Lawrence Livermore
National Laboratory
2015 Employee Benefits Guide
Health | Life | 401(k) | Additional Benefits
13873 Park Center Road, Suite 400N Herndon, VA 20171
Telephone: 571-323-5200
Fax: 571-323-5749
www.akima.com
Akima, LLC
16
•
Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request medical
plan enrollment within 30 days after the marriage, birth,
adoption, or placement for adoption.
•
Lose Medicaid or Children’s Health Insurance Program
(CHIP) coverage because you are no longer eligible. You
must request medical plan enrollment within 60 days after
the loss of such coverage.
If you request a change due to a special enrollment event within
the 30 day timeframe, coverage will be effective the date of birth,
adoption or placement for adoption. For all other events, coverage
will be effective the irst of the month following your request for
enrollment. In addition, you may enroll in Akima, LLC’s medical
plan if you become eligible for a state premium assistance
program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan
coverage. If you request this change, coverage will be effective the
irst of the month following your request for enrollment. Speci ic
restrictions may apply, depending on federal and state law.
NOTE: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current
coverage or change to another medical plan. Any other currently
covered dependents may also switch to the new plan in which
you enroll.
Women’s Health and Cancer Rights Act (WHCRA) Notice:
If you have had or are going to have a mastectomy, you may
be entitled to certain bene its under the Women’s Health and
Cancer Rights Act of 1998 (WHCRA). For individuals receiving
mastectomy-related bene its, coverage will be provided in a
manner determined in consultation with the attending physician
and the patient, for:
•
All stages of reconstruction of the breast on which the
mastectomy was performed;
•
Surgery and reconstruction of the other breast to produce
asymmetrical appearance;
•
Prostheses; and
•
Treatment of physical complications of the mastectomy,
including lymphedema.
These bene its will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical
bene its provided under this plan. Therefore, the following
deductibles and coinsurance apply: SEE APPLICABLE SUMMARY
OF BENEFITS AND COVERAGE (SBC). If you would like more
information on WHCRA bene its, call your Akima Human
Resources Representative.
Newborns’ and Mothers’ Health Protection Act (NMHPA or
“Newborns’ Act”) Notice: Group health plans and health insurance issuers generally may not, under Federal law, restrict bene its
for any hospital length of stay in connection with childbirth for
the mother or newborn child to less than 48 hours following a
vaginal delivery, or less than 96 hours following a cesarean section.
However, Federal law generally does not prohibit the mother’s or
newborn’s attending provider, after consulting with the mother,
from discharging the mother or her newborn earlier than 48 hours
(or 96 hours as applicable). In any case, plans and issuers may not,
under Federal law, require that a provider obtain authorization
from the plan or the insurance issuer for prescribing a length
of stay not in excess of 48 hours (or 96 hours). If you would like
more information on maternity bene its call your Akima Human
Resources Representative.
HIPAA Privacy Notice Reminder: The privacy rules under the
Health Insurance Portability and Accountability Act (HIPAA)
require the Akima, LLC Regional Corporation Group Health Plan,
Akima, LLC Management Services Health & Welfare Plan and
Akima, LLC Worley Parsons Health & Welfare Plan (the “Plan”) to
periodically send a reminder to participants about the availability of the Plan’s Privacy Notice and how to obtain that notice. The
Privacy Notice explains participants’ rights and the Plan’s legal
duties with respect to protected health information (PHI) and how
the Plan may use and disclose PHI.
To obtain a copy of the Privacy Notice contact your Akima Human
Resources Representative.
You may also contact the Plan’s Privacy Of icial at (907) 265-4100
for more information on the Plan’s privacy policies or your rights
under HIPAA.
Table of Contents
About this Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
What You Should Know. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Be Sure to Verify and Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Important to Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
SCA Health and Welfare Bene its Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
How to Enroll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Online Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Enrolling by Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Important . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Auto Enrollment for New Hires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Beneϐits Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
i
Health Advocate Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Your Health Plan Choices... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Health Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Auto Enrollment for New Hires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Medical Plan Summaries—How They Compare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Prescription Drug Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Delta Dental PPO Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
VSP Vision Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Cost of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
TRICARE Supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Flexible Spending Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
How an FSA Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Basic Life Insurance, AD&D, and Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Voluntary Life Insurance for You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Voluntary Dependent Life Insurance for Your Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Voluntary Life Rate Table for Employee and Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Voluntary Dependent Life Insurance for Your Child(ren) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Business Travel Accident (BTA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Beneϐits of a 401(k) Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Start Saving Today. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Enrolling in our 401(k) Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Auto Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Additional Beneϐits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Commuter Bene its (New!) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Member Assistance Program with Anthem BlueAssist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
AXA Travel Assistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Legal Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Employee Benefits Guide 2015
Legal Notices
Important Notice to Employees from Akima, LLC About Creditable Prescription Drug Coverage and Medicare: The purpose
of this notice is to advise you that the prescription drug coverage
available under the medical plans sponsored by Akima, LLC
Development Corporation are expected to pay out, on average, at
least as much as the standard Medicare prescription drug coverage will pay in 2015. This is known as “creditable coverage.”
Why this is important. If you or your covered dependent(s)
are enrolled in any prescription drug coverage during 2015 and
are or become covered by Medicare, you may decide to enroll in
a Medicare prescription drug plan later and not be subject to a
late enrollment penalty – as long as you had creditable coverage
within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.
If you or your family members aren’t currently covered by
Medicare and won’t become covered by Medicare in the next 12
months, this notice doesn’t apply to you.
Notice of Creditable Coverage: Please read this notice carefully. It has information about prescription drug coverage
available under Akima, LLC’s medical plans and prescription
drug coverage available for people with Medicare. It also tells you
where to ind more information to help you make decisions about
your prescription drug coverage.
You may have heard about Medicare’s prescription drug
coverage (called Part D), and wondered how it would affect
you. Prescription drug coverage is available to everyone with
Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of
coverage set by Medicare. Some plans also offer more coverage
for a higher monthly premium.
Individuals can enroll in a Medicare prescription drug plan
when they irst become eligible, and each year from October 15
through December 7. Individuals leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period.
If you are covered by an Akima, LLC prescription drug plan, you’ll
be interested to know that the prescription drug coverage under
the plans is, on average, at least as good as standard Medicare
prescription drug coverage for 2015. This is called creditable
coverage. Coverage under these plan[s] will help you avoid a
late Part D enrollment penalty if you are or become eligible for
Medicare and later decide to enroll in a Medicare prescription
drug plan.
Employee Benefits Guide 2015
If you decide to enroll in a Medicare prescription drug plan
and you are an active employee or family member of an active
employee, you may also continue your employer coverage. In this
case, the Akima, LLC plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription
drug plan. If you waive or drop Akima, LLC coverage, Medicare
will be your only payer. You can re-enroll in the employer plan at
annual enrollment or if you have a special enrollment event for
the Akima, LLC plan.
You should know that if you waive or leave coverage with Akima,
LLC and you go 63 days or longer without creditable prescription
drug coverage (once your applicable Medicare enrollment period
ends), your monthly Part D premium will go up at least 1% per
month for every month that you did not have creditable coverage.
For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19%
higher than what most other people pay. You’ll have to pay this
higher premium as long as you have Medicare prescription drug
coverage. In addition, you may have to wait until the following
October to enroll in Part D.
You may receive this notice at other times in the future – such
as before the next period you can enroll in Medicare prescription drug coverage, if this Akima, LLC coverage changes, or
upon your request.
For more information about your options under Medicare
prescription drug coverage: More detailed information about
Medicare plans that offer prescription drug coverage is in the
Medicare & You handbook. Medicare participants will get a copy
of the handbook in the mail every year from Medicare. You may
also be contacted directly by Medicare prescription drug plans.
Here’s how to get more information about Medicare prescription
drug plans:
•
Visit www.medicare.gov for personalized help.
•
Call your State Health Insurance Assistance Program (see
a copy of the Medicare & You handbook for the telephone
number).
•
Call 1-800-MEDICARE (1-800-633-4227). TTY users should
call 1-877-486-2048.
For people with limited income and resources, extra help paying
for a Medicare prescription drug plan is available. Information
about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit
SSA online at www.socialsecurity.gov or call 1-800-772-1213
(TTY 1-800-325-0778).
Remember: Keep this creditable coverage notice. If you
enroll in a Medicare prescription drug plan after your
applicable Medicare enrollment period ends, you may need
to provide a copy of this notice when you join a Part D plan
to show that you are not required to pay a higher Part D
premium amount.
HIPAA Special Enrollment Notice: If you decline enrollment in a
Akima, LLC’s medical plan for you or your dependents (including
your spouse) because of other health insurance or group health
plan coverage, you or your dependents may be able to enroll in
a Akima, LLC’s medical plan without waiting for the next open
enrollment period if you:
•
Lose other health insurance or group health plan coverage.
You must request enrollment within 30 days after the loss
of other coverage.
Employee Benefits Guide 2015
15
Akima, LLC
Contact Information
COMPANY
COVERAGE
GROUP NUMBER
CUSTOMER SERVICE
Akima Benefits Center
Enrollment
N/A
For questions about enrolling in benefits
Call 1-866-868-9449 or www.akimabenefits.com
7 a.m. to 7 p.m. Central Time, Monday - Friday
Health Advocate
Benefits Assistance Client Services
N/A
For questions and concerns
Call 1-866-695-8622 or www.healthadvocate.com
7 a.m. to 8 p.m. Central Time, Monday - Friday
Anthem Medical*
Medical
Group #00164414
For questions about your medical claims
Call 1-800-490-6145 or www.anthem.com
8 a.m. to 6 p.m. Central Time, Monday - Friday
14
Medical Precertification
To receive prior approval for medical services
Call 1-800-992-5498
8 a.m. to 6 p.m. Central Time, Monday - Friday
360° Health/Nurse Line
Call 1-866-647-6117
24/7
Express Scripts Rx Provider Service
For questions about your prescriptions
Call 1-800-957-5129
7 a.m. to 8 p.m. Central Time, Monday - Friday
Refill by Mail
Call 1-866-216-4766
7:30 a.m. to 7 p.m. Central Time, Monday - Friday
Anthem BlueAssist
EAP for Anthem enrollees
N/A
Call 1-888-209-7841 or www.anthemeap.com
24/7
Kaiser Permanente
Medical
Group ID: 603512
For questions about your medical claims Call
1-800-464-4000 or www.kp.org
24/7
Delta Dental
Vision Service Plan (VSP)
Dental
Vision
Group #554931
Group #30019417
For questions about your dental plan
Call 1-800-662-8856 or www.deltadentalnc.org
7:30 a.m. to 7 p.m. Central Time, Monday - Friday
For questions about your vision coverage
Call 1-800-877-7195 or www.vsp.com
7 a.m. to 9 p.m. Central Time, Monday - Friday
8 a.m. to 7 p.m. Central Time, Saturday
TRI-AD
FSA
N/A
1-888-844-1372
www.tri-ad.com/FSA
Prudential
Life and AD&D Short Term Disability, Long
Term Disability
Plan #49466
Life Claims—Call 1-800-524-0542
Disability Claims—Call 1-800-842-1718
7 a.m. to 7 p.m. Central Time, Monday - Friday
Principal
401 (k)
Plan #807055
For questions about 401(k)
Call 1-800-547-7754 or www.principal.com
7 a.m. to 9 p.m. Central Time, Monday - Friday
AXA Travel Assistance
Travel Assistance
*Mail claims to: P.O. Box 36550, Louisville, KY 40233-6550
N/A
For questions about travel assistance
Call 1-800-565-9320 or www.axa-assistance.us
Outside the
t US call (collect) 312.935.3654
24 hours a day/ 7 days a week/ 365 days a year
About
this Guide
This guide is a basic outline of your bene its
and highlights the plans that are part of
Akima’s Bene its program. This guide does
not include all of the details or exclusions
that are found in the insurance contracts or
of icial plan documents. If there is a con lict
between this guide or the information at
www.akimabeneϔits.com and the of icial
Plan Documents, the Plan Documents will
govern. Akima reserves the right to amend,
modify, or terminate its plans and change
costs at any time and without prior notice.
Your participation in any of Akima’s Bene its
Plans does not give you the right to continued or future employment. If you are a new
employee, you must enroll within 30 days
from your date of hire or wait until the next
annual open enrollment.
WHAT YOU SHOULD KNOW
Akima is committed to providing comprehensive and competitive bene its to you and
your family.
Eligibility
If you are a regular full-time or part-time
employee working 30 hours or more each
week, you are eligible to enroll in Akima’s
Bene its Plan.
Important: Affordable Care Mandate
Effective January 1, 2015
Under the Affordable Care Act (ACA), the
Individual Mandate provision requires that
most people have medical coverage or pay a
penalty. All Akima medical plans meet the
ACA’s minimum essential coverage requirements and if you enroll in an Akima medical
plan for 2015 there is nothing you need to do
because you will satisfy the Mandate. If you
do NOT enroll in an Akima medical plan for
2015, you are now required by law to make
sure the plan you enroll in meets the ACA’s
minimum essential coverage requirements.
If you enroll in a medical plan such as your
spouse’s plan or, if you are under the age
of 26, your parents’ plan, you should verify
whether the plan meets the requirements
under the law. If it does, you do not need to
do anything and you will not be subject to
any penalties. If you do not have coverage,
or you enroll in a plan that does not meet the
ACA’s requirements, you will be required to
have quali ied coverage going forward or be
subject to a penalty (generally the greater
of 2% of your household income or $325 for
each adult, and $162.50 for each dependent
under age 18 up to $975 per family) .
This Bene its Guide along with the tools and
plan summaries you will ind on the Akima
Bene its web site at www.akimabeneϔits.com
will help you make informed decisions about
your health and welfare bene its and enroll
in the choices that are right for you. If you
cannot ind the answers to your questions in
this guide or online, Akima Bene its Center
representatives are available to assist you
at 1-866-868-9449, Monday through Friday,
between the hours of 7 a.m. and 7 p.m.
Central Time, excluding holidays.
3
BE SURE TO VERIFY
AND UPDATE
Verify Dependents
It is your responsibility to verify that the
dependents you plan to cover are, in fact,
eligible. Because ineligible dependents can
increase the cost of health care coverage
signi icantly for all employees, audits of randomly selected participants whose current
bene it coverage includes at least one dependent are conducted routinely. Dependents
determined ineligible will not be covered.
Beneϔiciary Information
When you enroll, an important step is
updating your bene iciary designations.
Current, accurate information is critical to
ensuring that proper payment is made to
your bene iciaries in the unfortunate event
of your death. If you wish to change or add
bene iciaries, go to www.akimabeneϔits.com.
Employee Benefits Guide 2015
Akima, LLC
IMPORTANT TO NOTE
• Enrollment is via the Internet. You
can access the website at
www.akimabeneϔits.com, 24 hours a
day/7 days a week. See page 4 for
detailed instructions on how to enroll
online or by phone.
• After your bene its become effective, or if you have waived bene its,
changes are not allowed during the
plan year unless you have a “qualifying life event.”
Examples of Qualifying Life Events:
• Marriage, legal separation, or divorce
4
• Birth or adoption of a child
• Death of a dependent
• Medicare entitlement
• Loss of other coverage
If you have a qualifying life event, you must
notify the Akima Bene its Center at
1-866-868-9449 and provide necessary documentation within 30 days of the event. If
you do not do so, you will have to wait until
Akima’s next Open Enrollment to make any
changes to your bene its.
SCA HEALTH AND WELFARE
BENEFITS PORTAL
The Health and Welfare Portal provides SCA
employees with 24/7 access to Health and
Welfare reconciliation details.
Employees working 30 hours or more each
week have immediate access to their H&W
statements per pay period, after their irst
reconciliation.
Logging on:
• Go to www.akimabeneϔits.com.
• All new users will be required to
register and create a user name and
password.
• Once logged on, users can select “My
Fringe” located on the left toolbar.
Have additional questions? Problems
logging on?
If you have problems logging on or have
additional questions regarding the H&W
Portal, please contact the Akima Bene its
Center at 1-866-868-9449, option 1.
How to Enroll
ONLINE ENROLLMENT
Online enrollment is convenient and secure.
The Akima Bene its Center is available
online from any computer with Internet
access 24 hours a day/7 days a week. Enroll
online in three easy steps.
1. Log on and sign in
Log on to: www.akimabeneϔits.com.
• On the Welcome page select “Click Here”
to create a user name and password.
• When you access the secure website for
the irst time, you must create a new
account. You will be prompted to setup
your user pro ile by entering identifying information in order to access the
Enrollment page.
• Once you are registered and have a
user ID and password, the next time
you visit the website simply enter them
to sign on.
2. Make your choices and enroll
• You will be able to select from the left
navigation bar to make your bene its
choices.
• Add the dependents you wish to enroll,
and be prepared to enter their birth
dates and Social Security numbers.
• Select a bene it in which to enroll, such
as medical; then choose coverage levels.
• Navigate to the previous page or
proceed to the next page of each record
by selecting “PREVIOUS” or “NEXT.”
Additional Benefits
COMMUTER BENEFITS (NEW!)
The new Commuter Bene it Plan helps you save on commuting costs by letting you pay for
eligible expenses with tax-free dollars – up to $130 per month for transit and $250 per month
for parking. Depending on your tax bracket, you can save up to 40% on your commute. Eligible expenses include public transportation such as trains, buses, subway and ferries. Parking
at or near your place of employment, or at a location from which you commute to work, is
also part of the plan. Toll fees are not covered by this bene it due to government regulations.
Participants can order transit passes, vouchers, and parking arrangements online. For more
details, and to sign up, visit www.tri-ad.com/commute.
MEMBER ASSISTANCE PROGRAM WITH ANTHEM BLUEASSIST
This bene it is offered at no cost to employees enrolled in the Akima Standard or
Value Plans.
13
As you go through life, you may be faced with family or work challenges. Through BlueAssist,
employees enrolled in the Anthem medical plan can receive con idential services by phone
with licensed professional counselors at no cost to you. If you need assistance, you can call
BlueAssist 24 hours a day, 7 days a week for a variety of issues such as:
• Change or stress
• Family life transitions or con licts
• Grief and loss
• Alcohol and drug abuse
• Financial and legal concerns
Through the secure website, you can also access an online library of valuable articles covering a wide range of topics as well as a legal and inancial resource center.
The BlueAssist toll free number: 1-888-209-7841
You can ϐind them online: www.anthemeap.com
Enter the name for access: BlueAssist
AXA TRAVEL ASSISTANCE
This bene it is offered at no cost to employees.
Our travel assistance program - provided through AXA - is available to you and
members of your family when traveling more than 100 miles from home.
Services include:
• Medical, dental, and legal referrals
• Lost document and lost luggage help
• Transportation of a family member to you if you are hospitalized,
and/or transportation of minor children home
• Political evacuation
• Emergency cash or bail
AXA toll free number: 1-800-565-9320 or Outside the U.S. call
(collect) 312-935-3654
You can ϐind them online: www.axa-assistance.us
Employee Benefits Guide 2015
Akima, LLC
Benefits of a 401(k) Plan
Help increase your retirement savings by enrolling in our 401(k) plan. There are many good
reasons to start contributing to the Akima 401(k) plan. Here are just a few:
• Tax-deferred contributions. Generally, you don’t have to pay income tax on the part of
your earnings that you contribute to your 401(k) account until you take a withdrawal. If
you wait until retirement age, you may be in a lower tax bracket than you are now. You
can lower your current income tax bill and delay paying income taxes on your contributions and any earnings until you withdraw them from the plan. Withdrawals must be
compliant with plan guidelines.
• Compounding. Your retirement investments earn interest, then that interest you’ve
earned can start earning interest too. This helps you grow your retirement savings
• Make good investment choices. When you establish a 401(k) account, you can choose
from a variety of professionally managed investment options.
12
• Access to your savings. You may be able to take a loan or withdrawal from your
account if serious needs arise. Keep in mind, however, there may be penalties for taking
your money out early. Be sure you understand plan guidelines and the impact of taking
a loan before initiating a loan from your account.
START SAVING TODAY
It’s easy to save. See how quickly your savings add up.
Idea
Monthly Savings
Value in 35 Years*
Bring lunch to work
$75
$128,000
Skip the daily coffee break
$50
$86,000
Do your movie night at home
$30
$51,000
Skip one dinner out a month
$40
$68,000
3. Conϔirm your elections and enrollment
• Once you have completed your enrollment and are satis ied with your
enrollment selections, click “PRINT
CONFIRMATION STATEMENT” at the
bottom of the page to retain a copy of
your elections for your records. Be sure
to review your con irmation statement
carefully.
• If your con irmation statement shows
that you enrolled yourself or your
dependents incorrectly, you may make
changes online up to the end of your
enrollment period.
ENROLLING BY TELEPHONE
The easiest, most convenient way to enroll
in your bene its is through the Akima
Bene its Center at www.akimabeneϔits.com.
However, if you do not have Internet access,
you can also enroll by calling the Bene its
Center at 1-866-868-9449.
• Assisting with elder care
AUTO ENROLLMENT FOR
NEW HIRES
New employees are eligible to participate in the plan immediately and make pre-taxed contributions up to the IRS maximums for 2015. Please refer to the IRS website www.irs.gov for
more information about the IRS maximums as they are reviewed by the IRS annually.
If you are a new hire and you fail to take
action during your new hire enrollment
period of 30 days, you will be automatically
enrolled in (“defaulted” into) the Akima
Value Complete Plan at the “Employee Only”
coverage level unless otherwise speci ied
by the contract or the collective bargaining
agreement.
Employees who do not elect to contribute or waive participation within 60 days of their
eligibility will be automatically enrolled to contribute 3% of pay, with a 1% escalation each
January until your deferral reaches 6%. Employees may opt out of Auto Enrollment at any
time. If you wish to enroll or opt out of our 401(k) plan, go to www.principal.com or call Principal at 1-800-547-7754.
5
Once you contact Health Advocate, you will
be assigned a Personal Health Advocate to
assist you and your immediate family with:
IMPORTANT
The irst time you access the website, at the “Account Login” prompt select login type “Personal,”
and then click on “Go.” On the following Login page, click on “Establish Your User Name and Password,” to proceed with creating your account. You will need to enter Plan Number 807055.
AUTO ENROLLMENT
Akima is pleased to provide employees who
enroll in our medical bene its with Health
Advocate, the nation’s leading advocacy
and bene its assistance company. The staff
at Health Advocate are highly experienced
healthcare professionals including registered nurses and healthcare administration
experts who help you ind solutions to your
healthcare or insurance-related issues.
There is no cost to you and no form needed
to enroll.
• Untangling insurance claims and issues
Visit the Principal Financial Group online at www.principal.com. You may use this website to
enroll or change your 401(k) contributions and choose or change investment selections. You
may also enroll by calling Principal at 1-800-547-7754.
ENROLLING IN OUR 401(K) PLAN
HEALTH ADVOCATE SERVICES
Representatives are available to assist you
and answer your questions Monday through
Friday, between 7 a.m. and 7 p.m. Central
Time, excluding holidays.
You may change your enrollment choices
with the Akima Bene its Center up to the
end date of your enrollment period, which
is within 30 days of your hire date, or by the
annual open enrollment deadline. You can
make changes to your 401(k) elections at
any time.
*Assumes 7% regular deferrals per pay period.
Benefits
Assistance
• Answering diagnostic questions
• Finding the best doctors and arranging
appointments
• Negotiating provider fees
Please note that while this bene it is
designed to support Akima’s medical plans,
if you are enrolled in one of Akima’s medical
plans, your immediate family members
(spouse, child, parents, and parents-in-law)
may use Health Advocate Services even if
they are not covered under your plan.
Health Advocate can be accessed 24/7, but
normal business hours are Monday – Friday
between 7 am and 8 pm CST. You may
contact them by telephone or email at the
following:
Provider: Health Advocate Services
Email: [email protected]
Website: www.healthadvocate.com
Phone: 1-866-695-8622
Employee Benefits Guide 2015
Akima, LLC
Your Health Plan Choices...
HEALTH PLAN OPTIONS
If you are a regular Akima full-time or part-time employee working 30 hours or more per
week or a Part Time Extended Term employee, you have three medical plans from which to
choose (including a new medical plan option, the Akima Value Plan ) as well as two dental
plan options and a vision plan. They are listed below.
Pages 7-9 of this guide provide summary information on these plans. Visit the Akima Bene its
Center online at www.akimabeneϔits.com for Summary Plan Descriptions.
Medical Plan Options
6
1. Anthem Medical Plan and Prescription Drug Plan
2. Anthem Medical Value Plan and
Prescription Drug Plan
3. Kaiser Medical Plan and Prescription Drug Plan
Dental Plan Options
1. Delta Dental Core Plan
2. Delta Dental Plus Plan
Vision Plan Option
VSP Vision Plan
AUTO ENROLLMENT FOR
NEW HIRES
If you are a new hire and you fail to take
action during your new hire enrollment
period of 30 days, you will be automatically enrolled in (“defaulted” into)
the Anthem Medical Value Plan at the
“Employee Only” coverage level.
VOLUNTARY LIFE INSURANCE FOR YOU
You may be able to purchase additional life insurance coverage for yourself in increments of
$10,000 to the lesser of $750,000 or 8 times your base annual earnings. Your eligibility may
be subject to Evidence of Insurability with a Guaranteed Issue of 3 times your base annual
earnings or $200,000 for yourself and a guaranteed issue amount of $30,000 for your spouse.
VOLUNTARY DEPENDENT LIFE INSURANCE FOR YOUR SPOUSE
You may be able to purchase coverage for your spouse in increments of $5,000 up to $250,000,
limited to 100% of employee voluntary supplemental life amount not to exceed your base
annual earnings. You must elect voluntary life insurance for yourself in order to elect voluntary
life insurance coverage for your spouse.
Any voluntary life insurance coverage amounts in excess of the Guaranteed Issued amounts
of $200,000 for employee or $30,000 for spouse will require completion of an Evidence of
Insurability form.
Enrolling in or increasing the amount of coverage after initial eligibility also will require an
Evidence of Insurability form to be completed. Evidence of Insurability forms may be found
in the Resource Library online at www.akimabeneϔits.com.
11
VOLUNTARY LIFE RATE TABLE FOR EMPLOYEE AND SPOUSE
AGES
MONTHLY RATE PER $1,000 OF COVERAGE
Under 25
$0.052
25-29
$0.049
30-34
$0.056
35-39
$0.083
40-44
$0.133
45-49
$0.220
50-54
$0.384
55-59
$0.628
60-64
$0.836
65-69
$0.836
70-74
$1.318
75+
$2.324
VOLUNTARY DEPENDENT LIFE INSURANCE FOR YOUR
CHILD(REN)
You may be able to purchase coverage for your children in $2,000 increments up to $10,000;
limited to 50% of employee voluntary supplemental life amount. There is no Evidence of
Insurability required for child coverage. You must elect voluntary life insurance for yourself
in order to elect voluntary life insurance for your child.
MONTHLY RATE PER $1,000 OF COVERAGE
Child Life
$0.086
BUSINESS TRAVEL ACCIDENT (BTA)
This bene it is offered at no cost to employees.
All regular Akima full-time or part-time employees who work 30 hours or more are
covered up to $100,000 by BTA insurance in the event of loss of life while traveling on
company business.
Employee Benefits Guide 2015
Akima, LLC
Flexible Spending Accounts
Akima offers Health Care and Dependent Care Flexible Spending Accounts (FSAs) that let you
set aside pre-tax dollars out of your paycheck to pay for certain expenses such as co-payments, medical equipment and day care costs. With an FSA, you get to keep more money and
pay less in taxes. Each year during Open Enrollment, you can:
• Contribute up to $2,500 per year in a Health Care FSA.
• Contribute up to $5,000 per year (or $2,500 if married iling separate tax returns) in a
Dependent Care FSA.
HOW AN FSA WORKS
MEDICAL PLAN SUMMARIES—HOW THEY COMPARE
The Akima Standard Plan and the new Akima Value Plan are both Anthem PPO Plans and use the same Blue Cross Blue Shield
network of providers. All percentages shown are carrier-paid percentages. All services requiring coinsurance (where you pay
a percentage) are subject to the deductible unless otherwise indicated. Services with co-payments are NOT subject to the
deductible, unless otherwise indicated.
ANTHEM BCBS PPO PLAN
ANTHEM BCBS PPO VALUE PLAN
KAISER HMO PLAN
Coverages
In Network
Out-Of-Network
In Network
Out-Of-Network
In Network Only
Calendar Year Deductible
*Includes Q4 Rollover
$1,500 per individual
$4,500 per family
$3,000 per individual
$9,000 per family
$2,500 per individual
$5,000 per family
$2,500 per individual
$5,000 per family
$1,000 per individual
$2,000 per family
Calendar Year Out of
Pocket Maximum (OOPM)
$4,500 per individual
$13,200 per family
The OOPM includes any
deductible, coinsurance,
and medical (but not Rx)
co-payments.
$9,000 per individual
$27,000 per family
The OOPM includes any
deductible, coinsurance,
and medical co-payments.
It does not include Rx
co-pays or amounts above
the allowable charges
(balance billing).
$6,050 per individual
$12,100 per family
The OOPM includes any
deductible, coinsurance,
and medical (but not Rx)
co-payments.
$10,000 per individual
$20,000 per family
The OOPM includes any
deductible, coinsurance,
and medical co-payments.
It does not include Rx
co-pays or amounts above
the allowable charges
(balance billing).
$3,000 per individual
$6,000 per family
The OOPM includes any
deductible, coinsurance,
and medical (but not Rx)
co-payments.
Here are a few key highlights:
10
• The elections are made on a annual basis and only expenses incurred during the plan
year are eligible for reimbursement. The plan year begins January 1st and ends on
December 31st.
• Your contributions will be deducted from your paychecks in equal amounts during the
plan year.
• You will receive a debit card to pay for your eligible healthcare expenses.
• Plan allows a run-out up to March 31 to submit claims of services incurred in the prior
plan year.
• Money cannot be transferred between accounts for expense reimbursements.
• You cannot stop or change your FSA contributions during the plan year unless you have
a quali ied life event.
• Reimbursements for valid claims paid for out-of-your-own-pocket, will be made by
check or ACH deposit on a semi-monthly basis.
• IRS stipulates that you will forfeit any funds remaining in your account after all claims
incurred during the calendar year have been processed.
Interested employees must complete the Flexible Spending Account Enrollment Form that is
included in the bene its package. Completed forms should be submitted to your local Human
Resources contact or faxed directly to the Akima Bene its Department at 1-571-323-5749.
Life Insurance
BASIC LIFE INSURANCE, AD&D, AND DISABILITY
All regular Akima full-time and part-time employees who work 30 hours or more per week
are eligible to receive Life and Disability bene its depending upon the Akima company and
the project they support. Please note that union employees’ bene its may vary by collective
bargaining agreement. When you enroll online or visit www.akimabeneϔits.com, you will be
able to see your eligibility for these bene its and the associated costs. Be sure to review your
Life, AD&D, and Disability coverage carefully to determine the options and coverages that
best meet your needs. This will help you decide whether you wish to take out additional
coverage for you, your spouse and/or your child(ren).
7
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Preventive Care
100% covered, no
deductible
60%
100% covered, no
deductible
50%
100% covered, no
deductible
Office Visits
Primary Care Provider $20
co-pay
Specialist $40 co-pay
60%
Primary Care Provider $50
co-pay
Specialist $50 co-pay
50%
Primary Care Provider $20
co-pay
Specialist $20 co-pay
Allergy Injections
$5 co-pay
60%
$5 co-pay
50%
$0 co-pay after Deductible
Allergy Testing
80%
60%
60%
50%
$0 co-pay after Deductible
Inpatient Hospital
80%
60%
60%
50%
80%
Outpatient Surgery,
Hospital/Alternative Care
Facility
80%
60%
60%
50%
80%
Emergency Room
Services (co-pay waived if
admitted)
$200 co-pay
$200 co-pay
$200 co-pay
$200 co-pay
80%
Urgent Care Center
Services
$50 co-pay
60%
$50 co-pay
50%
$20 co-pay
MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT
Chemical Dependency
(Hospital Based and
Outpatient Services)
80%
60%
60%
50%
80%
Individual therapy - $20
co-pay
Group therapy - $5 co-pay
Mental Health Inpatient
80%
60%
60%
50%
80%
Mental Health Office Visits
$20 co-pay
60%
$50 co-pay
0%
Individual therapy - $20
co-pay
Group therapy - $10 co-pay
REHABILITATION THERAPY
All rehabilitation therapy subject to annual benefit limits.
For detail on specific therapies, visit the Akima Benefits Center online at www.akimabenefits.com for Summary Plan Descriptions.
Spinal Manipulations
$40 co-pay
Not Covered
$50 co-pay
Not Covered
Not Covered
* Q4 Rollover: Any payments applied to the deductible for expenses incurred during the last three months of the plan year will also be applied toward the next plan year’s
deductible. For example, amounts paid toward your 2013 deductible for expenses incurred in October-December 2013 will also be credited toward your 2014 deductible.
This assumes you remain insured by Akima and with the same carrier from one year to the next.
** All percentages shown are carrier-paid percentages.
*** All services requiring coinsurance (where you pay a percentage) are subject to the deductible unless otherwise indicated.
**** Services with co-payments are NOT subject to the deductible unless otherwise speci ied.
Employee Benefits Guide 2015
Akima, LLC
PRESCRIPTION DRUG PLANS
STANDARD PLANS
IN NETWORK
VSP VISION PLAN
ALL PERCENTAGES SHOWN ARE EMPLOYEE PAID PERCENTAGES
NEW VALUE PLANS
OUT OF NETWORK
IN NETWORK
OUT OF NETWORK
KAISER
HMO PLAN
VISION SERVICE PLAN (VSP)
VSP PROVIDER
Annual Eye Exam
$15 co-pay every 12 months
Up to $44 every 12 months
Lenses
(single vision, lined bifocal and lined trifocal)
Covered in full less $25 copayment; every 12 months
Up to $32 single vision
Up to $48 lined bifocal
Up to $64 lined trifocal
Up to $100 Lenticular
Frames
$25 co-payment; Limited to
once every 24 months, up to
the Plan Allowance of $130
Up to $45; Limited to once
every 24 months
Necessary Contact Lenses
$25 co-payment; Limited to
once every 12 months up to
Plan Allowance of $210.
Covered up to $210; Limited to
once every 12 months
Elective Contact Lenses
(in lieu of lenses/frames)
Limited to $130 every 12
months
Up to $100 every 12 months
Supplemental Testing for Low Vision
(includes evaluation, diagnosis, and
prescription of vision aids where indicated)*
Covered in full
Up to $125
Supplemental Aids for Low Vision**
75% of amount up to $1,000
Annual Pharmacy
Deductible
$100 (generic drugs not
subject to deductible)
$100 (generic drugs not
subject to deductible)
$100 (generic drugs not subject to
deductible)
$100 (generic drugs not
subject to deductible)
No Rx deductible
Participating Retail
Pharmacies
30 day supply
$10 Generic
$35 Preferred Brand
$75 Non-Preferred
Brand
50% (minimum $75)
$10 Generic
40% Preferred Brand ($150 Script Max)
40% Non-Preferred Brand ($300 Script Max)
40% Specialty Medications ($300 Script
Max)*
50% (min $75)
$10 Generic
$30 Brand
Mail Order
Pharmacy**
90 day supply
$10 Generic
$70 Preferred Brand
$150 Non-Preferred
Brand
Not Covered
$20 Generic
40% Preferred Brand ($300 Script Max)
40% Non-Preferred Brand ($600 Script Max)
40% Specialty Medications ($300 Script
Max)*
Not Covered
$20 Generic
$60 Brand
100 day supply
* Specialty medications must be obtained via the Specialty Pharmacy Network to receive in-network pricing.
8
** Anthem’s Reϐill By Mail program allows up to two ills for a maintenance drug at your local pharmacy. After that, you must order those drugs from the Home Delivery
Pharmacy, managed by Express Scripts.
DELTA DENTAL PPO PLANS
Akima offers a choice of two Delta Dental plans, Core and Plus. All percentages shown are
carrier-paid percentages.`
OUT-OF-NETWORK*
9
75% of amount up to $1,000
*Out-of-network bene its shown are maximum reimbursement amounts.
** Maximum bene it for all Low Vision services and materials is $1,000 every 2 years.
COST OF COVERAGE
DELTA DENTAL PPO PLANS
CORE PLAN
PLUS PLAN
Deductible*
(per person)
$50
per covered participant
$50
Family maximum: $100
Calendar Year Maximum
(per person)
$1,250
$3,000
Orthodontic Lifetime Maximum:
$1,500
$2,000
Orthodontics Available to:
Dependents to age 26
Children and adults
Implants Covered?
No
Yes
Delta Dental PPO Providers †
Plan pays:
Plan pays:
Preventive
100%
100%
Basic
80%
90%
Major
50%
60%
Ortho
50%
70%
Delta Dental Premier Providers †
Plan pays:
Plan pays:
Preventive
80%
100%
Basic
70%
80%
Major
50%
50%
Ortho
50%
50%
Out of Network Providers †**
Plan pays**:
Plan pays**:
Preventive
80%
100%
Basic
70%
80%
Major
50%
50%
Ortho
50%
50%
ANTHEM PPO
PLAN
ANTHEM PPO
VALUE PLAN
KAISER HMO
PLAN
DELTA DENTAL
CORE PLAN
DELTA DENTAL
PLUS PLAN
VSP
MONTHLY RATE
MONTHLY RATE
MONTHLY RATE
MONTHLY RATE
MONTHLY RATE
MONTHLY RATE
Employee
$128.71
$118.43
$176.76
$6.63
$9.04
$1.02
Employee + Child(ren)
$222.66
$204.68
$314.86
$18.15
$24.53
$2.19
Employee + Spouse
$253.97
$233.41
$366.65
$12.68
$17.24
$2.04
Family
$347.91
$319.65
$504.75
$26.33
$36.13
$3.50
COVERAGE OPTIONS
TRICARE Supplement
The TRICARE Supplement Plan is available as a supplement to the government’s TRICARE
health insurance for retired military personnel. If you are interested in this coverage, we
provide the convenience of payroll deduction for your premium payments to Selman &
Company. If you need further information please contact Selman & Company at
1-800-638-2610 between the hours of 9:00 a.m. - 7:00 p.m. Eastern Time, Monday - Friday.
Please note: TRICARE Supplement premiums will be deducted from paychecks on a
pre-tax basis.
Provider: Selman & Company
Plan: TRICARE Supplement
Website: www.asicorporation.com
Phone #: 1-800-638-2610
* The Deductible does not apply to diagnostic and preventive services, emergency palliative treatment, X-rays, sealants, and
orthodontic services.
† Preventive care includes services such as routine examines, cleanings, luoride treatments, sealants, bitewing X-rays. Basic
care includes services such as root canals, extractions, and illings. Major care includes services such as bridges, crowns,
implants, and dentures.
**When you receive services from an out-of-network dentist, the reimbursement percentages indicate the portion of Delta
Dental’s nonparticipating dentist fee.
Employee Benefits Guide 2015