New Employee Benefits Orientation 2013 Plan Year October 2012.
2013 Employee Benefits Guide - tk-esource.comtk-esource.com/downloads/2013 Open...
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2013 Employee Benefits Guide Walnut and Computerized Elevator Control Employees ThyssenKrupp Elevator Americas
Transcript of 2013 Employee Benefits Guide - tk-esource.comtk-esource.com/downloads/2013 Open...
2013 Employee Benefits GuideWalnut and Computerized Elevator Control Employees
ThyssenKrupp Elevator Americas
2 2013 Benefits
Who is EligiblE?
If you are a full-time non-bargaining unit employee (working 30 or more hours per week), you are eligible to enroll in the benefits described in this guide. Your eligible dependents may be enrolled as well. The definition of eligible dependent is described in detail on page 6.
hoW to Enroll
The first step is to review your current benefit elections.
Fill out the enclosed Enrollment Form and return it to your Human Resources Department by Friday, November 16, 2012.
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, as detailed below.
WhEn to Enroll
The Open Enrollment period runs from November 5, 2012, through November 16, 2012. The benefits you elect during Open Enrollment will be effective from January 1, 2013, through December 31, 2013.
QualifiEd ChangE in status
Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in your spouse’s employment status. Status changes must be reported to e*source within 30 days of the change.
Qualified changes also include loss of coverage under a Medicaid or State Plan or becoming eligible for group health plan premium assistance under a Medicaid or State Plan. These status changes must be reported to e*source within 60 days of the date coverage terminates under a Medicaid or State Plan, or within 60 days after you or your dependent(s) is determined to be eligible for Medicaid or State premium assistance. Unless you have one of these qualified events take place during the 2013 calendar year, you cannot make changes to the benefits you elect until the next open enrollment period.
Enrolling for the 2013 Plan Year
Walnut and Computerized Elevator Control Employees 3
Summary of Material Modifications as of January 1, 2013
Corporate Health Plans (Excluding Middleton Hourly)
80/60 PPo Plan – sPECialist CoPay, dEduCtiblE and out-of-PoCkEt MaxiMuM ChangEs
The office visit copay for specialists is $35. The in-network calendar year deductible is $600 for employee-only coverage and $1,200 for family coverage ($700 individual and $1,400 family for out-of-network services). The out-of-pocket limit for in-network services is $2,600 for employee-only coverage and $5,200 for family coverage ($5,000 individual and $10,000 family for out-of-network services).
hEalth savings Plan oPtion
A new health plan is being offered. It is called the Health Savings Account Plan and consists of a medical plan with a high deductible that applies to all health care expenses (including office visits and prescription drugs), except the plan pays 100% of preventive care. Preventive care services are defined under the Affordable Care Act and include routine physicals, routine colonoscopies, and women’s contraceptives, among others. The complete list is available at www.healthcare.gov/law/resources/regulations/prevention/index.html.
If you enroll in the Health Savings Account Plan, you can set up a personal Health Savings Account (HSA). You and ThyssenKrupp Elevator may contribute to the HSA on a pre-tax basis and these funds are owned by you and may be used to cover your unreimbursed health expenses. The medical plan uses the same network of providers as the PPO plan. The deductible is $2,200 for single coverage and $4,400 for family coverage. Once the deductible is met, the plan pays 80% of remaining covered network expenses up to $1,000 out-of-pocket, then 100% for the rest of the calendar year. ThyssenKrupp Elevator will contribute $250 to your HSA if you elect employee only coverage and $500 if you cover dependents. It will also match your contribution to the HSA up to an additional $250 for employee-only coverage and $500 for family coverage. Further details are provided in this booklet and during enrollment. This plan is not grandfathered under the Affordable Care Act.
tErMination of EPo, 70/50 PPo, and hra Plans
Only two plan options will be offered in 2013 — the 80/60 PPO Plan and the Health Savings Account Plan (HSA). The EPO, PPO 70/50, and HRA plans will no longer be available.
$2500 MaxiMuM annual Contribution to thE hEalth CarE flExiblE sPEnding aCCount
The maximum annual contribution to the Health Care Flexible Spending Account has been reduced to $2,500 as required by federal legislation.
What’s New for 2013?
4 2013 Benefits
hra rollovEr Plan
Remaining account balances from the Health Reimbursement Account (HRA) plan will be rolled over to a separate program. Your account balance will be available to you to pay for unreimbursed dental and vision expenses. The program will be administered by Discovery Benefits. You will need to pay your dental and vision expenses then submit claims for reimbursement from Discovery Benefits. The account balances will be available to you through 2014 if you remain an active employee or while on COBRA.
In order to provide time for Anthem to process claims for 2012, the account balances won’t be available for reimbursement until March 1, 2013. However, you may submit claims for expenses from January 1, 2013.
your Cost for 2013
ThyssenKrupp strives to provide quality benefits packages at affordable rates. For 2013, there are changes to the medical and vision contributions. The Dental contribution will remain the same as 2013.
dEntal
There are no changes to the plan or the contributions to the dental plan for 2013. The Delta Dental schedule of benefits is enclosed.
vision
There are no changes to the vision plan. However, there are some changes to the contributions for 2013.
for additional inforMation
Visit www.tk-esource.com.
Walnut and Computerized Elevator Control Employees 5
2013 Benefits Enrollment Form
M F
80/60 PPO PlanHSA Plan
HSA Account (set aside pre-tax dollars)
Opt-Out Credit (Medical Only-do not check any boxes above)
Delta Dental
$
If you answered YES to both questions above and did not complete the Coordination of Benefits section, the Spousal Surcharge of $30 per month will apply
This Policy Covers?Y N
Address City State Y N
Employee Signature Date
Standard Health Care FSA (for PPO)
Dependent Care FSALimited Purpose Heath Care FSA (for HSA)
Elect
$
Notice Regarding Special Enrollment Rights: If you are declining enrollment in the medical plan for yourself or your dependents (including your spouse) because of other health insurance coverage you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 30 days after your coverage ends. In addition, if you have a new dependent as a result of marriage, birth adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement of adoption forwarding to us proper certification (ex. birth certificate)
Decline Annual ContributionFLEXIBLE SPENDING ACCOUNTS
e*source: Phone: 866-910-6085 / Fax: 866-848-3351 / email: [email protected]
I have carefully read this application and agree to its terms. This information above is true and complete and are representations made to issue my insurance coverage. I understand any misrepresentation constitutes fraud and may be subject to corrective action.
$
ADD Y/NSexM/F
Date ofBirthDEL
MedicalADD DEL
DentalDELADD
11605 Haynes Bridge Rd, Suite 650 Alpharetta, GA 30009
Dep
Date of Divorce
Family
Home Phone Number
Work Phone Number
Date of MarriageDivorced
Name
Married
Soc. Sec. #
Sex Marital StatusSingle
Sole
Home Address (Street)
RE-HIRE Re-hire date
Social Security NumberDate of Birth
___/___/___
Employer Use Only:Effective Date:
Employee Name (Last, First, MI)
Reason for ChangeEMPLOYEE COMPLETE: CHANGE
Completed By:Division:
2013 Benefits Enrollment Form
OPEN ENROLLMENTNEW HIRE
City, State & Zip
Date of Hire
Dep
Employee +1
$1,000 per year prorated (attach proof of other medical coverage)
Individual
Support
Effective Date
SPOUSAL SURCHARGE (Please answer both questions)Yes No
Policy Number
YesIs your spouse eligible for coverage under his/her Employer's Medical Plan?
To:
No
YouInsurance of Company Zip
COORDINATION OF BENEFITS Are you, your spouse, or any children listed below, covered by any other health insurance plan?
Is your spouse enrolled in TKE's Medical Plan for 2013 as your dependent?
Yes No If yes, please complete the following:
VSP Vision
From:Name of Policyholder
Dep
Spouse
Elect Annual Contribution
COVERAGE SELECTION
DEPENDENT INFORMATION:
(Selected coverage requires appropriate box checked)
DisabledVision
HSA Catch-up (If 55 or older, annual max $1,000 )
Waive (no account)
$HSA Account (annual max: $2,750/EE Only; $5,450/EE+1 or Family)
Dependent
$
Dep
6 2013 Benefits
your bEnEfits Plan
ThyssenKrupp Elevator offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.
Eligibility
You are eligible to enroll in the benefits described in this guide if you are an active, full-time, non-bargaining unit employee working 30 or more hours per week. Your benefits become effective on the first day following 30 days of active employment, provided you enroll in the plan within 30 days of your date of hire into an eligible class. Time worked for ThyssenKrupp Elevator in an ineligible class, such as a part-time employee, will be counted toward the 30 days. If you are not actively at work on the date your coverage would otherwise become effective, your benefits will not begin until the date you return to active employment. For purposes of satisfying the waiting period for health benefits, you will be considered actively at work if you are absent due to illness, injury, or disability.
If you are enrolled as an employee in this plan, your eligible dependents may also participate. Eligible dependents include your lawful spouse, as defined in the benefit Summary Plan Description (SPD), and children. Dependent children remain eligible up to the last day of the month in which they attain age 26, however, the child may not be eligible for other employer-sponsored health insurance, other than through his/her parents.
NOTE: Please refer to the SPD or contact e*source for definitions of children, physically/mentally challenged dependents, spouse, and information regarding COBRA 1993 and Qualified Medical Child Support Orders.
dEPEndEnt vErifiCation
In order to ensure the dependents enrolled in our plans are eligible for coverage, we require employees to submit documentation as proof of eligibility for all dependents covered under the plan. If we discover an employee has covered an ineligible dependent, the dependent will not have coverage. Any erroneous benefit payments made for any ineligible dependent must be refunded by the employee.
Examples of acceptable documentation include copies of a marriage certificate for a spouse, birth certificate for children, adoption agreement, and court orders.
ChangEs in Plan PartiCiPation
Unless you have a qualified change in status, you cannot make changes to the benefits you elect (excluding Life and AD&D) until the next open enrollment period. Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of a spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in spouse’s benefits or employment status.
Status changes must be reported to e*source within 30 days of the change in order to change, if applicable, the payroll deductions. Qualifed changes also include loss of coverage under a Medicaid or State Plan or becoming eligible for group health plan premium assistance under a Medicaid or State Plan. These status changes must be reported to e*source within 60 days of the date coverage terminates under a Medicaid or State Plan, or within 60 days after you or your dependent(s) is determined to be eligible for Medicaid or State premium assistance.
Welcome to Your Benefitsfor Plan Year 2013
Walnut and Computerized Elevator Control Employees 7
ThyssenKrupp Elevator remains committed to providing our employees with a comprehensive, competitive healthcare package. As we all know, healthcare and prescription drug costs in the U.S. continue to escalate at double-digit rates annually. Our objective is to provide a selection of benefit choices that meet your individual needs.
Enclosed you will find summary information regarding the ThyssenKrupp Elevator benefit programs for 2013. We encourage you to review this information carefully before making your benefits decisions.
MEdiCal Plan oPtions
ThyssenKrupp Elevator provides two healthcare plan options. Anthem Blue Cross Blue Shield (BCBS) is our healthcare partner for 2013. Access to the BCBS network of providers means that nearly 100% of our employees will receive healthcare services from BCBS network providers. This translates into significant discounts for medical services as well as lower out-of-pocket costs for you and your family. We expect that BCBS’s network, discounts, and services will continue to help us all manage our healthcare costs well into the future. The most current listing of providers is available online at www.anthem.com.
To help you understand the benefits that are available under each of the plans, we have enclosed a side-by-side comparison of the two options.
PrEsCriPtion drug PrograM
We are pleased to provide a comprehensive, well-designed prescription drug benefit. Enclosed you will also find a benefit overview that describes how the CVS/Caremark Prescription Drug program works. The Mandatory Generic Prescription Drug program, which was implemented to encourage the use of lower cost generic drugs, is a feature of this benefit. In addition we have implemented two programs, the Step Therapy Program and the Maintenance Choice Program. Detailed information on both programs is available in the Prescription Drug Coverage section of this book.
We encourage you to talk to your doctor about generic and formulary drugs that can save you money. We also encourage you to use the CVS/Caremark website to monitor your prescription usage, compare generic vs. brand name prices, confirm your mail-order receipt and shipment, and endeavor to learn more about drugs you may be taking (as well as the potential interactions between them).
dElta dEntal Plan
ThyssenKrupp Elevator is pleased to offer comprehensive dental benefits. Enclosed is a Schedule of Benefits that outlines the coverage provided by Delta Dental.
vsP vision Plan
The company considers vision care to be part of a comprehensive healthcare package. We provide vision benefits through Vision Service Plan (VSP). Enclosed is a Schedule of Benefits that outlines the benefits provided in this plan.
Healthcare Summary:Our Comprehensive Package
8 2013 Benefits
lifE & aCCidEntal dEath Plan
ThyssenKrupp Elevator offers several basic and supplemental life insurance plans through The Hartford. These programs provide additional financial security during difficult times. Additional detail concerning these plans follows.
voluntary lifE Plans
For additional protection, additional life insurance, dependent life insurance, and accidental death and dismemberment coverage can be purchased by the employee. ThyssenKrupp partners with The Hartford to offer these coverages. During open enrollment you can add or change your Voluntary Life, AD&D, and Dependent Life coverages. If you are adding or increasing any of these coverages, you may be required to get approval by submitting a Evidence of Insurability (EOI). You will need to e-mail or call e*source for the form.
disability Plan
The company is pleased to offer income replacement in the event you become disabled from a non-Workers’ Compensation injury or sickness. The plan provides income protection long-term disabilities. More information regarding these Hartford plans follows.
EMPloyEE Contributions for 2013 bEnEfit Plans
Our goal is to provide comprehensive benefit choices with different levels of employee cost to permit our employees to choose the plan that best satisfies their personal needs. Each year plan costs are evaluated, and costs for the coming year are estimated based on several factors.
sPousal surChargE
Spousal surcharges are fees employees pay to include their spouses as dependents when the spouse has coverage available through their own employer, but declines that coverage. As healthcare costs continue to increase, a growing number of employers are implementing such spousal surcharges.
Spousal coverage is a key cost driver in health plans, therefore, the Spousal Surcharge of $30 per month will apply and be deducted from your pay if your spouse is enrolled in TKE’s medical coverage and is eligible for coverage under his/her employer’s medical plan but has declined that coverage. Please note: the Spousal Surcharge does not apply if your spouse works for TKE.
It is very important to compare plan benefits, out-of-pocket costs and payroll contributions of both employers’ plans before deciding which plan you or your spouse will enroll in. The annual open enrollment period is the ideal time to consider your elections.
Walnut and Computerized Elevator Control Employees 9
oPt-out CrEdit oPtion
In today’s economic environment, many families have dual working spouses with healthcare coverage available to them by both employers. As healthcare costs continue to skyrocket, most employers are seeking ways to control these costs by implementing contribution incentives. Therefore, we are pleased to continue to offer our Opt-Out Credit Option.
If you are already or choose to be covered under another family member’s medical plan for 2013, you may waive coverage under the ThyssenKrupp Elevator Medical Plan and receive an Opt-Out Credit. The Opt-Out Credit amount is $1,000 per year and will be paid to you on a pro-rated basis each payroll period. Employees electing to opt out of coverage must do so during the enrollment process, and will be required to submit verification of other coverage (copy of ID card or application from other plan) to be eligible to receive the Opt-Out Credit amount. If your spouse works for ThyssenKrupp Elevator AND you are enrolled as a dependent under his/her coverage (excluding the NEI Benefit Plan), you are not eligible to receive the Opt-Out Credit. The Opt-Out Credit will not go into effect until proof of other coverage is submitted to the e*source team.
It is very important to compare the plan benefits, out-of-pocket costs, and payroll contributions of both employers’ plans before deciding which plan you will enroll in. The annual open enrollment period is the ideal time to consider your elections.
NOTE: If you wish to enroll for the first time or continue to participate in the Opt-Out Credit, you MUST enroll or re-enroll for the Plan Year 2013. This enrollment must be completed during your online enrollment.
PrE-tax Payroll dEduCtions
The pre-tax program allows employees to pay medical/dental/vision payroll contributions with “pre-tax” dollars, saving employees money and taxes. For example, if you contribute $2,000 towards family medical/dental premiums, based on a combined 25% tax rate, you save $500 in taxes. All employees are automatically enrolled in this program, unless you submit a “waiver” form. Please contact e*source at 866-910-6085 for a form.
flExiblE sPEnding aCCounts
The Healthcare and Dependent Care Flexible Spending Account Programs are offered to reduce out-of-pocket cost for our employees. These programs allow employees to set aside money through pre-tax deduction to pay for out-of-pocket expenses, saving employees tax dollars.
10 2013 Benefits
vHealthcare Flexible Spending Account
This program allows you to set aside up to $2,500 through pre-tax payroll deduction to pay for anticipated out-of-pocket healthcare cost not covered by the medical, dental, or vision insurance (deductibles, co-insurance, dental work, vision care, prescriptions and over-the-counter drugs, etc).
There are two options for the Healthcare FSA:
· Standard Healthcare FSA – For those employees who enroll in the PPO 80/60, you may elect a traditional FSA, which allows you to set aside up to $2,500 through pre-tax payroll deduction to pay for anticipated out-of-pocket healthcare costs for medical, dental, and/or vision insurance.
· Limited Purpose FSA – For those employees who chose to enroll in the HSA Plan, you may only use FSA funds to cover dental and vision only. The Limited Purpose FSA will allow you to set aside up to $2,500 through pre-tax payroll deduction to pay for anticipated out-of-pocket costs for dental and/or vision insurance only. Medical expenses will be covered by the HSA Account.
REMINDER: Over-the-counter drugs or medicines (except insulin) are reimbursable only if the patient receives a prescription from a physician or other health care provider as allowed under state law.
Dependent Care Flexible Spending Account
This program allows you to set aside up to $5,000 through pre-tax payroll deduction to pay for anticipated dependent day care (children or elderly) expenses.
NOTE: As required by law, if you wish to enroll of the first time or to continue to participate in the FSA healthcare or dependent care accounts you MUST enroll or re-enroll for the Plan Year 2013. This enrollment must be completed during your online enrollment.
EMPloyEE assistanCE PrograM (EaP)
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.
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.
WEllnEss PrograM
Integral to our benefits package is Elevate Your Health, our corporate wellness program. This program includes education and activities to promote healthy lifestyles for you and your family. The goal is to bring about increased awareness which can bring about lifestyle changes.
This wellness initiative is important because we want to keep you and your families well. Studies show that 70% of chronic diseases are related to poor lifestyle choices which are preventable. Not only is it the right thing to do, but studies also show that healthy employees are happier and more productive. Since we all spend so much time at work, the workplace is a logical place to provide information, encouragement and support for improving your health and well-being. Successful wellness programs help reduce health care costs. When that happens, it’s a win/win situation. And as we’ve always heard, an ounce of prevention is worth a pound of cure.
Look for more communication pieces throughout the year!
Walnut and Computerized Elevator Control Employees 11
PrE-Existing Condition liMitation
Pre-existing condition limitations do not apply to plan participants under age 19. A pre-existing condition limitation will continue to apply to all others during the first 12 months (18 months if a late enrollee) of enrollment in the health plan. You are entitled to a reduction or elimination of exclusionary periods of coverage for pre-existing conditions under the plan if you have creditable coverage from another plan. You should be provided a Certificate of Creditable Coverage, free of charge, from your group health plan or health insurance carrier when you lose coverage under that plan, when a person becomes entitled to elect COBRA continuation of coverage, or when COBRA continuation ceases if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a pre-existing condition exclusion. This limitation does not apply to individuals covered by our plan prior to 1/1/10 and is not applied to pregnancies.
your rEsPonsibilitiEs
• Review enrollment materials.
• Complete the enrollment process, including any necessary waivers, within specified time frame
• Complete the Section 125 Waiver, if you wish to make your payroll contributions on an after-tax basis
• Provide proof of eligibility for dependents, if applicable
• Enroll or re-enroll in the Flexible Spending Accounts, if applicable (participation does not carry forward from year to year)
• Opt out of coverage if you are declining coverage under our plan and wish to receive the Opt-Out Credit (requires action on your part)
• Provide proof of other coverage, if applicable (to receive the Opt-Out Credit)
Coordination of bEnEfits
Coordination of Benefits sets out rules for the order of payment of covered charges when this plan and one or more other plans providing health coverage – including Medicare – are paying. When you or your dependents are covered by our plan and another plan, our plan will coordinate benefits when claims are received.
The plan that pays first according to the rules, outlined in your certificate of coverage, will pay as if there were no other plan involved. If this plan is secondary, this plan will pay the balance due up to the allowed benefit. For example, if the primary health plan benefit is 70% of the allowed amount and this plan’s allowed benefit is 80%, this plan as secondary payor would pay an allowable charge of 10%. If the primary plan pays an amount that is equal to or greater than what this plan would have paid as primary, then this plan, as secondary payor, would not pay further benefits.
subrogation
This plan reserves the right to be reimbursed for benefits paid under this plan if the person for whom benefits are paid has a right to recover these benefits from a third party. This is called subrogation. The purpose of this provision is to help ThyssenKrupp Elevator continue providing high-quality healthcare benefits, while controlling the costs of the plan. By accepting benefits under this plan, you specifically acknowledge the plan’s right of subrogation and reimbursement.
12 2013 Benefits
360° hEalth®
Whether you’re the picture of health, living with a chronic condition, or somewhere in between, Anthem’s plans give you the tools, resources, and support to help you live healthier. Through a program called 360° Health®, you’ll find the things you’ve come to expect, such as:
• anthem.com: Search for a doctor, check your claims, and track your health account online.
• MyHealth Assessment: Identifying potential health risks is important, that’s why we encourage you to take an online checkup. Just click the MyHealth Assessment link after you log on to anthem.com.
• My Health Coach and Condition Care: With these programs, you’ll continue to get the support you’ve come to expect from your Personal Health Coach, so you can better manage chronic conditions, such as high blood pressure, asthma, or diabetes.
• FutureMoms: This program helps a mom-to-be prepare for baby.
• Healthy Lifestyles: If you need help losing weight or quitting smoking, you have free and confidential access to a customized program through Healthy Lifestyles.
• 24/7 NurseLine: Similar to the 24-Hour Nurse Advice Line, this phone service lets you talk to a registered nurse — anytime, day or night.
Resources Available to You
Walnut and Computerized Elevator Control Employees 13
Anthem Blue Cross Blue Shield Schedule of Benefits2013 Plan Year
PLA
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Prim
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ysic
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13 P
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$20
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$35
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100%
, no
dedu
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vidu
al $
1,00
0Fa
mily
$2,
000
Indi
vidu
al $
5,30
0Fa
mily
$10
,600
80%
afte
r Ded
uctib
le60
% a
fter D
educ
tible
Indi
vidu
al $
5,00
0Fa
mily
$10
,000
(Max
imum
$5,
000
per p
erso
n)
80%
afte
r Ded
uctib
le
PPO
PL
AN
(80/
60)
Indi
vidu
al $
2,20
0Fa
mily
$4,
400
Empl
oyer
:In
divi
dual
$25
0 +
$250
mat
chin
g fu
nds
Fam
ily $
500
+ $5
00 m
atch
ing
fund
sEm
ploy
ee:
Indi
vidu
al -
Up
to $
2,75
0Fa
mily
- U
p to
$5,
450
Plus
$1,
000
addi
tiona
l for
thos
e ag
e 55
or o
lder
80%
afte
r Ded
uctib
le60
% a
fter D
educ
tible
100%
, no
dedu
ctib
le60
% a
fter D
educ
tible
$20
Cop
ay p
er v
isit
60%
afte
r Ded
uctib
le
In N
etw
ork
Ben
efits
Indi
vidu
al $
600
Fam
ily $
1,20
0(M
axim
um $
600
per p
erso
n)
Indi
vidu
al $
2,60
0Fa
mily
$5,
200
(Max
imum
$2,
600
per p
erso
n)
$20
Cop
ay, t
hen
100%
$20
Cop
ay, t
hen
100%
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le80
% a
fter D
educ
tible
Non
e
100%
, no
dedu
ctib
le60
% a
fter D
educ
tible
60%
afte
r Ded
uctib
le
HSA
PL
AN
(Hea
lth S
avin
gs A
ccou
nt P
lan)
In N
etw
ork
Ben
efits
80%
afte
r Ded
uctib
le
60 d
ays p
er c
alen
dar y
ear
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
$35
Cop
ay, t
hen
100%
$20
PCP,
$35
SPC
Cop
ay, t
hen
100%
60%
afte
r Ded
uctib
le
Out
-of-N
etw
ork
Ben
efits
$20
Cop
ay, t
hen
100%
Indi
vidu
al $
700
Fam
ily $
1,40
0(M
axim
um $
700
per p
erso
n)
60%
afte
r Ded
uctib
le
60 d
ays p
er c
alen
dar y
ear
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le60
% a
fter D
educ
tible
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
$20
PCP,
$35
SPC
Cop
ay, t
hen
100%
60%
afte
r Ded
uctib
le$2
0 PC
P, $
35 S
PC C
opay
, the
n 10
0%
80%
afte
r Ded
uctib
le60
% a
fter D
educ
tible
60%
afte
r Ded
uctib
le
14 2013 Benefits
PLA
N
BE
NE
FIT
S
THYS
SEN
KR
UPP
ELE
VATO
R-C
OR
POR
ATE
Sche
dule
of B
enef
its P
lan
Com
paris
on20
13 P
lan
Year
Out
-of-N
etw
ork
Ben
efits
PPO
PL
AN
(80/
60)
In N
etw
ork
Ben
efits
HSA
PL
AN
(Hea
lth S
avin
gs A
ccou
nt P
lan)
In N
etw
ork
Ben
efits
Out
-of-N
etw
ork
Ben
efits
Dia
gnos
tic T
estin
g &
Pro
cedu
res:
M
RI,
CT
Sca
ns, e
tc
(See
#7
belo
w)
Den
tal S
ervi
ces R
elat
ed to
Acc
iden
tal I
njur
y
Dur
able
Med
ical
Equ
ipm
ent
(Pre
Aut
hori
zatio
n R
equi
red)
Ort
hotic
Dev
ices
for
Foot
& S
hoe
Pros
thet
ic A
pplia
nces
(See
#8
belo
w)
Am
bula
nce
Serv
ice
Alle
rgy
Tes
ting
Hom
e H
ealth
Car
e (P
lan
of T
reat
men
t Req
uire
d)
Hos
pice
(Pla
n of
Tre
atm
ent R
equi
red)
Med
ical
Sup
plie
s
Dru
g T
ype
Pref
erre
dB
rand
Bra
nd
Ret
ail C
opay
– 3
0 D
ay su
pply
$35
$55
Mai
l Ord
er o
r M
aint
enan
ce C
hoic
e C
opay
– 9
0 D
ay su
pply
$70
$110
PLE
ASE
NO
TE
:
3. P
rece
rtific
atio
n re
quire
d fo
r spe
cific
inpa
tient
and
out
patie
nt se
rvic
es.
5. C
oins
uran
ce a
pplie
s tow
ards
the
Out
-of-P
ocke
t Max
imum
s.6.
Rou
tine
Mam
mog
raph
y: (
See
prev
entiv
e ca
re li
stin
g fo
r HSA
Pla
n)
•
One
bas
elin
e sc
reen
ing
for a
ges 3
5 th
roug
h 39
yea
rs
•
One
scre
enin
g ev
ery
24 m
onth
s or m
ore
frequ
ent i
f rec
omm
ende
d by
a h
ealth
care
pra
ctiti
oner
for a
ges 4
0 th
roug
h 49
• O
ne sc
reen
ing
ever
y 12
mon
ths f
or a
ges 5
0 ye
ars a
nd o
ver
7.
Dia
gnos
tic S
ervi
ces a
nd O
ther
Pro
cedu
res
8. P
rost
hetic
Dev
ices
– R
epai
rs a
nd re
plac
emen
ts li
mite
d to
onc
e du
ring
• A
ny 1
2 m
onth
per
iod
if m
embe
r is 1
9 ye
ars o
f age
or u
nder
• A
ny 3
6 m
onth
per
iod
if m
embe
r is 2
0 ye
ars o
f age
or o
lder
9.
*H
SA
Pre
scri
ptio
n D
rugs
: I
n th
e H
SA
Pla
n: w
omen
's c
ontr
acep
tive
med
icat
ions
(ge
neric
and
som
e si
ngle
sou
rce
bran
ds)
cove
red
at 1
00%
with
no
dedu
ctib
le
60%
afte
r Ded
uctib
le$2
00 c
alen
dar y
ear m
axim
um80
% a
fter D
educ
tible
60%
afte
r Ded
uctib
le
Mis
cella
neou
s
Pres
crip
tion
Dru
gs
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le80
% a
fter D
educ
tible
80%
afte
r Ded
uctib
le
120
visi
ts p
er c
alen
dar y
ear
80%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le$2
00 c
alen
dar y
ear m
axim
um60
% a
fter D
educ
tible
80%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le60
% a
fter D
educ
tible
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le12
0 vi
sits
per
cal
enda
r yea
r
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le80
% a
fter D
educ
tible
80%
afte
r Ded
uctib
le$2
00 c
alen
dar y
ear m
axim
um
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le
120
visi
ts p
er c
alen
dar y
ear
80%
afte
r Ded
uctib
le
Thi
s is a
bri
ef su
mm
ary
of b
enef
its; i
t is n
ot a
cer
tific
ate
of c
over
age.
For
full
cove
rage
pro
visi
ons,
incl
udin
g a
desc
ript
ion
of w
aitin
g pe
riod
s, lim
itatio
ns a
nd e
xclu
sion
s, pl
ease
con
tact
Blu
e C
ross
Blu
e Sh
ield
or
your
Hum
an R
esou
rces
Rep
rese
ntat
ive.
Ant
hem
Blu
e C
ross
and
Blu
e S
hiel
d is
the
trade
nam
e of
: In
Geo
rgia
: pro
duct
s ar
e un
derw
ritte
n by
Blu
e C
ross
Blu
e S
hiel
d of
Geo
rgia
. Ind
epen
dent
lice
nsee
s of
the
Blu
e C
ross
and
Blu
e S
hiel
d A
ssoc
iatio
n. A
nthe
m®
is a
regi
ster
ed tr
adem
ark.
Th
e B
lue
Cro
ss a
nd B
lue
Shi
eld
nam
es a
nd s
ymbo
ls a
re th
e re
gist
ered
mar
ks o
f the
Blu
e C
ross
and
Blu
e S
hiel
d A
ssoc
iatio
n.
60%
afte
r Ded
uctib
le
Gen
eric
/Bra
ndA
t Par
ticip
atin
g Ph
arm
acy
80%
afte
r D
educ
tible
*
80%
afte
r D
educ
tible
*
1. T
his s
ched
ule
is in
tend
ed to
be
a su
mm
ary
of b
enef
its a
nd d
oes n
ot in
clud
e al
l pla
n pr
ovis
ions
, inc
ludi
ng e
xclu
sion
s or l
imita
tions
. If
ther
e is
a d
iscr
epan
cy b
etw
een
this
doc
umen
t and
the
grou
p co
ntra
ct, t
he p
rovi
sion
s of t
he g
roup
co
ntra
ct w
ill g
over
n.
4. C
opay
s are
not
app
lied
tow
ards
cal
enda
r yea
r Ded
uctib
les a
nd O
ut-o
f-Poc
ket M
axim
ums.
In
clud
es b
ut is
not
lim
ited
to X
-ray,
MR
I, C
T Sc
ans,
Bio
psy,
Exc
isio
ns, e
tc.
All
X-ra
ys a
nd L
abs a
re su
bjec
t to
the
cale
ndar
yea
r ded
uctib
le if
not
per
form
ed d
urin
g a
phys
icia
n of
fice
visi
t.
2.
P
re-e
xist
ing
cond
ition
s are
not
cov
ered
for t
he fi
rst 1
2 m
onth
s (18
mon
ths i
f lat
e en
rolle
e).
Cre
idt i
s giv
en fo
r prio
r cre
dita
ble
cove
rage
$30
$15
Gen
eric
60%
afte
r Ded
uctib
le
60%
afte
r Ded
uctib
le12
00 v
isits
per
cal
enda
r yea
r
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le80
% a
fter D
educ
tible
60%
afte
r Ded
uctib
le
80%
afte
r Ded
uctib
le$2
00 c
alen
dar y
ear m
axim
um
NO
TE:
1. T
his
sche
dule
is in
tend
ed to
be
a su
mm
ary
of b
enefi
ts a
nd d
oes
not i
nclu
de a
ll pl
an p
rovi
sion
s, in
clud
ing
excl
usio
ns o
r lim
itatio
ns. I
f the
re is
a
disc
repa
ncy
betw
een
this
doc
umen
t and
the
grou
p co
ntra
ct, t
he p
rovi
sion
s of
the
grou
p co
ntra
ct w
ill g
over
n.2.
Pre
-exi
stin
g co
nditi
ons
are
not c
over
ed fo
r th
e fir
st 1
2 m
onth
s (1
8 m
onth
s if
late
enr
olle
e). C
redi
t is
give
n fo
r pr
ior
cred
itabl
e co
vera
ge3.
Pre
cert
ifica
tion
requ
ired
for
spec
ific
inpa
tient
and
out
patie
nt s
ervi
ces.
(Not
app
lied
to C
DH
P)4.
Cop
ays
are
not a
pplie
d to
war
ds c
alen
dar
year
Ded
uctib
les
and
Out
-of-
Pock
et M
axim
ums.
5. D
educ
tible
and
Coi
nsur
ance
app
lies
tow
ards
the
Out
-of-
Pock
et M
axim
ums.
6. R
outin
e M
amm
ogra
phy:
(See
pre
vent
ive
care
list
ing
for
CD
HP)
•
One
bas
elin
e sc
reen
ing
for
ages
35
thro
ugh
39 y
ears
•
One
scr
eeni
ng e
very
24
mon
ths
or m
ore
freq
uent
if re
com
men
ded
by a
hea
lthca
re p
ract
ition
er fo
r ag
es 4
0 th
roug
h 49
•
One
scr
eeni
ng e
very
12
mon
ths
for
ages
50
year
s an
d ov
er7.
Dia
gnos
tic S
ervi
ces
and
Oth
er P
roce
dure
s In
clud
es b
ut is
not
lim
ited
to X
-ray
, MRI
, CT
Sca
ns, B
iops
y, E
xcis
ions
, etc
. All
X-ra
ys a
nd L
abs
are
subj
ect t
o th
e ca
lend
ar y
ear
dedu
ctib
le if
not
pe
rfor
med
dur
ing
a ph
ysic
ian
office
vis
it.8.
Pro
sthe
tic D
evic
es–
Repa
irs a
nd re
plac
emen
ts li
mite
d to
onc
e du
ring:
• A
ny 1
2 m
onth
per
iod
if m
embe
r is
19
year
s of
age
or
unde
r •
Any
36
mon
th p
erio
d if
mem
ber
is 2
0 ye
ars
of a
ge o
r ol
der
9. H
SA
Pre
scrip
tion
Dru
gs: I
n th
e H
SA
Pla
n, w
omen
’s c
ontr
acep
tive
med
icat
ions
(gen
eric
and
som
e si
ngle
-sou
rce
bran
ds) a
re c
over
ed a
t 100
%
with
no
dedu
ctib
le.
This
is a
brie
f sum
mar
y of
ben
efits
; it i
s no
t a c
ertifi
cate
of c
over
age.
For
full
cove
rage
pro
visi
ons,
incl
udin
g a
desc
riptio
n of
wai
ting
perio
ds,
limita
tions
and
exc
lusi
ons,
ple
ase
cont
act B
lue
Cro
ss B
lue
Shi
eld
or y
our
Hum
an R
esou
rces
Dep
artm
ent.
Ant
hem
Blu
e C
ross
and
Blu
e S
hiel
d is
the
trad
e na
me
of p
rodu
cts
unde
rwrit
ten
by B
lue
Cro
ss B
lue
Shi
eld
of G
eorg
ia. I
ndep
ende
nt li
cens
ees
of th
e B
lue
Cro
ss a
nd B
lue
Shi
eld
Ass
ocia
tion.
Ant
hem
® is
a re
gist
ered
trad
emar
k. T
he B
lue
Cro
ss a
nd B
lue
Shi
eld
nam
es a
nd s
ymbo
ls a
re th
e re
gist
ered
mar
ks o
f the
Blu
e C
ross
and
Blu
e S
hiel
d A
ssoc
iatio
n.
Walnut and Computerized Elevator Control Employees 15
PrEsCriPtion drug bEnEfit ovErviEW for PPo 80/60 CovEragE
We know how important it is to provide you with dependable healthcare benefits that cover prescription medications you and your family need. That’s why prescription drug coverage is an integral part of the ThyssenKrupp Elevator Group Healthcare Plan. Some features of our prescription drug plan include:
• Your choice of pharmacies from an extensive network that includes pharmacies throughout the country, including national chains and independent drugstores.
• Affordable co-payments that give you a choice of covered drugs.
• Convenience and cost savings of mail order.
thE Cvs/CarEMark thrEE-tiEr (gEnEriC, forMulary, brand) PrEsCriPtion drug PrograM
This program is designed to offer prescription drug coverage that encourages the use of cost effective medications while providing quality medical treatment. The plan encourages the use of generic drugs and certain brand-name drugs (also known as Formulary drugs). Under this program you pay a different co-pay depending on whether you choose a generic drug, a preferred brand-name drug on the formulary listing, or a non-formulary brand-name drug.
Always remember to talk to your doctor about using generic or formulary drugs that can save you money. You and your doctor should check your formulary list before you receive a prescription. An updated formulary listing is available on the CVS/Caremark website at www.caremark.com or by calling them at 877-406-4465.
hoW thE PrograM Works (rEtail PharMaCy & Mail ordEr) for PPo 80/60 CovEragE
Retail (up to a 30-day supply)
Tier 1 $15 Co-pays for generic drugs — all generic drugs available
Tier 2 $35 Co-pays for preferred brand (formulary) drugs
Tier 3 $55 Co-pays for brand-name (non-formulary drugs)
Mail order (up to a 90-day supply)
Tier 1 $30 Co-pays for generic drugs — all generic drugs available
Tier 2 $70 Co-pays for preferred brand (formulary) drugs
Tier 3 $110 Co-pays for brand-name (non-formulary drugs)
If you are electing the HSA, the prescriptions will be subjected to the deductible and co-insurance. Please refer to the grid on the previous page.
Prescription Drug Coverage
NO
TE:
1. T
his
sche
dule
is in
tend
ed to
be
a su
mm
ary
of b
enefi
ts a
nd d
oes
not i
nclu
de a
ll pl
an p
rovi
sion
s, in
clud
ing
excl
usio
ns o
r lim
itatio
ns. I
f the
re is
a
disc
repa
ncy
betw
een
this
doc
umen
t and
the
grou
p co
ntra
ct, t
he p
rovi
sion
s of
the
grou
p co
ntra
ct w
ill g
over
n.2.
Pre
-exi
stin
g co
nditi
ons
are
not c
over
ed fo
r th
e fir
st 1
2 m
onth
s (1
8 m
onth
s if
late
enr
olle
e). C
redi
t is
give
n fo
r pr
ior
cred
itabl
e co
vera
ge3.
Pre
cert
ifica
tion
requ
ired
for
spec
ific
inpa
tient
and
out
patie
nt s
ervi
ces.
(Not
app
lied
to C
DH
P)4.
Cop
ays
are
not a
pplie
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t 100
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For
full
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ple
ase
cont
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ss B
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hem
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k. T
he B
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gist
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mar
ks o
f the
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ross
and
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e S
hiel
d A
ssoc
iatio
n.
16 2013 Benefits
What is a gEnEriC drug?
A generic drug is a prescription that by law must have the same chemical composition as a specific brand-name prescription drug. Generic medications that are recommended for us by CVS/Caremark have been thoroughly evaluated and certified by the FDA as bioequivalent to their brand name counterparts. This ensures that quality generic medications are used, maximizing your prescription benefits. Therefore, these generic medications can provide you with the same high quality of prescriptions at drastically reduced costs. This translates into lower co-pays for you.
What is a PrEfErrEd-brand (forMulary) drug?
Preferred-Brand (Formulary) drugs are certain brand-name prescription drugs that are on the CVS/Caremark Formulary List that have been approved by the FDA as safe and effective. Most drugs listed on the Formulary are subject to manufacturer volume discounts and therefore are more cost effective than those not on the formulary listing. These discounts translate into greater savings over brand-name drugs and therefore offer you a lower co-pay than the brand-name drugs.
What is a brand-naME drug?
A Brand-Name drug is a prescription drug that has been given a name by a pharmaceutical company to distinguish it as produced or sold by a specific company. It may be protected by a trademark. Brand-name drugs are expensive to create. Pharmaceutical companies spend years to develop, test and get FDA approval for all new drugs. All of these costs are included in the price you pay for the drug. This is why brand-name drugs cost more than generic or preferred brand-name drugs. This means higher costs and higher patient co-pays.
What is a Mandatory gEnEriC drug PrograM?
The Mandatory Generic Drug Program requires that the pharmacist fill your prescriptions with a generic equivalent whenever one is available, unless your physician requires that you have a brand name drug. If you choose to purchase the brand name drug, you will be responsible for the co-pay plus the difference in the cost between the generic drug and the brand name drug. The Mandatory Generic Drug Program will continue in the 2013 Plan Year.
What is Mail ordEr?
If you currently have a prescription for maintenance drugs, you can take advantage of additional savings on your co-pays by using the Mail-Order program. A 90-day supply of your maintenance prescription is mailed directly to your home at a reduced co-pay. Contact Caremark/CVS at 877-406-4465 for more information.
Walnut and Computerized Elevator Control Employees 17
What is thE MaintEnanCE ChoiCE PrograM?
A maintenance drug is a prescription medication taken regularly for chronic conditions such as, but not limited to, diabetes, high blood pressure, high cholesterol, or ulcers and GERD, or taken for long term therapy such as contraceptives or hormone replacement therapy. You must use either the Caremark Mail Service Program or a local CVS pharmacy to fill your maintenance medications. The advantage to you is that you will get up to a 90-day supply for only 2 retail (30 day supply) copays. The mail service program delivers the prescription to your mailbox or other location you choose. Or you may use a local CVS pharmacy. The Plan will allow you to obtain initially two 30-day supply prescription fills of a maintenance medication from a local pharmacy. Beyond that, you will need to obtain a 90-day supply prescription (generally with 3 refills) from your doctor. To use the mail service plan, you will need to send Caremark a completed mail service order form (downloaded from www.caremark.com or call 877-406-4465). You can either have your doctor fax the prescription to Caremark’s mail service or you can mail the original prescription to Caremark with the mail service order form. Be sure to write your Caremark member number (from your Caremark ID card) on the back of each prescription and include the applicable copayment or your credit card information with your order. The other method is to take the 90-day supply prescription to a local CVS pharmacy. The same mail service copay will apply. A list of common maintenance medications is available from your employer or from Caremark. For questions on using the mail service or the “Maintenance Choice Plan”, please contact Caremark by calling 877-406-4465.
What is thE stEP thEraPy PrograM?
Given that many brand named drugs cost between $3 and $7 a day while many generic drugs cost less than $.50 a day, the prescription program has a Step Therapy plan. Step Therapy requires plan participants to try an available generic drug for at least 30 days before brand name drugs will be covered for certain drug classes. These drug classes include drugs to treat high cholesterol, high blood pressure, stomach acid, allergies, pain(non-steroidal), sleep aids, , migraines, overactive bladder, enlarged prostate, osteoporosis, high triglycerides, glaucoma, and depression. The following three pages are a list of the current drugs in these classes. This list is effective January 2013 and is subject to change. Brand name drugs used in these drug classes will not be covered unless you have tried a generic drug in the last 24 months through the Caremark plan or your doctor sends Caremark an explanation of why you should not try a generic drug. Your doctor can call Caremark at 1-877-203-0003 to obtain the authorization forms. For drugs to treat depression, only new prescriptions are applied to step therapy requirements.
What is PharMaCy advisor?
Pharmacy Advisor is a voluntary program offered by Caremark to help those participants with diabetes maximize their drug therapy. Caremark will offer one-on-one guidance from CVS pharmacist who fill the prescriptions or through letter and phone calls if other pharmacies are used. For further information on this program, please contact Caremark at the phone number on your ID card.
18 2013 Benefits
You can save money by using safe and effective generic medications when possible. According to your prescription benefit plan, in order for certain brand-name medications to be covered, you will have to try a generic medication first. The chart below tells you which kinds of drugs require you to use a generic first. This chart only provides a sample list of generic drug options and may not include all drugs available.
Drug Class (Condition Treated*)
Step One You will have to try one of these
generic medications first...
Step One ...before you can try one of these
name-brand drugs
ACE Inhibitors/Angiotensin II Receptor Antagonists (ARBs) / Direct Renin Inhibitors / Combinations High blood pressure
amlodipine-benazepril benazepril / benazepril HCTZ
captopril / captopril HCTZ enalapril / enalapril HCTZ
eprosartan 600 mg fosinopril / fosinopril HCTZ irbesartan/irbesartan HCTZ lisinopril / lisinopril HCTZ losartan / losartan HCTZ
moexipril / moexipril HCTZ quinapril / quinapril HCTZ
ramipril trandolapril
trandolapril-verapamil ext-rel
Atacand / Atacand HCT Benicar / Benicar HCT
Edarbi Edarbyclor
Micardis / Micardis HCT Tekturna / Tekturna HCT
Teveten 400mg / Teveten HCT
Antihistamines / Combinations Allergies
desloratadine levocetirizine
levocetirizine solution
Clarinex-D
Benign Prostatic Hyperplasia / Alpha Blockers Prostate
alfuzosin ext-rel doxazosin tamsulosin terazosin
Cardura XL Rapaflo
Benign Prostatic Hyperplasia / Alpha Reductase Inhibitors / Combinations Prostate
finasteride
** tamsulosin also considered a covered generic alternative for Jalyn
Avodart Jalyn**
Bisphosphonates / Combinations Osteoporosis
alendronate ibandronate
Actonel Atelvia
Fosamax Plus D
Cholinesterase Inhibitors Alzheimer’s Disease
donepezil galantamine rivastigmine
Aricept 23 mg
Brand Medications Requiring Use of a Generic First
Walnut and Computerized Elevator Control Employees 19
COX-2 Inhibitors / Nonsteroidal Anti-Inflammatory (NSAIDs) / Combinations Pain & Inflammation
ibuprofen indomethacin
meloxicam naproxen
Additional generic NSAIDs available
Arthrotec Cambia Celebrex Duexis Flector Nalfon
Naprelan CR Pennsaid
Voltaren Gel Zipsor
Fibrates High Triglicerides
fenofibrate fenofibrate micronized
gemfibrozil
Antara Fenoglide Lipofen Triglide Trilipix
HMG-CoA Reductase Inhibitors (HMGs or Statins) /Combinations High Cholesterol
amlodipine-atorvastatin atorvastatin
fluvastatin/fluvastatin ext-rel lovastatin
pravastatin simvastatin
Advicor Altoprev
Crestor (excluding 40 mg) Livalo Simcor Vytorin
Nasal Steroids Allergies
flunisolide nasal fluticasone nasal
triamcinolone acetonide spray
Beconase AQ Nasonex Omnaris
Omnaris HFA Qnasl
Rhinocort Aqua Veramyst
Ophthalmic / Prostaglandins Glaucoma
latanoprost Lumigan Travatan Z
Zioptan
Proton Pump Inhibitors (PPIs) Stomach Acid
lansoprazole lansoprazole delayed-rel ODT
omeprazole omeprazole-sodium bicarbonate
pantoprazole
Aciphex Dexilant Nexium
Prilosec Packets Protonix Packets
Zegerid Powder for Oral Susp
20 2013 Benefits
Selective Serotonin Agonists / Combinations
Migraines
naratriptan sumatriptan
Alsuma Axert Frova Maxalt Relpax
Sumavel Treximet Zomig
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Depression
venlafaxine venlafaxine ext-rel
Cymbalta Pristiq
Selective Serotonin Reuptake Inhibitors (SSRIs) Depression
citalopram escitalopram tab
fluoxetine fluvoxamine
paroxetine / paroxetine ER sertraline
Luvox CR Pexeva Viibryd
Sleeping Agents Insomnia / Sleep Problems
zaleplon zolpidem
zolpidem ext-rel
Edluar Intermezzo
Lunesta Rozerem Silenor
Zolpimist
Urinary Antispasmodics Overactive Bladder / Incontinence
oxybutynin / oxybutynin ER tolterodine trospium
Anturol Detrol LA Enablex Gelnique Myrbetriq Oxytrol
Sanctura XR Toviaz
Vesicare
* This list indicates the common uses for which the drug is prescribed. Some medicines are prescribed for more than one condition. Brand-name drugs not listed here may be covered by your plan without the use of a generic first. Information provided here is not a substitute for medical advice or treatment.
Discuss this information with your doctor or health care provider. CVS Caremark assumes no liability for the information provided or for any diagnosis or treatment made in reliance thereon, nor is it responsible for the reliability of the content.
Subject to state law restrictions. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. Targeted therapeutic classes and specific drug targets are subject to change based on new generic drug launches, product approvals, drug withdrawals, and other market changes.
Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.
©2012 Caremark. All rights reserved. 5295-1044224 v1 1012 TGST
Walnut and Computerized Elevator Control Employees 21
Delta Dental Schedule of Benefits2013 Plan Year
Dental Benefits
In-Network Benefit (Delta Preferred Option and Delta
Premier Dentist)Out-of-Network Benefit
(Non-Delta Dentist)
Deductibles & Calendar Year Benefit Maximums
Calendar Year Deductible $50 for each Eligible Person $50 for each eligible person
Calendar Year Maximum (except Ortho) $1,500 for each Eligible person $1,500 for each eligible person
Diagnostics (Not Subject to the Deductible)
Oral Exam Limited to twice in a calendar year
100% of allowed amount 80% of allowed amount
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
100% of allowed amount 80% of allowed amount
Preventive (Not Subject to the Deductible)
Prophylaxis (Cleaning) Limited to twice in a calendar year
100% of allowed amount 80% of allowed amount
Fluoride Application Limited to enrollees to age 19
100% of allowed amount 80% of allowed amount
Space Maintainer 100% of allowed amount 80% of allowed amount
Restorative (Subject to the Deductible)
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
Sealants Limited to dependent enrollees to age 15 on permanent molars only
80% of allowed amount after Deductible 50% of allowed amount after Deductible
Oral Surgery (Subject to the Deductible)
Extractions 80% of allowed amount after Deductible 50% of allowed amount after Deductible
General Anesthesia 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
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 $1,250 per child Limited to dependent children to age 26
50% of allowed amount 50% of allowed amount
22 2013 Benefits
Delta Dental Schedule of Benefits2013 Plan Year
Claims should be submitted to:
Delta Dental Insurance Company P.O. Box 1809 Alpharetta, GA 30023-1809
To obtain a list of dentists, visit our website at www.deltadentalins.com
NOTE:
• Allowed amount for Delta Preferred Dentists is limited to the DPO fee schedule.
• Allowed amount for DeltaPremier Dentists is limited to the lesser of: the dentist’s filed fee, submitted fee, or Delta’s UCR (Usual, Customary and Reasonable) fee.
• Allowed amount for Non-Delta Dentists is Delta Dental’s UCR (Usual, Customary and Reasonable) fee. These dentists may also balance bill for amounts over Delta’s UCR.
• This is a summary of benefits. Please refer to the Evidence of Coverage for further exclusions and limitations. For additional information regarding benefits and eligibility, please contact Customer Service at 1-800-510-9545 or visit our website at www.deltadentalins.com
• These services are performed as needed and deemed as necessary by your attending dentist; subject to the limitations and exclusions governing administrative policies of the program.
Walnut and Computerized Elevator Control Employees 23
Vision Benefits2013 Plan Year
Vision Benefits
In-Network Benefit (Delta Preferred Option and Delta
Premier Dentist)Out-of-Network Benefit
(Non-Delta Dentist)
Deductibles & Calendar Year Benefit Maximums
Calendar Year Deductible $0 $0
Calendar Year Maximum (except Ortho) By Benefit By Benefit
Eye Examination
Eye Exam Limited to one in a calendar year
$20 co-payment Up to $46 will be reimbursed
Materials Benefits
Lenses Limited to one in a calendar year
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.
Frames Limited to one every two years
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.
Contact Lenses Limited to one in a calendar year
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 $95 will be reimbursed
Frames Up to $50 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
Claims may be submitted online at www.vsp.com or by calling 800-877-7195.
24 2013 Benefits
Life & 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. Full-time, 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.
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.
suPPlEMEntal lifE bEnEfit ElECtion
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.
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.
Walnut and Computerized Elevator Control Employees 25
Disability Coverage
In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income.
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.
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.
26 2013 Benefits
Important Notices: ThyssenKrupp Elevator Group Health Plan
sPECial EnrollMEnt right
Loss of Other Coverage
If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan as a Special Enrollee if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). You will be asked to provide proof that you had other coverage and the reason that the other coverage ended . Benefits may be subject to pre-existing condition limitations.
New Dependent by Marriage, Birth, Adoption, or Placement for Adoption
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, after your initial enrollment period, you may be deemed a Special Enrollee and able to enroll yourself and/or your new dependents . However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Benefits may be subject to pre-existing condition limitations.
Medicaid or State Plan
If you and your dependent child(ren) either lose coverage under a Medicaid or State Plan or become eligible for group health plan premium assistance under a Medicaid or State Plan, you and your eligible dependent child(ren) may be deemed a Special Enrollee and eligible to enroll in this health plan as long as your enrollment request is made within 60 days of the date coverage terminates under a Medicaid or State Plan, or within 60 days after you or your dependent(s) is determined to be eligible for Medicaid or State premium assistance.
Pre-existing Condition Limitations
A pre-existing condition limitation will apply to Special Enrollees age 19 or older for the first 12 months of coverage under this Health Benefits Plan. The limitation may be eliminated or reduced if you present a Certificate of Coverage from your prior health benefits plan. The pre-existing condition limitation will not apply to pregnancies.
Late Enrollees
If you waive coverage for you and/or your eligible dependents under this Plan and later wish to enroll, you will be considered a Late Enrollee unless you qualify as a Special Enrollee as noted above. A Late Enrollee may enroll only during the Annual Enrollment Period each year and coverage will be effective January 1. No evidence of good health is required to obtain coverage as a Late Enrollee; however, a pre-existing condition limitation (not applicable to pregnancies or enrollees under the age of 19) will apply for the first 18 months of coverage . The limitation may be eliminated or reduced if you present a Certificate of Coverage showing you or your dependents had prior health benefits.
To request special enrollment or obtain more information about enrollment, please contact your human resources department.
Walnut and Computerized Elevator Control Employees 27
WoMEn’s hEalth and CanCEr rights aCt
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
• all stages of reconstruction of the breast on which the mastectomy was performed;
• surgery and reconstruction of the other breast to produce a symmetrical appearance;
• prostheses; and
• treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under your elected medical plan.
If you would like more information on your special enrollment rights or the Women’s Health and Cancer Rights Act, please call the e*source team at 866-910-6085.
grandfathEr status of hEalth Plan
This group health plan believes the medical PPO 80/60 and prescription drug benefit plans are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at ThysssenKrupp Elevator, 11605 Haynes Bridge Road, Suite 650, Alpharetta, GA 30009. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
MEdiCarE Part d CrEditablE CovEragE notiCE
The required Medicare Part D Creditable Coverage Notice was distributed to all employees and spouses over age 55. If you, or your spouse, require a copy of the notice, please contact e*source at 866-910-6085 or [email protected] and a copy will be made available.
28 2013 Benefits
Joint Notice of Privacy Practices: ThyssenKrupp Elevator Group Health Plan
NOTE: This Notice describes how medical information about you may be used and disclosed by our Plan and how you can get access to your information. Please review it carefully.
1. Why aM i rECEiving this notiCE?
ThyssenKrupp Elevator provides health benefits to employees and their dependents through the healthcare components of the ThyssenKrupp Elevator Employee Health and Welfare Benefit Plan.
The privacy of your personal health information that is created, used, or disclosed by the Plan is protected by federal law. The Plan is required by law to provide you with this Notice of the Plan’s legal duties and privacy practices with respect to your protected health information (or your “PHI”), and abide by the terms of this Notice.
Some health benefits are provided through insurance, where ThyssenKrupp Elevator does not obtain access to PHI. To the extent that you are enrolled in any insured arrangement under the Plan, you will receive a separate privacy notice from your insurer. That notice describes the insurer’s privacy practices under that option.
2. What is ProtECtEd hEalth inforMation (Phi)?
PHI is health information created, received or maintained by the Plan that identifies individuals like you. It does not include employment records held by the ThyssenKrupp Elevator.
3. WhEn Will thE Plan usE or disClosE My Phi?
The Plan must:
• give your PHI to you or your legal representative when you ask for information;
• give your PHI to the U.S. Department of Health and Human Services, if necessary, to make sure your privacy is protected; and
• use or give out your PHI when required by applicable law.
The individuals who administer the Plan may use, receive or disclose your PHI for the following purposes:
• Treatment. Examples: Providing care (diagnosis, medical procedures, etc.) or managing that care.
• Payment of benefits. Examples: Receiving bills from your health care providers, processing payments, sending explanations of benefits (EOBs), pre-certifying hospital admissions or otherwise reviewing the medical necessity of services, conducting claims appeals and coordinating benefit payments under the Plan.
• Healthcare operations. The Plan may use and disclose your PHI for certain operational purposes. Examples: Enrollment, claims audits, and plan design evaluations.
The Plan may use and disclose your PHI to provide you with appointment (and treatment) reminders, information about treatment alternatives or information about other health-related benefits and services that may be of interest to you.
Our Plan contracts with other businesses for certain administrative services. These “business associates” maintain and use most of the PHI under the Plan, and must agree in writing to protect the privacy of your information. In addition to performing services for the Plan, business associates may use PHI for their own management and legal responsibilities, for purposes of aggregating data for Plan design and for other health care operations.
Walnut and Computerized Elevator Control Employees 29
Under certain terms and conditions, the Plan or insurers offering benefits under the Plan may disclose PHI to ThyssenKrupp Elevator, as the plan sponsor. Ordinarily these disclosures are limited to enrollment information and information necessary for Plan administration.
The Plan and its business associates may disclose PHI to certain other entities (including other health plans and health care providers) for the other entity’s treatment, payment or health care operations purposes.
4. undEr What othEr CirCuMstanCEs Will My Phi bE usEd or disClosEd?
The Plan is also permitted to use or disclose your PHI in the following circumstances:
• For certain required public health activities (such as reporting disease outbreaks);
• To a health oversight agency for oversight activities authorized by law;
• For judicial or administrative proceedings (such as in response to a court order or subpoena);
• For a law enforcement purpose to a law enforcement official (such as providing limited information to locate a missing person);
• To a coroner, medical examiner, or funeral director;
• For certain organ, eye, or tissue donations;
• For research studies (such as research related to the prevention of disease or disability) that meet all privacy law requirements;
• To avert a serious threat to the health or safety of you or any other person;
• For specified government functions, such as intelligence activities;
• To the extent necessary to comply with laws and regulations related to workers’ compensation or similar programs; and
• When otherwise required by law.
These uses and disclosures may be subject to special legal requirements.
5. What if thE CirCuMstanCEs dEsCribEd in itEMs 3 and 4 do not aPPly?
If items 3 or 4 do not apply, the Plan may not use or disclose your PHI unless you authorize the use or disclosure in writing. You may take back (“revoke”) your written authorization at any time, except if the Plan has already acted based on your authorization.
If you have questions or a problem relating to a claim, a network provider or other health care matter, you will generally be directed to a contact person with the relevant business associate to resolve the matter. If it is necessary for ThyssenKrupp Elevator to assist you, you will usually be required to complete an authorization form.
Remember, your PHI applies to you. Your family members will not automatically be provided with access to this information on their request. However, the Plan will provide your PHI to your family members if they verify that they are your legal representatives, if you have appropriately authorized their access to your PHI, or in certain other unusual circumstances (such as a medical emergency).
30 2013 Benefits
6. do statE PrivaCy laWs also aPPly to Phi?
Generally, no. Federal law usually supersedes state law from applying to the Plan, particularly where benefits are self funded by ThyssenKrupp Elevator. In certain unusual circumstances where state law is not superseded, a state law may impose more stringent privacy requirements.
7. What arE My individual rights With rEsPECt to My Phi?
You have the right to:
• See and get a copy of the PHI held by the Plan (subject to certain limitations). Your request should be made in writing. Copying and mailing fees may apply.
• Request that the Plan amend your PHI if you believe the information is incorrect or incomplete. You will be required to specify the reasons for your request.
• Receive a list of those who have accessed your PHI for reasons other than for treatment, payment or health care operations. Certain exceptions apply. For example, the Plan does not need to account for disclosures that were made to you or that you have authorized in writing.
• Get a paper copy of this Notice at any time.
• Request that the Plan’s confidential communications of your PHI be sent to you at another location or by alternative means.
• Request the Plan to limit how it uses and gives out your PHI. Please note that the Plan may not be able to agree to your request.
Because most of your PHI under the Plan is held by your claims administrator or insurance carrier, you may wish to contact that entity directly to exercise your individual rights. Otherwise, you should contact the Plan’s Information Contact (see item 9). Certain administrative or other rules may apply to these individual rights.
8. hoW do i MakE a CoMPlaint if i think My rights havE bEEn violatEd?
You may file a complaint with the Plan’s Information Contact and with the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by the Plan. Their addresses are indicated below. All complaints must be filed in writing. You will not be retaliated against for filing a complaint.
9. Who is thE Plan’s inforMation ContaCt?
If you have any questions about this Notice, please refer to the Information Contact:
ThyssenKrupp Elevator Attn: HR Manager (HIPAA) 11605 Haynes Bridge Road, Suite 650 Alpharetta, GA 30009 Tel: 866-910-6085
Walnut and Computerized Elevator Control Employees 31
10. hoW do i ContaCt thE fEdEral govErnMEnt if i Want to MakE a CoMPlaint or inQuiry?
To contact the Secretary of Health and Human Services, write to:
U.S. Department of Health and Human Services Office of Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Tel: (202) 619-0257 Toll free: 1-877-696-6775 www.hhs.gov/contacts
11. What is thE EffECtivE datE of this notiCE?
The effective date of this Notice is October 1, 2011.
12. hoW Can this notiCE bE ChangEd?
The Plan reserves the right to change the terms of this Notice with respect to its privacy and information practices and to make the new provisions effective for all PHI it maintains. Any revisions to the Notice will be provided to you electronically or on paper, as appropriate.
32 2013 Benefits
Medicaid
Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families. If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are not currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan — as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2011.You should contact your state for further information on eligibility.
ALABAMA – Medicaid Website: www.medicaid.alabama.gov Phone: 1-800-362-1504
ALASKA – Medicaid Website: dhss.alaska.gov/dpa/Pages/medicaid/default.aspx Phone (Anchorage): 907-269-6529 Phone (outside of Anchorage): 1-888-318-8890
ARIZONA – CHIP Website: www.azahcccs.gov/applicants/default.aspx Phone (Maricopa County): 602-417-5437 Phone (outside of Maricopa County): 1-877-764-5437
CALIFORNIA – Medicaid Website: www.dhcs.ca.gov/services/Pages/ TPLRD_CAU_cont.aspx Phone: 1-866-298-8443
COLORADO – Medicaid and CHIP Medicaid Website: www.colorado.gov Medicaid Phone (in state): 1-800-866-3513 Medicaid Phone (out of state): 1-800-221-3943 CHIP Website: www.CHPplus.org CHIP Phone: 303-866-3243
FLORIDA – Medicaid Website: www.flmedicaidtplrecovery.com Phone: 1-877-357-3268
GEORGIA – Medicaid Website: http://dch.georgia.gov/medicaid Phone: 1-800-869-1150
IDAHO – Medicaid and CHIP Medicaid Website: www.accesstohealthinsurance.idaho.gov Medicaid Phone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Phone: 1-800-926-2588
INDIANA – Medicaid Website: www.in.gov/fssa Phone: 1-800-889-9948
IOWA – Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562
KANSAS – Medicaid Website: www.kdheks.gov/hcf/ Phone: 1-800-792-4884
KENTUCKY – Medicaid Website: chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570
LOUISIANA – Medicaid Website: www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447
Walnut and Computerized Elevator Control Employees 33
MAINE – Medicaid Website: www.maine.gov/dhhs/OIAS/public-assistance/index.html Phone: 1-800-572-3839
MASSACHUSETTS – Medicaid and CHIP Website: www.mass.gov/MassHealth Phone: 1-800-462-1120
MINNESOTA – Medicaid Website: http://mn.gov/dhs/partners-and-providers/health-care/ Phone (Twin Cities): 651-431-2670 Phone (outside of Twin Cities area): 800-657-3739
MISSOURI – Medicaid Website: www.dss.mo.gov/mhd/participants/pages/ hipp.htm Phone: 573-751-2005
MONTANA – Medicaid Website: medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml Phone: 1-800-694-3084
NEBRASKA – Medicaid and CHIP Website: www.dhhs.ne.gov/med/medindex.htm Phone: 1-877-255-3092
NEVADA – Medicaid Website: dwss.nv.gov Phone: 1-800-992-0900
NEW HAMPSHIRE – Medicaid Website: www.dhhs.nh.gov/ombp/index.htm Phone: 603-271-8183
NEW JERSEY – Medicaid and CHIP Medicaid Website: www.state.nj.us/humanservices/ dmahs/clients/medicaid Medicaid Phone: 1-800-356-1561 CHIP Website: www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
NEW YORK – Medicaid Website: www.medicaid.alabama.gov Phone: 1-800-362-1504
NORTH CAROLINA – Medicaid Website: www.nc.gov Phone: 919-855-4100
NORTH DAKOTA – Medicaid Website: www.nd.gov/dhs/services/medicalserv/medicaid Phone: 1-800-755-2604
OKLAHOMA – Medicaid and CHIP Website: www.insureoklahoma.org Phone: 1-888-365-3742
OREGON – Medicaid and CHIP Website: www.oregon.gov/OHA/OPHP/FHIAP/index.shtml Phone: 1-888-564-9669
PENNSYLVANIA – Medicaid Website: www.dpw.state.pa.us/hipp Phone: 1-800-692-7462
RHODE ISLAND – Medicaid Website: www.dhs.ri.gov Phone: 401-462-5300
SOUTH CAROLINA – Medicaid Website: www.scdhhs.gov Phone: 1-888-549-0820
TEXAS – Medicaid Website: www.gethipptexas.com Phone: 1-800-440-0493
UTAH – Medicaid and CHIP Website: health.utah.gov/upp Phone: 1-866-435-7414
VERMONT – Medicaid Website: www.greenmountaincare.org Phone: 1-800-250-8427
VIRGINIA – Medicaid and CHIP Medicaid Website: www.dmas.virginia.gov/rcp-HIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: www.famis.org CHIP Phone: 1-866-873-2647
WASHINGTON – Medicaid Website: hrsa.dshs.wa.gov/premiumpymt/Apply.shtm Phone: 1-800-562-3022 ext. 15473
34 2013 Benefits
WEST VIRGINIA – Medicaid Website: www.dhhr.wv.gov/bms Phone: 304-558-1700
WISCONSIN – Medicaid Website: www.badgercareplus.org/pubs/p-10095.htm Phone: 1-800-362-3002
WYOMING – Medicaid Website: www.health.wyo.gov/healthcarefin/index.html Phone: 307-777-7531
To see if any more States have added a premium assistance program since July 31, 2011, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services cms.hhs.gov 1-877-267-2323 ext. 61565
OMB Control Number 1210-0137 (expires 09/30/2013)
Walnut and Computerized Elevator Control Employees 35
Contact Information
e*source 866-910-6085 www.tk-esource.com [email protected]
Anthem Blue Cross Blue Shield (Claims or Provider Questions)
866-475-4303 www.anthem.com
CVS/Caremark Rx 877-406-4465 www.caremark.com
Delta Dental Insurance 800-510-9545 www.deltadentalins.com
Discovery Benefits HSA Account 866-451-3399 www.discoverybenefits.com
VSP Vision Service Plan 800-877-7195 www.vsp.com
Discovery Benefits — FSA 866-451-3399 www.discoverybenefits.com
LifeWorks EAP 888-267-8126 www.lifeworks.com
The Hartford (Short-Term Disability) 800-445-9057 www.thehartfordatwork.com
This benefit guide includes a general description of the ThyssenKrupp Elevator benefit plans offered as of January 1, 2013. This guide is meant to be brief and informational. Please refer to the SPD for details. This guide is not intended to create a contract or promise for benefits. Participation in the plans, as well as benefits offered under the plans, are all subject to applicable terms and conditions of the plans. The official plan documents will govern administration of these programs in the event any unintentional discrepancy is found between this guide and the plan contracts. ThyssenKrupp Elevator reserves the right to make all revisions and interpretations with respect to the plans described here. The decisions of ThyssenKrupp Elevator shall be final and binding upon all participants. ThyssenKrupp Elevator reserves the right, without your consent or concurrence, to amend, modify, suspend, replace, or terminate the plans, in whole or in part. If the plans are amended, modified, suspended, replaced, or terminated, you or other participants may not receive benefits as described here.
Walnut/CEC 10/12
ThyssenKrupp Elevator
2600 Network Blvd., Ste. 450, Frisco, TX 75034
Phone (877) 230-0303
thyssenkruppelevator.com | version 10.12
All illustrations and specifications are based on information in effect at time of publication approval.
ThyssenKrupp Elevator reserves the right to change specifications or design and to discontinue items without
prior notice or obligation. Copyright © 2012 ThyssenKrupp Elevator Corporation. CA License #651371
