ONLINE BENEFITS DIRECTORY

Medical Plan C

Eligibility

If you:

1) are an active, full time employee working at least 30 hours per week and are classified as benefits eligible;

You must enroll online (see page 8 in the Yellow Book for instructions) by the deadline provided by the . You are effective for benefits on the first day of the month following two (2) full calendar months of employment. If you enroll, you may cover eligible dependents by proving dependent eligibility. Dependent Eligibility forms on the Enrollment site https://jmsmith.bcenroll.net > Posted Forms. If you enroll your spouse a Working Spouse Affidavit will be sent to you for completion.

Eligibility continues as long as you are a regular full time employee scheduled to work at least 30 hours per week.

The Wellness Plan

J M Smith Corporation encourages employees to take care of their health.

Please click image to visit Wellness Plan page…

Vision Coverage

J M Smith Corporation includes routine vision exams as a preventive service under the medical plan. Benefits for routine vision exams are paid at 100%.

Lasik or Laser Eye surgery is covered under the J M Smith Corporation’s medical plan. It is subject to your plan deductible then 50% up to $1,000 per year when utilizing participating providers only. A $2,000 lifetime maximum applies.

Continuing coverage after I stop working

You may continue coverage for you and your legal dependents at your own expense. Certain conditions apply. You will be provided with the proper forms, information, and costs upon leaving your employment with J M Smith Corporation.

Other resources

Pam Watson
Employee Health Plan Advocate
pwatson@jmsmith.com
864.542.9419 ext 5483 or
800.428.7281 ext 5483

Phone: 864-582-1216 ext. 1508

Consumer Reports “Best Buy Drugs” Guide: https://www.crbestbuydrugs.org/
American Medical Association:  www.ama-assn.org
Medicare: www.medicare.com
Cobra Continuation Information: www.dol.gov


Online forms

You may obtain the following forms simply by clicking on the description. Since these files are in a special format (PDF) you will need to download the Adobe Acrobat Reader.

Plan C Summary of Benefits and Coverage


Online booklet

SPECIAL NOTICES

  HIPAA

Health Insurance Portability and Accountability Act (HIPAA) of 1996 Notice

Special Enrollment Information

This information is being provided to you pursuant to the Health Insurance Portability and Accountability Act (HIPAA) of 1996. It contains some special information regarding your rights to enroll for coverage under the medical plan in the future. This information is very important if you are currently declining coverage under the medical plan for yourself or for any of your dependents. We are required to provide you with this notice in order to comply with HIPAA.

If You are Declining Coverage Now

If you have decided to decline coverage for yourself or for any of your dependents (including your spouse), you may be able to enroll yourself and/or your dependents in this plan later, under some circumstances, without waiting for an open enrollment period.

Special Enrollment Allowed

You can enroll yourself and your dependents in this plan without waiting for an open
enrollment period if:

1. You decline coverage under this plan because you have other health care coverage, then you lose the other coverage because you are no longer eligible or because the employer failed to pay the required premium. In such cases, you must enroll in this plan within 30 days after losing the other coverage.

2. You decline coverage under this plan and then a new dependent is added to your family due to marriage, birth, adoption, or placement or adoption. In such cases, you must enroll in this plan (or add your new dependent) within 31 days after the marriage, birth, adoption, or placement for adoption.

Any request must be consistent with the change in family status. For example, the birth or adoption of a child would permit enrollment in or change to family coverage.

Other Late Entrants

If you decide not to enroll in this plan now and then want to enroll later, you must qualify for special enrollment as described above. If you do not qualify for special enrollment, you will have to wait until an open enrollment period.

For more information, please contact your human resources administrator.

WHCRA

Women’s Health and Cancer Rights Act (WHCRA) Notice

Re: Health Plan Coverage for Reconstructive Breast Surgery under The Women’s Health and Cancer Rights Act of 1998

Since 1998, Congress has required that all health plans cover reconstructive surgery following a mastectomy. When a covered individual receives benefits for a mastectomy and decides to have breast reconstruction based on consultation between the attending physician and the patient, the health plan must cover:

  • reconstruction of the breast on which the mastectomy was performed;
  • surgery and reconstruction of the other breast to produce symmetrical appearance; and
  • prostheses and physical complications of all stages of mastectomy, including lymphedema.

Our plan complies with the Federal mandate. This coverage will be subject to all other Plan provisions.