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2015

Benefit Guide

This Plan Year


March 1, 2015 February 29, 2016

Plan Administrator
T & O Refrigeration
170 Walter Way
Fayetteville, Georgia 30214
770-461-5217

Our benefits are offered as a World of Thanks


and can keep whats most important
to you in good health.

Welcome This Years Benefit Highlights


We offer you a wide menu of ala carte choices. Plus, youve got access to the
tools, information and resources to help you decide whats right for you! The
perks of our company benefits are gifted to you in addition to your normal pay
and include:

Tax savings & other incentives


Group rates & guarantee issue
Convenience of payroll deduction
Up to $10,462 in company contributions each year
Employee & dependent coverage available
Free preventative care & access to big discounts

Our benefits are


designed to help keep you
and your bank account healthy.

Benefit Eligibility
All benefits are offered ala carte. I n order to be eligible to
participate in the benefits offered, you must maintain all of the
following:
Our benefits
give you
something to
smile about!

Plus, this enrollment guide contains most everything you need to know to get
you through the plan year. An electronic copy of it is also available with all
of the forms, benefit summaries and hotlinks to make accessing your important
benefit information easy!
You can also request (free) copies of important plan information, employee
notices, Plan Summary Documents (and much more) by making a written
request to the Plan Administrator (see Contacts).

Employees
W2 employees employed 90
days (eligible as of the first
day following the
probationary period)
A resident alien or citizen
Reside in the continental US,
and
Work 30 or more hours per
week,

Dependents
Legal spouse, or
Legal dependent
children up to age 19
for all benefits and to
age 26 for certain
health benefits. Some
children may qualify
for extended eligibility
due to disability or
impairment.

Some plans may impose additional eligibility requirements


see plan details, contact the plan or Plan Administrator to
confirm your eligibility.

When can you Enroll?


You or your dependents have up to 30 days to enroll or make
changes when you:
Become newly eligible;
Experience a Qualified Life Event (Status Change);
Participate in our Annual Open Enrollment (usually held in
February each year)

We help you know and enroll - easily 24/7


Log into: https://resourceseven.easyappsonline.com
2 |Printed 2/12/15

Make your decisions wisely they can affect you for the entire
plan year! Use our Counselors at the Resource Center for help .

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

T & O REFRIGERATION BENEFIT GUIDE

Benefit & Cost Info

Contact Info

Our plan year starts March 1 & ends February 29 .

Weve brought the best resources together for you -

Many plan benefits are based on a calendar year (not plan year) - check plan info carefully.

their knowledge and powerful tools are available to you!

Safeguard Your Finances

Plan Administrator

BCBS
Base Life & AD&D
We provide you with up to

170 Walter Way


Fayetteville, Georgia 30214
770-461-5217
www.torefrig.com

Guardian
Accident Benefit
$15,000

Cash benefit by reimbursement

Resource Center
Guardian
Supplemental Life
Employee up to
Spouse up to

$100,000
$50,000

Child/ren up to

$10,000

T & O Refrigeration

770-716-3200

Guardian

www.resourceseven.com

Critical Illness + Cancer Benefits

Use our Resource Center for your

Employee

$10,000

Spouse & Children up to

$2,500

technical benefit, insurance and


financial planning questions or to
get personal claims assistance.

Guardian
Employee Assistance Program (EAP)

T & O Refrigeration
Pre-Tax Plan

24/7 help to you & your family with lifes issues

Sponsored by the company to help you save taxes

Plan Contacts

Safeguard Your Health

Need an ID card, provider or plan


website assistance?

InfiniSource. 800-300-3838

Blue Cross Blue Shield of GA


Health Plan Options

My Ideal Doc
Telemedicine Benefits

Offers members

Access basic medical care 24/7/365 from the

free preventative & other member benefits

convenience of anywhere in the US

Blue Cross Blue Shield.

Guardian
Vision Benefits

Guardian
Dental Benefits

Guardian. 800-541-7846

Low copays for exams, lens & frames; discounts

Access to free preventative benefits, discounted

for upgrades, additional hardware & Lasik

services & benefits to cover your oral health needs

www.infinisource.com
800-441-2273
www.bcbsga.com

www.guardiananytime.com

My Ideal Doc. 855-879-4332


www.myidealdoctor.com
Medical
Surcharge

Rates shown

Dental*

Vison

TeleMed Accident

Child

$59.62

Are weekly

EE

$6.57

$3.28

$2.31

$5.30

Spouse

$34.52

Rate tables

EE+SP

$15.32

$12.03

$2.31

$8.96

provided for all

EE+CH

$15.11

$11.82

$2.31

$9.33

other benefits

Family

$23.85

$20.57

$2.31

$12.99

3 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Table of Contents
Find your topic and the corresponding page.
Viewing this electronically? Double click the page #.

Benefit Eligibility ............................................................ 2


Benefit & Cost Info ........................................................ 3
Contact Info .................................................................... 3
Decline, Enroll or Change ............................................. 5
Newly Eligible? ............................................................... 5
When You Can Enroll .................................................... 6
Be Savvy Know Your Freebies ................................... 7
Intro to Using our Company Portal ............................. 8
Pre-Tax Highlights .......................................................... 9
Know Your #s Our Wellness Plan ........................... 10
Health Plan Highlights ................................................. 11
Telemedicine Benefits................................................. 12
HRA Plan for Our Health Plan Members................... 13
Dental Plan Highlights ................................................. 14
Vision Plan Highlights .................................................. 15
Health Plan Basics ........................................................ 16
Important Information ................................................ 18
Life Benefits .................................................................. 19
Employee Assistance Plan .......................................... 20
Accident Benefits ......................................................... 21
Critical Illness & Cancer Benefits ............................... 22
We Need Your Help to Make it Work at Work! ....... 23
After Enrollment Whats Next? .............................. 23
Need Help with Claims Issues? .................................. 24
Continue, Convert or Port? ........................................ 25
Self-Care Tips Save You $ ............................................ 26
Preventative Benefits .................................................. 26
On Medicare & Working? ........................................... 28
Be a Savvy Healthcare Consumer .............................. 29
Notices .......................................................................... 33
Privacy Practices & Policies ........................................ 33
Common Insurance Terms ......................................... 35
Document Disclosure .................................................. 36

4 |Printed 2/12/15

Our people are our best


resources thank you for
the good things you do for
T & O Refrigeration.

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Decline, Enroll or Change


All benefit eligible employees will be required to elect or
decline all of the benefits available within 30 days of your
eligibility or qualifying event date.
If forms are required - double click on the thumbtack icon
below or refer to the hard copy provided.

Complete
What?
Login to our portal at
https://resourceseven.easyap
psonline.com

Premium Only (Pre-Tax)


Authorizes us to convert your deferrals
to a pre-tax status.

Life Beneficiary Form


.

Dependent
Eligibility Cert Form
Health Plan Eligibility
Health Reimbursement
Account Claim Form

Request Reimbursement for Covered


Expenses.

HIPAA Authorization Form

Authorizes assistance with medical


claims.

Newly Eligible?
To protect your rights, we are required to obtain your
acknowledgement to decline or enroll in any benefits
available to you within 30 days of your eligibility date.
A newly benefit eligible employee or dependent may
also be given special guarantee issue privileges for
benefits that would otherwise require approval based
on health status. In these instances, often, electing the
lowest level of coverage may secure your ability to
increase coverage in the future, should the need arise.

New Hire Event,


Change Request,
Address or Dependent
Update or Open
Enrollment

If you attempt to elect coverage that you previously


declined, you may:

This form.

Review the terms of the benefits offered before


declining coverage.

Use to update a
beneficiary(s) any
time.
Employees electing
health plan coverage
for a dependent
spouse and/or child.
Yes.
Complete (timely) to
request
reimbursement for a
covered health claim.
Yes.
To authorize anyone
to help you or another
family member with
claims issues.

When you complete your enrollment, you may also need


to provide additional information in order for your request
to be considered. You will be notified, in writing, if any
documentation is required from you.

Be turned down,
Have to wait until open enrollment,
Have a delay or reduction in benefits for a time.

Questions?
For more details about eligibility, look to the plans
Insurance Certificates, Summary Plan Descriptions,
benefit summaries or visit www.irs.gov for Publication
969.

We Take Our Role Seriously


We offer free tools and lots of resources to keep you
informed. This Benefit Guide is intended as a summary
only and does not replace or supplement any
Certificate of Insurance, Summary Plan Description,
Summary of Benefits & Coverage, law or regulation. In
addition, each of our benefit plans produce Certificates
of Insurance and/or Summary Plan Descriptions (also
known as SPDs).
These documents outline, in detail, plan provisions
benefit eligibility, limitations and exclusions. It also
informs participants of their rights and responsibilities.
These documents are provided &/or made available
within 60 days of the effective date. Copies are
provided at no charge, by requesting a copy, in writing,
from your Plan Administrator.
Its T & O Refrigerations intent to act in the best interest
of our employees and plan participants. And, its our
intent to comply with federal and state requirements
and ensure the welfare of plan participants is protected.
We take care to protect personal information. Copies
of privacy policies are included in the appropriate plan
information.

Resource Center 770.716.3200


5 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

When You Can Enroll

Qualifying Life
Event(s)

Benefit eligible employees have multiple opportunities


(listed below) to enroll or make changes to your elections.
As a condition of employment, your Plan Administrator
requires that you formally acknowledge your decision to
enroll or decline in the benefits available when initially
eligible and during our annual Open Enrollment.

Birth, adoption or
gain of legal
guardianship

Newly Eligible Employee

Dependent Death

When newly benefit eligible, your request to enroll or


participate must be made on or prior to your benefit
eligibility date. If you choose to decline any of the benefits
when first eligible to enroll, you will be required to wait until
Open Enrollment to make any election changes, unless
you experience a Qualifying Life Event (see below).

(Annual) Open Enrollment


Re-enrollment or Open Enrollment is held once each year,
prior to your plans anniversary (start) date. Educational
opportunities and individual benefits counseling are
available during our annual Open Enrollment. Spouse
and adult children (over age 18) inquiries are also
welcome.

Qualifying Life (Mid-Year) Events


Qualifying Life Events, are also called Lifestyle or Status
changes, allow you to make changes to your elections
outside of open enrollment.
If you experience a qualifying life event, you have 30 days
from the date of the event to make the written request (or
electronic, whichever method is made available to you)
to your Plan Administrator indicating your intent to
change your elections. The change in coverage request
must be consistent with the qualifying event. Information
(proof of the change) may be required for the plan to
consider and approve a request.
The effective date of any change will be: the date of the
event retroactively or the date the change request is
made depending on the benefit and the reason for the
change (check each plan!). If you fail to notify your Plan
Administrator accordingly, youll have to wait until the
next Open Enrollment.

HSA or Retirement Plan Deferrals


Participants are allowed to stop deferrals (deductions) at
any time. However, re-entering the plan or making
changes may be limited by the plans rules. Ask your Plan
Administrator for more details.
A Summary Plan
Description outlining the benefits, rights and restrictions of
the plan is provided and/or made available within 60 days
of the effective date of coverage to all participants.
Copies are available, at no charge, by requesting a copy,
in writing, from the Plan Administrator.
6 |Printed 2/12/15

Documentation
Example(s)
Birth Certificate, the
Hospital Certificate may
be used or Adoption or
Legal Guardianship
Papers.
Death Certificate.

Dependent
Loss of Eligibility

Proof of Full-Time Student


Status or physical
impairment may be
required. Check with your
Plan Administrator.

Dependent
Qualified Minor
Support Order
(QMSO)

We will comply
appropriately with any
court order received.

Divorce or
Annulment

Finalized Divorce Decree


or Certificate of
Annulment.

Employee change
in employment
status that affects
eligibility

N/A. Your Plan


Administrator will help you
facilitate the changes.

Judgment or Court
Order

A copy of the judgment,


decree or court order.

Loss or Gain of
eligibility for medical
programs funded by
state or federal
assistance
Marriage
Spouse change in
employment and
loses coverage
Spouse change in
employment and
gains coverage

Check with your Plan


Administrator.

Marriage Certificate or
Affidavit of Marriage.
HIPAA Certificate of
Credible Coverage from
your Spouses (Qualified)
Group Health Plan.
Proof of Enrollment under
your Spouses (Qualified)
Group Health Plan.

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Be Savvy Know Your Freebies


As with all insurance benefits, there are always some perks and
ways to save money for your wellbeing that people dont
typically think or know about. Below are some freebies (or really
low cost benefits) that can help you take advantage of the perks
offered to plan members throughout the year.
Questions? Contact the Plan Administrator
or our Resource Center
Description

of Membership Benefits
Dental

Vision

Min Value
of Benefits

One (1) free cleaning each 6 months


Dental rewards
Discounts for using network providers
Additional cleanings for members
with certain health conditions

$360

Low cost comprehensive eye exam


Free contact lens
Discounts for using network providers
Hardware upgrade discounts
Lasik surgery discounts

$210

Per person

Per person

Generous employer reimbursements


for in network hospital or outpatient
facility services

EAP

24/7 counseling
Concierge services for personal needs
Free face to face counseling services
Travel assistance
Will preparation

$114-1500
Per Visit

Per person

Free wellness benefits


Easy to make claim no keeping
track of expenses

Save 15-25% by pre-taxing premiums


Save by contributing to your account

Our
Resource
Center

1 Stop Shop
Private Exchange (24/7/365)
Professional benefits guidance
Open enrollment decision support
Claims assistance
Benefits & financial education

$500 ++
Per Year

Per Person/
Incident

Per Year

Priceless

Resource Center 770.716.3200


7 |Printed 2/12/15

Diabetes, high blood pressure, high cholesterol, breast, cervical


and colon cancer screenings are all important to good health.
These are examples of some of the preventative benefits that
are covered at no cost to you.
Knowledge is power. Your health plan provides you with tools
and resources to become more informed about your good
health. Want to quit smoking but don't know how? Concerned
about bone loss or obesity? Health counseling can help you
learn how to improve your health and treat depression. Talk to
your physician and check with your insurance plan to see what
is covered.

You don't have to pay anything out of pocket to get your kids
immunized, except perhaps a copay for an office visit if the
immunizations are billed separately. Routine vaccines for adults
are also covered. As well as, the CDC recommends
vaccination for everyone 6 months and older during the flu
season.

Pregnancy, Well-Baby & Well-Child Visits


Making sure your baby arrives safely and remains well gives your
child a great start to a good healthy life.

Take a Health Assessment (HA), a brief online questionnaire


about your medical history and current lifestyle.

15-45%
Pre-Tax

Network providers offer substantial discounts for covered


services. Discounts can range from 10-80% and help make out
of pocket expenses more affordable.

Health Assessment Tools

$75-5,000

Critical
Illness
Benefits

Network Providers Discounts

Routine Vaccines & Flu Shots

Up to $2500
HRA

Below are some common freebies. Check your


plan for details.

Health Screenings & Educational Counseling

No or low cost primary care needs


Save time and hassle associated with
traveling
Health records portal

TeleMed

Health Plan Membership Freebies

With the HA, you'll get a report with steps you can take to
improve your health. Your personal health information won't
have an impact on your benefits coverage. But, with some
plans you can earn points for taking a health assessment. These
points can be redeemed for cash prizes! And, with a few plans,
you can actually pay a lower rate for taking an HA.

Membership Discounts
With your health plan membership, you may have free access
to discounted services and programs typically not covered
under your benefit plan. You are also able to nominate service
providers in your area that you would like to see included in the
discount program.
The following is a list of discounts, services, and programs
commonly available:

Acupuncture, Chiropractic Services & Massage Therapists


Audiology & Vision Care Services
Day Spas, Health Clubs & Wellness Centers

Minimum Value Per Person: $350-Millions

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Before Logging In
You need basic information about
yourself and your dependents:
Social Security Number
Date of Birth
Address Info

User Tips
Refresh your screen often or keep
moving. The system times-out to
protect your privacy after 14 minutes
of inactivity.
Any enrollment, declination or
change
requires
an
acknowledgement and e-signature.
Please note, the portal is unable to
manage all of the rules associated
with eligibility.
To prevent payroll deduction issues
or the need for corrections, please
ensure you request only those
benefits that you or your dependents
are eligible for when navigating
through the enrollment pages in the
portal.

Forget Your Password?


1.Login to our portal:
resourceseven.easyapps.com
2.Click 'Forgot Login Info'

Intro to Using our Company Portal


In an effort to streamline our processes and provide you with easy access to
important benefit and Human Resources related information, our advocate,
Resource Seven, has provided us with a portal known as
https://resourceseven.easyappsonline.com.
All employees will access the portal to complete a pre-screen exercise (for
underwriting purposes when prompted) or to complete an enrollment event
or to decline benefits.

1st Time Users

Returning Users

Go to

Go to

https://resourceseven.easyappsonline.com

https://resourceseven.easyappsonline.com

Click 'First Time User'

Select 'I Agree - Let's Get Started'

Enter your last name, birth


month (MM) & year (YYYY)

Complete the enrollment pages &


Elect employer paid (free to you) benefits

Click 'Find Me'

You will elect or waive - decline all of the


benefits available

Enter your SSN# to create a username &


password then click Save'

Follow the instructions on each screen

Review & Agree to the


Security & Online Agreement

Provide health history information when


requested

You will be prompted to create a new


password

Using your mouse (hold the left click) sign in


the signature box

Then follow the Steps for 'All Users'

Once you click 'I Agree' - congrats - you've


completed the event
Log off & close the browser to protect your
personal data

3.Enter your last name, birth month


(MM) & year (YYYY)
4.Click 'Find Me'
5.Enter your SSN to receive (2) emails
that contain your login instructions

Need Help?
Please visit our help desk at:
www.easyappsonline.com/employe
ehelp.asp

Resource Center 770.716.3200

8 |Printed 2/12/15

We keep you plugged in


to the information you need 24/7.
The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Pre-Tax Highlights
Pre-tax plans convert taxable dollars into tax free dollars.
Taxes and healthcare are a huge cost to you.
Saving money is good. Saving tax money is even better.
Pre-tax plans save you money.
The IRS Section 125 refers to these plans as Premium Only
Plans, Cafeteria Plans or as Flexible Spending
Accounts (FSA).
Any of these pre-tax plans allow premiums to be pretaxed for health, dental, vision and most accident
benefits.
Savings account pre-tax plans, if available, allow you to
contribute to them to pay for certain out of pocket
eligible expenses with the tax free dollars available in your
account.

Pre-Tax Plan Rules & Info


In order to offer and maintain a favorable tax status, an
employer is required to follow IRS Code consistently and
to impose these rules upon you. For information, you can
also visit www.irs.gov/publications/p15b/ar02.html.
You are not obligated to pre-tax contributions or
premiums or participate in a pre-tax benefit.
However, if you want to pre-tax any benefits, the IRS
requires that you make the election within 30 days of your
eligibility date. You are eligible to pre-tax elections the
pay period after you make your pre-tax elections.
If you miss your eligibility window, youll have to wait until
the companys next open enrollment period.

Plus, you cannot pre-tax outside of work!

Once made, you cannot change or cancel pre-tax


elections (or declinations) during the plan year unless you
experience a qualifying life event.

Pre-Tax Works but


Pre-Tax Works Only at Your Work!
No
Pre-Tax
Pre-Tax

A Summary Plan Description outlining the benefits, rights


and restrictions of the plan is provided and/or made
available within 60 days of the effective date of coverage
to all participants. Copies are available, at no charge,
by requesting a copy, in writing, from the Plan
Administrator.

W2 Pay (Income)

$31,000

$31,000

Pre-Tax Elections

N/A

($ 2,400)

Taxable Income

$31,000

$27,600

Est. Taxes (20%)*

($ 6,000)

($ 5,520)

Elections Not PreTaxed

($ 2,400)

--

Take-Home Pay

$21,600

$22,080

Pre-Tax Savings
(Results)

N/A
(Bad)

$480*
(Good)

*Actual tax savings vary by individuals tax rate.

Use your benefits wisely to

9 |Printed 2/12/15

stay healthy,
be happy,
live long and be wise.

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Know Your #s Our Wellness Plan

Health Assessment Tips

T & O Refrigeration is implementing a Wellness Initiative known as Know Your


Numbers in order to promote a corporate culture of health. Good health is
about a journey of a lifetime!

Results are confidential.


Results dont affect your premiums.

Healthy people are happier, live longer, are more confident and productive.
As an added benefit, healthy people spend less on health plan insurance
premiums, out of pocket (health related) expenses and are less likely to
become disabled.

To participate in our
health plan this year:

Complete the
Health Assessment:

Complete our normal health


benefits eligibility requirements.

Within 30 days of your health plan


effective date, log in and take the
health assessment.

Employees are also required to


complete an on-line health
assessment.

1.
2.
3.
4.
5.
6.
7.

Body Mass Index (BMI)


Blood Pressure Reading
Cholesterol (Total & HDL)
Glucose Level
Height
Waist Circumference
Weight

Get Your 7 Numbers


If you've had a wellness exam (within
the last 90 days) get your numbers
from your physician!
Schedule a wellness visit with your
health plan network primary care
physician.

Have your 7 Numbers before you


begin taking the free (on-line)
health assessment.

Contact the health plan to obtain a


voucher for biometric screening
only lab work at a contracted lab.

It usually takes less than 30 minutes


to learn how you can improve
your health!
A completion confirmation will
appear at the end of the
assessment.

Your screening requires you to fast,


schedule it early in the day!
Follow these tips when getting a
preventative exam:

Print the confirmation page at the


end of your health assessment.
Provide a copy (not the results) of
the confirmation to the
Administrator.

Key Health Indicators

To learn more,
please visit -https://www.bcbsga.healthand-wellness.

No eating 12 hours prior.


Only drink black coffee or water 12
hours prior.
Avoid alcohol and strenuous activity
or exercise 12-24 hours prior.
Rememberpreventative benefits are
covered at no cost to you.
When you receive the results of your
biometric or wellness exam youll
have your numbers handy to take your
Health Assessment!

10 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Health Plan Highlights


In Network
Plan Highlights

Option 1
BCBSGA OAP5 3.5K/0 6.6K B

Health Plan
Summary of Benefits & Coverage

Double Click to Open Here

Not viewing the doc electronically?


Refer to printed materials

Additional
Health Plan Eligibility
Requirements

EMPLOYEES MAY BE REQUIRED TO PAY FOR A SPOUSE OR CHILD/REN


THAT DO NOT QUAILFY FOR FREE DEPENDENT COVERAGE. REFER TO
OUR DEPENDENT ELIGIBILITY (SEE FORMS SECTION) FOR MORE DETAILS.

Network Name (& Link)


Type of Health Plan

Blue Open Access POS


POS
Plan Year
Embedded
$3,500
$10,500

Medical Deductible
Individual
Family
After the Deductible,
The Plan Pays (Co-Insurance %)

Out of
Pocket Max

100%

Individual
Family

$6,600
$13,200

Misc Info
Primary Care Office Visit
Specialist Office Visit
RX Deductible Per Person
Prescriptions by Tier
Urgent Care
Emergency Room

All Co-Pays Do Apply


$25
$50
$200 (Non Tier 1 Rx)
$15/40/75/20% to $300
$60
$150

Health Plan Extras


24 Hour nurse line

Be Well With Our Health Plan Tips

Health coaching

Your health plan has free preventative benefits.

Member discounts

Emergency room coverage is available for a life or


limb threatening injury or illness at any ER in the US.

Free quit smoking resources

4th quarter carryover is included (Non-QHDHPs).


Mail order RX can save money on maintenance
meds.
If you get a brand name RX when a generic is
available, youll pay the difference between the two.

Health & wellness resources


Mail order Rx savings
Special care for pregnant members
Special care for chronic medical conditions

Tips to Lower Healthcare Expenses


Be proactive
Make healthy choices
Get preventative exams
Be informed about your health
11 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Telemedicine Benefits

Telemed is Smart Care

Our Telemedicine benefit compliments any health plan. Its a physician


owned company that offers members with 24/7-365 on demand access to
board certified physicians for diagnosis and prescriptions. Whats even better
is the visit is free!
Telemedicine is provided via telephone, video, text or secure email, for
common and acute illnesses, offering members and their families with
unlimited access to basic healthcare without the typical hassle or expense of
traditional medicine.

The AMA (American Medical Assoc.)


recently stated that 70% of doctor visits
and 40% of emergency room visits can
be avoided with the use of
telemedicine?
Many simple short-term and long-term
illnesses can be treated effectively
with telemedicine.

Easy, Effective & Fast


Common ailments can be treated by TeleMed physicians such as:
Acid Reflux
Acne
Allergies
Asthma
Bacterial Infections
Bronchitis
Burns
Cellulitis
Cold & Flu
Cold Sores
Cough & Congestion
Constipation
Diabetes
Diarrhea
Ear Pain & Infection
Fever
Flu

Fungal Infection
Gout
Headache
Heartburn
High Blood Pressure
Infections
Insect Bites
Joint Aches
Migraines
Nausea
Pink Eye
Rashes & Hives
Runny Nose
Sinus Conditions
Sore Throat
Stomach Virus
Urinary Tract Infections
Vomiting

Meds that can be


Prescribed
The list includes:
(Antibiotics & Antihistamines)
Augmentin
Amoxicillin
Bactrium
Cephalexin
Cipro
Guaifenesin
Indomethacin

12 |Printed 2/12/15

Levaquin
Lisinopril
Macrobid
Prednisone
Z-Pak

Benefits of TeleMed

Avoid costly ER or urgent care visits


for non-emergency medical issues.

Access care at a moments notice or


when traveling easily.

Get care when your primary care


doctor isnt available.

Obtain care when you simply feel


too bad to get out of bed.

Request prescriptions or get refills.

Escape long wait times at a doctors


office.

Avoid travel time for simple issues.

Maintain personal health records for


the whole family in a secure on-line
portal.

Find easy to use health tools on-line.

Using Telemed can lower health plan


claims, which means lower health plan
increases!

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

HRA Plan for Our Health Plan Members


If you elect one of our
health plans
These expenses may
be eligible for
reimbursement

Option 1
BCBS OAP5 3.5K/0 6.6KB
In Network hospital or facility claims applied to the deductible and
co-insurance only. Does NOT include copays.
First $1000 of the calendar year deductible per member
(to a max of 3 per family).

After you spend


Then, you may
be reimbursed for
Max calendar year
reimbursement per
Employee/Family

Last $2500 of deductible per member (to a max of 3 per family).

$2500 per insured person to a max of $7500 each calendar year.

Our HRA is a Generous Benefit!


A Health Reimbursement Account (HRA) compliments our
health plans and makes our health benefits more
affordable when you use them.
T & O Refrigeration sets aside company funds to reimburse
you for certain healthcare expenses.
The plan is designed to reimburse eligible individuals who
incur qualified expenses identified for reimbursement
during the HRA plan year.
There is no cost for your HRA benefits.
Any benefits received are tax free reimbursements.

Tips to Using Your HRA Benefit


You must submit a claim to be reimbursed for
eligible expenses.
To get your claim processed quickly, submit:
A completed, signed, paper claim form timely
Backup documentation with the claim
Back up documents verify an eligible member has
incurred qualified reimbursable expenses during the
year.
The Summary Plan Description (SPD) and claim form
outlining the benefits, rights and restrictions of the
plan is provided and/or made available within 60
days of the effective date of coverage to all
participants. Copies of plan documents and claim
forms are available, at no charge, by requesting a
copy, in writing, from the Plan Administrator.
Review your SPD and/or HRA claim form for more
details.

Our HRA makes using our health plan for big stuff more affordable.
13 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Frequency Limitations
Be familiar with frequency limitations
most commonly found in dental, vision
and/or prescription plans.
Common
examples
of
benefit
provisions that have frequency
limitations include:

Dental
Cleanings
X-Rays
Materials

Vision
Exams
Lenses
Frames

Rx
Dosage
Pills

Dental Plan Highlights


In Network Plan
Highlights

Guardian
Value Plan

Guardian
NAP Plan

Dental Plan Benefits

Double Click to
Open Here

Double Click to
Open Here

Type of Dental Plan


Network Name & Link

OPEN ACCCESS
POS
DentalGuard
Preferred (PPO)

Primary Dentist
Referral Required
DentalGuard
Preferred (PPO)

Deductible

CALENDAR YEAR

CALENDAR YEAR

$50

$50

$150

$150

NONPREVENTATIVE
ONLY

NONPREVENTATIVE
ONLY

$1,500++

$1,500++

100%

100%

100%

80%

60%

50%

50% to
$1500 Lifetime Max

50% to
$1500 Lifetime Max

Not viewing the doc electronically?


Refer to printed materials

Individual
Family

Pre-Treatment Estimate
A pre-treatment estimate is a written
estimate of your share of the cost and
how much the plan will pay for a
dental treatment plan.
Request your dental provider to submit
(on your behalf) a pre-treatment
estimate to the dental plan for any
dental services that are likely to
exceed $250.
Getting a pre-treatment estimate
allows you to budget for out of pocket
dental expenses in advance.
Your dentist may also be able to
present alternative treatment options
that will lower your share of the bill,
while still meeting your basic dental
care needs.

Got a DHMO?
A DHMO (dental health maintenance
organization) is a discount plan that
offers unlimited dental benefits.
However, theres a tradeoff a fairly
restrictive provider network.
A DHMO also requires you to elect a
Primary Care Dentist.
A DHMO plans only cover services
performed by your Primary Care
Dentist or by a referred network
specialist.
You can change your primary care
dentist by calling the dental plan.

Deductible Applies to
Max Annual
Benefit/Member
Type I
Preventative
Type II Basic
Type III Major
Type IV Child Only
Ortho

The mouth is the gateway to the body keep it healthy! Remember, good
oral health is critical for good overall health.
People who access affordable preventative dental benefits regularly are less
likely to need expensive, invasive procedures in the future.

Keep Smiling
with Our Dental Plan Tips
Rollover benefits are included!
Your plan includes no cost preventative benefits.
Certain health conditions may qualify for more preventative
benefits.
Network providers make your dental benefit dollars go farther.
Preventative benefits dont count towards the annual max
benefit.
Your dental plan has a missing tooth exclusion limitation.
Cleanings are covered once each 6 months. (Not any sooner!)
A late entrant penalty applies if you decline the coverage
initially.

Resource Center 770.716.3200


14 |Printed 2/12/15

Your dental plan has waiting periods for certain services.


IfThe
youBenefit
do notGuide
elect T Copyright
& O Refrigerations
medical plan,
are
2013-15. Benevestco.
Allyou
rights
reserved.
eligible for an employer contribution towards dental.

Vision Plan Highlights

Healthy Body Healthy Mind

In Network
Guardian Vision
Plan Highlights
Vision Plan Benefits
Not viewing the doc electronically?
Refer to printed materials

Provider Network
Plan Name & Link
Preventative
Exam Co-Pay
Material Co-Pay
(Lens or Frames)
Elective Contact Lens
Allowance Per Year
Benefit Frequency
Exam
Lens
Frames

Double Click to Open


Here
Davis Network

Mental health disorders are the leading cause of


disability in the United States. The resulting disease
burden of mental illness is among the highest of all
diseases.
Mental health disorders account for 25% of all years of
life lost to disability and premature mortality. Mental
health plays a major role in peoples ability to maintain
good physical health.
Mental illnesses, such as depression and anxiety, affect
peoples ability to participate in health-promoting
behaviors. In turn, problems with physical health, such
as chronic diseases, can have a serious impact on
mental health and decrease a persons ability to
participate in treatment and recovery.

$10
$20
$120

12 MONTHS

The tools and resources are virtually unlimited. Use your


plan resources and whats provided by public health
and non-profit organizations to stay on top your health.

12 MONTHS
24 MONTHS

Getting a routine eye exam at least once a year ensures


your vision is maintained and it helps maintain good
overall health.

Feed your mind & soul with good things


your health shows it.

Healthy $ Habits Be Wise & Beware!

Some of the benefits of getting preventative eye exams:


Maintain good eyesight and health.
Catch illnesses early.
Identify early learning or developmental issues.

Our Tips Make It Clear


Purchase contact lenses from any provider.
Lens benefits are either for your eyes or frames.
Contact lens fitting fees may not be covered ask!
Spend 100% of your contact lens benefit at once.
Your plan offers access to discounts, such as Lasik.
Network providers make benefit dollars go further.

Food & Housing:


36.34%
Transportation
12.29%
Healthcare
5.05%
Personal Insurance & Retirement
8.6%
Income Taxes
15.02%

This table shows how


the average
American spends
more than $0.75 of
every $1.00 he or she
makes!

Taxes are a large part of your expenses. Our pre-tax


plans help you pay less taxes.
Insurance is a necessity and essential to a sound
financial plan. However, when you can buy as little as
possible but always as much as necessary.

Finally, the best way to spend less on healthcare is to


need it less being heathy is the best way to save
yourself some money and heartache.

Little improvements = big impacts!


15 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Health Plan Basics


With the cost of delivering high tech medical and pharmacy care and an
aging population, health plans continue to increase in cost. It pays to pick
the right plan for you! We can help!

The Life Cycle of a Member

Start by SHOPPING!!!
Our dedicated team is here to assist
you with finding the best plan for you,
your family and your company!

Review Your Plan


Periodically!

Let us help you review your


plan every year or if you
have a life change to make
sure youve got the right
plan for your situation.

The Building Blocks of Health Plans


Deductibles, co-insurance and co-pays are ways members cost share with
the insurance company for the high cost of medical care.
In most instances, all three apply to the annual out of pocket maximum.
The out of pocket maximum limits what the member pays in a (calendar or
plan) year.
Youve got coverage during the time you are meeting the annual deductible
and you still receive the value of significant negotiated (discounted) rates
when using network providers. Network discounts can range from 10-70%!
The cost of your plan (monthly premium) is based on the benefits you
purchase. The richer the plan the more expensive the premium as shown
below.

You pay each month


to belong!

By paying your monthly


premium, you have many
benefits of membership!

Annual Deductible
Calendar or plan year

Traditional
Health Plans

HDHPs
(H.S.A. Eligible)

Usually applies to services


other than doctors visits
or prescriptions.

Applies to all covered


expenses.

You may have a small


separate Rx deductible
for expensive meds.

When you use it, you


cost share to a cap!

The cap is called the out of


pocket maximum. It starts
over when your plans
renews or Jan 1. Even when
youre meeting your
deductible youve got
coverage!

Use your benefits!

Preventative care is
covered at 100%. Plus, you
can receive medical care
from in-network doctors and
hospitals and get
prescription coverage using
significant member
discounts!

Co-Insurance %

Co-Pays

Fixed or flat dollar expenses

The family deductible is:


embedded (per person)
or
unembedded (shared).

After you have met your plans deductible, the plan


begins to cost share with you in the form of coinsurance.

Usually, you will have copays for things like doc


visits and prescriptions.

You may have co-pays


as a form of cost share
after you have met the
deductible.

Free Preventative
Covered at 100% - Waive Deductible

16 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Sizing it Up & Adding It Up

Comparing Different Health Plans What it Means


Benefits are paid on
your behalf if you use the
plan.
The lower the price, the
more you pay if you use
the plan.

Traditional
Co-Pay Plans

QHDHPs
(HSA Eligible)

Remember all plans


have an annual cap
(called an out of
pocket maximum)

The plan cost shares with


you for day to day
expenses for things like
doc visits and meds. In
return, you pay a higher
premium or have a
higher out of pocket limit.
The plan applies the
deductible to most all
other covered benefits
aside from doc visits and
medications. Some plans
do have prescription
deductibles for
expensive meds.

For a lower premium or


out of pocket limit, you
pay for day to day
expenses for things like
doc visits and
prescriptions up to the
plans deductible.

of what you may pay to


use the plan.

Price (Premium)

Theres pros and cons to every plan. Its important to pick the right plan for
you. When it makes sense, keep as much $ in your pocket as possible try to
buy the right amount of insurance not too little and not too much.

Doc Visits &


Prescriptions

Is a promise to pay
whether you use it or not.

Annual Deductible
(Can be calendar
or plan year)
In the end, you add the premium to the total you spend (or could
spend) to determine your true cost for the plan.
Opt 1

Opt 2

Opt 3

Total Premium for the year

_______

_______

_______

+ (add) Out of Pocket

_______

_______

_______

- (less) Tax benefits, If any

_______

_______

_______

= Real cost for the year

_______

_______

_______

17 |Printed 2/12/15

Preventative
Benefits

The plan applies the


deductible to all
covered benefits.

Covered at 100% - waive deductible.


Traditionally lower
increases and lower
renewal increases.

Premiums &
Renewal Increases

Traditionally higher
premiums and renewal
increases.

Typically, this plan


is ideal for

Those with moderate


health or who need help
with the cost of everyday
care (doc & Rx) or who
are over age 65.

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

The idea is to fund a


pre-tax Health Savings
Account to pay for out
of pocket expenses on
a tax free basis from
the premium savings.
Those who are really
sick or really healthy.

Important Information
The plans provide documents including Summaries of Benefits &
Coverage, Insurance Certificates.
As well as, Summary Plan
Descriptions (also known as SPDs) outline, in detail, plan provisions
such as benefit eligibility, limitations and exclusions and your rights and
responsibilities as a plan participant.
These documents are provided &/or made available within 60 days of
the effective date of coverage to participants. Copies are available,
at no charge, by requesting a copy, in writing, from your Plan
Administrator.

Get Your SBCs


In an effort to comply with Affordable Care Act (Healthcare Reform),
a copy of the Summary of Benefits & Coverage (SBC) for our health
plan(s) is provided and available to you.

Deductibles are based on a calendar or plan year. Know which applies


to your plan! A health plan deductible is also described as:
Un-Embedded Deductible:
A combined deductible shared by the employee & dependents. IE. all
family members' deductible expenses apply to the shared family
deductible. This deductible is always associated with a H.S.A. eligible
health plan.

Embedded:
A per person deductible applies. Any per person deductible incurred
applies to the maximum family deductible.

The SBC is designed to help you better understand and evaluate your
health insurance choices and includes:

Short, plain language explaining benefits & coverage


A uniform glossary of health insurance terms
Coverage details which are comparison tools
You may also request a copy of the glossary of terms from your health
insurance company or group health plan. To learn more, contact the
health plan, the Plan Administrator or our Resource Center.
Finally, if you dont speak English, you may be entitled to receive the
SBC and uniform glossary in your native language upon request to your
health insurance company or group health plan.

The Plan Administrator

Health Plan Tips


Always present your insurance ID card.
Your health plan negotiates discounts with network providers (physicians,
clinics and pharmacies, etc). Use network providers - network discounts can
be substantial!
Only pay what the insurance company tells you to pay. You can get this
information from an Explanation of benefits (EOB). The EOB shows you what
you owe for each covered claim.

T & O Refrigeration
170 Walter Way
Fayetteville, Georgia 30214
770-461-5217

Resource Center 770.716.3200


18 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Life Benefits

Money Matters & Life Tips

Life insurance is an important and basic tool in any


financial plan. Chances are, if someone will suffer
financially when you die, chances areyou need or dont
have enough life insurance!
T & O Refrigeration helps you by providing (at no cost to
you) base life benefits and offering supplemental life
benefits that are easy to get. And, the amount of base
life provided, has no impact on the amount of
supplemental life benefits you can elect.

Other Life Plan Highlights

Life Benefit Info

Click on the icon to


view more plan info

BASE
LIFE

SUPPLEMENTAL
LIFE

Double Click to
Open Plan Info

Double Click to
Open Plan/Rate
Info

Max Amt of Benefit


employee Up to $15K
Spouse

N/A

Children

N/A

Up to $100K
100% of EE to
$50k
50% of EE to
$10k

Accidental Death
&
Dismemberment
Benefits

Included

Included

Living Benefits

Included

Included

Yes

Yes

Included

Included

Benefits may be
continued if you
leave the Co?
Waiver
of Premium

You:
Your age
Rates are
determined by
amount of
coverage plus:

N/A- Your
Employer Pays
for this
Coverage

Your Spouse:
Your age
Your Children:
One rate covers
all children!

Please note, in subsequent years, the rate is based on your


age as of the plan year anniversary (beginning) date. Use
the rate table to calculate the rates or our portal will do it
for you. Age reductions and/or limitations apply to our life
benefits.
And, remember, life insurance at work should supplement
your personal life insurance.

19 |Printed 2/12/15

Your benefits at work can help you bridge gaps in your


personal financial plan! A sound financial plan no
matter your financial status includes every aspect of
your finances.
Be determined to make healthy
progress mind, body & bank account! Youre more
likely to succeed if you commit to your plan in writing!
Make sure you are properly insured (not too much &
not too little!).
Pay debt down (& keep it down!).
Plan for the future - save and invest!
Take advantage of freebies & tax savings strategies
offered.
Ensure you have adequate insurance & emergency
savings that provide a safety net for you and your
family.
Keep a valid will, living will and estate plan in place
and review them periodically to ensure they continue
to meet your needs.
Use advice from experts who have your best interest in
mind.

7 Life Insurance Beneficiary Tips


1. Naming a minor child or forgetting a spouse
If you haven't created a trust or made any legal
arrangements for someone to manage the money,
the court will appoint a guardian, a costly process,
to handle the proceeds until a minor child reaches
18 or 21, depending on the state. And, if you live in
a community property state, your spouse must sign
a waiver to relinquish rights to your life insurance
proceeds.
2. Failing to keep it up to date
Review your policy every few years and after major
life events to ensure coverage and beneficiaries are
up to date.
3. Only naming a primary beneficiary
Always name a contingent or secondary
beneficiary.
4. Making a dependent ineligible for govt benefits
Naming a lifelong dependent, such as a child with
special needs, as beneficiary can put him/her at risk
for losing eligibility for government assistance.
5. Falling into a tax trap
Most often, life insurance proceeds are tax free
but, naming the wrong beneficiary can create a
taxable event.
6. Assuming your will trumps the policy
A life insurance policy is a contract. Regardless of
what your will says, the life insurance money will be
paid to the beneficiary listed on the policy.
7. Not telling someone whos in charge
Tell someone so they know you have a life insurance
policy, where it is and how to (easily) find it.

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Employee Assistance Plan


Everyone needs a little help in dealing with lifes
challenges from time to time. Our Employee Assistance
Plan (EAP) can help with many important real life issues!
Using an EAP can save time and money and gives access
to free benefits regardless of health plan coverage. Use
our EAP for help with:

EAP
Benefit
Highlights

7 Facts You Should Know


about Buying Health Insurance Today
1. You can only buy it during certain times of the year:
a. Annual Open Enrollment, or
b. If you become newly eligible to a plan, or
c. If you experience a Qualifying Life Event
2. You can buy it from 3 sources:
a. At work (if offered)
b. Individual/Medicare Market**
c. Healthcare.gov**

Substance abuse

Emotional distress

Financial needs

Major life events & health care


concerns

Personal or work relationship issues

Double click to open plan info


Not viewing the doc electronically?
Refer to the printed materials provided

Benefits are extended to all family


members.

Unlimited 24/7 telephonic & on-line


services.

Theres no cost to use the benefit.

3 free face to face counseling


sessions per year. All other benefits
are unlimited.

Identity Theft benefits are included.

Will preparation services are


included.

3. Most must have coverage or pay a penalty. (Some


people qualify for an exemption based on income
or other factors.)
4. You arent eligible for a subsidy if you:
a. Make too much or make too little;
b. Or your spouse have access to qualified
coverage available at work or government
sponsored coverage (Medicare, Tricare,
Medicaid); or
c. Arent a legal citizen (or havent filed your
federal income taxes)
5. You dont have to buy health plan coverage at
healthcare.gov (the Marketplace). In fact, you
should only buy it there if youre subsidy eligible and
dependent on the subsidy to get coverage.
6. Buying health insurance at work is usually the most
cost effective way to do so because of pre-tax.
(Thank your employer!)
7. If you change health plans midyear you may lose
all of the money you have paid towards your health
plans deductible and out of pocket limit. Check
with your health plan for more details.
**These plans renew January 1 annually.

Know What it Costs?


Average 'Employee Only'
Healthcare Costs in the U.S.

To learn more, contact the EAP plan or visit our EAP plans
member home page:
EAP plan member home web page.

Username Matters
Password- wlm70101
20 |Printed 2/12/15

Total

U.S.

U.S.: Private
Employer

U.S.: Public
Employer

$4,939

$5,222

$6,157

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Planning Ahead
Reality isdeath is a real fact of life and
disability can be.
Both carry harsh consequences if not
planned for properly.
In fact, most
Americans admit they:
Wouldnt be able to meet expenses if
they couldnt work for a period of
time; and
Dont have enough life insurance.

Insurance provides peace of mind. And,


while you have a budget, insurance has
to be on the list.

Basic Financial Tips


The average person needs 7-12 times
his/her annual income in life insurance
coverage.
If your family depends on your income,
protect it with disability.
Set aside 3-6 months of income for
emergency savings.
Be prepared for the unexpected.
Have adequate savings to protect your
finances or insure them with disability.

Accident Benefits
Accidents happen to all kinds of people every day.
Accident benefits are ideal for those who have an active lifestyle or kids
who play sports.
Accident benefits are designed to provide cash benefits by reimbursing
an insured throughout different stages of care, regardless of the severity of
the injury.

Benefit Highlights
Accident
Plan Benefits

Accident Benefits
Double Click to Open the Plan
Summary

Not viewing the doc electronically?


Refer to printed materials

Wellness Incentive
Benefits are for
Benefits Begin
Other Perks

$100 each year for employee only


for simply for getting a wellness
exam even if the exam is free!
Treatment received for covered off
and on the job accidents.
1st day of coverage for any covered
accident.
Benefits are paid regardless of other
coverage.
Plus, benefits are paid directly to you
- tax free.

Ask Yourself
What are my biggest assets?
Do I have adequate insurance to
protect my biggest assets?
Have I planned properly?

Insure the things you cannot afford to lose


- get as much coverage as necessary and
yet as little as possible.
Plus, if youre married and/or have kids,
you need to make sure you have the
proper wills and healthcare documents in
place.
Having a valid will gives you the ability to
have a final say in what happens to your
assets when you die.

Accidents happen.
When they do they dont have to wreck your life.
21 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Kicking Cancer
Getting diagnosed with cancer
changes your life but, it doesnt have
to end it!
Staying positive, living healthy and
being financially able to fight the
disease can make all the difference in
the outcome.
Learn about your condition.
Seek care from the best practioners
avaialble in treating your disease. Stick
to your guns rely on people who care
about your health.
Seek natural foods and activities to
compliment medical treatment.
Andif youre lucky enough to have
never had the diagnosis, try to help
your body keep it that way!
Healthy living is simpleeat fresh
vegetables and fruits. Lean meats and
good fats.

Critical Illness & Cancer Benefits


Critical illness benefits can provide a lump sum cash payment to help you
deal with the unexpected costs of a serious illness.
Benefits are paid regardless of other coverage.

Benefit Highlights
Tax free cash benefits are paid directly to you upon the diagnosis of a
(covered) critical illness or occurrence of cancer.

Critical
Illness Plan Benefits
Not viewing the doc electronically?
Refer to printed materials

Reoccurence Benefits
Wellness Incentives

Rates are Determined


by
The Amount
of Coverage Plus

Stay active.
And, most of all, keep a positive
attitude knowing that yourattitude
is a little thing that makes a big
diference.

Double Click to Open Here

Rates Change

Included.
$100 each year for employee only for simply getting a wellness or
preventative exam even if the
wellness or preventative exam is
free!
You:
Your age
Your Spouse:
Your spouses age
Your Children:
One flat rate covers all children!

When you hit a new age bracket at


anniversary.

Age reductions and restrictions apply to this benefit.

The heart of any battle


starts in the mind
stay strong.
22 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

We Need Your Help to Make it


Work at Work!
Its no surprise that insurance and healthcare costs
continue to escalate at an alarming rate.
Creative plans, rate reviews and partnering with our
Consultant/Broker, Resource Seven, helps us avoid
unreasonable cost increases.
If you want to have the best plans at the lowest cost, you
must also take responsibility in the process by actively
managing your health, even if by small improvements!

After Enrollment Whats Next?


Whether youre new to the plan, have had
a qualifying event or just completed open
enrollment take note:
Make sure all of your dependents are
enrolled correctly before you need to use
the coverage! Call or log into the plan to
confirm enrollment today.
Get your Health, Dental & Vision ID Cards
make sure they reflect the correct plan
and dependent coverage.

The truth is were in this together.


Each of us can do our part so that together we are a
healthy, happy and safe workplace!
And, please remember, to respond to HR timely you are
a critical part of any process!

Check payroll deductions they should


coincide with your elections.
Get the information you need about the
plans elected Summary Plan Descriptions
and Certificates of Insurance provide
important plan details to plan participants.
Information is available &/or distributed
within 60 days of enrollment or if benefit
plan changes occur by accessing the
corresponding plans Member Home
Page or by requesting, in writing, a copy
of plan documents from your Plan
Administrator.
If you had to apply (provide health history)
for any (non-health) plan, you will be
notified of approval or denial. You will not
have coverage until/if approved.
The
underwriting
process
involves
collecting health history from you, your
Medical Information Bureau profile, and/or
physicians records.
Please notify your Plan Administrator immediately if any
discrepancy(s) exists.

23 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Need Help with Claims Issues?


If you need help with a health, dental or vision claim,
before contacting our Resource Center take the simple
steps below to help determine the best and most efficient
course of action to help you resolve your issue.
In most instances, you need the Explanation of Benefits
(EOBs) that corresponds to the claim in question.
EOBs are generated by the plan when a claim is
presented for payment. EOBs identify how the claim is
paid and the amount you owe, if any.

After taking the steps above, if you determine:


Claim has been received by the plan,
Provider has provided all of the required info to the
plan, and,
Plan is refusing to pay the claim properly,
Call our Resource Center so that they can assist you
with your claims problem!

Before Calling on a Claims


Please Take These Few Steps

Issue

You do not have


the EOB(s)

You do have the


EOB(s)

If you have not received


an EOB from the plan
that corresponds to the
date and/or charges
billed by the provider,
contact the plan to
confirm that the claim
has been received and
processed.

Match provider (doctor,


dentist, hospital, etc.)
statements received to
the EOBs (Explanation
of Benefits) sent by the
plan.

If the plan has not


received the claim, stop
here - you do not have a
claims issue - the claim
must be submitted to
the plan.

Check your EOB to


determine if the plan
has received the claim

Contact the billing


provider and request
them to file the claim.

Has the plan asked your


provider for additional
information necessary to
process the claim?
Stop here - you do not have
a claims issue - this is a
provider problem.
Please
contact
the
provider to request that
they comply with the
insurance
companys
request
for
additional
information required by the
plan to process the claim.

After taking
determine:

the

steps

above,

if

you

Claim has been received by the plan,


Provider has provided all of the required
info to the plan, and,
Plan is refusing to pay the claim properly,
Call our Resource Center so that they can assist
you with your claims problem!

24 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Loss of Benefits Eligibility


Below are examples of events that can
trigger a loss of eligibility for:

You (the Employee):


Fail to maintain an 'Actively at Work' status.
No longer work the required # of hours.
Resign, retire or are terminated.
Are on an extended absence (beyond 30
days).
Exhaust FMLA, if available.
Exceed the age limitations of the plan.
Permanently move out of the health plan's
network service area.

Your Dependents:

Exceed the age limitations of the plan.


Lose eligibility b/c employee loses eligibility.
Death of a covered employee.
Lose eligibility due to a divorce.
Permanently move out of the health plan's
network service area of the plan.

When Benefits End


If you or your dependents fail to meet the
eligibility requirements of the plan, your
benefits will end the date you or your
dependents are no longer eligible.
However benefits end the last day of the
month after a loss of eligibility for the
following:
Health & RX
Dental & Vision
HRA Benefits
No worries!
Many of your benefits can be retained by
paying for them outside of work contact
the Administrator or Resource Center for help
and more information.

When You Have a Life Change


Consider All Options
When you lose coverage, have a life change
or just have a birthday - its the perfect time
to consider all of your options. Our Resource
Center Can help.

Resource Center 770.716.3200


25 |Printed 2/12/15

Continue, Convert or Port?


An employee or dependent must remain eligible as defined by the
rules of the plan(s) in order to maintain coverage. However, if you or
your dependents fail to meet the eligibility requirements, you may be
able to keep your benefits at your own expense without regard to your
health status.
The chart below describes the different ways you can retain coverage
outside of work.

Keeping Coverage on Your Own with...


Conversion

Continuation

Portability

The ability to
convert group life
insurance to
individually owned
life coverage
(typically converted
to a form of
permanent life).

The ability to
continue Health &
Welfare benefits at
the same cost and
coverage offered
to active
employees.

The ability for


certain individuals
to elect coverage
on an individual
basis at the same
rate structure.

Specific rules determine your ability to continue, convert or port


coverage. These rules can be found in each plans Insurance
Certificate or Summary Plan Description document.
In any instance, you or your covered dependents must be actively
participating in the benefit(s) the day prior to loss of eligible status in
order to continue, convert or port coverage. You must also request to
retain your coverage &/or make payment arrangements within 30
days of losing benefits eligibility status.
To determine eligibility rules, conversion, portability or continuation
options, review your Insurance Certificate or SPD or contact the plan or
your Plan Administrator.
Summary Plan Descriptions (SPDs) and Insurance Certificates are
available &/or distributed within 60 days of enrollment or if benefit plan
changes occur. All plan information is available to you by accessing
the corresponding plans Member Home Page or by requesting, in
writing, a copy of plan documents from your Plan Administrator.

Questions?
To obtain information about your COBRA rights, please contact our
COBRA Administrator, Aetna, 866-472-0897. To obtain information
about portability or conversion, please contact the Plan Administrator

When one door closes,


So another opens
The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Self-Care Tips Save You $

Preventative Benefits

Below are a few tips:

Preventive care helps you stay healthy.

Take personal responsibility for your health & finances.

Avoid unnecessary stress in your personal or work life.

Look for ways to become less dependent on sickness


related healthcare.

Utilize your plans freebies and member resources


your plan might also offer member discounts ask!

Make healthier choices: exercise, rest, nutrition, etc.


progress not perfection is something you can achieve

Be informed and make wise use of time. For example,


make a list of your questions in advance of an
appointment or trip to the pharmacy. Research your
situation to get an idea of common questions.

Live a lifestyle that keeps you out of the doctors


office.

Use preventative benefits for your eyes, teeth and


body!
If you elect the coverage, preventative
benefits are free (health and dental) or just a small copay (vision).

Use preventative benefits for your eyes, teeth and body!


If you elect the coverage, preventative benefits are free
(health and dental) or just a small co-pay (vision).
With the advent of Healthcare Reform, most plans must
cover the following list of preventive services at no cost
when these services are delivered by a network provider.

Self care is key in health promotion,


decisions and actions that allow you to
better cope with or prevent a health

problem.

Remember, when it comes to a


serious health condition, early
detection is the key to success.

Preventive Services for Adults


Most importantly, being wise about
your health will save you money
and can save your life.

1. Abdominal Aortic Aneurysm one-time screening for


specific age men who have smoked
2. Alcohol Misuse screening & counseling
3. Aspirin use to prevent cardiovascular disease for men
& women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at

Life is full of nice


surprises -

higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood
pressure
9. Diet counseling for adults at higher risk for chronic
disease
10. HIV screening for everyone ages 15 to 65 & other ages
at increased risk

26 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

11. Immunization

vaccines

for

adults--doses,

recommended ages & populations vary:


Hepatitis A
Measles Mumps, Rubella
Hepatitis B

Meningococcal
Herpes Zoster
Pneumococcal
Human Papillomavirus
Tetanus, Diphtheria, Pertussis
Influenza (Flu Shot)
Varicella
12. Obesity screening & counseling for all adults
13. Sexually

Transmitted

Infection

(STI)

prevention

counseling for high risk adults


14. Syphilis screening for all adults at higher risk
15. Tobacco Use screening for all adults & cessation
interventions for tobacco users

Covered Preventive Services for Women


1. Anemia screening on a routine basis for pregnant
women
2. Breast Cancer Genetic Test Counseling (BRCA) for
women at higher risk for breast cancer
3. Breast Cancer Mammography screenings every 1 to 2
years for women over 40
4. Breast Cancer Chemoprevention counseling for
women at higher risk
5. Breastfeeding comprehensive support & counseling
from trained providers, & access to breastfeeding
supplies, for pregnant & nursing women
6. Cervical Cancer screening for sexually active women
7. Chlamydia Infection screening for younger women &
other women at higher risk
8. Contraception: Food & Drug Administrationapproved contraceptive methods, sterilization
procedures, & patient education & counseling, as
prescribed by a health care provider for women with
reproductive capacity (not including abortifacient
drugs). Does not apply to health plans sponsored by
certain exempt religious employers.
9. Domestic & interpersonal violence screening &
counseling for all women
10. Folic Acid supplements for women who may become
pregnant
11. Gestational diabetes screening for women 24 to 28
weeks pregnant & those at high risk of developing
gestational diabetes
12. Gonorrhea screening for all women at higher risk
27 |Printed 2/12/15

13. Hepatitis B screening for pregnant women at their first


prenatal visit
14. HIV screening & counseling for sexually active women
15. Human Papillomavirus (HPV) DNA Test every 3 years for
women with normal cytology results who are 30 or
older
16. Osteoporosis screening for women over age 60
depending on risk factors
17. Rh Incompatibility screening for all pregnant women
& follow-up testing for women at higher risk
18. Sexually Transmitted Infections counseling for sexually
active women
19. Syphilis screening for all pregnant women or other
women at increased risk
20. Tobacco Use screening & interventions for all women
& expanded counseling for pregnant tobacco users
21. Urinary tract or other infection screening for pregnant
women
22. Well-woman visits to get recommended services for
women under 65

Covered Preventive Services for Children


1. Autism screening for children at 18 & 24 months
2. Behavioral assessments for children at the following
ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to
14 years, 15 to 17 years.
3. Blood Pressure screening for children at the following
ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to
14 years, 15 to 17 years.
4. Cervical Dysplasia screening for sexually active
females
5. Depression screening for adolescents
6. Developmental screening for children < age 3
7. Dyslipidemia screening for children at higher risk of
lipid disorders at the following ages: 1 to 4 years, 5 to
10 years, 11 to 14 years, 15 to 17 years.
8. Fluoride Chemoprevention supplements for children
without fluoride in their water source
9. Gonorrhea preventive medication for the eyes of all
newborns.
10. Hearing screening for all newborns
11. Height, Weight & Body Mass Index measurements for
children at the following ages: 0 to 11 months, 1 to 4
years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
12. Hematocrit or Hemoglobin screening for children
13. Hemoglobinopathies or sickle cell screening for
newborns
14. HIV screening for adolescents at higher risk
15. Hypothyroidism screening for newborns

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

16. Immunization vaccines for children from birth to age


18 doses, recommended ages & populations vary:
Diphtheria, Tetanus, Pertussis

On Medicare & Working?


If youre working and Medicare eligible or covered by
Medicare, you may be able to:
retain your employer sponsored health plan, and/or
solely elect Medicare and enroll in a Medicare
Supplement and Medicare Drug Plan
You may want to consider your options at work versus
those you can obtain individually.

Haemophilus influenzae type b


Hepatitis A
Hepatitis B
Human Papillomavirus

Some health plans require you to obtain Medicare when


eligible.

Inactivated Poliovirus
Influenza (Flu Shot)

If you happen to be covered both by an employer


sponsored plan and Medicare, you may have questions
about who pays first - Medicare or other insurance.
Additionally, your enrollment in your employers plan may
or may not affect your future enrollment in Medicare.

Measles, Mumps, Rubella


Meningococcal

Pneumococcal
Rotavirus
Varicella

To learn more, call our Resource Center or visit Medicare


at www.medicare.gov or www.medicare.gov - Who Pays
1st?

17. Iron supplements for children ages 6 to 12 months at


risk for anemia
18. Lead screening for children at risk of exposureMedical
History for all children throughout development at the
following ages: 0 to 11 months, 1 to 4 , 5 to 10 , & 15 to
17 years old
19. Obesity screening & counseling
20. Oral Health risk assessment for young children Ages: 0
to 11 months, 1 to 4 years, 5 to 10 years
21. Phenylketonuria (PKU) screening for this genetic
disorder in newborns
22. Sexually Transmitted Infection (STI) prevention
counseling & screening for adolescents at higher risk
23. Tuberculin testing for children at higher risk of
tuberculosis at the following ages: 0 to 11 months, 1 to
4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
24. Vision screening for all children

28 |Printed 2/12/15

The Benefit Guide Copyright 2013-15. Benevestco. All rights reserved.

Rx Tips For You


Consult your health plans formulary prior to
getting your RX filled to determine if any
restrictions apply such as step therapy, prior
authorization or quantity limits (all requiring your
physicians assistance for approval).
Split Pills
If you are taking a tablet that comes in more
than one dosage, you may be able to cut your
medication costs by cutting higher strength
tablets in .

Be a Savvy Healthcare Consumer


The best way to reduce healthcare costs is to reduce your
dependency on healthcare. Getting regular preventative exams
reduces long term costs and improves your chances of living a
healthier and longer life. And, when you do need care arm yourself
with information to keep you and your bank account healthy. And,
follow (good) doctors orders so that you can get well (and stay well)
quicker.

Get Care from the Right Place

Ask about OTC Meds


Before you fill a prescription, talk to your
physician to see if a lower cost or over the
counter med would work.

Need minor or
basic care?

Be a Savvy Shopper
Some pharmacies or drug manufacturers offer
coupons or savings card, free antibiotics &/or
100s of low cost prescriptions for a 30 or 90 day
supply! And, not all charge the same price shop around. If your Rx is covered at the
lowest co-pay (if you have a co-pay plan),
make sure the pharmacy charges the lower of
the actual cost of the medication or copay.
Plus, you can search for coupons that can
save your lots of money!

Use your TeleMed


Benefits or Nurseline
24/7

Use Mail Order


Mail order can save you time & money on
maintenance meds. Ask your doctor to give
you a 90-day (or longer) prescription with
multiple refills.
Consider Alternatives
Discuss the effectiveness of alternate drugs
and consider generics. Name brand drugs
cost substantially more than their generic
(equivalent) counterparts. Some plans will
charge you the difference between the name
brand drug & the generic when a generic is
available.
Consult with your doctor &
pharmacist to ensure the course of treatment
is covered by your health plan & the most
effective for you.
Seek Samples
Using samples can also be a highly effective
way to try out new medications before you
make a financial investment in them. Ask your
physician, pharmacy or provider for samples
for one off or new prescriptions.
Get Help When You Need It
If you cannot afford your Rx, contact:
www.pparx.org
or
call,
toll-free,
1-888-4PPA-NOW for assistance or search the
internet for the name of your Rx and patient
assistance.

Self-Care

Walk In
Clinics*

$$

Wait to See
Your
Doctor*

Urgent
Care*

$$$

$$$$

Risk to life,
limb or vision?

Emergency Room

Call 911

$$$$$

Our Tips Can Save You Time & Money

Where

Who

When
You Can

Use telemedicine
benefits or your
health plans nurse
line to save yourself
time and money.
Use an outpatient

Seek care from


competent
professionals.
Network providers
save you money
plus, some plans
dont offer out of
network benefits!
Avoid specialists
when a general
physician will serve
the purpose.

When you can,


treat your health
problem naturally.
When you have

imaging center

rather than a
hospital for imaging
services.
Make sure lab
services are sent to
your in network

preferred lab
service provider.

it, use EAP plan


benefits, when

available, for free


counseling
benefits.
When you can,
avoid synthetic
medications and
processed foods.

Finally, use our resources to help you make sure you pick the benefits
and plans that make the most sense for you and your family. Request
a prior authorization for a recommended service or procedure.

29 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

Workplace Health & Safety

The information contained herein is helpful to begin a


journey towards better health. Better health improves
your quality of life and costs you less money!

Ideally, T & O Refrigeration wants to protect the safety and


wellbeing of our employees and want to provide you with
opportunities for better long-term health and an improved
quality of life. We are focused on offering lots of tools and
education to help you improve your health and safety at
work.
Get engaged, educated, and empowered to adopt a
healthy lifestyle that includes regular physical activity and
good nutrition.

Fruits and vegetables are packed with the nutrients


your body needs, they help turn the Im hungry
message off in your brain.
Fruits and vegetables are rich in fiber, helping you feel
full or at least satisfied.
You need at least 5-9 (combined) servings every day.

Drink an ample supply of water. Water brings nutrients to


the cells and carries away toxins. Divide your weight by
two (2) to determine the minimum number of ounces you
should drink per day.
Buy a large water bottle - its easier to track that way.

And most importantly pass it on to your family.

Obesity Our Nation Weighs In


Consider this, according to the CDC, in 2000, no US states
had an obesity rate over 20%. Now, there are no US states
that have less than a 20% obesity rate.
Help yourself and help your kids turn obesity, our American
epidemic, around.

Consume healthy fats. Healthy fats are those that arent


cooked! Cold pressed olive oil, raw nuts, and avocados
are all good examples. You dont need a lot. A
tablespoon or two of olive oil on your salad or a handful
of raw nuts will give you what you need.
What fats should you avoid? Animal fats, hydrogenated
fats and fried foods.
And what about low-fat or fat-free goods? Theyre usually
loaded with sugar which just turns to fat in the body
anyway!

http://www.iom.edu/weightofthenation
Research has shown that as peoples weight increase so
does their risk for developing some of the most deadly
health conditions.

Weight Loss Simplified


It is almost impossible to achieve good health or lose
weight without eating right, drinking water or adding
exercise to your daily routine.
Eat fruits and vegetables. Eating fruits and vegetables
promotes weight loss in a couple of ways:

How many calories? Determine out what your ideal


weight is (be realistic), and add a zero to the back of that
number (for example if 150 is your goal weight; your
calories should be 1,500).
And, eating the right amounts of calories throughout the
day is important. Once-a-day eating is one of the worst
enemies of good health and achieving ideal weight. Your
body thinks a famine is going on during the 23-1/2 hours
you arent eating! The ideal way to eat would be 200-310
calories, 5 or 6 times a day! If you cant swing that, shoot
for at least 3 well-balanced meals per day. An insufficient
number of calories sends the same message!
Avoid the Scale. Weight tells you very little about your
health and muscle weighs more than fat! Body fat
composition is a far more important means of determining
health. After getting an initial reading, body
measurements can help you track your progress.

30 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

Eat the Right Proteins


Each meal should include some protein.
Believe it or not, there is a substantial amount of protein in
vegetables. Legumes (beans, lentils, etc.) are a great
source. For women, soy is a must!
Fish and other low fat meats are better for you. Try to eat
red meats in moderation.
How much protein is good per meal? Think about an
amount that would fit in the palm of your hand,
particularly with meat.

Consume Good Carbohydrates & Fats


If youve heard the high-protein and no- or low-
carbohydrate hype, beware!
Heres what you need to know: simple carbohydrates like
french bread, pasta, rice, most cereals, etc., turn to sugar
if your body doesnt have an immediate demand for the
energy they provide.
Guess what happens to excess sugar? It is stored as fat in
your body!
So which carbohydrates are good? Those with high fiber
like fruits, vegetables and whole grains.
Why? Fiber slows the intake of carbohydrates, allowing
your body to use these calories over a longer period. If you
love carbs, start reading labels. A good ratio between
carbohydrates and fiber is no greater than 5:1.

Healthy Lifestyles Look the Same


One of the biggest problems in America today is lack of
activity. The truth is, movement is movement and the
more you move, the healthier youll be. Eating a healthy
diet is another part of the healthy lifestyle. Not only can a
clean diet help with weight management, it can also
improve your health and quality of life as you get older.
Creating a healthy lifestyle doesnt have to mean drastic
changes. Making small changes in how you live each day
can lead to big rewards.

And, contrary to negative


belief, you can eat healthy
on a budget. It just takes a
little effort. Plus, when you
eat better you also eat less.
When at the grocery store, try
to shop the outside walls and
four corner of the store.
The outside isles contains all
the good for you stuff.

How Much Exercise is Enough?


Starting an exercise program means rearranging your
schedule to allow time for it, but it doesnt require that
much time. Short bouts of exercise can help lower
cholesterol, reduce the risk of heart disease and can be
just as effective for weight loss and health as longer
workouts. Plus, people find it easier to stick with shorter
workouts.
Adding a little movement can
Reduce the risk of heart disease, stroke & diabetes.
Improve joint stability.
Improve range of movement & maintain flexibility.
Maintain bone mass & prevent osteoporosis.
Improve mood & reduce stress & anxiety.
Reduce signs of depression & enhance self-esteem.
Improve memory in elderly people.

Do it Naturally
Even if you have a health condition, look for ways to solve
your health problems naturally.
Avoid prescription cocktails when possible. Make sure the
side effects dont outweigh the symptom(s) youre looking
to cure.

Get Connected
There are lots of free resources to help you get healthy,
educated or obtain assistance.
Commonly used resources include your benefits plans
and our Resource Center. Others include:

Use the new Food Guide Pyramid. It shows you how much
of which foods you should eat every day.
Good eating habits, include:

Eat more fruit & veggies.


Find lower calorie substitutes.
Eat natural, fresh foods.
Avoid processed foods.
Avoid white starches & sugars.
Drink more water.

Learn. Grow. Share and go.

31 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

32 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

Notices

PRIVACY OF THE
IMPORTANT TO US.

Please note, it is T & O Refrigerations intent to comply with


federal and state requirements in the best interest of our
employees.

1. Statement of Our Duties. We are required by law to

As an employee or plan participant, you may receive


various notices from us. Notices are sent upon specific
events or simply in an effort to comply with our
responsibilities. These notices are provided below in good
faith and with earnest effort to comply with federal
requirements.
At different and specific times throughout the year, we
distribute certain information to help inform you about
your benefits, rights and responsibilities. As well as, we
make this information and tools and resources available
to you. We also offer personal assistance, should you
require it.
The benefit plan information included in this Benefit
Guide is intended as a summary only and does not
replace any Certificate of Insurance or Summary Plan
Description.
To obtain copies of important plan information or to get
more information or help, please contact the Resource
Center or Plan Administrator.

Privacy Practices & Policies


This provides notice of the privacy practices and policies
of Resource Seven Inc. (and any subsidiaries of the
Principals). These protections have been adopted to
ensure that the information that we obtain and maintain
for our clients and customers, which may also include
information about the employees, dependents, former
employees and dependents, and other eligible
participants on a group health plan for which we are
providing services (Protected Parties). The Notice
outlines our practices, policies, and legal duties to
maintain and protect against prohibited disclosure of
personally-identifiable financial information (as required
by
the
federal
Gramm-Leach-Bliley
Financial
Modernization Act (GLB Act), and the various state laws
implementing those requirements) and protected health
information of those Protected Parties (under the privacy
regulations mandated by the Health Insurance Portability
and Accountability Act (HIPAA Privacy) and further
expanded by the Health Information Technology for
Economic and Clinical Health Act (HITECH) provisions in
Title XIII of the American Recovery and Reinvestment Act
(ARRA).
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT A PROTECTED PARTY MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. THE PROTECTION OF THE

INFORMATION

WE

MAINTAIN

IS

maintain the privacy of non-public personal


information (NPPI) and protected health information
(PHI) (collectively referred herein as Protected
Information) of the Protected Parties and to provide
our clients with this notice of our privacy practices and
legal duties. We are required to abide by the terms of
this notice. We reserve the right to change the terms
of this notice and to adopt any new provisions
regarding the Protected Information that we maintain
about the Protected Parties. If we revise this notice, we
will provide each client or customer with whom there
is a current and direct business relationship with a
revised notice by mail, electronic mail, facsimile, or
hand delivery.

2. Statement of the Clients Rights under HIPAA Privacy

and HITECH. As our client or customer, you have a right


to know how we may use or disclose the Protected
Information we maintain on those Protected Parties
with whom there is a direct relationship. In the event
that our customer or client is an employer sponsoring
a group health plan, we do not have a direct duty to
their employees, dependents, former employees or
dependents or other eligible participants on the group
health plan. Our obligations to not disclose the
Protected Health Information we maintain about
those individuals may arise due to our contractual
obligations as a Business Associate of both the client
or customer, as well as to any other third party who is
a Covered Entity under the HIPAA Privacy Regulations
and as revised by HITECH, but does not create a
special legal duty to provide notice to those
individuals of their rights through a Notice of Privacy
Practices.

Primary Uses and Disclosures of Protected Health


Information: We use and disclose protected health
information about Protected Parties for payment and
health care operations. HIPAA Privacy does not generally
preempt (or take precedence over) state privacy or
other applicable laws that provide individuals greater
privacy protections. As a result, to the extent state law
applies, the privacy laws of a particular state, or other
federal laws, rather than the HIPAA Privacy, might impose
a privacy standard under which we will be required to
operate. For example, where such laws have been
enacted, we will follow more stringent state privacy laws
that relate to uses and disclosures of the protected health
information concerning HIV or AIDS, mental health,
substance abuse/chemical dependency, genetic testing
and reproductive rights.

33 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

In addition to these state law requirements, we also may


use or disclose Protected Information in the following
situations:
Payment: We might use and disclose your protected
health information for all activities that are included within
the definition of payment within the HIPAA Privacy
regulations. For example, we might use and disclose a
Protected Partys Protected Information to assist with the
payment of claims for services provided to that Protected
Party by doctors, hospitals, pharmacies and others for
services that are covered by a group health plan. We
might also use your information to determine your
eligibility for benefits, to coordinate benefits, to examine
medical necessity, to obtain premiums, and to issue
explanations of benefits to the person who subscribes to
the health plan in which you participate.
Health Care Operations: We might use and disclose a
Protected Partys Protected Information for all activities
that are included within the definition of health care
operations within the HIPAA Privacy regulations. For
example, we might use and disclose the Protected
Information of a Protected Party to an insurer to determine
the premiums for your health plan, to conduct quality
assessment and improvement activities, to engage in
care coordination or case management, and to manage
our business.
Business Associates: In connection with our payment and
health care operations activities, we contract with
individuals and entities (called Business Associates) to
perform various functions on our behalf or to provide
certain types of services. To perform these functions or to
provide the services, our business associates will receive,
have access to, create, maintain, use, or disclose
protected health information, but only after we require
the business associates to agree in writing to contract
terms designed to appropriately safeguard your
information.
Other Covered Entities: In addition, we might use or
disclose your protected health information to assist health
care providers in connection with their treatment or
payment activities, or to assist other covered entities in
connection with certain of their health care operations.
For example, we might disclose a Protected Partys
Protected Information to a health care provider when
needed by the provider to render treatment to that party,
and we might disclose protected health information to
another covered entity to conduct health care
operations related to billing, claims payment or
enrollment.
For all other uses and disclosures, we first must obtain your
permission.

In addition, you have the following rights:

The right to request that we place additional


restrictions on our uses and disclosures of the personal
health information of Protected Parties. However, we
are not obligated to agree to impose any such
additional restrictions.
The right to access, inspect and copy the protected
information pertaining to Protected Parties that we
maintain in our files, and the right to have us correct
or amend any information that we create in error.
Requests to access or amend your health information
should be sent to the contact person and address
provided below.
The right to receive an accounting of the disclosures
of the Protected Information we maintain on
Protected Parties that we make for purposes other
than activities related to payment functions or other
health care operations.
The right to request that communications containing
a protected partys Protected Information are sent in
a confidential manner.
If you received this notice electronically, you also
have the right to obtain a paper copy of this notice
from us on request.

Information We Collect About You. We collect the


following categories of information for group and/or
individual policies from the following sources:

Information that we obtain directly from you, in


conversations or on applications or other forms that
you or a Protected Party completes.
Information regarding current or prospective plan
participants we obtain about them on applications or
other forms.
Information about the plans transactions with our
affiliates, others or us.
Information that we obtain as a result of our
transactions with you.

Permissible Uses and Disclosures of Protected Information.


We disclose the information we receive regarding current
or prospective plan participants only in accordance with
the terms and conditions of the various Business Associate
contracts we have entered to with Covered Entities under
HIPAA Privacy Regulations and as permitted under state
and federal laws concerning the privacy of your
insurance and financial information. Those include:
Situations Permitted or Required by Law. We also may use
or disclose your protected health information without your
written permission for other purposes permitted or
required by law, including, but not limited to the following:

As authorized by and to the extent necessary to


comply with workers compensation or other no fault
laws;

34 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

To an oversight or insurance regulatory agency for


activities including audits or civil, criminal or
administrative actions;
To a public health authority for purposes of public
health activities (such as to the Federal Food and Drug
Administration to report consumer product defects);
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;
To organ procurement organizations or other entities
for approved research; or
To a governmental authority, including a social service
or protective services agency, authorized to receive
reports of abuse, neglect or domestic violence.

For any Purposes to Which you have Not Objected. In


certain limited circumstances, we may use or disclose
your protected health information after we have given
you an opportunity to object and you have not objected.
For example, if you do not object, we may use limited
information about you to maintain an office directory, to
notify family members or any other person identified by
you regarding issues directly related to such persons
involvement with your care or payment for that care, or in
emergency circumstances.
For Purposes for Which We Have Obtained your Written
Permission. All other uses or disclosures of your protected
health information will be made only with your written
permission, and you may revoke any permission that you
give us at any time.

3. Complaints about Misuse of Health Information. You

may complain either directly to us or to the Secretary


of Health and Human Services if you believe that your
rights with respect to our protection of your health
information have been violated. To file a complaint
with us, you may send a written statement outlining
your complaint, the facts and circumstances
surrounding your complaint, including the names,
dates and as many details as possible. You will not be
retaliated against in any way for filing a complaint.

4. Practices Regarding Confidentiality and Security. We

restrict access to nonpublic personal and personally


identifiable health information about you to those
employees and agents who need to know that
information in order to provide products and services
to you. We maintain physical, electronic and
procedural safeguards that comply with state and
federal regulations to guard your nonpublic personal
information.

5. Notice of Breach of Protected Health Information. In


the event of any unauthorized acquisition, access, use
or disclosure of Protected Health Information, we shall
fully
comply
with
the
breach
notification
requirements, including any and all regulations which

have been or may be promulgated, which will include


notification to you of any impact that breach may
have had on you, your employees, dependents or
other participants in any plan in which we are
providing services.

6. Our

Policy Regarding Dispute Resolution. Any


controversy or claim arising out of or relating to our
privacy policy, or the breach thereof, shall be settled
by arbitration in accordance with the rules of the
American Arbitration Association, and judgment upon
the award rendered by the arbitrator(s) may be
entered in any court having jurisdiction thereof.

7. To File a Complaint or Obtain Info:

Benevestco, Inc. & Resource Seven Inc.


736 Old Greenville Rd., Fayetteville, GA 31215
info@resourceseven.com
770.716.3200 office
770.716.3201 facsimile

Common Insurance Terms


These terms apply to health, dental and vision plans.
An amount that must be paid by an
insured before an insurer will pay.
Deductible
Deductibles help keep premiums
affordable.
The percentage of cost sharing
applied after the deductible is met.
Co-Insurance
The amount of co-insurance is
represented by what the plan pays.
A statement generated by the plan
each time a claim is processed. An
EOB is sent to the member (insured)
and provides details about how the
EOB
claim was processed, paid or denied
Explanation
and the amount due, if any, by the
of Benefits
insured. Always pay the provider
based on what the EOB shows you
owe. The EOB should be correct. You
can access copies of EOBs by calling
the plan.
Out of
The most a member (insured) will be
Pocket
required to pay for covered claims
Maximum
applied to the co-insurance.
UCR only applies to indemnity plans
or out of network benefits.
UCR is the amount paid for a medical
service in a geographic area based
Usual,
on what other providers in the area
Customary &
usually charge for the same or similar
Reasonable
service. The UCR amount is used to
(UCR)
determine the allowed amount.
Any amount above UCR is the
members (your) responsibility.

35 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.

Document Disclosure

Notes & To Dos

It is your responsibility to understand the provisions of your


plan, including limitations, exclusions and how to access
the highest level of coverage.
Review all materials provided to you thoroughly and
make benefit elections carefully.
The Resource Center
770.716.3200
info@resourceseven.com

Your
wellbeing

relies on...

This document is:


1. Protected by copyright laws
2. Not intended to provide tax or legal advice.
3. The proprietary information of Glendae Tuthill and/or
Benevestco, Inc., and may not be re-produced or
distributed without express written consent of
Glendae Tuthill of Benevestco, Inc..
4. Intended for informational purposes only and does
not replace or supplement any Certificate of
Insurance or Summary Plan Description or governing
law.

good health

good
education

reliable
resources

plans for
financial
security

36 | The Benefit Guide Copyright 2014. Benevestco. All rights reserved.