The Power of Share JACAM Chemical Company 2013, LLC. | 2014-2015
Eligibility
If you are a JACAM Chemical Company 2013, LLC. full-time employee (working 30 or more hours per week) and have successfully completed your waiting period, you are eligible to enroll in the benefits described in this guide.
New hires are eligible for benefits on the first of the month following 30 days of the first date of employment.
Benefits
Medical Dental Voluntary Vision Life and AD&D Insurance Voluntary Life Insurance Voluntary Long Term Disability Voluntary Short Term Disability Voluntary Critical Illness, Cancer & Accident 401k Retirement Plan Voluntary Legal Protection Flexible Spending Account
K Welcome to your 2014-2015 Benefits!
At JACAM Chemical Company 2013, LLC., our employees are our most valuable asset.
We recognize the importance of your familys financial security and understand the significance of offering you a comprehensive benefits package. We invest many hours each year evaluating our plans. The Affordable Care Act (ACA) has forced benefit changes and added additional financial responsibility to JACAM in the form of fees and taxes. However, we feel we are continuing to achieve our goal of meeting your needs and expectations.
This Benefits Overview is a snapshot of the benefits available and is intended for illustrative purposes only. Please refer to the Summary Plan Descriptions or Plan Certificates for further details, which can be provided by Human Resources. We hope you find this overview useful and will participate in the benefits to the fullest extent possible. If you have any questions regarding these plans, please contact the Human Relations Department.
The following benefits are effective May 1, 2014 through April 30, 2015.
Thank you, Jason West
JACAM Chemical Company 2013, LLC. | 2014-2015
Medical Insurance CoreSource, a Trustmark Company
You have the freedom to choose from 2 plans. Plan summaries are illustrated on the next page.
Both plans include: Access to either Cigna or First Health national networks. o To find Cigna providers, search www.cigna.com o To find First Health providers, search www.firsthealth.com Affordable Care Act benefits that are covered under the plan include: o Preventive care services are covered by the plan at 100% with no office visit copay or deductible responsibility o Unlimited Lifetime Maximum with No Pre-Existing Conditions, for all ages o Dependents covered until age 26 JACAM Chemical Company 2013, LLC. reserves the right to perform a dependent eligibility audit on covered spouses and children to verify eligibility at any time during the plan year. o Womens Care Preventive Services Many generic contraceptives are covered at 100% with no copay Breastfeeding support, supplies and counseling o Tobacco Cessation Treatment Programs Once enrolled in the medical insurance, register at www.myCoreSource.com to create an account. This will allow you to have 24/7 access to check on claims status, find a doctor, access plan documents and print a temporary ID card.
Monthly Medical & Pharmacy Premiums:
Traditional Health Plan Option 1 Employee Employee/ Child(ren) Employee/ Spouse Family $1,000 Individual Deductible / $2,000 Family Deductible 20% Member Coinsurance $2,000 Individual Out-of-Pocket Max / $4,000 Family Out-of-Pocket Max $25 Office Visit Copays $250 Emergency Room Copay (the only plan change from 2013/2014 plan) $15/30/45 Prescription Copays $114.45 $232.30 $245.67 $364.00 High Deductible Health Plan Option 2 Employee Employee/ Child(ren) Employee/ Spouse Family $3,000 Individual Deductible / $6,000 Family Deductible $3,000 Individual Out-of-Pocket Max / $6,000 Family Out-of-Pocket Max Rx - Deductible then $15/30/45 Copays $95.47 $176.90 $158.10 $258.99 JACAM Chemical Company 2013, LLC. | 2014-2015
This is a summary description of benefits. All plan provisions are subject to the covered charges, limitations and exclusions set forth in the plan document. If this summary and the plan document are contradictory, the plan document takes precedence. The employer reserves the right to modify or terminate these benefits for any reason at any time. Medical Plan Benefits Traditional Plan Option 1
High Deductible Health Plan Option 2 IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK WELLNESS (Routine Care) Physical Exams 100% 60% (deductible applies) 100% 80% (deductible applies)
Well Child Care (Including Immunizations) 100% 60% (deductible applies) 100% 80% (deductible applies) Mammogram (Test and Reading) 100% 60% (deductible applies) 100% 80% (deductible applies) Pap Smears (Test and Reading) 100% 60% (deductible applies) 100% 80% (deductible applies) Prostate Blood Test (Test and Reading) 100% 60% (deductible applies) 100% 80% (deductible applies)
Colonoscopy and Sigmoidoscopy (Test and Reading) 100% 60% (deductible applies) 100% 80% (deductible applies) MAJOR MEDICAL
Deductible (combined in/out of network) $1,000/Individual $1,000/Individual $3,000/Individual $3,000/Individual
Out-of-Pocket Maximum (combined in/out of network) $2,000/Individual $2,000/Individual $3,000/Individual $5,000/Individual
(Includes Deductible) $4,000/Family $4,000/Family $6,000Family $10,000/Family Lifetime Maximum per Family Member Unlimited Unlimited Unlimited Unlimited HOSPITAL BENEFITS
Emergency Room (must be medical emergency) $250 copay (deductible applies- copay waived if admitted) then 80% $250 copay (deductible applies- copay waived if admitted) then 80%
Retail (30 day supply) $15/$30/$45 Deductible then $15/$30/$45 Deductible Then Copays $15/$30/$45 Deductible Then Copays $15/$30/$45
Mail Order (90 day supply) $37.50/$75/$112.50 $37.50/$75/$112.50 Deductible Then Copays $37.50/$75/$112.50 Deductible Then Copays $37.50/$75/$112.50
JACAM Chemical Company 2013, LLC. | 2014-2015
Vision Premiums Per Month Employee $9.77 Employee + 1 $14.16 Employee + 2 or more $25.39
Dental Premiums Per Month Employee $23.67 Employee + Spouse $46.96 Employee + Child(ren) $50.89 Family $73.59
Dental Delta Dental To find PPO or Premier Network providers: www.deltadentalks.com 100% Diagnostic and Preventative Services (cleanings & exams: one per six months). $25 individual deductible / $75 family deductible (waived for diagnostic & preventative services) 80% Basic Services (fillings, oral surgery, endodontics, periodontics) 50% Major Services (crowns, dentures, bridges, implants) No waiting period on any service Maximum Benefit for all covered services (diagnostic, basic & major) for each Enrollee in any one Calendar Year is $1,000 100/80/50% Out-of-Network Benefits for Non- Participating Delta Premier Providers Orthodontics Not Covered Dependents eligible until the end of the month of which they turn age 26
Vision VSP To find VSP providers, visit www.vsp.com o VSP Choice Network Comprehensive eye exam (includes refraction and dilation) every 12 months after $10 copay Frames: $130 allowance every 12 months after $25 copay with 20% off any amount over your allowance Lenses: Choose from standard, premium, or custom progressive lenses. Allowance ranges from $55-$175 depending on type of lenses after $25 copay. Contacts in lieu of glasses ($130 allowance per year elective contacts, $250 if medically necessary). Copay does not apply. 20% discount for additional glasses and sunglasses within 12 months of last exam
JACAM Chemical Company 2013, LLC. | 2014-2015
Life and Disability Assurant Employee Benefits
Life & AD&D (employer paid) $65,000 benefit paid 100% by JACAM Chemical Company 2013, LLC. for benefit-eligible employees
Voluntary Life Insurance (employee paid) Supplement the employer-paid benefit by purchasing: o Up to 5 times your annual earnings up to $500,000 for yourself in increments of $10,000 with a minimum of $20,000 o Up to $250,000 for your spouse in increments of $5,000 o $10,000 for your children (no underwriting) Evidence of Insurability (medical underwriting) is required if this is not your first time eligible. o Increase current benefit amount by $10,000 without Evidence of Insurability Rates based on election amount and age
Voluntary Long Term Disability (employee paid) Elect up to 60% of monthly earnings to $6,000 Benefits begin 90 days after disability Payable to the later of age 65 or 24 months Rates based on election amount and age
Voluntary Short Term Disability (employee paid) Elect up to 60% of weekly earnings to $2,500 Benefit payable on 8 th day of accident, sickness or pregnancy Payable for 12 weeks Pre-existing conditions limitation of 12 months for medical conditions treated by a physician, including prescriptions taken, within the last 6 months of applying for coverage Rates based on election amount and age
Voluntary Worksite Benefits Allstate Critical Illness High & Low Option (employee paid) Lump Sum coverage for Heart Attack/ Stroke/ Cancer/ Renal Failure and more Wellness benefit pays $50 per year per person Premium locked in at current age and no reduction of benefits Family gets 50% of benefit amount Each Critical Illness paid only once and must be separated by 90 days Benefits paid directly to you, not to provider Cancer (employee paid) Cash benefits for cancer and 29 specified diseases and related surgeries & services Wellness benefit pays $50 per year per person Elect coverage for you or your entire family No Evidence of Insurability at initial enrollment Waiver of premium after 90 days of disability due to cancer Benefits paid directly to you, not to provider Accident High & Low Option (employee paid) 24-hour off-the-job coverage
Initial hospital confinementpays 1x/person
Hospital confinement (per day) pays per accident for up to 90 days Medical expenses pays based on actual bill (before insurance pays) Outpatient Physicians Treatment pays for any visit outside hospital for any reason 2 per year (employee only)/4 per year (family) Physical Therapy 6 per accident
Accident follow up treatments 2 per accident
Paid in addition to any other benefits and paid directly to employee, not to provider
JACAM Chemical Company 2013, LLC. | 2014-2015
401k Retirement Plan Nationwide
JACAM Chemical Company 2013, LLC. allows eligible employees to contribute up to 75% of compensation to a 401k plan through payroll deduction.
JACAM Chemical Company 2013, LLC. will make matching contributions equal to 100% of your eligible elective deferrals, up to 4% of compensation.
You have the ability to select from investment choices provided under the Plan. The Plan is intended to be an ERISA Section 404(c) plan, which means you exercise control over some or all of the investments in your Plan
Legal Protection Legal Shield (employee paid) Legal Advice unlimited issues Letters/calls made on your behalf Contracts & documents reviewed up to 10 pages Mortgage document preparation Uncontested Separation, Divorce, Name Change & Adoption Wills, Living Wills & Healthcare Power of Attorney prepared by Lawyers Traffic-Related Issues (Speeding Tickets, Accidents) Trial Defense (Pre-Trial, Representation at trial) IRS Audit Assistance 24/7 Emergency Access for Covered Situations Online Legal Forms Coverage for yourself, spouse and dependents (under 21 living at home or 23 for full-time college students, never married) Identity Theft Legal Shield Credit Report Personal Credit Score with Analysis Continuous Monitoring with Activity Alerts Identity Restoration Service Flexible Spending Account (FSA) ADP
Reduce your taxes and increase your take-home pay while paying for expenses with pre-tax dollars.
There are 2 types of FSA plans to contribute: Unreimbursed Medical o Elect up to $2,500 per year o Pay for medical expenses including copays, vision & dental Dependent Care o Contribute up to $5,000 per year to pay for the care of dependents under the age of 13
Contact Information Power Group Companies (for all benefit questions) Enrollment Call Center: 1-877-277-7209 Amy Zeller: 913-754-5934 Diana Loera: 913-754-5941
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