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A ROADWAY TO YOUR BENEFIT ELECTIONS PLAN YEAR October 1, 2015 September 30, 2016

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A ROADWAY TO YOUR BENEFIT ELECTIONS

PLAN YEAR October 1, 2015 – September 30, 2016 

     

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Contact Information and Table of Contents

Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.

OUR EMPLOYEES:

Page 1

ELIGIBILITY:

Page 2

IMPORTANT NOTICES:

Page 13

BROKER SERVICES:

Norton Financial Services (800) 777-5244 www.Nortonne.com

DENTAL PLAN:

Reliance Standard Customer Care Center (800) 351-7500 www.reliancestandard.com

Page 4

LIFE AND AD&D:

Reliance Standard: Customer Care Center (800) 351-7500 www.reliancestandard.com

Page 5

LONG-TERM DISABILITY:

Reliance Standard: Customer Care Center (800) 351-7500 www.reliancestandard.com

Page 6

EMPLOYEE ASSISTANCE PROGRAM (EAP): Provider Name Health Management Systems of America Provider Phone Number 800-767-5320 Provider Web Address www.my-life-resource.com 24-HOUR TRAVEL ASSISTANCE SERVICE: Provider Name On Call International Provider Phone Number 800-456-3893

MEDICAL PLAN:

Harvard Pilgrim/Health Plans Inc. Customer Service (800) 532-7575 www.healthplansinc.com

Page 3

FLEXIBLE SPENDING ACCOUNTS (FSA):

Group Dynamic, Inc. Customer Service (800) 626-3539 www.GDynamic.com

Page 9

401(k) RETIREMENT PLAN:

Empower Customer Service (800) 338-4015 www.empower-retirement.com

NORTON: 800-777-5244: Ray Emery - ext: 7326 or Dustin Fier - ext: 7306

Page 12

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The purpose of this booklet is to provide you with the information that you need to review your benefit elections for the October 1, 2015 through September 30, 2016 plan year. The IRS allows employees to select certain benefit options through pre-tax salary reductions, which lowers taxes and saves money. Because of these tax savings, other than your initial benefits selection at time of hire, the IRS allows you to make changes only during an open enrollment period, unless you experience a qualified status change. Since this is your one opportunity to enroll in or make changes to your benefits this year, please carefully consider your anticipated needs for the upcoming plan year. We encourage you to take the time to educate yourself about Child and Family Service’s benefit options and choose the best coverage for you and your family. Included in this booklet is summary information for each line of coverage we offer, contact information for each of the carriers, as well as some important annual notices you should be aware of. If you have questions or need further information please do not hesitate to contact your HR team or your Account Manager from our broker, Norton, whose information is also listed with carrier contacts.

Staying Healthy and Feeling Secure

• Medical and Prescription Drug • Dental Insurance • Life and AD&D Insurance • Long-term Disability • Flexible Spending Accounts • Travel Assistance Program • Employee Assistance Program • Aflac • 401(k) Retirement Plan

Sincerely,

Child & Family Services Management Team

Our employees are our most valuable asset

That’s why at Child & Family Services we are committed to offering a comprehensive employee benefit program that helps you and your family members stay healthy, feel secure and maintain a work/life balance.

Please note this is an overview of your benefits. For more detailed information, please refer to your official Plan Documents. If there are discrepancies between this benefit overview and the Plan Documents, the Plan Documents will govern.

2

Eligibility

All eligible employees may elect to enroll in the Child & Family Services benefits program during our annual open enrollment period, or when they first become eligible (the first day following 30 days of employment). The minimum required hours employees must work in order to be eligible are listed below.

Type of Coverage Minimum Number of Hours Medical 20 hours/week Voluntary Dental 20 hours/week Term Life and AD&D 20 hours/week Long Term Disability 20 hours/week Flexible Spending Accounts (FSA) 20 hours/week 401(k) Retirement Plan Age 21 and completed 30 days

Which Family Members Can Be Covered?

The following family members are eligible for medical and dental benefits through Child & Family Services: • Legal Spouse • Children under the age of 19 • Adult children to age 26, regardless of marital and/or student status • Mentally or physically disabled children of any age if they were disabled prior to the plan’s limiting age

How do I Enroll?

Enrollment is a simple process that is facilitated by your HR team. Depending on which coverage you choose to participate in, each carrier has an enrollment form to be completed by you and signed by both you and your employer.

Times when you will need to complete a new enrollment form would be: • If you are a newly eligible employee and you are enrolling for the first time • If the group is changing plans and/or carriers • If you are adding or dropping a dependent or have a change in your own status (ie: marriage, divorce, etc.)

There are also instances when you will not need to complete a new enrollment form, those would be: • If the plans stay the same from one year to the next • If you choose to stay on the same plan and it is still available through your employer • If your employer pays for things like disability or life insurance you may not need to complete an enrollment form, but

you are automatically enrolled by your employer, assuming you work the required hours to qualify

When do I Enroll?

Every group has what is called “open enrollment period”. This is the month prior to your renewal date. Since your group renews on October 1 your open enrollment period is the month of September. If you are a newly eligible employee who either did not work there during open enrollment or were not eligible (perhaps you were part time), then you may enroll after you satisfy the new hire waiting period. You may also enroll or change your decision to some extent during the year if you should experience a qualified change in status, or a “qualifying event”.

You have 30 days from the date of the event to notify Child & Family Services of a qualified change in status.

What Happens If I Don’t Enroll?

If you decline coverage, you will not have another opportunity to enroll yourself or your eligible dependents until the next annual enrollment period unless you have a qualified change in status during the year.

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Medical & Prescription Drug Plans Our Preferred Provider Option (PPO) plans allow you the freedom to use providers in and out-of-

network, with separate deductibles for each. The program does not require you to select a Primary Care Physician or to obtain referrals to be seen by a specialist. Simply verify that the provider participates in the Harvard Pilgrim-Health Plans network to receive the highest level of benefits. You may do this by visiting www.healthplansinc.com or contacting customer service.

Harvard Pilgrim-Health Plans Services In-Network Out-of-Network

Individual Family Individual Family Plan Year Deductible $500 $1,000 $1,000 $2,000

(Deductibles & Out-of-Pocket accumulate on a plan year basis) (The In and Out of Network limits accumulate separately)

Coinsurance NONE 80%/20% Out of Pocket Max $2,500 $5,000 $4,000 $8,000

(Includes Deductible, Coinsurance & Copayments, including RX copayments) (The In and Out of Network limits accumulate separately)

Primary Physician Office Visit $25 Copay, then covered in full Deductible, then 20% Specialist Office Visit $40 Copay, then covered in full Deductible, then 20% Preventive Care (schedule of benefits) Covered in Full Deductible, then 20% Inpatient Hospital Services Deductible, then covered in full Deductible, then 20% Outpatient Surgery Deductible, then covered in full Deductible, then 20%

Emergency Room $250 Copay (The emergency room co-pay is waived if the visit results in admission)

Urgent Care Center Services $50 Copay, then covered in full Deductible, then 20%

Diagnostic Lab & X-ray Covered in Full Deductible, then 20%

(High Tech Radiology - Subject to Deductible)

PT, OT & Speech Therapy $25 Copay, then covered in full Deductible, then 20%

(each service is limited to 20 visits per plan year)

Chiropractic $25 Copay, then covered in full Deductible, then 20%

(limit of 20 visits per plan year)

Mental Health - Inpatient Deductible, then covered in full Deductible, then 20%

- Outpatient $25 Copay, then covered in full Deductible, then 20% - Office Visits $25 Copay, then covered in full Deductible, then 20%

Routine Eye Exam $25 Copay, then covered in full

(one exam every 2 years) ($100 lens reimbursement every 2 years)

Prescriptions - Tier 1 $10 copay per 30 day supply - Tier 2 $30 copay per 30 day supply - Tier 3 $60 copay per 30 day supply

31-90 day by Mail Order $25/$75/$150

Lifetime Maximum Unlimited

Cost of Coverage per Month Eligibility Coverage Type Employer pays Employee pays

30+

H

ours

Employee only $517.35 $172.45

Employee plus one $1,034.60 $344.87

Employee plus two or more $1,396.63 $465.57

20-2

9 H

ours

Employee only $413.88 $275.92

Employee plus one $827.68 $551.79

Employee plus two or more $1,117.36 $744.91

4

Voluntary Dental Insurance Child & Family Services provides employees working at least 20 hours per week with an opportunity to purchase dental benefits for you and your family at group rates.

Reliance Standard Voluntary Dental

Services What's Covered In Network I Out of Network

Deductible Applies to Type 2 and Type 3 services only

$50 Individual / $150 Family (per calendar year)

Preventive & Diagnostic Services Type 1

Exams (2/yr), cleanings (2/yr), x-rays, fluoride for children, sealants, space maintainers

100% - no deductible in and out of network *No waiting period

Basic Restorative Services Type 2

Fillings, extractions, endodontic, periodontics, denture repair, anesthesia

100% - after deductible in network / 80% after deductible out of network *No waiting period

Major Restorative Services Type 3

Crowns, crown repair, onlays, implants prosthodontics (dentures, bridges)

60% - after deductible in network / 50 % after deductible out of network *No waiting period

Annual Maximum $1,250 calendar year maximum benefit per person for Type 1, 2, and 3 coverage combined

Allowance Contracted Fee in network / 90th % UCR out of network

In addition to the dental benefits listed above, Reliance Standard Dental includes a Maximum Rollover provision: * Must have dental services with paid claims under $500 for that benefit year * Can then carry $250-$350 in benefit $$ to following year (**$350 if you use in network providers only**) * Maximum rewards accumulation is $1,000

Cost of Coverage per Month Coverage Type Employee pays

Employee only $38.52 Family $97.52

5

Life and AD&D Insurance

Child & Family Services provides eligible employees working at least 20 hours per week with a Life and AD&D benefit equal to one times their annual salary to a maximum benefit of $100,000.

Reliance Standard Group Life and Accidental Death & Dismemberment Benefit Details

Benefit Class All Employees Amount of Coverage 1 x Annual Base Earnings Maximum Benefit $100,000 Accelerated Benefit Included Age Reduction by 50% at Age 70 Right to Convert Included

6

Long-term Disability Income Benefits

Child & Family Services provides employees with long-term disability income benefits. In the event you become unable to work due to a non-work-related injury or sickness, disability income benefits are provided to cover some of your loss of income. You are not eligible to receive disability benefits if you are receiving workers’ compensation benefits.

Reliance Standard Long-term Disability Benefit Details Benefit Class Earnings over $40,000 per year Earnings under $40,000 per year Definition of Earnings Annual Base Salary Benefit Percentage of Earnings 60% Maximum Monthly Benefit $5,000 Maximum Benefit Duration To SSNRA Definition of Disability Own Occupation To SSNRA 2 Year Own Occupation Elimination Period 180 Days Pre-existing Conditions 3/12

7

EMPLOYEE ASSISTANCE PROGRAM • Dedicated toll free crisis line 24/7/365 • Diagnostic assessment and problem resolution sessions • Legal Consultations • Financial Consultations • Online work-life EAP resources • Additional online resources

8

Travel Assistance Program

9

Health and Dependent Care Flexible Spending Accounts (FSA)

Child & Family Services provides you the opportunity to pay for out-of-pocket medical, dental and dependent care expenses with pre-tax dollars through Flexible Spending Accounts. You can save approximately 25% on these expenses when you participate in a FSA. Your GDI debit card can access Health Care FSA funds. You may be asked to submit receipts for covered expenses. You must enroll in the plan each year in order to participate. A health care FSA is used to reimburse eligible out-of-pocket medical expenses incurred by you and your dependents. A dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse work.

Contributions to your FSA come out of your paycheck before taxes are withheld. This means that you don’t pay federal income tax, Social Security taxes, and state and local income taxes on the portion of your pay you contribute to your FSA. You should contribute the amount of money you expect to pay out of pocket for eligible expenses for the plan period. If you do not use the money you contribute by the end of the plan year, it will be forfeited. This is the “use-it-or-lose-it” IRS rule. You have a run out of 90 days, meaning you have through December to get receipts/claims in for prior plan year. You have a grace period of 75 days, meaning you have until December 15 to incur claims for prior plan year.

The amounts you can contribute to the Health Care and Dependent Care Flexible Spending Accounts are as follows:

Flexible Spending Accounts

Minimum Annual Contribution

Maximum Annual Contribution

Health Care $260 $1,500

Dependent Care $260 $5,000 if single or married filing jointly

$2,500 if married filing separately

The following example shows how you can save money with a flexible spending account:

Bob and Jane’s combined gross income is $80,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $1,500 in out-of-pocket health care expenses and $3,300 for day care for the remainder of the year, they decide to direct a total of $4,800 into their FSAs.

Without FSAs With FSAs

Gross income: $80,000 $80,000

FSA contributions (before taxes): $0 -$4,800 Taxable wages: $80,000 $75,200

Estimated Taxes Federal (using a 12% tax rate) -$9,600 -$9,024

State (using a 5% tax rate) -$4,000 -$3,760

FICA (Social security and Medicare): -$6,120 -$5,753

After-tax earnings: $60,280 $56,663

Medical & dependent care expenses (after tax): -$4,800 $0

Remaining spendable income: $55,480 $56,663

Spendable income increase: $0 $1,183

10

11

Medical FSA Eligible Expenses The list below includes generally eligible IRS Code Section 213 expenses. Items marked with a * require a copy of a current prescription (written on a prescription pad). The prescription must be submitted each time a request for reimbursement is submitted for these items.

12

401(k) Retirement Plan Saving for retirement is becoming more and more important as the financial landscape continues to change. Child & Family Services offers you the opportunity to save for your retirement through our 401(k) Retirement Plan.

Plan Year: January 1 to December 31

Eligibility: 21 years of age and completed 30 days

Entry Dates: Monthly, enrolled at 4% unless you opt out

Change Dates: Monthly

Auto Escalation: Year 1 and 2 stay at 4%, then increase 1% per year up to 6% of pay

Employee Contributions: 0 - 100% of compensation not to exceed $18,000 per year plus a $6,000 “catch -up” contribution for those age 50 or older (2015).

Roth Deferrals: Allowed

Employer Contributions: Matching – 100% on first 1%, then 50% of next 5%

Vesting: EE Contributions -100% at all times ER Match- 100% at all times (Safe Harbor)

Loans: Allowed

Hardship Withdrawals: Available subject to IRS restrictions.

In-Service Withdrawals: Available at age 59 and a half and over

* Please see the Summary Plan Description for more complete information on the 401(k)*

Questions? Call Norton Financial Services: 1-800-777-5244: Ray Emery ext: 7326 or Dustin Fier ext: 7306

Empower Retirement: 1-800-338-4015

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Important Notices

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WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 (WHCRA)

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Please see your plan overview for applicable deductibles and coinsurance. If you would like more information on WHCRA benefits, contact your plan administrator

16

INITIAL COBRA NOTIFICATION

** CONTINUATION COVERAGE RIGHTS UNDER COBRA **

Introduction

You are receiving this notice because you have recently become covered under the Day One group health plan (the Plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage under the employer’s plan must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:

• Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

• Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

• The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the plan as a “dependent child.”

When is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, commencement of a proceeding in bankruptcy with respect to the employer, or the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event. You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Human Resources in written form, along with supporting documentation of event.

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How is COBRA Coverage Provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of continuation coverage

If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan Contact Information

Name of Entity: Child & Family Services Attn: Nelia Lopes Address: 3057 Acushnet Avenue, New Bedford, MA 02745 Phone: (508) 742-1024

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DISCLOSURE OF CREDITABLE PRESCRIPTION DRUG COVERAGE

Important Notice from CHILD & FAMILY SERVICES About Your Prescription Drug Coverage and Medicare

If you or your dependents are not currently entitled to Medicare, then you may disregard this notice until you or they become entitled to Medicare.

If you or your dependents are currently entitled to Medicare, please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Child & Family Services and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered and their cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. 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.

2. Child & Family Services has determined that the prescription drug coverage offered by its employer sponsored health plan (“Employer Health Plan”) is on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage. Therefore, your coverage is considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When can you join a Medicare drug plan? There are three times when you may join a Medicare drug plan:

1. When you first become eligible for Medicare 2. During any following Medicare enrollment period which runs every year from October 15th to December 7th. 3. During the two-month Special Enrollment Period (SEP) which begins when, through no fault of your own, you lose

creditable prescription drug coverage under an employer or union sponsored health plan What happens to your current coverage if you join a Medicare drug plan? If you decide to join a Medicare drug plan, your current prescription drug coverage under your Employer Health Plan will not be affected unless you decide to drop your prescription drug coverage under your Employer Health Plan. Your current Employer Health Plan provides coverage for many other medical expenses in combination with coverage for prescription drugs.

If you keep the prescription drug coverage offered under your Employer Health Plan, you will continue to receive all the medical and prescription drug benefits available under the Plan.

If you drop the prescription drug coverage provided through the Plan, coverage of your other medical benefits under the Plan will also be terminated since all benefits are provided on a combined basis.

If you do decide to join a Medicare drug plan and drop your current coverage under your Employer Health Plan, you and your dependents may not be able to get this coverage back at a later date. When will you pay a higher premium (penalty) to join a Medicare drug plan?

You should also know that if you drop or lose your current coverage under your Employer Health Plan and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary 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 permanently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join. For more information about this notice or your current prescription drug coverage… Please contact the person listed below for further information about your prescription drug coverage. NOTE: Your employer will distribute this notice at least once a year. You will also get a notice if your Employer Health Plan changes and no longer provides creditable prescription drug coverage. You also may request a copy of this notice at any time.

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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. After you become eligible for Medicare, Medicare will send you a copy of the handbook in the mail every year. 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).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: October 1, 2015 Name of Entity/Sender: Child & Family Services Contact--Position/Office: Nelia Lopes Address: 3057 Acushnet Avenue, New Bedford, MA 02745 Phone Number: 508-742-1024

PREMIUM ASSISTANCE UNDER MEDICAID and the CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2015. Contact your State for further information on eligibility –

MAINE – Medicaid Website: www.maine.gov/dhhs/ofi/public- assistance/index.html Phone: 1-800-977-6740 TTY: 1-800-977-6741

MASSACHUSETTS – Medicaid and CHIP Medicaid & CHIP Website: www.mass.gov/MassHealth Medicaid & CHIP Phone: 1-800-462-1120

NEW HAMPSHIRE – Medicaid Website: www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: (603) 271-5218

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Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment.

Use of Leave An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis.

Substitution of Paid Leave for Unpaid Leave Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer’s normal paid leave policies.

Employee Responsibilities Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call-in procedures.

Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave.

Employer Responsibilities Covered employers must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employees’ rights and responsibilities. If they are not eligible, the employer must provide a reason for the ineligibility.

Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement. If the employer determines that the leave is not FMLA-protected, the employer must notify the employee.

Unlawful Acts by Employers FMLA makes it unlawful for any employer to: • interfere with, restrain, or deny the exercise of any right provided

under FMLA; and • discharge or discriminate against any person for opposing any

practice made unlawful by FMLA or for involvement in any proceeding under or relating to FMLA.

Enforcement An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer.

FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights.

FMLA section 109 (29 U.S.C. § 2619) r equires FMLA covered employers to post the text of this notice. Regulation 29 C.F.R. § 825.300(a) may require additional disclosures.

EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FAMILY AND MEDICAL LEAVE ACT

Basic Leave Entitlement FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons: • For incapacity due to pregnancy, prenatal medical care or child

birth; • To care for the employee’s child after birth, or placement for

adoption or foster care; • To care for the employee’s spouse, son or daughter, or parent,

who has a serious health condition; or • For a serious health condition that makes the employee unable

to perform the employee’s job.

Military Family Leave Entitlements Eligible employees whose spouse, son, daughter or parent is on covered active duty or call to covered active duty status may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.

FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered servicemember during a single 12-month period. A covered servicemember is: (1) a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness*; or (2) a veteran who was discharged or released under conditions other than dishonorable at any time during the five-year period prior to the first date the eligible employee takes FMLA leave to care for the covered veteran, and who is undergoing medical treatment, recuperation, or therapy for a serious injury or illness.*

*The FMLA definitions of “serious injury or illness” for current servicemembers and veterans are distinct from the FMLA definition of “serious health condition”.

Benefits and Protections During FMLA leave, the employer must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.

Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee’s leave.

Eligibility Requirements Employees are eligible if they have worked for a covered employer for at least 12 months, have 1,250 hours of service in the previous 12 months*, and if at least 50 employees are employed by the employer within 75 miles.

*Special hours of service eligibility requirements apply to airline flight crew employees..

Definition of Serious Health Condition A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the function of the employee’s job, or prevents the qualified family member from participating in school or other daily activities.

For additional information: 1-866-4US-WAGE (1-866-487-9243) TTY: 1-877-889-5627

WWW.WAGEHOUR.DOL.GOV U.S. Department of Labor | Employment Standards Administration | Wage and Hour Division WHD Publication 1420 Revised February 2013

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SMALL NECESSITIES LEAVE ACT

MASSACHUSETTS GENERAL LAW (M.G.L) CHAPTER 149, SECTION 52D

The Small Necessities Leave Act permits eligible employees to take up to a total of 24 hours of leave within a 12-month period to attend a child’s school activity or accompany a child or elderly relative to a doctor’s appointment. The legislated effective date of this act is August 4, 1998.

The Small Necessities Leave Act permits an employee leave for the following purposes:

• To participate in school activities directly related to the educational advancement of a son or daughter of the employee, such as a parent-teacher conference or interviewing for a new school;

• To accompany a son or daughter of the employee to routine medical or dental appointments, such as check-ups or vaccinations; and

• To accompany an elderly relative of the employee to routine medical or dental appointments or appointments for other professional services relating to the elder’s care, such as interviewing at nursing or group homes.

The 24 hours of leave available under this benefit are in addition to the 12 weeks of leave provided for under the federal Family and Medical Leave Act. The 24 hours may be taken within the 12-month calendar year period and the time may be taken on an intermittent (i.e. 2 hours to attend a parent-teacher conference) or reduced-time schedule.

Attending parent-teacher conferences, interviewing for a new school, routine check-ups or vaccinations, or interviewing at nursing or group homes qualify as acceptable purposes.

An employee is required to provide his/her department with seven (7) days’ notice of the need for the leave if the leave is foreseeable. If the necessity for the leave is not foreseeable, the employee is required to provide notice of the leave as soon as practicable.

The law provides for an unpaid leave of absence. An employee may elect to use any available accrued vacation, personal or sick leave benefits provided the use of such time is in accordance with the employee’s appropriate collective bargaining agreement. Also, An employer may require the employee to substitute any of the employee's paid vacation leave, personal leave or sick leave for the leave provided for by the Small Necessities Leave Act. In other words, the employer may require that the employee first utilize vacation leave, personal leave or sick leave before taking the unpaid Small Necessities Leave.

A department may require that written certification or documentation support a request for leave under this act.

DEFINITIONS

Son or daughter … any child under 18 who is the biological child of the employee, who is adopted by the employee, or whom the employee supervises on a day to day basis and for whom the employee is financially responsible. A "son or daughter" is also a child over 18 who is incapable of self-care because of a mental or physical disability.

Elderly relative … an individual of at least 60 years of age who is related by blood or marriage to the employee, including a parent.

School … a public or private elementary or secondary school, a Head Start program, or a children’s day care facility.

Federal Act … the Family and Medical Leave Act (FMLA) of 1993. Unless this section provides otherwise, the terms of FMLA shall apply to leave under this section.

Eligible employee … an employee must have been employed for 12 months at the time the leave is to begin. Also an employee must have worked for at least 1,250 hours during the 12-month period prior to the beginning of the leave.

     

Prepared by Norton Financial Services