This section describes the major features of your FlexSolutions health care benefits. Keep in mind that the medical plans in which you are eligible to enroll are based on where you live. The table below summarizes the various plans and eligibility rules, and provides links to the detailed plan descriptions.
Note that the information provided in this section, while detailed, is for summary purposes only. While every effort has been made to ensure the accuracy of this information, you should refer to the applicable plan booklet or document (available from your local Human Resources representative) or contact the applicable claims administrator directly, particularly if you have a concern regarding benefit coverage levels and payments.
| The FlexSolutions Health Care Options* | |
|---|---|
| The Following Plan... | Is Available To... |
|
Preferred Provider (PPO) Health Plan Hawaii Plus (HMO) |
Hawaii employees |
|
Low Option Preferred Provider Organization Open Access Plus (PPO OA+) High Option Preferred Provider Organization Open Access Plus (PPO OA+) Network HMO |
Mainland employees |
|
Hawaii and Mainland employees; availability subject to where you live |
|
|
All medical plan participants excluding Kaiser participants (Kaiser participants are eligible for the vision benefits provided through Kaiser) |
|
|
Option 1 Option 2 Option 3 |
All employees; administered by HDS in Hawaii and MetLife on the Mainland |
|
* In addition to the individual plan descriptions, information that applies to all of the health care plans (including definitions of health care terms, COBRA information, and more) is provided under More About Your Health Care Benefits. |
|
You are eligible for health care coverage on the first day of the month coincident with or following your date of hire as long as you...
Are a full-time salaried, non-bargaining U.S. employee or an employee working in a U.S. territory or possession, and
Enroll in FlexSolutions by the date requested (as explained under Who Is Eligible).
You may also enroll your eligible dependents, as defined under Who Is Eligible.
When you enroll, you may choose from the following medical/vision and dental coverage levels...
You only
You and your child or children
You and your spouse/domestic partner
You and your family (spouse/domestic partner plus child or children)
... or, you may decline medical and/or dental coverage with proof of other group coverage.
You may choose the same medical/vision and dental coverage levels, or you may elect different coverage levels. For example, you may choose to elect medical/vision coverage for yourself only, but dental coverage for your entire family. These choices allow you to spend your health care dollars more efficiently by electing coverage only for those dependents (your spouse/domestic partner, children, or both) who need it.
If you and your spouse/domestic partner are both benefits-eligible employees of A&B, each of you must enroll separately—neither you nor your spouse/domestic partner can be covered as both an employee and a dependent. Your eligible dependent children may be covered by either of you, but not by both.
Back to TopHealth care coverage for you and your eligible dependents begins on the first day of the month coincident with (or next following) your first day of active work at A&B. However, the following rules do apply...
If you do not enroll by the date requested when you initially become eligible, you will automatically be enrolled in health care coverage (as explained under What Happens If You Do Not Enroll? below).
Likewise, if you do not enroll your dependents within 31 days after they become eligible, you will not be able to enroll them until the next Open Enrollment, unless you have a qualifying change in status or qualify for a "special enrollment right" under HIPAA. (See Changing Your FlexSolutions Elections During the Year or Your Special Enrollment Rights )
In accordance with a legislative mandate, coverage under any of the FlexSolutions Medical Plans may be extended to an employee's child(ren) residing with the employee's spouse/domestic partner or ex-spouse/domestic partner. Such an extension will be made if required by a qualified medical child support order (QMCSO).
A QMCSO is an order issued by a court or administrative agency pursuant to applicable state domestic relation laws that assigns to a child the right of a participant or beneficiary to receive benefits under an employer-provided health plan, regardless of with whom the child resides.
To be qualified, the order must...
Specify the name and last known mailing address of the covered employee and the employee's child(ren)
Indicate the type of coverage to be provided (or the manner in which such coverage will be determined)
Identify the period covered by the order
Specify each plan to which the order applies
If the order is qualified, A&B will notify the employee and the affected child(ren), or the child(ren)'s representative, informing them that a QMCSO has been received and explaining how it will be processed. In addition, procedures permitting the child(ren) to designate a representative will be explained.
Coverage for a dependent named in a QMCSO will begin in accordance with that order.
Note: A&B, not the Claims Administrator, is responsible for all notifications regarding QMCSOs, and for establishing written procedures to determine whether a QMCSO is qualified and, if so, administering the benefits under such qualified orders by promptly notifying the appropriate Claims Administrator (HMSA, CIGNA or Kaiser) of the...
Receipt of a QMCSO
Determination by A&B as to whether the QMCSO is qualified
Name and address of alternate recipients whom A&B has determined are eligible to receive benefits under the applicable plan(s)
Name and address of any custodial parent or legal guardian designated to receive benefit payments on behalf of such alternate recipient.
If you do not enroll in FlexSolutions within 31 days of your date of hire, or during the annual Open Enrollment, you will automatically be enrolled in a medical plan and the Option 1 Dental Plan. Your dependents will not be enrolled. The medical plan in which you will be enrolled will be determined by your local Human Resources representative, based on the location in which you work.
If you gain a new dependent during the year (such as through marriage, birth, adoption, etc.), and you do not enroll him or her within 31 days after he or she becomes eligible, you will not be able to enroll your new dependent until the next Open Enrollment, unless you have an additional qualifying "change in status." (Details on status changes are provided under Changing Your FlexSolutions Elections During the Year.)
Back to TopGenerally, you (and your dependents) must remain in the medical and dental plan you elect through the entire Plan Year (January 1 through December 31). If you want to change plans, you may do so during the next Open Enrollment period without submitting evidence of good health.
The only exception to this is if, during the Plan Year, you move from your medical plan's service area or your elected medical plan is discontinued. If you move from your plan's service area, you must notify your local Human Resources representative and enroll in another plan within 31 days of the move (or discontinuance of the plan). If you do not elect another plan within 31 days, you (and any covered dependents) will receive "core" medical coverage, as described previously under What Happens If You Do Not Enroll?.
If you change your medical coverage in accordance with these rules, your new coverage will begin on the day after the date your present coverage ends.
If you are currently enrolled in the Option 1 Dental Plan, or if you have declined dental coverage, you may not enroll in the Option 3 Dental Plan for the next Plan Year. You will need to participate in the Option 2 Dental Plan for one year before enrolling in the Option 3 Dental Plan. In addition, other limitations may apply.
Back to TopA&B will give you enough FS Credits to pay for a significant portion of your medical/vision and dental coverage. The actual percentage amount that A&B pays for is determined by the plans and coverage levels you elect.
Any contributions you make toward the cost of your health care coverage are made on a pre-tax basis through payroll deductions, however, you may elect to pay for medical and/or dental coverage on an after-tax basis. However, you must make such a request through your local Human Resources representative.
For more details on pre-tax contributions, refer to FS Credits. For specific information regarding the cost of your health care coverage, refer to your most recent FlexSolutions Worksheet or Confirmation Statement, contact your local Human Resources representative, or log on to www.flexab.com.
Please note that due to IRS restrictions, the value of the contribution A&B makes toward the cost of your domestic partner coverages will be considered taxable income to you. Also, any contribution you make toward the cost of your domesic partner coverage must be paid for on an after-tax basis. However, these rules will not apply if your domestic partner qualifies as a tax dependent under Section 152 of the Internal Revenue Code. In addition, expenses for domestic partners and their children may not be eligible for reimbursement under the Reimbursement Accounts, unless they are tax dependents under IRS rules.
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