Contractor Benefit Guide 2012-2013

Benefit Guide for Contract Employees
June 1, 2012 May 31, 2013

Enroll Online at www.AllegisBenefits.com
People. Service. Performance.
LEGAL STAFFING SERVICES
Table of Contents
Eligibility When Benets Begin How to Enroll ID Cards Page 5 Page 6 Page 6 Page 8 Page 8 Page 9 Page 13 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 22 Page 24 Page 26 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 35
People.Service.Performance.
Paying for Your Benets Medical Plans Prescription Benets Pre-existing Conditions Hospital Indemnity Plan Major Expense Protection Plan Health Advocate Dental Plan Vision Plan Disability Plans Life and AD&D Plans Filing Claims 401(k) Employee Assistance Plan (EAP) Transportation Benets Changing Your Benets When Coverage Ends COBRA Key Contacts
That is what Allegis Group and our operating companies are all about. One way we recognize our employee's contributions is by offering an extensive benets package. The Allegis Group Benet Program gives access to plans that help you protect the health and security of you and your family. We realize benet needs vary from person to person, so we provide a range of plans that let you choose the level of coverage and the combination of benets you want and need. This guide highlights the benets available to you and explains how to enroll. In this guide, you will nd: Your 20122013 Benets-at-a-Glance; Who is eligible and how to enroll; Summaries of each benet plan; and Phone numbers and websites where you can obtain more information about each plan.
Your Allegis Group Benets At-A-Glance

Type of Coverage Benets for 2012-2013 Aetna Voluntary Plans limited benets insurance plan underwritten by Aetna Life Insurance Company (Aetna) and administered by Strategic Resource Company (SRC), an Aetna company Choice of three limited medical benet coverage options Access to Aetnas nationwide network of providers Plans pay 70% for most in-network services covered under the plans, after deductible is met, up to the overall limits or service-specic limits of the plan Plans include a reimbursement prescription drug benet that pays 70% after deductible, subject to outpatient benet limit. This benet covers only medical prescriptions, except for dental prescriptions issued in connection with treatment resulting from a covered accident. Symetra Life Insurance Company Provides direct payment to the insured for inpatient hospitalization Coverage can be purchased separately or in addition to any of the three medical options If hospitalized, plan pays $1,000 for three hospital stays per covered person per calendar year, and $300 per day (at least 24 hours in a hospital) for up to 30 days per year Includes a Prescription Drug Discount Program and Health Advocate Services Symetra Life Insurance Company Provides direct payment to the insured for emergency room and inpatient hospital benets which includes substance abuse and mental health Coverage can be purchased separately or in addition to any one of the three medical options or the Hospital Indemnity plan If hospitalized the plan pays $1,500 per day up to 30 days per plan year Health Advocate Access to a Personal Health Advocate, typically a registered nurse, supported by a team of physicians and administrative experts, who will help in handling health care and insurance related issues You, your spouse, children, parents and the parents of your spouse are eligible to use this service You automatically receive this benet when you enroll in the PPO MAX, PPO 15, or PPO 5 Medical Plan You must be enrolled in one of the three PPO Medical Plans to be eligible to use this resource MetLife Dental: Pays 100% for preventive and diagnostic care Pays 50% to 80% for other services Deductible $50 per person Vision Service Plan (VSP): In and out-of-network option (eye exam every 12 months, lenses/frames/ contacts every 24 months) Interim Benets for lenses and frames
Medical (with prescription drug benet)*
Hospital Indemnity*
Major Expense Protection Plan (MEPP)*
Health Advocate
Dental*
Vision*
For Benets Online, visit www.AllegisBenets.com - 3
Type of Coverage
Benets for 20122013 The Hartford: Plan pays 60% of pre-disability weekly pay up to a maximum benet of $600 per week Benets begin on the 8th day of total disability and will be paid for up to 13 weeks Weekly premiums are based on age and weekly benet amount
Short Term Disability**
MetLife: 2 plan optionsve year option or to age 65 option Long Term Disability** Plan pays 60% of pre-disability monthly base pay after 90 days of disability Maximum monthly benet is $5,000 Weekly premiums are based on age, monthly earnings, and plan option Voluntary Life Insurance** Reliance Standard Life: Employee Voluntary Lifeup to $150,000, cost is based on age and level of coverage Spouse Voluntary Lifeup to $30,000, cost is based on age and level of coverage Child Voluntary Lifeup to $10,000cost is based on level of coverage Reliance Standard Life: Employee Voluntary AD&D up to $500,000 Family Voluntary AD&Dspouses benet is 60% of employees, dependent childrens benet is 15% of employees Wells Fargo Save up to $17,000 of your income for 2012 Wide range of investment options You can contribute to the 401(k) plan via pre-tax contributions or to the Roth via post-tax contributions Alliance Capital Build a tax-favored savings account for college expenses Wide range of investment options MetLife Buy MetLife auto, renters, boat, and personal liability coverage Special group rates and policy discounts Health Advocate Condential counseling for emotional, legal, nancial, and other personal issues You automatically receive this benet when you enroll in the PPO MAX, PPO 15, or PPO 5 Medical Plan ConnectYourCare Allows you to use pre-tax payroll dollars to pay for qualied parking and transit expenses Allegis Group, Inc. Discounts on car rentals, electronics, entertainment and many other services
Accidental Death and Dismemberment (AD&D)**
401(k) Plan*** Traditional 401(k) plan, Roth 401(k) plan
529 College Savings Plan*** Auto and Home Insurance*** Employee Assistance Plan (EAP) and Work/Life Benets Transportation Benets Work Life Employee Discount Program
*You may elect or change these benets during the annual open enrollment period or anytime during the year with a qualifying status change. **You may elect or change these benets anytime during the year with medical underwriting requirements. ***You may elect or change these benets anytime during the year once you meet eligibility, without restriction. ^Except in NY, this plan is led as a major medical plan that contains an annual benet maximum and a number of additional coverage limitations and exclusions.
4 - For Benets Online, visit www.AllegisBenets.com
Generally, if you are an active employee working at least 20 hours a week, you are eligible for benets. The following individuals are also eligible: A spouse: (1) a person who is legally recognized as the Employees spouse pursuant to a legally recognized ceremony between a man and a woman, or (2) a same-sex partner who either: (a) is legally recognized as the Employees spouse or partner pursuant to a state-sanctioned legal union between two individuals of the same sex, which affords substantially similar rights to the parties thereto as those imposed by an opposite sex marriage; or (b) provided the employee resides in a state that does not permit same-sex legal unions as described above, meets Allegiss denition of a Domestic Partner and completes an Afdavit of Domestic Partnership. For more information about Allegiss denition of Domestic Partnership and/or a copy of Allegiss Afdavit of Domestic Partnership, please contact the Human Resources Department. A child who: A. Is under the age of 26 or is permanently and totally disabled (and meets the eligibility requirements described below); and B. Is related to you in one of the following ways: 1. You or your spouses by birth or legal adoption; 2. Under testamentary or court appointed guardianship, other than temporary guardianship of less than 12 months duration, and who resides with, and is the dependent of you or your spouse; 3. A child who is the subject of a Medical Child Support Order or a Qualied Medical Support Order that creates or recognizes the right of the child to receive benets under a parents health insurance coverage; 4. A grandchild who is in the court-ordered custody, and who resides with, and is the dependent of you or your spouse.
Children whose relationship to you is not listed above, including, but not limited to grandchildren (except as provided above), foster children or children whose only relationship is one of legal guardianship (except as provided above) are not eligible, even though the child may live with you and be dependent upon you for support.
Eligibility
Please note, the Allegis Group Inc. Health Plan for Contract Employees does not recognize common law marriage. Employee contributions for health care coverage are generally taken on a pre-tax basis, however, according to federal law, employee benet contributions for same sex spouses who are not dependents as dened in the Internal Revenue Code, and children of same sex married couples who are not dependents of the employee as dened in the Internal Revenue Code cannot be taken pre-tax. If you and your spouse both work for Allegis Group and its operating companies, each family memberyou, your spouse, and your eligible childrencan be covered only once for medical, dental and vision. One of you can enroll in a plan and cover all eligible children, and the other can waive coverage, or you can both enroll. Children can not be covered by each parent separately.
Disabled Children
Coverage may be available to your disabled child who is over age 26, provided the child is nancially dependent on you, is unmarried and was enrolled in the plan prior to attaining age 26. If you have an over age disabled dependent child, documentation of the disability may be required to continue coverage under the Plan. Note: Enrolling an individual that is not eligible for Allegiss plans is a fraudulent act and could result in disciplinary action up to and including termination.
When Benets Begin
If you are a new hire, your benet coverage begins on the rst of the month coinciding with or following your hire date if you are on active service. Active service means you are doing your regular duties in the usual manner on a scheduled work day at one of the places of business where you normally work or where your work sends you. Coverage for your dependents begins when yours does, unless you add them to your coverage later. You have 30 days from your effective date to enroll for benets. Example 1: Example 2: Hired 6/9/12 Hired 7/1/12 Benet Coverage Begins 7/1/12 Benet Coverage Begins 7/1/12 Must Enroll By: 12 Midnight ET, 7/30/12 Must Enroll By: 12 Midnight ET, 7/30/12 Please keep in mind, you pay for benets through weekly payroll deductions and if you miss deductions, payment will automatically be made up with double deductions. Please see the Paying for Your Benets section of the guide for more detailed information.
How to Enroll
Enroll Online at AllegisBenets.com
AllegisBenets.com is an online benets service that puts benets information and enrollment at your ngertips 24 hours a day, seven days a week. AllegisBenets.com lets you look at your personal benets record, including current coverage, dependents, and costs. You can also nd details about all the available plans, so you can choose benets that will work best for you and your family. In addition: You DO NOT have to ll out a paper enrollment form. AllegisBenets.com is private and accessible from any computer, anywhere, anytime. You can enroll online and print a conrmation. You can print a Temporary Benet Conrmation to present to your providers in the event you have not received your ID cards. You can access AllegisBenets.com after the enrollment period whenever you have questions about your benets. You can not enroll over the phone. If you do not have web access, please contact your local ofce for a paper application. You may fax your enrollment form and all other forms to the Benets Department. You have from your date of hire through the end of your rst full calendar month of employment to enroll. If you wait until the latter part of your effective month to enroll, your benets will still begin on the rst of the month and you will be responsible for all missed premiums.
Logging on to AllegisBenets.com
First Time AllegisBenets.com Users
Go to www.AllegisBenets.com. You will see a login box on the right of your screen where you can enter your Username and Password. Enter your social security number (without dashes) as both your Username and Password and then select Login. You will then be asked to verify your birth date (MM/DD/YYYY) and to enter your login identier. Your login identier is Allegis. You may now choose and conrm a new password only you will know. You must also choose a security question and provide an answer to that question. In the event you forget your password, a password will be provided to you by answering the security question properly. Please read the AllegisBenets.com user agreement carefully as it explains your rights and responsibilities regarding online enrollment. Then, verify your understanding of the agreement by selecting the appropriate statement at the bottom of the page. Select Enroll to proceed to your online enrollment.
Returning AllegisBenets.com Users
Go to www.AllegisBenets.com. There will be a login box on the screen. Enter your Username and Password and then select Login. Read the information on this page and; Select Continue at the bottom of the page to proceed to your online enrollment.
The Enrollment Process
Once you log in, just follow these steps: 1. Review your personal information, a. Demographic (if you need to make changes, you may do so at this screen. If you need to change a eld you do not have access to, please contact your local ofce) b. Employment information (if this information is incorrect, please contact your local ofce) c. Dependent Review. If you need to add or remove a dependent, you should do so from this screen. Please note, adding a dependent here DOES NOT enroll them in benets. You must add them to each plan you wish to enroll them in. 2. Review your current benets and details of your 2012-2013 options. 3. Elect your 20122013 benets or waive those you do not wish to elect. a. Medical i. Choose your coverage level (Employee, Employee + One Dependent, Family) or waive medical coverage ii. If you choose coverage other than employee only, you must add your dependents to the plan b. Hospital Indemnity Plan c. Major Expense Protection Plan d. Dental e. Vision f. Voluntary Life Insurance (if you enroll outside of your eligibility period or increase your existing coverage you will be subject to approval by Reliance) g. Voluntary AD&D h. Voluntary Short Term Disability (STD) i. Voluntary Long Term Disability (LTD) 4. Review all of your elections and continue through the enrollment process. 5. Review the Online Enrollment User Acknowledgment and complete the online enrollment process 6. Print your online Enrollment Election form and keep this copy for your records.
Beneciaries
Many people overlook and underestimate the importance of designating a beneciary. In many cases, people dont designate a beneciary at all, and in other cases, the information is outdated. Taking the time to designate or update your beneciaries today can eliminate many challenges for your family in the event of your death.
How to Designate or Update Your Beneciaries
Below is a list of the benets that need a beneciary as well as step-by-step instructions on how to check and update your beneciaries Voluntary Life Insurance and AD&D Log on to www.AllegisBenets.com. Click on the My Benefits & Personal Information tab at the top of the page. Click Change Beneficiary Designations. 401(k) Log on to www.wellsfargo.com/allegisgroup. Click on My Profile. Click on Beneficiary Maintenance.
Benet Identication (ID) Cards
Your medical ID cards will arrive at your home approximately 3 weeks from the time your enrollment is received at SRC. You will not receive ID cards for the hospital indemnity, dental and vision plans, as SRC, MetLife and VSP do not require you to have an ID card for these plans. You may print a Temporary Benet Conrmation if you have not received your medical id card or if you would prefer to have your dental and vision information on hand when you visit your provider. To print your Temporary Benet Conrmation, log on to AllegisBenets.com and select the My Benets & Personal Information tab at the top of the Homepage. Under the Benets Information Column, select Print Temporary Benet Conrmation. Select the benets you would like to print a temporary conrmation for and select Retrieve ID Cards.
If You Do Not Enroll
If you do not enroll during your initial eligibility period (generally 30 days from the rst day of the month coincident with or following your date of hire), you cannot enroll or make changes to your medical/prescription, dental, vision, hospital indemnity, or major expense protection benets until the next open enrollment period, unless you have a qualifying life status change, described later in this guide. You may enroll for short-term disability, long-term disability, voluntary life and/or AD&D insurance at any time, but you must complete the Evidence of Insurability (EOI) questionnaire if you do not elect during your initial eligibility period.
If You Do Not Have Web Access
If you do not have access to AllegisBenets.com, you may complete a paper enrollment to enroll in your benets. To obtain a paper enrollment form, please contact your local ofce. You may fax your completed forms to the Benets Department at 410-540-7549, inter-ofce the forms to; Allegis Group Benets Department, Mail StopAG-29 OR mail them to: Allegis Group Benets Department, 7312 Parkway Drive, Hanover, MD 21076.
Paying for Your Benets
You pay for your benets through weekly payroll deductions. Your premiums for your medical, dental, vision, hospital indemnity, and major expense protection coverage will be deducted from your paycheck on a pre-tax or post-tax basis, depending on the option you choose. However, according to federal law, premiums for a same-sex spouse or domestic partner and his/her child(ren) cannot be paid on a pre-tax basis unless, the spouse, domestic partner or child qualies as your dependent as dened under the Internal Revenue Code. Under Section 125 of the Internal Revenue Code, if you choose pre-tax contributions, you may not change or cancel your benets unless you incur a qualifying life status change, described later in this guide. If you choose post-tax contributions you may completely cancel all of the benet plans you are enrolled in at any time during the year without restriction, however, you may not just cancel one benet plan and keep the others (i.e., cancel medical, keep dental and vision) or change medical plans. In addition, you cannot change your benets (i.e. adding/removing dependents) unless you incur a qualifying life status change. 401(k) contributions are made on a pre-tax basis (unless you elect to make after-tax Roth 401(k) contributions). Deductions for Disability, Life, and AD&D insurance are made on a post-tax basis. Please keep in mind: Weekly payroll deductions begin the rst full week of benet coverage; If you wait until the latter part of your effective month to enroll, your benets will still begin on the rst of the month and you will be responsible for all missed premiums; Missed deductions will be made up with double deductions in subsequent weeks. You must pay for your benets every week, regardless of how often you use them.
If You Have Questions
If you have questions about your benet choices or the enrollment process, contact your local ofce or the Benets Service Center at 1-866-886-9798, Monday through Friday 8am to 6pm EST, or send an email to AskBenets@ allegisgroup.com. Phone numbers and web addresses for the various benet plan providers are found on the back of this guide.
Patient Protection and Affordable Care ActNotice of Grandfathered Status
Allegis Groups medical plan is considered a grandfathered health plan under recent health reform legislation (the Patient Protection and Affordable Care Act). The law allows a grandfathered plan to preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that the Allegis Group PPO MAX, PPO 15 and PPO 5 medical plans do not have to incorporate certain provisions of the Affordable Care Act that apply to non-grandfathered plans. However, grandfathered health plans must comply with certain other provisions in the Affordable Care Act (for example, offering coverage to eligible adult children up to age 26). Questions regarding which provisions apply and which provisions 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 1-866-886-9798. You may also contact the Employee Benets 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.
Medical Plans Aetna Voluntary Plans limited benets insurance plan from SRC, an Aetna company
Before you decide if one of these limited medical plans is right for you, review both the following summary and the enrollment kit materials created by SRC. To view these online, go to www.aetna.com/src (login: 800180, password AAHC) and follow the links to the Document Library, then click on Enrollment Kit. Once you access the websites, you may view, print or save copies of the materials. You may also request a printed copy of the SRC enrollment materials by calling 1-866-894-2778.
Notice of Waiver from the Annual Limit Requirement
The Affordable Care Act prohibits health plans from applying dollar limits below a specic amount for certain benets. This year, if a plan applies a dollar limit on the coverage it provides for key benets in a year, that limit must be at least $1,250,000. Your health insurance coverage, offered by Aetna Life Insurance Company, does not meet the minimum standards required by the Affordable Care Act described above. Your coverage has an annual limit of: Medical Coverage Limits: PPO 5 Most this plan will pay overall per coverage year Most this plan will pay per coverage year for: Outpatient charges Hospital services other than daily room charge Most this plan will pay per coverage year for preventive visits $5,000 $1,500 $1,500 $100
This means that your health coverage might not pay for all of the health care expenses you incur. For example, a stay in a hospital costs around $1,853 per day. At this cost, your insurance would only pay for 2 days. Medical Coverage Limits: PPO 15 Most this plan will pay overall per coverage year Most this plan will pay per coverage year for: Outpatient charges Hospital services other than daily room charge Most this plan will pay per coverage year for preventive visits $15,000 $2,500 $1,500 $100
This means that your health coverage might not pay for all of the health care expenses you incur. For example, a stay in a hospital costs around $1,853 per day. At this cost, your insurance would only pay for 8 days. Medical Coverage Limits: PPO MAX Most this plan will pay overall per coverage year Most this plan will pay per coverage year for: Outpatient charges Hospital services other than daily room charge Most this plan will pay per coverage year for preventive visits $150,000 $10,000 $10,000 $100
This means that your health coverage might not pay for all of the health care expenses you incur. For example, a stay in a hospital costs around $1,853 per day. At this cost, your insurance would only pay for 80 days. If you are concerned about your plans lower dollar limits on key benets, you and your family may have other options for health care coverage. For more information, to to: www.healthcare.gov. If you have any questions or concerns about this notice, contact SRC, an Aetna company, at 1-866-894-2778. In addition, for plans offered in states with a Consumer Assistance Program (CAP), you can contact your states CAP. For more information, go to: www.healthcare.gove/law/provisions/cap/index.html.
PLEASE READ CAREFULLY BEFORE DECIDING WHETHER THIS PLAN IS RIGHT FOR YOU: This plan will not pay more than the overall maximum benet in a coverage year. This plan also limits what it will pay for particular kinds of services in addition to the overall annual maximum benet. Once any of these limits have been reached, the plan will not pay any more towards the cost of the service in question, and your health care providers can bill you for what the plan does not pay. Many illnesses cost much more to treat than this plan will cover. This benets guide explains these limits, the overall annual maximum benet, and other cost sharing features of your plan, such as copayments and deductibles. See the full plan for more information. You may choose one of three limited medical benets coverage options. The plans are administered by Strategic Resource Company (SRC) and underwritten by Aetna Life Insurance Company. The plans offer access to Aetnas nationwide network of providers. Referrals are not required. The options differ in the weekly premium amount you pay for coverage, the maximum amount each plan will pay overall, and the maximum amounts each plan will pay for specic kinds of services. For a network provider near you, visit AllegisBenets.com for a direct link to the Aetna website or go to www.aetna.com/docnd/custom/aahc, click on Enter Doc Find. Or, call SRC at 1-866-894-2778. If you use a doctor outside the network, benets are paid at the out-of-network level shown in the following chart. If you live in an area with no network providers, benets will be paid at the in-network levels; but network discounts will not apply. Percentages of remaining charges you pay are based on Negotiated Charges in network and Recognized Charges out of network. A provider outside the network may require that you pay more than the Recognized Charge, and this additional amount would be your responsibility. For a full description of covered services and exclusions, please see the Certicate and Booklet Summary of Coverage (SOC) available online at www.AllegisBenets.com, or at www.aetna.com/src. If you access the documents via www.aetna.com/src your login is 800180. Use the password AAHC, then follow the links to the Document Library. Once you access the websites, you may view, print or save the copies of the documents.
Are benets coordinated?
No. Usually, the plans pay regardless of other coverage. Since the plans specically exclude expenses from onthe-job injury or sickness, the plans would not pay when Workers Compensation or similar coverage is available. Except in NY, this plan is led as a major medical plan that contains an annual benet maximum and a number of additional coverage limitations and exclusions. Group limited benet medical coverage is not available if you live and work in New Hampshire. This limited health plan does not meet Massachusetts Minimum Creditable Coverage standards.
Medical Benets
The following chart highlights commonly covered services under the Aetna Voluntary Plans limited medical insurance plan. For a full description of covered services and exclusions, please see the Certicate and Booklet Summary of Coverage (SOC) available online at www.AllegisBenets.com, or at www.aetna.com/src. If you access the documents via www.aetna.com/src, your login is 800180. Use the password AAHC, then follow the links to the Document Library. Once you access the websites, you may view, print or save copies of the documents. Please note, deductibles and annual plan limits are per coverage year (June 1May 31).
Benet In-Network $500 per person each coverage year** $600 per person each coverage year** $250 per person each coverage year** $300 per person each coverage year** $250 per person each coverage year** Out-of-Network In-Network Out-of-Network In-Network
PPO MAX Out-of-Network
PPO 15
PPO 5 $300 per person each coverage year**
Deductible (per coverage year**)
Annual Plan Limits (per coverage year**) Total Benet Maximum $150,000 (per person each coverage year**) $10,000 (per person each coverage year**) $10,000 (per person each coverage year**) $1,500 (per person each coverage year**) $2,500 (per person each coverage year**) $15,000 (per person each coverage year**)
$5,000 (per person each coverage year**) $1,500 (per person each coverage year**) $1,500 (per person each coverage year**)
(including inpatient hospital svcs. shown below)
Outpatient Benet Limit
(including prescription drugs)
Other Hospital Services Limit
12 - For Benets Online, visit www.AllegisBenets.com N/A 80%* $15 copay, no deductible 100%* N/A 80%* $15 copay, no deductible100%* N/A 80%* $100 per covered person $10 per visit deductible, then plan pays 80%* $20 per visit deductible, then plan pays 80%* Plan pays 60%*, after deductible**, subject to annual plan limits**
(total benet maximum and other hospital services limit above)
Wellness (Preventative) Care Benet Per Visit Co-pay Percentage of remaining charges paid by plan Maximum Benet per coverage $100 per covered person $10 copay, no deductible, then plan pays 100% $20 copay, no deductible then plan pays 100%* Plan pays 70%*, after deductible**, subject to annual plan limits** $100 per covered person $100 per covered person $10 per visit deductible, then plan pays 80%* $20 per visit deductible, then plan pays 80%* Plan pays 60%*, after deductible**, subject to annual plan limits**
$15 copay, no deductible 100%*

$100 per covered person $10 copay, no deductible, then plan pays 100% $20 copay, no deductible then plan pays 100%* Plan pays 70%*, after deductible**, subject to annual plan limits **
$100 per covered person $10 per visit deductible, then plan pays 80%* $20 per visit deductible, then plan pays 80%* Plan pays 60%*, after deductible**, subject to annual plan limits **
Walk-In/Retail Health Care Clinics
$10 copay, no deductible, then plan pays 100%
Doctor Ofce Visits
$20 copay, no deductible then plan pays 100%*
Inpatient Hospital Services Room & Board Services & Supplies Anesthesia Surgeons Fees Plan pays 70%* after deductible**, subject to annual plan limits** Plan pays 70%* after deductible**, subject to annual plan limits** Plan pays 60%* after deductible**, subject to annual plan limits**
(total benet maximum and outpatient benet limit above)
Plan pays 70%*, after deductible**, subject to annual plan limits**
Prescription Drugs
Plan pays 70%* after deductible**, subject to annual plan limits** Plan pays 70%* after deductible**, subject to annual plan limits** Plan pays 70%* after deductible**, subject to annual plan limits**
Plan pays 70%* after deductible**, subject to annual plan limits** Plan pays 70%* after deductible**, subject to annual plan limits** Plan pays 60%* after deductible**, subject to annual plan limits**
Emergency Room
Outpatient Services Outpatient Surgery Physical Therapy Diagnostic x-ray and lab Other outpatient services
Plan pays 70%* after deductible**, subject to annual plan limits**


This is a brief description of the medical coverage options. Actual benet payments made in accordance with the master contract. Health Insurance plans contain exclusions and limitations and some benets are subject to visit maximums. This material is for informational purposes only and does not constitute a contract. While this material is believed to be accurate, it is subject to change. 1Not all charges are paid up to the annual maximum. Carefully review the following limits. 2Other hospital services are charges for certain services and supplies billed by a hospital in addition to those charges for room occupancy. These charges may be signicant and may include, but are not limited to: pharmacy; medical and surgical supplies and devices; lab and x-rays; and operating and recovery room expenses. They do not include charges for Inpatient professional services such as charges billed by surgeons, physicians, radiologists, pathologists and anesthesiologists for services provided during an inpatient stay..3Benets for emergency room services will be provided at the in network rate, regardless of whether the provider is in or out of network. The in network deductible and percentage of remaining charges paid by the plan will apply to all emergency room services. * Where a benet is expressed as a percentage, the lower of the negotiated charge(s) or the recognized charge(s) will be the basis of payment. A negotiated charge is the maximum amount that a preferred provider has agreed to charge for the visit, service, or supply. After your plan limits have been reached, the provider may require that you pay the full charge rather than the negotiated charge. A Recognized Charge is the amount that Aetna recognizes as payable by the plan for a visit, service, or supply. For non-preferred providers (except inpatient and outpatient facilities and pharmacies), the Recognized Charge generally equals the 80th percentile of what providers in that geographic area charge for that service, based on the FAIR Health RV Benchmarks database from FAIR Health, Inc. This means that 80% of the charges in the database for geographic area are that amount or lessand 20% are morefor that service or supply. For preferred providers, the Recognized Charge equals the Negotiated Charge. A non-preferred provider may require that you pay more than the Recognized Charge, and this additional amount would be your responsibility. **Deductibles and Annual Plan Limits are per coverage year (June 1 May 31) Please note, Group limited benet medical coverage is not available if you live and work in New Hampshire. This limited health plan does not meet Massachusetts Minimum Creditable Coverage standards.
Medical/Prescription Plan 20122013 Weekly Premiums

Coverage Level Employee Only Employee plus One Dependent* Family* PPO MAX $66.59 $170.52 $243.98 PPO 15 $34.55 $88.45 $126.01 PPO 5 $24.97 $63.77 $90.80
*Please see the Eligibility section of this guide for the denition of an eligible dependent.
Prescription BenetsAetna Pharmacy Network from SRC, an Aetna company
All three medical coverage options offer prescription coverage, in which the plan covers 70% of the cost of prescriptions, in or out of network. You will have to pay for your prescription out of pocket and submit your receipts for reimbursement. Once you meet the annual deductible, SRC will reimburse you according to the plan. Prescriptions do apply toward the outpatient expense benet limit. You may be eligible to receive a discount on your cost of the prescriptions at participating pharmacies.
To Use Your Prescription benets:
A) Present your Aetna Voluntary Plans identication (ID) card to the pharmacist. B) Participating pharmacies will apply a discount. C) You pay the amount charged by the pharmacy. *D) Submit a medical claim form to SRC for reimbursement. *If the pharmacy submits your claim(s) for you, then these steps do not apply.
Aetna Rx Home Delivery
Aetna Rx Home Delivery is Aetnas mail order prescription drug service for maintenance medications (prescription medications used to treat chronic conditions or diseases). Aetna Rx Home Delivery offers you: Convenience Quick, condential shipping of your maintenance medications right to your home, place of work or any other location of your choice. Standard delivery is free. Overnight requests can be shipped for an additional cost. Ease of Use A simple, two-step process makes ordering your maintenance medications easy. Rells can be ordered by mail, phone, online, or by fax. Quality Service Registered pharmacists check orders for accuracy and are available 24 hours a day, 7 days a week in case of emergency. For additional information about Aetna Rx Home Delivery, please log into www.AllegisBenets.com and view the Aetna Rx Home Delivery Information and Order Form located under the Important Form Downloads section. For questions about your pharmacy benet, please call the Member Services number on your member ID card.
In accordance with applicable law and our pharmacy policies, Aetna Rx Home Delivery can only dispense the brand name version of certain medications, unless your doctor specically prescribes the generic alternative by name. This document was created and is maintained by Allegis, who is responsible for its accuracy. Health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. In the event of any conict between this document and the ofcial plan documents, the ofcial plan documents will govern.
Walk-In/Retail Health Care Clinics
You may have a Doctor Ofce Visit performed in a Walk-In or Retail Health Care Clinic for a $10 copay, where-as if the service is performed in your doctors ofce you would pay a $20 copay. Walk-in Clinics and Retail Health Care Clinics are clinics that are either free-standing or located in retail stores, supermarkets and pharmacies. Both are an alternative to a physicians ofce visit for treatment of unscheduled, non-emergency illnesses and injuries and the administration of certain immunizations. They are not alternatives for emergency room services or the ongoing care provided by a physician. Neither an emergency room, nor the outpatient department of a hospital are considered walk-in clinics or retail health care clinics. Some examples of walk-in/health care clinics are MinuteClinic (inside select CVS stores) and TakeCare Health (inside select Walgreens stores). To determine whether a walk-in or health care clinic in your area is a participating provider, visit www.aetna. com/docnd/custom/aahc and select Enter Doc Find. Enter the required information and when you select the Provider Category, choose Facilities (such as lab, walk in clinics and xray). Or, call SRC at 1-866-894-2778.
Discounts and Programs You Receive If Enrolled in Aetna Voluntary Plans limited medical plan
Your medical membership with Aetna Voluntary Plans includes special programs* and discounts** with a wealth of features. These programs include savings on products and educational materials geared toward particular health needs. Here are a few highlights: Weight management discount program You and your eligible family members can save on weight-loss programs and products from Jenny Craig. Hearing discount program Receive a discount** on hearing exams and services with HearPO at participating locations nationwide. Oral health care discounts Receive savings on products and services to help improve dental and overall health. Aetna pharmacy management In addition to prescription discounts, you receive information to help control certain medical conditions. Aetna Natural Products and ServicesSM program Professional services**, such as acupuncture, chiropractic care, massage therapy and nutritional counselors offered at reduced rates. Discounts on health-related products* including over-the-counter vitamins, herbal and nutritional supplements and natural products. Fitness program Discounted rates on memberships at participating health clubs contracted with GlobalFit as well as savings on home exercise equipment. Aetna VisionSM Discounts Receive discounts** on eyewear, contact lenses, LASIK eye surgery and eye care accessories at participating optical centers such as Sears Optical, LensCrafters, Target Optical and many Pearle Vision locations. To learn more about these programs and discounts, go to www.aetna.com/docnd/custom/aahc or call the Member Services number at 1-866-894-2778.
* These discount programs are rate-access programs and may be in addition to any plan benets. Discount and other similar health programs offered hereunder are not insurance. Program features are not guaranteed under the plan contract and may be discontinued at any time. Program providers are solely responsible for the products and services provided hereunder. Aetna does not endorse any vendor, product or service associated with these programs. It is not necessary to be a member of an Aetna plan to access the program participating providers. ** Discounts are from the providers usual fee for the service (retail price). These discount programs are not insured benets, but provide access to discount programs maintained by Aetna Inc. and its afliates.
Nurse Hotline
Members enrolled in medical coverage will have access to a dedicated nurse hotline. Aetnas Informed Health Line can help you make informed choices about your health care. This 24-hour, toll-free access health line gives you access to a team of registered nurses experienced in providing information on a variety of health topics. You can learn about health conditions and medical procedures, or how to improve the way you communicate with your doctor. For example, the Informed Health Line nurses can provide tips on how to describe health symptoms more clearly and ask the right questions during the ofce visits with your doctor. Informed Health Line also features an audio health library, a recorded collection of more than 2,000 health topics available in both English and Spanish. The audio health library contains information about common conditions and diseases, age and gender-specic health issues, dental care, mental health, substance abuse, weight loss and much more. Transfer to an Informed Health Line nurse at any time during your call. Call the Informed Health Line at 1-800-556-1555. Available 24 hours a day, 7 days a week.
Aetna Voluntary Plans limited benets insurance plan exclusions and limitations
Medical Pre-existing Conditions Limitation This plan imposes a pre-existing condition exclusion. This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within the 180 days prior to your enrollment in this plan. Generally, this 180-day period ends on the day before the medical plan waiting period begins (for example, on your date of hire). The pre-existing condition exclusion does not apply to pregnancy, or to members under 19 years of age including a newborn child or a child who is enrolled in the plan within 30 days after birth, adoption, or placement for adoption. This exclusion may last up to 365 days from the rst day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior creditable coverage. Most prior health coverage is creditable coverage and can be used to reduce the pre-existing condition exclusion period if you have not experienced a break in coverage of at least 63 days. To reduce the 365-day exclusion period by your creditable coverage, provide SRC with a copy of any certicates of creditable coverage you have. If you do not have a certicate but you have had prior health coverage, SRC will help you obtain a certicate from your prior plan or insurer. There are also other ways to show you have had creditable coverage. Please contact SRC at 1-866-8942778 if you need help demonstrating creditable coverage. Exclusions The medical plans do not cover all health care expenses and include exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s) purchased. All medical or hospital services not specically covered in, or which are limited or excluded in the plan documents. Cosmetic surgery, including breast reduction. Custodial care. Dental care and X-rays, unless medically necessary to repair an injury to the mouth, jaw or teeth resulting from an accident. Donor egg retrieval. Experimental and investigational procedures. Hearing aids. Immunizations for travel or work. Infertility services, including, but not limited to, articial insemination and advanced reproductive technologies. Non-medically necessary services or supplies. Orthotics. Over-the-counter medications and supplies. Reversal of sterilization. Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, or counseling. Special duty nursing.
Hospital Indemnity Plan Symetra
If you are hospitalized as an inpatient, the plan will pay you $1,000 in cash per admission, up to 3 admissions per covered person per calendar year. Each covered person will also receive a benet for each day (24 hour period) hospitalized as illustrated by the chart below subject to all policy provisions. The plan also includes a Pharmacy Discount Program at no additional cost. The Pharmacy Discount Program is a benet for those without prescription drug coverage on an Allegis medical plan or another medical plan that includes prescription drug coverage. A discount from usual and customary drug charges will be given to you when prescriptions are purchased through an in-network pharmacy. This is not a prescription drug benet but a discount program provided through ReStat (www.restat.com). Most national pharmacies are included in the ReStat network as are many regional and local pharmacies. You can verify participation by asking your pharmacy or checking on-line. You should not attempt to use this discount program if you have prescription drug coverage through your medical plan with Allegis or another plan. You can use only one pharmacy benet program. Benets cannot be duplicated. Health Advocate services are also included at no additional cost. This limited health plan does not meet Massachusetts Minimum Creditable Coverage standards.
Benet Coverage None None 500 days lifetime maximum (except for Mental Health Facility Stay) $1,000 per admission, per covered person, per calendar year $300 per day, 30 days maximum per covered person, per calendar year $600 per day, 30 days maximum per covered person, per calendar year $300 per day, 30 days maximum per covered person, per calendar year $300 per day, 30 days maximum per covered person, per calendar $150 per day, 60 days maximum per connement per covered person under the age of 65 Deductible Copay Lifetime Maximum Hospital Admission Hospital Stay (regular room) Hospital Stay (ICU) Hospital Stay (Substance Abuse Facility) Hospital Stay (Mental Health Facility) Post Hospital Nursing Facility Stay,
This is a summary of benets for illustration purposes only. Policy provisions govern. See policy for details, exclusions and limitations. 500 days per lifetime maximum 180 days per lifetime maximum Following a hospital stay of at least 3 days
Hospital Indemnity Plan Weekly Premiums

Coverage Level Employee Only Employee plus One Dependent* Family*
2012-2013 Weekly Premium $6.32 $12.43 $17.92
Major Expense Protection Plan - Symetra
The Major Expense Protection Plan offers you the opportunity to buy additional emergency room and inpatient hospital coverage, which includes inpatient hospitalization for substance abuse, and mental health. This plan can be purchased as a stand alone plan, or in addition to any one of the three limited medical insurance plan options (PPO MAX, PPO 15, PPO 5), and/or the Hospital Indemnity Coverage. The MEPP does not issue restrictions on hospitals, meaning there is no requirement to use participating providers. The following chart is a summary of the plan.
Benet Deductible Copay Lifetime Maximum Emergency Room Benet: Covered events that are the result of an illness or accident are paid at a pre-selected xed dollar amount per visit up to a calendar year maximum. This benet will be paid only for procedures received in an emergency room. Coverage None None 500 days lifetime maximum for each benet per person (except for Mental Illness) $200 per visit/$500 calendar year maximum per person, per calendar year $1,500 per daily hospital stay / 30 days maximum per calendar year $1,500 per day, per person for stays in a substance abuse facility / 30 days maximum per calendar year $3,000 per day, per person for stays in the Intensive Care Unit / 30 days maximum per calendar year $750 per day, per person for stays in a mental health facility / 30 days maximum per calendar year, 180 days per lifetime $750 per day, per person for stays in a nursing facility (only if following a covered hospital stay of at least 3 consecutive days and the person is less than age 65) / maximum 60 consecutive days per stay Covered as any other condition
Inpatient Hospital Benet: Coverage for inpatient hospital stays is provided and benets are paid at a pre-selected xed dollar amount per day of connement up to a maximum number of days per calendar year. Daily Hospital Substance Abuse Intensive Care Unit Mental Health Facility Nursing Facility
Maternity Care
Major Expense Protection Plan Weekly Premiums

Coverage Level Employee Only Employee plus One Dependent* Family*
*Please see the Eligibility section of this guide for the denition of an eligible dependent. The Major Expense Protection Plan is not a replacement for a major medical policy or other comprehensive policy. It is designed to cover benets used on a routine basis at a pre-selected, xed dollar amount. Coverage may be subject to exclusions, limitation, reductions, and termination of benet provisions. Exclusions, limitations, denitions, and benets may vary by state. Please see the policy for details. The Major Expense Protection Plan is insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA, 98004. SymetraSM is a service mark of Symetra Life Insurance Company.
2012-2013 Weekly Premium $23.29 $48.43 $55.46
Health Advocate
Health Advocate, the nations leading health advocacy company, provides condential, personalized, one-on-one assistance to you and eligible family members to help navigate many aspects of the health care world. You will have access to a Personal Health Advocate, typically a registered nurse, supported by a team of physicians and administrative experts, who will help in handling healthcare and insurance related issues. Eligible family members who can use Health Advocate include you, your spouse, your children, your parents, and your spouse's parents.
Top Ten Reasons to call Health Advocate
1. Finding the best doctors, hospitals, dentists, and other leading healthcare providers anywhere in the country. This includes locating providers in your health insurance plans network. 2. Scheduling appointments with providers including hard to reach specialists and critical care providers and arranging for specialized treatments and tests. 3. Helping to resolve insurance claims and assisting with negotiating billing and payment arrangements, and related administrative issues. 4. Working with our insurance companies to obtain appropriate approvals for needed services often fostering communications between physicians and insurance companies. 5. Assisting with eldercare and related healthcare issues facing your parents and parents-in-law. They work with Medicare and other government insurance programs and help make arrangements following discharge from a hospital for in-home or needed institutional service. 6. Answering questions about test results, treatment recommendations and medications recommended or prescribed by your physician. 7. Obtaining unbiased health information to help make an informed decision. 8. Assisting in the transfer of medical records, x-rays and lab results. 9. Locating and researching the newest treatments for a medical condition. 10. Assisting with nding qualied wellness programs, providers and services. Employees who participate in the SRC/Aetna PPO MAX, PPO 15, or PPO 5 medical plans are eligible to use Health Advocate. To utilize the services offered by Health Advocate, simply call 1-866-799-2728 or send an email to answers@HealthAdvocate.com. When you request service, you will be asked to complete a Medical Information Release Form. Please be assured Health Advocate will keep all information strictly condential and will protect your privacy. For more information about the company and services, visit www.HealthAdvocate.com/members.
The MetLife dental plan covers preventive, basic, and major dental services and supplies. Generally, when you receive care from a MetLife participating dentist, your out-of-pocket expenses will be lower than if you receive services from a non-participating dentist. For a participating dentist near you, visit AllegisBenets.com for a direct link to the MetLife website or go to www.metlife.com/dental or www.metlife.com/mybenets. You can also call MetLife at 1-800-942-0854.
Dental Plan - MetLife
Dental Benets
This chart provides highlights of some covered services. For a full description of covered services and exclusions, please see the detailed plan description provided on www.AllegisBenets.com. Please note, deductibles and annual plan limits are per coverage year (January 1December 31).
Benet Annual (calendar year) Deductible (for Type B and C Expenses Combined) Annual (calendar year) Plan Limit Maximum Benet Type A Expenses - Preventive Oral Exams once every six months Cleaning, polishing once every six months Type B Expenses X-rays, llings, minor oral surgery Type C Expenses Crowns, dentures, bridgework, complex oral surgery Type D Expenses Orthodontia In-Network $50 per person $1,000 per person Plan pays 100%* no deductible Plan pays 80%* after deductible Plan pays 50%* after deductible Not Covered Out-of-Network $50 per person $1,000 per person Plan pays 100%** no deductible Plan pays 80%** after deductible Plan pays 50%** after deductible
Additional Type A, B & C information can be found in the MetLife Dental Plan Certicate of Insurance. *Plan Benets subject to the Maximum Allowed Charge for the types of dental services shown in section C of the Plan Certicate of Insurance. The Maximum Allowed Charge is the lower of: a. the amount charged by the Participating Provider for the service or supply; and b. the maximum amount that the Participating Provider agreed with us to charge for that service or supply. This maximum amount is specied or based on the amounts specied in the Preferred Dentist Program Table of Maximum Allowed Charges. ** Plan Benets subject to Reasonable and Customary (R&C) limits for the types of dental services shown in section C of the Plan Certicate of Insurance. The Reasonable and Customary Charge is the lowest of: a. the usual charge by the Dentist or other provider of the services or supplies for the same or similar services or supplies; or b. the usual charge of most other Dentists or other providers in the same geographic area for the same or similar services or supplies; or c. the actual charge for the services or supplies.
Dental Plan Weekly Premiums

Coverage Level Employee Only Employee plus Child* Employee plus Spouse Family*
2012-2013 Weekly Premium $6.54 $13.15 $14.99 $16.94
Vision care benets are provided through Vision Service Plan, or VSP. Generally, when you receive care from a VSP participating provider, your out-of-pocket expenses will be lower than if you receive services from a nonparticipating provider. To nd a VSP provider, visit AllegisBenets.com for a direct link to the VSP website or go to www.vsp.com. Select Members and Consumers and Find a VSP Network Doctor. Or, call VSP at 1-800-8777195. When you make an appointment, indicate you are a VSP member. The provider will obtain the necessary approvals. If you use non-participating providers, you must pay for services and then submit a claim form to VSP for reimbursement.
Vision Plan - VSP
Vision Benets
This chart provides highlights of some covered services. For a full description of covered services and exclusions, please see the detailed plan description provided on www.AllegisBenets.com.
Benet Eye Exam Frequency* Well/Vision: Once every 12 months Contact Lens: Once every 24 months Once every 24 months In-Network $15 co-pay, then plan pays 100% Plan pays 100% for selected frames up to $130 Combined $15 co-pay for lenses and frames, then Plan pays 100% Out-of-Network Plan pays up to $43
Frames Lenses: Single vision Bifocal (lined) Trifocal (lined) Lenticular
Plan pays up to $45 Plan pays up to: $35 $51 $68 $80
Once every 24 months
INTERIM BENEFITS for lenses (including contact lenses) and frames every 24 months - If your lens prescription changes before you are eligible for new lenses and those prescriptions meet at least one of the following criteria, lenses & frames will be replaced at a 12 month frequency; a) a new prescription differs from the original by at least a .50 diopter sphere or cylinder; b) an axis change of 15 degrees for more; c) a. 5 prism diopter change in at least one eye. Visually Necessary contact lenses Elective contact lenses Once every 24 months Once every 24 months $15 co-pay, then plan pays 100% Plan pays up to $130 Plan pays up to $210 Plan pays up to $105
*Frequency is based on your last date of service with any VSP plan. VSP will not cover eye exams more than once in a 12-month period, or contact lenses and eyeglasses/ frames in the same 24-month period.
Vision Plan Weekly Premiums

Coverage Level Employee Only Employee plus Child* Employee plus Spouse Family*
2012-2013 Weekly Premium $1.69 $2.71 $2.66 $4.37
VSP Members Portal
The VSP Members Portal offers features for you to use that make managing your VSP benets and eye health simple. View Your Benets provides a concise benets overview and a member reference card that you may print and carry with you. Find a VSP Doctor assists you in nding a participating VSP doctor and provides you information about VSP doctors. Member Resources guides you in using your VSP benets; provides Frequently Asked Questions and much more. Visit www.vsp.com and select Members. To access the Members Portal you will need to register by selecting Log In/Registration at the top of the page and select Register Now. If you have already registered simply select Log In/Registration and enter your username and password.
If you are enrolled in the Aetna Voluntary Plans medical insurance plans through SRC, an Aetna company, you have access to the Aetna Visionsm Discounts at no additional cost. With this program, you and your family can receive discounts on eye exams, glasses, contact lenses, non prescription sunglasses, contact lens solutions and other eye care accessories. You can also receive discounts on LASIK eye surgery. The Aetna Visionsm Discount program has a nationwide network of vision care providers. For a network provider near you, visit AllegisBenets.com for a direct link to the Aetna website or go to www. aetna.com/docnd/custom/ aahc, click on Enter Doc Find. For questions regarding exams and eyewear call 1-800-793-8616. For questions about contacts call 1-800-391-5367. For LASIK customer service call 1-800-422-6600.
Please note, Aetna Visionsm Discounts provides access to discounted prices only. It is NOT an insurance plan and is not associated with the vision benets offered through Vision Service Plan (VSP).
Aetna Visionsm Discounts
Short-Term Disability Coverage (STD) The Hartford
The company offers a Short-Term Disability (STD) plan through The Hartford that protects you against loss of income if you can not work due to a sickness or injury that is not work related. If you become totally disabled, your benet will be 60% of your pre-disability weekly pay up to a maximum benet of $600 a week. Benets begin on the 8th day of total disability, and will be paid for up to 13 weeks. If you enroll during your initial eligibility period, you will not be subject to approval by The Hartford. Late enrollees are subject to approval by The Hartford and medical questions will be required to be answered. Deductions are taken on a post-tax basis, so any benet paid is tax free. Coverage ends on your last day of employment. If you become disabled in the rst 12 months after you enroll for STD coverage, benets will not be paid for a disability caused by any medical condition for which you have been treated or diagnosed within the six months before joining the STD plan, including pregnancy. For information about the availability of state leave, please contact the Benets Department. The cost of coverage is based on your age and weekly benet amount, as shown in the following chart. When completing your new hire enrollment on www.AllegisBenets.com, you will be able to automatically calculate your weekly STD premium.
Your Age Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55 and over
*The costs shown above are per $10 of weekly benet. Example An individual age 36 with $480 in weekly pay, the weekly benet is $288 and the weekly cost to the employee is $3.92. The weekly benet of $288 is based on 60% of the $480 weekly pay. Weekly premiums are calculated for every $10 of weekly benet amount (i.e. $288/$10 = 28.80). Using the age of the employee and the chart above the premium multiplier is determined. In this example the employee is 36 years old therefore the multiplier is $.136. When the $.136 is multiplied by 28.80 the employee arrives at their weekly premium of $3.92.
STD Weekly Premium Multiplier* $.182 $.155 $.155 $.136 $.143 $.162 $.203 $.242
Family and Medical Leave (FMLA)
The company provides Family and Medical Leaves of Absence without pay to eligible employees. Qualied individuals must have worked for the Company for at least 12 months in the last seven (7) years, and must also have worked at least 1,250 hours during the 12 months immediately preceding the request. Qualied individuals may be eligible to take up to 12 weeks of unpaid Family and Medical Leave within a rolling 12 month period for the following reasons: To care for the employees child during the rst 12 months following birth, adoption or foster care. To care for the employees spouse, child or parent with a serious health condition For incapacity due to the employees pregnancy or child birth. For the employees own serious health condition. Furthermore, qualied individuals may be eligible to take up to 26 weeks of unpaid Family and Medical Leave within a rolling 12 month period for the following reasons: To care for the employees spouse, child, parent or next of kin who is a service member recovering from serious illness or injury sustained in the line of active duty. Due to a qualifying exigency arising because the employees spouse, child or parent is on active duty or has been notied of an impending call to order to active duty in support of a contingency operation. In addition to FMLA leave, employees may also be eligible for leave under a similar state law. For information about the availability of state leave, please contact the Benets Department.
Long-Term Disability Coverage (LTD) - MetLife
The company offers a Long-Term Disability (LTD) plan through MetLife that pays benets if total disability lasts more than 90 days. The monthly LTD benet is 60% of your pre-disability monthly base pay, reduced by Social Security and other disability income benets. The maximum monthly LTD benet is $5,000. The minimum monthly benet is the greater of $100 or 10% of your monthly benet before reductions for Social Security and other income benets. Deductions are taken on a post-tax basis. Coverage ends on your last day of employment. When you enroll, you can choose a ve year benet period or a benet period to age 65. LTD benets are not paid for more than 24 months for mental or nervous disabilities. A work incentive benet lets you return to work during partial disability. If you die while on LTD, three months of benets will be paid to your survivor. If you enroll during your initial eligibility period, you will not be subject to approval by MetLife. Late enrollees are subject to approval by MetLife and medical questions will be required to be answered. Conditions existing within three months of your effective date of coverage are considered pre-existing and are not covered until you are continuously insured for 12 months. The cost of coverage is based on your age, monthly earnings, and benet period you choose, as shown in the following chart. When completing your new hire enrollment on www.AllegisBenets.com, you will be able to automatically calculate your weekly LTD premium.
Your Age Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55 and over
The costs shown above are per $100 of monthly earnings. Example for an individual age 36 with $3,000 in monthly earnings who chooses benets to age 65, the weekly cost is $3.93 [$.131 (weekly rate for age 36) times 30 (monthly earnings divided by 100)]. (Please note, the maximum insurable monthly earnings amount is $8,333.33 ($100,000 annually)
LTD Weekly Premium Multiplier* 5 Year Plan 0.031 0.036 0.050 0.067 0.090 0.144 0.237 0.404 To Age 65 Plan 0.045 0.056 0.081 0.118 0.157 0.254 0.355 0.452
Life Insurance Reliance Standard Life
The Allegis Group Voluntary Term Life Insurance plans let you choose coverage for yourself, your spouse, and dependent children under age 19 (26 if full-time student). You may elect coverage for your spouse without buying coverage for yourself. However, in order to buy coverage your child(ren), either you or your spouse must elect coverage. Coverage is portableyou may purchase an individual policy if your Allegis Group employment ends. Employee Life Insurance -You may buy up to $150,000 in term life insurance coverage. Evidence of Insurability is not required if you enroll within your original eligibility period. If you enroll outside of your original eligibility period, you must provide Evidence of Insurability. Coverage is available in increments of $10,000. When you enroll, you must name a beneciary. The amount of insurance in effect is subject to automatic reduction beginning at age 75. Life Insurance for your Spouse You may buy up to $30,000 in term life insurance for your spouse. Evidence of Insurability is not required if you enroll your spouse within your original eligibility period. If you enroll outside of your original eligibility period, you must provide Evidence of Insurability. Coverage is available in increments of $10,000. You are the beneciary for spouse's coverage. On the date of application, your spouse must be under age 70. Insurance on a spouse terminates at age 75. Life Insurance for Dependent Children You may elect $2,500, $5,000, $7,500, or $10,000 for dependent children up to age 19 (26 if full-time student). This benet covers all of your eligible children. Coverage for children 14 days of age but less than 6 months is $1,000. Coverage for children age 6 months but less than 26 years is the elected amount. You are the beneciary. The cost of employee and spouses term life insurance is based on age and the amount of coverage you select. The rates are the same for the employee and spouses coverage. Weekly Premium Multipliers are shown on the following chart. When completing your new hire enrollment on www.AllegisBenets.com, you will be able to automatically calculate your weekly Life Insurance premiums.
Age Under 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 and over
*The costs shown above are per $10,000 of life insurance coverage. Example for an individual age 46 with $50,000 in life insurance, the weekly cost is $3.27 [$.653 (weekly rate for age 46) times 5].
Employee/Spouse Life Insurance Weekly Premium Multiplier* $.141 $.171 $.247 $.351 $.653 $1.057 $1.638 $2.993 $4.403 $7.145
The cost of life insurance for dependent children is based on the coverage level you choose, regardless of how many eligible children you have. Weekly Premium Multipliers are shown on the following chart. When completing your new hire enrollment on www.AllegisBenets.com, you will be able to automatically calculate your weekly Life Insurance premium.
Amount of Insurance $2,500* $5,000* $7,500* $10,000* Age 6 months but less than 26 years 6 months but less than 26 years 6 months but less than 26 years 6 months but less than 26 years Dependent Child(ren) Life Insurance $.136 $.205 $.275 $.344
* If 14 days but less than 6 months, benet will be $1,000.
Please note, Life Insurance is not a COBRA eligible plan. However, if your employment ends you may elect to continue Life Insurance for yourself and your dependents under the Portability and Conversion terms of the plan. You have 30 days to send your completed application to the Allegis Group benets department. Please refer to the plan certicate, which can be located on www.AllegisBenets.com for more details.
Accidental Death and Dismemberment (AD&D) Insurance Reliance Standard Life
Accidental Death and Dismemberment (AD&D) insurance covers you if you die or suffer serious injury as a result of an accident. You may buy AD&D coverage of up to $500,000 in $10,000 increments. Benets are paid to your beneciary if you die, or to you if you suffer certain injuries as a result of an accident. AD&D benets are paid in addition to your life insurance coverage if you die as a result of an accident. Proof of good health is not required. You may choose employee-only coverage or family coverage (family includes coverage for yourself). If you choose family coverage, your spouses benet is 60% of yours and dependent childrens benet is 15% of yours. You are the beneciary for your dependents AD&D coverage. The cost of AD&D coverage depends on the coverage level you choose, as shown on the following chart. When completing your new hire enrollment on www.AllegisBenets.com, you will be able to automatically calculate your weekly AD&D premiums.
Coverage Level Employee Only Family Employee/Family AD&D Weekly Premium Multiplier $.090 $.210
*The costs shown above are per $10,000 of coverage. Example: For an individual who chooses family AD&D coverage of $50,000, the weekly cost is $1.05 [$.210 (weekly rate for family coverage) times 5].
Please note, AD&D Insurance is not a COBRA eligible plan. However, if your employment ends you may elect to continue AD&D Insurance for yourself and your dependents under the Portability and Conversion terms of the plan. You have 30 days to send your completed application to the Allegis Group benets department. Please refer to the plan certicate, which can be located on www.AllegisBenets.com for more details.
Filing Claims
Below are instructions on how to le a claim with each of the benet carriers. All claim forms (where applicable) can be found on www.AllegisBenets.com.
For Medical Claims:
In Networkprovider should submit claims to SRC Out-of-NetworkThe employee will pay the claim out-of-pocket and submit the claim to the address located on the Aetna Medical Claim Form: SRC, an Aetna Company PO Box 14463 Lexington, KY 40512
All claims must be submitted within 90 days from the date of service. Claims are not covered if they are led more than two years after the 90-day deadline. To obtain a medical claim form, go to AllegisBenets.com or visit www.aetna.com/docnd/custom/aahc or call the member services number at 1-866-894-2770.
For Prescription Claims:
Submit the claim form, along with your register receipt and the appropriate drug receipt with name of pharmacy, name of the drug etc. to the address located on the Aetna Medical Claim Form: SRC, an Aetna Company PO Box 14463 Lexington, KY 40512
All claims must be submitted within 90 days from the date of service. Claims are not covered if they are led more than two years after the 90-day deadline. To obtain a prescription claim form, go to AllegisBenets.com or visit www.aetna.com/docnd/custom/aahc or call the member services number at 1-866-894-2770.
For Hospital Indemnity Plan or Major Expense Protection Plan (MEPP) Claims:
Simply mail a copy of your itemized receipt for services (given to you by your provider) to the address below: CLAIMS: Select Benefit Administrators of America P.O. Box 440 Ashland, WI 54806 Make sure the following information is shown on your service receipt: Insureds ID (Social Security Number) Patient Name Provider name, address and ID Diagnosis or ICD-9 code(s) [description of your medical condition] Procedure or CPT or revenue codes [that indicate services rendered] Associated charges Dates of service. If any of this information is missing, simply write it in.
For Dental Claims:
In Network-the dentist should submit the claim to MetLife Out-of Network-the employee should submit the Dental Claim form to: MetLife (National) P.O. Box 981282 El Paso, TX 79998
To obtain a dental claim form, go to AllegisBenets.com or visit Metlife.com.
For Vision Claims:
In Network-the employee pays appropriate co-pay, the physician submits the claim to Vision Service Plan Outof-Network-the employee should pay the provider the full amount of the bill and request an itemized copy of the bill that shows the amount of the eye examination, lens type, and frame (if applicable). The employee should send a copy of the itemized bill to: Vision Service Plan Attn: Non-Member Doctor Claims P.O. Box 997105 Sacramento, CA 95899-7100 The following information must be included: Member's name and mailing address Member's social security number Member's employer (Allegis Group) Patient's name, relationship to member, and date of birth Submit the above information on any generic insurance claim form that may be available upon request from your Non-Participating provider. We do not have the claim forms available at Corporate.
All claims must be submitted within 6 months from the date of service.
For Life Insurance and Accidental Death & Dismemberment (AD&D) Claims:
The appropriate Reliance Standard Life Insurance Company Claim Form should be completed in full. The form, along the required documentation (listed on the form) should be mailed to: Allegis Group Corporate Benefits Department7312 Parkway Drive Hanover, MD 21076
To obtain a claim form, go to AllegisBenets.com.
For Short Term Disability (STD) Claims:
You may le a claim by calling The Hartford's toll-free number 1-866-945-7781 8:00 a.m.8:00 p.m. EST, or you le a claim online at www.TheHartfordAtWork.com. You will be asked to provide: 1. Your name and social security number 2. Department and last day of active full-time work 3. Manager's name and phone number 4. Nature of claim and whether it's work-related 5. Treating physician's name, address and phone number
Family and Medical Leave (FMLA)
Complete the following forms: Family and Medical Leave of Absence Form Certication of Health Provider Form You must contact your local ofce to make a request for leave. Both forms must be completed in full and sent together to: Allegis Group Corporate Benefits Department 7312 Parkway Drive Hanover, MD 21076
To obtain a form, go to AllegisBenets.com.
For Long Term Disability (LTD) Claims:
The physician must complete the Long Term Disability Claim Form-Attending Physician, in full The employee must complete the Long Term Disability Claim Form-Employee Statement, in full The employer must complete the Long Term Disability Claim Form-Employer Statement, in full All three fully completed forms must be sent together to: MetLife P.O. Box 14590 Lexington, KY 40511-4590
To obtain a claim form, go to AllegisBenets.com.
Allegis Group 401(k) Plan
The Allegis Group 401(k) plan gives you an opportunity to build retirement savings. Here is how it works: You can contribute up to 100% of your eligible compensation up to the maximum permitted by the IRS. The dollar limit is $17,000* for 2012. The plan offers a variety of different investment options, so you can tailor an investment strategy that suits your current situation and your future needs. The plan offers you two ways to save. You can make traditional 401(k) pre tax contributions and lower your taxable income today or make Roth 401(k) post tax contributions and your investments will grow tax free. Employees are eligible to participate in the 401(k) plan on the 1st of the month following 30 days of employment. Deductions usually begin during the rst full week of payroll. Employees that are 50 or over are entitled to contribute an additional catch-up contribution. The maximum catch-up contribution is $5,500 for 2012. This full amount can be contributed even if you are highly compensated. The plan allows up to one loan at a time. The amount of the loan is limited to the lesser of one half of your vested account balance or $50,000. The minimum loan amount is $1,000. All loans must be repaid within 5 years (or 10 years if such loan is taken for the purchase of a primary residence). A $75 initiation fee for loans will be taken out of the proceeds of your loan. *Highly compensated employees may not be able to defer the statutory maximum. For more information or to enroll, visit AllegisBenets.com for a direct link to the Wells Fargo website or go to www.wellsfargo.com/allegisgroup.
529 College Savings Plan Alliance Capital
Paying for college can be hard; but saving for college is easy with a 529 College Savings Plan. That is why Allegis Group offers access to the Alliance Capital CollegeBoundFund. This plan is not part of open enrollment, you can sign up at any time. There are no income limits; you can contribute no matter how much you earn. You can save as little as $50 per month, and can contribute until your account reaches the current maximum of $350,000. You have a variety of investment options through Alliance Capital. Earnings on your account grow tax-free. You can open an account for yourself, for a family member, or as a gift to a friend. Withdrawals from your account can be used at accredited colleges, universities, graduate schools, and most community colleges and vocational-technical schools in the U.S. You may enroll any time throughout the year. For more information or to enroll, visit www.corporate.collegeboundfund.com. On your rst visit, select Company as your ID type and use Allegis as your username and Allegis529 as your password. Follow the instructions on the web site to enroll. If you do not have access to a computer or the internet, call Alliance Capital at 1-800-227-2900.
Work Life Employee Discount Programs Allegis Group
There are over 20 worklife programs available that include discounts in the following categories: cars, cell phones, child care, clothing, moving and homes, technology, theme parks, tness, travel, etc. Please contact your local ofce for further information.
MetLife Auto and Home is a voluntary group benet program that offers special group rates and policy discounts for personal insurance coverage needs. Policies include auto, landlords rental dwelling, condo, mobile home, renters, recreational vehicle, boat, and personal excess liability (umbrella) polices. For more information or to get a quote, visit AllegisBenets.com for a direct link to MetLife .Or go to www.metlife.com or call MetLife at 1-800-438-6388.
Auto and Home Insurance - MetLife
Employee Assistance Plan (EAP) and Work Life BenetsHealth Advocate

What is EAP and Work/Life?
The EAP and Work/Life program is designed to help you lead a happier and more productive life at home and at work. Balancing the needs of work, family and personal responsibilities isnt always easy. This program offers the right support at the right time.
What does it do?
The EAP and Work/Life program provides a professional counselor or work life specialist to listen and; 1) Help dene the problem clearly, 2) Assess the type of help needed, and 3) Either provide the required help or make the most appropriate, cost-effective referral for you. Your counselor can address: Stress, depression, anxiety Marital relationships, family/parenting issues Work conicts Anger, grief and loss Drug and alcohol abuse Work/Life Specialist can assist with: Eldercare, childcare, in-home care Legal, nancial issues Summer camps Time management Parenting Adoption Pet sitting
How does it work?
Simply call 1-866-799-2728 (toll-free) or visit online at www.HealthAdvocate.com/members to access EAP or Work/Life services.
Who can use it?
The EAP and Work/Life program is available to you, your spouse and dependent children if you participate in the SRC/Aetna PPO MAX, PPO 15, or PPO5 Medical Plans. The EAP/Work Life Benet is a COBRA eligible plan.
Transportation Benets - ConnectYourCare

How Do I Place My Order?
Transportation Benets allow you to use pre-tax payroll dollars to pay for qualied parking and transit expenses.
You can place your order by selecting the ConnectYourCare link located on the left side of your AllegisBenets.com home page. Once you arrive at the ConnectYourCare home page, you will then: Select new members and existing user log in here >> in the upper right hand corner. If it is your rst time visiting the site, choose New User Registration to select your user name and password. From My Account, select Transportation Benets to be taken to the Transit and Parking Home Page. Once you have selected your metropolitan area, you can select your transit and/or parking provider and the type of pass you require. You can set your order up as recurring, meaning ConnectYourCare will automatically process it each month until you notify them otherwise. ConnectYourCare can also send you an email each month reminding you that you have an order in the system and prompting you to re-enter the site if you need to make a change. You can enroll in Transportation Benets at anytime during the year. Orders must be placed by the 10th of each month for use the following month (example: orders placed by March 10 are for vouchers to be used in April). The amount of your purchase, plus a $2.00 post-tax administrative fee, will be deducted from your paycheck on or around the 12th of the month. After you place your order your passes or vouchers will be mailed directly to you, or if you elect, your parking provider will be paid directly. Additional information regarding Transportation Benets, including eligible and ineligible expenses, can be found in IRS publication 15B. You may also call ConnectYourCare at 1-866-468-7010.
Changing Your Benets During the Plan Year
Once you enroll for pre-tax Medical, Dental, and Vision, Hospital Indemnity and Major Expense Protection coverage you generally cannot change elections during the plan year unless you have a qualifying status change as dened by the IRS.
Qualifying Status Changes and Effective Dates

Status Change Event Marriage Birth or adoption or placement for adoption of a child(ren) Divorce/Legal Separation (only in states that recognize legal separation) Spouse or child(ren) loses other coverage1 You, spouse, or child(ren) gains other group coverage2 Change in dependents eligibility for benets, such as age What You May Change Add yourself, spouse, child(ren) and/or stepchild(ren) to existing coverage Add yourself, spouse, and child(ren) Cancel coverage for your spouse and stepchildren if enrolled in your employers plan/Add coverage for yourself and your children if enrolled in your spouses plan Add yourself, spouse or child(ren) Cancel coverage for yourself, spouse, and/or child(ren) who gain coverage Cancel coverage for your dependent Effective Date First of the month following event Date of the Event
First of the month following the event First of the month coinciding with or following the event End of the week in which coverage is gained End of the month following the event
Cancelling an individual health plan is not ordinarily considered a qualifying change and does not allow you to add coverage with Allegis Group. Purchasing an individual health plan is not considered a qualifying change and does not allow you to cancel your coverage with Allegis Group.
This is a brief overview of potential qualifying events. Eligible qualifying events are dictated by Internal Revenue Code Section 125. You have 30 days from the date of the status change to change your benets. If you or your dependent become eligible for a state premium subsidy for Medicaid or through a state childrens health insurance program with respect to coverage under this plan, you have 60 days from the date of such eligibility determination to enroll in the plan. If you or your dependent decline to participate in the plan because you have medicaid coverage or coverage under a state childrens health insurance program and you later lose that coverage you have 60 days from the date of such loss of coverage to enroll in the plan You may make your change on AllegisBenets.com or submit a change form. In either case, you need to submit hard copy proof of the change, such as a birth or marriage certicate. You can only make changes consistent with the status change. For instance, If you add a child, you may add dependent life insurance and change your medical plan coverage level (i.e. employee plus one or family), but you may not change or cancel your medical plan. Please note, if you choose pre-tax contributions you may not change or cancel your benets unless you incur a qualifying status change. If you choose post-tax contributions you may completely cancel all of the benet plans you are enrolled in at any time during the year without restriction, however, you may not just cancel one benet plan and keep the others (i.e., cancel medical, keep dental and vision) or change medical plans. In addition, you cannot change your benets (i.e., adding/removing dependents) unless you incur a qualifying status change.
When Coverage Ends
Medical, Dental, Vision, Hospital Indemnity, and Major Expense Protection coverage will end at midnight on the Saturday following your last day of employment. Example: Employee works their nal day on Friday, June 15, 2012. Medical, Dental, Vision, Hospital Indemnity, and Major Expense Protection benets will terminate at midnight on Saturday, June 16, 2012. Disability, Life and AD&D coverage end on your last day of work. Your benet coverage also ends when you are no longer eligible, when you stop paying premiums, or when the group plan ends, whichever comes rst. Coverage for dependents ends when they are no longer eligible, when dependent coverage is no longer offered, or when your coverage ends. Please see the Eligibility section of this guide for the denition of an eligible dependent. COBRA information will be mailed to you when your COBRA eligible coverage ends. This information will come in the mail to you from Kelly & Associates Insurance Group in Hunt Valley, Maryland. You may want to verify that your address is correct in the Benets System to prevent any delays in receiving your information. Please note, Life Insurance, AD&D Insurance and Disability Insurance are not COBRA eligible plans. However, you may elect to continue Life Insurance & AD&D Insurance for yourself and your dependents under the Portability and Conversion terms of the plan. You have 30 days to send your completed application to the Allegis Group Benets Department. Please refer to the plan certicate, which can be located on www.AllegisBenets.com for more details.
Reinstatements
If you are rehired within 30 days from the date your employment ended, you have the option to have your medical/ prescription, dental and vision coverage reinstated without a lapse in coverage. In order to do so, you must contact the Benets Service Center. You will be reinstated with the same coverage and contributions you had prior to your employment ending. Please keep in mind, you will be responsible for any missed weekly premiumspayment will automatically be made up with double deductions.
Continuation of Health Care Coverage - COBRA
COBRA (Consolidated Omnibus Budget Reconciliation Act) provides for continuation of health care coverage for employees and covered dependents that lose their group coverage for a variety of reasons. It requires employers to offer the same medical coverage as is offered to active employees and their families. You and your eligible dependents covered at the time your Company medical coverage ends may elect to continue coverage, but you must pay the full (employee plus company) premium plus an additional administrative fee.
When you can elect COBRA coverage
You can continue medical coverage for yourself and your covered dependents for up to 18 months, if your group coverage ends because: You separate from service with the Company (for reasons other than gross misconduct on your part). Your hours are reduced so that you are no longer eligible for the Company Plan. If youor a dependentare determined to be disabled (for Social Security benet purposes) when the group coverage ends or within the rst 60 days of COBRA coverage, coverage for that person may continue for up to a total of 29 months. Your spouse and covered children can elect to continue coverage for up to 36 months if their coverage ends due to: Your death Divorce or legal separation If a termination or reduction of hours occurs less than 18 months after the employees Medicare entitlement (36 months of COBRA coverage is allowed from the date of the Medicare entitlement).
Applying for COBRA coverage
When your coverage under the Company Plan ends, you or your dependents have 60 days to elect continued coverage. If you lose coverage due to separation from service or a reduction in work hours, the Company will automatically notify you of your COBRA rights. In the case of a divorce, legal separation, or when a child no longer qualies for dependent coverage, you, your spouse, or dependent child must notify the Company within 60 days of the event. You then will be provided with information on your COBRA rights.
When COBRA coverage ends
The Company has the right to end your COBRA continued coverage if: The Company stops providing medical coverage for all employees You do not pay your premium on time You become covered by another group health plan You become covered by Medicare You extended COBRA coverage to 29 months due to disability, but are no longer considered disabled
Monthly 2012-2013 COBRA Premiums

Medical Monthly Premium Coverage Level Employee Only Employee Plus One Dependent Family Coverage Level Employee Only Employee Plus One Dependent Family Dental and Vision Coverage Level Employee Only Parent & Child Husband & Wife Family Dental Monthly Premium $28.93 $58.14 $66.24 $74.86 Vision Monthly Premium $7.48 $11.97 $11.74 $19.32 PPO MAX $294.33 $753.70 $1,078.40 Major Expense Protection Plan Monthly Premium $102.95 $214.06 $245.11 PPO 15 $152.71 $390.95 $556.96 PPO 5 $110.36 $281.87 $401.34
Please note, the Hospital Indemnity Plan is not COBRA eligible
A Final Word
In this brochure, we describe your employee benets in a clear, simple, and concise manner. Complete descriptions of the plans are contained in the corresponding contracts or plan documents. If there is any disagreement between this brochure and the wording of the corresponding contract or plan document, the contract or plan document will govern. Allegis Group reserves the right to modify, amend, suspend, or terminate any plan, in whole or in part, at any time. This brochure does not constitute a guarantee of employment.
Key Contacts, Telephone Numbers, & Websites

For Enrollment, Eligibility or Administrative Questions, contact the Benets Service Center Website Email For Medical/Prescription Claim Questions, or Questions About How Medical/ Prescriptions Benets Work, contact SRC, an Aetna company Website For Hospital Indemnity Claim Questions, or Questions About How Hospital Indemnity Benets Work, contact Select Benets For Major Expense Protection Plan (MEPP) Benets or Claims Questions, contact Select Benets For Health Advocate Advocacy Services, Employee Assistance Plan (EAP) and Work Life Benets Call Email Website For Dental Benets, Claim Questions, or Participating Dentists, contact MetLife Website For Vision Benets, Claim Questions, or Participating Eye Care Providers, contact VSP Website For Short Term Disability, contact The Hartford For Long Term Disability, contact MetLife For Life and Accidental Death & Dismemberment (AD&D) Insurance, contact Reliance Standard Life Insurance For 401(k), contact Wells Fargo Website For 529 College Savings Plan, contact Alliance Capital Website For Auto & Home Insurance contact MetLife Website For Transportation Benets contact ConnectYourCare Website 1-866-886-9798 www.AllegisBenets.com askbenets@allegisgroup.com
1-866-894-2778 www.aetna.com/src, or www.aetna.com/docnd/custom/aahc
1-800-497-3699
1-800-497-3699 1-866-799-2728 answer@HealthAdvocate.com www.HealthAdvocate.com/members
1-800-942-0854 www.metlife.com/dental 1-800-877-7195 www.vsp.com 1-866-945-7781
1-800-300-4296
1-800-644-1103 1-800-377-9188 www.wellsfargo.com/allegisgroup 1-800-227-2900 www.corporate.collegeboundfund.com 1-800-438-6388 www.metlife.com 1-866-468-7010 www.connectyourcare.com
Acknowledgement
By signing this form, you acknowledge: You have received the summary of the benet plans in which you are eligible to participate. You acknowledge if you choose to participate in the benet for which you are eligible, you will need to visit www.AllegisBenets.com or complete the required paper enrollment forms to enroll. You acknowledge this is only a summary of the benets. In this brochure, we describe your employee benets in a clear, concise manner. Complete descriptions of the plans are contained in the corresponding contracts or plan documents. If there is any disagreement between this brochure and the wording of the corresponding contract or plan document, the contract or plan document will govern. Allegis Group and its operating companies reserve the right to modify, amend, suspend, or terminate any plan in whole or in part, at any time. This brochure does not constitute a guarantee of employment. Hire/Rehire Date: _______________________________________________________________________ Benet Effective Date: ___________________________________________________________________ Last Day to Enroll in Benets: _____________________________________________________________ If you enroll in benets during the rst month in which you are eligible to participate, your enrollment will be backdated to the rst of the month and you will be double deducted from your paycheck for any missed weekly premiums. Printed Name of Employee: _______________________________________________________________ Signature of Employee: ___________________________________________________ Date: ___________ Printed Name of Witness: _________________________________________________________________ Allegis Group, Inc., Employee Signature of Witness: ____________________________________________________________________ Allegis Group, Inc., Employee
Appendix A: Important Annual Medical Plan Notices The Womens Health and Cancer Rights Act of 1998
The Womens Health and Cancer Rights Act of 1998 requires Allegis Group Inc., to notify you, as a participant of the Allegis Group Inc. Health Plan for Contract Employees, of your rights related to benets provided through the plan in connection with a mastectomy. You as a participant or beneciary have the right for coverage to be provided in a manner determined in consultation with your attending physician for: a) All stages of reconstruction of the breast on which the mastectomy was performed; b) Surgery and reconstruction of the other breast to produce a symmetrical appearance; c) Prostheses; and d) Treatment of physical complications of all stages of the mastectomy, including lymphedemas. These benets are subject to the same deductibles and coinsurance applicable to other medical and surgical benets under the plan as described in the plans Summary Plan Description (SPD). For further details, refer to your SPD
Newborns and Mothers Health Protection Act Notice
Group health plans and health insurance issuers federally may not, under federal law, restrict benets for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following vaginal delivery or less that 96 hours following a cesarean section. However, federal law generally does not prohibit the mother or newborns attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours, or 96 hours as applicable. In any case, plans and insurers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours/96 hours.
Medicare Part D
PLEASE NOTE: This Notice only applies to you if you are eligible for Medicare. If your covered spouse or dependent is covered by Medicare please share this notice with them. Important Notice from Allegis Group Inc., About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can nd it. This notice has information about your current prescription drug coverage with Allegis Group Inc., and about your options under Medicares prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are three important things you need to know about your current coverage and Medicares prescription drug coverage: 1. 2. 3. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Allegis Group Inc., has determined that the prescription drug coverage offered with the PPO MAX, PPO 15 and PPO 5 medical plan is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you only have prescription drug coverage from the Allegis Group Inc., plan. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you rst become eligible. You can keep your current coverage from the Allegis Group Inc., plan. However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefullyit explains your options.
When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you rst become eligible for Medicare and each year from October 15th to December 7th. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? Since the coverage under the Allegis Group Inc., is not creditable, depending on how long you
go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were rst eligible to join a Medicare drug plan but didnt join, if you go 63 continuous days or longer without prescription drug coverage thats creditable, your monthly premium may go up by at least 1% of the Medicare base beneciary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneciary premium. You may have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Aetna Voluntary Plans coverage will not be affected. You can keep this coverage if you elect part D. While the Aetna Voluntary Plans limited benets insurance plans do not coordinate benets, Medicare may reach out to SRC/ Aetna when there is the potential of duplicate payment. If you do decide to join a Medicare drug plan and drop your current Aetna Voluntary Plans coverage, be aware that you and your dependents will not be able to get this coverage back until the plans next open enrollment period unless you experience a Qualifying Life Event (QLE). For More Information About This Notice Or Your Current Prescription Drug Coverage Contact the person listed below for further information. NOTE: Youll get this notice each year. You will also get it before the next period you can join a Medicare drug plan and if this coverage through Allegis Group Inc., changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Youll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778). Date: June 2012 Name of Entity/Sender: Allegis Group Inc. ContactPosition/Ofce: Benets Service Center Address: 7312 Parkway Drive, Hanover, MD 21076 Phone Number: 1-866-886-9798
Medicaid and the Childrens 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 ofce to nd 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 ofce or dial 1-877-KIDS NOW or www.insurekidsnow.gov to nd 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 employers health plan is required to permit you and your dependents to enroll in the planas long as you and your dependents are eligible, but not already enrolled in the employers 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 January 31, 2012. You should contact your State for further information on eligibility.
ALABAMA Medicaid
Website: http://www.medicaid.alabama.gov Phone: 1-855-692-5447
LOUISIANA Medicaid
Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447
ALASKA Medicaid
Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529
MAINE Medicaid
Website:
http://www.maine.gov/dhhs/OIAS/public-assistance/index.html
Phone: 1-800-572-3839
ARIZONA CHIP
Website: http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437
MASSACHUSETTS Medicaid and CHIP

Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120
MINNESOTA Medicaid
Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone: 1-800-657-3629
COLORADO Medicaid
Medicaid Website: http://www.colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943
MISSOURI Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
MONTANA Medicaid
Website:
http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml
Phone: 1-800-694-3084
FLORIDA Medicaid
Website: https://www.medicaidtplrecovery.com/ Phone: 1-877-357-3268
NEBRASKA Medicaid
Website: http://dhhs.ne.gov/medicaid/Pages/med_kidsconx.aspx Phone: 1-877-255-3092
GEORGIA Medicaid
Website: http://dch.georgia.gov/ Click on Programs, then Medicaid Phone: 1-800-869-1150
NEVADA Medicaid
Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900
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
NEW HAMPSHIRE Medicaid

Website: www.dhhs.nh.gov/ombp/index.htm Phone: 603-271-5218
INDIANA Medicaid
Website: http://www.in.gov/fssa Phone: 1-800-889-9948
NEW JERSEY Medicaid and CHIP

Medicaid Website:
http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
Medicaid Phone: 1-800-356-1561 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
IOWA Medicaid
Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562
KANSAS Medicaid
Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884
NEW YORK Medicaid

Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831
KENTUCKY Medicaid
Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570
NORTH CAROLINA Medicaid and CHIP

Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100
NORTH DAKOTA Medicaid

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-800-755-2604
UTAH Medicaid and CHIP

Website: http://health.utah.gov/upp Phone: 1-866-435-7414
OKLAHOMA Medicaid and CHIP

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
VERMONT Medicaid
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
OREGON Medicaid and CHIP

Website: http://www.oregonhealthykids.gov
VIRGINIA Medicaid and CHIP

Medicaid Website: http://www.dmas.virginia.gov/rcp-HIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.famis.org/ CHIP Phone: 1-866-873-2647
http://www.hijossaludablesoregon.gov
Phone: 1-877-314-5678
PENNSYLVANIA Medicaid
Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462
RHODE ISLAND Medicaid

Website: www.ohhs.ri.gov Phone: 401-462-5300
WASHINGTON Medicaid
Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm Phone: 1-800-562-3022 ext. 15473
SOUTH CAROLINA Medicaid

Website: http://www.scdhhs.gov Phone: 1-888-549-0820
WEST VIRGINIA Medicaid

Website: www.dhhr.wv.gov/bms/ Phone: 1-877-598-5820, HMS Third Party Liability
SOUTH DAKOTA - Medicaid

Website: http://dss.sd.gov Phone: 1-888-828-0059
WISCONSIN Medicaid
Website: http://www.badgercareplus.org/pubs/p-10095.htm Phone: 1-800-362-3002
TEXAS Medicaid
Website: https://www.gethipptexas.com/ Phone: 1-800-440-0493
WYOMING Medicaid
Website: http://health.wyo.gov/healthcaren/equalitycare Phone: 307-777-7531
To see if any more States have added a premium assistance program since January 31, 2012, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benets Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565

Contractor Benefit Guide 2012-2013

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Contractor Benefit Guide 2012-2013

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Benefit Guide for Contract Employees

June 1, 2012 May 31, 2013

People. Service. Performance.

LEGAL STAFFING SERVICES

Your Allegis Group Benets At-A-Glance

Medical (with prescription drug benet)*

Major Expense Protection Plan (MEPP)*

For Benets Online, visit www.AllegisBenets.com - 3

Short Term Disability**

Accidental Death and Dismemberment (AD&D)**

401(k) Plan*** Traditional 401(k) plan, Roth 401(k) plan

4 - For Benets Online, visit www.AllegisBenets.com

For Benets Online, visit www.AllegisBenets.com - 5

When Benets Begin

Enroll Online at AllegisBenets.com

6 - For Benets Online, visit www.AllegisBenets.com

Returning AllegisBenets.com Users

The Enrollment Process

How to Designate or Update Your Beneciaries

For Benets Online, visit www.AllegisBenets.com - 7

Benet Identication (ID) Cards

If You Do Not Enroll

If You Do Not Have Web Access

Paying for Your Benets

If You Have Questions

Patient Protection and Affordable Care ActNotice of Grandfathered Status

For Benets Online, visit www.AllegisBenets.com - 9

Notice of Waiver from the Annual Limit Requirement

Are benets coordinated?

For Benets Online, visit www.AllegisBenets.com - 11

PPO MAX Out-of-Network

PPO 5 $300 per person each coverage year**

Deductible (per coverage year**)

(including inpatient hospital svcs. shown below)

Outpatient Benet Limit

(including prescription drugs)

Other Hospital Services Limit

$15 copay, no deductible 100%*

Walk-In/Retail Health Care Clinics

$10 copay, no deductible, then plan pays 100%

Doctor Ofce Visits

$20 copay, no deductible then plan pays 100%*

(total benet maximum and other hospital services limit above)

Plan pays 70%*, after deductible**, subject to annual plan limits**

(total benet maximum and other hospital services limit above)

Plan pays 70%* after deductible**, subject to annual plan limits**

Plan pays 70%* after deductible**, subject to annual plan limits**

(total benet maximum and outpatient benet limit above)

Plan pays 60%* after deductible**, subject to annual plan limits**

Medical/Prescription Plan 20122013 Weekly Premiums

Prescription BenetsAetna Pharmacy Network from SRC, an Aetna company

To Use Your Prescription benets:

Aetna Rx Home Delivery

For Benets Online, visit www.AllegisBenets.com - 13

Walk-In/Retail Health Care Clinics

14 - For Benets Online, visit www.AllegisBenets.com

Hospital Indemnity Plan Symetra

Hospital Indemnity Plan Weekly Premiums

2012-2013 Weekly Premium $6.32 $12.43 $17.92

16 - For Benets Online, visit www.AllegisBenets.com

Major Expense Protection Plan - Symetra

Major Expense Protection Plan Weekly Premiums

2012-2013 Weekly Premium $23.29 $48.43 $55.46

For Benets Online, visit www.AllegisBenets.com - 17

Plan pays 70%*, after deductible, subject to annual plan limits

Plan pays 70%* after deductible, subject to annual plan limits

Plan pays 70%* after deductible, subject to annual plan limits

Plan pays 60%* after deductible, subject to annual plan limits