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Associate Beneft Plans 2011

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Page 1: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

Associate

Benefit Plans2011

Page 2: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

Who is Eligible and When:

ThreeWill full time Associates and their eligible dependents may elect to participate in the group benefit programs. If you are a full time Associate, coverage will be effective on date of hire. If coverage is declined or

you fail to enroll before your eligibility date, the next opportunity to enroll will be during open enrollment.

Associates may add dependents or join benefit plans when the Associate experiences a qualifying life event such as marriage, the birth or adoption of a child, or a spouse’s open enrollment. The Associate has 30 days from the

life event to make any eligible additions or changes.

Stay Healthy • Medical Coverage • Dental Coverage

Feel Secure • Basic Life and AD&D Insurance • Disability Insurance • 401k Retirement Plan

Remain Balanced • Employee Assistance Program • Vacation Allowances

Our Associates are our most

valuable asset

MEDICALCoverage Level Associate Monthly Cost

7AA

$500 Deductible7AP

$2,500 DeductibleAssociate Only $0.00 $0.00

Spouse $195.00 $170.00Child/ Children $235.00 $205.00

DENTALCoverage Level Associate Monthly CostAssociate Only $0.00

Spouse $35.00

Child/ Children $70.00

Page 3: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

Needing Assistance?

Contact Benefit Website/Email Phone

United Healthcare Medical www.myuhc.com (800) 357-0978

Principal Dental/ Life www.principal.com (800) 247-4695

Principal Employee Assistance Programwww.MagellanHealth.com/

member(800) 450-1327

Securian 401 (k) Savings Planwww..SecurianRetierment

Center.com(800) 233-2881

Benefits

Contacts

Our partners at The A.I. Group are here to help! Should

you need assistance with general benefits questions or help with any claims resolution, call our Benefits HelpDesk at (678) 808-1150 or email

[email protected]

DENTALCoverage Level Associate Monthly Cost

Child/ Children

Page 4: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

ThreeWill provides medical insurance through United Healthcare. Through the plan, you are eligible to receive

comprehensive health care through a network of doctors and other health care professionals. When you enroll in

a UHC medical plan, you also have access to the prescription drug program. A web-based tool is available for plan

members to navigate through UHC’s wide range of health information and programs, as well as track personal

claims history, find in-network providers under the Choice Plus Network, and search for

preferred medications. To register visit www.myuhc.com or contact

United Healthcare’s Customer Service at (800) 357-0978.

Words to Remember:

Premium – What you pay for health

care coverage through payroll deduction.

Deductible – The amount you pay

before your medical plan begins paying

certain benefits.Coinsurance – Percentage of cost

sharing between the participant and the

plan once the deductible has been met.

Copay – A flat fee for certain services.

Out-of-Pocket – You must pay for

certain services directly. Generally,

the coinsurance you pay is considered

an “out-of-pocket” expense. There is

a maximum on out-of-pocket expenses

you must pay each year. Deductibles

and copays do not apply towards the

out-of-pocket maximum.

Network – Doctors and hospitals that

have negotiated with the medical plan

or have agreed to specific rates are “in-network”. Providers who have no

agreement with the plans are “out-of-

network” and usually result in higher

fees.

your medical benefitsare here to help you

Deductibles and Out-of-Pockets at a Glance

PPO 7AA PPO 7AP

Annual Deductible (In-Network)

Individual $500 $2,500

Family $1,500 $7,500

Annual Out-of-Pocket (In-Network)

Individual $3,000 $2,500

Family $6,000 $7,500

Page 5: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

Covered ServicePPO 7AA PPO 7AP

In-Network Out-of-Network In-Network Out-of-Network

Medical Facility Visits

Deductible

- Individual

- Family

$500

$1,500

$1,000

$3,000

$2,500

$7,500

$5,000

$15,000

Out of Pocket Maximum

- Individual

- Family

$3,000

$6,000

$6,000

$12,000

$2,500

$7,500

$10,000

$20,000

Physician’s Office- sickness and injury $25 copay

Plan pays 60% after

deductible$30 copay

Plan pays 80% after

deductible

Physicians OfficePlan pays 100%

Plan pays 60% after

deductiblePlan pays 100%

Plan pays 80% after

deductible- preventive care, well child visits

Specialist Office $50 copay

Plan pays 60% after

deductible$60 copay

Plan pays 80% after

deductible

Maternity Visits - copay applies to initial visit, see hospital benefits for delivery and nursery

$50 copayPlan pays 60% after

deductible$60 copay

Plan pays 80% after

deductible

Urgent Care - non-urgent use of the urgent care is not covered $75 copay

Plan pays 60% after

deductible$100 copay

Plan pays 80% after

deductible

Emergency Room$200 copay $200 copay $250 copay $250 copay

Hospital - Inpatient

Plan pays 80% after

deductible

Plan pays 60% after

deductible

Plan pays 100% after

deductible

Plan pays 80% after

deductible

Hospital - Outpatient

- surgery facility/hospital charges Plan pays 80% after

deductible

Plan pays 60% after

deductible

Plan pays 100% after

deductible

Plan pays 80% after

deductible - diagnostic x-ray and lab services

- complex imaging

Therapy Services

Chiropractic Care $25 copay

Plan pays 60% after

deductible$30 copay

Plan pays 80% after

deductible

Physical, Occupational, Speech Therapy $25 copay

Plan pays 60% after

deductible$30 copay

Plan pays 80% after

deductible

Prescription Drugs

Tier 1 $10 copay $10 copay $10 copay $10 copay

Tier 2 $35 copay $35 copay $35 copay $35 copay

Tier 3 $60 copay $60 copay $60 copay $60 copay

Tier 4 $100 copay $100 copay $100 copay $100 copay

Mail-Order Maintenance Drug 2.5 X’s retail copay 2.5 X’s retail copay 2.5 X’s retail copay 2.5 X’s retail copay

plan highlights

This is meant to be a summary of benefits only. Limitations or restrictions may apply. Please refer to your benefit booklet, contact Customer Service at (800) 357-0978, or visit www.myuhc.com for a list of Network providers.

Page 6: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

It’s

dental planyour

Going to the dentist for regular checkups & cleanings is one of the most important

factors in maintaining good oral health. Regular checkups can prevent cavities, root

canals, gum disease, oral cancer, and other dental conditions. Don’t wait until you

have a problem before you see your dentist; help prevent problems before they

happen.

• 78% of Americans have had at least 1 cavity by age 17.

• People who drink 3 or more sugary sodas daily have 62% more dental decay, fillings and tooth loss.

• Gum disease is one of the main causes of tooth loss in adults and has also been linked to heart disease and stroke.

Dental coverage is provided through Principal. With this plan you have the freedom to see any dentist, however

you will spend less out of pocket if you choose an in-network dentist. To find out if your dentist is in-network, visit www.principal.com and select Provider Directory- The Principal Plan PPO Network.

Preventive Services• Routine Oral Exams• Cleanings (once every 6 months)• Fluoride• Dental X-rays

Basic Services• Fillings

• Sealants

• Emergency Exams

Major Services• Major Restorative• Inlays, Onlays and Crowns• Bridges, Denture Repair• Surgical Periodontic Services• Surgical Tooth Extraction• Endodontics• Non-Surgical Periodontic Services

Benefits You ReceiveCalendar Year Deductible

- Individual $50

- Family $150

Annual Maximum $1,000

Preventive Services (deductible waived) 100%

Basic Services 80%

Major Services 50%

This is meant to be a summary of benefits only. Limitations or restrictions may apply. Please refer to your benefit booklet, contact Customer Service at (800) 247-4695, or visit www.principal.com for a list of Network providers.

Page 7: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

Security for your

peace of mind

All full time Associates of ThreeWill receive $25,000 in term life insurance from Principal at no cost.

Benefits You Receive

Term Life Benefits Employee Spouse Child (ren)

Benefit Increments $25,000 $5,000

0-6 Months: $1,000

6 Months- 25 Years:

$2,000

ThreeWill provides full time Associates with Disability Insurance through Principal.

ThreeWill pays the full cost for these benefits and Associates are automatically enrolled in the plans.

Benefits You Receive- Weekly Benefit - minimum benefit - maximum benefit

60% of your base salary

$15

$500

Elimination Period 30 days

Duration of Benefits 9 weeks

Short Term Disability Long Term Disability

Benefits You Receive- Monthly Benefit - minimum benefit - maximum benefit

60% of your base salary

$50

$6,000

Elimination Period 3 Months

Duration of Benefits To age 65 or normal Social

Security retierment age

Mental & Nervous Condition Limitation 12 months

Page 8: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

the icing on the cake

Employee Assistance ProgramProblems are just a part of everyday life. This is why Principal has teamed with Magellan Health

Services to offer you an easy and convenient way to find the help you need. Whether it is an emotional, legal or financial issue, Magellan Health Services offers a multitude of resources available to you.

How to access the EAPToll-Free Counselor: 1-800-450-1327

Online: www.MagellanHealth.com/member

Self-Screening: 1-866-272-4084

HolidaysNew Year’s Day

Good Friday

Memorial Day

Independence Day

Labor Day

Thanksgiving

Friday following Thanksgiving

Christmas Eve

Christmas

Paid Time Off (PTO)First Year 10 PTO

1 Year 15 PTO

4 Years 20 PTO

8 Years 25 PTO

12 years 30 PTO

Assistance is available for:

• Family, relationship and parenting issues

• Child and elder care needs• Emotional and stress related issues• Conflicts at home or work• Alcohol and drug dependencies• Health and wellness issues• Emotional and stress related issues

Holidays & Paid Time Off

401 kThreeWill provides a comprehensive 401 (k) Investment Savings Plan through Securian. The plan offers

Associates an outstanding combination of savings. You may contribute up to $16,500 for 2011. Enrollment

information provided under separate cover.

ThreeWill contributes a 3% safe harbor automatic contribution

Page 9: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

The Fine

Print...IMPORTANT EMPLOYEE NOTICES

HIPAA NOTICE OF SPECIAL ENROLLMENT

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll

yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’

other coverage). However, you must request enrollment within 31 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other

coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you

must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

The following events also qualify as special enrollment events and request for enrollment must be made within 31 days:

• If you reach a plan’s lifetime limit on benefits, you may “special enroll” in another health plan.• If you no longer reside or work in an HMO’s service area and there is no other access to any other benefit option, you may “special enroll” on another health plan.• If you enroll in an option (e.g., HMO) and subsequently obtain a new dependent, you may enroll yourself and the dependent in a different option under the plan (e.g., PPO).• If you enroll in the group health plan but your dependent declines coverage due to other coverage and then loses that coverage, your dependent has the right to “special enroll” in the plan.

The following events also qualify as special enrollment events and request for enrollment must be made within 60 days:

• If you decline coverage because you and/or your dependents are covered under Medicaid or a State Children’s Health Insurance Program (SCHIP) and the coverage terminates, you may “special enroll” in the plan with 60 days of the termination.

• If you enroll in an option but you and/or your dependent becomes eligible for a State Children’s Health Insurance Program (SCHIP) premium assistance subsidy during the plan year, you and/or your dependent has the right to “special enroll” in the plan within 60 days of the termination of Medicaid or SCHIP coverage or becoming eligible for the premium

subsidy.

To request special enrollment or obtain more information, contact our partners at The A.I. Group, Inc., Outsourcing Department, 678-726-1000.

GENERAL NOTICE OF PRE-EXISTING CONDITION EXCLUSION

This plan imposes 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

a six-month period. Generally, this six-month period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six-month

period ends on the day before the waiting period begins. The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days

after birth, adoption, or placement for adoption.

This exclusion may last up to 12 months (18 months if you are a late enrollee) from your first day of coverage, or, if you were in a waiting period, from the first 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 if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month (or 18-month) exclusion period

by your creditable coverage, you should give us a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating

creditable coverage.

Page 10: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

WOMEN’S HEALTH & CANCER RIGHTS ACT

Beginning on January 1, 1999, Federal law requires group health plans to provide coverage for the following services to an individual receiving benefits in connection with a mastec-

tomy:

• Reconstruction of the breast on which the mastectomy has been performed;• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and• Prostheses and physical complications for all stages of a mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).• Coverage will be in a manner that is determined in consultation with the attending physician and patient.This notice is being sent to you to comply with the Federal legislation requiring notification to all employees during the open enrollments on or after October 28, 1998.

The coverage for breast reconstruction and related services will be subject to the same conditions and provisions as any other covered service. Benefits will be paid consistent with all other medical benefits that apply under this plan.

CONSUMER CHOICE OPTION

This notice concerns Georgia Senate Bill 210, which requires the insurance carrier to offer the new “Consumer Choice Option” to Georgia residents enrolled in certain insured man-

aged care medical and/or dental plans as those plans are issued or renewed on or after January 1, 2000.

Under this new benefit option, and with certain restrictions required by law, members of certain plans may nominate an out-of-network provider or hospital to provide covered services, for themselves and their covered family members, for an additional monthly premium cost. Benefits and co-payments will be the same as for in-network providers. The out-of-network provider must agree to:

• accept the insurance carrier compensation, • to not balance bill a member,• to adhere to the plan’s quality assurance requirements,• to meet all other reasonable criteria required by the plan of its in-network providers and hospitals. It is possible your nominated provider will not agree to participate.

Please note that, in selecting any such non-participating provider, you will not have the benefit of the credentialing that the health insurance carrier usually performs when determin-

ing whether to admit a provider to their network. The carrier will not credential or otherwise perform any review of the qualifications of the non-participating provider you select, beyond verifying that the provider holds a current, valid Georgia license.

This Consumer Choice Option is available from the date your plan is issued or renews on or after January 1, 2000. It will be available for an increased premium, in addition to the

premium you would otherwise pay, and will be effective from the date of your signed election form.

Exact pricing and additional information, including an election form and package, can be obtained by calling The A.I. Group at 678-726-1000. Please have your member identification (ID) card available when you call.

You will have 31 days from the time of receiving your Consumer Choice Option election package to return the election form to us. If you do not return your election form within this

time period, you will not be eligible to enroll in this option until the next open enrollment period. Existing members should note that failure to re-enroll could result in termination of

the Consumer Choice Option coverage. This action, however, does not affect the basic health care coverage provided by your employer.

If you have questions regarding this notice, the provisions, or benefits you may contact our partners at The A.I. Group at (678) 726-1000 or contact the Human Resources Department

More Fine Print...

Page 11: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

2011 Benefit Election Form

FO

LD

TH

EN

TEAR O

N D

OTTED

LIN

E

To Elect Benefits: (Medical and Dental)

Check if Electing Group Medical (Choose One) Cost/Month Election Cost

PPO 7AA PPO 7AP

$500 Ded $2,500 Ded

_______ Associate $0 $0 ____________

_______ Spouse $195 $170 ____________

_______ Child/Children $235 $205 ____________

Check if Electing Group Dental Cost/Month Election Cost

_______ Associate $0 ____________

_______ Spouse $35 ____________

_______ Child/Children $70 ____________

Total Deduction / Month ____________

(Total all costs)

Signature____________________________________ Date_____________________

Name_______________________________________

Printed

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I decline Medical and/or Dental Benefits offered by ThreeWill, LLC . I understand that the next opportunity I have to elect benefits will be at open election time (annual renewal / company benefit change), if I have a life event change, or if my current benefits are terminated.

_____I have other coverage

_____Other reasons__________________________________

Signature________________________________ Date___________________

Name___________________________________

Printed

Page 12: Beneit Plans - ThreeWill · 2020. 9. 4. · • 401k Retirement Plan Remain Balanced • Employee Assistance Program • Vacation Allowances Our Associates are our most valuable asset

The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by ThreeWill. The text con-

tained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.