Managed Choice POS Enrollment for SPFPA

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What Are Your Managed Choice POS Benefits?
What Are Your Coverage Choices
Who Is Eligible for Managed Choice POS
Who Is Eligible for Managed Choice POS Network Benefits
How Are Your Elections Confirmed
When Does Coverage Begin
When Can You Change Your Elections During the Year
How Do You Change Your Elections During the Annual Election Period
When Does Coverage End

What Are Your Managed Choice POS Benefits?

Your Managed Choice POS benefits help protect you and your family against financial losses resulting from treatment of a non-occupational injury or illness. This section summarizes the Managed Choice POS benefits available to you and your enrolled dependents.

Here's how Managed Choice POS works. Each time you or an enrolled dependent needs medical treatment:

You may visit your in-network
Primary Care Physician

or

You may visit any
out-of-network physician

Your Primary Care Physician will arrange any hospitalization, surgery, or special care that is needed.

For covered services provided or arranged by your Primary Care Physician, including preventive care:

You pay $10 for each visit to the physician.
You pay $7 for each prescription at participating pharmacies
You pay no deductibles.
In most cases, you file no claim forms.
Reimbursement for copayments can come from your pretax payroll deposits in your health care Flexible Spending Account.

For hospitalization and certain outpatient surgical and diagnostic procedures, you must receive advance approval to avoid a benefit penalty.

For covered services provided or out-of-network physicians or facilities:

You must first satisfy an annual deductible before benefits are payable.
The plan pays up to usual and prevailing charges for covered expenses. You pay the cost of any remaining expenses not paid by the plan.
You must file a claim form to receive reimbursement for plan benefits
You can be reimbursed on a pretax basis for your deductible and your share of covered expenses from your health care Flexible Spending Account.

Managed Choice POS does not limit you to in-network physicians or facilities. Each time you or an enrolled dependent needs care, you decide whether to use in-network or out-of-network providers. If you or an enrolled dependent lives permanently outside the network area, Managed Choice POS provides out-of-area benefits. The medical and surgical coverage under Managed Choice POS is administered by Blue Cross Blue Shield of Illinois.

Substance abuse treatment and psychiatric benefits are available ONLY through a separate network managed by Value Options. No other benefits will apply to substance abuse or psychiatric treatment.

Dental coverage is available to all eligible active employees and dependents through UniCare.

Click here for a benefit comparison chart that gives a quick overview of your Managed Choice POS medical benefits.

What Are Your Coverage Choices

The company offers several coverage choices. Review this section carefully to understand how the choices differ.

Your medical coverage is:

Managed Choice POS

Whether you choose Managed Choice POS coverage, benefits for psychiatric and substance abuse treatment are provided only through a separate mental health network managed by Value Options.

Besides deciding between Managed Choice POS offered in your location, you also choose whether you want coverage for:

You alone or
Yourself, plus any eligible dependents.

You and any dependents you enroll for Managed Choice POS automatically become covered under the separate psychiatric and substance abuse network.

Dental coverage is company paid and provided automatically for all eligible employees and for all eligible dependents.

What Are the Cost Differences

You and the company share the cost of medical coverage. Your contribution is based on whether you choose Managed Choice POS.

If you choose Managed Choice POS, the company pays 100% of the cost of employee coverage. There is a weekly cost to cover your eligible dependents.

Your contribution for Managed Choice POS is generally deducted from your paycheck on a pretax basis. This method allows you to reduce your pay to cover your costs of coverage before taxes are deducted, to the extent the law allows. You, therefore, do not pay federal income or Social Security taxes on the portion of your pay used for these benefits. In many locations, you may also save on state and local income taxes. However, the tax savings mean you may pay less into Social Security, and your Social Security benefit could be slightly reduced.

Why You Should Choose Carefully

Because of Internal Revenue Service regulations regarding pretax contributions, you may make changes to your elections during the year only if you have a family status change. Otherwise, you must wait until the next Annual Enrollment period to make changes.

Who Is Eligible for Managed Choice POS

Managed Choice POS provides health care benefits for eligible employees, retirees, and their enrolled dependents. Your Managed Choice POS benefits generally become effective on your first day at work.

As an employee, you are eligible for Managed Choice POS if you are a regular, full-time, hourly employee scheduled to work at least 40 hours per week. Retirees may participate in Managed Choice POS up to age 65.

Who Is an Eligible Dependent

You can enroll your eligible dependents under Managed Choice POS. Eligible dependents include:

Your legally recognized spouse
Not a legally separated or divorced spouse even if the separation agreement or divorce decree states that coverage must be provided
Your common-law spouse only if a Declaration of Informal Marriage or a common-law affidavit has been submitted to the company and common-law status is recognized in your state.

You may enroll your employed spouse, provided that he or she is enrolled in a health care plan provided by the spouse's employer.

Unmarried children who are dependent on you for support -
- Your natural child, legal ward, or legally adopted child
- A natural child, legal ward, or legally adopted child of your spouse if the child resides with you in a parent/child relationship
- A child under age 19, or under age 25 and a full-time student, or disabled.

A child is a full-time student if he or she is enrolled in a at least twelve hours of a regular curriculum at an accredited high school, technical school, college or university. The curriculum must lead to a degree and the child must take no less than the minimum credits designated by the school for classification as full-time. A temporary reduction in credit hours once the semester has started does not cause a change in status unless the child is no longer enrolled in a degree program.

A child continues to be considered a full-time student if he or she was enrolled the previous semester unless the child secures a full-time permanent job, gets married, does not enroll when school resumes, or is no longer being supported by you.

A disabled child is one who is unable to earn a living because of a mental or physical handicap. To be eligible, the disability must have started both while the child was covered by the plan and before the child reached the maximum age of 19 (or 25 if the child was covered as a full-time student). Coverage for a disabled child can continue as long as the child remains disabled and your coverage is also in effect. You should contact the Vought Benefits Center for information on how to certify dependent disability.

If a child is claimed as a dependent by parents who are divorced or separated so that the child could be covered by two or more company employees, the company will allow only one employee to enroll the dependent in health care coverage. That employee will be determined in the following order:

the natural parent with whom the child is living
the other natural parent or
the step-parent with whom the child lives.

Eligible dependents do not include any person who is a member of the armed forces of any country.

How Is Dependent Eligibility Verified

To enroll dependents after the initial enrollment period, the employee (including new hires) must provide evidence of eligibility, such as a birth certificate or marriage license. The company reserves the right at any time to require documents to verify eligibility of any dependent.

What Happens If You and Your Spouse Are Both Company Employees, Or Both Company Retirees, Or If Your Spouse Is a Company Retiree

A special situation exists if you and your spouse both qualify for company health care. Generally, the rules are as follows:

Both Active Employees - If both you and your spouse are active employees of the company, you may:
- Combine coverage under Managed Choice POS. If you choose to combine, you must decide under which spouse to combine. You can change to the other spouse only at the Annual Enrollment or upon loss of coverage.
Note: This rule does not apply if either employee was disabled before January 1, 1983 and is still considered an active employee.
- You and your spouse may elect separate coverage. If you elect separate coverage, one spouse must carry all enrolled children as dependents.
Active Employee, Retiree Spouse - If you are an active employee and your spouse is a company retiree, your spouse may be covered as your dependent under Managed Choice POS, including dental coverage while you are an active employee. You may not be a dependent of a retiree.
Both Retirees - Should both you and your spouse become retirees of the company (each eligible for health care independently), you may at that time make a change as though you were both active employees.
Active Employee Who Is Survivor of Retiree
- If you are an active employee and qualify for health care as a survivor of a retiree, you may, at termination, elect to receive the survivor health care.

What Happens If You Become Disabled

Employees who become disabled retain health care coverage according to the following schedule:

Seniority on Last Day Worked	Health Care Eligibility
90 days to 3 years 3 years to 5 years 5 years or more	1 year 1-1/2 years 2 years

Contributions for dependent coverage will be waived while an employee is on an approved disability leave which is not work-related.

Employees who become eligible for disability retirement under the company pension plan will continue coverage as explained in the section, See What Happens If You Retire.

Who Is Eligible for the Psychiatric and Substance Abuse Network

All eligible employees and their dependents who are enrolled in Managed Choice POS are eligible for the psychiatric and substance abuse network regardless of their place of residence. Managed Choice POS participants will receive benefits for psychiatric and substance abuse treatment ONLY if they use the network managed by Value Options.

Who Is Eligible for Dental Coverage

All employees and dependents who are eligible for Managed Choice POS are also eligible for dental coverage.

Who Is Eligible for Managed Choice POS Network Benefits

The Dallas/Fort Worth Managed Choice POS network applies to employees who live in the immediate 14-county area.

Eligible employees living in the Dallas/Fort Worth network service area have the options of Managed Choice POS in-network or out-of-network coverage. Employees living outside the network service area are eligible for Managed Choice POS out-of-area coverage, or, if they work in the service area, they may elect Managed Choice POS network coverage. If you live outside the service area and want to elect Managed Choice POS network coverage, contact the Vought Benefits Center, 1-866-689-5999.

What Happens If You Are on Temporary Assignment Outside the Service Area

An assignment is considered temporary if the company does not relocate your family. An employee on temporary assignment and enrolled dependents are eligible for Managed Choice POS network coverage. The employee receives benefits at the in-network level by calling his or her Primary Care Physician (PCP) in advance to have the care authorized, or by calling the Member Services for a referral to a local network, if one is available. If Blue Cross Blue Shield of Illinois has another network at the temporary off-site location, the employee can join that program.

What Happens If a Dependent Lives Outside the Service Area

If an otherwise eligible and enrolled dependent permanently lives outside the service area, such as a child living with a divorced spouse, the dependent has out-of-area coverage. Any individual out-of-network deductible and out-of-pocket expense apply toward the out-of-area family deductible and out-of-pocket maximum.

If the dependent is temporarily living outside the service area, such as a college student, the dependent is eligible for Managed Choice POS network coverage. This means that emergency medical care is covered at the in-network level (if the PCP is contacted within 48 hours). Non-emergency care that is received outside the service area is covered at the out-of-network level. Non-emergency care rendered by the PCP is, of course, covered at the in-network level. If Blue Cross Blue Shield of Illinois has another network at that location, the dependent can become part of that network.

How Are Your Elections Confirmed

You will receive an identification (ID) card confirming your elections once your enrollment is processed.

If you elect Managed Choice POS coverage, your identification (ID) card identifies you as a network participant and includes the name of the PCP you selected. In addition, the card contains general in-network and out-of-network guidelines and other Managed Choice POS information, including the toll-free phone numbers for the medical network and for the psychiatric and substance abuse network. An ID card will be provided for you and each enrolled dependent.

If you live outside the service area and have Managed Choice POS out-of-area coverage, the ID card identifies you as an out-of-area participant and includes the procedures and phone number for advance approval and for the psychiatric and substance abuse network.

How Do You Use Your ID Card

You should carry your ID card at all times. Present it whenever you visit a doctor or other provider or use a medical service. Failure to present your ID card could mean more cost to you or more paperwork. The ID card is for identification only. Payment of benefits will be based on eligibility at the time services are received.

How Do You Replace a Lost Or Damaged ID Card

If you lose or damage your ID card, please call the carrier or the Vought Benefits Center, 1-866-689-5999.

When Does Coverage Begin

Your coverage begins the first day you report to work as an eligible employee. However, you must enroll your dependents before their coverage can start. Special rules apply if you or a dependent is receiving medical treatment when coverage would otherwise begin.

As a new employee, you may choose, within your first 30 days of employment, to enroll in Managed Choice POS.

Even though employee coverage begins on your first day on the job, enrollment is required for these reasons:

You need to indicate your coverage.
Unless you have Managed Choice POS out-of-area coverage, you need to choose a Primary Care Physician.
Coverage for eligible dependents cannot start without enrollment.

If you do not complete an enrollment form, you will be enrolled in Managed Choice POS for yourself only. Coverage for your eligible dependents will be delayed and evidence of your dependents' good health may be required before their coverage can begin.

When Does Coverage Begin for Dependents

Coverage for eligible dependents begins on the day your coverage begins if you enroll them within 30 days of that date. If you add a new dependent and enroll him or her within 60 days of the date the dependent first becomes eligible, dependent coverage is effective the day the dependent became eligible.

If a dependent is in the hospital or is under the care of a home health agency when the dependent's coverage would otherwise become effective, coverage for that dependent will not become effective until the date the dependent is discharged from the hospital or released from the care of the home health agency. This rule does not apply for children born to you while you are covered under the plan.

If you do not enroll your dependents within 30 days of eligibility, you can later enroll them if you have a family status change affecting them. Otherwise, they must provide evidence of good health or wait until the next Annual Enrollment. Coverage for each dependent will become effective when Blue Cross Blue Shield of Illinois approves the dependent's evidence of good health.

How Do You Enroll New Dependents

You must enroll a new dependent before coverage for that dependent can start, even if you have other dependent coverage. Use the appropriate form found on the Download Forms page or call the Vought Benefits Center, 1-866-689-5999, to request one.

If you enroll the new dependent within 60 days of when the dependent is first eligible, coverage for the dependent is retroactive to the eligibility date. If you enroll the new dependent after 60 days, coverage for the new dependent begins on the date Blue Cross Blue Shield of Illinois approves evidence of the dependent's good health. You are responsible for any cost associated with providing the dependent's evidence of good health.

You must enroll a newborn child, even if you already have other dependent coverage. You - not the doctor or hospital - are responsible for enrolling your baby for coverage. To enroll your newborn, you must present your child's birth certificate to the Vought Benefits Center and complete the appropriate form within 60 days of birth.

After 60 days, you must provide evidence of the baby's good health.

If adding a dependent means an increase in your cost for coverage, the increase will be on:

a pretax basis if you enroll the dependent within 60 days of initial eligibility or
an after-tax basis if you enroll the dependent later than 60 days after initial eligibility. (The contribution will change to pretax the following July 1.)

When you add a dependent to your coverage, you must provide evidence of that person's dependent status, such as a copy of the marriage license, birth certificate, etc. Coverage cannot be approved until evidence of eligibility is provided. If 60 days have passed since the dependent first became eligible for coverage, you may be required to provide evidence of the dependent's good health.

When Can You Change Your Elections During the Year

During the year, you may need to add or drop dependents from coverage. If you make the change within 60 days of a family status change affecting the dependent, any change in your cost for coverage will be on a pretax basis and evidence of the dependent's good health will not be required for adding coverage for that dependent.

A change in family status includes:

A dependent child reaching the maximum age for eligibility or changing full-time student status
Birth
Adoption
Marriage
Death
Divorce
Change in your spouse's employment that affects health care coverage
Significant change in your spouse's health care coverage.

For example, a significant change in your spouse's health care coverage might include a change in your spouse's plan to catastrophic-only coverage. At your request, the plan administrator will review such a change to your spouse's health care coverage to determine if the change can be considered “significant” as required by the Internal Revenue Service. Contact the Vought Benefits Center if you think this type of situation applies to you and you want to change your coverage.

What Changes Can You Make

If you have a family status change, you can:

Add coverage for the dependent(s) affected by the change.
Drop coverage for the dependent(s) affected by the change.

A dependent added within 60 days of a family status change will not be required to provide evidence of good health. Your cost for coverage of the dependent, if any, will be on a pretax basis. Any increase or decrease in your cost will become effective the first pay period following the date the Benefits Office receives and approves your request to change coverage.

You also can add or drop dependents from coverage for other than a family status change. However, the following rules apply:

To add a dependent, Blue Cross Blue Shield of Illinois must approve evidence of the dependent's good health before coverage for the dependent can start. Any cost to you will be on an after-tax basis for the rest of the plan year.
Any decrease in your cost for dropping a dependent will not take effect until the next July 1. Contributions will not be reimbursed.

A form is available from the Excel Web site or the Vought Benefits Center if you want to add or drop dependents.

To add a dependent for any reason, you must provide documentation of dependent status, such as a marriage license, birth certificate, etc. Coverage cannot be approved until such evidence is provided. If 60 days have passed since the dependent first became eligible for coverage, you may be required to provide evidence of the dependent's good health.

How Do You Change Your Elections During the Annual Election Period

You can change your type of coverage during the Annual Enrollment period. You can also add or drop dependents from coverage.

The Annual Enrollment period is held near the end of each plan year. During Annual Enrollment, you can:

Change your coverage from an HMO to Managed Choice POS or another HMO, or from Managed Choice POS to an available HMO.
Keep your current coverage.

Any changes you make during Annual Enrollment become effective the next July 1.

You will receive instructions during the Annual Enrollment period for changing your benefits elections. At other times you can obtain forms from the Excel Web site or the Vought Benefits Center for changing your coverage within plan and IRS rules.

If you do not make new elections during Annual Enrollment, your elections from the previous plan year will continue.

How Can You Change Dependent Coverage

If you want to add coverage for a previously eligible dependent during the Annual Enrollment period, you must verify dependent status by providing applicable documents, such as a birth or marriage certificate.

Coverage cannot be approved until the Vought Benefits Center has the documentation.

To add or drop dependents from coverage, use the appropriate form available on the Excel Web site or from the Vought Benefits Center. The change will be effective the following July 1, provided the required documentation has been received and approved by the Vought Benefits Center. If coverage is approved after July 1, any change in your cost will be on an after-tax basis until the following July 1.

When Does Coverage End

Managed Choice POS has provisions for continuing your coverage. See page 45 for more information.

Subject to special provisions, your personal coverage will end on the earlier of the following dates:

You are no longer eligible for coverage,
Your employment with the company ends, or
The company no longer offers the coverage.

If your employment ends as the result of a layoff, coverage will continue for 30 days after your termination date.

If you are taking an approved leave of absence, contact the Vought Benefits Center before your absence starts regarding continuing coverage.

When Does Dependent Coverage End

Subject to the special provisions for continuing coverage, coverage for your dependents will end on the earlier of the following dates:

The dependent no longer qualifies as a dependent
Your coverage stops
You stop making required contributions
The company no longer offers the coverage
The benefits office receives your request to drop coverage for your dependent(s). If you request that dependent coverage end during Annual Enrollment, dependent coverage will end on the following July 1.

In case of your death, coverage will continue for your enrolled dependents for up to 30 days after the date of your death.