Blue Crss Blue Shield Health Saver 2800 Highmark Blue Crss Blue Shield Health Saver 3000 Cmbinatin f Highmark Blue Crss Blue Shield PPO Medical Plans: Health Chice 500, 1000, 2000, 3000, 5000, Health Legacy 200, Health Tday, Health Saver 2600, 2800 and 3000 Highmark Blue Crss Blue Shield Health Tday Ecnmy Lng-Term Disability Plan (clsed t new Participants) Standard Lng-Term Disability Plan (clsed t new Participants) Emplyee Optinal Term Life Pst Retirement Life Plan (clsed t new Participants) Premier Lng-Term Disability Plan Premier Shrt-Term Disability Plan Care Basic Plan fr retired r inactive Emplyees and their dependents GROUP PLANS 6/13 Page 32

33 HOW TO PROCESS MONTHLY BILLING STATEMENTS RETSRW RETSR+W RLIFE RPLUS RTODAY SLIFE SOLIFE SPAI STED STSD WLIFE Senir Plan fr retired r inactive Emplyees and their dependents Senir Plus Plan fr retired r inactive Emplyees and their dependents Retiree Term Life Plan Care Plus Plan fr retired r inactive Emplyees and their dependents Care Tday fr retired r inactive Emplyees and their dependents Spuse Term Life Plan Spuse Optinal Term Life Plan Spuse Persnal Accident Plan Ecnmy Shrt-Term Disability Plan (clsed t new Participants) Standard Shrt-Term Disability Plan (clsed t new Participants) Widw Term Life Plan Back credits When a back credit is payable, it will appear n yur mnthly statement n the line belw the apprpriate cverage. A back credit wuld result if a terminatin f an Emplyee, dependent r prduct is reprted and prcessed t late t be reflected in a current billing statement. The statement prepared fr the next mnth wuld then reflect a credit due the Emplyer fr the terminatin. Nte: Grup Plans limit back credit t tw billed mnths fr retractive changes. Back charges If ntificatin f a change is delayed, a back charge t the effective date may appear n yur mnthly statement. When a back charge is due, it appears n the line belw the apprpriate cverage. Back charges may be billed fr: Additin f new Emplyees r dependents Increase t existing cverage Additin f a new cverage Cmputatin f charges The basis fr cmputing yur mnthly charges and credits is as fllws: GROUP PLANS 6/13 Page 33

34 HOW TO PROCESS MONTHLY BILLING STATEMENTS Enrllments Fr new Emplyees and their Eligible Dependents whse cverage becmes effective n r befre the 15th day f a mnth, a charge will be made fr that mnth. Example: Assume an Emplyee is hired August 6 and the Emplyer s Prgram has a ne mnth Waiting Perid befre cverage becmes effective. Cverage becmes effective September 6, and charges are made fr the mnth f September. Fr Participants whse cverage becmes effective n r after the 16th day f the mnth, there will be n charge fr the mnth. The first charge fr the cverage will be fr the mnth fllwing enrllment. Example: Assume an Emplyee is hired August 20, and the Emplyer s Prgram has n Waiting Perid. Cverage becmes effective August 20, but n charges are made fr August. Charges will be reflected beginning n the Emplyer s September billing statement. Terminatins If the effective date f a terminatin is n r befre the 15th f the mnth, n charge will be made fr the mnth. Benefits will cease n the day after the last day wrked (r the last day the Participant was eligible fr cverage). Example: Assume an Emplyee terminates emplyment n September 9. N charges are made fr the Emplyee s cverage fr the mnth f September. Benefits cease n September 10. If cverage is terminated n r after the 16th f the mnth, benefits will cease n the day after the last day wrked (r the last day the Participant was eligible fr cverage), and there will be a charge fr the mnth. Example: Assume an Emplyee s dependent with Medical cverage reaches age 26 n September 22 and is n lnger an Eligible Dependent. Charges are made fr dependent Medical cverage fr the mnth f September but the dependent s Medical cverage ceases n his r her 26th birthday. Nte: The effective date requested fr terminatin f Medical cverage may be adjusted t cmply with Rescissin rules. Refer t the HOW TO PROCESS TERMINATIONS chapter. Prcedures fr prcessing the mnthly billing statement Prcess the mnthly billing statement as fllws: 1. Review the name and cverage f each Emplyee listed n the statement. Pay particular attentin t the fllwing: The Emplyee s mnthly Salary (runded up t the next whle dllar) is shwn t the right f the Emplyee s Scial Security number. GROUP PLANS 6/13 Page 34

35 HOW TO PROCESS MONTHLY BILLING STATEMENTS Cverage fr Term Life, Emplyee Optinal Term Life, Spuse Term Life, Spuse Optinal Term Life, Accidental Death and Dismemberment and Emplyee and Spuse Persnal Accident are shwn in terms f vlume. The charge fr each plan is shwn in the clumns ppsite the cverage amunt. Emplyee mnthly charges are summarized at the far right in the clumn headed Ttal Charge. Retractive adjustments identify a frm and thrugh date fr the time perid f adjustment. 2. Review the Emplyer recap n the first page f the billing statement. The recap summarizes the number f members cvered and charges payable fr each plan r plan categry. Adjustments, when necessary, are itemized by plan r plan categry. 3. Except fr reprting Salary changes fr all Emplyees, d nt change r alter the Emplyee cverage and rate infrmatin. Changes received by the 1st f the mnth will appear n yur next mnth s billing statement. Reprt any discrepancies n a separate transmittal and send it prmptly t: Insurance Operatins, Grup Plans GuideStne Financial Resurces, SBC 2401 Cedar Springs Rad Dallas, TX Nte: D nt send payments t this address. 4. After the billing statement has been fully reviewed and any discrepancies nted n a separate transmittal, prepare a check (except fr accunts using Emplyer Access Payment Management) fr the Ttal Amunt Due as shwn n the recap page. D nt include payments fr any ther GuideStne Financial Resurces plans r prgrams with yur Grup Plans payment. Please pay as billed. D nt deduct fr terminated cverage. Apprpriate credit will be reflected n the next mnth s billing statement. Make the check payable t GuideStne Financial Resurces f the Suthern Baptist Cnventin. Payment is due by the 1st day f the mnth fr which cverage is being billed. 5. Retain a cpy f the billing statement in yur permanent Grup Plans file. GROUP PLANS 6/13 Page 35

36 HOW TO PROCESS MONTHLY BILLING STATEMENTS 6. Send the riginal detachable prtin f the recap page f the billing statement and a check (except fr accunts using Emplyer Access Payment Management) fr the ttal mnthly payment due t the address n the return envelpe enclsed with the billing: Insurance Operatins GuideStne Financial Resurces, SBC P.O. Bx Dallas, TX Nte: The abve address is t be used nly fr payments. GROUP PLANS 6/13 Page 36

37 HOW TO PROCESS MONTHLY BILLING STATEMENTS Payment Management General infrmatin Payment Management is a way f mving mney electrnically withut the use f paper. This type f bill payment will allw an Emplyer t pay fr Grup Plans cverage by authrizing mney t be transferred frm the Emplyer s checking r savings accunt each mnth as a recurrent payment r a ne-time payment. Advantages f Payment Management Eliminates writing checks Saves time and mney Increases the accuracy f payments Reduces the risk f lst checks Hw t sign up fr Payment Management Enrll using Emplyer Access by selecting the Insurance Billing tab. Call GuideStne Financial Resurces tll free number, GUIDE ( ), r yur Grup Plans Accunt Administratr, and request a Payment Management Draft Authrizatin Frm. This frm may als be accessed by ging t the GuideStne Financial Resurces website at: Cmplete the authrizatin frm and return it t GuideStne Financial Resurces. Once yur financial institutin is prepared t prcess scheduled mnthly Payment Management transactins n the Emplyer s accunt, GuideStne Financial Resurces will ntify the Emplyer by mail f the date f the first transmissin. Cntinue t mail in the mnthly payment until ntified that Payment Management withdrawals have been established. Please cntact yur Grup Plans Accunt Administratr fr instructins if yur accunt is past due. Hw t edit Payment Management withdrawals Yu can edit Payment Management withdrawals by using Emplyer Access and selecting the Insurance Billing tab t edit Payment Management withdrawals by cntacting yur Grup Plans Accunt Administratr. Please allw sufficient time when requesting a Payment Management change. GROUP PLANS 6/13 Page 37

38 HOW TO PROCESS MONTHLY BILLING STATEMENTS Hw t stp making Payment Management withdrawals Use Emplyer Access by selecting the Insurance Billing tab t stp Payment Management withdrawals. Call GuideStne Financial Resurces tll free number t request a Payment Management Terminatin Frm. This frm may als be accessed by ging t the GuideStne Financial Resurces website at Cmplete the frm and return it t GuideStne Financial Resurces. Terminatin requests received less than 10 days prir t the debit prcessing date may nt be cmpleted befre the next debit. Please allw sufficient time when requesting terminatin f Payment Management debits. GROUP PLANS 6/13 Page 38

39 HOW TO PROCESS ENROLLMENTS HOW TO PROCESS ENROLLMENTS New emplyees The Grup Plans benefits prvided by the Emplyer and any required Emplyee cntributins shuld be fully explained t each new Emplyee. A sample f a suggested Enrllment Checklist that may help yu in prviding this infrmatin is shwn in the Prcedures sectin f this chapter. Prmpt enrllment is imprtant. Enrllment Frms fr new Emplyees shuld be cmpleted at the time f hire and mailed r faxed prmptly t GuideStne Financial Resurces Insurance Operatins, Grup Plans. This assures that cverage will becme effective n the first day f eligibility and avids requiring the Emplyee t submit the Evidence f Gd Health Applicatin at a later date r delay f cverage. (See the HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION chapter in this manual.) Nte: Delaying submissin f Enrllment Frms fr Medical cverage can result in denial f cverage until the annual pen enrllment perid. Fr Emplyers with a standard renewal perid, Medical cverage wuld nt be effective until the fllwing January 1. Eligible emplyees All regular, full-time Emplyees f the Emplyer are eligible fr cverage, prvided they meet the eligibility prvisins f the plans. The fllwing classes f Emplyees are nt eligible fr cverage under the plans: Temprary Emplyees Emplyees wh wrk less than 20 hurs per week Cntributry vs. Nn-cntributry plans The Emplyer may elect t pay a part r all f the charges fr these Emplyee benefits. The tw funding appraches are utlined in the GENERAL ADMINISTRATIVE GUIDELINES chapter f this manual. T summarize, the Emplyer chses t ffer each plan t its Emplyees in ne f the fllwing ways: Nn-cntributry Plan(s) The charges fr cverage are paid entirely by the Emplyer. Emplyees and dependents that meet eligibility requirements must be enrlled in the plan(s). Cverage becmes effective n the date the Emplyee r dependent first becmes eligible. Emplyees d nt cntribute tward the cst f the Prgram. GROUP PLANS 6/13 Page 39

40 HOW TO PROCESS ENROLLMENTS Cntributry Plan(s) - The charges fr cverage are paid by participating Emplyees r jintly by Emplyer and cvered Emplyees. Eligible Emplyees and dependents receive cverage if they elect t enrll in the plan(s) within 31 days f the Eligibility Date and agree t make cntributins tward the cst f the Prgram. Emplyees d cntribute tward the cst f cverage under Cntributry plans. Refer t the GENERAL ADMINISTRATIVE GUIDELINES chapter f this manual fr detailed Emplyee and dependent eligibility requirements. When emplyee cverage becmes effective The date cverage becmes effective depends n the length f the Waiting Perid, if any, and whether the Emplyer s plans are Nn-cntributry r Cntributry. Nn-cntributry Plans This cverage becmes effective n the Emplyee s Eligibility Date. Cntributry Plans This cverage als becmes effective n the Emplyee s Eligibility Date if the date f signature n the cmpleted Enrllment Frm is within 31 days f the Emplyee s Eligibility Date. If the Enrllment Frm is nt signed within 31 days f the Emplyee s Eligibility Date: Life r Disability cverage will becme effective when satisfactry Evidence f Gd Health is apprved. (See the HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION chapter in this manual.) Emplyees can enrll in Premier Dental Care, Chice Dental Care r the Guided Dental HMO Plans at any time. Emplyee Persnal Accident r Accidental Death and Dismemberment (AD&D) cverage will becme effective n the date the cmpleted Enrllment Frm is received. Emplyee Life cverage is a prerequisite fr Accidental Death and Dismemberment cverage. The Emplyee Optinal Term Life Plan requires cmpletin f an Evidence f Gd Health Applicatin. This cverage becmes effective when the Evidence f Gd Health Applicatin is apprved by the Claims Administratr. Nte: If the Emplyee is away frm wrk n the date cverage wuld nrmally becme effective, Term Life, Accidental Death and Dismemberment, Dental, Disability and Persnal Accident cverage will nt becme effective until the Emplyee returns t fulltime wrk fr ne full day. This rule als applies t increases in cverage nce an Emplyee is a Participant. GROUP PLANS 6/13 Page 40

41 HOW TO PROCESS ENROLLMENTS When dependent cverage becmes effective Nn-cntributry Plans This cverage becmes effective n the Emplyee s Eligibility Date. Cntributry Plans This cverage als becmes effective n the Emplyee s Eligibility Date if the date f signature n the cmpleted Enrllment Frm is within 31 days f the Emplyee s Eligibility Date. If it is nt signed within 31 days f the Emplyee s Eligibility Date: Term Life cverage will becme effective when satisfactry Evidence f Gd Health is apprved, prvided the Emplyee is enrlled. (See the HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION chapter in this manual.) The Dependent cannt enrll in a Medical plan until the Annual Re-enrllment perid unless Special Enrllment Requirements are met. (See the SPECIAL AND LATE ENROLLMENT chapter in this manual.) Dependents can enrll in the Premier Dental Care Plan, Chice Dental Care Plan r the Guided Dental HMO Plan at any time, prvided the Emplyee is enrlled. Spuse Persnal Accident cverage will becme effective n the date the cmpleted Enrllment Frm is received, prvided the Emplyee is enrlled. Spuse Optinal Term Life cverage will becme effective when the Evidence f Gd Health Applicatin is apprved by the Claims Administratr. Nte: Benefits fr Child Term Life cverage d nt begin befre the 14th day f life. Rehired emplyees A terminated Emplyee wh is rehired within ne year is eligible fr waiver f the Waiting Perid. A rehire ccurring after ne year f the date f terminatin shuld be treated as a new Emplyee. Re-enrll the Emplyee in either instance, accrding t the prcedures shwn fr new Emplyees. Enrllment and rientatin The Grup Plans prvided by the Emplyer shuld be explained in detail in the Emplyee s rientatin. Once the cverage has been explained, have the Emplyee cmplete a Grup Plans Enrllment Frm and, if applicable, an Evidence f Gd Health Applicatin. T speed the actual enrllment prcess and help guarantee the accuracy f the basic data needed fr recrd keeping, we recmmend that yu type the basic Emplyee and emplyment infrmatin n the GROUP PLANS 6/13 Page 41

42 HOW TO PROCESS ENROLLMENTS Grup Plans Enrllment Frm befre yu meet with the new Emplyee. See the Prcedures sectin f this chapter fr specific infrmatin and instructins. Enrllment prcedures Discuss the fllwing with the new Emplyee: The eligibility requirements f the plans and when cverage will becme effective The amunt f the Emplyee s required cntributins (if any) and hw the payrll deductin amunt is determined When persnal Emplyee and dependent status changes shuld be reprted t yu The basic types f Term Life cverage Beneficiary designatins that may be used The basic plan prvisins and benefits prvided by the plans The Preauthrizatin requirements and prcedures f the Medical plan, if applicable The Pre-existing Cnditin Limitatins f the Medical plan, if applicable, including the applicatin f prir Creditable Cverage t the Pre-existing Cnditin Limitatin Perid Hme Delivery Pharmacy Service and Prescriptin Drug Prgram, if applicable The Waiting Perids f the Dental Plan, if applicable The effect f retirement r terminatin f emplyment n Grup Plans cverage The suggested Enrllment Checklist shwn n the next few pages may be cpied and used when yu discuss the basic prvisins and cverage prvided under the Emplyer s Grup Plans. GROUP PLANS 6/13 Page 42

43 HOW TO PROCESS ENROLLMENTS Enrllment checklist Name f emplyee: Date f full-time emplyment: Scial Security number: Cverage effective date: Discuss each Emplyee benefit available t the new Emplyee at the time f hire. Be sure t cver the basic prvisins f the plans, when benefits will becme effective and each electin decisin the Emplyee is eligible t make. Check ff each bx after the subject is discussed with the Emplyee. Life and accident benefits Eligibility Emplyee and dependent When cverage becmes effective Basic plan/prvisins, as applicable Emplyee Term Life Emplyee Optinal Term Life Spuse Term Life Spuse Optinal Term Life Child Term Life Persnal Accident Benefits Accidental Death and Dismemberment Claim filing prcedures Rates, as applicable Life Prtability and Cnversin rights at terminatin Medical benefits Eligibility Emplyee and dependent When cverage becmes effective Benefits f using a netwrk prvider Basic plans/prvisins, as applicable Prescriptin drug prgram, if applicable Preauthrizatin, if applicable Pre-existing Cnditin Limitatins, including the applicatin f prir Creditable Cverage t limitatin perid Claim filing prcedures GROUP PLANS 6/13 Page 43

44 HOW TO PROCESS ENROLLMENTS Rates, as applicable Cntinuatin prvisin at terminatin, if applicable Separate Medical and Prescriptin Drug ID cards will be mailed within 10 wrking days f the enrllment being prcessed by GuideStne Financial Resurces Disability benefits Eligibility Emplyee When cverage becmes effective Basic plans/prvisins, as applicable Rates, as applicable Claim filing prcedures Dental benefits Eligibility Emplyee and dependent When cverage becmes effective Basic plans/prvisins, as applicable Rates, as applicable Waiting Perids, as applicable Claim filing prcedures ID cards will be mailed by the Dental carrier Prcess the Enrllment Frm fr the new Emplyee and give the Emplyee the fllwing materials: Infrmatin n GuideStne Financial Resurces and Claims Administratr s website fr referencing Emplyee Bklets and PPO Prviders Ntice f Pre-existing Cnditin Limitatins Ntice f Special Enrllment Rights Summary f Benefits and Cverage fr the plan(s) currently ffered Cntraceptives Ntice and Certificatin Privacy Practices f Health Plans Administratr: Date f rientatin: GROUP PLANS 6/13 Page 44

45 HOW TO PROCESS ENROLLMENTS 1. Cmplete the fllwing infrmatin n a Grup Plans Enrllment Frm: Sectin A General Infrmatin Emplyer name and number Name f Emplyee, Emplyee date f birth and Scial Security number Hme address, daytime telephne number and address Gender and marital status Emplyee Classificatin Mnthly Salary Date f full-time emplyment and cverage effective date Nte: It is essential that the Emplyee Classificatin blank be cmpleted if the Emplyer has mre than ne Emplyee Classificatin. Sectin B Benefit Electin Indicate each prduct elected by the Emplyee and the cverage amunt if applicable. Fr Emplyee Optinal Term Life electin and Spuse Optinal Term Life electin, separate applicatin is required. Nte: If the Emplyee has Eligible Dependents and yur dependent Medical plan r dependent Dental plan is Nn-cntributry, then the Emplyee must be enrlled fr family cverage. Sectin C Participant and Dependent Infrmatin The name f the Participant and the Guided Dental HMO Dental ID number, if applicable The name, Scial Security number, relatinship, birth date, sex and Guided Dental HMO Dental ID number fr any Eligible Dependent Sectin D Beneficiary Designatin The name, relatinship, birth date, Scial Security number f the Emplyee s Beneficiary fr Life and Persnal Accident cverage Sectin E Required Signatures Emplyee s signature and date signed Emplyer s signature and date signed GROUP PLANS 6/13 Page 45

46 HOW TO PROCESS ENROLLMENTS 2. The fllwing electins require submissin f an Evidence f Gd Health Applicatin t the Claims Administratr fr apprval in additin t the Grup Plans Enrllment Frm. Emplyee Term Life ffered by the Emplyer which exceeds fur times the Emplyee s annual Salary Emplyee Optinal Term Life cverage Spuse Optinal Term Life cverage which exceeds the Emplyer s base plan Emplyee Term Life, Spuse Term Life, Child Term Life r Disability cverage fr Cntributry plans when the Enrllment Frm date f signature is mre than 31 days past the date the Emplyee r dependent first became eligible fr cverage See the HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION chapter f this manual. 3. If there are any missins r questins, reslve them with the Emplyee befre submitting the frm. 4. Sign and date the Enrllment Frm in Sectin E Required Signatures as the Emplyer Representative. 5. Request frm the Emplyee a Certificate f Creditable Cverage frm his r her prir grup Medical plan, if applicable. 6. Keep a file cpy f all materials sent t GuideStne Financial Resurces. Fr Emplyers cvered by the Americans with Disabilities Act (ADA), regulatins require Emplyee Medical infrmatin t be kept in cnfidential files separate frm regular persnnel files. Always retain a cpy f the Grup Plans Enrllment Frm if applicable. 7. Send the fllwing cmpleted material t GuideStne Financial Resurces Insurance Operatins, Grup Plans: Grup Plans Enrllment Frm Certificate f Creditable Cverage frm prir Medical cverage, if applicable 8. If applicable, have the Emplyee send the Evidence f Gd Health Applicatin t GuideStne Financial Resurces Insurance Operatins, Grup Plans. GROUP PLANS 6/13 Page 46

47 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) General infrmatin Under specific circumstances, Special and Late Applicant prvisins may apply fr Emplyees and/r Eligible Dependents wh d nt enrll in a Medical plan ffered by the Emplyer within 31 days f their first eligibility. These prvisins may allw the Emplyee and/r Eligible Dependent(s) t enrll in the Medical plan at a later date if he r she qualifies as either a Special Enrllee r Late Enrllee. These prvisins apply nly t Medical cverage ffered n a Cntributry basis. Fr Nn-cntributry Medical cverage, all eligible Emplyees and dependents must enrll in the Medical plan effective n the first date f eligibility. Special and Late Applicant prvisins are applicable t active full-time Emplyees and their Eligible Dependents fr Medical cverage nly. Evidence f Gd Health is nt required fr Medical cverage as a Special r Late Enrllee. When an Emplyee r any f the Emplyee s Eligible Dependents meet Special Enrllment Requirements, the Emplyee and any Eligible Dependents may be enrlled in Medical cverage effective n the date f the Qualifying Event. Special Enrllment is nt limited t the dependent wh meets the requirement. Emplyee cverage is a prerequisite fr dependent cverage. (See the HOW TO PROCESS ENROLLMENTS chapter f this manual fr details n enrlling an Emplyee.) Special enrllees A Special Enrllee is an individual wh meets the Special Enrllment Requirement f either acquiring a dependent(s) r reaching the end f ther Medical cverage due t lss f eligibility. As a Special Enrllee, these individuals are permitted t enrll in a Grup Plans Medical Plan within 60 days f the Qualifying Event due t lss f eligibility r 60 days due t acquisitin f a dependent. Special Enrllees, wh are age 19 r ver, are subject t a 12-mnth Pre-existing Cnditin Limitatin, less any Creditable Cverage. The Pre-existing Cnditin Limitatin des nt apply t any Special Enrllee wh is under the age f 19. Dependent additin T qualify as a Special Enrllee due t the acquisitin f a dependent, the Emplyee and/r his r her Eligible Dependent(s) must meet ne f the fllwing requirements: Marriage Birth Adptin GROUP PLANS 6/13 Page 47

48 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Placement fr adptin Lss f Medicaid r CHIP due t eligibility (dcumentatin required) Becmes eligible fr premium assistance under Medicaid r CHIP (dcumentatin required) Request fr Medical cverage must be submitted within 60 days f the Qualifying Event. If apprved, cverage will becme effective n the date f the Qualifying Event. Lss f ther health care cverage T qualify as a Special Enrllee due t the lss f ther health care cverage, the Emplyee and/r Eligible Dependent(s) must have been cvered by ther grup cverage that ceased within the last 60 days f the request fr cverage in Grup Plans. Prir grup cverage must have ceased fr ne f the fllwing reasns: Cmpany ut f business Terminatin f emplyment Layff End f COBRA eligibility Retirement Death Divrce If an Emplyee and/r Eligible Dependent(s) elects t enrll in the Emplyer s Medical Plan as a Special Enrllee, fllw the prcedures fr SPECIAL AND LATE ENROLLMENT in this chapter. Request fr Medical cverage must be submitted within 60 days f the lss f ther Medical cverage. If apprved, cverage will becme effective n the day fllwing the terminatin f the prir grup plan cverage. Special enrllees, age 19 and ver, are subject t a 12-mnth Pre-existing Cnditin Limitatin, less any Creditable Cverage. The Pre-existing Cnditin Limitatin des nt apply t any Special Enrllee wh is under the age f 19. Nte: Lss f eligibility des nt include a lss due t failure f the individual t pay premiums n a timely basis r terminatin f cverage fr cause, such as making a fraudulent claim. Late Enrllees A Late Enrllee is an Emplyee r Eligible Dependent wh des nt enrll in a Grup Plans Medical plan during his r her initial eligibility perid and des nt qualify as a Special Enrllee. These individuals are permitted t enrll in a Grup Plans Medical plan during the Annual Re-enrllment Perid which fr GROUP PLANS 6/13 Page 48

49 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Emplyers with a standard renewal perid is every January 1. Late Enrllees, age 19 and ver, are subject t a 12-mnth Pre-existing Cnditin Limitatin, less any Creditable Cverage. The Pre-existing Cnditin Limitatin des nt apply t any Late Enrllee wh is under the age f 19. If an Emplyee and/r Eligible Dependent(s) elects t enrll in the Emplyer s Medical Plan as a Late Enrllee, fllw the prcedures fr Special and Late Enrllment in this chapter. Fr Emplyers with a standard renewal perid, Medical cverage fr the Emplyee and/r Eligible Dependents will becme effective n the January 1 fllwing submissin f the applicatin. Prcedures fr Special and Late Enrllment 1. Discuss the fllwing with the Emplyee wh is enrlling himself and/r his r her Eligible Dependent(s) in a Medical plan as Special r Late Enrllees: The eligibility requirements f the Medical plan and when cverage will becme effective The amunt f the Emplyee s required cntributins and hw the payrll deductin amunt is determined When persnal Emplyee and dependent status changes shuld be reprted t yu The basic plan prvisins and benefits prvided by the Medical plan The Preauthrizatin Requirements and prcedures f the Medical plan, if applicable The Pre-existing Cnditin Limitatins f the Medical plan, if applicable, including the applicatin f prir Creditable Cverage t the limitatin perid Express Scripts Pharmacy service The suggested Enrllment Checklist in the HOW TO PROCESS ENROLLMENTS chapter f this manual may be cpied and used when yu discuss the basic prvisins and cverage prvided under the Emplyer s Grup Plans. 2. Have the Emplyee cmplete a Special and Late Applicant Frm fr Health care Cverage as fllws: If the Emplyee is nt currently n yur Grup Plans bill with ther prducts, a Grup Plans Enrllment Frm must accmpany this frm fr enrllment. (See the HOW TO PROCESS ENROLLMENTS chapter f this manual.) Cmplete the fllwing infrmatin: Emplyer name Emplyer number Name f emplyee Scial Security number Emplyee address GROUP PLANS 6/13 Page 49

50 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Emplyee telephne number Indicate the persn(s) fr whm the cverage is being requested. Frm the chices listed n the Enrllment Frm, indicate the reasn cverage is being requested and the date f the Qualifying Event, if applicable. Fr Late Enrllees at Emplyers with a standard renewal perid, cverage will becme effective n the January 1 fllwing the applicatin. Fr each dependent requesting cverage, indicate: Dependent s name, Scial Security number and date f birth Relatinship t emplyee Sex Have the Emplyee and the Emplyer s Authrized Representative sign and date the frm. Applicatin must be made within 60 days f the Qualifying Event due t lss f eligibility r 60 days due t acquisitin f a dependent. 3. Attach a Certificate f Creditable Cverage frm prir health care plan, if applicable. 4. Give the Emplyee a packet which includes: Infrmatin n GuideStne Financial Resurces and Claims Administratrs websites fr referencing Emplyee Bklets and PPO Prviders The apprpriate Emplyee Bklet, if access is nt available n the website Ntice f Pre-existing Cnditin Limitatins, if PPO Medical Plans Summary f Benefits and Cverage fr the plan(s) currently ffered Cntraceptives Ntice and Certificatin Privacy Practices f Health Plans 5. Keep a file cpy f all materials sent t GuideStne Financial Resurces. Fr Emplyers cvered by the Americans with Disabilities Act (ADA), regulatins require Emplyee Medical infrmatin t be kept in cnfidential files separate frm regular persnnel files. 6. Send the fllwing cmpleted material t GuideStne Financial Resurces Insurance Operatins, Grup Plans: Special and Late Applicant Enrllment Frm fr Health Care Cverage Grup Plans Enrllment Frm, if applicable Certificate f Creditable Cverage frm prir Medical cverage, if applicable Nte: Under n circumstances shuld the Special and Late Applicant Frm fr Health Care Cverage be sent directly t the Claims Administratr. GROUP PLANS 6/13 Page 50

51 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Prtected Health Infrmatin (PHI) PHI that GuideStne Financial Resurces handles: Medical reasns fr declines n applicatins Detailed Medical infrmatin that claims can access Medical infrmatin that Claims Appeals Cmmittee members use Any crrespndence frm members cntaining Medical infrmatin n themselves r n a cvered individual Medical infrmatin n applicatins Hw the Plan will use members infrmatin The Plans may use, share r disclse Prtected Health Infrmatin withut authrizatin frm the members t pay Medical benefits, perate the Plan r in cnnectin with treatment by a Health Care Prvider cvered by HIPAA. In additin, the Plans may use r disclse members infrmatin in ther special circumstances described in the ntice (Privacy Practices f Health Plans), which GuideStne Financial Resurces sends t all members wh enrll in a Medical Plan. T review this ntice r btain a cpy, g t GuideStne Financial Resurces website ( r call yur Grup Plans Accunt Administratr. Authrizatin t disclse PHI The plans require written authrizatin fr the use r disclsure f a members Prtected Health Infrmatin fr any ther purpse. A PHI Disclsure Frm #8010 shuld be cmpleted and returned t Grup Plans. This frm can be lcated at r yu can call yur Grup Plans Accunt Administratr t request the frm. Withdrawal f authrizatin fr (PHI) disclsure The individual has the right t withdraw their authrizatin at any time. A Withdrawal f Authrizatin fr PHI Disclsure Frm #8111 needs t be cmpleted and returned t Grup Plans. This frm can be lcated at r yu can call yur Grup Plans Accunt Administratr t request the frm. GROUP PLANS 6/13 Page 51

52 HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION General infrmatin The Claims Administratr reserves the right t accept r decline any Medical infrmatin supplied in cnnectin with Evidence f Gd Health. When evidence is requested and fund acceptable, plan cverage becmes effective n the date it is apprved by the Claims Administratr. When Evidence f Gd Health is required Evidence f Gd Health may be required in cnnectin with Life and Disability cverage under the Emplyer s Prgram and t upgrade Medicare-crdinating Plans. Evidence f Gd Health is required in the fllwing situatins: If an Emplyee r an Emplyee s Eligible Dependent(s) des nt enrll fr Cntributry Life r Disability plans ffered by the Emplyer within 31 days f the date first eligible t participate, Evidence f Gd Health is required befre cverage becmes effective. See the Emplyee Bklet fr specific infrmatin regarding plan cverage that may require Evidence f Gd Health under the Emplyer s Prgram. Evidence f Gd Health is required f the Emplyee wh requests reinstatement f Cntributry Life r Disability cverage previusly discntinued. Evidence f Gd Health is required fr any amunt f Emplyee Term Life ffered by the Emplyer that exceeds fur times the Emplyee s annual Salary. Evidence f Gd Health will be required in cnnectin with Optinal Term Life cverage fr the fllwing reasns: Initial enrllment r requested increase in Emplyee Optinal Term Life cverage Initial enrllment r requested increase in Spuse Optinal Term Life cverage which exceeds the Emplyer s base plan Cverage increases due t Salary increases when it has been at least tw years frm the last date the Emplyee prvided satisfactry Evidence f Gd Health Cumulative increases in cverage due t Salary increases that exceed 15% f the amunt f cverage frm the last date the Emplyee prvided satisfactry Evidence f Gd Health Cumulative increases in cverage due t Salary increases that exceed $50,000 frm the last date the Emplyee prvided satisfactry Evidence f Gd Health GROUP PLANS 6/13 Page 52

53 HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION When Evidence f Gd Health is nt required Evidence f Gd Health is nt required in the fllwing situatins: Since Emplyees are cvered autmatically fr all Nn-cntributry plans made available by the Emplyer, Evidence f Gd Health is nt required in cnnectin with these plans. N Evidence f Gd Health is required fr the Persnal Accident r Accidental Death and Dismemberment Plans. N Evidence f Gd Health is required in cnnectin with cverage in any Dental plan. Emplyees and Eligible Dependents can enrll in the Premier Dental Care, Chice Dental Care r the Guided Dental HMO Plans at any time. N Evidence f Gd Health is required fr an active Emplyee r his r her cvered dependent(s) in cnnectin with cverage in a Medical plan. An emplyee r dependent wh requests cverage in a Cntributry Medical plan mre than 31 days after initial eligibility will be ineligible t enrll in the Medical plan until the Emplyer s annual re-enrllment (which is usually January 1 fllwing the request) unless Special Enrllment Requirements are met. (See the SPECIAL AND LATE ENROLLMENT chapter f this manual.) Prcedures fr cmpleting the Evidence f Gd Health Applicatin Prcess Evidence f Gd Health Applicatin as fllws: 1. Emplyer s Authrized Representative cmpletes Sectin A Sectin A: Emplyer Infrmatin. Prvide the fllwing infrmatin: Emplyer name Emplyer telephne and fax number Emplyer accunt number Emplyer address Emplyer address Emplyee Classificatin Emplyee s ttal mnthly Salary Emplyment status Sign and date the frm cnfirming that the Emplyee is actively wrking r retired. 2. Assist the emplyee in cmpleting sectins B and C f the frm, if needed. Sectin B: Emplyee Infrmatin. Have the Emplyee cmplete the fllwing: Emplyee name Emplyee Scial Security number GROUP PLANS 6/13 Page 53

54 HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION Emplyee birth date Emplyee address Emplyee hme telephne number Emplyee address Emplyee gender Emplyee marital status Sectin C: Cverage Optins. Have the Emplyee check nly the cverage fr which he r she is applying and prvide the fllwing infrmatin: Basic Term Life cverage, if applicable, including: Emplyee Basic Term Life cverage currently in frce, and Emplyee Basic Term Life cverage amunt fr which applicatin is being made. Emplyee Optinal Term Life Cverage, if applicable, including: Times Annual Salary amunt fr which applicatin is being made, Optinal Term Life cverage currently in frce, and Optinal Term Life cverage amunt fr which applicatin is being made. Ttal Term Life amunt requested (Emplyee Basic Term Life and Emplyee Optinal Term Life cmbined) (Nte: Emplyee Basic Term Life and Emplyee Optinal Term Life cmbined cverage amunt cannt exceed the lesser f eight times the annual Salary r the standard plan maximum f $750,000.) Spuse Basic Term Life cverage, if applicable Spuse Basic Term Life cverage currently in frce, and Spuse Basic Term Life cverage amunt fr which applicatin is being made. Spuse Optinal Term Life Cverage, if applicable, including: Spuse Optinal Term Life cverage currently in frce, and Spuse Optinal Term Life cverage amunt fr which applicatin is being made. Ttal Spuse Term Life amunt requested (Spuse Basic Term Life and Spuse Optinal Term Life cmbined) Nte: Spuse Term Life must be in $5,000 increments. Spuse Basic Term Life and Spuse Optinal Term Life cmbined cverage amunt cannt exceed 50% f the cmbined ttal f Emplyee Basic Term Life and Emplyee Optinal Term Life cverage, up t the standard plan maximum f $250,000. GROUP PLANS 6/13 Page 54

55 HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION Child Term Life cverage, if applicable Ecnmy Lng-Term Disability Chice Lng-Term Disability Premier Lng-Term Disability Ecnmy Shrt-Term Disability Chice Shrt-Term Disability Sectin D: Beneficiary Designatin. If applicatin is fr Emplyee Term Life r Emplyee Optinal Life cverage, have the Emplyee cmplete the Beneficiary designatin including: Full name Relatinship t emplyee Birth date Scial Security number f primary and, if applicable, cntingent Beneficiary Nte: See the HOW TO CHANGE A BENEFICIARY chapter f this manual fr guidelines fr naming a Beneficiary. 3. After cmpleting sectin A give the Evidence f Gd Health Applicatin and a GuideStne Financial Resurces return envelpe t the Emplyee. Instruct the Emplyee t cmplete sectins B G. The Emplyee shuld then send the cmpleted Evidence f Gd Health Applicatin t GuideStne Financial Resurces Insurance Operatins, Grup Plans. Under n circumstance shuld the Evidence f Gd Health Applicatin be sent directly t the Claims Administratr. Nte: Because f privacy regulatins under the Health Insurance Prtability and Accuntability Act (HIPAA), it wuld be prudent t avid cpying an Emplyee s persnal Medical infrmatin. Sectin E: Applicant and Dependent Infrmatin. The Emplyee shuld cmplete questins 1 and 2. Only family members wh are requesting cverage shuld be listed. The Emplyee shuld prvide the address(es) f any Eligible Dependent(s) wh is applying fr cverage and des nt reside with the Emplyee. Sectin F: Applicant and Dependent Medical Infrmatin. The Emplyee shuld cmplete questins 1 and 2. GROUP PLANS 6/13 Page 55

56 HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION Sectin F: Part I The Emplyee shuld cmplete questins 1 thrugh 6 n all persns wh are requesting cverage. Fr any yes answers t questin 1 r 2, cmplete item 3 f sectin F. Sectin F: Part II The Emplyee shuld cmplete questins 7 55 n all persns wh are requesting cverage. Sectin F: Part III The Emplyee shuld cmplete this sectin if any questins were checked in Part II. Sectin F: Part IV The Emplyee shuld cmplete fr any persn that is requesting cverage. Sectin G: Applicant and Dependent Authrizatin The Emplyee (and spuse, and children age 18 and ver, if applicable) must read, then sign and date the statement n bth pages where indicated. 4. When the Emplyee has cmpleted the health infrmatin, the Emplyee shuld make a cpy f the entire applicatin fr his r her recrds and return the frm directly t GuideStne Financial Resurces Grup Plans: Insurance Operatins, Grup Plans GuideStne Financial Resurces 2401 Cedar Springs Rad Dallas, TX Grup Plans crdinates the prcessing f the Evidence f Gd Health Applicatin with the Claims Administratr. If the Claims Administratr requires additinal Medical infrmatin, they will cntact yur Emplyee and furnish specific instructins fr the data required. 6. The Insurance Operatins, Grup Plans will ntify yu when the evidence is apprved r declined and infrm yu f the effective date fr the apprved cverage. When Evidence f Gd Health has been apprved, infrm the Emplyee f the date cverage becmes effective. Declinatin ntices frm the Claims Administratr are sent directly t the Emplyee, stating the reasn fr declinatin. GROUP PLANS 6/13 Page 56

57 HOW TO PROCESS CHANGES HOW TO PROCESS CHANGES General infrmatin Emplyee persnal data changes affecting emplyment status and/r cverage electins shuld be recrded and reprted t GuideStne Financial Resurces as sn as pssible. This chapter f the manual explains hw the fllwing changes shuld be prcessed and reprted t GuideStne Financial Resurces Insurance Operatins, Grup Plans. Persnal Data Name changes Salary changes Marital status changes Emplyee address changes Cverage Status Adding r drpping cverage (Cntributry and Nn-cntributry) Increasing r decreasing cverage Attainment f age 65 during active service (des nt need t be reprted by the Emplyer) Dependent changes Emplyment Status Emplyee Classificatin changes Temprary/part-time t regular, full-time Regular, full-time t temprary/part-time Transfers Between Medical r Dental plans ffered by the Emplyer T r frm anther participating Emplyer GROUP PLANS 6/13 Page 57

58 HOW TO PROCESS CHANGES This chapter f the manual cvers changes nly. See ther manual chapters, as indicated belw, fr infrmatin and prcedures fr prcessing new Emplyees, terminatins, Beneficiary changes, etc. TYPE OF ACTIVITY Enrlling New Emplyees Terminating Emplyees Beneficiary Changes Retiring Emplyees Leave f Absence Cntinuatin During Unemplyment Medical/Dental Cntinuatin After Terminatin MANUAL CHAPTER Hw t Prcess Enrllments Hw t Prcess Terminatins Hw t Change a Beneficiary Leaving Active Emplyment Leaving Active Emplyment Hw t Prcess Terminatins Hw t Prcess Terminatins When changes ccur that require the cmpletin and submissin f a Grup Plans Emplyer Change Reprt, reprt the change and its effective date immediately. D nt send changes with the mnthly billing statement. Certain types f changes may be made nline thrugh Emplyer Access. See the EMPLOYER ACCESS chapter in this manual fr further infrmatin. Persnal data changes Name changes If an Emplyee s name changes because f marriage, divrce, curt rder, etc., reprt the change in the Emplyee Infrmatin sectin f the Emplyer Change Reprt by checking the name change bx. Salary changes Salary adjustments, whether increases r decreases, shuld be reprted in the Types f Changes sectin f the Emplyer Change Reprt. Cmplete the Effective date f change field, check whether the Salary change is an increase r decrease and indicate the new Salary. Salary changes that affect all Emplyees may be nted n the Emplyer s mnthly billing statement. The effective date f change must be included. The Salary changes shuld be sent t GuideStne Financial Resurces Insurance Operatins, Grup Plans. GROUP PLANS 6/13 Page 58

59 HOW TO PROCESS CHANGES Cverage and rates resulting frm Salary changes will be adjusted effective the date the change is received by GuideStne Financial Resurces. This culd result in a billing adjustment fr any Salary changes received. If the effective date is in the future, that is the date that will be used. Nte: It is imprtant that yu ntify Grup Plans f Salary changes in a timely manner. Since mst Term Life, Accidental Death and Dismemberment and Lng- and Shrt-Term Disability Plan cverage amunts are based n an Emplyee s current Salary, failure t ntify Grup Plans f a change culd result in a decreased level f benefits fr yur Emplyees. Payment f any claim r benefits will be determined by the last earnings reprted t GuideStne Financial Resurces, prvided the reprted effective date is prir t the date the claim was incurred. Marital status change If an Emplyee s marital status changes due t marriage, divrce, etc., reprt the change in the Types f Changes sectin f an Emplyer Change Reprt. Check the marital status bx t indicate the type f change. Use the prvided blank t prvide details cncerning the change. Als, remind the Emplyee t review existing Beneficiary designatins and Medical r Dental dependent cverage status fr pssible changes. Explain the Emplyee s Special Enrllment Rights fr Medical cverage due t a Life-changing Event, if applicable. Address changes If an Emplyee s hme address changes, reprt the change in the Emplyee Infrmatin sectin f the Emplyer Change Reprt. Check the change f address bx t indicate type f change. A change f address may affect yur Emplyee s eligibility in the Guided Dental HMO Plan. Mving ut f the DHMO service area may cause a Participant t becme ineligible fr the plan. Cverage status changes Adding Cntributry cverage If prvided under yur Prgram, Emplyees may elect t add r reinstate cverage, except Medical cverage, at any time. Reinstatement f discntinued Medical cverage can be made nly during the Annual Re-enrllment Perid, which is usually the January 1 fllwing the request, unless Special Enrllment Requirements are met. (See the Special and Late Enrllment sectin in the HIPAA chapter f this manual.) Late Term Life r Disability plan electins require Evidence f Gd Health befre cverage becmes effective. (See the HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION chapter f this manual.) GROUP PLANS 6/13 Page 59

60 HOW TO PROCESS CHANGES The additin f Accidental Death and Dismemberment, Dental and/r Persnal Accident cverage shuld be reprted in the Types f Changes sectin f the Emplyer Change Reprt. The Effective date f change field shuld shw the date the cverage shuld be added. The effective date will be the date the request is received at GuideStne Financial Resurces unless a future date is indicated in the Effective date f change field. Indicate in the Prduct Changes sectin which prduct is being added and the vlume f the cverage, if applicable. If a dependent is als being added t the prduct, the dependent infrmatin and prduct changes sectins n the secnd page f the frm wuld als need t be cmpleted. Nte: Emplyee Term Life cverage is a prerequisite fr Accidental Death and Dismemberment cverage. Drpping Cntributry cverage An Emplyee may drp a Cntributry cverage at any time. Terminatin f a plan shuld be submitted n an Emplyer Change Reprt. Indicate in the Types f Changes sectin the reasn fr the requested terminatin. The Effective date f change field shuld shw the requested date cverage shuld be terminated. If Medical cverage is being terminated, the Emplyee paid thrugh date must be cmpleted. Credit is limited t a maximum f tw billed mnths. Evidence f Gd Health is required f the Emplyee wh requests reinstatement f Cntributry Life r Disability cverage previusly discntinued. Nte: The effective date requested fr terminatin f Medical cverage may be adjusted t cmply with Rescissin rules. Refer t the HOW TO PROCESS TERMINATIONS chapter. Adding Nn-cntributry cverage When Grup Plans are prvided fr Emplyees and Eligible Dependents n a Nn-cntributry basis, all eligible Emplyees and their Eligible Dependents are autmatically cvered. The rules cncerning delayed applicatin fr cverage and the requirements fr Evidence f Gd Health d nt apply t Nncntributry plans. Reprt the additin n the Emplyer Change Reprt in the same manner as adding Cntributry cverage. GuideStne Financial Resurces adjusts the cverage, and charges are reflected n the mnthly billing statement being prepared at the time ntice f the change is received. If ntificatin f a change is delayed, a back charge t the effective date may appear n yur mnthly billing statement. Drpping Nn-cntributry cverage Fr cverage that is Nn-cntributry, 100% Participatin f all eligible Emplyees and their Eligible Dependents is required. Nn-cntributry cverage may nt be terminated as lng as the Emplyee and/r dependent(s) are eligible fr cverage unless the Emplyee elects t waive Medical/Dental cverage. (See Waiver f Medical/Dental in the GENERAL ADMINISTRATIVE GUIDELINES chapter f this manual.) GROUP PLANS 6/13 Page 60

61 HOW TO PROCESS CHANGES Nte: When a child reaches the limiting age f a Life, Medical r Dental plan, cverage terminates n the date the dependent n lnger meets the definitin f an Eligible Dependent. (See Eligible Dependents in the IMPORTANT TERMS chapter f this manual.) Increasing r decreasing cverage Increases r decreases in Term Life, Accidental Death and Dismemberment and Lng-Term Disability cverage due t a Salary change are autmatically prcessed when the Salary change is reprted t GuideStne Financial Resurces Insurance Operatins, Grup Plans. An increase r decrease in Persnal Accident cverage (if applicable t the Emplyer s Prgram) is prcessed nly when the change is requested by the Emplyer. An Emplyer Change Reprt shuld shw the newly elected Persnal Accident amunt (in increments f $25,000) and shuld be cmpleted and submitted t GuideStne Financial Resurces Insurance Operatins, Grup Plans. An increase in Emplyee Optinal Term Life cverage due t an increase in Salary is autmatically prcessed when a Salary increase is reprted t GuideStne Financial Resurces. There may be instances where satisfactry Evidence f Gd Health will be required befre an increase in the Emplyee Optinal Term Life cverage will be effective. (Evidence f Gd Health is always required t increase Spuse Optinal Term Life cverage. See the HOW TO PROCESS EVIDENCE OF GOOD HEALTH APPLICATION chapter f this manual.) The multiple f annual rate f basic earnings fr Emplyee Optinal Term Life may be reduced upn request but increased nly by satisfying Evidence f Gd Health subject t apprval by the Claims Administratr. When an Emplyee becmes eligible fr additinal amunts f Term Life cverage, and the cverage is prvided n a Cntributry basis but the Emplyee prefers t decline the additinal amunt, have the Emplyee cmplete an Emplyee s Refusal f Increase in Amunt f Optinal and/r Cntributry Life Insurance Frm. Send the frm t GuideStne Financial Resurces Insurance Operatins, Grup Plans and retain a cpy f the frm. Nte: The Emplyee shuld be aware that if additinal Term Life cverage is refused and then requested at a later date, the additinal amunt will nt becme effective until satisfactry Evidence f Gd Health has been prvided. All Emplyees must participate in the Term Life cverage plan accrding t the schedule chsen by the Emplyer. Refusal f increases f cverage applies nly t Emplyees wh have had an increase in Salary that affects their existing amunt f Optinal Term Life cverage and thse whse Term Life cverage is Cntributry. GROUP PLANS 6/13 Page 61

62 HOW TO PROCESS CHANGES Nte: If Emplyee Term Life cverage decreases, Spuse Term Life cverage will be reduced, if necessary, nt t exceed 50% f the Emplyee Term Life Plan and Emplyee Optinal Term Life Plan cmbined. Attainment f age 65 during active service When an active Emplyee r spuse attains age 65, certain changes are made that directly affect benefit plan cverage. These changes are made autmatically by GuideStne Financial Resurces Insurance Operatins, Grup Plans. Emplyee Term Life cverage is reduced by 35% r t $20,000, whichever is greater, n the January 1 fllwing attainment f age 65. If the cverage amunt prir t reductin is $20,000 r less, n reductin in cverage will be made. Accidental Death and Dismemberment cverage is reduced by 35% r t $20,000, whichever is greater, n the January 1 fllwing attainment f age 65. If the cverage amunt prir t reductin is $20,000 r less, n reductin in cverage will be made. Persnal Accident cverage is reduced by 35% n the January 1 fllwing attainment f age 65. Spuse Persnal Accident cverage is reduced by 35% n the January 1 fllwing the Emplyee s attainment f age 65. Emplyee Optinal Term Life cverage is reduced by 35% n the January 1 fllwing attainment f age 65. Spuse Term Life cverage will be reduced, if necessary, nt t exceed 50% f the Emplyee Term Life Plan and Emplyee Optinal Term Life Plan cmbined. Term Life, Accidental Death and Dismemberment, Persnal Accident and Emplyee Optinal Term Life are runded t the next highest $1,000 f cverage after the reductin is taken, prvided it is nt an increment f $1,000. (i.e. A $101,000 Term Life amunt wuld reduce t $65,650, which wuld rund t $66,000.) Spuse Persnal Accident is runded t the next $500 f cverage after the reductin is taken prvided it is nt an increment f $500. A Participant wh is actively wrking and turns 65 can cnvert the amunt f cverage lst t individual life plicies directly with Unum. Medical cverage may be affected if the Emplyee r spuse is eligible fr Medicare. A Medicare Crdinating Plans Enrllment Frm will be requested if Medical cverage will be affected. (See the BASIC MEDICARE INFORMATION chapter f this manual.) Nte: See the LEAVING ACTIVE EMPLOYMENT chapter f this manual fr specific infrmatin cncerning changes in Prgram cverage that ccur at retirement. GROUP PLANS 6/13 Page 62

63 HOW TO PROCESS CHANGES Dependent additins r terminatins The additin r terminatin f an Emplyee s dependent cverage shuld be reprted t GuideStne Financial Resurces Insurance Operatins, Grup Plans. Changes in dependent cverage shuld be reprted using the Emplyer Change Reprt. In the Types f Changes sectin, the Effective date f change field shuld shw the date the change ccurred and the apprpriate bx shuld be checked t indicate the type f change needed. The dependent infrmatin and prduct changes sectins n the secnd page f the frm wuld als need t be cmpleted. If the Emplyee is adding a dependent t Medical cverage due t a Life-changing Event, a Special and Late Applicant Enrllment Frm fr Health Care Cverage is required in place f the Grup Plans Change Reprt. Cntributry Plans Emplyees may add cverage fr newly acquired dependent(s) withut Evidence f Gd Health, as lng as the change is reprted within 60 days. If the change is reprted mre than 60 days beynd the dependent s riginal Eligibility Date: Evidence f Gd Health Applicatin must be submitted and apprved by the Claims Administratr befre Term Life cverage becmes effective. The newly acquired dependent(s) will be eligible t apply fr Medical cverage during the Annual Re-enrllment Perid which is usually fr the fllwing January 1. Nte: Each dependent child must be individually identified in rder t be cvered under the Child Term Life plan. Even when the mnthly rate fr Child Term Life cverage fr an Emplyee s dependent(s) was established prir t the birth f a child, adptin r placement in the hme, t add a new dependent, an Emplyer Change Reprt must be cmpleted with the new dependent s name, date f birth, Scial Security number and cverage electin. The change reprt shuld be sent t GuideStne Financial Resurces within 60 days f the birth f the child. Evidence f Gd Health will be required fr the newbrn enrlling mre than 60 days after initial eligibility, regardless f whether ther dependent children are already enrlled in the plan. Nn-cntributry Plans Cverage fr newly acquired dependent(s) is autmatic; hwever, the change must be reprted t GuideStne Financial Resurces. The rules cncerning late applicatin fr dependent cverage and Evidence f Gd Health requirements d nt apply t Nn-cntributry plans. If ntificatin f a change is delayed, a back charge t the Effective Date may appear n yur mnthly billing statement. GROUP PLANS 6/13 Page 63

64 HOW TO PROCESS CHANGES Eligible Dependents can enrll in the Premier Dental Care Plan, Chice Dental Care Plan r the Guided Dental HMO Plan at any time. The effective date will be the date the request is received at GuideStne unless a future date is indicated in the effective date field. Dependent Medical/Dental cverage may be waived if certain requirements are met. (See Waiver f Medical/Dental in the GENERAL ADMINISTRATIVE GUIDELINES chapter f this manual.) Emplyment status Emplyee Classificatin changes When an Emplyee s reclassificatin results in a change f plan cverage, the change must be reprted t GuideStne Financial Resurces Insurance Operatins, Grup Plans. If an Emplyee s Classificatin changes, reprt the change in the Types f Changes sectin f an Emplyer Change Reprt. Check the class bx t indicate the type f change. Use the prvided blank t prvide details cncerning the change. Example: Change frm Administrative t Nn-administrative Temprary/part-time t regular, full-time When an Emplyee changes frm a temprary r part-time psitin t a regular, full-time psitin, all Prgram benefits becme available t the Emplyee and the Emplyer may waive the Waiting Perid. The Prgram benefits shuld be explained and the Emplyee shuld cmplete a Grup Plans Enrllment Frm and, if applicable, an Evidence f Gd Health Applicatin. The date f emplyment n the frm(s) shuld reflect the date the Emplyee becmes regular, full-time. (See the HOW TO PROCESS ENROLLMENTS chapter f this manual.) Regular, full-time t temprary/part-time When an Emplyee changes t temprary r part-time status, all Prgram benefits terminate. Hwever, the Emplyee has the right t apply fr Prtability r Cnversin f any Term Life cverage t individual direct payment plicies administered by the Claims Administratr. (See the HOW TO PROCESS TERMINATIONS chapter f this manual.) If an Emplyee has a change f emplyment status, reprt the change in the Types f Changes sectin f an Emplyer Change Reprt. Cmplete the date the Emplyee s emplyment status changed in the Effective date f change field and indicate the change as Terminate Emplyee. If Medical cverage is GROUP PLANS 6/13 Page 64

65 HOW TO PROCESS CHANGES being terminated, the Emplyee paid thrugh date must be cmpleted. Use the Other field t explain the change. Credit is limited t a maximum f tw billed mnths. Nte: The effective date requested fr terminatin f Medical cverage may be adjusted t cmply with Rescissin rules. Refer t the HOW TO PROCESS TERMINATIONS chapter. Transfers Emplyees transferring between Medical plans during annual re-enrllment perid During the Annual Re-enrllment Perid, which is usually effective each January 1 fr a standard renewal, cvered Emplyees may elect t transfer between Medical plans ffered by the Emplyer. Emplyees and/r Eligible Dependents wh did nt enrll in a Grup Plans Medical plan during their initial 31-day eligibility perid may als elect t enrll in a plan at this time as a Late Enrllee. (See the Special and Late Enrllment sectin in the HIPAA chapter f this manual.) The Emplyer will be ntified each year f the time perid in which re-enrllment applicatins will be accepted. If an Emplyee elects t transfer between Medical plans ffered by the Emplyer, have the Emplyee cmplete an Emplyee Annual Change Request indicating his r her new plan electin(s). Submit the frm t GuideStne Financial Resurces Insurance Operatins, Grup Plans during the Annual Reenrllment Perid. Fr an Emplyer with a standard renewal perid, the new Medical plan electin will becme effective n the January 1 fllwing submissin f the applicatin. Emplyees transferring t r frm anther participating emplyer When an Emplyee already cvered under the Grup Plans transfers frm anther Emplyer t a new Emplyer, the Emplyee must cmplete a new Grup Plans Enrllment Frm and, if applicable, an Evidence f Gd Health Applicatin. (See the HOW TO PROCESS ENROLLMENTS chapter f this manual.) The Emplyer may waive the Waiting Perid fr cverage prvided there is n break in cverage and the request is made within 31 days f the Eligibility Date. Hwever, the Waiting Perid must be bserved fr cverage requested mre than 31 days after their eligibility date, r if there has been a break in cverage. If an Emplyee transfers t anther participating Emplyer, indicate the change as a Terminate Emplyee in the Types f Changes sectin n the Emplyer Change Reprt. Indicate the terminatin date in the Effective date f change field. Use the Other field under Terminatin Reasns t indicate the Emplyee s new Emplyer. GROUP PLANS 6/13 Page 65

66 HOW TO PROCESS CHANGES Prcedures fr prcessing changes Prcess changes as fllws: 1. An Emplyer Change Reprt must be cmpleted and sent t GuideStne Financial Resurces Insurance Operatins, Grup Plans as sn as ne f these changes ccurs. a) Persnal data change b) Cverage status change c) Emplyment status change d) Transfers ut f the Emplyer s Prgram 2. Be sure t include the effective date f the change, the date thrugh which Medical premiums have been paid if Medical cverage is terminating and t sign and date the frm. 3. Retain a cpy f the Grup Plans Emplyer Change Reprt in the Emplyee s permanent persnnel file. 4. Send the cmpleted Emplyer Change Reprt t the fllwing address: GuideStne Financial Resurces Insurance Operatins, Grup Plans 2401 Cedar Springs Rad Dallas, TX GROUP PLANS 6/13 Page 66

67 HOW TO PROCESS A CHANGE OF BENEFICIARY HOW TO PROCESS A CHANGE OF BENEFICIARY General infrmatin A Beneficiary fr cverage is named n a new Emplyee s Grup Plans Enrllment Frm. T change Beneficiaries, a Beneficiary Designatin Frm must be cmpleted and submitted t GuideStne Financial Resurces Insurance Operatins, Grup Plans. Cmmn Beneficiary designatins The fllwing pages cntain a list f the mst frequently used Beneficiary designatins and examples f hw these designatins shuld be wrded: Type f Beneficiary One Beneficiary Estate Tw Beneficiaries (Equal Shares) Three r Mre Beneficiaries (Equal Shares) Children (Equal Shares) Minr Child One Secndary Beneficiary Mre Than One Secndary Beneficiary Children as Secndary Beneficiaries Trustee Examples f Wrding t be Used Mary Jnes, wife (if nt related t Emplyee, shw as friend ). Estate. Jhn Jnes and Mary Jnes, father and mther, in equal shares r the survivr, if any. Jhn Jnes, Peter Jnes and Martha Jnes, brthers and sister, in equal shares r the survivrs r survivr, if any. Jhn Jnes, Peter Jnes and Martha Jnes, the insured s children, if living at the time f the insured s death, in equal shares r the survivrs r survivr, if any. Preferred methd is t set up a testamentary trust t prvide fr the minr child. Nte: If a minr child is the Beneficiary and prper legal guardianship r trust is nt established, payment f claims t the minr child may be delayed. Lis Jnes, wife, if living, therwise, Herbert Jnes, sn. Lis Jnes, wife, if living; therwise, Herbert Jnes, Alice Jnes and Ann Jnes, sn and daughters, in equal shares, r the survivrs r survivr, if any. Lis Jnes, wife, if living; therwise, Jhn Jnes, Peter Jnes and Mary Jnes, the insured s children, if living at the time f the insured s death, in equal shares, r the survivrs r survivr, if any. (See Minr Child abve.) (Cmpany r Individual s Name) Trustee, in ne sum, under Trust Agreement dated (insert date). A Trust Agreement must be in existence. GROUP PLANS 6/13 Page 67

68 HOW TO PROCESS A CHANGE OF BENEFICIARY Designatins that shuld nt be used The Beneficiary designatin f each Emplyee shuld be carefully checked t determine if it crrectly reflects the Emplyee s intent. Certain designatins cannt legally be used. T avid cmplicatins at death, an rganizatin r endwment shuld nt be named unless it is a legal entity (has a legal existence as a crpratin r trust). An Emplyee may name their church/emplyer as their Beneficiary. The Beneficiary designatin shuld include the legal name f the Emplyer, taxpayer identificatin number, address and phne number. Additinal cnsideratins All Beneficiary designatins as shwn n the Grup Plans Enrllment Frm and Beneficiary Designatin Frm shuld be carefully reviewed, keeping the fllwing pints in mind: The Emplyee s designatin must be legible. If yu cannt read a Beneficiary s name n the frm, request that a new frm be cmpleted. Prvide full name f each child designated as a Beneficiary. (See Minr Child n previus page.) The Beneficiary s name must always be shwn in full, (i.e., Mary Jnes, nt Mrs. Jhn Jnes), and the date f birth, Scial Security number and the relatinship f the Beneficiary t the Emplyee must be stated. If the Beneficiary designated is nt related t the Emplyee, the relatinship shuld be shwn as friend. In an effrt t imprve legibility, the Beneficiary sectin must nt cntain erasures, markthrughs, r white-uts. The Grup Plans Enrllment Frm and the Beneficiary Designatin Frm enable Emplyees t name different Beneficiaries fr Term Life and Persnal Accident benefits. Nte: When yu have a questin abut the exact wrding r the acceptability f a Beneficiary designatin, refer yur questin immediately t GuideStne Financial Resurces Insurance Operatins, Claims Unit. Benefit assignments With the cnsent f the Claims Administratr, the Term Life and Persnal Accident plans under the Grup Plans allw Emplyees t execute gift and value assignments f all incidents f wnership in their plan benefits. Fr further infrmatin cncerning cverage assignments, cntact GuideStne Financial Resurces Insurance Operatins, Claims Unit. GROUP PLANS 6/13 Page 68

69 HOW TO PROCESS A CHANGE OF BENEFICIARY Prcedures fr changing a Beneficiary Prcess a change in an Emplyee s Beneficiary fr Term Life, Emplyee Optinal Term Life and/r Persnal Accident cverage as fllws: 1. Give the Emplyee a Beneficiary Designatin Frm t cmplete. The Emplyee must prvide the full name, relatinship, date f birth and Scial Security number f the Beneficiary. The Emplyee may designate a secndary Beneficiary in the event the primary Beneficiary designated is deceased at the pint f benefit claim. 2. When an Emplyee returns a cmpleted Beneficiary Designatin Frm, review the frm t make sure all infrmatin has been prperly and legibly cmpleted. 3. Send the cmpleted Beneficiary Designatin Frm t GuideStne Financial Resurces Insurance Operatins, Grup Plans. 4. Retain a cpy f the frm in the Emplyee s permanent persnnel file. Nte: Cntact an Emplyee whse marital status has changed t determine whether the Beneficiary designatin(s) shuld be changed. GROUP PLANS 6/13 Page 69

70 HOW TO PROCESS TERMINATIONS HOW TO PROCESS TERMINATIONS General infrmatin Yu are respnsible fr prviding infrmatin t terminating Emplyees r in case f the Emplyee s death, the Surviving Spuse r dependents, f the effects f terminatin n the Emplyee s plan benefits. (See the LEAVING ACTIVE EMPLOYMENT chapter f this manual fr infrmatin regarding an Emplyee wh is leaving active emplyment due t leave f absence, Disability r retirement.) Yu shuld meet with each terminating Emplyee t discuss hw leaving wrk r vluntary terminatin f Cntributry cverage will affect the Emplyee s plan benefits. The Terminatin Checklist in this chapter has been develped t help yu cver the items that shuld be discussed with a terminating Emplyee. Each item n the checklist is cvered in detail in this chapter. Terminatin f cverage ccurs when: The Emplyee requests the terminatin f a cverage that is Cntributry. The Emplyee terminates emplyment. The Emplyee r dependent is n lnger in an eligible class. This may apply t all r part f the Emplyer s benefits prgram. The dependent n lnger meets the plan s definitin f an Eligible Dependent as defined in the IMPORTANT TERMS chapter f this manual. Cntributins cease fr the cverage. Medical and Dental cverage may cntinue fr a specified perid f time after terminatin f cverage if certain requirements are met. (See the Cntinuatin f Cverage sectin f this chapter.) Determining the date f terminatin It is vital that yu ntify GuideStne f terminatins as sn as pssible, but n later than within 31 days f the decisin t terminate cverage. GuideStne is unable t terminate cverage mre than 31 days prir t the date f ntificatin except in certain situatins: fraud r intentinal misrepresentatin f a material fact r nn-payment f premiums. Until ntificatin, the Emplyer will cntinue t be respnsible fr premiums billed fr the affected Emplyee. Nte: In all cases, credits are limited t tw billed mnths. Medical Rescissin rules prhibit Emplyers frm retractively terminating Medical cverage fr which an Emplyee has prepaid. Basically, if an Emplyee cntributes tward the cst f Medical cverage, that cverage cannt be terminated prir t the date thrugh which the cverage is paid. GROUP PLANS 6/13 Page 70

71 HOW TO PROCESS TERMINATIONS Example: If an Emplyee has paid fr cverage thrugh Nvember 30, the terminatin date fr the cverage may nt be prir t Nvember 30, even if yu ntify GuideStne f the desire t terminate cverage prir t that date (ex: Nvember 12). Fr Emplyees whse Emplyer pays fr the cst f Medical cverage, cverage will be terminated as f a current r future date. Hwever, if there is an Administrative delay in the terminatin ntificatin, cverage may be terminated up t 31 days prir t the date f ntificatin. Example 1: The Emplyee terminated emplyment n Nvember 11 and ntificatin was received by GuideStne n Nvember 30. The date cverage will be terminated is Nvember 11. Example 2: The Emplyee terminated emplyment n Nvember 11 and ntificatin was received by GuideStne n January 30. The date cverage will be terminated is December 30, 31 days prir t the date f ntificatin. When requesting terminatin f cverage, yu will be respnsible fr prviding GuideStne with bth the last day wrked and the date thrugh which the cverage has been paid fr by the Emplyee. Dental, Disability, Accident and Term Life Fr lss f eligibility, cverage will terminate the date f the lss f eligibility. Example: The Emplyee lst eligibility when emplyment terminated n Octber 16 and ntificatin was received by GuideStne n Nvember 8. The date cverage will be terminated is Octber 16. Fr all ther terminatin requests, cverage will terminate as f the date f ntificatin t GuideStne. If there is an Administrative delay in the terminatin ntificatin, cverage may be terminated up t 31 days prir t the date f ntificatin. Example: The Emplyee requests that Cntributry life cverage be terminated n Octber 16 but ntificatin was nt received by GuideStne until Nvember 30. The date cverage will be terminated is Octber 30. Cntinuatin f cverage In sme cases, special prvisins allw an Emplyee r Eligible Dependent t cntinue cverage fr a specified amunt f time when his r her cverage wuld nrmally terminate due t ne f the fllwing events: (See the chart in this chapter utlining prvisins and requirements fr cntinuatin f specific cverage.) Emplyee s terminatin Emplyee s lss f cverage due t reduced number f hurs wrked Emplyee s death GROUP PLANS 6/13 Page 71

72 HOW TO PROCESS TERMINATIONS Eliminatin f eligible class f Emplyees Lss f dependent child status Divrce r legal separatin frm the Emplyee The cntinuatin ptins available t the Emplyer include the fllwing. The Medical/Dental Cntinuatin Prvisin is an ptinal prvisin that the Emplyer may r may nt elect t ffer t Emplyees r their dependents. All ther prvisins shuld be ffered t all Emplyees and dependents when applicable. Medical/Dental Cntinuatin Prvisin (MCP/DCP), ptinal Cntinuatin f Insurance Eligibility (CIE) Prtability f Term Life cverage Cnversin f Term Life cverage Cntinuatin f cverage fr surviving Spuse and dependents If the Emplyer elects t ffer a severance package t a terminating Emplyee, any cntinuatin f insurance cverage thrugh GuideStne Financial Resurces must fllw the prvisins f MCP/DCP r CIE. Cverage fr an Emplyee n a severance package will cease n the last day f wrk unless a cntinuatin ptin is selected. Nte: Due t Sectin 4980B f the Internal Revenue Cde, GuideStne Financial Resurces Medical plans are exempt frm COBRA. Sectin 4980B cncerns the failure t satisfy cntinuatin cverage requirements f grup health plans. Accrding t Sectin 4980B (d), there is an exemptin fr Emplyers with fewer than 20 Emplyees, gvernmental plans r church plans within the meaning f Sectin 414 (e). The Medical plans ffered by GuideStne Financial Resurces meet the definitin f church plan under Sectin 414 (e). President Obama signed a stimulus package n February 17, 2009 that included a new COBRA subsidy. As a church plan under the Internal Revenue Cde, GuideStne s Medical prgrams are exempt frm COBRA. While GuideStne des ffer a Medical cntinuatin prgram with prvisins similar t COBRA, cngress did nt include church plans in the subsidy. Medical/Dental Cntinuatin Prvisin (MCP/DCP) The Medical/Dental Cntinuatin Prvisin (MCP/DCP) is an ptinal prvisin that the Emplyer may chse t ffer t Emplyees r dependents whse Medical r Dental cverage wuld therwise terminate. The MCP/DCP is available nly if the Emplyer has chsen this prvisin and has frmally ntified GuideStne Financial Resurces f the electin. The MCP/DCP allws cntinuatin f Medical and/r Dental cverage nly. All ther cverage will terminate n the date the Emplyee and/r dependent becmes ineligible under the Grup Plans. If the GROUP PLANS 6/13 Page 72

73 HOW TO PROCESS TERMINATIONS Emplyer ffers the MCP/DCP, an individual whse Medical and/r Dental cverage wuld nrmally terminate may elect t cntinue his r her current Medical and/r Dental cverage after the date he r she wuld nrmally becme ineligible fr cverage under Grup Plans. Medical and/r Dental cverage may cntinue under the MCP/DCP fr a perid f up t 18 r 36 mnths, dependent upn the reasn fr terminatin. (See Length f Cntinuatin Perid sectin belw). Only dependents wh are participating in the Prgram prir t becming ineligible fr cverage are eligible fr Participatin in the MCP/DCP. Evidence f Gd Health is nt required fr the cntinuatin f Medical cverage thrugh the MCP, hwever, applicatin must be made within 60 days f the date the Emplyee r dependent becmes ineligible fr cverage thrugh Grup Plans. Length f cntinuatin perid Cverage under the MCP/DCP may cntinue fr up t 18 mnths fr Emplyees r their dependents that becme ineligible fr cverage due t: Terminatin f the Emplyee s emplyment Lss f cverage due t the reductin in the number f hurs the Emplyee wrks Eliminatin f the eligible class f Emplyees t which the Emplyee belngs Cverage under the MCP/DCP may cntinue fr up t 36 mnths fr Emplyees cvered dependents wh becme ineligible fr cverage due t: Divrce r legal separatin frm the Emplyee Lss f dependent child status (e.g. children wh reach the maximum age limit under the plan) Cverage under the MCP/DCP will terminate at the first t ccur f: End f the 18 r 36 mnth perid The Participant becmes cvered as an Emplyee r dependent under anther grup Medical/Dental plan The Participant ceases t make necessary payments t the Emplyer The Participant becmes eligible fr Medicare The grup plan terminates fr all Emplyees f the Emplyer Nte: The effective date requested fr terminatin f Medical cverage may be adjusted t cmply with Rescissin rules. Refer t the Determining the Date f Terminatin sectin in this chapter. Payment f charges GROUP PLANS 6/13 Page 73

74 HOW TO PROCESS TERMINATIONS When an Emplyee and/r Eligible Dependent(s) elect t cntinue Medical and/r Dental cverage thrugh the MCP/DCP, the mnthly charges fr the Medical and/r Dental cverage will cntinue at the same rate as fr an active Emplyee. Charges will cntinue t be billed n the Emplyer s mnthly billing statement. It is the respnsibility f the Emplyer t cllect payment fr the charges frm the Participant and submit payment alng with the regular mnthly payment. When nly a dependent is applying fr the MCP/DCP, a separate mnthly charge will be made n yur mnthly billing statement fr the dependent. Cntinuatin f Insurance Eligibility (applies t SBC emplyers/emplyees nly) Cntinuatin f Insurance Eligibility (CIE) is a prvisin that the Emplyer shuld ffer t all terminating Emplyees wh are actively seeking full-time emplyment with a church, agency r institutin affiliated with r sharing cmmn religius bnds with the Suthern Baptist Cnventin. CIE allws cntinuatin f Medical, Term Life, Dental and AD&D cverage at the Emplyee s current cverage vlume fr a perid f up t 12 mnths after the date he r she becmes ineligible fr cverage under Grup Plans. Disability and persnal accident cverage and any ther cverage that the terminating Emplyee des nt elect t cntinue will terminate n the date the Emplyee becmes ineligible under Grup Plans. Emplyee Participatin in CIE is a prerequisite fr dependent cverage. Only dependents wh are participating in the Prgram prir t the Emplyee s terminatin are eligible fr Participatin in CIE. Evidence f Gd Health is nt required fr the cntinuatin f cverage thrugh CIE; hwever, applicatin must be made within 60 days f the date the Emplyee becmes ineligible fr cverage thrugh Grup Plans. Length f cntinuatin perid Cverage under CIE may cntinue fr up t 12 mnths fr Emplyees and their dependents that becme ineligible fr cverage due t the terminatin f the Emplyee s emplyment. Cverage under CIE will terminate at the first t ccur f: The end f the 12-mnth perid The time the Participant accepts anther denminatinal psitin with a church, agency r institutin affiliated with r sharing cmmn religius bnds with the Suthern Baptist Cnventin The time the Participant ceases t make necessary payments t the Emplyer GROUP PLANS 6/13 Page 74

75 HOW TO PROCESS TERMINATIONS The time the Participant becmes eligible fr Medicare The time the grup plan terminates fr all Emplyees f the Emplyer Nte: The effective date requested fr terminatin f Medical cverage may be adjusted t cmply with Rescissin rules. Refer t the Determining the Date f Terminatin sectin in this chapter. Payment f charges When an Emplyee elects t cntinue cverage thrugh CIE, the mnthly charges fr cverage will cntinue at the same rate as fr an active Emplyee. Charges will cntinue t be billed n the Emplyer s mnthly billing statement. It is the respnsibility f the Emplyer t cllect payment fr the charges frm the Participant and submit payment alng with their regular mnthly payment. Prtability f Term Life and Accidental Death and Dismemberment (AD&D) Cverage Prtability is a feature f Term Life Cverage that enables Emplyees t cntinue their Term Life and, if applicable, Optinal Term Life and AD&D cverage, t direct payment plicies with the Life Claims Administratr at grup rates when cverage under Grup Plans terminates. In additin, Spuse Term Life, Spuse Optinal Life and Child Term Life, under certain cnditins, may be cntinued. Prtability cverage is available t dependents nly if the Emplyee elects Prtability cverage. T cntinue Term Life and AD&D cverage thrugh the Prtability ptin, an Emplyee and his r her cvered dependents must prvide Evidence f Gd Health t the Term Life carrier. An individual is nt eligible fr the prtability ptin if he r she has a Medical cnditin which has a material effect n life expectancy. Cverage under the Prtability ptin may be cntinued up t the lesser f five times the Participant s Salary r the cverage amunt lst. The Emplyee and the Emplyee s Eligible Dependent(s), if applicable, must make applicatin within 31 days fllwing the date he r she becmes ineligible fr cverage thrugh Grup Plans. If an Emplyee wants t cntinue Term Life and AD&D cverage under the Prtability ptin, the Emplyee must send a cmpleted Life Insurance Electin f Prtability Cverage Frm t the Life Claims Administratr. If a Participant is ineligible fr Prtability f Term Life cverage, r if his r her Prtability cverage terminates, he r she may be eligible fr Cnversin f Term Life cverage. Cnversin is nt available fr AD&D. GROUP PLANS 6/13 Page 75

76 HOW TO PROCESS TERMINATIONS Prtability f Term Life and AD&D is permitted when: Term Life and AD&D cverage is lst due t terminatin f emplyment. Term Life and AD&D cverage is reduced due t the plan s retirement reductin prvisin. Term Life and AD&D cverage is lst due t eliminatin f eligible class f Emplyees. Payment f charges The Emplyee must pay the full charge directly t the Term Life Claims Administratr fr the Term Life and AD&D plicy(ies) under the Prtability ptin. The Emplyer makes n payment tward the charges fr these plicies. The charges will nt appear n the Emplyer s mnthly billing statement. Rates fr Prtability cverage are nt the same as Grup Plans rates. Cnversin f Term Life cverage Grup Plans enables Emplyees t cnvert their Term Life and, if applicable, Optinal Term Life cverage, t individual direct payment plicies when cverage under the plans terminates. In additin, Spuse Term Life, Spuse Optinal Life and Child Term Life, under certain cnditins, may be cnverted t direct payment plicies. Term Life cverage may be cnverted in any amunt up t and including the amunt lst, t any f the standard cnversin cntracts ffered by the Life Claims Administratr, withut Evidence f Gd Health. The Emplyee r Eligible Dependent must make applicatin within 31 days fllwing the date he r she becmes ineligible fr cverage thrugh Grup Plans. (Or within 31 days f the date the Emplyee r dependent is declined fr Prtability f his r her Term Life cverage, if applicable.) If an Emplyee wants t cnvert Term Life cverage, the Emplyee must send a cmpleted Life Insurance Cnversin Ntificatin f Cnversin Privilege Frm t the Life Claims Administratr. The cnversin plicy will nt cntain Accidental Death and Dismemberment r ther supplemental benefits. The charges will be based n the type f plicy and amunt f cverage selected by the individual, the class f risk t which he r she belngs, and the individual s age n the effective date f the cnversin plicy. Charges are nt based n grup rates and culd be significantly higher than the Participant s cverage under the Grup Plans. Term Life Cnversin is permitted when: Term Life cverage is lst due t terminatin f emplyment. Term Life cverage is reduced due t age r the plan s retirement reductin prvisin. GROUP PLANS 6/13 Page 76

77 HOW TO PROCESS TERMINATIONS Term Life cverage is lst due t eliminatin f eligible class f Emplyees. Dependent Term Life is lst due t lss f dependent eligibility. Nte: The amunt f Term Life cverage in frce as an active Emplyee is payable if death ccurs within the 31-day perid allwed fr cnversin. This amunt is payable whether the actual applicatin was made r the first premium was paid fr the cnversin plicy. The 31-day perid begins n the Emplyee s terminatin date as reprted t GuideStne Financial Resurces. Payment f charges The Emplyee must pay the full charge directly t the Term Life Claims Administratr fr cnverted Term Life plicy(ies). The Emplyer makes n payment tward the charges fr these plicies. The charges will nt appear n the Emplyer s mnthly billing statement. Nte: Rates fr Cnversin cverage are nt the same as Grup Plans rates. Cntinuatin f cverage fr a surviving Spuse and Dependents In the event f an Emplyee s death, the surviving Spuse and ther dependents enrlled in the plan prir t the Emplyee s death may cntinue Term Life, Medical and Dental cverage. In rder t establish the prper recrds, a cmpleted Grup Plans Enrllment Frm shuld be submitted n behalf f the surviving Spuse and Eligible Dependents using the surviving Spuse s Scial Security number and date f birth. When nly children f a deceased Emplyee are cntinuing cverage (n surviving Spuse cverage), use the name and date f birth f the ldest Eligible Dependent n the Enrllment Frm(s). If the surviving Spuse and/r Eligible Dependent(s) are cntinuing Term Life cverage after the Emplyee s death, a new Beneficiary designatin must be made n the new Enrllment Frm. Evidence f Gd Health is nt required fr the cntinuatin f cverage as a surviving Spuse r dependent, hwever, ntificatin must be cmpleted within 90 days f the date f the Emplyee s death. GROUP PLANS 6/13 Page 77

78 HOW TO PROCESS TERMINATIONS Length f cntinuatin perid Cverage as a surviving Spuse r dependent may cntinue indefinitely but will terminate at the first t ccur f: Spuse r dependent becmes eligible under anther grup plan. Dependent n lnger meets the Prgram definitin f an Eligible Dependent. Spuse r dependent ceases t make necessary payments t the Emplyer. The grup plan terminates fr all Emplyees f the Emplyer. Payment f charges The mnthly charges fr cverage fr a surviving Spuse and dependents will cntinue at the same rate as fr an active Emplyee. The surviving Spuse will be set up as Emplyee n the Emplyer s mnthly billing statement. It is the respnsibility f the Emplyer t cllect payment fr the charges frm the surviving Spuse and submit payment alng with the regular mnthly payment. GROUP PLANS 6/13 Page 78

79 HOW TO PROCESS TERMINATIONS Cverage Cntinuatin Prvisins FEATURES MEDICAL/ DENTAL CONTINUATION PROVISION (MCP/DCP) CONTINUATION OF INSURANCE ELIGIBILITY (CIE) (Applies t SBC Emplyers/ Emplyees Only) SURVIVING SPOUSE AND/OR DEPENDENT COVERAGE AFTER EMPLOYEE S DEATH Qualifying Events fr Emplyee t Cntinue Cverage 1. Terminatin f emplyment (except in the case f grss miscnduct ) 2. Lss f cverage due t reduced number f hurs wrked 3. Eliminatin f Eligible Class f Emplyees Same as Medical/Dental Cntinuatin Prvisin. Additinally, the Emplyee must be actively seeking full-time emplyment with a church, agency r institutin affiliated with r sharing cmmn religius bnds with the SBC Nt Applicable 1. Terminatin f the Emplyee s emplyment Qualifying Events fr Dependent(s) t Cntinue Cverage 2. Emplyee s lss f cverage due t reduced number f hurs wrked 3. Divrce r legal separatin frm the Emplyee 4. Lss f dependent child status (i.e., children wh reach limiting age under the plan) Emplyee s cverage is being cntinued accrding t CIE prvisins Death f Emplyee Requirement fr Cntinuatin Emplyee r dependent must have been enrlled in the plan prir t terminatin f cverage 1. Emplyee and dependent(s) must have been enrlled in the plan prir t Emplyee s terminatin 2. Emplyee cverage is a prerequisite fr dependent cverage t be cntinued Surviving Spuse and ther dependent(s) must have been enrlled in the plan prir t Emplyee s death GROUP PLANS 6/13 Page 79

80 HOW TO PROCESS TERMINATIONS FEATURES MEDICAL/ DENTAL CONTINUATION PROVISION (MCP/DCP) CONTINUATION OF INSURANCE ELIGIBILITY (CIE) (Applies t SBC Emplyers/ Emplyees Only) SURVIVING SPOUSE AND/OR DEPENDENT COVERAGE AFTER EMPLOYEE S DEATH Cntinued Benefits fr Emplyee and Dependent(s) Medical/Dental Term Life, AD&D, Medical, Dental Term Life, Medical, Dental Enrllment 1. Emplyee r dependent must sign an applicatin t cntinue cverage within 60 days f the date cverage wuld therwise terminate 2. Lss f dependent eligibility will result in an enrllment separate frm the Emplyee Emplyee must sign an applicatin t cntinue cverage within 60 days f the date cverage wuld therwise terminate Spuse r dependent must prvide an Enrllment Frm t cntinue cverage within 90 days f the date cverage wuld therwise terminate Payment f Charges Emplyer is respnsible fr cllecting payments frm the frmer Emplyee r dependent and remitting payment t GuideStne Financial Resurces n a mnthly basis alng with the Emplyer s regular payment Same as Medical/Dental Cntinuatin Prvisin Emplyer is respnsible fr cllecting payments frm the spuse r dependent and remitting them t GuideStne Financial Resurces n a mnthly basis alng with the Emplyer s regular payment Length f Cntinuatin Perid mnths fr Emplyees and dependent(s) in the event f terminatin f emplyment r lss f cverage due t a reductin in number f hurs wrked mnths fr all ther dependent categries 12 mnths Indefinitely GROUP PLANS 6/13 Page 80

81 HOW TO PROCESS TERMINATIONS FEATURES MEDICAL/ DENTAL CONTINUATION PROVISION (MCP/DCP) CONTINUATION OF INSURANCE ELIGIBILITY (CIE) (Applies t SBC Emplyers/ Emplyees Only) SURVIVING SPOUSE AND/OR DEPENDENT COVERAGE AFTER EMPLOYEE S DEATH Events that Terminate Cverage 1. Emplyee r dependent ceases t make necessary payments 2. Emplyee r dependent becmes cvered as an Emplyee under any grup plan 3. The individual becmes eligible fr Medicare cverage 4. Frmer spuse f an Emplyee remarries and becmes cvered as a dependent under any grup plan 5. The grup plan terminates fr all Emplyees 6. End f cntinuatin perid Same as Medical/Dental Cntinuatin Prvisin 1. Spuse r dependent ceases t make necessary payments 2. Spuse r any ther dependent becmes eligible fr benefits under any grup plan 3. A dependent n lnger meets the Prgram definitin f a dependent 4. Dependent cverage is discntinued fr the eligible class in which the Emplyee was a member 5. The grup plan terminates fr all Emplyees Prtability/ Cnversin Optin When Cntinuatin Ceases N prtability r cnversin ptin fr PPO Medical/Dental plans Cnversin fr Life cverage must be requested within 31 days f terminatin f cverage, prvided requirements are met. Prtability is nt available. Prtability fr AD&D cverage must be requested within 31 days f terminatin f cverage, prvided requirements are met. Cnversin is nt available. Cnversin fr Life cverage must be requested within 31 days f terminatin f cverage, prvided requirements are met. Prtability is nt available. N prtability/cnversin fr PPO Medical/Dental plans N prtability/cnversin fr PPO Medical/Dental plans. GROUP PLANS 6/13 Page 81

82 HOW TO PROCESS TERMINATIONS Certificate f Creditable Cverage fr Medical When an Emplyee r dependent terminates Medical cverage thrugh Grup Plans, a Certificate f Creditable Cverage will be issued t the Emplyee and/r cvered dependent(s). A Certificate is als issued when an Emplyee and/r cvered dependent(s) elects t cntinue Medical cverage thrugh the Medical/Dental Cntinuatin Prvisin (MCP/DCP) r Cntinuatin f Insurance Eligibility (CIE). Certificatin f cverage extends t each cvered persn, nt just the Emplyee. Grup Plans prvides a cnslidated certificate cvering all members f the same family when infrmatin is identical fr each individual r separate certificate when the infrmatin is different. Grup Plans will prvide certificates t a third party at the cvered individual s request. Nte: Certificates will be prvided at the request f the individual fr up t 24 mnths after the cverage ceases r after a cntinuatin perid ends. A Certificate f Creditable Cverage may be used by an individual when enrlling in a new Medical plan. The Certificate may reduce the Pre-existing Cnditin Limitatin Perid f the new plan. An individual shuld retain the Certificate f Creditable Cverage fr 24 mnths after terminatin f cverage fr use in prviding evidence f prir cverage. GROUP PLANS 6/13 Page 82

83 HOW TO PROCESS TERMINATIONS Terminatin checklist Name f Emplyee: Date f full-time emplyment: Scial Security number: Date f terminatin: Discuss with the Emplyee the effects f terminatin n benefits and the date that cverage under the Emplyer s plan stps. Check ff each bx after the subject has been discussed r the material listed has been given t the terminating Emplyee. Date all benefits stp Ntice f Cntinuatin Prvisins (if applicable) Term Life cverage Prtability and Cnversin prvisins and applicatin prcess Certificate f Creditable Cverage fr Medical Administratr: Date interviewed: GROUP PLANS 6/13 Page 83

84 HOW TO PROCESS TERMINATIONS Terminatin prcedures Prcess terminatins as fllws: 1. The Emplyee shuld be tld what effect leaving active emplyment will have n the Emplyee s plan benefits. The Terminatin Checklist lcated n the previus page can help yu t prvide this infrmatin. Be sure t cver the fllwing pints: Date cverage under the plans terminates Cntinuatin Prvisins, if applicable Term Life cverage Prtability and Cnversin prvisins Certificate f Creditable Cverage fr Medical 2. If the Emplyee wants t cntinue Term Life and Accidental Death and Dismemberment (AD&D), if applicable, cverage under the Prtability prvisin, a Life Insurance Electin f Prtability Cverage Frm must be cmpleted and returned t the Term Life Claims Administratr. Nte: If an Emplyee submits an applicatin fr Prtability cverage, and Prtability cverage is denied, the Term Life Claims Administratr will cntact the Emplyee cncerning the Cnversin ptin. The Emplyer shuld cmplete the fllwing infrmatin n the Prtability cverage applicatin: Cmpany name GuideStne Financial Resurces, SBC Plan number Divisin number 001 unless a different three digit number appears n yur life bklet in the upper right hand crner. Date cverage ended Reasn fr cverage terminatin Current life amunt The Emplyee s current vlume f life cverage. Als include the current vlume f spuse and/r dependent cverage if the Emplyee wants t cnvert that cverage. Emplyer signature Date The Emplyee shuld cmplete the remainder f the applicatin and mail it t the Term Life Claims Administratr at the address n the tp f the frm. Emphasize that applicatin fr Prtability cverage must be made within 31 days f the date cverage terminates thrugh Grup Plans. GROUP PLANS 6/13 Page 84

85 HOW TO PROCESS TERMINATIONS 3. If the Emplyee is ineligible t cntinue Term Life cverage under the Prtability prvisin because f health prblems, a Life Insurance Ntificatin f Cnversin Privilege frm shuld be cmpleted and returned t the Term Life Claims Administratr. The Emplyer shuld cmplete the fllwing infrmatin n the cnversin cverage applicatin: Cmpany name GuideStne Financial Resurces, SBC Plan number/divisin number Emplyee s name, Scial Security number and date f birth include this infrmatin even if the applicatin is fr dependent cverage. Dependent name, Scial Security number and date f birth this shuld be cmpleted nly if a dependent is applying fr cverage. A separate applicatin must be cmpleted fr the Emplyee and each dependent. Verify if the Emplyee was disabled n the date f terminatin r reductin, if applicable Date f terminatin r reductin Amunt f cverage lst Was the Emplyee disabled n the date f terminatin r reductin? Emplyer signature Date The Emplyee shuld cmplete the remainder f the Cnversin cverage applicatin and mail it alng with the first mnth s premium t the Term Life Claims Administratr at the address n the tp f the frm. (Rates are included in the applicatin.) 4. Cmplete the Emplyer Change Reprt indicating the terminatin f the Emplyee. Be sure t include the effective date f the change, the date thrugh which Medical premiums have been paid if Medical cverage is terminating and t sign and date the frm. 5. If the Emplyee and/r his r her Eligible Dependents wish t cntinue cverage thrugh the Medical/Dental Cntinuatin Prvisin (MCP/DCP), if ffered by the Emplyer, r the Cntinuatin f Insurance Eligibility (CIE), cmplete the applicable cntinuatin frm in additin t Emplyer Change Reprt. 6. Retain a cpy f the Grup Plans Emplyer Change Reprt and the cntinuatin frm, if applicable, fr yur permanent file. 7. Send the Emplyer Change Reprt and if applicable, the cntinuatin frm t the fllwing address: GuideStne Financial Resurces Insurance Operatins, Grup Plans 2401 Cedar Springs Rad Dallas, TX GROUP PLANS 6/13 Page 85

86 HOW TO PROCESS TERMINATIONS 8. If the terminating Emplyee is nt cntinuing cverage thrugh MCP/DCP r CIE, remve cpies f the Emplyee s Enrllment Frm and change frms frm the active enrllment file. Place this material in the file kept fr terminating Emplyees. These recrds shuld be held fr a minimum f five years frm the date the Emplyee terminates. GROUP PLANS 6/13 Page 86

87 LEAVING ACTIVE EMPLOYMENT LEAVING ACTIVE EMPLOYMENT General infrmatin Yu are respnsible fr telling an Emplyee what will happen t plan benefits and t the benefits f cvered dependent(s) when an Emplyee leaves active emplyment status. The varius cnditins that cnstitute leaving active wrk status are listed belw: Leave f absence Disability leave Retirement The effects n an Emplyee s plan benefits in the event f death, resignatin r discharge are described separately under the chapter HOW TO PROCESS TERMINATIONS. Leave f absence If an Emplyee is granted a leave f absence, cverage under Grup Plans, with the exceptin f Disability, may cntinue up t 12 mnths, prvided mnthly payment f charges cntinues n the Emplyer s billing. Respnsibility fr payment is at the Emplyer s discretin. An Emplyer Change Reprt must be cmpleted and sent t GuideStne Financial Resurces Insurance Operatins, Grup Plans within 31 days f the date the leave f absence begins. The change reprt shuld include the date the leave f absence begins, as well as the date the Emplyee is expected t return t active emplyment. At the end f the 12-mnth perid, r at any time befre that date when mnthly billing payments are discntinued, the Emplyee may elect t cntinue Term Life cverage as direct payment plicies thrugh the Life Claims Administratr. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter in this manual.) Disability leave Verificatin f Disability status In rder t cntinue Participatin in the Grup Plans during a perid f Disability, an Emplyee s Disability status must be verified thrugh ne f the fllwing surces: The Emplyee is apprved t receive Disability benefits under a Grup Plans Disability Plan r anther Lng-Term Disability plan. GROUP PLANS 6/13 Page 87

88 LEAVING ACTIVE EMPLOYMENT The Emplyee is apprved fr Waiver f Payment fr a GuideStne Financial Resurces Term Life Plan and/r Emplyee Persnal Accident Plan. The Emplyee is apprved fr Scial Security Disability benefits. Sme cverage under the Grup Plans may be cntinued when an Emplyee becmes disabled. Sme cverage has Waiver f Payment prvisins; thers require that charges cntinue t be paid. Sme cverage is cntinued fr specified perids f time while thers are cntinued until the Emplyee attains age 65 r age 70. In sme situatins, the Emplyee may be cnsidered retired. Cntact yur Grup Plans Accunt Administratr fr infrmatin regarding cverage fr any disabled Emplyee. When Disability ends An Emplyee may be apprved fr Disability status indefinitely r fr a specific time perid. The Emplyee is eligible t cntinue Participatin in Grup Plans nly during the perid f Disability. When an Emplyee s Disability cannt be verified (see the Verificatin f Disability Status sectin f this chapter), he r she is n lnger eligible fr cverage under Grup Plans as a disabled Participant. (When a Participant s Disability benefits cease but Waiver f Payments cntinues, the Participant is still cnsidered t be disabled and may cntinue cverage in Grup Plans.) When a Participant reaches the end f the time perid fr which his r her Disability status was apprved, he r she may: Return t wrk, if n lnger disabled. Cntinue cverage thrugh the Medical/Dental Cntinuatin Prvisin (MCP/DCP) fr 18 mnths if the Emplyer ffers the Prgram r thrugh Cntinuatin f Insurance Eligibility (CIE) fr 12 mnths and the Participant is therwise eligible. (See the Cntinuatin f Cverage sectin f the HOW TO PROCESS TERMINATIONS chapter in this manual.) Cntinue cverage as a Retiree if the Participant is ver age 55 and is cnsidered by his r her Emplyer t be retired, and the Emplyer ffers retiree cverage. (See the Retirement at Age 55 r Older sectin f this chapter.) If cverage is nt cntinued thrugh ne f the abve prvisins, all cverage will terminate. The Emplyee has the ptin f cntinuing Life cverage accrding t the Prtability r Cnversin privilege as a direct payment plan with the Term Life Claims Administratr when he r she is n lnger eligible t cntinue cverage under Grup Plans. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter f this manual.) GROUP PLANS 6/13 Page 88

89 LEAVING ACTIVE EMPLOYMENT Retirement befre age 55 Grup Plans benefits terminate n the date f retirement fr thse Emplyees wh retire prir t age 55. These Emplyees have the ptin f cntinuing Life cverage accrding t Prtability r Cnversin privilege as a direct payment plan with the Term Life Claims Administratr. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter f this manual.) Retirement at age 55 r lder Fr Grup Plans cverage purpses, retirement age is cnsidered age 55 r lder. A dependent is eligible fr cverage under the retired Emplyee s Medical, Dental and Term Life plans nly if the dependent was enrlled in the plan(s) at the time f the Emplyee s retirement. Charges will cntinue t be billed n the Emplyer s mnthly statement. It is the respnsibility f the Emplyer t cllect payment fr the charges frm the Participant and submit payment alng with the Emplyer s regular payment. These Emplyees may be eligible t cntinue the amunt f Term Life cverage lst due t reductin thrugh a direct payment plicy with the Term Life Claims Administratr. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter f this manual.) A retiree s eligibility fr cverage is based n the Emplyer s cntinued Participatin in the plan. GROUP PLANS 6/13 Page 89

90 LEAVING ACTIVE EMPLOYMENT Retired Emplyees in this age grup and their cvered dependents are eligible fr Grup Plans cverage as summarized belw. PLAN BENEFIT Medical Dental Disability Emplyee Term Life Cverage Emplyee Optinal Term Life Cverage EFFECT OF RETIREMENT ON COVERAGE If the Emplyer ffers retirement benefits, Medical cverage may cntinue fr the retired Emplyee and spuse, if eligible, until each reaches age 65. At age 65, the Emplyee and/r spuse must select a Medicare crdinating plan if he r she wants t cntinue Medical cverage under Grup Plans. Cverage is then ffset by the benefits prvided by Medicare. A Medicare-crdinating Plans Enrllment Frm is required t enrll. The effective date f cverage will depend n the date the frm is received and the plan chsen. Dental cverage terminates upn the Emplyee s retirement unless the Emplyer has elected t ffer cntinuatin f Dental cverage int retirement. Cverage terminates upn Emplyee retirement. If the Emplyer ffers retirement benefits, cverage is reduced upn Emplyee retirement. The amunt f standard cverage is limited t a maximum f $20,000 in multiples f $5,000. The amunt f cverage may nt increase fllwing the Emplyee s electin at retirement. The Emplyee has the ptin f cntinuing the amunt f Term Life cverage lst due t retirement accrding t Prtability r Cnversin privilege as a direct payment plan with the Term Life Claims Administratr when he r she is n lnger eligible t cntinue cverage under Grup Plans. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter f this manual.) If the Emplyer ffers retirement benefits, cverage is reduced r terminated upn Emplyee retirement. The cmbined ttal f bth the Emplyee Term Life cverage and Emplyee Optinal Term Life cverage is limited t a maximum f $20,000 in multiples f $5,000. The amunt f cverage may nt increase fllwing the Emplyee s electin at retirement. The Emplyee has the ptin f cntinuing the amunt f Emplyee Optinal Term Life Cverage lst due t retirement accrding t Prtability r Cnversin privilege as a direct payment plan with the Term Life Claims Administratr when he r she is n lnger eligible t cntinue cverage under Grup Plans. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter f this manual.) GROUP PLANS 6/13 Page 90

91 LEAVING ACTIVE EMPLOYMENT Term Life Cverage fr Dependents Persnal Accident Cverage Accidental Death and Dismemberment Cverage Cverage may cntinue fr the retired Emplyee s eligible spuse and children. Spuse cverage will be reduced, if necessary, nt t exceed 50% f the ttal amunt f Emplyee Term Life and Emplyee Optinal Term Life cverage elected at retirement. The minimum Spuse Term Life amunt is $5,000. The Emplyee has the ptin f cntinuing the amunt f Term Life Cverage fr Dependents lst due t retirement accrding t Prtability r Cnversin privilege as a direct payment plan with the Term Life Claims Administratr when he r she is n lnger eligible t cntinue cverage under Grup Plans. (See the Prtability f Term Life Cverage and Cnversin f Term Life Cverage sectins f the HOW TO PROCESS TERMINATIONS chapter f this manual.) Cverage terminates upn Emplyee retirement. Cverage terminates upn Emplyee retirement. Prcedures fr prcessing an emplyee leaving active emplyment Prcess changes as fllws: 1. The Emplyee shuld be tld what effect leaving active emplyment will have n the Emplyee s plan benefits. Be sure t cver the fllwing pints: The plans that may be cntinued and hw lng they may be cntinued prvided any required charges are paid The date Disability cverage terminates Hw Medical benefits are affected by Medicare The reductin r terminatin f Term Life cverage due t retirement Emplyee and Dependent Term Life cverage Prtability and/r Cnversin rights 2. If applicable, give the Emplyee a Life Insurance Electin f Prtability Cverage Frm and/r a Life Insurance Cnversin Ntice f Cnversin Privilege Frm. If the Emplyee wants t cntinue his r her Life cverage r dependent life cverage under the Prtability r Cnversin privilege, the apprpriate Life Insurance Electin f Prtability Cverage Frm and/r a Life Insurance Cnversin Ntice f Cnversin Privilege Frm must be cmpleted and returned t the Life Claims Administratr. Nte: Emphasize that Term Life Prtability r Cnversin rights must be exercised within 31 days f the date emplyment terminates. GROUP PLANS 6/13 Page 91

92 LEAVING ACTIVE EMPLOYMENT 3. Cmplete the Emplyer Change Reprt. A change reprt must be cmpleted and sent t GuideStne Financial Resurces Insurance Operatins, Grup Plans when an Emplyee leaves active emplyment. Be sure t include the effective date f the change, the date thrugh which Medical has been paid if Medical cverage is terminating and t sign and date the frm. 4. In additin, a Medicare-crdinating Plans Enrllment Frm shuld be cmpleted if the Emplyee is: Retiring frm active emplyment Cntinuing Medical cverage The Emplyee and/r a cvered dependent are age 65 r lder The Emplyee and any cvered dependent are nt currently enrlled in a Medicare crdinating plan The effective date f cverage will depend n the date the frm is received and the plan chsen. It is critical that all requested infrmatin and signatures are cmpleted n the frm including the Emplyer Tax ID number and the Medicare Claim number. 5. Retain a cpy f the Emplyer Change Reprt and the Medicare-crdinating Plans Enrllment Frm, if applicable, fr yur permanent file. 6. Send the cmpleted Emplyer Change Reprt and the Medicare-crdinating Plans Enrllment Frm, if applicable, t the fllwing address: GuideStne Financial Resurces Insurance Operatins, Grup Plans 2401 Cedar Springs Rad Dallas, TX GROUP PLANS 6/13 Page 92

93 LIFE, PERSONAL ACCIDENT AND DISABILITY CLAIMS LIFE, PERSONAL ACCIDENT AND DISABILITY CLAIMS General infrmatin Ntify GuideStne Financial Resurces Insurance Operatins when a claim fr benefits under any f the fllwing plans ccurs: Emplyee, Spuse and Child Term Life Plans Lng- and Shrt-Term Disability Plans Emplyee and Spuse Persnal Accident Plans Accidental Death and Dismemberment (AD&D) Plan GuideStne Financial Resurces Insurance Operatins will send yu the necessary claim frms and instructins cncerning hw t file a claim fr benefits. Tax withhlding frm Disability payments The Claims Administratr is required t withhld FICA taxes frm Disability benefit payments made during the six calendar mnths fllwing the mnth in which the Emplyee last wrked. Unum matches the amunt withheld by the Claims Administratr. The Claims Administratr may als, at the Emplyee s request, withhld Federal Incme Tax (FIT) frm Disability benefit payments. If this tax is withheld, the Claims Administratr will reprt it n the Frm W-2 n which it reprts any FICA withheld. The percent f Disability payments subject t FIT taxatin is the same as the percent f the cst f Disability cverage paid by the Emplyer. Fr example, if 100% f the cst f Disability cverage is paid by the Emplyer, then 100% f the Disability benefit payment is subject t FIT. Hwever, if 100% f the cst f Disability cverage is paid by the Emplyee, then the Disability benefit payment is nt subject t FIT. If a prtin f the cst f Disability cverage is paid by bth the Emplyer and Emplyee, the prtin f the Disability benefit payment subject t FIT is the percentage f the cst f Disability cverage paid by the Emplyer. In additin, the Claims Administratr will match the FICA tax that is nrmally paid by the Emplyer. Prcedures The Emplyer will peridically receive frm the Claims Administratr a Disability Detailed Tax Reprt f Disability payments, which are subject t FICA taxatin. GROUP PLANS 6/13 Page 93

94 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS HOW TO PROCESS MEDICAL AND DENTAL CLAIMS General infrmatin Medical and Dental cverage ffers Emplyees and their Eligible Dependents prtectin against cstly Medical and Dental bills and expenses. Specific details are utlined in the Emplyee Bklet fr each plan. Refer t the Bklet fr specific plan cverage. This chapter f the manual gives yu general infrmatin abut hw claims will be prcessed under the PPO Medical Plans, Medicare-crdinating Plans as well as the Premier, Chice and Guided Dental plans. The plans have been designed t simplify yur invlvement with claims prcessing. Hwever, the Administrative success f the plans may depend t a large degree n hw well yur Emplyees are infrmed n the benefits f the plans and the prper prcedures fr filing a claim. Yur respnsibilities include the fllwing: Explaining t Emplyees the benefits prvided by the plans Explaining t Emplyees the prcedures fr filing a claim Distributing t Emplyees the Plan Bklet, and infrmatin regarding Preferred Prvider Organizatin (PPO) and Dental Health Maintenance Organizatin (DHMO) prvider netwrks, as applicable Distributing Summaries f Benefits and Cverage Distributing the Cntraceptives Ntice and Certificatin Nte: Fr yur cnvenience all f ur bklets are nline at Imprtant reminders The fllwing pints shuld be discussed with Emplyees prir t the time they actually receive health care services. Explain the plan benefits including the required Preauthrizatin guidelines if applicable. Refer the Emplyee t the apprpriate Medical Bklet. Explain the hme delivery service and retail features f the Prescriptin Drug Prgram. If a Participant has given the Health Care Prvider permissin t submit a claim, the Participant shuld nt file the claim himself. Duplicate filing increases the Administrative csts f handling claims and results in denied and pended claims. If the Participant is nt sure whether r nt the GROUP PLANS 6/13 Page 94

95 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS prvider has submitted a claim, he r she shuld ask the prvider befre filing the claim. Participants may view their claims nline fr the Highmark PPO Medical Plans at Fr the Medicare-crdinating Plans, nce Medicare has prcessed the claim, Medicare shuld file the claim with the Claims Administratr r Emplyees can frward their itemized bills and cpies f their Medicare Explanatin f Benefits Frm t the Claims Administratr fr prcessing. If the patient has ther grup cverage that is primary, a cpy f the primary grup cverage explanatin f benefit payment and the itemized statement must be submitted with the claim. Canceled checks and cash register receipts are nt acceptable when filing a claim. The Participant s ID card will cntain infrmatin regarding the PPO netwrk, including a phne number t verify participating prviders. PPO physicians and facilities may als be lcated thrugh Highmark Blue Crss Blue Shield at PPO Netwrk infrmatin des nt apply t Participants enrlled in the Medicare-crdinating plans. If internet access is nt available, prvider infrmatin may be btained by calling the Claims Administratr at the number listed in the HOW TO GET HELP chapter f this manual. Since prviders may discntinue Participatin in PPO netwrks at any time, it is imprtant fr Participants t verify a prvider s cntinued Participatin by calling the number n the Medical ID card each time he r she receives services. Grup Plans als prvides health care cverage fr Emplyees and Eligible Dependents while they are utside f the United States. (See the Internatinal Claims sectin f this chapter fr details.) Dental benefits are paid fr cvered services received in a freign cuntry nly in the case f an emergency. Preauthrizatin guidelines fr Medical plans Highmark BCBS administers GuideStne Financial Resurces Preauthrizatin prgrams fr inpatient hspital stays cvered by the PPO Medical Plans. Preauthrizatin is a determinatin that a Participant s admissin t a hspital r treatment facility is medically necessary. Refer t Health Care Management Services sectin f the Bklet fr specific guidelines r cntact the Claims Administratr, by calling the phne number n the back f the Participant s Medical ID card. Preauthrizatin prcedure Whenever a Participant s Health Care Prvider recmmends hspitalizatin, the Participant shuld call the Claims Administratr listed n the back f the Participants Medical ID card seven t 10 days prir t the date f admissin. If the hspitalizatin is an emergency, the Participant must call within 48 hurs after the start f the emergency admissin. If inpatient treatment f substance abuse r mental illness is recmmended, the Participant must call the tll-free number befre treatment begins. GROUP PLANS 6/13 Page 95

96 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS Befre a Participant calls fr Preauthrizatin, the Participant will need t have the fllwing infrmatin. Sme f the infrmatin shuld be btained frm the Health Care Prvider. Patient s name, birth date, and relatinship t Emplyee Emplyee s name, Scial Security number, address and telephne number Emplyer s name Reasn fr hspitalizatin Dctr s name, address and telephne number Name, address and telephne number f hspital r place f surgery r treatment The Claims Administratr s Medical review specialist will discuss the request fr hspitalizatin, inpatient mental health r substance abuse treatment with the Participant. In many cases, the Medical review specialist will cnfirm the Medical necessity fr hspitalizatin ver the telephne. If there is a questin abut the Medical necessity fr hspitalizatin, r mre infrmatin is needed, the Medical review specialist will discuss this with the Health Care Prvider r his r her designated staff. If the Participant disagrees with the Claims Administratr s decisin, the Participant r his r her Health Care Prvider can request anther review. Nte: Obtaining a Preauthrizatin des nt guarantee that the plan will pay benefits. Preauthrizatin is nly a determinatin that a Participant s admissin t a hspital is medically necessary. All terms and cnditins f the plan must be met. Reductin f benefits If a Participant des nt call the Claims Administratr within the specified time limits, benefits fr services that require Preauthrizatin will be reduced: If a Participant des nt btain a Preauthrizatin fr an inpatient hspital stay, including hspitalizatin fr treatment f mental illness r substance abuse, the reductin will be applied t all hspital inpatient stay charges. If a Participant calls t request Preauthrizatin after he r she has been admitted t the hspital, including hspitalizatin fr treatment f mental illness r substance abuse, the reductin will be applied t all hspital inpatient stay charges incurred up t the date a hspital admissin review is btained. If the Claims Administratr denies a Participant s request fr a Preauthrizatin, the plan will nt pay any f the charges fr the hspital stay r fr the listed prcedure r service. Refer t the Health Care Management Services sectin f the Bklet and the Schedule f Benefits fr specific guidelines. GROUP PLANS 6/13 Page 96

97 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS Filing a Medical claim PPO Medical plans PPO Medical Plans Participants must submit a claim t the Claims Administratr within ne year frm the end f the year fllwing the date f service. These steps shuld be fllwed when filing a claim: 1. When a Participant ges t a Health Care Prvider, the Participant shuld shw the prvider his r her Medical ID card with the Claims Administratr s phne number and mailing address n it. 2. If the Emplyee files the claim, he r she shuld mail the prvider s itemized statement t the address listed n the Medical ID card. If the prvider files the first claim, the prvider shuld mail an itemized statement fr the services t the address listed n the Medical ID card, r the prvider may submit the claim electrnically t the Claims Administratr. 3. The Emplyee shuld retain cmplete cpies f all claim submissins s that, in the event a claim is lst, the Emplyee will be prepared t re-submit the claim. 4. An Explanatin f Benefits may be sent t the Emplyee when charges include anything ther than an ffice visit c-payment. Unless benefits have been assigned, Medical plan payments fr each claim submitted will be sent t the Emplyee. 5. After reviewing the Explanatin f Benefits received in cnnectin with a paid claim, if the Emplyee suspects that the payment is in errr, the Emplyee shuld cntact the Claims Administratr s claim ffice at the Member Services number n the Medical ID card. 6. After fur weeks, if the Participant s claim has nt been paid r acknwledged, the Emplyee shuld cntact the Claims Administratr s claim ffice at the number n the Medical ID card t determine the status f the claim. Claim infrmatin may als be accessed thrugh Highmark Blue Crss Blue Shield s website Medicare-crdinating plans Claims fr the Senir Plus, Senir, Care Plus, Care Basic and Care Tday Plans are filed just as they are fr the PPO Medical Plans. (See the PPO Medical Plans sectin f this chapter fr details.) Hwever, since Medicare is the primary payer f benefits, the claims shuld first be filed with Medicare. Once Medicare has paid its prtin f the claim, Medicare shuld electrnically file with the Claims Administratr r the claim may be submitted t the Claims Administratr alng with Medicare s Explanatin f Benefits. Pretreatment review f Dental benefits Whenever the estimated cst f a recmmended Dental treatment plan exceeds $300, the treatment plan shuld be submitted t the Claims Administratr fr review befre treatment begins. GROUP PLANS 6/13 Page 97

98 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS Nte: Obtaining a Pretreatment Review f Dental Benefits des nt guarantee that the plan will pay benefits. All terms and cnditins f the plan must be met. Pretreatment review prcedure T btain a Pretreatment Review f Dental Benefits, the Dental Care Prvider shuld prepare a treatment plan and send it t the Claims Administratr befre any Dental services are perfrmed. The treatment plan shuld: List the recmmended Dental services Shw the charge fr each Dental service Be accmpanied by supprting preperative X-rays and any ther apprpriate diagnstic materials The Claims Administratr will ntify the Emplyee and the attending Dental Care Prvider f the benefits payable based upn the treatment plan. Filing a Dental claim Premier and Chice Plans Premier and Chice Dental Plan Participants must submit a claim t the Dental Claims Administratr within 90 days f the date the claim is incurred. These steps shuld be fllwed when filing a claim: 1. When a Participant ges t a Dental care prvider, the Participant shuld present his r her Dental Plan ID Card t the prvider. 2. Either the Participant r the Dental Care Prvider shuld cmplete an American Dental Assciatin Dental Claim Frm, r yu can dwnlad a Dental Claim Frm frm Cigna s website, 3. The Emplyee shuld retain cmplete cpies f all claim submissins s that, in the event a claim is lst, the Emplyee will be prepared t resubmit the claim. 4. The Emplyee r Dental Care Prvider shuld submit the claim frm within 90 days f the date the claim is incurred t: Cigna Health Care P.O. Bx Chattanga, TN An Explanatin f Benefits will be sent t the Emplyee. Unless benefits have been assigned, Dental plan payments fr each claim submitted will be sent t the Emplyee. 6. After reviewing the Explanatin f Benefits received in cnnectin with a paid claim, if the Emplyee suspects that the payment is in errr, the Emplyee shuld cntact the Claims Administratr s claim ffice at GROUP PLANS 6/13 Page 98

99 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS 7. After fur weeks, if the Participant s claim has nt been paid r acknwledged, the Emplyee shuld cntact the Claims Administratr s claim ffice at t determine the status f the claim. Nte: Whenever the estimated cst f a recmmended Dental plan treatment exceeds $300, the Dental treatment plan shuld be submitted t the Claims Administratr fr review befre treatment begins. The treatment plan shuld be accmpanied by supprting preperative X-rays and any ther apprpriate diagnstic materials as requested by the Claims Administratr. (See the Pretreatment Review fr Dental Benefits sectin f this chapter.) Guided DHMO Dental Plan T receive benefits frm the Guided DHMO Dental Plan, cntracted r apprved Dental Care Prviders must be used. N claim frms are necessary t receive benefits. Participants pay nly a c-pay fr Dental care services received frm their selected plan dentist r frm a plan specialist fr services that the plan dentist is unable t prvide. N referral is needed frm the selected plan dentist in rder t btain services frm a plan specialist. (Refer the Emplyee t the Certificate f Insurance issued by the Claims Administratr fr detailed benefit infrmatin.) Prescriptin drug prgram The prescriptin drug prgram fr the PPO Medical Plans and Medicare-crdinating Plans is administered by Express Scripts. Participants enrlled in any f the PPO Medical Plans r Medicare-crdinating Plans will receive a separate prescriptin drug ID card frm Express Scripts. Hme delivery prgram Fr prescriptin medicatins used n a regular basis, the Hme Delivery Pharmacy Service ffered thrugh Express Scripts prvides the highest level f benefits. Yur Emplyees shuld receive a Hme Delivery Prescriptin Drug Frm and envelpe frm Express Scripts when they enrll in the PPO Medical Plans r Medicare-crdinating Plans. T get a prescriptin filled thrugh the Hme Delivery Pharmacy Service: 1. A Participant shuld ask his r her dctr t prescribe a 90-day supply f the needed medicatin, plus refills, if apprpriate. The physician s name and daily dsage shuld be clearly indicated n the prescriptin. GROUP PLANS 6/13 Page 99

100 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS 2. The Participant can call Express Scripts tll-free number, , r dwnlad and print the Express Scripts Hme Delivery Pharmacy Order Frm. Participants shuld then mail the prescriptin with the crrect c-payment in a cmpleted mail rder envelpe t the fllwing address: Express Scripts P.O. Bx Dallas, TX Or, a Participant can ask his r her Health Care Prvider t call EASYRX1 ( ) fr instructins n hw the Health Care Prvider can fax the prescriptin. 3. Express Scripts will prcess the rder upn receipt and will return the medicatin(s) t the Participant, via U.S. Mail r UPS, alng with re-rdering instructins fr future prescriptins r refills, if applicable. 4. When it is time fr a refill, the Participant shuld mail his r her refill slip and c-payment in the special rder envelpe prvided with the initial prescriptin r call Express Scripts at t use the autmated refill system. A Participant can als request refills thrugh Express Scripts website at Retail prgram The retail drug prgram is fr prescriptin medicatins used n a shrt-term basis. When an Emplyee enrlls in a PPO Medical Plan r a Medicare-crdinating Plan, the Emplyee will receive a prescriptin drug ID card(s) that can be used t btain prescriptin medicatins at a lcal pharmacy. A participating pharmacy shuld be used t receive maximum benefits fr prescriptin drugs. A Participant des nt have t file a claim frm fr prescriptins filled at a participating pharmacy. A list f participating pharmacies can be fund at Express Scripts website, r by calling T get a prescriptin filled at a participating pharmacy: 1. A Participant shuld present his r her prescriptin drug ID card and prescriptin(s) t the pharmacist at a lcal participating pharmacy. Eligibility fr benefits will be cnfirmed via a cmputerized system. 2. The pharmacist will tell the Participant the crrect c-payment amunt that he is respnsible fr paying. T get a prescriptin filled at a nn-participating pharmacy: 1. When a Participant uses a nn-participating pharmacy, a claim may be filed thrugh Express Scripts, and a reduced benefit will be paid. 2. The Participant is respnsible fr 100% f the price f the prescriptin at the time f purchase. GROUP PLANS 6/13 Page 100

101 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS 3. The Participant shuld cmplete a claim frm, which prvides direct reimbursement fr prescriptins that were purchased at a nn-participating pharmacy, and return the frm alng with the prescriptin receipt(s) t the address fllwing address: Express Scripts P.O. Bx Lexingtn, KY A claim frm must accmpany the prescriptin receipt(s) and can be btained by calling Member Services at Reimbursement will be made usually within 21 days frm the date the claim frm is received. Reimbursement will be the cst f the drug at a participating pharmacy less the c-pay and deductible, if applicable. 4. The Participant shuld keep cmplete cpies f all claim submissins. In the event a claim is lst, the Participant will be prepared t resubmit claims. Internatinal claims Internatinal Medical claims The PPO Medical Plans prvide cverage fr Participants even while utside f the United States. GuideStne Financial Resurces recmmends that a Participant traveling t a freign cuntry call the Claims Administratr befre leaving the cuntry t discuss the best way t file freign claims. While in a freign cuntry, PPO Medical Participants shuld always call the BlueCard Wrldwide Prgram at befre receiving any rutine inpatient r utpatient care. The Participant may als call the BlueCard Wrldwide Prgram t help lcate a dctr r hspital r access Medical assistance services. The Medicare-crdinating Plans d nt pay benefits fr services received utside the United States. Refer t the BASIC MEDICARE INFORMATION chapter fr further infrmatin. T receive benefits fr cvered Medical services received in a freign cuntry, a PPO Medical Plan Participant shuld fllw these steps: 1. Yur Emplyee may have t pay Medical expenses in full when services are received. Usually benefits cannt be assigned t a freign Health Care Prvider. The Participant shuld btain a receipt in English frm the Health Care Prvider clearly indicating: Health Care Prvider s name Diagnsis Date f service Type f service(s) rendered Charge amunt fr each service in U.S. dllars GROUP PLANS 6/13 Page 101

102 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS 2. The Emplyee r Health Care Prvider shuld submit claims t the address n the Medical ID card within 12 mnths f the date the claim is incurred. 3. Medical plan payments and an Explanatin f Benefits fr each claim submitted will be returned t the Emplyee. 4. After reviewing the Explanatin f Benefits received in cnnectin with a paid claim, if the Emplyee suspects that the payment is in errr, the Emplyee shuld cntact the Claims Administratr s claim ffice at the number n the Medical ID card. 5. After fur weeks, if the Participant s claim has nt been paid r acknwledged, the Emplyee shuld cntact the Claims Administratr s claim ffice at the number n the Medical ID card t determine the status f the claim. Claim infrmatin may als be accessed thrugh Highmark Blue Crss Blue Shield s website at Internatinal prescriptin drug claims Participants residing and wrking utside the United States will have access t a tll-free Custmer Service supprt number fr internatinal prescriptin drug claims. The number is with AT&T access cde r cllect at (614) T file a claim, participants shuld fllw these steps: 1. Fill ut the Express Scripts Claim Frm and attach detailed receipts. Receipts must cntain the fllwing infrmatin: Date prescriptin filled Name and address f pharmacy Dctr name r ID number NDC number (drug number) Name f drug and strength Quantity and day s supply Prescriptin number 2. The participant shuld send the claim t Express Scripts via mail t the fllwing address. Express Scripts will nly accept claim frms via mail. Express Scripts P.O. Bx Lexingtn, KY GROUP PLANS 6/13 Page 102

103 HOW TO PROCESS MEDICAL AND DENTAL CLAIMS Internatinal Dental claims The Premier, Chice and Guided DHMO Dental Plans pay benefits fr cvered services received in a freign cuntry nly in the case f an emergency. (Refer the Emplyee t the Certificate f Insurance issued by the Claims Administratr fr detailed benefit infrmatin.) GROUP PLANS 6/13 Page 103

104 BASIC MEDICARE INFORMATION BASIC MEDICARE INFORMATION General infrmatin Medicare is a tw-part federal health insurance prgram: Hspital insurance benefits (Part A) and Medical insurance benefits (Part B). A persn age 65 r ver and eligible fr mnthly Scial Security benefits is eligible fr Part A Medicare. A persn is autmatically enrlled in Part A if Scial Security benefits are being received. Part B Medicare is available t all citizens living in the U.S. wh are age 65 r lder. Retired Emplyees and dependent spuses age 65 and ver must enrll and remit premiums t receive Part B Medicare. A persn less than age 65 wh has been entitled t Scial Security Disability benefits fr 24 mnths may als btain Medicare benefits (bth Part A and Part B). Medicare determines when a disabled persn is entitled t Medicare benefits. Nte: Cngress passed a law in 1997 that made many changes in the Medicare prgram. The law includes a sectin called Medicare+Chice that, starting in 1999, allwed mre private insurance cmpanies t ffer cverage t peple with Medicare. This Medicare prgram allws fr mre chices amng Medicare health plans. Fr mre infrmatin, call MEDICARE ( ), r visit n the internet. Fr a persn wh is eligible fr Medicare, generally, Medicare is the secndary payer when: All r sme f the charges incurred are payable under an aut r liability insurance plicy. Medical benefits are prvided t a wrking persn age 65 r ver (r the wrking persn s spuse wh is age 65 r ver) thrugh an Emplyer s grup health plan. This applies nly t Emplyers with 20 r mre Emplyees since these Emplyers cannt claim exemptin t Medicare Secndary Payer Rules. The charges are incurred by a disabled Medicare Beneficiary wh is cvered as an active Emplyee under a Large Grup Health Plan as defined by the Centers fr Medicare and Medicaid Services (CMS). Any Emplyer in Grup Plans is cnsidered a Large Grup Health Plan regardless f the number f Emplyees. Medicare enrllment Retired Emplyees and dependent spuses ver age 65 autmatically receive Medicare Part A cverage at n cst when they enrll fr Scial Security retirement benefits. Retired Emplyees and dependent spuses ver age 65 must enrll and make payments in rder t receive Medicare Part B cverage. GROUP PLANS 6/13 Page 104

105 BASIC MEDICARE INFORMATION The Medicare Part B enrllment perid begins n the first day f the third mnth befre an individual becmes eligible fr Medicare (usually age 65) and cntinues fr seven mnths. If the Emplyee des nt enrll fr Medicare Part B at any time during his r her initial enrllment perid, he r she will nt have anther chance t enrll until the next general enrllment perid. A general enrllment perid is held each year frm January 1 t March 31 and if the Emplyee enrlls during this perid, he r she will nt be able t get Medicare until July f that year. The Emplyee may als be charged a premium surcharge fr late enrllment. Nte: It is extremely imprtant fr individuals t enrll in Medicare Part B when they becme eligible t elect this cverage. The Emplyer grup health plan will crdinate benefits as if Medicare Part B is in effect even if the individual des nt enrll in Medicare Part B. Therefre, the Emplyer grup health plan will pay n benefits fr type B charges if the Participant is nt enrlled in Part B. If Medicare des nt pay, GuideStne Financial Resurces plan des nt pay. GuideStne Financial Resurces Medicare-crdinating Plans Medical benefits under Grup Plans change when an Emplyee r dependent spuse becmes eligible fr Medicare benefits and Medicare is determined t be the primary payer. An Emplyee, Retiree r any cvered dependent fr whm Medicare becmes the primary payer f benefits must transfer frm his r her current Medical plan t a GuideStne Financial Resurces Medicare-crdinating Plan if he r she wants t cntinue Medical cverage thrugh GuideStne Financial Resurces. GuideStne Financial Resurces Medicare-crdinating Plans crdinate with Medicare and are designed t cver sme f the expenses that Medicare allws but des nt pay in full. GuideStne Financial Resurces Medicare-crdinating Plans pay benefits based n Medicare apprved amunts. Services r supplies nt cvered by Medicare and charges abve the Medicare apprved amunt are nt cvered under the plans and are the respnsibility f the Participant. All Medical expenses cvered under Medicare, but nt paid in full, can be cnsidered under GuideStne Financial Resurces Medicare-crdinating Plans up t the maximum allwed under the plans. Determinatin f payer f benefits Medicare Secndary Payer (MSP) rules determine hw Medicare and GuideStne Financial Resurces pay Medical benefits fr the fllwing tw grups: Participants, age 65 r lder, wh are currently emplyed Cvered spuses, age 65 r lder, f Participants wh are currently emplyed MSP rules state that, fr the tw grups named abve, GuideStne Medical plans will be the primary payer f Medical claims fr Emplyers with a ttal f 20 r mre Emplyees n the payrll fr any 20 r mre calendar weeks in the current r preceding calendar year. The cnditin is met as lng as the ttal GROUP PLANS 6/13 Page 105

106 BASIC MEDICARE INFORMATION number f individuals n the Emplyer s payrll fr the week adds up t at least 20 regardless f the number f Emplyees wh actually wrk r wh are expected t reprt fr wrk n a particular day. If an Emplyer des nt meet this cnditin, Medicare will be the primary payer f Medical claims, and the cst f Medical cverage may be lwer fr the tw grups named abve. An Emplyee is anyne wh has been carried n the payrll, whether currently wrking r nt, and will include all full-time and part-time Emplyees, any Emplyee receiving Disability benefits frm which FICA taxes are withheld, and any ministers. T determine if yur Emplyer is subject t MSP rules: List the number f Emplyees n the payrll during each week in the current calendar year and previus calendar year. Cunt the number f weeks in each year in which the Emplyer had 20 r mre Emplyees n the payrll n any given day. If, in the preceding year r in the current year (viewed independently), yu have 20 r mre weeks with 20 r mre Emplyees n the payrll, yu are nt exempt frm the MSP rules. The Emplyer must ntify the Insurance Operatins, Grup Plans f eligibility fr the MSP exemptin by submitting a cmpleted Exemptin Frm fr Medicare Secndary Payer Rules. The Emplyer s Medical cverage will then pay secndary t Medicare fr the tw grups named abve. Anyne in these tw grups must transfer frm their current Grup Plans Medical plan t a GuideStne Financial Resurces Medicare-crdinating Plan. Under the Medicare-crdinating Plan, Participants will file claims with Medicare first. Once Medicare prcesses their claims, Medicare shuld file with the Claims Administratr r Emplyees can frward their itemized bills and cpies f their Medicare Explanatin f Benefits Frm t the Claims Administratr fr prcessing. If the Emplyer qualifies fr the MSP exemptin nw, but the number f Emplyees increases t 20 r mre fr each day in each f 20 r mre calendar weeks in the current r preceding calendar year, the grup cverage must revert t paying primary t Medicare at the end f the 20th week. Please ntify the Insurance Operatins, Grup Plans if this happens s that charges may be adjusted t accurately reflect required cverage. Generally, if the Emplyer has 20 r mre Emplyees, but falls belw that number during a calendar year, the Emplyer des nt becme exempt frm Medicare Secndary Payer rules immediately. Medicare rules require that the Emplyer s grup cverage cntinue t pay primary t Medicare fr the remainder f that calendar year and all f the fllwing year. Nte: There are severe penalties impsed by the Centers fr Medicare and Medicaid Services (CMS) fr nncmpliance with Medicare Secndary Payer Prvisins. GROUP PLANS 6/13 Page 106

107 BASIC MEDICARE INFORMATION Disabled Medicare beneficiaries Fr disabled beneficiaries, the Crdinatin f Benefits Cntractr ( COBC ) fr Centers fr Medicare and Medicaid Services (CMS), is respnsible fr determining when Medicare becmes the primary payer f benefits. The test f whether Medicare is primary r secndary is whether the cverage f the disabled Medicare Beneficiary under a Large Grup Health Plan is by virtue f the current emplyment status f either the Beneficiary r a member f the Beneficiary s family. Since disabled Medicare beneficiaries are usually nt engaged in active wrk, CMS has established guidelines fr use in determining whether cverage under a Large Grup Health Plan is by virtue f the Emplyee s r dependent s current emplyment status fr purpses f the primary/secndary payer rules. Generally, an Emplyee will be cnsidered t have current emplyment status (and Medicare will be secndary payer): 1. If the persn is actively wrking as an Emplyee, is the Emplyer (including a self-emplyed persn) r is assciated with the Emplyer in a business relatinship, r 2. The individual is nt actively wrking and is receiving Disability payments frm the Emplyer that are subject t FICA tax, r wuld be subject t FICA tax were the Emplyer nt exempt frm such tax under the Internal Revenue Cde (the first six mnths f Disability benefits are subject t FICA tax), r 3. If the persn is nt actively wrking but all f the fllwing are true: The persn retains emplyment rights in the industry (e.g., is furlughed, temprarily laid ff r n sick leave r is a teacher r seasnal wrker wh des nt wrk year-rund). The persn has nt had their emplyment terminated by the Emplyer. The persn has nt been receiving Disability benefits frm an Emplyer fr mre than six mnths. The persn is nt receiving Scial Security Disability benefits. If an Emplyee des nt meet the cnditins required t have current emplyment status, then Medicare is primary n the basis f Disability. Please see the fllwing sectin fr Prcedures. GROUP PLANS 6/13 Page 107

108 BASIC MEDICARE INFORMATION Prcedures fr prcessing disabled Medicare beneficiaries When a disabled Emplyee becmes eligible fr Medicare benefits due t his r her Disability: Frward t GuideStne Financial Resurces a cpy f the disabled Emplyee s Health Insurance Claim Number (HICN) identificatin card fr Disability and a Grup Plans Medicarecrdinating Plans Enrllment Frm indicating the Emplyee s chice fr a Medicarecrdinating Plan. This frm is required t enrll in a GuideStne Medicare-crdinating Plan. The Emplyee s Grup Plans recrds will be updated t reflect Medicare as the primary payer f benefits with an effective date based n when the frm was received and the plan chsen. The Emplyee s current Grup Plans Medical plan will be terminated the day befre the effective date f the Medicare-crdinating plan. It is imperative yu send GuideStne Financial Resurces a cpy f the disabled Emplyee s HICN identificatin card and the Grup Plans Medicare-crdinating Plans Enrllment Frm as sn as pssible. A delay in sending the identificatin card t GuideStne Financial Resurces culd result in incrrect payment f claims. Nte: Effective in 1996, disabled individuals diagnsed with End Stage Renal Disease (ESRD) generally becme Medicare primary beginning with the 33 mnth after the mnth in which the individual starts a regular curse f dialysis. This applies even if the individual is eligible fr Medicare due t age r anther Disability. GROUP PLANS 6/13 Page 108

109 BASIC MEDICARE INFORMATION Guidelines fr rder f benefit determinatin with Medicare under the Grup Plans Medical Plans CLAIMANT EMPLOYER S GROUP HEALTH PLAN MEDICARE Active Participant age 65 and ver emplyed by an Emplyer with 20 r mre Emplyees First Secnd ACTIVE EMPLOYEES Active Participant age 65 and ver emplyed by an Emplyer with less than 20 Emplyees (MSP exempt) Secnd First SPOUSES OF ACTIVE EMPLOYEES RETIRED EMPLOYEES SPOUSES OF RETIRED EMPLOYEES DISABLED EMPLOYEES DISABLED SPOUSES SURVIVING SPOUSES Spuse age 65 and ver and Emplyer has 20 r mre First Secnd Emplyees Spuse age 65 and ver and Emplyer has less than 20 Emplyees (MSP exempt) Secnd First Retired Emplyee under age 65 First N/A * Retired Emplyee age 65 and ver Secnd First Spuse, age 65 and ver, f retiree under age 65 Secnd First Spuse, age 65 and ver, f retiree age 65 and ver Secnd First Spuse, under age 65, f retiree under age 65 First N/A * Spuse, under age 65, f retiree age 65 and ver First N/A * Disabled active Emplyee, entitled t Medicare First Secnd Disabled Emplyee entitled t Medicare and nt an active Emplyee as determined by Secnd First Medicare Disabled spuse f active Emplyee, entitled t Medicare Disabled spuse entitled t Medicare f retired Emplyee First Secnd Secnd First Surviving Spuse, age 65 and ver Secnd First Surviving Spuse, under age 65 First N/A* *Nt entitled until age 65 GROUP PLANS 6/13 Page 109

110 BASIC MEDICARE INFORMATION Medicare benefits utside the United States Medicare primary participants traveling utside the United States Medicare benefits are nt available t a Participant eligible fr Medicare when Medical expenses are incurred utside the United States, except in case f an emergency. GuideStne Financial Resurces Medicare-crdinating Plans d nt pay benefits fr health care services received utside f the United States since these plans cver nly thse expenses cvered by Medicare. Medicare primary participants living utside the United States If a Participant is eligible fr Medicare and lives utside f the United States, he shuld enrll in the Grup Plans PPO Medical Plans. The Participant may need t pay in full fr Medical expenses received utside f the United States since benefits usually cannt be assigned t a freign prvider. The Participant shuld btain a receipt clearly indicating the fllwing infrmatin: Name f the licensed practitiner Diagnsis Date f service Type f service(s) rendered Amunt charged fr each service The Participant shuld have the receipt translated int English and the charges cnverted int U.S. currency values n the date f service. The Participant can seek guidance frm the nearest American Embassy t find a licensed practitiner r assistance with translating a Medical bill. The Participant shuld file the claim with the Claims Administratr. If benefits are nt cvered by Medicare, the Claims Administratr will prcess the eligible charges as thugh the Participant had full cverage with the Claims Administratr. Medicare Part D Beginning January 1, 2006, individuals eligible fr Medicare are als eligible fr a Medicare-apprved prescriptin benefit, als knwn as Medicare Part D. GuideStne will make available Medicarecrdinating Plans that incrprate the benefits f the new Medicare legislatin. GuideStne Participants will nt need t purchase a Part D plan elsewhere as the prescriptin benefits included in ur Medicarecrdinating Plans meet r exceed the minimum standard established fr Part D cverage. GROUP PLANS 6/13 Page 110

111 BASIC MEDICARE INFORMATION Nte: If a Participant chses t get Part D cverage elsewhere, they will becme ineligible fr the Medicare-crdinating Plans that GuideStne currently makes available (except in the instance f qualifying fr the Lw Incme Subsidy). Lw Incme Subsidy The Lw Incme Subsidy is a feature f the Medicare Part D legislatin that will allw thse Medicare Participants wh meet specific eligibility and incme criteria t receive prescriptin drug benefits at a discunted rate r free f charge. Cntact CMS fr the current eligibility requirements fr the Lw Incme Subsidy at Medicare r Participants wh qualify fr this subsidy will be given an pprtunity t enrll in the Medicarecrdinating Plan withut the prescriptin benefits included. Ntice f creditable/nn-creditable cverage CMS requires that a ntice be sent t all participants age 65 and lder t ntify them as t whether their current prescriptin drug plan will qualify as creditable cverage. Creditable Cverage wuld include any prescriptin cverage that meets r exceeds the minimum Part D standard. The imprtance f this ntificatin is t advise a participant that fr every mnth they are eligible fr Medicare Part D and remain enrlled in a nn-creditable prescriptin drug plan, a late enrllment penalty culd be incurred. Please review Medicare s website at fr further details. The fllwing plans d nt prvide Creditable Cverage : Health Saver 2600 Health Saver 2800 Health Saver 3000 Health Saver 5000 GROUP PLANS 6/13 Page 111

112 EMPLOYER ACCESS EMPLOYER ACCESS General infrmatin Emplyer Access is an nline service designed t help yu maintain and access infrmatin regarding yur retirement and insurance accunts. Currently available features fr Insurance include: Accunt Maintenance/Inquiry Prvides access t existing Emplyees t make persnal data changes Prvides access t existing Emplyees t make Salary changes Prvides access t existing Emplyees t submit changes fr: Adding a dependent Adding a prduct Terminating an Emplyee Terminating a dependent Terminating a prduct Prvides access t submit an enrllment fr a new Emplyee Emplyer Annual Electin and Re-enrllment Tracking Available fr annual re-enrllment (usually Octber thrugh December) Allws nline Emplyer electin f plans fr the next plan year Prvides infrmatin n Emplyees plan electin fr the next year Emplyees may be accessed either individually by inputting their Scial Security number r by selecting frm a list f all Emplyees Insurance Billing Prvides access t view and pay the mst recent bill Prvides access t billing histry Allws dwnlad f billing t an Excel file Allws ne-time payment f bill and creatin f autmatic mnthly payments Emplyer Reprts Allws an Emplyer t run varius reprts such as: New Emplyees (within a date range) Dependents lsing eligibility Participants turning age 65 GROUP PLANS 6/13 Page 112

113 EMPLOYER ACCESS Emplyees n cntinuatin Allws an Emplyer t schedule regular reprts with ntificatin when reprt is ready Claims Infrmatin Plan Bklets Prvides access t links fr claim filing infrmatin fr the varius plans A new brwser page will pen when a link is chsen Prvides access t links t plan bklets A new brwser page will pen when a link is chsen Prviders/Vendrs Sites Prvides access t links fr GuideStne vendrs and prviders A new brwser page will pen when a link is chsen It is nt necessary t lg back int Emplyer Access when the page is clsed unless the sessin expires Frms Prvides access t PDFs (Prtable Dcument Frmat) fr frms used t administer Grup Plans It is nt necessary t lg back int Emplyer Access when the page is clsed unless the sessin expires (applies t the three items abve as well) NOTE: By using this prgram, yu agree t adhere t eligibility rules fr Emplyees and dependents and that failure t d s culd result in terminatin f their cverage and reimbursement t GuideStne. Getting access Yu may register yur Emplyer fr the Emplyer Access Prgram n the GuideStne website. Select Emplyer Lgin frm the hmepage, In the Lgin bx, select Register Emplyer with Emplyer Access. Yu may als cmplete the Letter f Agreement and the Designatin f Emplyer Access Prgram Administratr Frm and have them signed by an authrized fficer f the Emplyer. Once GuideStne Financial Resurces receives this infrmatin, yur authrizatin will be established and yur designated administratr can access the Emplyer s accunt. GROUP PLANS 6/13 Page 113

114 EMPLOYER ACCESS Call Custmer Relatins at GUIDE ( ), r yur Grup Plans Accunt Administratr t request the abve frms. Yu may als find these frms n the Grup Plans frms page at in the Miscellaneus sectin. Yu will use the same user ID and passwrd fr Emplyer Access as yu use fr persnal nline services. If yu are nt a current Participant with a user ID and passwrd, when yu sign nt Emplyer Access fr the first time, select Register Nw and fllw the nline directins. Prcedures fr using Emplyer Access Lgging in 1. Select Emplyer Lgin frm the hme page, 2. Lg in with user ID and passwrd 3. If this is yur first time t lg int GuideStne s website, yu will need t select Create ID/Passwrd. Address changes 1. Fllw abve steps 1-2 fr lgging in 2. Select Emplyees 3. Select an Emplyee frm the Emplyee list, r enter the Emplyee SSN in the Search By: bx. 4. Select the Cntact Inf tab. 5. Select the Edit buttn. 6. Make necessary changes. 7. Select Save. GROUP PLANS 6/13 Page 114

115 EMPLOYER ACCESS Salary changes 1. Fllw abve steps 1-2 abve fr lgging in. 2. Select Emplyees. 3. Select Update Salaries. 4. Type in New Salary Effective Date (must be the current date r a future date in the frmat f mmdd-ccyy). 5. Place the cursr in the New Mnthly Salary t the right f the Emplyee whse Salary is changing. 6. Type in the new mnthly Salary in the blank prvided a) DO NOT use decimal pints r cents. b) The Salary must be runded up t the next dllar amunt. Example: Salary is $1,502.35, input c) The Salary may nt be zer. 7. Cntinue inputting Salaries in the same manner fr ther Emplyees if applicable. 8. Select Update nce all Salaries have been input. Submissin f changes fr adding r terminating an emplyee, dependent r prduct Emplyer Access als prvides fr nline submissin t Grup Plans f changes that need t be made t existing Emplyees and new Emplyees that need t be enrlled. This methd f nline submissin may be used in place f mailing r faxing a paper frm t Grup Plans. In rder t submit a change nline, fllw the directins in the Lgging In sectin f this chapter. Then select the Emplyees tab. T enrll a new Emplyee, yu may chse Add Emplyee frm this screen. T make ther changes, chse an Emplyee frm the Emplyee list r prvide the Emplyee s SSN in the Search By: bx. Select the applicable change frm the list and prceed thrugh the self-explanatry screens. The type f infrmatin required t be input will vary by the type f Maintenance Functin selected. Once the change has been submitted, ntificatin will be sent t Grup Plans wh will prcess the change the same as if a paper frm had been received. If Add Emplyee is selected, the system will mve thrugh a series f self-explanatry screens that will require persnal data, dependent infrmatin and plan electins be input. Once the change has been submitted, ntificatin will be sent t Grup Plans wh will prcess the change the same as if a paper frm had been received. Fr additinal assistance with using Emplyer Access, cntact yur Grup Plans Accunt Administratr. GROUP PLANS 6/13 Page 115

116 FLEXIBLE SPENDING ACCOUNT FLEXIBLE SPENDING ACCOUNT General infrmatin Flexible benefit plans, ften called cafeteria plans r sectin 125 plans allw Emplyees t pay utf-pcket csts with pretax dllars. These accunts are cmpletely Emplyee-funded, meaning Emplyers cannt make direct cntributins. An Emplyee decides hw much he r she wants t cntribute t the FSA fr a perid f ne calendar year plus a three-mnth grace perid. After this time frame, the Emplyee lses any mney left in the accunt. FSA funds can be used t pay fr qualified health care expenses including premiums and ut-f-pcket Medical, Dental and visin expenses. FSA s als allw Emplyees t pay fr child care expenses with pretax dllars. GuideStne has an endrsed arrangement with Emplyee Benefits Crpratin (EBC) t prvide flexible spending accunts. The Emplyer must have Medical r Dental cverage thru GuideStne Financial Resurces t be eligible. 1. Emplyers must establish flexible benefit plans fr their Emplyees. Emplyees may chse t participate thrugh the Emplyer plan. N individual plans are available. 2. Plans may take between 30 and 60 days t set up depending n the chices Emplyers make. 3. Emplyers can set up plans any time in the year. Yu can get mre infrmatin abut flexible benefit plans by calling EBC at r thrugh their website at GROUP PLANS 6/13 Page 116

117 ADMINISTRATIVE FORMS ADMINISTRATIVE FORMS Abut this sectin Fr yur cnvenience, this sectin cntains infrmatin n hw yu can get frms and bklets nline, and infrmatin n the mst cmmnly used frms. Frms and bklets Mst frms and bklets may be dwnladed thrugh GuideStne Financial Resurces internet website at When accessing frms thrugh the website, be sure t select nly Grup Plans frms. Frms may be fund n the website by selecting: Insurance, Frms and FAQs, Grup Plans Frms. Bklets may be fund n the website by selecting: Insurance, Frms and FAQs, Plan Bklets. If internet access is nt available r yu prefer t rder frms by telephne, cntact yur Grup Plans Accunt Administratr fr assistance. Cmmnly used frms Grup Plans Enrllment Frm T enrll a new Emplyee, r enrll a current Emplyee wh is nt n yur billing. Waiver f Medical and/r Dental Cverage, Grup Plans Must be cmpleted t waive (decline) Emplyer paid Medical r Dental cverage when the Emplyee has ther cverage. Emplyer Change Reprt, Grup Plans T make changes t current Emplyees cverage, such as: Terminatin f emplyment, Salary change, add a dependent, terminate a dependent, change in current cverage. Special and Late Applicant Enrllment Frm fr Health care Cverage, Grup Plans T add Medical cverage after the Emplyee s r dependent s initial eligibility perid has passed, add cverage mid-year (Special Enrllment) with a Qualifying Event r at pen enrllment (Late Enrllment) withut a Qualifying Event Medicare-crdinating Plans Enrllment Frm, Grup Plans Required fr enrllment when the Participant is Medicare primary with GuideStne cverage secndary. Emplyee/Retiree Medicare-crdinating Plans Terminatin Frm, Grup Plans Required fr terminatin frm ne f ur Senir r Care Plans. Evidence f Gd Health Applicatin, Grup Plans Applicatin t apply fr Life and Disability cverage when underwriting is required. GROUP PLANS 6/13 Page 117

118 ADMINISTRATIVE FORMS Request fr Medical and/r Dental Cntinuatin, Grup Plans (MCP/DCP) T cntinue Medical r Dental cverage when an Emplyee r dependent is n lnger eligible due t terminatin f emplyment, reductin in number f hurs wrking, divrce r legal separatin, lss f dependent child status. Request fr Cntinuatin f Insurance Eligibility, Grup Plans (CIE) T cntinue life, AD&D, Medical and Dental cverage after terminatin when the Emplyee is seeking ther emplyment with a church, agency r institutin affiliated with, r sharing cmmn religius bnds with, the Suthern Baptist Cnventin. ID cards Medical and Prescriptin ID cards fr the PPO Medical Plans r Medicare-crdinating Plans may be rdered thrugh the numbers listed in the HOW TO GET HELP chapter f this manual. ID cards fr the Premier, Chice r Guided Dental Plan may be rdered frm Cigna at the numbers listed in the HOW TO GET HELP chapter f this manual. GROUP PLANS 6/13 Page 118