2015 Benefits Enrollment Guide ThyssenKrupp Elevator Americas Table of Contents Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Life and Accidental Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Employee Assistance Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Flexible Spending Accounts (FSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 How to Enroll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Contacts and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Addendum: Required Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2 Welcome to 2015 Open Enrollment! Open Enrollment begins November 3 and ends November 14, 2014. This is your once-a-year opportunity to connect with your benefits. Review your options carefully, and then choose the ones that will meet your needs for the coming year. As we move to one common medical plan in 2015, please keep in mind: • This is an active enrollment, which means you need to either waive coverage or choose a new medical plan and take specific steps to enroll. • All employees must make an election for 2015 by November 14. • If you do not make an election, even if it’s to waive coverage, you will automatically be enrolled in the default option: single coverage (no spouse/dependents) in the HRA plan (Health Reimbursement Account), with applicable monthly premiums. Your Choices Last All Year Choose all your benefits carefully, because your elections will last through December 31, 2015. You will not be able to change them during 2015 unless you have a qualifying life event (marriage, divorce, birth or adoption of a child, and so on) and notify your benefits representative within 30 days of the event. Don’t let the deadline pass you by — everyone needs to elect a new medical plan option or waive coverage for 2015 by November 14, 2014. Use Your Power to Choose Take the time to read and understand the materials. Ask questions. Get help from your local benefits representative. Follow the enrollment process outlined in this guide and make your elections by November 14, 2014. Please call “e*source”, your internal benefits line, for enrollment questions at (866) 910-6085. You may also visit www.tk-esource.com. 1 Eligibility You are eligible for the Medical Plan if you are a non-bargaining employee scheduled to work 30 hours or more per week. You can also cover your eligible dependents: • Your legal spouse (recognized for federal tax purposes). • Your dependent children under age 26 (including stepchildren, foster children, legally adopted children and children placed with you for adoption). • Mentally or physically disabled children who are unmarried and rely on you for financial support. Coverage for disabled children requires disability certification from Blue Cross Blue Shield for coverage. 2 Medical The ThyssenKrupp medical plan is designed to promote good health and personal wellbeing for you and your family, and to provide care if you have an unexpected illness or accident. You can elect medical coverage for yourself, your spouse and your children up to age 26 regardless of their marital, financial, or student status. You have three distinct options to choose from: a PPO plan (Preferred Provider Organization), an HSA plan (Health Savings Account), and an HRA plan (Health Reimbursement Account). Although there are differences among the options, they have several things in common. Each one: • Provides coverage for preventive/wellness care, doctor’s office visits, urgent/emergency care, hospitalization, prescription drugs and more. • Is administered by Blue Cross Blue Shield of Illinois, one of the nation’s largest healthcare networks with more than a million providers coast-to-coast. • Allows you to use any doctor, hospital or other healthcare provider; however, when you use in-network providers, you’ll pay less of the cost. 2015 Medical Plan Options The table below provides a high-level summary of how these options compare. PPO PLAN Preferred Provider Organization Lowest out-of-pocket expenses (deductibles, coinsurance) and out-of-pocket maximums Features HSA PLAN Health Savings Account Opportunity to open a tax-advantaged HSA, funded by personal and company contributions Balance rolls over each year (no “use-it-or-lose-it”), and goes with you when you leave the company or retire HRA PLAN Health Reimbursement Account Provides a company-funded HRA to help pay for out-ofpocket expenses Balance rolls over at the end of the year (no “use-it-or-lose-it”), but doesn’t go with you when you leave the company or retire Employee Payroll Contributions Highest of the three options In the middle of the three options Lowest of the three options Deductibles, Coinsurance and Out-of-Pocket Maximums Lowest of the three options In the middle of the three options Highest of the three options For information on the accounts associated with the HSA & HRA, visit www.tkbenefitsconnect.com (Password: tkconnect2015). Spouse Coverage Tobacco Surcharge Any spouse who doesn’t have the option of insurance through his/her own employer is welcome to join the ThyssenKrupp plan without a surcharge. There will be a spousal surcharge of $100 per month for those who have access to health coverage under another employer’s plan and still choose to join our plan. The tobacco surcharge is $40/month per employee and/ or spouse. Some surcharges, such as for tobacco use, are designed to encourage healthy behavior, which helps to lower claims costs. Tobacco use is tied to higher healthcare expenses and to higher costs in a group medical plan overall. 3 Which Plan Is Right for You? You can begin the decision-making process by reviewing your recent medical expenses, and then calculating what your out-of-pocket expenses (deductibles, copays, coinsurance) would have been under the PPO, HSA and HRA. Other factors to consider as you prepare to enroll include: • Employee payroll contributions • Annual deductibles and out-of-pocket maximums • Copay and/or coinsurance percentages • Availability of savings accounts (HSA) • Network participation by your current doctors and hospitals. Call (888) 895-1563 or visit www.bcbsil.com to confirm whether your doctor is included in our network. 4 Your 2015 Medical Plan Options This is a brief overview; not all covered expenses are listed. For full coverage provisions, including a description of waiting periods, limitations and exclusions, please contact Blue Cross Blue Shield at (888) 895-1563. Note: The table is color-coded to show what the plan pays and what you pay. KEY: Plan Pays, You Pay PPO PLAN HSA PLAN HRA PLAN Preferred Provider Organization Health Savings Account Health Reimbursement Account Annual HSA Employer Contribution Individual/Family Not applicable $250/$500 (annual) Not applicable Annual HRA Employer Contribution Individual/Family Not applicable Not applicable $750/$1,500 (annual) EMPLOYER CONTRIBUTIONS PROGRAM BASICS In-Network Out-ofNetwork In-Network Out-ofNetwork In-Network Out-ofNetwork Annual Deductible Individual coverage/Family coverage $600/ $1,200 $1,200/ $2,400 $2,000/ $4,000 $4,000/ $8,000 $3,000/ $6,000 $6,000/ $12,000 Annual Out-of-Pocket Maximum Individual coverage/Family coverage $2,200/ $4,400 $4,400/ $8,800 $4,000/ $8,000 $8,000/ $16,000 $6,000/ $12,000 $12,000/ $24,000 Preventive Care (Routine annual physicals, well-baby exams, immunizations and other preventive health services) 100% 60% after deductible 100% 60% after deductible 100% 50% after deductible Office Visit: Generalist (Family practice, internist, OB/GYN, pediatrician) $30 copay, then 100% 60% after deductible Office Visit: Specialist $50 copay, then 100% 60% after deductible 80% after deductible 60% after deductible 70% after deductible 50% after deductible Maternity Services $30 copay, then 100% 60% after deductible Medical/Surgical Services 80% after deductible 60% after deductible Hospital Admission Deductible $0 $0 $0 $0 $0 $0 Inpatient & Outpatient Hospital Services 80% after deductible 60% after deductible 80% after deductible 60% after deductible 70% after deductible 50% after deductible PHYSICIAN SERVICES HOSPITAL SERVICES Outpatient Emergency Care (Accident or illness) $150 copay, then 100% 80% after deductible 70% after deductible 5 Prescription Drug (Rx) Coverage PPO PLAN HSA PLAN HRA PLAN Preferred Provider Organization Health Savings Account Health Reimbursement Account $0 Rx expenses apply to medical deductible Rx expenses apply to medical deductible $3,000/$6,0001 Rx expenses apply to medical out-of-pocket maximum Rx expenses apply to medical out-of-pocket maximum Generic Retail (30-day supply)/ Mail order (90-day supply) $10/$20 $10/$20 after deductible3 $10/$20 after deductible3 Formulary Brand Name Retail (30-day supply)/ Mail order (90-day supply) $35/$70 $35/$70 after deductible3 $35/$70 after deductible3 Non-Formulary Brand Name Retail (30-day supply)/ Mail order (90-day supply) $60/$120 $60/$120 after deductible3 $60/$120 after deductible3 PROGRAM BASICS Annual Prescription Drug Deductibles Annual Prescription Drug Out-of-Pocket Maximum Individual coverage/ Family coverage PRESCRIPTION DRUGS2 Separate from and in addition to medical out-of-pocket maximum. For mail order prescriptions, the 90-day prescription is available for the cost of a two-month supply (PPO only). 3 Covered member pays 100% of prescription until the deductible is met. 1 2 6 Dental The dental plan, administered by Delta Dental Insuarnce, covers a wide range of services. Providers in the Delta Preferred and Delta Premier networks have agreed to discounts on covered services, which means you will pay less out of pocket. To find a network provider, call Delta Dental Insurance at (800) 521-2651, or visit www.deltadentalins.com. Here is a brief summary of what the plan covers and pays. PLAN PAYS BENEFITS In-Network Out-of-Network $50 for each eligible person $50 for each eligible person $1,250 for each eligible person $1,250 for each eligible person Calendar Year Deductible Calendar Year Benefit Maximum DIAGNOSTIC & PREVENTATIVE CARE (NOT SUBJECT TO THE DEDUCTIBLE) Oral Exam 100% of allowed amount 80% of allowed amount 100% of allowed amount 80% of allowed amount 100% of allowed amount 80% of allowed amount 100% of allowed amount 80% of allowed amount 100% of allowed amount 80% of allowed amount Fillings 80% of allowed amount after deductible 50% of allowed amount after deductible Denture Repairs 80% of allowed amount after deductible 50% of allowed amount after deductible 80% of allowed amount after deductible 50% of allowed amount after deductible 80% of allowed amount after deductible 50% of allowed amount after deductible When administered by a dentist for a covered oral surgery procedure 80% of allowed amount after deductible 50% of allowed amount after deductible Endodontics (Root Canals) 80% of allowed amount after deductible 50% of allowed amount after deductible Periodontics (Gum Treatment) 80% of allowed amount after deductible 50% of allowed amount after deductible Limited to one in a calendar year X-Rays Full mouth x-rays provided not more than once each 5 years. Bitewing x-rays once each 6 months for enrollees under age 18; once each 12 months for enrollees age 18 and over Prophylaxis (Cleaning) Limited to twice in a calendar year Fluoride Application Limited to enrollees to age 19 Space Maintainer RESTORATIVE (SUBJECT TO THE DEDUCTIBLE) Sealants Limited to dependent enrollees to age 15 on permanent molars only ORAL SURGERY (SUBJECT TO THE DEDUCTIBLE) Extractions General Anesthesia CROWNS & PROSTHODONTICS (SUBJECT TO THE DEDUCTIBLE) Crowns 50% of allowed amount after deductible 50% of allowed amount after deductible Bridges 50% of allowed amount after deductible 50% of allowed amount after deductible Dentures 50% of allowed amount after deductible 50% of allowed amount after deductible ORTHODONTICS (NOT SUBJECT TO THE DEDUCTIBLE) Orthodontics Lifetime maximum of $1,000 per child Limited to dependent children to age 26 50% of allowed amount 50% of allowed amount 7 Vision Vision Service Plan (VSP) administers the vision plan. Network providers have agreed to discount on covered exams and eyewear. That means when you go in-network, you will pay less. Find a network provider in your area by visiting www.vsp.com. BENEFITS Eye Exams Limited to one in a calendar year Eyeglass Frames* Limited to one in a calendar year Eyeglass Lenses* Limited to one in a calendar year Contact Lenses* Limited to one in a calendar year PLAN PAYS In-Network Out-of-Network $20 co-payment Up to $50 will be reimbursed Limited to one in a calendar year VSP provides a $130 allowance for frames. If the patient selects a frame that exceeds the plan allowance, VSP offers a 20% discount off the amount over the retail allowance. VSP’s standard lenses are covered in full (less any applicable plan co-payment), including glass or plastic single vision, bifocal, trifocal, or other more complex lenses necessary for the patient’s visual welfare. Covered up to $130 allowance, applied to the contact lens exam (fitting and evaluation) and lenses. VSP providers also provide a 15% discount off their professional services for prescription contact lenses. OUT- OF- NETWORK BENEFIT ALLOWANCE Single-Vision Lenses Up to $55 will be reimbursed Bifocal Lenses Up to $75 will be reimbursed Trifocal Lenses Up to $100 will be reimbursed Frames Up to $70 will be reimbursed Contact Lenses Up to $105 will be reimbursed The following items are excluded under this plan: • Plano lenses (non-prescription) • Two pairs of glasses instead of bifocals • Replacement/repair of lost/broken lenses or frames • Medical or surgical treatment • Orthoptics, vision training, or supplemental testing • Expenses associated with securing materials 8 Life and Accidental Death Coverage ThyssenKrupp Elevator provides employees with basic life and AD&D insurance. These coverages can give your family additional financial security during difficult times. The Hartford is our partner in offering these coverages. BASIC LIFE AND AD&D BENEFITS Basic Life and AD&D are paid for by ThyssenKrupp Elevator. Fulltime, active, bargaining unit employees receive: • Life insurance equal to two times base salary (not to exceed $1,000,000), rounded up to the next higher $1,000 if not already a multiple of $1,000. • Accidental death and dismemberment insurance equal to two times base salary (not to exceed $1,000,000), rounded up to the next higher $1,000 if not already a multiple of $1,000. VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT ELECTION • Voluntary AD&D is a separate benefit that can be elected with the Supplemental Life. Coverage is equal to the coverage amount elected for Supplemental Life. • If you are electing any additional coverage during open enrollment, please contact e*source at (866) 910-6085 for the proper EOI forms. Employee Assistance Program (EAP) On January 1st following the date you obtain age 65, your benefit amount will be reduced by 8% of the original amount and reduced by an additional 8% at each January 1st, until reaching age 71 when the benefit will be 50% of the original amount. ThyssenKrupp Elevator is increasingly aware of the stress our families face during these troubling economic times, both at work and at home. Our EAP, offered through LifeWorks, offers free, confidential, professional counseling and consultation services. Through the EAP, employees and their family members have access to qualified consultants 24-hours a day, 365 days a year. You may call for any number of reasons: crisis intervention assistance, short-term problem resolution and referrals, information, assessment, or action planning. SUPPLEMENTAL LIFE BENEFIT ELECTION Access to this benefit is convenient and completely confidential, via the web at www.lifeworks.com (User ID: thyssenkrupp, Password: tke) or via phone at 888-267-8126. Supplemental Life is an insurance program that provides employees the opportunity to choose additional protection that best suits them and their family members. You purchase the plan through convenient payroll deductions. • You may elect benefit coverage in increments of 1x, 2x, 3x, 4x, or 5x your annual salary up to a maximum of $1,000,000. You may elect up to 2x your annual salary up to $750,000 without providing a Evidence of Insurability (EOI) as long as you apply within 30 days of your hire date. Any change in your supplemental coverage after that time will require a EOI. • Your spouse is eligible for coverage in increments of $10,000, ranging from $10,000 to $100,000 not to exceed 50% of your combined Basic Life and Supplemental Life elections. You may elect up to $20,000 of Spouse Life coverage without providing a EOI as long as you apply within 30 days of your hire date. Any change in your Spouse Life coverage after that time will require a EOI. • Dependent child(ren) six months to age 26 are eligible for coverage in increments of $2,000, ranging from $2,000 to $10,000. Disability In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income. SHORT-TERM DISABILITY Benefits Begin: • For disability caused by injury: on the 1st day of disability. • For disability caused by sickness: on the 8th consecutive day of disability. 9 For hospital confinements of 24 hours or more, benefits commence on the first day of hospital confinement. You are not eligible to receive short-term disability benefits if you are receiving Workers’ Compensation benefits. Weekly Benefit: • For weeks 1 to 6: 100% of your pre-disability earnings, reduced by other income benefits. • For weeks 7 to 25: The lesser of: • 60% of your pre-disability earnings; or • $3,500, reduced by other income benefits. • Minimum weekly benefit: $25. • Maximum duration of benefits payable: 25 weeks. LONG-TERM DISABILITY Monthly Benefit: • 60% of monthly earnings (monthly base salary excluding overtime and bonus) up to plan maximums • Begins after 180 consecutive days of disability • Minimum monthly benefit: $100 • Maximum monthly benefit: See plan documents • Maximum benefit duration: Benefits continue while you remain disabled, up to normal retirement age, if you are disabled prior to age 63. Refer to the Summary Plan Description (SPD) for reductions in benefit duration for disabilities occurring at age 63 and beyond. Flexible Spending Accounts (FSA) With an FSA, you can set aside pre-tax dollars to pay for eligible expenses. • Healthcare FSA. Use your account to pay or reimburse yourself for out-of-pocket expenses not covered by the medical, prescription drug, dental and vision plans: deductibles, copays, coinsurance. You can contribute up to $2,500 per year. • Limited Purpose FSA. The Limited Purpose FSA is the same as the Healthcare FSA, except only non-medical services (such as dental, vision, and hearing expenses) may be reimbursed. The Limited Purpose Account is offered for those who elect to participate in the Health Savings Plan and establish a Health Savings Account. • Dependent Care FSA. Get reimbursed for work-related daycare for your children up to age 13, for disabled children of any age, and dependent parents who live with you. You can contribute up to $5,000 per year. FSAs have a use-it-or-lose-it provision. You must incur all eligible expenses between January 1 and December 31. Any unused balance will be forfeited, so plan carefully. Benefit amounts are offset by other disability income. Benefits for a mental illness or substance abuse disability, if not confined, are payable for a total of 24 months for all such disabilities during your lifetime. Benefits will not be paid for disabilities resulting from pre-existing conditions. Refer to the plan documents for other policy provisions and limitations. 10 When to Enroll The Open Enrollment period runs from November 3, 2014, through November 14, 2014. The benefits you elect during open enrollment will be effective from January 1, 2015, through December 31, 2015. How to Enroll The first step is to review your current benefit elections. Visit e*source Self Service at www.tk-esource.com. e*source is a secure website that provides online acess to your personal data and benefits information. Once online, verify your personal information or make necessary changes. Step-by-step instructions for e*source Self Service are included on the following pages. For assistance with online enrollment, call toll free at (866) 910-6085. NOTE: Once you have made your elections, you will not be able to change them until the next open enrollment period, unless you have a qualified change in status. 11 Step 1: Go to www.tk-esource.com. Step 2: Click on either “e*source Self Service at Work” or “e*source Self Service at Home” depending on where you are accessing your account. Step 3: Log onto e*source Self Service with your user name and password. (For assistance, call e*source at (866) 910-6085.) Step 4: From the left side of the screen, click once on “TKE Employee Self Service.” 12 Step 5: From the left side of the screen, click once on “My Benefits,” then “Benefits.” Step 6: Add the dependents you will cover under your medical plan and anyone that you would like to list as a beneficiary for your life insurance. When adding a dependent and/or beneficiary, list your hire date as their effective date. When you are done, click “Apply.” Continue adding dependents and/or beneficiaries until everyone is listed. Then click “Next.” 13 Step 7: To elect your benefits, click on “Update Benefits.” Step 8: Select the Plans and Options you would like and click on the select the box next to your option. When you have elected all the benefits you would like, click “Next.” Step 9: Select the dependents you would like to cover under each plan you have selected, then click “Next.” Step 10: Choose your beneficiaries by listing the percent of your life insurance you would like to give each one, then click “Next.” Please note: Although your name is listed, you are not able to elect yourself as a beneficiary. 14 Step 11: This page shows which plans require certifications. No action is necessary on this page. Click “Next” to proceed. Step 12: Review your elections, covered dependents and beneficiaries. If all is correct, click Finish. 15 Contacts and Resources BENEFIT ADMINISTRATOR PHONE WEBSITE General Benefits Info/ Enrollment Assistance e*source (866) 910-6085 www.tk-esource.com Medical Blue Cross Blue Shield of Illinois (888) 895-1563 www.bcbsil.com Prescription Drug Coverage CVS Caremark (888) 886-8520 www.caremark.com Dental Delta Dental Insurance (800) 521-2651 www.deltadentalins.com Vision Vision Service Plan (VSP) (800) 877-7195 www.vsp.com Short-Term Disability The Hartford (800) 445-9057 www.thehartfordatwork.com Flexible Spending Accounts Discovery Benefits (866) 451-3399 www.discoverybenefits.com Employee Assistance Plan Lifeworks EAP (888) 267-8126 www.lifeworks.com 16 Addendum: Required Notices Summary of Material Modification (SMM) Please note that the Anthem Blue Cross Blue Shield plan is being amended and no medical benefits will be available from this plan after December 31, 2014. Instead, effective January 1, 2015, medical benefits from your company will be offered under the ThyssenKrupp North America Health and Welfare Plan. Please see the enclosed open enrollment materials for more details. Women’s Health and Cancer Rights Act of 1998 Notice As required by the Women’s Health and Cancer Rights Act of 1998, each medical plan sponsored by ThyssenKrupp North America provides coverage for the following breast reconstruction procedures in connection with mastectomies: • Reconstruction of the breast that was operated on; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas. Coverage is provided in a manner determined in consultation with the attending physician and the patient. The deductible, coinsurance and copayment requirements that apply to other covered services also apply to these post-mastectomy reconstructive and treatment services. Special Enrollment Rights If you decline enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in a ThyssenKrupp North America medical plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). You must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). The plan will also allow a special enrollment opportunity if you or your eligible dependents either: • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or • Become eligible for a state’s premium assistance program under Medicaid or CHIP. For these enrollment opportunities, you will have 60 days — instead of 30 — from the date of the Medicaid/CHIP eligibility change to request enrollment in the plan. Note that this new 60-day extension doesn’t apply to enrollment opportunities other than the Medicaid/CHIP eligibility change. Also, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents in a ThyssenKrupp North America plan. You must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption. To request special enrollment or to learn more, contact e*source at (866) 910-6085 or [email protected]. Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices for Protected Health Information The ThyssenKrupp North America Health and Welfare Plan privacy notice describes how protected health information about you may be used or disclosed and how you can obtain access to your protected health information. To view the HIPAA Privacy Notice, please visit the 2015 enrollment microsite at www.tkbenefitsconnect.com. To request a printed copy of your HIPAA rights, please contact the Director, Compensation and Benefits, ThyssenKrupp North America, Inc. 17 You have the power to choose what is right for you and your family. 18
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