Important documents for our health plan and retirement plan are available in Workday. Paper copies of these documents and notices are available if requested. If you would like a paper copy, please contact the Plan Administrator.

Summary Plan Description (SPD)

The legal documents for describing benefits provided under the plan as well as plan rights and obligations to participants and beneficiaries.

SUMMARY OF BENEFITS AND COVERAGE (SBC)

A document required by the Affordable Care Act (ACA) that presents benefit plan features in a standardized format.

Health Plan Notices

These notices must be provided to plan participants on an annual basis and are available in the Annual Notices document, here.

• Medicare Part D Notice: Describes options to access prescription drug coverage for Medicare eligible individuals.
• Women's Health and Cancer Rights Act: Describes benefits available to those that will or have undergone a mastectomy.
• Newborns' and Mothers' Health Protection Act: Describes the rights of mother and newborn to stay in the hospital 48-96 hours after delivery.
• HIPAA Notice of Special Enrollment Rights: Describes when you can enroll yourself and/or dependents in health coverage outside of open enrollment.
• Availability of Privacy Practices Notice: Describes how health information about you may be used and disclosed.
• Notice Regarding Wellness Program: Describes voluntary nature of wellness program that includes biometrics and/or a Health Risk Assessment (HRA)
• Notice of Availability of Alternative Standard for Wellness Plan: Describes right to alternative ways of participating in an employer's wellness program.
• Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP): Describes availability of premium assistance for Medicaid eligible dependents.
• ACA Disclaimer: Describes subsidy eligibility.
• Illinois Consumer Coverage Disclosure Act: Describes essential health benefits that are and are not covered by the CBH employer-provided group health insurance coverage.

COBRA Continuation Coverage

You and/or your dependents may have the right to continue coverage after you lose eligibility under the terms of our health plan. Upon enrollment, you and your dependents receive a COBRA Initial Notice that outlines the circumstances under which continued coverage is available and your obligations to notify the plan when you or your dependents experience a qualifying event. Please review this notice carefully to make sure you understand your rights and obligations.

Deadline For Filing Lawsuit Under ERISA After Exhaustion Of All Claims Procedures

Any lawsuit must be filed within 36 months of the final decision on the claim. Exhaustion of all claims and appeals procedure is required prior to filing suit. Please refer to the WRAP Summary Plan Description for the plan specific statute of limitations.

Your rights to enroll in and maintain coverage under the Benefit Plans are described in detail in the Benefit Plan Descriptions or enrollment materials provided by the Employer as stated in this document under Section 3. Eligibility. This addendum provides you with additional general information regarding how eligibility is determined for enrollment in your Employer’s Health Plan based on Internal Revenue Service (IRS) final regulations under the Affordable Care Act (ACA).

For you to be eligible to participate in the Employer’s Health Plan, you must be a full-time employee as defined in the regulations. In general, you are a full-time employee if you average at least 30 hours of service per week (or 130 hours of service in a calendar month). As a full-time employee you may also elect coverage for your dependent children up to age 26. Please refer to the applicable Benefit Plan Descriptions, Insurance Contracts or enrollment materials provided by the Employer and incorporated by reference in this document for information on other individuals (e.g., your spouse) that may be eligible for coverage.

If you are hired as a regular full-time non-seasonal employee your Employer has hired you to perform 30 or more hours of service per week (or 130 hours of service in a calendar month). Your eligibility and the eligibility of your dependents and other individuals (e.g., your spouse) for coverage under the health plan is set forth in the Benefit Plan Description(s) or enrollment materials as provided by your Employer and incorporated by reference in this document. These materials will address any waiting period, enrollment procedures and other pertinent information. You will continue to be treated as a Full-time employee as long as you maintain hours of service in keeping with the Full-time definition outlined above.

If you are not hired as regular full-time non-seasonal employee, but are hired as a variable hour, part-time or seasonal employee, your Employer will use a Look-Back Measurement Method to determine if you are a full-time employee for purposes of Plan coverage. This Look-Back Measurement Method is used to provide greater predictability for Plan coverage determinations.

The Look-Back Measurement Method involves three different periods:

• A Measurement Period for counting your hours of service to determine your status as a Full-Time employee eligible for health coverage. o If you are an Ongoing variable hour, part time or seasonal employee, this Measurement Period (which is also called the “Standard Measurement Period”) will be used in determining your eligibility for health coverage during the Standard Stability Period. The Standard Measurement Period used by your Employer is the 12 month period beginning November 1 each year and ending the following October 31. o If you are a New variable hour, part-time or seasonal employee, the Measurement Period (which is also known as the “Initial Measurement Period”) will be used in determining your eligibility for health coverage during the Initial Stability Period. The Initial Measurement Period used by your Employer is the 12 month period beginning on the first day of the calendar month following your start date.

• An Administrative Period is a short period between the Measurement Period and the Stability Period when your Employer performs administrative tasks, such as determining eligibility for health coverage and facilitating Plan enrollment. o If you are an Ongoing variable hour, part-time or seasonal employee, the Administrative Period (which is also known as the” Standard Administrative Period”) used by your Employer is the 2 month period beginning November 1 each year and ending the following December 31. o If you are a New variable hour, part-time or seasonal employee, the Administrative Period (which is also known as the “Initial Administrative Period”) used by your Employer is the partial month (if any) before the Initial Measurement Period plus the 1 month period after the Initial Measurement Period and prior to the Initial Stability Period.
• A Stability Period is a period that follows a Measurement Period and is the period during which you will be entitled to health coverage if you are determined to be a Full-Time employee. Your hours of service during the Measurement Period will determine whether you are a full-time employee who is eligible for coverage during the Stability Period. As a general rule, your status as a full- time employee or a non-full-time employee is “locked in” for the Stability Period, regardless of how many hours you work during the Stability Period, as long as you remain an employee of the Employer. There are exceptions to this general rule for employees who experience certain changes in employment status. o If you are an Ongoing variable hour, part-time or seasonal employee, the Stability Period (which is also known as the “Standard Stability Period”) used by your Employer is the 12 month period beginning January 1 each year and ending the following December 31. o If you are a New variable hour, part-time or seasonal employee , the Stability Period (which is also known as the “Initial Stability Period”) used by your Employer is the 12 month period beginning the first day of the 2nd calendar month after the end of the initial measurement period.

Special rules apply when an employee is rehired by the Employer or returns from an unpaid leave.

The rules for the Look-Back Measurement Method are very complex. Keep in mind that this is just a general overview of how the rules work. More complex rules may apply to your situation. The Company intends to follow the IRS final regulations (including any future guidance issued by the IRS) when administering the Look-Back Measurement Method. If you have any questions about this measurement method and how it applies to you, please contact your Benefits Manager. This applies to you if you are a participant, beneficiary, enrollee, or covered individual in a group health plan or group or individual health insurance coverage, including a Federal Employees Health Benefits (FEHB) plan.

What You Need To Know About The “No Surprises” Rules

Beginning January 1, 2022 the “No Surprises Act” provides protections against surprise billing for emergency services, air ambulance services, and certain services provided by a non-participating provider at a participating facility. For these services, the member’s cost are generally limited to what the charge would have been if received in-network, leaving any balance to be settled between the insurer and the out-of-network provider. Consult your health plan documents for details.

The “No Surprises” rules protect you from surprise medical bills in situations where you can’t easily choose a provider who is in your health plan network. This is especially common in an emergency situation, when you may get care from out-of-network providers. Out-of-network providers or emergency facilities may ask you to sign a notice and consent form before providing certain services after you are no longer in need of emergency care. These are called “post-stabilization services.” You should not get this notice and consent form if you are getting emergency services other than post-stabilization services. You may also be asked to sign a notice and consent form if you schedule certain non-emergency services with an out-of-network provider at an in-network hospital or ambulatory surgical center.

The notice and consent form informs you about your protections from unexpected medical bills, gives you the option to give up those protections and pay more for out-of-network care, and provides an estimate of what your out-of-network care might cost. You are not required to sign the form and should not sign the form if you did not have a choice of health care provider or facility before scheduling care. If you do not sign, you may have to reschedule your care with a provider or facility in your health plan’s network.

View a sample notice and consent form (PDF).

This applies to you if you are a participant, beneficiary, enrollee, or covered individual in a group health plan or group or individual health insurance coverage, including a Federal Employees Health Benefits (FEHB) plan.