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The Wittern Group
Benefit Summary
Benefits Overview
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The Wittern Group is pleased to offer a comprehensive benefits package to all eligible, full-time employees. The complete benefit package is briefly summarized
in this Summary, however, you will receive plan booklets for elected benefits which will provide more detailed information about each of the following programs.
You will share the costs of some benefits while The Wittern Group provides other benefits at no cost to you. In addition, there are voluntary benefits which you
can purchase with reasonable group rates through The Wittern Group payroll deductions. The benefit plans offered are Medical, Dental, Life Insurance, Accidental
Death and Dismemberment (AD&D) Insurance, Long-Term Disability, Optional Life and Dependent Life coverage, Voluntary Short Term Disability and Voluntary Vision.
This Summary gives you an overview of the main features of your benefit plan however; the plans are administered according to legal plan documents and insurance
contracts. Although we’ve tried to summarize the provisions clearly and accurately, if any information presented here conflicts with the legal documents, the
legal documents will govern. This document does not guarantee any benefits.
Which Employees Are Eligible For Coverage?
You are an eligible employee if you are a full-time employee regularly working 40 hours per week. You become eligible for benefit coverage on the first day
of the month following 30 days of employment. Part-time, temporary or seasonal employees are not eligible for coverage. See your insurance plan documents
for further information about your eligibility.
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Medical Coverage ~ Administered by Wellmark
Blue Cross/Blue Shield |
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You will be covered with one of the most widely-recognized worldwide insurance carriers. Wellmark Blue Cross/Blue Shield is one of the
nation’s leading providers of medical benefits. They put information and helpful resources to work for millions of members to help them make better informed
decisions about their health care and protect their finances against health-related risks.
Wellmark will administer your coverage and provides an extensive provider network system around the country. In most cases, you should not have to file claim
forms or pay anything more than your co-payment(s) or deductible(s) in advance. The Wittern Group offers you a choice of a PPO (the choice of in-network or
out-of-network providers) or HMO (all care must be provided or coordinated by the HMO network) medical plans. The following guide highlights your benefits but for
more complete information, please references your benefit booklet or contact Wellmark.
How Does Your Medical Program Work?
You pay less out-of-pocket if you use the physicians, hospitals, and other healthcare providers that participate in the PPO or HMO networks with Wellmark. You receive the
highest level of benefits when you use Network or Preferred Providers. To find this these providers:
- Visit the Wellmark web site at www.wellmark.com and look for information regarding Wellmark’s
Preferred Provider Organization (PPO) network, or Health Maintenance Organization (HMO) or
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Call their Customer Service with questions about eligibility, benefits, or providers: 800-526-8995.
Remember, with a Preferred Provider (PPO) you pay more out of your pocket when you use Out-of-Network Providers. The chart in this booklet shows a comparison
between benefits when you use In-Network Providers and benefits when you use Out-of-Network Providers. The Blue Access Health Maintenance Organization (HMO)
provides a high level of benefits by which your care must be provided or coordinated within the Blue Access network of Physicians. Also keep in mind that your
health plan pays the Allowed Price for services and supplies. In-Network Providers agree to accept the Allowed Price as payment in full. When you use Out-of-Network
Providers, you must pay the difference between the usual and customary rate and the provider’s charge, in addition to any deductibles and coinsurance amounts that
may apply.
Benefits for some services require that you pay a deductible each year for In-Network Providers’ services and a higher deductible each year for Out-of-Network Providers’
services. Once you have met your deductible, you share the cost of your care through coinsurance.
Once again, the coinsurance amount for Out-of-Network Providers is higher than that for In-Network Providers. You need only pay the deductible and coinsurance
until you meet your out-of-pocket maximum for the year. For many services performed in a doctor’s office you receive first-dollar coverage. With first dollar
coverage you pay a small co-payment for each visit, but you may not have to pay a deductible or coinsurance. Please review your plan booklet for further information.
SUMMARY OF BENEFITS
Dental ~ Administered by Met Life
Good oral care enhances overall physical health, appearance and mental and physical well-being. Problems with the teeth
and gums are common and easily treated. Keep your teeth healthy and your smile bright with
The Wittern Dental benefit plan.
LIFE and ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D)
~ Administered by Sun Life Assurance Co.
Life insurance provides financial security for people who depend on you. With Sun Life Assurance Co. Life/AD&D insurance, your family will be protected with benefits
and a variety of support services designed to help them cope with both emotional and financial issues. It can help you preserve your dream of a secure lifestyle
for your family, even if you can't be there.
Eligible employees will automatically receive a Basic Life and AD&D Insurance benefit equal to 1 x annual salary (up to $105,000). The Wittern Group pays the full
cost of this basic coverage. Benefits will reduce for employees age 65 or older. See your Human Resources representative for more information.
OPTIONAL LIFE and DEPENDENT LIFE BENEFITS
~ Administered by Sun Life Assurance Co.
You may add to your Basic Life and AD&D Insurance amount by purchasing Optional Life and Dependent Insurance coverage in increments of $10,000 up to a maximum of
$500,000 or 3 times your basic annual earnings, whichever is less.
For those employees who enroll in Optional Life Insurance, you may also purchase Dependent Spouse Optional Life Insurance for your spouse in increments of $10,000
to a maximum of $100,000. Additionally, you may purchase Dependent Child Life Insurance coverage (for eligible dependents) in $5,000 increments up to $10,000.
The amount of Dependent Optional Life Insurance cannot exceed 50% of the Employee’s amount of Optional Life Insurance.
DISABILITY BENEFITS
~ Administered by Sun Life Assurance Co.
What happens if you have an unexpected injury or illness that leaves you unable to work or earn a paycheck? Few people believe it will happen to
them, but the truth is, your risk of becoming disabled is far greater than you may think. Meeting your basic living expenses can be a real challenge if
you become disabled.
LONG TERM LIFE DISABILITY
Eligible employees will be provided long-term disability insurance coverage by Sun Life Assurance Co. provided at no cost by The Wittern Company.
After being disabled for a certain period of days (your elimination period), the LTD monthly benefit will pay 60% of your total monthly earnings up
to a maximum monthly benefit of $10,000 per month. LTD payments may be reduced by deductible sources of income and other disability earnings. LTD coordinates
with Social Security. Benefits for covered disabilities begin after the elimination period. See your Human Resources Representative or Benefit Certificate for
more information.
VOLUNTARY SHORT TERM DISABILITY
You may choose to elect Short Term Disability (STD) insurance which provides income if you become disabled due to an injury or illness that prevents you from
working. Benefits begin on the first day of any injury or hospitalization, and after seven days for any illness. Benefits can continue up to 13 weeks and are
payable at 100% of total weekly earnings to a maximum weekly benefit of $130.00/week.
VOLUNTARY VISION ~ Administered by Avesis Vision Plan
You have the opportunity to join millions of people who use Avesis to meet their vision care needs. This program has been specifically designed to
provide you and your covered family members with quality, professional vision care, all at a tremendous savings to you!
In-Network Vision Benefits include discounts on vision exams, frames, contact lenses and spectacle lenses. Affordable and easy to use!
IMPORTANT THINGS TO REMEMBER
- Show your identification card every time you go to the doctor or pharmacy.
- Be sure that all providers (doctors, labs, x-rays, etc.) participate in-network for the best coverage.
- If you acquire or lose a dependent during the year, you must notify Human Resources within 30 days of the event.
- The choices you make now will remain in effect until the next open enrollment period unless you experience a family status change.
All benefit plans are subject to change from time to time and The Wittern Group reserves the right to amend or cancel any benefits described in this Summary, with or without notice. For more detailed information on the plans and your legal rights under the plan,
be sure to read the summary plan description or request a copy of the plan documents. If you have any questions please contact
the Human Resources Department at 515-271-8405.
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| LEGAL UPDATES |
| What is a Pre-Existing Condition? |
A "pre-existing condition" is an injury or disease for which a person:
- received treatment or services; or
- took prescribed drugs or medicines;
during the 180 days right before the person's effective date of coverage (or, if the Plan requires you to serve a probationary period,
the 180 days right before the first day of the probationary period). See the Effective Date of Coverage or Late Enrollee section of the Summary
of Coverage, whichever applies, to determine a person's effective date of coverage. For the first 365 days following such date, Covered Medical Expenses
do not include any expenses for treatment of a pre-existing condition.
Special Rules as To a Pre-existing Condition
If a person had creditable coverage and such coverage terminated within 90 days prior to the date he or she enrolled (or was enrolled) in this Plan,
then any limitation as to a pre-existing condition under this Plan will not apply for that person. Also, if a person enrolls (or is enrolled) in this
Plan immediately after any applicable probationary period has been served, and that person had creditable coverage which terminated within 90 days prior
to the first day of such probationary period, then any limitation as to a pre-existing condition will not apply for that person. As used above: "creditable
coverage" means a person's prior medical coverage as defined in the Federal Health Insurance Portability and Accountability Act (HIPAA) of 1996. Such coverage
includes the following: coverage issued on a group or individual basis, Medicare, Medicaid, military-sponsored health care, a program of the Indian Health Service,
a state health benefits risk pool, the Federal Employees' Health Benefit Plan (FEHBP), a public health plan as defined in the regulations, and any health benefit
plan under Section 5(e) of the Peace Corps Act.
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| The Women’s Health And Cancer Rights Act |
Under this health plan, coverage will be provided to a person who is receiving benefits for a medically necessary mastectomy and who elects breast
reconstruction after the mastectomy, for:
(1) reconstruction of the breast on which a mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance;
(3) prostheses; and
(4) treatment of physical complications of all stages of mastectomy, including lymph edemas.
This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and
coinsurance provisions that apply for the mastectomy. If you have any questions about our coverage of mastectomies and reconstructive surgery, please
contact the Aetna Member Services number on the back of your ID card.
Making Enrollment Changes During The Year
In most cases, your benefit elections remain in effect for the entire year (January 1 – December 31). During each annual enrollment period, you will have the
opportunity to review your benefit elections and make changes for the coming year.
Certain coverages allow limited changes to elections during the year. These benefits include the medical and dental plans. Under these benefits, you may only make changes to your
elections during the year if you have a change in family status. Family status changes include:
- Marriage, divorce or legal separation
- Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, marriage, or reaching the dependent child age limit
- Changes in your spouse’s employment affecting benefit eligibility
- Changes in your spouse’s benefit coverage with another employer that affects benefit eligibility
The change to your benefit elections must be consistent with the change in family status. You have 30 days from the date of a change in family status to complete an
enrollment change form and return it to Human Resources. In most cases your election will become effective the first day of the month following your request.
Otherwise, you must wait until the next annual enrollment period to make a change to your elections.
IMPORTANT: This Benefit Summary is an outline of the coverages proposed by the carriers, based on information provided by your company.
It does not include all of the terms, coverages, exclusions, limitations, and conditions of the actual contract language.. This document does not amend,
extend, or alter the coverage provided by the actual insurance policies and contracts. Please see your policy or contact us for specific information or
further details in this regard.
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