J. Medical, Dental, Vision, Life, AD&D, Supplemental Life, Supplemental AD&D, STD and LTD Insurance Benefits

Company:	Eugene Burger Management Corporation
Author:
Date:	03/01/2010
Group:	NEW Personnel Policy Manual
Category:	03 Employee Benefits
Title:	J. Medical, Dental, Vision, Life, AD&D, Supplemental Life, Supplemental AD&D, STD and LTD Insurance Benefits

J. Medical, Dental, Vision, Life, AD&D, Supplement Life, Supplemental AD&D, STD and LTD Insurance Benefits

EBMC provides a comprehensive insurance plan for eligible employees. Participation in EBMC’s health insurance, dental, vision and disability insurance programs is entirely voluntary. All eligible employees will automatically be enrolled in Life/AD&D which is paid in full by EBMC or the employee’s worksite location.

Provided his/her Introductory Period has been completed, a regular full-time employee is eligible for health care benefits beginning on the first of the month following six months of employment. Employees who have not completed the Introductory Period, temporary employees, and part-time employees are not eligible for health insurance benefits.

To assist employees with the cost of medical insurance, EBMC or the employee’s worksite location will contribute $200 toward the cost of monthly medical premiums. The employee is responsible for paying the rest of the monthly premiums through payroll deduction. In the event of an increase in medical insurance premium rates, all employees may be required to contribute to the cost of increased premiums to retain coverage.

If an employee does not complete and submit insurance forms within 30 days of his/her hire date, the employee will not be eligible for coverage until the next open enrollment period. Employees will be provided with a Summary Plan Description for each benefit plan. Please see the Payroll Department for additional information about EBMC’s insurance plans.

(1) Section 125 Plan

Under Section 125 of the IRS Code, EBMC has set-up a flexible spending account for employees who wish to take advantage of this provision of the IRS Code. Section 125 allows employees to make their premium contribution to group health insurance with pre-tax dollars. All employees electing medical coverage will automatically be enrolled for these pre-tax benefits. Enrollment for pre-tax benefits requires the employee to continue his/her medical coverage through the end of the plan year.

(2) 401(k) Investment Program

EBMC provides a qualified deferred compensation plan for its employees. This plan enables the employee to save money, lower taxes, and invest in his/her financial future. Under the 401(k) plan, employee election contributions are made on a before tax basis; which means that the amount of deferred income will be excluded from the employee’s taxable income. The following are some of the advantages of EBMC’s 401(k) plan:

(a) Contributions

Elective deferrals are voluntary and the amount contributed is up to the employee. Employees may contribute up to 15% of his/her salary up to the current Federal limit.

(b) Tax Benefit

Deferrals are made before tax; therefore, employees pay less in Federal and State income taxes.

(c) Distribution

Earnings and income are not taxed until the money is distributed from the plan. When an employee receives retirement benefits, he or she may be in a lower tax bracket than when contributions are made.

(d) Retirement

Cash payments might qualify for favorable tax treatment when taken at retirement.

It is important to understand that to benefit from this program, an employee must be prepared by means of a salary reduction, to contribute to his/her financial future. EBMC realizes that it may be difficult for an employee to commit a portion of their income to this program. EBMC encourages each employee to participate in this program at some level.

To be eligible to enroll in the 401(k) plan, employees must be at least twenty-one (21) years of age and have been employed by EBMC for one year of continuous employment, with at least 1,000 hours. When an employee is eligible to participate in this program he or she will be provided with the “Summary Plan Description” by EBMC’s Plan Administrator.

(3) Social Security Insurance (FICA)

During an employee’s employment, the employee and EBMC both contribute funds to the Federal government to support the Social Security Program. This program is intended to provide employees with retirement benefit payments and medical coverage once reaching retirement age.

(4) Unemployment Insurance

EBMC pays a state and federal tax to provide employees with unemployment insurance coverage in the event they become unemployed through no fault of their own or due to circumstances described by law. This insurance is administered by applicable state agencies, who determine eligibility for benefits, the amount of benefits (if any), and duration of benefits.

(5) State Disability Insurance

These state sponsored programs provide for temporary disability benefits for employees unable to work because of disability due to a non-occupational accident or illness. These programs are financed through deductions from each employee's taxable earnings and through employer contributions as established by law in each particular state. Benefits are not automatic. Employees must complete the required form to receive benefits.

(6) Paid Family Leave Program (Family Temporary Disability Insurance) – (CA Employees Only)

Within the California state disability insurance program, a family temporary disability insurance program has been established which is called the Paid Family Leave Program (PFL). Paid Family Leave is funded through payroll deductions and coordinated through the Employment Development Department. The Paid Family Leave Program provides limited compensation for up to six weeks within a 12 month period (after an unpaid, seven day wait period) to workers who take time off work to care for a seriously ill child, spouse, parent, domestic partner, or to bond with a minor child within one year of the birth or placement of the child in connection with foster care or adoption. The PFL Program does not provide employees with a right to a leave of absence; it is limited to a state-mandated wage replacement benefit. Both Disability Insurance and Paid Family Leave require a seven (7) calendar day non-payable waiting period. In other words, an employee must be off work at least 8 days before qualifying for benefits. For additional information, employees should contact the Payroll Department for a brochure concerning this law and review EBMC’s Employee Handbook regarding eligibility for a leave of absence.

(7) COBRA

Generally, the Payroll Department should be contacted regarding any specific questions on the benefits and operations of COBRA, as changes or amendments may have occurred which affect an employee's eligibility or coverage.

(a) Overview

Under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986, if an employee is covered under EBMC’s health insurance plan(s) he or she is entitled to continue coverage in the event that employment with EBMC ends. COBRA coverage is a continuation of health plan coverage when coverage would otherwise end because of an event known as a “qualifying event.”

(b) Qualifying Events

Employees who receive medical benefits under EBMC's comprehensive group health plan (“Plan”), are eligible to continue coverage after termination of employment if he/she looses coverage under the Plan. No evidence of insurability is required for continued group health insurance coverage under COBRA.

(i) Employee. An employee will become a qualified beneficiary under COBRA if he/she looses coverage under the Plan because of either of the following qualifying events happens:

(A) the employee’s hours of employment are reduced to less than full time, or

(B) the employee’s employment ends for any reason, other than for gross misconduct.

(ii) Employee’s Spouse. The spouse of an employee will become a qualified beneficiary if the spouse loses his/her coverage under the Plan because any of the following qualifying events happens:

(A) The spouse-employee dies;

(B) The spouse-employee’s hours of employment are reduced;

(D) The spouse-employee becomes entitled to Medicare benefits (under Part A, Part B, or both); or

(E) The spouse-employee becomes divorced or legally separated from his/her spouse.

(iii) Employee’s Children. An employee’s dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

(A) The parent-employee dies;

(B) The parent-employee’s hours of employment are reduced;

(D) The parent-employee becomes entitled to Medicare benefits (under Part A, Part B, or both);

(E) The parents become divorced or legally separated; or

( (F) The child loses eligibility for coverage under the plan as a “dependent child.”

(c) Notifications Required Under COBRA.

(i) Plan Administrator. When an employee becomes eligible for EBMC’s group health insurance, he/she will be informed about COBRA. Under the COBRA scheme, the "Plan Administrator" for EBMC's group health insurance plan is responsible for most notifications to employees and beneficiaries. The Plan Administrator must notify the employee about his/her eligibility to continue coverage under the group health plan when a qualifying event occurs. Within 14 days of receiving notice from a beneficiary of one of the events described in subparagraph (b) above, the Plan Administrator must notify the qualified beneficiaries of their rights under COBRA

(ii) Employee. An employee must notify the Plan Administrator within 30 days of the birth of a child.

(iii) Beneficiary. A beneficiary must notify the Plan Administrator within 30 days of the following:

(A) divorce;
(B) legal separation
(C) child ceasing to be a dependent

(iv) Employees may obtain the name and contact information for EBMC’s Plan Administrator from the Payroll Department.

(d) Employee Decision to Continue Coverage

An employee or beneficiary who wishes to continue benefits under the Plan must make that election within 60 days of a qualifying event. The Plan must be offered at no more than 102 percent of the cost of the original plan. To maintain coverage, the employee or the beneficiary electing coverage must:

(i) pay their premium, including a 2% administrative fee.

(ii) not become covered by another group health policy (if the individual has an illness that would be a pre-existing condition under the new policy, that individual may continue to be covered by his former employer's policy through COBRA even though the individual is covered by a new group policy.) This rule applies to qualifying events occurring after December 31, 1989.

If the qualifying employee decides to continue coverage, the employee has a minimum of 45 days from the date of the decision in which to make the first premium payment. If an employer terminates all group health insurance, an employee is not allowed to continue the policy under COBRA. Upon leaving employment with EBMC, the employee will be provided with written information about COBRA rights and insurance premiums.

(8) Workers’ Compensation

(a) Occupational Injuries

All states have Workers' Compensation laws whose purpose is to promote the general welfare of people by providing compensation for accidental injuries or death suffered in the course of employment. These laws are designed to provide protection to workers suffering occupational disabilities through accidents arising out of, and in the course of employment. EBMC carries Workers' Compensation Insurance for all employees and pays the entire cost of the insurance program. An employee who suffers an injury or illness in connection with the job is usually eligible to receive payment through the insurance company for lost time.

(b) Benefits

In addition to disability payments, necessary hospital, medical and surgical expenses are covered under Workers' Compensation, with payments being made directly to the hospital or physician. Workers’ Compensation benefits to injured workers also includes assistance to help qualified injured employees return to suitable employment. Specific benefits of Workers’ Compensation Insurance are prescribed by law depending on the circumstances of each case. To be assured of maximum coverage, all work-related accidents, no matter how small, must be reported immediately by the employee to his/her Supervisor and the Payroll Department. The injured employee must complete a written Employee’s Claim Form (DWC Form1) and return it to the Payroll Department, where the claim will be filed, processed and resolved according to law.

(c) Selecting Physician

During the first thirty days following a work-related illness or injury, EBMC may designate a physician to provide medical treatment to the injured or ill employee. This physician would be associated with the Medical Provider Network (MPN) through EBMC’s Workers’ Compensation carrier. The injured employee may obtain a list of approved physicians in this MPN by contacting the Payroll Department. If an employee prefers to be treated by a personal physician, the employee must complete and submit to the Payroll Department a Physician Designation Form prior to the illness or injury. An employee may utilize his/her personal physician after the initial thirty days of an illness or injury as well. The Physician Designation Forms are available from the Payroll Department. Ill or injured employees who utilize their own personal physician must provide EBMC with timely certification from the health care provider regarding the injury or illness.

(d) Commencement of Payments

Workers’ Compensation payments, paid by EBMC’s insurance carrier, begin after the 3rd day of illness or injury or immediately if an employee is hospitalized. If the disability continues beyond 14 days, the employee will be compensated for the first 3 unpaid days by EBMC’s Workers’ Compensation Carrier. Employees on Workers’ Compensation disability leave will receive continued benefit coverage on the same basis as an employee taking another medical leave. Once an employee ceases to be covered by EBMC health plan he/she may continue coverage through COBRA.

(e) Sick Leave

When an employee is unable to work due to a work-related accident or illness, the employee may use accrued sick leave for the first 3 days before Workers’ Compensation payments begin. Sick leave may also be used to pay the difference between the Workers’ Compensation payment to which the employee is entitled and his/her full pay, for as long as the accrued sick leave lasts.

(f) Return to work

Upon submission by the employee of a medical certification that he/she is able to return to work after a Workers’ Compensation leave, the employee will, under most circumstances, be reinstated to the same or similar position held at the time of leaving in accordance with applicable law and the doctor’s restrictions. Failure to notify the employee’s Supervisor of the employee’s return to work status or failing to return to work when released to do so will be considered a voluntary termination without notice. If, after returning from a Workers’ Compensation disability leave, an employee is unable to perform the essential functions of the job because of a physical or mental disability, EBMC’s obligations to the employee may include reasonable accommodation as governed by the American with Disabilities Act. However, if an employee is fully released to return to work by his/her doctor, he/she must return to performing the essential functions of the original position.

(g) Non-Covered Activities

Neither EBMC nor its insurer will be liable for payment of Workers’ Compensation benefits for any injury that arises out of an employee’s voluntary participation in any off-duty recreational, social, or athletic activity that is not part of the employee’s work-related duties including, but not limited to, an employee’s voluntary participation in any off-duty recreational, social, or athletic activity sponsored by EBMC.

(h) Reporting Injuries

All employee injuries arising out of and in the course of employment must be reported the employee’s Supervisor, regardless of how minor the injury may be. The injured employee’s Supervisor will file a report on the job-related injury with EBMC’s Payroll Department.

Attachments;

History______________________________________________________________
Gabrielle Harris composed this Policy/Procedure on 03/01/2010 03:26:33 PM.
Gabrielle Harris edited this Policy/Procedure on 03/02/2010 09:23:44 AM.
Gabrielle Harris edited this Policy/Procedure on 03/12/2010 11:47:02 AM.

�EBMC.