AtlantiCare Benefits Book 2020

Life Insurance

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES.........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Company-provided basic group term life insurance coverage is a tax-free benefit up to $50,000. If your coverage exceeds $50,000, the IRS considers this amount taxable as “imputed income.” This does not represent a deduction from your pay but will be reported as taxable income on your annual W-2. “Imputed income” will appear on your pay stub under the heading of “Group Term Life.” If you request a change to increase your coverage during Open Enrollment, you will be required to complete a medical history form known as a Statement of Health (SOH) or Evidence of Insurability (EOI). ! IMPORTANT! Designate a beneficiary. Your beneficiary is the person(s) who will receive your life insurance benefits payment upon your death. Designate, update or view your beneficiary at www.portal.adp.com . Supplemental Life Insurance You may elect supplemental life insurance when you are first eligible with no medical questions asked. However, if you do not elect when you are first eligible, or if you request a change during open enrollment, you will be required to complete a medical questionnaire known as a Statement of Health (SOH). You can retrieve the NJHA EOI Form through the Forms & Plan Documents tile on the AtlantiCare Benefits Enrollment/Service Site. You will have 60 days to complete and submit the document. Your additional coverage amount must be approved by the carrier prior to taking effect. You will not see a payroll deduction for the additional amount until coverage is approved.

As a full-time employee you automatically receive, at no cost, basic group term life insurance and AD&D insurance benefits in the amount of 1.5 times your base annual salary. Coverage takes effect the first day of the month following your date of hire/full time eligibility status. You may elect supplemental life insurance when you are first eligible with no medical questions asked. Company-provided basic group term life insurance coverage is a tax-free benefit up to $50,000. If your coverage exceeds $50,000, the IRS considers this amount taxable as “imputed income.” This does not represent a deduction from your pay but will be reported as taxable income on your annual W-2. “Imputed income” will appear on your pay stub under the heading of “Group Term Life.”

FORMS

24