Provided to you by:2024–2025Employee Benefits Guide1
2024–25 Employee Benefits GuideNavia Benefit Solutions2WelcomeWe would like to welcome you to the 2024 annual benefits summary package for NAVIA BENEFIT SOLUTIONS. This packet contains summaries of the benefits offered to you by NAVIA BENEFIT SOLUTIONS. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.This benefit guide provides an overview of benefit plans, including eligibility, election periods and costs. In addition, the guide offers descriptions and explanations of each coverage plan option. We urge you to carefully consider all aspects of these programs, including their premiums, accessibility to health care services, flexibility and restrictions.Info on the Go!Scan with your Smartphone to access your 2024-2025 Benefits Guide and enrollment materials online ANYTIME.
A Note About This Benefits GuideFull details are available in the legal documents governing the individualplans. If there is any discrepancy or conflict between the plan documentsand the information presented here, the plan documents govern. If youhave any questions about the contents of this guide or how thisinformation may apply to you, please contact your Human ResourcesDepartment.2024–25 Employee Benefits GuideNavia Benefit Solutions 3ContentsBenefits Overview Eligibility and EnrollingMedical & Prescription Drug Benefits Where to Go for CareHealth Savings Account (HSA)Dental and Vision BenefitsCost of Coverage—Medical, Dental and Vision Flexible Spending Accounts (FSA) Life/Accidental Death & Dismemberment Disability Income Benefits Commuter Benefits Employee Assistance Program (EAP) NEW Wishbone Pet Insurance Wellness Reimbursement Plan Value Added ProgramsContact Information Important NoticesPage 4 Pages 5 – 6 Pages 7 – 8 Page 9 Pages 10 – 11 Page 12 Page 13 Page 14 Pages 15 – 16 Pages 17 – 18 Page 19 Page 20 Page 21 Page 22 Pages 23– 24 Page 25 Pages 26 – 35
Benefits OverviewHere’s a quick look at the NAVIA BENEFIT SOLUTIONS benefits available to full-time employees. Additional details on all these benefits are included in this guide. If you have any questions about the benefits in this guide, feel free to call the benefit providers directly or visit their websites. See the table on page 24 for contact information. Our HR Team is also available to help answer any questions you may have. Please don’t hesitate to call us at (425) 452-3470, or e-mail JTarasewicz@naviabenefits.com if you have any questions.BenefitEnrollmentOptional or AutomaticCoverageMedicalOptionalYou and NAVIA BENEFITSOLUTIONS share the costNAVIA BENEFIT SOLUTIONS offers two different plans through Benefit Plan Administrators (BPA) including one High Deductible Health Plan (HDHP/HSA) and one Preferred Provider Organization Plan (PPO)Health Savings Account (HSA)OptionalYou and NAVIA BENEFITSOLUTIONS contributeIf you elect to participate in a HDHP/HSA, you can contribute pre-tax dollars to use for eligible heath care expenses. NAVIA BENEFIT SOLUTIONS will also contribute money to your HSA. You must open an account through NAVIA BENEFIT SOLUTIONS in order to receive the employer contributions.Dental ReimbursementOptionalYou and NAVIA BENEFITSOLUTIONS share the costNAVIA BENEFIT SOLUTIONS offers a dental reimbursement program up to $1,500 per member per plan year.Vision ReimbursementOptionalYou and NAVIA BENEFITSOLUTIONS share the costNAVIA BENEFIT SOLUTIONS offers a vision reimbursement program up to $650 per member per plan year.Flexible Spending Accounts (FSA)OptionalYou contributeIf you elect to participate in an FSA, you can contribute pre- tax dollars to use for eligible heath care and dependent care expenses. You must open an account through NAVIA BENEFIT SOLUTIONS.Basic Life and AD&DAutomaticNAVIA BENEFIT SOLUTIONSpays the costNAVIA BENEFIT SOLUTIONS pays for Basic Life and AD&D in the amount of two times your Basic Annual Earnings up to a maximum of $200,000.Voluntary Life and AD&DOptionalYou pay the costYou may elect life insurance in $10,000 increments to a maximum of $500,000. You can also purchase life insurance for your spouse and child(ren).Voluntary Short-Term Disability (STD)OptionalYou pay the costYou may elect disability coverage in the amount of 60% of your annual base salary to a weekly maximum of $1,500.Long-Term Disability (LTD)AutomaticNAVIA BENEFIT SOLUTIONSpays the costYou are eligible for coverage after 90 days of disability in the amount of 60% of annual base salary to a monthly maximum of $10,000.Commuter BenefitsOptionalYou pay the costYou can put aside money on a pre-tax basis to pay for work-related commuting and parking expenses.2023–25 Employee Benefits GuideNavia Benefit Solutions 4
2024–25 Employee Benefits GuideNavia Benefit Solutions 5Eligibility and Enrolling✓ Your legal spouse✓ Your Domestic Partner (same or opposite sex) orcommon law spouse✓ Your children up to age 26✓ Your unmarried dependent children over age 26who are incapable of self-care because of a disabilityand who rely on you for supportWhen you enroll dependents, please submit copies of the following (if applicable):✓ Marriage Certificate, an Affidavit of DomesticPartnership or Common Law Marriage✓ Birth Certificate(s)✓ Adoption Papers or papers to show legal adoptionproceedings have startedIf you do not provide this documentation within 31 days of hire, your dependents will not be enrolled in benefits.Enrolling For CoverageYour enrollment period is an important time to review your benefits and choose the best options for you and your family. Review the 2024–25 Employee Benefits Guide to understand the coverage available and changes to the NAVIA BENEFIT SOLUTIONS Benefit Program. You can enroll for coverage within 31 days of your hire date or during the annual open enrollment period.Newly hired full-time employees enrolling for the first time, will make their benefit elections via Namely, our online enrollment tool. You can make your benefit elections during the enrollment window, and coverage begins on the first of the month following 60 days of employment.Please visit https://navia.namely.com/ to create your account profile. Your personal benefit elections will be housed in Namely.Active EnrollmentFor 2024, EVERYONE must access Namely to enroll or waive benefits. You must complete the registration process on Namely and make your elections between May 28 ,2024 to June 7, 2024, that will be effective as of July 1, 2024.If you do not access Namely to make your benefit elections during open enrollment, you will NOT be enrolled, and your benefits coverage will end June 30, 2024. Please note, this is a change from previous years. Current elections will NOT remain in force for 2024, if you do nothing.Once you access your benefit information, please be sure to verify personal information and enter any missing information related to your benefits, such as dependent and beneficiary information. If you have questions, please contact Human Resources.Who is Eligible?If you are a full-time employee, you are eligible to enroll in the benefits described in this guide. You are eligible for benefits on the first of the month following 60 days of employment.You may enroll your eligible dependents in the same plans you choose for yourself, including medical, dental, and vision coverage. Eligible dependents may include the following:
2024–25 Employee Benefits GuideNavia Benefit Solutions 6Eligibility and EnrollingChanging Your Coverage During the YearWhether you are a newly hired employee or a current employee enrolling during the annual open enrollment, the elections you make at this time will remain in effect until NAVIA BENEFIT SOLUTIONS next open enrollment period, unless you have a qualifying life event (as defined by the IRS) that allows a mid-year plan change.These changes include (but are not limited to):✓ Birth or adoption of a baby or child✓ Loss of other healthcare coverage✓ Eligibility for new healthcare coverage✓ Marriage✓ Divorce✓ Change in child’s dependent statusIf you experience a qualifying life event, or if you have questions, please contact Human Resources (HR). You have 30 days after a qualifying eventto notify HR and request a change to your benefit elections.NOTE: The benefit changes you make must be consistent with the life event.When Dependent Children Age OutDependent children can remain on the medical, dental and/or vision coverage(s) until the end of the month in which they turn 26, at which time their coverage will be cancelled. For Life Insurance, the aging out rule will be the same, unless their birthday is on the first of the month, in which case coverage would end last day of prior month (day before 26th birthday).READY SET ENROLL
2024–25 Employee Benefits GuideNavia Benefit Solutions 7Medical & Prescription Drug BenefitsPlan Year—July 1st,2024 through June 30thNAVIA BENEFIT SOLUTIONS offers a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them. These plans encourage you to seek care from In-Network providers, which provide a higher level of benefit. You may choose to use Out-Of-Network providers, but if you do, your benefits will be reduced, and your out-of-pocket expense will increase. These plans do not require you to select a primary care provider, nor is it necessary to obtain a referral in order to see a specialist.The following chart provides a brief summary of both Medical Plans In-Network benefit options. Complete benefit summaries including Out-of-Network benefits are available on the Namely Portal.BENEFIT OPTIONS (IN-NETWORK) HDHP (HSA) PLAN PPO PLANNetwork Name Cigna PPO Cigna PPOHSA Eligible Yes NoCalendar Year DeductibleIndividual $1,600 $500Family $3,200 $1,500*Aggregate **EmbeddedCoinsurance 20% 20%Calendar Year Out-of-Pocket MaximumIndividual $5,000 $3,000Family $10,000 $6,000Includes Deductible, Coinsurance, Copays **Embedded **EmbeddedPhysician Office VisitPrimary 20% after deductible $20 copay (deductible does not apply)Specialist 20% after deductible $20 copay (deductible does not apply)Preventive Care Adult / Well Child Covered at 100% Covered at 100%Telemedicine 20% after deductible $20 copay (deductible does not apply)Emergency Room 20% after deductible$100 copay, deductible and coinsuranceUrgent Care 20% after deductible $20 copay (deductible does not apply)Inpatient Services 20% after deductible 20% after deductibleOutpatient Services 20% after deductible 20% after deductibleOutpatient DiagnosisX-Ray, Laboratory,Complex Imaging20% after deductibleNo charge for the first $400, then deductible and 20% coinsurancePrescription DrugsRetail(30-day supply)20% after deductible $10 / $35 / $75Mail Order(90-day supply)20% after deductible $30 / $105 / $225* Aggregate deductible and out-of-pocket (OOP), means once Family Deductible is met, all family members will be considered as having met theirDeductible for the remainder of the contract year. There is no Individual Deductible to satisfy within the Family Deductible.** Embedded deductible and out-of-pocket (OOP), means that a “per member” deductible and OOP are embedded within the “per family” thresholds. Eachcovered family member is subject only to their “per member” deductible or OOP, and the family’s exposure as a whole is limited by the family deductibleand OOP limits.
Medical & Prescription Drug Benefits2024–25 Employee Benefits GuideMedical Key Reminders✓ In order to limit your Out-of-Pocket expenses, please seek services from a Cigna PPO provider. To find a provider,visit https://hcpdirectory.cigna.com/web/public/consumer/directory.✓ If services are provided by a non-Cigna provider, the member is responsible for any amounts that exceed the“allowable charges,” in which case balance billing could occur.✓ Dependent Child Age Limits: Covered to age 26.Choose Generics The member pays the applicable copay only if the physician requires brand name Rx. If the member requests brand name when a generic is available, the member pays the applicable copay plus the difference between the two Rx. Be sure to discuss this with your physician when he or she writes your prescription.Prescription Drug CoverageWe know prescription drug coverage is important to you and your family, so when you elect medical coverage, you are automatically covered under the prescription drug plan. You may fill your prescriptions at participating retail pharmacies. Under the PPO Plan, the mail order option allows you to buy qualified prescriptions in larger 90-day quantities for the same copay amount as a 90-day supply at the retail pharmacy. Mail order saves you time in trips to the pharmacy because prescriptions are delivered right to your door.There are several categories of drugs under the plans. The differences between these categories are described below:✓ Tier 1—Generic: Frequently prescribed generic drugs. Represents 83% of all subscribed drugs.✓ Tier 2—Preferred Brand: Drugs with higher costs than preferred generics but arethe lowest cost brand name drugs. Represents 9% of all subscribed drugs.✓ Tier 3—Non-Preferred Brand: Highest cost brand name drugs. Represents 8% of all subscribed drugs.Simply register for an account or sign into your CVS Caremark account to get individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies. You may also call CVS Caremark Customer Care at 1-800-552-8159.Navia Benefit Solutions 8Helpful TermsDeductible—The amount you have to pay out-of-pocket for expenses before the insurance company will cover any benefit costs for the year (except for preventive care and other services where the deductible is waived).Coinsurance—The cost share between you and the insurance company. Coinsurance is always a percentage totaling 100%. For example, if the plan pays 80%, you are responsible for paying the remaining 20% of the cost.Copay—The fee you pay to a provider at the time of service.Out-of-Pocket Maximum—The most you would pay out-of- pocket for covered services in a year. Once you reach your out- of-pocket maximum, the plan covers 100% of eligible expenses.Balance Billing—Non-network providers are allowed to charge you more than the plan's allowable charge. This is called Balance Billing.
Where To Go For CareYou think you may be sick, but your primary care physician is booked through the end of the month. You have a questionabout the side effects of a new medication, but the pharmacy is closed. Instead of immediately choosing an expensive tripto the emergency room or relying on questionable information from the internet, take a look below at various carecenters and resources and the types of care they provide.TelemedicineWhen would I use this?You need care for minor illnesses and ailments but would prefer not to leave home. These services are available by phone and online (via webcam).What type of care would they provide?✓ Cold & flu symptoms✓ Allergies✓ Bronchitis✓ Urinary tract infection✓ Sinus problemsWhat are the costs and time considerations?✓ Often requires a copay and/or coinsurance✓ Access to care is usually immediate. Some statesmay not allow for prescriptions throughtelemedicine or virtual visits.Primary Care CenterWhen would I use this?You need routine care or treatment for a currenthealth issue. Your primary doctor knows you andyour health history, can access your medical records,provide routine care, and manage your medications.What type of care would they provide?✓ Routine checkups✓ Immunizations✓ Preventive Services✓ Manage your generalWhat are the costs and time considerations?✓ Often requires a copay and/or coinsurance.✓ Normally requires an appointment.✓ Usually little wait time with scheduledappointment.Do Your Homework What may seem like an urgent care center could actually be a standalone ER. These newerfacilities come with a higher price tag, so ask for clarification if the word emergency appears in the company name.* This is sample of services and may not be all-inclusive. ** Cost and time information represent average only and are not tied to a specific condition or treatment.Navia Benefit Solutions 9 2024–25 Employee Benefits GuideEmergency RoomWhen would I use this?You need immediate treatment for a serious life threatening condition. If a situation seems life threatening, call 911 or your local emergency number right.What type of care would they provide?*✓ Heavy bleeding✓ Chest pain✓ Major burns✓ Spinal injuries✓ Severe head injury✓ Broken bonesWhat are the costs and time considerations?**✓ Often requires a much higher copay and/orcoinsurance.✓ Open 24/7 but waiting periods may be longerbecause patients with life- threateningemergencies will be treated first.Urgent Care CenterWhen would I use this?You need care quickly, but it is not a true emergency. Urgent care centers offer treatment for non-life threatening injuries or illnesses.What type of care would they provide?*✓ Strains, sprains✓ Minor broken bones✓ Minor infections✓ Minor burns✓ X-raysWhat are the costs and time considerations?**✓ Often requires a copay and/or coinsurance that isusually higher than an office visit.✓ Walk-in patients welcome but waiting periodsmay be longer as patients with more urgentneeds will be treated first.
2024–25 Employee Benefits GuideNavia Benefit Solutions 10Health Savings Account (HSA)Plan Year—July 1st through June 30thNAVIA BENEFIT SOLUTIONS will offer an HSA to those who enroll in the BPA HDHP (HSA) Plan. The HSA provides you the ability to save and use pretax dollars to pay for eligible medical expenses (i.e., deductible). You can save approximately 25 percent of each dollar spent on medical expenses when you participate.Contributions to your HSA are withdrawn from your paycheck on a pre-tax basis. This means you don’t pay federal income tax, Social Security taxes, or local income taxes on the portion of your paycheck you contribute to the HSA. See “HSA Taxation” on page 11.What are the benefits of an HSA?✓ Funds Rollover—No “use it or lose it” provision.✓ Earns Interest—Monies accrue tax-free interest.✓ Portable—Yours to keep. If you leave your employer,your HSA funds go with you.The IRS HSA Contribution Limits are as follows: NOTE: If you are age 55 or older, you may make an additional “catch-up” contribution of $1,000.THE COMPANY’S CONTRIBUTION TO YOUR ACCOUNT*NAVIA BENEFIT SOLUTIONS administers the HSA services. You will be able to manage your account online to submit eligible claims, review your account balance, review your claim history, and more. We will provide you more information about the Welcome Kit and how to set up your account.In order to receive the full HSA contribution from the company, your personal annual contributions—made via payroll deduction or directly from your personal checking/savings account—can be no more than the amounts listed below, unless you are over age 55.Annual Contribution Limits2024 2025Single $4,150 $4,300Family $8,300$8,550If Enrolled in the HDHP (HSA)You Only $1,000 annuallyYou + Dependent(s)$1,250 annually** Your contribution limits are calculated based coverage under the company’s HDHP for the full calendar year, exclusive of any “catch-up contribution.” Please contact HR to confirm your contribution limit if you have a mid-year enrollment change.If Enrolled in the HDHP (HSA)**You Only Up to $3,200 annuallyYou + Dependent(s)Up to $7,300 annually* The company’s contribution to your HSA will be made in January.Mid-year enrollees will receive a pro-rated contribution from the company based on the month they join the medical plan.
2024–25 Employee Benefits GuideNavia Benefit Solutions 11Health Savings Account (HSA)IRS-Qualified Medical ExpensesYou can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free. HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to Navia Benefits Solutions, you must save your bills and receipts for tax purposes.Examples of IRS-Qualified Medical Expenses: Ineligible Medical Expenses May Include: This list is not all-inclusive; additional expenses may qualify, and the items listed above are subject to change in accordance with IRS regulations. For more information or clarification on individual list items, refer to Publication 502 or consult a tax professional.HSA State Taxation: There are currently three states that, unlike the federal government, subject your HSA contributions (employee and employer) to state income taxes. The three states are New Jersey, California and Alabama. Similarly, these three states also subject earnings (interest and capital gains) on your HSA to state taxation. There are currently two other states, New Hampshire and Tennessee, that subject earnings on the account (but not the contributions) to state taxes. Tax laws are subject to change. Please contact your state tax authority or consult with a tax advisor to confirm the details for your state.✓ Acupuncture✓ Ambulance✓ Annual Physical Examination✓ Bandages✓ Birth Control Pills, contraceptivedevices✓ Body Scan✓ Breast Pumps and Supplies✓ Breast Reconstruction Surgery✓ Chiropractor✓ Contact Lenses✓ Crutches✓ Dental Treatment✓ Diagnostic Devices✓ Disabled Dependent Care Expenses✓ Eye Exam✓ Eyeglasses✓ Eye Surgery✓ Hearing Aids✓ Home Care✓ Hospital Services✓ Insurance Premiums✓ Laboratory Fees✓ Lactation Expenses✓ Learning Disability✓ Long-Term Care✓ Medicines✓ Nursing Home✓ Nursing Services✓ Optometrist✓ Oxygen✓ Physical Examination✓ Pregnancy Test Kit✓ Prosthesis✓ Psychiatric Care✓ Special Education✓ Sterilization✓ Stop-Smoking Programs✓ Surgery✓ Transplants✓ Vasectomy✓ Vision Correction Surgery✓ Weight-Loss Program✓ Wheelchair✓ Wig✓ X-Ray Fees Baby Sitting, Childcare, and NursingServices for a Normal, Healthy Baby Controlled Substances Cosmetic Surgery Dancing Lessons Diaper Service Electrolysis or Hair Removal Flexible Spending Account Funeral Expenses Future Medical Care Hair Transplant Health Club Dues Health Coverage Tax Credit Health Savings Accounts Household Help Illegal Operations and Treatments Maternity Clothes Veterinary Fees Medicines and Drugs From OtherCountries Nonprescription Drugs and Medicines Nutritional Supplements Personal Use Items Swimming Lessons Teeth Whitening
The information in this Enrollment Guide is presented for illustrative purposes and the text contained herein was taken from varioussummary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies orerrors are always possible. In case of discrepancy between the Guide and the actual plan documents, the actual plan documents willprevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have anyquestions about your Guide, contact Human Resources.2024–25 Employee Benefits GuideNavia Benefit Solutions 12Dental and Vision BenefitsDental BenefitsPlan Year—July 1st through June 30thRegular visits to your dentists can help more than protect your smile, they can help protect your health as well. Recent studies have linked gum disease to damage elsewhere in the body and dentists are able to screen for oral symptoms of many other diseases including cancer, diabetes and heart disease. The company offers you a reimbursement dental plan through NAVIA BENEFIT SOLUTIONS.The following chart shows the features of the Dental benefit option. For more information contact Human Resources.* Orthodontia is covered under this reimbursement planVision BenefitsPlan Year—July 1st through June 30thYour vision health is an important part of your complete wellness. Routine vision exams are important, not only for correcting vision, but because they can detect other serious health conditions. That’s why NAVIA BENEFIT SOLUTIONS offers you a reimbursement vision plan up to an annual maximum of $650 per enrolled participant to be used for eligible vision expenses. Contact Human Resources for more information.Benefit Dental ReimbursementFirst $500 This first $500 is reimbursed at 100%Next $600 The next $600 is reimbursed at 80%Next $1,040 The next $1,040 is reimbursed at 50%Annual Plan Maximum Reimbursement*$1,500 per member
2024–25 Employee Benefits GuideNavia Benefit Solutions 13Cost of CoverageMedical, Dental and VisionPer 26 Pay PeriodsNAVIA BENEFIT SOLUTIONS pays a portion of your health care premiums; however, we do require employees contribute toward their health care costs as well. Employees pay a dollar amount based on the level of coverage they select. The following Employee Payroll Deductions will be effective for this plan year and will be reflected on your first paycheck after effective date.yourDENTAL AND VISION PLAN Payroll Deductions (per 26 pay periods)Employee Employee + SpouseEmployee + Child(ren)Employee + Spouse + Child(ren)$5.00 $25.00 $10.00 $35.00MEDICAL PLAN Payroll Deductions with spousal surcharge (per 26 pay periods )TIER BPA HDHP (HSA) BPA PPO PLANEmployee$20.31 $85.38Employee + Spouse$221.54 $286.15Employee + Child(ren)$36.92 $164.31Employee + Spouse + Child(ren)$258.46 $369.23The information in this Enrollment Guide is presented for illustrative purposes and the text contained herein was taken from various summary plan descriptionsand benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancybetween the Guide and the actual plan, documents the actual plan documents will prevail. All information is confidential, pursuant to the Health InsurancePortability and Accountability Act of 1996. If you have any questions about your Guide, contact Human Resources.
2024–25 Employee Benefits GuideNavia Benefit Solutions 14Flexible Spending Accounts (FSA)Section 125 PlanAn FSA allows you to place money in a tax-sheltered, short-term account for use in paying for approved healthcare expenses. Enrollment occurs before the beginning of each plan year, or for new employees, during your initial enrollment period. You must enroll each year in order to participate in the Healthcare and Dependent Care Reimbursement Accounts. The amount you designate will be taken from your paycheck in equal amounts throughout the plan year. Keep your receipts and Explanation of Benefits (EOBs) in the event that NAVIA BENEFIT SOLUTIONS or the IRS requests additional information on your transaction.Limited Purpose Health Care FSA✓ Contribution Limit—$3,200 (2024)✓ Limited Purpose FSA is for those enrolled in the HDHP (HSA) Plan.You are eligible to contribute to an FSA and use the funds fordental and vision expenses not covered by the plan.✓ The FSA contribution will be deducted from your paycheck over thecourse of the year. Since you pay no taxes on the money placed inthe FSA, you effectively adjust your annual taxable salary.✓ Contributions available first day of new plan year.General Purpose Health Care FSA✓ Contribution Limit—$3,200 (2024)✓ General Purpose Health Care FSA is for those NOT enrolled inthe HDHP HSA Plan but having a regular PPO plan elsewhere.You are eligible to contribute to an FSA and use the funds formedical, dental and vision expenses not covered by the plan.✓ The Health Care FSA contribution will be deducted from yourpaycheck over the course of the year. Since you pay no taxes onthe money placed in the FSA, you effectively adjust your annualtaxable salary.✓ Contributions available first day of new plan year.Dependent Care FSA✓ Contribution Limit (2024): $5,000 if you are a single employee or married filing jointly $2,500 if you are married and filing separately Money only available as contributed via your payrolldeductionsIMPORTANT: Elections cannot be changed during the plan year unless you have a qualified change in family status like birth, death, marriage or divorce. Unused Health Care FSA amounts in excess of $640 will be forfeited, so plan carefully before making your elections.You will receive a NAVIA BENEFIT SOLUTIONS Debit Card as an alternative to submitting paper claims and waiting for reimbursement of eligible Flexible Spending Account (FSA) expenses. The card is simple to use when paying for office visit copays, prescription copays, balances remaining after insurance has paid, and certain “over the counter” health care products. Visit www.naviabenefits.com/participants/resources/benefits-card/ for more information on eligible items.Limited and General Purpose Health Care FSA Rollover Provision✓ Up to $640 of 2024 unused FSA dollars can be used to reimburse 2024 eligible FSA expenses.✓ Claims must be incurred between July 1, 2023 and June 30, 2024.✓ These claims may be submitted for reimbursement between July 1, 2023and September 30, 2024.
2024–25 Employee Benefits GuideNavia Benefit Solutions 15Life/Accidental Death & DismembermentGroup Life and AD&DPlan Year—July 1st through June 30thCoverage is available through Guardian. Life and AD&D insurance is an important benefit as it provides your beneficiaries financial protection in the event of a tragic loss. NAVIA BENEFIT SOLUTIONS provides full-time employees with group life and accidental death and dismemberment (AD&D) insurance and pays for 100% of the coverage.The amount provided by NAVIA BENEFIT SOLUTIONS is two (2) times salary up to a benefit maximum of $200,000.Age Reduction: If you are age 70 or older, the amount of your Group Life Insurance will reduce to the following percentage of its original value: Age of Employee PercentageAge 7065%Age 7545%Please make sure to add your beneficiary(ies)information upon enrollment.
2024–25 Employee Benefits GuideNavia Benefit Solutions 16Life/Accidental Death & DismembermentVoluntary Life and AD&DPlan Year—July 1st through June 30thIf you need additional Life insurance to meet your financial needs, you can purchase Voluntary Life and AD&D insurance through after-tax payroll deductions for yourself, your spouse, and your child(ren). Life insurance is about more than paying for memorial services—it’s about making sure your family can maintain its standard of living if something happens to you. How much your family needs depend on your personal situation (other income, monthly expenses, short and long-term debt such as credit card or mortgage expenses, etc.).Please know you must purchase Voluntary Life Coverage for yourself as an employee, in order to purchase coverage for your dependents. Should you leave the company, you can elect to continue this coverage directly with Guardian. Benefit reductions begin at age 70. Refer to Guardian Benefit Summaries and/or Certificates for additional details.* Spouse rates are based on his/her individual age.NOTE: Amounts over the GI are subject to completion of a Statement of Health (SOH).Statement of Health (SOH) Rules✓ New Entrant: Employee—If you elect coverage when you are initially eligible, aSOH is required only for any amount over $200,000. Spouse—If you elect coverage for your spouse or domestic partnerwhen you are initially eligible, a SOH is required only for any amountover $50,000.✓ During Open Enrollment: Employee Coverage—You can increase your coverage up to the$200,000 guarantee issue amount without a SOH, so long as you areactively at work. If you wish to increase your coverage over the GI,you must complete the required SOH form. Spouse or Child(ren) Coverage—Your can increase your Spouse orChild(ren) coverage up to the guarantee issue amount without aSOH. If you wish to increase spousal coverage over the $50,000 GI,you must complete the required SOH form.✓ Coverage for dependents who turn age 26 will end the last day of the month they turn 26, unless their birthday is onthe first of the month, in which case coverage would end last day of prior month (day before 26th birthday).Life HintRemember, you can’t get life insurance once you need it.Life / AD&D Benefit AmountEmployee✓ Increments of $10,000 to a maximum of $500,000✓ Guarantee Issue (GI) Amount $200,000Spouse*✓ Increments of $5,000 to a maximum of $100,000 (not to exceed 100% of the employeeelection)✓ GI Amount $50,000Child(ren)✓ Options of $5,000 or $10,000 (not to exceed 100% of the employee election)✓ GI Amount: $10,000Statement of Health (SOH) is required if you are requesting an amount of coverage that exceeds the maximum guaranteed issue amount in your plan. You will have 30 days to provide a complete SOH. Once your SOH is reviewed by Guardian Life Insurance,, they will notify you in writing, approving or denying your request for coverage. If you do not complete SOH within 30days or are denied the increase by the carrier, coverage will revert back to your original election(s).
2024–25 Employee Benefits GuideNavia Benefit Solutions 17Disability Income BenefitsIf you become disabled and cannot work, no benefit becomes more important to your financial security than Disability Income protection. Disability coverage provides income protection in the event that you experience a non-occupational injury or illness that prevents you from working. You have access to Short-Term Disability (STD) and Long-Term Disability (LTD) insurance through Guardian.Voluntary STD InsurancePlan Year—July 1st through June 30thIf you aren’t able to work after 7 consecutive days of disability due to an eligible injury or illness, this benefit pays 60% of your weekly pay up to a maximum benefit of $1,500 per week, for a maximum of 13 weeks. You pay the full cost of this coverage and rates are based on your age and annual base salary as of the effective date of coverage.If elected, there is a pre-existing condition limitation in which you will not be covered for any disability beginning in the first twelve months caused by the related medical condition that you were diagnosed and/or treated in the three months prior to the effective date. This includes any condition/symptom for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs.If you waive coverage as a newly eligible team member and choose to elect at a later time (such as Open Enrollment), you will be subject to a Statement of Health (SOH).A complete benefit summary and the cost related to this coverage is available on our Namely Portal.* Maximum payment period is based on the first day you are disabled, not when benefits begin.Voluntary Short-Term Disability (STD) Benefit SummaryBenefits Begin ✓ 1st day for accident; 8th day for illnessIncome Replacement✓ 60% of your pre-disability earningMaximum Benefit✓ $1,500 Weekly✓ IMPORTANT: The ‘State TDI Benefit Amount’ will offset with the ‘VoluntaryBenefit Amount’ so the maximum any employee will receive is $1,500 per week.Maximum Benefit Period*✓ 13 weeksPre-Existing Condition3 months lookback; 12 months exclusion
2024–25 Employee Benefits GuideNavia Benefit Solutions 18Disability Income BenefitsLTD InsurancePlan Year—July 1st through June 30thNAVIA BENEFIT SOLUTIONS provides benefit-eligible employees with LTD benefits. In the event you become disabled due to injury or sickness, LTD income benefits are provided as a source of income on a monthly basis.This benefit is 100% Employer paid. * The age at which the disability begins may affect the duration of the benefits.Long-Term Disability (LTD) Benefit SummaryElimination Period✓ 90 daysIncome Replacement✓ 60% of your pre-disability earningMaximum Benefit✓ $10,000 MonthlyMaximum Benefit Period*✓ Up to your Social Security Normal Retirement Age (SSNRA)Helpful TermsElimination Period—It’s the period of time you have to wait before benefits begin, starting the day youbecome ill or injured.Maximum Monthly Benefit—This is the highestdollar amount a disabled employee can receive on amonthly basis under the LTD plan.Pre-Disability Earnings—The amount of apolicyholder’s wages or salary in effect on the daybefore the disability began.Maximum Benefit Period—This is a maximum lengthof time during which benefits will be paid.Pre-Existing Condition—A medical condition thatexists prior to the effective date of the policy and forwhich a person has received medical care.Pre-Existing Condition Exclusionary Period—Aperiod of time during which a person’s prior medicalcondition(s) will not be covered by the policy.However, after the pre-existing exclusionary periodexpires, the condition becomes covered under thecoverage.Pre-Existing Exclusion3 months lookback; 12 months exclusionA complete benefit summary is available on our Namely Portal.
2024–25 Employee Benefits GuideNavia Benefit Solutions 19Commuter BenefitsCommuter benefits allow you to put aside money on a pre-tax basis to pay for work-related commutingand parking expenses. This benefit is only available to you and not your dependents. It consists of two separate benefits, parking and transportation expense reimbursements.Qualified Parking ExpensesEligible:✓ Parking expenses at work or near a locationfrom which you commute to work by masstransit, vanpooling in a commuter highwayvehicle or carpool by other means✓ Vendor parking lots✓ Vendor parking garagesIneligible:✓ Parking expenses at or near your residence✓ Expenses incurred that are not for parking ator near your place of businessTransportation ExpensesEligible:✓ Bus and commuter highway vehicles✓ Mass transit vehicles, Metro, and transit passes (bus, rail, ferry)✓ Pass, token fare card, voucher or similar items fortransportation on mass transit✓ Vanpooling—transportation between employee’s residenceand place of employment in a vehicle that seats at least sixadults (excluding the driver) and where at least 80% ofmileage is for this purposeIneligible:✓ Carpooling✓ Gas✓ Toll feesHow much can I contribute pre-tax each month?For 2024, you can contribute up to the maximum monthly election amount pre-tax:✓ Parking Expenses: Maximum monthly election amount is$315.00✓ Transportation Expenses: Maximum monthly electionamount is $315.00How does the Commuter benefits work?1) If you decide to enroll in the plan, estimate the amount you will spend on parking and/or transportation expenses eachmonth. Keep in mind that your contribution will be taken out of your paycheck in equal amounts each pay period on a pre-tax basis.2) Per IRS Regulations:✓ Transportation fares must be purchased using the Benefit Card.✓ Parking claims must be submitted within 180 days.✓ Transportation and Parking are separate plans under Commuter Benefits. Money may not be transferred betweenthe two accounts.✓ Family members are not eligible to use this plan.3) As you incur transportation and parking expenses throughout the year, you can submit a claim to NAVIA BENEFITSOLUTIONS for reimbursement. You have the option of submitting a claim online OR you can complete a paper claim andfax or mail to Navia. Remember, you can only get reimbursed up to the amount that is available in your account at that time.4) Commuter benefits funds do not expire unless you leave your company. These funds will continue to rollover month tomonth, year to year, if you're still at the same company. However, when you leave the company, any unused funds in youraccount will be returned to the company.
FOR SUPPORT:Call: 1.888.881.LINC (5462)Text: ‘Support’ to 51230Visit: www.supportlinc.comGroup Code: naviaEmployee Assistance Program (EAP)At some point in our lives, each of us faces a problem or situation that is difficult to resolve. When these instances arise, SupportLinc will be there to help. The SupportLinc employee assistance program (EAP) is a confidential resource that helps you deal with life’s challenges and the demands that come with balancing home and work. SupportLinc provides confidential, professional referrals and up to five (5) sessions of face-to-face counseling sessions for a wide variety of concerns, such as: Anxiety ● Depression ● Marriage and Relationship Problems ● Grief and Loss ● Substance Abuse ● Anger Management ● Stress ● Financial Assistance ● Legal Assistance ● Family AssistanceSupportLinc EAP offers expert guidance to help address and resolve everyday issues, by providing: ✓ In-the-moment support—Reach a licensed clinician by phone 24/7/365 for immediate assistance.✓ Short-term counseling—Access up to five (5) no-cost counseling sessions, in-person or via video, to resolve stress, depression, anxiety, work related pressures, relationship issues or substance abuse.✓ Financial expertise—Consultation and planning with a licensed financial counselor.✓ Legal consultation—By phone or in-person with a local attorney.✓ Convenience resources—Referrals for child and elder care, home repair, housing needs, education, pet care and so much more.✓ Confidentiality—Strict confidentiality standards ensure no one will know you have accessed the program without your written permission except as required by law.The web portal and mobile app provides: ✓ One-stop shop for program services, information and more.✓ On-demand training to boost wellbeing and life balance.✓ Search engines, financial calculators and career resources.✓ Thousands of articles, tip sheets, self-assessments and videos.Convenient, on-the-go support: ✓ Textcoach®—Personalized coaching with a licensed counselor on mobile or desktop.✓ Animo—Self-guided resources to improve focus, wellbeing and emotional fitness.✓ Virtual Support Connect—Moderated group support sessions on an anonymous, chat-based platform.Start with NavigatorTake the guesswork out of your emotional fitness! Visit your web portal or mobile app to complete the short Mental Health Navigator survey. You’ll immediately receive personalized guidance to access support and resources.20Navia Benefit Solutions 2024–25 Employee Benefits GuideDownload the mobile app today!
ENROLL NOW:https://www.wishboneinsurance.com/naviabenefitsOptional wellness coverage is available for an additional cost.Wishbone Pet InsuranceNAVIA BENEFIT SOLUTIONS is offering Wishbone Pet Insurance to employees provided through Pet Benefit Solutions. The coverage is underwritten by Clear Blue Insurance Group.Nobody wants to imagine their pet getting sick or injured—but when it comes to your pet’s health, it’s best to expect the unexpected.Enroll in pet health insurance from Wishbone and receive 90% reimbursement on your pet’s veterinary care. With a low deductible of $250, protecting your pet’s health and your finances has never been easier!Wishbone Pet Insurance is accepted at any vet in the U.S., including emergency hospitals. Once you file a claim, expect to be reimbursed via mailed check in 5 business days or less. It’s that easy!Wishbone’s Base Plan starts at $12 per month and includes the following: ✓ 90% reimbursement✓ $250 deductible✓ $25k annual limit✓ Accidents and illnesses✓ Office visits and exam fees✓ Take-home prescription medicationsBonus plan perks—On top of best-in-class coverage and low monthly rates, your Wishbone plan also includes a few extras.✓ Durable pet ID tag—ThePetTag provides 25/7 lostpet monitoring service for those adventures thatget too far from home.✓ Free 24/7 vet support—Midnight counter-surfingcatastrophe? Get help anytime from an AskVetveterinarian via live chat.2024–25 Employee Benefits GuideNavia Benefit Solutions 21
2024–25 Employee Benefits GuideNavia Benefit Solutions 22Wellness Reimbursement PlanEstablished by NAVIA BENEFIT SOLUTIONS, INC. | Administered by NAVIA BENEFIT SOLUTIONSNAVIA BENEFIT SOLUTIONS is proud to be the administrator of your Wellness Reimbursement Plan. This reimbursement plan has been established by NAVIA BENEFIT SOLUTIONS, INC. to reimburse you for wellness related expenses.Benefit Summary Plan Year: July 1, 2024 – June 30, 2025Benefit Amount: At the beginning of each month, your Wellness Reimbursement plan will be funded with $25.00. Eligible Expenses: You may submit claims for eligible expenses that incurred during the plan year. Spouse and dependent expenses are not eligible.Wellness Plan or FSA?If you participate in the Health Care FSA, Wellness related expenses will be reimbursed from the Wellness Plan first. Please do not use the NAVIA BENEFIT SOLUTIONS Debit Card to pay for Wellness related expenses. The debit card is only tied to the funds in your Health Care FSA. Wellness related expenses will need to be submitted in the form of an itemized statement from the provider. NAVIA BENEFIT SOLUTIONS will process your claim and send you a reimbursement. Claim Submission 1) Complete a claim form, itemize your expenses, and list the total amount you are claiming.2) Attach an itemized statement showing the date, type and cost of service and the amount paid.3) Submit the claim form and supporting documentation to NAVIA BENEFIT SOLUTIONS. The most efficient way tosubmit a claim is by using the online claim submission tool or the MyNavia smartphone app for Android or iPhone.You may also submit claims via email, fax or mail. Please use only one method per submission. Allow 2 full businessdays for your claim to be reviewed and processed once it has been received.4) Reimbursements are processed weekly on Tuesday. Your reimbursement will be directly deposited into your bankaccount, or a check mailed to your home. Direct deposits may take 1 – 2 days to post to your bank account.5) If your employment is terminated, or you lose Wellness Plan coverage, 0 days after your date of termination to submitclaims for expenses incurred prior to your benefit termination date.✓ Athletic Event Registration Fees✓ Exercise Videos✓ Fitness/Exercise Classes✓ Fitness Tracking Equipment: Pedometers heart rate monitors Fitness Bands Watches (must be primarily fitness related)✓ Gym Membership✓ Home Exercise Equipment✓ Massage Therapy✓ Personal Training✓ Sport/Activity League✓ Weight Loss Program
2024–25 Employee Benefits GuideNavia Benefit Solutions 23Value Added ProgramsTeladocEnrolled medical plan members are eligible for the Telemedicine program at no cost. Telemedicine gives medical plan members 24/7/365 access to a national network of U.S. board-certified doctors. Members can reach Telemedicine from anywhere—home, work or on the road! Telemedicine doctors diagnose non-emergency medical problems; recommend treatment and can even call in a prescription to the pharmacy, when necessary.Telemedicine doctors can:✓ Diagnose non-emergency medical problems, such as respiratory infection, ear infections, urinary tract infections,allergies, cold and flu, sore throat, pink eye, etc.✓ Recommend treatment✓ Call in a prescription to your pharmacy of choice, when necessaryFirst time users will be asked to set up an account where you will be asked to complete questions similar to a first visit to a doctor’s office. The doctor reviews your medical history then contacts you, listens to your concerns, and asks questions. For the same cost as an office visit with your primary care provider per consultation, Telemedicine is a cost-effective alternative to an urgent care center or emergency room visit. Register today so you’ll be ready to use a Telemedicine service when and where you need it. Three ways to register:
2024–25 Employee Benefits GuideNavia Benefit Solutions 24Value Added Programs• Advanced health care directives• Estate taxes• Executors & probate• Financial power of attorney• Getting organized• Guardianship & conservatorship• Healthcare power of attorney• Living wills• Trusts• WillsEstate planning documentsMembers have access to a number of necessary planning documents such as wills, healthcare power of attorney, financial power of attorney and living wills. Documents are easy to use and understand.Resource library Learn the importance of estate planning, organizing your personal affairs and protecting your loved ones through unlimited access to a dedicated legal/financial website. Each member can gain access to a glossary of legal terms, a variety of legal articles and guides as well as legal Frequently Asked Questions (FAQs).Access to estate plannersThe complexities of estate planning can be overwhelming, especially during times of need. Each member has access to telephonic consultations with an estate planner.* Package cost paid by the employee. Package options available as of 1/1/22. WillPrep Services are provided by Uprise Health, and its contractors. The GuardianLife Insurance Company of America (Guardian) does not provide any part of WillPrep Services. Guardian is not responsible or for care or advice given by anyprovider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide theactual terms, services, limitations and exclusions. Guardian and Uprise Health reserve the right to discontinue the WillPrep Services at any time without notice.Legal services will not be provided in connection with or preparation for any action against Guardian, Uprise Health, or your employer. Guardian, its subsidiaries,agents, and employees do not provide tax, legal, or accounting advice. Consult your tax, legal, or accounting professional regarding your individual situation.Guardian® is a registered trademark of The Guardian Life Insurance Company of America. ©Copyright 2024 The Guardian Life Insurance Company of America.Expanded discounted estate planning package options* include:• $100: attorney assisted will package: attorneyassisted will; one advance medical directive/livingwill; one health care agent form; one durablepower of attorney• $179: couples will package: two simple wills; twoadvance medical directives/living wills; two healthcare agent forms; two durable powers of attorneys• $649: individual trust package: one A/Brevocable trust with a pour-over will; oneadvance medical directive/living will; one ealthcare agent form; one durable power of attorney• $999: couples trust package: one A/B revocabletrust with a pour-over will for each spouse; twoadvance health care directives/living wills; twohealth care agent forms; two durable powers ofattorneyAttorney assisted will and trust preparation While many people feel comfortable using the services’ interactive web-based program to develop their own will free of charge, others prefer to have an attorney actually prepare the will or trust. The option for an attorney prepared will is available for a modest charge.We are here to help:willprep.uprisehealth.com• Username: WillPrep• Password: GLIC09Call 1-877-433-6789WillPrep ServicesHelp protect the ones you loveWillPrep Services offer a range of will preparation services. For eligible members with voluntary term life plans, the services include online planning documents, a resource library and access to professionals to help with issues related to:
Navia Benefit Solutions 25ContactsYour CarriersYour Human Resources TeamCoverage Vendor / Carrier Contact InformationMedical Benefits Plan Administrators (BPA)Phone: (800) 236-7789Website: www.bpaco.comDental / Vision Navia Benefit SolutionsPhone: (425) 452-3470Website: HR Tab within ConfluenceHealth Savings Account (HSA) / Flexible Spending Account (FSA) / Commuter BenefitsNavia Benefit SolutionsPhone: (800) 669-3539Website: www.naviabenefits.comEmployee Assistance Program (EAP)SupportLincPhone: (888) 881-LINC (5462)Text: ‘Support’ to 51230Website: www.supportlinc.comGroup Code: naviaPet InsurancePet Benefit SolutionsPhone: (800) 891-2565Website: www.petbenefits.comEmail: customercare@petbenefits.comContact Name Title Contact InformationVP Human ResourcesPhone: (425) 452-3470Email: JTarasewicz@naviabenefits.comContact NameContact InformationContact InformationMatt Ott Client Executive Matt works closely with Navia and Hauser Team to provide consultation on benefit goals and future direction to develop and implement effective strategies. Ensures health plan runs smoothly and efficiently. Email: motto@thehausergroup.comLina Colon Client ExecutiveLina is responsible for benefit plan presentations to members and assisting in executing benefit initiatives. Also, a day-to-day contact for plan questions, eligibility, and assistance in resolving an escalated claim.Email: lcolon@thehausergroup.com2024–25 Employee Benefits GuideLife / AD&D and Disability Guardian Life Insurance CompanyPhone: (800) 525-4542(800) 268-2525Website: www.guardiananytime.comYour Hauser TeamJim ReynosoJack TarasewiczHuman Resources Manager Phone: (760)705-3052 Email: JReynoso@navia.com
2024–25 Employee Benefits GuideNavia Benefit Solutions 26Important NoticesNotice of Patient Protections & Prior Authorization ProceduresYour BPA PLANS allow you to visit any doctor or hospital you choose. However, Prior Authorization is required for certain services. Make sure Your Provider obtains Prior Authorization before any planned hospital stays (except maternity admissions), skilled nursing and rehabilitative facility admissions, certain outpatient procedures, Advanced Radiological Imaging services, certain Specialty Drugs, and Durable Medical Equipment costing $500 or more. Contact BPA Customer Service using the number on the back of your medical ID card or online at www.bpaco.com to find out which services require Prior Authorization. You can also call the customer service department to find out if your admission or other service has received Prior Authorization. For more information, please refer to your Evidence of Coverage document located online at www.bpaco.com.Women’s Health and Cancer Rights Act of 1998Patients who undergo a mastectomy, and who elect breast reconstruction in connection with the mastectomy, are entitled to coverage for:✓ All stages of reconstruction of the breast on which the mastectomy was performed;✓ Surgery and reconstruction of the other breast to produce a symmetrical appearance;✓ Prostheses; and✓ Treatment of physical complications of the mastectomy, including lymphedema.The coverage may be subject to Coinsurance and Deductibles consistent with those established for other benefits. For more information, please refer to your Evidence of Coverage document located online at www.bpaco.com.Newborns’ and Mothers’ Health Protection ActUnder federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your Out-of-Pocket costs, you may be required to obtain precertification. For information on precertification, contact your plan administrator.Notice of Special Enrollment RightsIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’other coverage). However, you must request enrollment within 31 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact Human Resources.
2024–25 Employee Benefits GuideNavia Benefit Solutions 27Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, yourstate may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIPprograms. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistanceprograms but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For moreinformation, visitwww.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your StateMedicaid or CHIP office to find out if premium assistance is available.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependentsmight be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW orwww.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help youpay the premiums for an employer-sponsored plan.If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under youremployer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a“special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible forpremium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor atwww.askebsa.dol.gov or call 1-866-444-EBSA (3272).If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2024. Contact your State for more information on eligibility:ALABAMA—Medicaid CALIFORNIA—MedicaidWebsite: http://myalhipp.com/Phone: 1-855-692-5447Website: Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hippPhone: 916-445-8322Fax: 916-440-5676Email: hipp@dhcs.ca.govALASKA—MedicaidCOLORADO—Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.comMedicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspxHealth First Colorado Website: https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center: 1-800-221-3943 / State Relay 711CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plusCHP+ Customer Service: 1-800-359-1991 / State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health-insurance-buy-programHIBI Customer Service: 1-855-692-6442ARKANSAS—Medicaid FLORIDA—MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.htmlPhone: 1-877-357-3268
2024–25 Employee Benefits GuideNavia Benefit Solutions 28Important NoticesGEORGIA—Medicaid MAINE—MedicaidA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipraPhone: 678-564-1162, Press 2Enrollment Website: https://www.maine.gov/dhhs/ofi/applications-formsPhone: 1-800-442-6003TTY: Maine relay 711Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-formsPhone: 1-800-977-6740TTY: Maine relay 711INDIANA—Medicaid MASSACHUSETTS—Medicaid and CHIPHealthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: https://www.in.gov/medicaid/Phone 1-800-457-4584Website: https://www.mass.gov/masshealth/paPhone: 1-800-862-4840IOWA—Medicaid and CHIP (Hawki) MINNESOTA—MedicaidMedicaid Website: https://dhs.iowa.gov/ime/membersMedicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/HawkiHawki Phone: 1-800-257-8563HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hippHIPP Phone: 1-888-346-9562Website:https://mn.gov/dhs/people-we-serve/children-and- families/health-care/health-care-programs/programs-and- services/other-insurance.jspPhone: 1-800-657-3739KANSAS—Medicaid MISSOURI—MedicaidWebsite: https://www.kancare.ks.gov/Phone: 1-800-792-4884Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005KENTUCKY—Medicaid MONTANA—MedicaidKentucky Integrated Health Insurance Premium PaymentProgram (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspxPhone: 1-855-459-6328Email: KIHIPP.PROGRAM@ky.govKCHIP Website: https://kidshealth.ky.gov/Pages/index.aspxPhone: 1-877-524-4718Kentucky Medicaid Website: https://chfs.ky.govWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084LOUISIANA—Medicaid NEBRASKA—MedicaidWebsite: www.medicaid.la.gov or www.ldh.la.gov/lahippPhone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)Website: http://www.ACCESSNebraska.ne.govPhone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) (continued)
2024–25 Employee Benefits GuideNavia Benefit Solutions 29Important NoticesPremium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) (continued)NEVADA—Medicaid SOUTH CAROLINA—MedicaidMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900Website: https://www.scdhhs.govPhone: 1-888-549-0820NEW HAMPSHIRE—Medicaid SOUTH DAKOTA—MedicaidWebsite: https://www.dhhs.nh.gov/oii/hipp.htmPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext. 5218Website: http://dss.sd.govPhone: 1-888-828-0059NEW JERSEY—Medicaid and CHIP TEXAS—MedicaidMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710Website: http://gethipptexas.com/Phone: 1-800-440-0493NEW YORK—Medicaid UTAH—Medicaid and CHIPWebsite: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831Medicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669NORTH CAROLINA—Medicaid VERMONT—MedicaidWebsite: https://medicaid.ncdhhs.gov/Phone: 919-855-4100Website: http://www.greenmountaincare.org/Phone: 1-800-250-8427NORTH DAKOTA—Medicaid VIRGINIA—Medicaid and CHIPWebsite: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-844-854-4825Website: https://www.coverva.org/en/famis-selecthttps://www.coverva.org/en/hippMedicaid Phone: 1-800-432-5924CHIP Phone: 1-800-432-5924OKLAHOMA—Medicaid and CHIP WASHINGTON—MedicaidWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742Website: https://www.hca.wa.gov/Phone: 1-800-562-3022OREGON—Medicaid WEST VIRGINIA—Medicaid and CHIPWebsite: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075Website: https://dhhr.wv.gov/bms/http://mywvhipp.com/Medicaid Phone: 304-558-1700CHIP Toll-Free Phone: 1-855-MyWVHIPP (1-855-699- 8447)PENNSYLVANIA—Medicaid WISCONSIN—Medicaid and CHIPWebsite:https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspxPhone: 1-800-692-7462Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htmPhone: 1-800-362-3002RHODE ISLAND—Medicaid and CHIP WYOMING—MedicaidWebsite: http://www.eohhs.ri.gov/Phone: 1-855-697-4347, or 401-462-0311 (Direct Rite Share Line)Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269
2024–25 Employee Benefits GuideNavia Benefit Solutions 30Important NoticesPremium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) (continued)To see if any other states have added a premium assistance program since January 31, 2024, or for more information on special enrollment rights, contact either:Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.Notice of Privacy PracticesBPA is required to maintain the privacy of all medical information as required by applicable laws and regulations; provide a notice of privacy practices to all Members; inform Members of the Plan’s legal obligations; and advise Members of additional rights concerning their medical information. For more information, please refer to your Evidence of Coverage document located online at www.bpaco.com.All Members will be notified of any changes by receiving a new notice of the Plan’s privacy practices. You may request a copy of this notice of privacy practices at any time by contacting BPA.Uniformed Services Employment and Reemployment Rights Act of 1994A Subscriber may continue his or her Coverage and Coverage for his or her Dependents during military leave of absence in accordance with the Uniformed Services Employment and reemployment Rights Act of 1994. When the Subscriber returns to work from a military leave of absence, the Subscriber will be given credit for the time the Subscriber was covered under the Plan prior to the leave.U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/agencies/ebsa1-866-444-EBSA (3272)U.S. Department of Health and Human Centers for Medicare & Medicaid Services www.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565
2024–25 Employee Benefits GuideNavia Benefit Solutions 31Important NoticesImportant Notice from NAVIA BENEFIT SOLUTIONS about Your Prescription Drug Coverage and Medicare for plans: ✓ BPA HDHP (HSA)✓ BPA PPO PlanMedicare Part D Prescription Drug NoticePlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with NAVIA BENEFIT SOLUTIONS and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.There are two important things you need to know about your current coverage and Medicare's prescription drug coverage:1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverageif you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offersprescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare.Some plans may also offer more coverage for a higher monthly premium.2. NAVIA BENEFIT SOLUTIONS has determined that the prescription drug coverage offered by the BPA PLANS is, onaverage for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage paysand is considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep thiscoverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?Since the coverage under your BPA PLAN is creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if you go 63 continuous days or longer without prescription drugcoverage that’s creditable, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.What Happens To Your Current Coverage If You Decide To Join A Medicare Drug Plan?If you decide to join a Medicare drug plan, your current BPA PLAN coverage will not be affected. You can keep this coverage if you elect Part D and this plan will coordinate with Part D coverage.If you do decide to join a Medicare drug plan and drop your current NAVIA BENEFIT SOLUTIONS coverage, be aware that you and your dependents will not be able to get this coverage back until next Annual Open Enrollment or a mid-year qualifying event.
2024–25 Employee Benefits GuideNavia Benefit Solutions 32Important NoticesMedicare Part D Prescription Drug Notice (continued)For More Information About Your Options Under Medicare Prescription Drug Coverage…More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.For more information about Medicare prescription drug coverage:✓ Visit www.medicare.gov✓ Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You”handbook for their telephone number) for personalized help✓ Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).Date: 07/01/2024Name of Entity/Sender: NAVIA BENEFIT SOLUTIONSOffice Contact/Position: Jack Tarasewicz / VP of Human ResourcesPhone: Address: (425) 452-3470600 Naches Avenue SW, Renton, WA 98057Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drugplans, you may be required to provide a copy of this notice when you join to show whether or notyou have maintained creditable coverage and, therefore, whether or not you are required to pay ahigher premium (a penalty).
2024–25 Employee Benefits GuideNavia Benefit Solutions 33Important NoticesPART A: General InformationWhen key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer..What is the Health Insurance Marketplace?The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.Can I Save Money on my Health Insurance Premiums in the Marketplace?You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1NOTE: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.How Can I Get More Information?For more information about your coverage offered by your employer, please check your summary plan description orcontact The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.Your Human Resources Department1An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.New Health Insurance Marketplace CoverageOptions and Your Health CoverageForm Approved OMB No. 1210-0149 (expires 6-30-2024)
1. Legal Spouses2. Domestic Partners (Same and Opposite Sex)3. Dependents up to age 262024–25 Employee Benefits GuideNavia Benefit Solutions 34Important NoticesPART B: Information About Health Coverage Offered by Your EmployerThis section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.Full time employeesHere is some basic information about health coverage offered by this employer:• As your employer, we offer a health plan to: All employees. Eligible employees are:⃣ Some employees. Eligible employees are:• With respect to dependents We do offer coverage. Eligible dependents are:⃣ We do not offer coverage.⃣ If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.3. Employer NameNAVIA BENEFIT SOLUTIONS4. Employer Identification Number (EIN)91-14677585. Employer Address600 Naches Avenue SW6. Employer Phone Number(425) 452-34707. CityRenton8. StateWA9. Zip Code9805710.Who can we contact about employee health coverage at this job?Jack Tarasewicz11.Phone Number (if different from above) 12.Employer Email Addressjtarasewicz@naviabenefits.com
2024–25 Employee Benefits GuideNavia Benefit Solutions 35Important NoticesThe information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers, but will help ensure employees understand their coverage choices.If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don't know, STOP and return form to employee.16. What change will the employer make for the new plan year? Employer won't offer health coverage Employer will start offering health coverage to employees or change the premium for the lowest-cost plan available only tothe employee that meets the minimum value standard.* (Premium should reflect the discount for wellness programs. See question 15.)a. How much would the employee have to pay in premiums for this plan? $b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in thenext 3 months? Yes (Continue)13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the employee eligible for coverage? (mm/dd/yyyy) (Continue) No (STOP and return this form to employee)14. Does the employer offer a health plan that meets the minimum value standard*?Yes (Go to question 15) No (STOP and return form to employee)15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't include family plans):If the employer has wellness programs, provide the premium that the employee would pay if he/she received the maximumdiscount for any tobacco cessation programs, and didn't receive any other discounts based on wellness programs.a. How much would the employee have to pay in premiums for this plan? $44.00b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly* An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the planis no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986).
2024–25 Employee Benefits Guide36NotesNavia Benefit Solutions
The information in this Enrollment Guide is presented for illustrative purposes and the text contained herein was taken from varioussummary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies orerrors are always possible. In case of discrepancy between the Guide and the actual plan documents, the actual plan documents willprevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have anyquestions about your Guide, contact Human Resources.600 Naches Avenue SWRenton, Washington 98057