2024 Employee Benefits GuideLINE STAFFMEDICAL DENTAL VISION LIFE FSAs & MORE
OVERVIEWWelcome to your 2024 Employee Benefits Guide!At Radiant Senior Living, our employees are our greatest asset! We appreciate the hard work and dedication our employees bring to Radiant Senior Living and want to thank you by offering a comprehensive and cost-effective benefits package. Each year a benefits review is conducted to ensure the right mix of programs and resources are provided to support the total well-being of teammates and their family members. Along with the review of benefits, costs for both our teammates and our company are considered.We have great news to share, for 2024 there will be no change to teammates’ costs for their benefits! The only benefit change is the increased annual contribution limit and carryover limit on the Healthcare FSA.This Employee Benefits Guide is designed to help teammates learn about their benefit options, choose the coverages that make sense for their unique needs and take advantage of an array of year-round resources to be in more control of their health and manage their total well-being!Disclaimers!This Guide provides only a summary of the benefit plans offered to you by Radiant Senior Living, and in no way serves as the actual plan description or legal plan document for the benefit plans. Certain restrictions and exclusions apply. For exact terms and conditions, please refer to the Summary Plan Description (SPD) or Certificate of Coverage of each benefit plan, as those are the legal documents of our benefit plans. If information in this Guide differs from the information in the SPD and Certificate of Coverage, those legal documents take precedence. Radiant Senior Living reserves the right to modify any or all of the benefit plans at anytime. Please see Human Resources for more information.The information provided in this Guide is advisory and is provided for general informational purposes only. This information should not be considered legal or tax advice or legal or tax opinion on any specific facts or circumstances. Readers and participants are urged to consult their legal counsel and tax advisor concerning any legal or tax questions that may arise.TABLE OF CONTENTSOverview 1Eligibility & Enrollment 2Contacts & Resources 2Medical Plans 3Dental Plan 4Vision Plan 4Flexible Spending Accounts 5Life/AD&D Plan 6Supplemental Plans 6Retirement 401(k) 6Employee Assistance Program 7Required Notices 8 – 101
ELIGIBILITYAll regular, active full-time Line Staff working 30 hours or more per week are eligible for benefits on the 1st of the month following 60 days from date of hire. Eligible dependents are also able to enroll in the available plans. Eligible dependents include your spouse or domestic partner, your children and your spouse’s or domestic partner’s children. Dependent children are eligible for coverage through the last day of the month of their 26thbirthday.ENROLLMENT OPPORTUNITIESYou are eligible to enroll/to make changes to your enrollment elections in the available benefit plans as follows:1. during your initial eligibility period;2. with a qualifying life event* - birth, death, marriage, divorce, adoption, and involuntary loss of other coverage;3. during the annual Open Enrollment period, which is held during November and December for a January 1steffective date.* If you have a qualifying life event change, you must notify Human Resources within 30 days of the event, otherwise you forfeit your opportunity to enroll or make changes and you must wait until the next Open Enrollment period.TO ENROLL GO TO www.paycom.com▪ Hover over Login button, then click Employee▪ Enter your user/login information▪ New users will receive login information from your manager.▪ New users will need your personal information to enroll, including your social security number and information for your dependents.From this site you will be able to:✓ Review detailed benefit summaries and documents plus additional information on the available benefit plans.✓ See how much the plans will cost you.✓ ENROLL!IMPORTANT NOTE!All eligible employees are required to enroll or waive available coverages through this website when initially eligible, and we recommend that you review your benefit elections annually during Open Enrollment.2ELIGIBILITY & ENROLLMENT | CONTACTS & RESOURCESCONTACTS & RESOURCESFollowing is the contact information for the benefit plans outlined in this Guide. If you have questions please contact your manager, Human Resources, the insurance company, or a representative at Brown & Brown, our employee benefits consultants. For questions about benefits/coverage, help finding participating providers, assistance with claims, to order ID cards and more, contact:MEDICAL PLANAllied Group # A15160www.alliedbenefit.com1.800.288.2078DENTAL PLAN & VISION PLANGuardian Group # 532228 www.guardianlife.comDental: 1.800.541.7846 | Vision: 1.877.814.8970FLEXIBLE SPENDING ACCOUNTSisolved Benefit Serviceswww.isolvedbenefitservices.com1.866.370.3040 or 1.800.300.3838LIFE/AD&D PLANGuardian Group # 532228 www.guardianlife.com1.800.525.4542EMPLOYEE ASSISTANCE PROGRAMCanopy Group # Radiant canopywell.comCall: 1.800.433.2320, Text: 503-850-7721SUPPLEMENTAL PLANSColonial LifeMargaret Bryantmargaret.bryant@coloniallifesales.com503.808.9130 ext. 218For questions about the available plans, escalated claims assistance and general employee benefits guidance contact our employee benefits consultants, Brown & BrownAndrya Paffile, andrya.paffile@bbrown.com, 206.902.1910Todd Olson, todd.olson@bbrown.com, 206.902.1904For plan costs, benefit documents, forms and to enroll:Login to your account at www.paycom.comDOWNLOAD PAYCOM’S MOBILE APP TO YOUR SMART PHONENeed Medicare Guidance?For anyone needing advice regarding their Medicare rights and options, information about how Medicare coordinates with employer provided coverage, etc., our employee benefits consultants recommend you contact your State Health Insurance Assistance Program. Trusted representatives will provide unbiased, one-on-one counseling and assistance to Medicare-eligible individuals, their families and caregivers. Visit, www.shiphelp.org, to find contact information for local Medicare help.
Radiant Senior Living offers Medical plans administered by Allied. Employees have the option of selecting from 3 Medical plans, for the coverage that best meets your needs.The following is a summary only. Refer to the Summary Plan Description for plan benefits, details and exclusions.3For more detailed benefit information go to www.paycom.com. TALK TO A DOCTOR ANYTIME, ANYWHERE, FREE www.teladoc.com 1.800.835.2362All 3 Medical plans include Teladoc. Teladoc provides FREE access to U.S. board-certified doctors who can resolve many of your medical issues, 24/7/365, via phone or online video consults from wherever you happen to be. Save yourself some time and an office visit copay. Register for Teladoc today!ONLINE MEMBER PORTAL RESOURCES www.alliedbenefit.comGet everything you need to know about your plan…▪ Find In-Network providers.▪ View claims details and a complete record of your health care activity.▪ Compare the quality of hospitals as well as drug treatment options.▪ Get answers to medical questions via Allied’s knowledge database.▪ Receive wellness reminders for tests and annual exams.MEDICAL PLANSMEDICAL PLAN 1:MEC Preventive PlanMEDICAL PLAN 2:PPO Base PlanMEDICAL PLAN 3:PPO Buy-Up PlanIN-NETWORK BENEFIT HIGHLIGHTSCoverage for Preventive Care services only, as defined under the Affordable Care Act (ACA).• Preventive Care Covered in Full• Prescription Drugs, as required by Federal law, including contraceptives for women and mandated OTC Drugs, Covered in FullCoverage is not included for any services outside of ACA defined preventive care. Hospital services, Urgent Care and Emergency Care are NOT COVERED.IN-NETWORK BENEFIT HIGHLIGHTS▪ $7,500 Individual & $15,000 Family Annual Deductible▪ $7,500 Individual & $15,000 Family Annual Medical & Prescription Drug Out-of-Pocket Maximum▪ Preventive Care Covered in Full▪ $20 Office Visit Copay, $30 Specialist Copay▪ $30 Urgent Care Copay▪ Emergency Room Covered In Full After Deductible▪ Hospital Service Covered In Full After Deductible▪ Prescription:▪ Retail: $10 Tier 1, $75 Tier 2, $150 Tier 3▪ Mail Order: $25 Tier 1, $187.50 Tier 2, $375 Tier 3IN-NETWORK BENEFIT HIGHLIGHTS▪ $1,500 Individual & $4,500 Family Annual Deductible▪ $4,700 Individual & $9,400 Family Annual Out-of-Pocket Maximum▪ Preventive Care Covered in Full▪ $10 Office Visit Copay, $30 Specialist Copay▪ $30 Urgent Care Copay▪ $200 Copay then 30% After Deductible for Emergency Room▪ Hospital Services 30% After Deductible ▪ Prescription:▪ Retail: $10 Tier 1, $25 Tier 2, $50 Tier 3▪ Mail Order: $25 Tier 1, $62.50 Tier 2, $125 Tier 3MEDICAL PLAN PROVIDER NETWORKS & PROVIDER SEARCH INSTRUCTIONSthe MEC Preventive Plan uses the MultiPlan Limited Benefit Plan provider network• Visit www.alliedbenefit.com• Login to your Member Portal account to conduct a Provider search in your plan’s network• If you don’t have a Member Portal account:• Click the PROVIDER NETWORKS button near the top of the page• Scroll down and Click Multiplan Limited Benefit Plan• Once the MultiPlan page loads, enter information to conduct a provider searchthe PPO Base Plan uses the Cigna provider network• Visit www.alliedbenefit.com• Login to your Member Portal account to conduct a Provider search in your plan’s network• If you don’t have a Member Portal account:• Click the PROVIDER NETWORKS button near the top of the page• Scroll down and Click CIGNA• Once the Cigna page loads, Click the Find a Doctorlink, then the Employer or School button, and enter information to conduct a provider searchthe PPO Buy-up Plan uses the Cigna provider network• Visit www.alliedbenefit.com• Login to your Member Portal account to conduct a Provider search in your plan’s network• If you don’t have a Member Portal account:• Click the PROVIDER NETWORKS button near the top of the page• Scroll down and Click CIGNA• Once the Cigna page loads, Click the Find a Doctorlink, then the Employer or School button, and enter information to conduct a provider searchEMPLOYEE PRETAX COST PER PAY PERIODMEC Preventive Plan PPO Base Plan PPO Buy-up PlanEMPLOYEE COST EMPLOYEE COSTNON-TOBACCO USER DISCOUNTED COSTEMPLOYEE COSTNON-TOBACCO USER DISCOUNTED COSTEmployee Only $14.14 $78.71 $70.91 $128.01 $120.21Employee + 1 Child $62.73 $232.79 $224.99 $314.22 $306.42Employee + Spouse $62.73 $552.20 $536.60 $707.17 $691.57Employee + 2(+) Children $98.62 $462.02 $454.22 $596.22 $588.42Employee + Family $121.07 $781.43 $765.83 $989.16 $973.56
Remember to ask your Dentist for a pre-treatment estimate prior to obtaining any non-preventive services. Your Dentist will verify benefits with Guardian and confirm what your total out of pocket cost will be.DENTAL BENEFITS IN-NETWORK OUT-OF-NETWORKAnnual Deductible $50 Per Member, $150 Per FamilyPreventive ServicesDeductible WaivedCovered In FullCovered In FullPlus Charges Over Max AllowableBasic Services 20% After Deductible20% After DeductiblePlus Charges Over Max AllowableMajor Services 50% After Deductible50% After DeductiblePlus Charges Over Max AllowableAnnual Maximum Benefit$1,500 Per MemberUnless you have accumulated Maximum Rollover dollarsVISION BENEFITS VSP CHOICE NETWORKWellVision Exam Once Per 12 Months$10 CopayLensesOnce Per 12 Months$25 Copay for GlassesIncludes Single Vision, Lined Bifocal and Trifocal, and LenticularFramesOnce Per 12 Months$25 Copay for Glasses$130 Allowance +20% Discount Off Remaining BalanceContact LensesOnce Per 12 MonthsIn Lieu of GlassesUp To $60 Copay for Evaluation & Fitting $25 Copay for Medically Necessary Contacts $130 Allowance for Elective ContactsEXTRA SAVINGS & DISCOUNTSVSP In-Network Frame Discounts: 20% discount off the remaining balance in excess of the frame allowance. Additional Glasses & Sunglasses: 20% off from any VSP doctor within 12 months of your last WellVision Exam. Laser Vision Correction: Average of 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities.4DENTAL PLAN & VISION PLANEMPLOYEE PRETAX COST PER PAY PERIODEmployee Only $3.56Employee + Spouse $7.11Employee + Child(ren) $7.61Employee + Family $11.24VISION PLANMaintaining good vision health by getting regular checkups not only diagnoses vision problems but can also provide early detection of serious health problems such as diabetes, hypertension, neurological disorders and brain tumors!To find an In-Network provider:• visit www.guardianlife.com• Login to your Member Portal account to conduct a Provider search in your plan’s network• If you don’t have a Member Portal account:• Click the Find a provider link at the top of the page• Click the Find a vision provider link at the top of the page, then click the VSP button• Once the VSP page loads, enter information to conduct a provider searchDENTAL PLANMaintaining good oral health, by getting regular exams and cleanings, may prevent you from needing major services later and is essential to your total health!To find an In-Network provider:• visit www.guardianlife.com• Login to your Member Portal account to conduct a Provider search in your plan’s network• If you don’t have a Member Portal account:• Click the Find a provider link at the top of the page• enter information to conduct a provider searchEMPLOYEE PRETAX COST PER PAY PERIODEmployee Only $11.33Employee + Spouse $30.50Employee + Child(ren) $32.33Employee + Family $47.67Radiant Senior Living offers Dental and Vision plans through Guardian, because oral health and eye health are important components of your total health!The following is a summary only. Refer to the Certificates of Coverage for plan benefits, details and exclusions.For more detailed benefit information go to www.paycom.com.
Radiant Senior Living offers Healthcare and Dependent Care Flexible Spending Accounts (FSAs), administered by isolved Benefit Services. FSAs allow you to use pre-tax dollars to reimburse yourself for a wide variety of healthcare and/or dependent care expenses that are not covered through your other benefit plans. The annual amount you elect to contribute to each account will be divided into equal amounts and deducted from your paycheck on a pre-tax basis. IMPORTANT REMINDER! You must make FSA elections annually to continue participation!The following is a summary only. Refer to the Summary Plan Description for plan benefits, details and exclusions.RULES AND REGULATIONSPlan your annual FSA contribution amounts carefully; the election you make when you enroll is binding for the entire plan year unless you have a qualifying status change. Additionally, the IRS imposes some rules and restrictions on the way you can use FSA funds.▪ You must incur eligible expenses during the plan year, January1st– December 31st.▪ After the end of the plan year, you will have a 90-day run-out period to submit your plan year expenses for reimbursement. ▪ With the Healthcare FSA, at the end of the plan year you may carryover up to $640 of unused contributions to the following plan year. You will forfeit any remaining balance over $640. ▪ You cannot transfer money from one account to another; money in your Healthcare FSA cannot be used for dependent care expenses, and money in your Dependent Care FSA cannot be used for healthcare expenses.▪ You may only make changes to your contribution amounts with a qualified status change; for example, marriage, divorce or legal separation, death of a spouse or dependent, change from part-time to full-time or full-time to part-time employment, termination or commencement of spouse's employment, significant change in health coverage due to spouse’s employment.If you incur fewer expenses than expected during the plan year, please contact isolved Benefit Services before the end of theplan year to help find ways to spend those FSA dollars!For more information on either the Healthcare FSA or Dependent Care FSA, visit www.isolvedbenefitservices.com and under the Resources dropdown near the top of the page, click FSA RESOURCE CENTER, then click enter under PARTICIPANTS$ $ $ If you don’t use your Prepaid Benefits Card … FILE A CLAIM FOR REIMBURSEMENT $ $ $• Online - visit www.isolvedbenefitservices.com, Login to your participant portal, click the File A Claim link and follow the prompts.• Via the Mobile App – download the isolved Benefit Services iFlex app, Login using the same Username and Password you use for the online participant portal, click the File A Claim link and follow the prompts.• By Mail or Email – follow the instructions above to access the FSA RESOURCE CENTER for PARTICIPANTS, then click Guides & FAQs and download the FSA Reimbursement Form. Complete the form and send it along with any necessary documentation to the mailing address or email address listed on the form.HEALTHCARE FSAOut-of-pocket healthcare expenses for yourself and your dependents – such as medical, dental and/or vision deductibles, coinsurance, and copays – are eligible for reimbursement from your Healthcare FSA.The maximum annual contribution limit is $3,200. DEPENDENT CARE FSAExpenses for dependent care services for children under age 13, a disabled spouse, or incapacitated parent are eligible for reimbursement from your Dependent Care FSA, as long as you incur them while you and your spouse work or attend school full-time.The maximum annual contribution limit is $5,000 (or $2,500 if married and filing taxes separately).5FLEXIBLE SPENDING ACCOUNTS (FSAs)For more detailed benefit information go to www.paycom.com.
6LIFE/ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)Life Benefit: $25,000AD&D Benefit: additional $25,000 if your death is the result of an accident. Benefits are also payable in the case of dismemberment; see the Certificate of Coverage for the Dismemberment benefit schedule.Plan Features include: • Accelerated Life Benefit – a lump sum is paid to you if you are diagnosed with a terminal condition.SUPPLEMENTAL PLANS – 100% EMPLOYEE PAIDRadiant Senior Living makes available a variety of supplemental, voluntary plans for you and your dependents through Colonial Life.Radiant Senior Living recognizes the importance of helping you protect your family from financial loss if you were to pass away, so provides employer paid Life/AD&D coverage through Guardian.The following is a summary only. Refer to the Certificates of Coverage for plan benefits, details and exclusions.IMPORTANT REMINDER! KEEP YOUR BENEFICIARY DESIGNATIONS UP TO DATEBeneficiary designation(s) can be made in you account online at www.paycom.com. LIFE/AD&D PLAN, SUPPLEMENTAL PLANS & RETIREMENT 401(k)Disability Insurance: Replaces a portion of your income to help make ends meet if you become disabled from a covered accident or covered sickness.Accident Insurance: Helps offset the unexpected medical expenses, such as emergency room fees, deductibles and copayments, that can result from a fracture, dislocation or other covered accidental injury.Life Insurance: Enables you to tailor coverage for your individual needs and helps provide financial security for your family members.Cancer Insurance: Helps offset the out-of-pocket medical and indirect, non-medical expenses related to cancer that most medical plans don’t cover. This coverage also provides a benefit for specified cancer screening tests.Critical Illness Insurance: Complements your major medical coverage by providing a lump-sum benefit that you can use to pay the direct and indirect costs related to a covered critical illness, which can often be expensive and lengthy.Hospital Confinement Insurance: Provides a lump-sum benefit for a covered hospital confinement and a covered outpatient surgery to help offset the gaps caused by copayments and deductibles that are not covered by most major medical plans.If you are interested in more information about the available plans and costs, please contact our Colonial Life Sales Representative:Margaret Bryant margaret.bryant@coloniallifesales.com503.808.9130 ext. 218For more detailed benefit information go to www.paycom.com. 401(k) RETIREMENT SAVINGS PLANRadiant Senior Living offers eligible employees the opportunity to save for retirement through a 401(k) plan.What is a 401(k)? A 401(k) is a type of retirement savings plan with special tax advantages. The plan allows you to have money deducted from your paycheck (you decide how much) and deposited into an account for your benefit. Once deposited, you decide how to allocate your money among various investment options.How can you learn more? Radiant Senior Living has teamed up with Fidelity Investments in an effort to provide you with the tools and investment advice you need to help make your retirement planning a success. They are available to answer questions, review investments, and make recommendations in step with global market conditions.When should you contact Fidelity Investments? If you have a question about the retirement plan, need website access, want to talk to a financial professional, or simply need help filling out a form, Fidelity’s customer service representatives are ready to help.www.401k.com 1.800.835.5095
7Radiant Senior Ling provides Employee Assistance Program (EAP) through Canopy. The EAP is a FREE and CONFIDENTIAL benefit to help assist you and your immediate family members manage life’s daily challenges – ranging from personal relationships to legal and financial resources.▪ STRESS MANAGEMENT▪ ALCOHOL OR DRUG ABUSE▪ DEPRESSION OR ANXIETY▪ NICOTINE CESSATION▪ PERSONAL AND FAMILY RELATIONSHIPS▪ GRIEVING A LOSS▪ FINANCIAL/CONSUMER CONCERNS▪ CAREER DEVELOPMENT SERVICESPersonal Consultation with an EAP ProfessionalDiagnosis and Treatment Planning consisting of up to three (3) paid telephonic or live video support sessions per unrelated incident for each employee/family unit. E-SupportA live online virtual session (video or chat) with an EAP professional. Crisis CounselingAvailable on a 24 hour 7 day a week basis.Work / Family / LifeCanopy will do the research for you. We will help locate resources and information related to Nicotine Cessation, Eldercare /Childcare, Identity Theft or anything else you may need.Gym MembershipCanopy’s partnership through GlobalFit provides discounts for gym and studio memberships, nutrition programs, and wellness resources. To access, visit: globalfit.com/canopywell and click Activate Benefit at the top of the page. Legal Consultations / MediationCall Canopy for a thirty-minute office or telephone consultation at no cost with a network attorney/mediator. If you decide to retain the attorney/mediator after the initial consultation, a 25% discount from the attorney’s/mediator’s normal hourly rate is available.Financial CoachingCoaches will provide 30 consecutive days of unlimited financial coaching, developing a needs analysis and an online written action plan to help develop better spending habits, reduce debt, improve credit, increase savings, and plan for retirement.Home Ownership ProgramIf you are looking to buy, sell, refinance, or invest in a home, this program offers a network of prescreened service providers that offer free consultations. Also available are pre-negotiated discounts for select services. Identity TheftThis service provides members with up to a 60-minute free consultation with a highly trained Fraud Resolution Specialist™(FRS) who will conduct emergency response activities and assist members with restoring their identity, good credit, and dispute fraudulentdebts.Legal Tools & FormsFree online legal forms for areas such as creating a will, financial power of attorney, living will or final arrangements. Complete instructions on the proper signing and specific witnesses' requirements are provided.To Access:Call: 1.800.433.2320, Text: 503-850-7721, Email: info@canopywell.comVisit: canopywell.com and click Member Login to login or Register Account. Enter Radiant for company name when you register.EMPLOYEE ASSISTANCE PROGRAMFor more detailed benefit information go to www.paycom.com.
Purposes to Which You Have Not ObjectedIn certain limited circumstances, the Plan may use or disclose your personal health information after the Plan has given you the opportunity to object and you have failed to do so. For example, disclosure of protected health information to family members, other relatives and your close personal friends if the information is directly relevant to the family or friend’s involvement with your care or payment of care, and you have either agreed to the disclosure or have been given an opportunity to object and have failed to do so.Written AuthorizationAll other uses or disclosures of your personal health information will be made only with your written authorization, and any authorization that you give the Plan may be revoked by you at any time.ComplaintsYou may complain either directly to the Plan or the Secretary of Health and Human Services if you believe that your rights with respect to the protection of your personal health information have been violated. To file a complaint with the Plan, you may submit a statement, in writing, that includes as many details as possible (including names and dates, where relevant). The complaint should be filed with Human Resources. You will not be retaliated against in any way for filing a complaint.Practice Regarding Confidentiality and SecurityThe Plan restricts access to nonpublic personal information about you to those employees who need to know the information in order to provide the Plan’s products and services to you. The Plan maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard nonpublic personal information.To Obtain Further InformationTo obtain further information about your privacy rights or to file a complaint, please contact Human Resources.Health Insurance Portability and Accountability Act of 1996 (HIPAA) Special Enrollment NoticeThis notice is being provided to insure that employees understand their right to apply for group health insurance coverage. Employees should read this notice even if they plan to waive coverage at this time.Loss of Other CoverageIf an employee is declining coverage for himself/herself or his/her other dependents (including his/her spouse) because of other health insurance or group health plan coverage, the employee may be able to enroll himself/herself and his/her dependents in this plan if the employee or his/her dependents lose eligibility for that other coverage (or if the employer stops contributing toward the employee or his/her dependents’ other coverage). However, the employee must request enrollment within 31 days after his/her or his/her dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).Example: An employee waived coverage because he/she was covered under a plan offered by his/her spouse's employer. The spouse terminates his/her employment. If the employee notifies Employer within 31 days of the date coverage ends, the employee and his/her eligible dependents may apply for coverage under Employer’s health plan. Marriage, Birth, or AdoptionIf an employee has a new dependent as a result of a marriage, birth, adoption, or placement for adoption, the employee may be able to enroll himself/herself and his/her dependents. However, the employee must request enrollment within 31 days after the marriage, birth, or placement for adoption.Example: When an employee was hired by Employer, the employee was single and chose not to elect health insurance benefits. One year later, the employee marries. The employee and his/her eligible dependents are entitled to enroll in this group health plan. However, the employee must apply within 31 days from the date of his/her marriage. Medicaid or CHIPIf you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy. Example: When you were hired by us, your children received health coverage under CHIP and you did not enroll them in our health plan. Because of changes in your income, your children are no longer eligible for CHIP coverage. You may enroll them in this group health plan if you apply within 60 days of the date of their loss of CHIP coverage. HIPAA Privacy NoticeThis notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.Plan ResponsibilitiesThe Plan is required by law to maintain the privacy of your personal health information and to provide you with this notice of privacy practices and legal duties. The Plan reserves the right to change or amend the terms of this notice and to make any new provisions effective to all of the personal health information that the Plan maintains about you. If this notice is revised, you will be provided with a revised notice via U.S. mail. If this notice is being provided to you electronically, you may obtain a paper copy of this notice by contacting Human Resources.Your RightsYou have a right to know how the Plan may use or disclose your personal health information. There are certain uses and disclosures of your personal health information that the Plan is permitted or required to make by law without your permission. For all other uses and disclosures, the Plan must first obtain your permission. In addition, you have the following rights.• The right to request that additional restrictions be placed on the Plan’s disclosures of your personal health information. However, the Plan is not required to agree to any such restrictions that you may request.• The right to access, inspect and copy your personal health information the Plan maintains in its files about you. You also have the right to have the Plan correct or amend any information that contains an error. Requests to access or amend your personal health information should be provided to the contact person provided in this notice.• The right to receive an accounting of the disclosures of your personal health information that the Plan makes for purposes other than activities related to your treatment, or the Plan’s payment functions or other health care operations.• The right to request that you receive communications of personal health information in a confidential manner.Uses and Disclosures of Personal Health InformationThe Plan may use and disclose personal health information for the following purposes, without your permission.• Uses of Personal Health Information• To carry out treatment functions, such as to health care providers to provide you with treatment.• To carry out payment functions, such as those activities related to fulfilling the Plan’s responsibilities for coverage and providing you benefits under the Plan. Such activities may include, but are not limited to reviewing health care services with respect to medical necessity, coverage under the policy, appropriateness of care, or justification of charges.• To carry out health care operations, such as those activities related to carrying out the Plan’s business functions. These activities may include, but are not limited to, reviewing the competence of qualification of health care professionals, conducting quality assessment activities, amending, replacing or adding benefits, and placing contracts for stop –loss insurance or reinsurance.• To business associates, such as service providers that the Plan has contracted with to perform various functions, such as administrative functions to pay your medical claims. Such business associates are required by law to agree in writing to contract terms requiring the business associate to appropriately safeguard your information.• In situations permitted or required by law, including but not limited to the following:o As authorized by and to the extent necessary to comply with workers’ compensation or other no-fault laws.o To a health oversight agency for activities including audits or civil, criminal or administrative proceedings.o To a public health authority for purposes of public health activities (such as the Food and Drug Administration to report consumer product defects).o To a law enforcement official for law enforcement purposes or in response to a court order or in the course of any judicial or administrative proceeding.o To organ procurement organizations, or to other entities for approved research purposes.o To a government authority, including a social service or protective services agency, authorized to receive reports of abuse neglect or domestic violence.o To avert a serious threat to someone’s health or safety.REQUIRED NOTICES8
Women’s Health and Cancer Rights Act NoticeThis Notice generally explains the protections available to patients who choose to have breast reconstruction in connection with a mastectomy. If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, 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.These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the employer’s group health plan. If you would like more information on WHCRA benefits, contact the Plan Administrator.Newborns’ and Mothers’ Health Protection Act of 1996 The Newborns’ Act and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier.The Newborns’ Act, and its regulations, prohibits incentives (either positive or negative) that could encourage less than the minimum protections under the Act as described above.A mother cannot be encouraged to accept less than the minimum protections available to her under the Newborns’ Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery. In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing the length of stay not in excess of 48 hours or 96 hours, as the case may be. The Mental Health Parity and Addiction Equity Act of 2008The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans to apply the same treatment limits on mental health or substance-related disorder benefits as they do for medical and surgical benefits. The MHPAEA also extends this parity requirement to inpatient and outpatient services, whether in-network or out-of-network, and to emergency care services and prescription drugs.MHPAEA revised the definition of “mental health benefits” to include substance use disorder benefits. The MHPAEA also requires group health plans to apply the same beneficiary financial requirements to mental health or substance use disorder benefits as they apply for medical and surgical benefits, including limits on deductibles, co-payments and out-of-pocket expenses. Plan administrators are also required to make the criteria for “medical necessity” determinations with respect to mental health and substance use disorder benefits available to plan participants, beneficiaries or providers upon request.Patient Protections and Selections of Providers NoticeRadiant Senior Living’s health plan generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the insurance company.Genetic Information Non-Discrimination Act of 2008 The Genetic Information Non-Discrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, Radiant Senior Living will generally never require a benefits participant to provide any genetic information when responding to any request for medical information in connection with enrollment in any Radiant Senior Living benefits plan or accessing any of your Radiant Senior Living plan benefits. Genetic information as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic test, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.For more information about GINA, visit www.dol.gov/ebsa/faqs/faq-GINA.html.New Health Insurance Marketplace Coverage Options and Your Health CoverageGeneral InformationIn 2015, the Health Insurance Marketplace provides U.S. citizens the ability to purchase medical insurance through a controlled online environment.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 takes place each year between October 15th and December 7th for coverage beginning on January 1, of the following year.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 Box 1 W-2 earnings 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. Note: 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 or contact Human Resources. 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.1 An 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.REQUIRED NOTICES9
Medical4Premium 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, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid 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 dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay 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 your employer 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 for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.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 July 31, 2023. Contact your State for more information on eligibility –REQUIRED NOTICES10To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either:U.S. Department of Labor U.S. Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare & Medicaid Serviceswww.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 MONTANA – Medicaid NEVADA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084Email: HHSHIPPProgram@mt.govMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900OREGON – Medicaid WASHINGTON – MedicaidWebsite: http://healthcare.oregon.gov/Pages/index.aspxPhone: 1-800-699-9075Website: https://www.hca.wa.gov/Phone: 1-800-562-3022