2024 CHAIL Benefit Guide

Benefits Guide Children’s Home Association of Illinois | 2024
2024
Benefits Guide
Your Benefits, Your Choice
Human Resources Page 1

Inside
Contacts ............................................. 3
Welcome!
Eligibility............................................. 4 At Children’s Home Association of Illinois, we are proud to offer our employees a
New this Year!.................................... 5 wide variety of benefits to choose from, at the most affordable prices possible.
How My Medical Plan Works ............. 6 We believe our commitment to your health and financial well- being is an
Flexible Spending Accounts (FSAs) .... 7 important aspect of what we offer as an employer, and we strive to provide
enough choices that every individual and family can be covered through all stages
FSA Frequently Asked Questions ....... 8 of life.
Health Savings Account (HSA)............ 9
Within this guide you will find highlights of each benefit. When you choose to
Medical ............................................ 10 enroll in a benefit the premium will be conveniently payroll deducted.
How to Find a Medical Provider ...... 11
Please make sure to enroll or make benefit changes before the deadline and come
Virtual Doctor Visits ......................... 12 to us with any questions you have before that time.
Prescription Drug Program .............. 13
Dental .............................................. 14 Your Action Is Needed
Vision ............................................... 15 Right now, is your chance to elect the coverage you want for yourself and your
family. We encourage you to read through this guide, share it with your family
Agency-Paid Benefit ......................... 16
members, and ask us any questions that you may have so that you are educated
Employee Assistance Program ......... 17 and empowered to choose the benefits that are best for you.
PTO & Sick Leave.............................. 18
Current Employees
Voluntary Life/AD&D ....................... 19
Open enrollment happens toward the end of the year, with benefit changes
Disability Insurance .......................... 20
becoming effective 1/1/2024. This is your chance to make changes to your benefits
Supplemental Health ....................... 21 including electing or declining coverage and adding or removing dependents. You
401(k) Retirement ............................ 22 will not get another chance to do this until the next open enrollment period unless
you experience a qualifying life event.
Children’s Home Association of
Illinois: Important Disclosures
New Employees
& Notices ......................................... 23
You have 30 days to enroll in benefits and your elections will become effective on
the 1st of the month following date of hire or eligibility. If you don’t act now, you
will not have the opportunity to enroll again until the next open enrollment period,
unless you experience a qualifying life event.
Benefits and premiums described in
this guide are effective as of 1/1/2024 Thank you again for your service to the agency. We look forward to an outstanding
and may incur changes during the plan 2024!
year.
Sincerely,
Disclaimer: The information described within this
guide is only intended to be a summary of your Children’s Home Association of Illinois HR Department
benefits. It does not describe or include all benefit
provisions, limitations, exclusions, or qualifications
for coverage. Please review your Summary Plan
Description for a complete explanation of your
benefits. If the benefits described herein conflict
in any way with the Summary Plan Description,
the Summary Plan Description will prevail. You can
obtain a copy of the Summary Plan Description
from the Human Resources Department.

Contacts
Benefits Department Phone/Email Address
Sami Hinthorne 309-687-7206
Human Resources Manager [email protected]
2130 N. Knoxville Ave.
Peoria, Illinois 61603
Meranda Villier 309-687-7244
Human Resources Generalist [email protected]
Coverage/Service Carrier Contact

Medical Insurance
1-800-826-9781
Prior-Authorization
UMR Phone number also listed on back of ID card
Flexible Spending Accounts
www.UMR.com
Preferred Provider Networks
Dental Insurance
www.metlife.com/mybenefits
Vision Insurance
Agency-Paid & Voluntary Life and
AD&D
MetLife Speak with CHAIL Human Resources
Agency- Paid Short Term Disability
Agency-Paid Long-Term Disability
Voluntary Accident
Voluntary Critical illness www.metlife.com/mybenefits
Voluntary Hospital Indemnity

800-835-5097
401(k) Retirement Account Fidelity
www.401k.com
Employee Assistance Program Employee Family Resources (EFR) 800-327-4692

Eligibility
Employee Eligibility
All full-time employees working 30 or more hours per week will be eligible for benefits. As a new employee, you have 30 days from
your initial start date to enroll in benefits.
• Medical, Dental, Vision: Medical, Dental, and Vision coverages will take effect on the first of the month following date of hire or
eligibility.
• Other Coverages: * All other coverages will take effect on the first of the month following date of hire or eligibility.
*IMPORTANT: These benefits may require employees to be actively at work at the time benefits become effective. Please review policy documents, or contact HR, for
additional information.
Dependent Eligibility
• Medical, Dental, Vision: Employees enrolled in Medical, Dental, and Vision coverages also have the option to enroll their
Dependent Spouse and Dependent Children on these plans. See below for a definition of an “eligible dependent” under these
plans.
• Other Coverages: Employees enrolled in Voluntary Life/AD&D coverage also have the option to enroll their Dependent Spouse
and Dependent Children. It is the responsibility of the employee to ensure dependents are eligible for coverage under these
policies. See page 14 for definitions of an “eligible dependent” under the Voluntary Life/AD&D Policy. Please refer to the policy
certificate or HR for more information.
Definition of “Eligible Dependents”

The below definitions refer to Medical, Dental, and Vision Coverages.
• Your legal spouse who is a resident of the same country in which the Employee resides. Such spouse must have met all
requirements of a valid marriage contract of the State in which the marriage of such parties was performed. For the purposes of
this definition, “spouse” shall not mean a common law spouse or domestic partner.
• The employee’s dependent children until the end of the month, in which, they attain age 26, legally adopted children from the
date the employee assumes legal responsibility, foster children that live with the employee and for whom the employee is the
primary source of financial support, children for whom the employee assumes legal guardianship and stepchildren.
• Also included are the employee’s children (or children of the employee’s spouse) for whom the employee has legal
responsibility resulting from a valid court decree.
• Children who are mentally or physically disabled and totally dependent on the employee for support, past the age of 26 or
older. To be eligible for continued coverage past the age of 26, certification of the disability is required within 31 days of
attainment of age 26. A certification form is available from the employer or from the claims administrator and may be required
periodically. You must notify the claims administrator and/or the employer if the dependent’s marital or tax exemption status
changes and they are no longer eligible for continued coverage.
Working Spouse Provision
• If your legal spouse has medical insurance offered through his or her employer, they are not eligible for our medical insurance.
Upon enrollment, you will be required to verify your spouse’s eligibility within ADP. Failure to complete this information will
result in coverage being terminated for your spouse.

New this Year!

Benefit Highlights
Benefit changes take effect on 1/1/2024. How to Enroll:
• Medical/Pharmacy: The deductibles on the H.S.A Plan will Action Required!
be increasing slightly due to IRS requirements. Otherwise,
No plan design or employee contribution changes. To ensure you are covered
appropriately, everyone is
• Working Spouse Provision: Spouses with other coverage
available to them through their employer will no longer be
required to complete open
eligible for the company health plan. Please contact HR with enrollment between November
any questions. 15th and December 6th, 2023.
Protect Your • Dental: Coverage will continue to be offered through
Health MetLife with a lifetime orthodontia maximum increase to
$1,000!
• Vision: Coverage will continue to be offered through
MetLife with enhancements to plan design, including a
frame allowance of $150!
• Company Paid Life/AD&D: Children's Home Association of

Illinois provides $2x Income of Life and AD&D insurance for
all full time-employees at no cost to you! Be sure to update
your beneficiaries during this enrollment period.
• Voluntary Life/AD&D: THIS YEAR ONLY, elect up to
Protect Your $150,000 of coverage for yourself without answering any
Family health questions. Guaranteed issue coverage is also
available for spouses ($25,000) and children ($10,000)
(limits may apply).
Enroll Online
• Voluntary Short-Term and Long-Term Disability: Protecting through ADP:
your paycheck is important! This insurance provides income
replacement in the event you are unable to work due to Scan QR code or visit
Protect Your injury or sickness -- provided at NO cost to you. Pre-existing https://bit.ly/ChildrensHomeADP-G
Income condition limitations apply.
• NEW! Accident: Now offered through MetLife! This

coverage pays you cash benefits if you are injured in a
covered, non-work-related accident. Can purchase for
yourself or your whole family. Also includes a $100 wellness
benefit!
• NEW! Critical Illness: Now offered through MetLife! This
coverage pays a cash benefit of up to $50,000 to you and/or
your dependents when diagnosed with a covered condition-
-including cancer, stroke and heart attack. No health
Protect Your questions asked--guaranteed issue. Also includes a $100
Wallet wellness benefit!
• NEW! Hospital Indemnity: Now offered through MetLife!
This coverage pays you cash benefits when admitted and/or
confined to a hospital or ICU. Coverage for pregnancy is
included without a waiting period or answering any health
questions. Also includes a $100 wellness benefit!

How My Medical Plan Works

Preferred Provider Organization
For a listing of preferred providers
(PPO) Plan:
Visit www.UMR.com , ChoicePlus Network
Children’s Home Association of Illinois offers you the choice
of 2 medical plans, both administered by UMR Both plans
utilize a PPO network, which is all about choice. You may visit Pre-Certification Process:
any provider you choose; however, you will pay the least out-
of- pocket when you visit only providers and facilities within Why do we have a Pre-Certification Requirement?
the PPO network. If you choose to go out-of- network, you In order to ensure that all covered members are receiving the
can visit any doctor or hospital you want, but you will pay a necessary and appropriate health care while providing the
greater portion of the costs. most cost-effective alternatives and avoiding unnecessary
expenses.
In-Network Benefits:
What Treatment Requires Pre-certification?
• When you visit a provider that is within the PPO network, All non-emergency or elective inpatient admissions including,
you will maximize the benefits of your medical plan. You but not limited to, hospitals, skilled nursing facilities,
do not have to select a Primary Care Physician, nor do rehabilitation facilities, behavioral health treatment facilities,
you need a referral to see a specialist. Simply visit any etc. Transplant services. Non- emergency ambulance and
doctor you choose within the PPO network for your ambulance transfers.
medical needs.
• Even within the PPO Network, you are responsible for When must I pre-certify?
the annual deductible before your plan begins paying At least 15 calendar days in advance of any of the above
coinsurance for most benefits. There are some services being rendered.
exceptions such as preventive care and Rx copays that
Who must pre-certify?
may be covered before your deductible.
When a Preferred Provider renders treatment, the provider
• After your deductible is met, you are only responsible for will follow the pre- certification procedures. If you go out-of-
your portion (coinsurance) up to your annual out- of- network, YOU are responsible for notifying UMR to obtain
pocket maximum. pre-certification. Detailed instructions are available in your
Plan Document which you can request from Human
Out-of-Network Benefits: Resources.
• Your plan allows you to visit any provider you want, even
What if I fail to pre-certify?
if they are not within the PPO network. However, your
If you are using only in- network providers, there is no
deductible, coinsurance, and out of pocket maximums
penalty to you for failure to pre-certify. For out-of-
are greater.
network/non-Preferred Providers, UMR will reduce the
• When you visit an out-of-network provider, the plan amount of eligible charges by $250. You will have to pay that
bases its payments on what it considers the maximum fee and it does not count towards your deductible or out-of-
allowable amount for each service. Because these pocket maximum.
providers do not have an agreement to charge only our
negotiated rates, you may be left with a “balance bill” if Other recommended services to pre-certify:
your provider charges more than the maximum allowable The following services are recommended to pre-certify for
amount. If you visit a non-preferred provider and medical necessity to avoid or minimize insurance denial. See
receive a balance bill, you are responsible for that the Plan Document for a complete list. Drugs or procedures
amount and it does not count towards your out-of- that could be construed to be cosmetic; home health care or
pocket maximum with the plan. hospice; outpatient surgeries; physical therapy; occupational
• When you receive out-of-network care, you are therapy, speech therapy and other outpatient therapies; pain
responsible for filing claim forms for reimbursement. As therapy; reconstructive surgery; durable medical equipment
with in-network providers, you will still need to contact (DME) or prosthesis.
Group Benefit Services to pre-certify hospital stays and
certain outpatient procedures.

Flexible Spending
Accounts (FSAs)
Children’s Home Association of Illinois offers you two
different FSA options: a Medical Reimbursement Account
and a Dependent Care Reimbursement Account. By using
these accounts, you can save money and bring home more of
your income by paying for medical care and dependent care
expenses using PRE-TAX dollars from your payroll. Health FSA Case Study
The following chart illustrates the financial benefits of
Introducing the FSA Benefits Card! participating in these accounts when you have out-of-pocket
medical and dependent care expenses. In this example, an
When you enroll in the CHAIL Flexible Spending Accounts, you
employee with an annual salary of about $35,000 who puts
will receive a Benefits Debit MasterCard in the mail to use on
aside $200 per month in the medical and dependent care
eligible FSA expenses. In most ways, your card will work just
FSAs will bring home $600 more per year than they would
like any debit card though there are a few important
without the FSAs! This is an example for your reference only
differences:
and actual amounts will vary based on your income,
1. Its use is limited to specific merchants based on the expenses, FSA election amount, and tax rates.
benefit account(s) you have selected, and to expenses
deemed eligible by your Benefit Plan. Without FSA With FSA
2. You cannot use it at an ATM, or to obtain “cash back” $2,917 $2,917
when making a purchase. Your Annual Income
Per Month Per Month
3. You are not given a PIN with this card. Should a merchant
$0 $200
or provider ask you for a PIN, just explain that this You Set Aside (Pre-Tax)
Per Month Per Month
particular card does not have one. When given the
option between debit and credit at the terminal, choose The IRS Taxes You On $2,917 $2,717
“CREDIT.” (25%) Per Month Per Month
For optimal convenience, your Benefits Card offers 24/7/365 You Bring Home
$26,256 $24,456
online access, so you can check your account balance and (After tax and medical
Per Year Per Year
other vital information with a single click. expenses)
To learn more about the benefits of FSAs and the Benefits You Have This Much
$0 $2,400
Card, simply ask your employer. Once you know the facts, Set Aside for FSA
Per Year Per Year
you’ll discover that FSAs and the Benefits Card spell real Expenses
savings. $0 $600
Your Savings Each Year
Per Year Per Year
Eligible FSA Expenses
Note: This is an example for illustration purposes only, based on a 25% tax
Medical FSA:
rate. Your personal income and tax savings will vary based on your income,
http://www.irs.gov/publications/p502/ tax rate, and the amount of money you contribute to your FSA. Consult your
financial advisor.
Dependent Care FSA:
http://www.irs.gov/publications/p503/ *Assumes standard deductions and four exemptions. **Varies, assumes 3
percent. This example is for illustrative purposes only. Every situation varies
and it is recommended you consult a tax advisor for all tax advice.
Your eligibility for an FSA may be misrepresented if you and/or your spouse
currently utilize an HSA. Check with the plan administrator or Human
Resources to learn more.

FSA Frequently Asked Questions

Why do I want to participate? What happens if my reimbursement request
By signing a participating agreement, you agree to have your exceeds the balance in my account?
salary reduced by the agreed upon amount. Therefore, you
Your medical reimbursement account claims will be paid in
are not responsible for federal income tax withholding or
full, up to the annual amount you have elected to have
FICA on the amount of the reduction, thereby saving you
withheld for that plan year. Your dependent care account will
7.65% on FICA, plus whatever income tax you would be
only be reimbursed with funds that you have paid into the
obligated to pay on this amount.
account to-date.
Another advantage of using a medical FSA is that the entire
amount you elect to contribute for the plan-year is available What happens to the money in my account if I
for you to use at the start of the year even though you have should terminate employment?
not actually contributed it yet.
You would be entitled to reimbursement for expenses which
were incurred between January 1st and the date you
When do I make my election? terminated employment. Your plan allows you 60 days
You need to make your election during open enrollment at following termination within which to submit claims for
your employer or upon your initial hire Open Enrollment reimbursement.
usually occurs once per year, prior to the start of the new
plan year. What happens to any money left over at the close
of the plan year?
Can I change my benefit election mid-year?
All FSA Funds are “use it or lose it”! If you have any remaining
Medical reimbursement accounts can be changed with a money in your medical or dependent care FSA at the end of
qualifying event (i.e. marriage, divorce, death of a spouse or the year, you will forfeit that money. The Plan shall provide
child, birth or adoption of a child, termination of employment for a carryover of $640 of any amount remaining unused in a
of your spouse, or a change in work schedule). You may health FSA as of the end of the Plan year. Such carryover
change your reimbursement election if you were enrolled in amount may be used to pay or reimburse medical expenses
the plan prior to the qualifying event and you wish to change under the health FSA incurred during the entire Plan year to
your election. Changes must be made within 30 days of the which it is carried over.
event.
When can I incur claims?
Dependent care reimbursement accounts can be changed
with a qualifying event (i.e. birth or death of a child, adoption Your plan year allows you to incur claims from January 1st
of a child, dependent is no longer eligible for daycare, change through December 31st of that particular plan year.
in employment status thus changing the need for daycare,
changing daycare providers, or a cost increase or decrease in What is the filing deadline for claims submission?
daycare). Changes must be made within 30 days of the event.
Your plan allows you 60 days following the end of the year to
file claims for reimbursement for expenses incurred during
the plan year. NOTE: You may not use the prior years’ funds
for expenses you incur after the close of the plan year on
12/31.
What are the annual contribution limits?

• Medical FSA for 2024: Up to $3,200 per year.
• Dependent Care FSA for 2024: Up to $5,000 if single or
married & filing taxes jointly or $2,500 if married & filing
taxes separately.

Health Savings Account (HSA)

Available to employees enrolled on Plan B (HDHP).
HSAs are a great way to save money and budget for qualified
expenses. Here’s why:
• It saves you money. HDHPs have lower monthly

premiums, meaning less money is being taken out of
your paycheck.
• It is portable. The money in your HSA is carried over
from year to year and is yours to keep, even if you leave
the company.
• It is a tax-saver. HSA contributions are made with pre-tax
dollars. Since your taxable income is decreased by your
contributions, you’ll pay less in taxes.
HSA Case Study
HSA Contribution Limits
Justin is a healthy 28-year-old single man who contributes
HSAs allow you to pay for qualified health care (medical, $1,000 each year to his HSA. His plan’s annual deductible is
dental, vision, prescription) expenses with pre-tax dollars. $1,500 for individual coverage. Here is a look at the first two
years of Justin’s HSA plan, assuming the use of in-network
HSA 2023 2024 providers. This example only includes HSA contribution
amounts and does not reflect any investment earnings.
Annual Contribution Limit
Individual $3,850 $4,150 Year 1 ➔ Year 2
Family HSA Balance $1,000 HSA Balance $1,850
$7,750 $8,300
Expenses: Expenses:
Annual Contribution Catch-Up
$1,000 $1,000 Prescriptions - $150 Office visits - $100
Ages 55 or older
Prescriptions - $200
Preventive care - $0
Your eligibility for an HSA may be misrepresented if you and/or your spouse (covered by insurance)
currently utilize an FSA. Check with the plan administrator or Human
HSA Rollover HSA Rollover
Resources to learn more. $850 $1,550
to Year 2 to Year 3
Since Justin did not spend all of Once again, Justin did not
his HSA dollars, he did not need spend all of his HSA dollars. He
Learn more about HSAs. to pay any additional amounts
out-of-pocket this year.
can carry over any remaining
HSA funds year after year.
Watch the video below for more information:

http://www.cottinghambutler.com/HSAOverview/

Medical
Plan A (PPO) Plan B (HDHP)
Preferred Non-Preferred Preferred Non-Preferred
Deductible1
Individual $1,000 $2,000 $3,200 $6,000
Family $2,000 $4,000 $6,400 $12,000
Coinsurance2* 25% after Ded. 50% after Ded. 20% after Ded. 60% after Ded.
Medical OOPM3
Individual $2,800 $7,000 $6,850 $13,700
Family $8,400 $21,000 $13,700 $27,400
Preventative Care No Charge Not Covered No Charge Not Covered
Primary Care Office Visit $30 copay 50% after Ded. 20% after Ded. 40% after Ded.
Specialist Office Visit $60 copay 50% after Ded. 20% after Ded. 40% after Ded.
$50 Copay,
Urgent Care 50% after Ded. 20% after Ded. 40% after Ded.
Then 25% after Ded.
$100 Copay,
Inpatient Hospital Services 50% after Ded. 20% after Ded. 40% after Ded.
Then 25% after Ded.
Emergency Transportation
25% after Ded. 20% after Ded.
(Ambulance)
Emergency Room (ER) $200 Copay 20% after Ded.
Prescription Drugs
Retail Pharmacy Mail-Order Retail Mail-Order
Only covered at preferred providers
Generic Drugs $10 Copay $20 Copay 20% after Ded.

Brand Name 25% after Ded. 20% after Ded.
Brand Name with Generic
50% after Ded. 20% after Ded.
Substitute
Per-Paycheck (26)
Plan A Plan B
Employee Cost
Employee $84 $64
Employee + 1 $218 $180
Employee + Family $267 $231
*NOTE: Coinsurance and copay amounts shown reflect how much you, as a member enrolled on the plan, would be responsible for paying.
1
Your Deductible does NOT include: Copays and coinsurance payments, such as prescriptions drugs or office visit copays.
2 Coinsurance is the percentage you pay for care after you reach the deductible.
3 Your Out-of-Pocket Maximum (OOPM) does NOT include: Prescription drug card benefit copayments, ER copayments, utilization review penalties, plan exclusions,
insurance premiums, balance-billed charges, and health care not covered by the plan.
Please review the full plan documents for details. If the benefits described herein conflict in any way with the Summary Plan Description, the Summary Plan
Description will prevail.

How to Find a Medical Provider
Just Follow These Steps to Find a

Medical Provider Online!
• Go to: UMR.com – available 24/7/365.

• Click: “Find a Provider”.
• Select: “UnitedHealthcare Choice Plus Network”.
• Select: Your search preference
Medical Plan Contact Information:
o By specialty, doctor name, etc.
• Enter: Requested information, including location Provider: UMR
o By clicking on “change address” Phone: 1-800-826-9781
• Refine your results: By choosing preferences (optional).
Website: www.umr.com

Virtual Doctor Visits

Teladoc | 800-835-2362 | www.Teladoc.com | www.Teladoc.com/Therapy
Teladoc can be a great alternative to visiting your normal

doctor or an urgent care, when you are suffering from one of
many common, non-emergency medical conditions. With
24/7/365 access to U.S. board-certified doctors, you can
access medical care for no cost to you, from home or on the
road—and in some cases, doctors can write a prescription to
a local pharmacy near you. *
How Does It Work?

Log in to your account or register if you don’t have one
set-up. Then, contact Teladoc from anywhere—and let
the doctor come to you!
Teladoc Contact Information

• Phone: (800) 835-2362
• Online: teladoc.com & teladoc.com/Therapy
Teladoc doctors can then diagnose non-emergency
medical problems, recommend treatment, and can even
call in a prescription to your pharmacy of choice, when
necessary. *
*Prescription services may not be available in all states.

Save Money and Time!
When Can I Use It? With no consult cost, Teladoc provides
significant savings over urgent care and
• When you need care now.
emergency room visits. Plus, you can use it
• If you’re considering the ER or urgent care center for
from the convenience of home or work,
a non-emergency issue.
allowing you to avoid the hassle of sitting in a
• On vacation, on a business trip, or away from home. waiting room.
Common Conditions We Treat

Learn More!
• Allergies
Watch this short video to learn
• Colds, respiratory problems, flu more about Teladoc.
• Ear infections www.youtube.com/
• Sore Throat watch?v=78LeLxyja5k&t=1s
• Pink eye
• Urinary tract infections
• Anxiety
• Depression
• Not feeling like yourself Meet Our Doctors!
• Marital issues • U.S. board-certified with an average of 15 years of
• Stress practice experience
• And more! • U.S. residents and licensed in your state

Prescription Drug Program

CanaRx | 866-893-6337
What is CanaRx?
You may have received an enrollment package in the mail or heard about the
international prescription program through an employee communication. If you are
ready to join, or need more information, the best option is to CALL CanaRx FIRST!
CanaRx will answer all of your questions including; program eligibility and medication
availability, and then all you need to do is submit your enrollment form and
$
CO-PAY*
0
prescription(s). Pack Sizes
Our program ONLY supplies Brand
Program Enrollment Name medications, dispensed in the
manufacturer’s original sealed
Enrollment forms and prescriptions can be submitted via fax or mail. As a safety container. Pack sizes vary from
measure, CanaRx only accept prescriptions that are faxed directly from your doctor’s country to country. For example,
office. In order to have a continuous supply of medication on hand, they request that a standard container quantity might
you submit a prescription for a 3-month quantity, with 3 refills. If your prescription be 84. CanaRx factors this
does not cover a full year, CanaRx can still accept it – but it must be written for a in when scheduling your refill call.
minimum 3-month supply.
If you did not contact CanaRx prior to enrolling, they will call you once they receive your Refills
paperwork and welcome you to the program! CanaRx will confirm the following: Refills are not automatic, but they’re
easy – CanaRx calls you! As an added
• Your personal information
safety measure before processing a
• Medication availability
refill, they need to confirm how much
• Shipping time
medication you have on hand and
• Refill schedule
whether you’ve had any health or
• And answer any questions you may have medication changes. CanaRx will
Enroll only once – and at any time! There is no need to enroll now, contact you one month prior to ensure
unless you are ready to order through the program. you always have sufficient supply of
medication on-hand.
Submit your Enrollment Form
Generic Medications
Fax: Generic medications provide the
greatest savings to your health care
1-866-715-6337
plan. Therefore, if you are currently
taking a Generic medication, you are
CanaRx: not eligible to order the Brand Name
235 Genie St. West, Suite 105D medication through this program.
Windsor, ON, Canada, N8X 2X7
Shipping
Contact CanaRx Your medication will be shipped
• (866)-893-6337 directly from an international
• Monday– Friday: 7:30AM – 5:30PM CST pharmacy to your home AT NO COST
Saturday: 8:00AM – 4:30PM CST TO YOU, via regular mail. Please allow
20 business days (1 month) for your
package to arrive.
For More Information, Watch Our Video: https://youtu.be/_bzt6jhVRd0

Dental
Children’s Home Association of Illinois offers you the option to purchase affordable
Dental Insurance through MetLife.
The dental plan uses a PPO Network so you may choose to visit any dentist you want,
but your costs may be higher outside the network if your dentist charges more than
what the plan considers “Reasonable & Customary” or (R&C). Any remaining bills
from out-of-network providers are your responsibility.
To locate a participating dentist please see www.metlife.com.
In-Network / Out-of-Network /
Dental**
Participating Non-Participating
$50 per Individual
Yearly Deductible
Maximum of $150 per Family
Reimbursement Plan pays according to Plan pays
Level negotiated fee 90th percentile R&C*
Annual Maximum
$1,000 per Individual
Benefit
Covered 100% *Covered 100%
Preventive Services
- Ded. Waived - Ded. Waived
Basic Services 20% after Ded. *20% after Ded.
Major Services 50% after Ded. *50% after Ded.
50% of cost, *50% of cost,
Orthodontia Up to Lifetime max of Up to Lifetime max of
$1,000 $1,000
Per-Paycheck (26) Employee Only $15.78

Employee Cost Family $39.02
**NOTE: Coinsurance and copay amounts shown reflect how much you, as a member enrolled on the
plan, would be responsible for paying.
Please review the full plan documents for details. If the benefits described herein conflict in any way with
the Summary Plan Description, the Summary Plan Description will prevail.

Vision
Children’s Home Association of Illinois offers you the option to purchase affordable
Vision Insurance through MetLife.
This insurance helps you pay for eye exams, glasses, and contacts while allowing you
to visit any Eye Doctor you choose. Please note, when you visit a Non-Preferred
Provider, the plan will reimburse you based on the chart below. Always use a
preferred provider for the best benefit coverage.
Locate a Preferred Provider at www.metlife.com.
In-Network Out-of-Network
Vision*
(Full Coverage) (Plan Partially Reimburses)
Comprehensive Eye Exam $10 copay Up to $45
Retinal Imaging Up to $39 copay Applied to exam allowance
Standard or Premium fit:
Contact Lens Fit and Follow-up Applied to contact lens allowance
Covered in full with maximum copay of $60
$0 copay; $150 allowance;
Frames Up to $65
20% off balance over $150
Standard Plastic Lens
Single Vision $25 copay Up to $30
Bifocal $25 copay Up to $50
Trifocal $25 copay Up to $65
Lenticular $25 copay Up to $100
See plan document for details on progressive, tints,
Other Lens Options coatings, and other options
Applied to lens allowance
Contact Lenses $100 allowance Up to $80 allowance

Medically Necessary Contact Lenses Covered in full after $25 copay Applied to contact lens allowance
Frequencies
Exams, Lenses & Contact Lenses Once every 12 months
Frames Once every 24 months
Employee Only $3.39

Per-Paycheck (26) Employee Cost
Family $7.28
*See your full MetLife plan document for additional details and discounts on Laser Correction, sunglasses, and additional pairs of glasses/lenses each year.
Please review the full plan documents for details. If the benefits described herein conflict in any way with the Summary Plan Description, the Summary Plan
Description will prevail.

Agency-Paid Benefit
Children’s Home Association of Illinois provides several valuable benefits to all of our full-time employees at no cost to you. Please
review this page for highlights of these agency-paid benefits and speak with the benefits department for more details. Including the
Basic Group Life coverage shown here, Children’s Home Association of Illinois also provides Long-Term Disability coverage at no cost.
Basic Group Life

CHAIL offers you a basic group life policy through MetLife. This benefit pays your beneficiary in the case of your death so please
make sure that your beneficiaries are up to date with human resources upon hire and each year going forward.
Basic Group Life

Employee: 2x annual salary rounded up to the nearest $1,000 – up to a maximum of
Benefit Amount
$200,000
Benefits may be reduced for employees over age 65 per ADEA.
Important – Please Read!

• New Enrollees must be actively at work on the effective date for coverage to be in force. If not, enrolled coverage will
become effective upon return to Active at Work/eligible status.
Please review the full plan documents for plan details including exclusions and limitations. This plan highlight is a
summary provided to help you understand your insurance coverage. Details may differ from state to state. If the terms
of this plan highlight summary or your certificate differ from your policy, the policy will govern.

Employee Assistance Program

EFR Employee and Family Resources | 800-327-4692
In addition to the MetLife Employee Assistance Program, we offer resources through EFR. When you find yourself in need of some
professional support to deal with personal, work, financial or family issues, your Employee Assistance Program (EAP) can assist. You
and your immediate family (spouse or domestic partner, dependent children) can use this program for a variety of issues, including:
• Marital and family conflicts

• Job related difficulties
• Stress, anxiety, and depression
• Parent and child relationships
• Legal and financial counseling
• Elder Care Consultation
• Various other related issues
• Online resources
Phone Based Support In-Person or Telehealth Counseling Telephonic Life Coaching

6 sessions per issue per year
6 sessions per issue per year
Unlimited Speak with a life coach and receive
Arrange in-person counseling sessions
Call us any time you have and issue, tailored advice on matters involving time
with a licensed mental health therapist
concern, or question. You have 24/7 management, work-life integration, goal
near your home or work. Each family
access to masters-level clinicians. setting, communication skills, and other
member is eligible.
areas of personal growth.
In-Person or
Telephonic Financial Consultation Child/Eldercare Resources
Telephonic Legal Consultation
One 30-min session per issue One 30-min session per issue
Speak with a financial professional about Meet with a licensed attorney with As Needed
each separate issue, and access a free expertise in your area of need. Visit Access information, referral resources,
financial check-up, financial library, and a efr.org/legal for more information and support involving the care for your
variety of other financial tools by visiting regarding retention and self-help legal children or aging family members.
efr.org/financial. documents.
Identity Theft Resolution Services 1:1 Nutrition Consulting 1:1 Retirement Readiness Consultation
As Needed 4 sessions
Access one-on-one telephonic nutrition
Receive assistance with restoring identity consulting designed to help you Meet with an independent financial
and good credit from a highly trained establish healthy habits, meal planning, advisor for a multistep consultation
FCRA certified fraud resolution specialist and assist in reaching weight goals. process helping with your long-term
or licensed attorney. financial planning goals.
Our provider is EFR Employee and Family Resources and is available 24/7/365. If you need help or guidance, you may reach out to
the EAP at 800-327-4692 or www.efr.org/myeap.

PTO & Sick Leave

Full-time employees accrue PTO on a bi-weekly basis based on the number of years of service with the agency. Employees who
regularly work less than 40 hours but at least 20 hours per week are eligible for PTO accrual on a pro-rated basis.
You may only take PTO hours/days that have been accrued to-date. That is, no borrowing against future accruals of PTO. You
must receive supervisor approval of your PTO before the dates you plan on using it.
For CHAIL employees, see the charts below for your annual PTO accrual amounts and maximums. Accrued PTO does roll-over if not
used within a year however it is subject to the maximum and you will not continue to accrue PTO if you hit the maximum (until you
use some of your banked PTO).
Employees 40 hours per week 30-39 hours per week 20-29 hours per week
working… 1 PTO “day” pays you for 8 hours 1 PTO “day” pay you for 6 hours 1 PTO “day” pay you for 4 hours
Years of PTO Days Accrued Maximum Allowable PTO Days Accrued Maximum Allowable PTO Days Accrued Maximum Allowable
Service per Year PTO Accrual per Year PTO Accrual per Year PTO Accrual
0-2 15 120 hours 15 90 hours 15 60 hours

3-19 20 160 hours 20 120 hours 20 80 hours
20+ 25 200 hours 25 150 hours 25 100 hours
Any PTO that is accrued but unused will be paid out at your current hourly wage upon termination of employment with CHAIL.
Holidays Kiefer School & Academy for Autism PTO

The agency offices are closed on the following days each On July 1, of each year, staff will receive 3 PTO days to use
year: New Year’s Day, Martin Luther King Day, Good Friday, throughout the fiscal year. Any unused PTO time as of June
Memorial Day, Juneteenth, July 4th, Labor Day, Thanksgiving 30 will be paid out. Beginning with their twentieth
Day, Friday after Thanksgiving, Christmas Day. anniversary, Kiefer teaching staff will receive one day off each
year in celebration of their anniversary with the Agency. This
Location-Specific PTO Policies day will be credited as an additional PTO day at the beginning
of the fiscal year.
Kiefer School & Academy for Autism Vacations: Full-time
Kiefer School and Academy for Autism teaching staff are
eligible for three calendar weeks of vacation per year: One Sick Leave
week at the end of spring school term and two weeks at the The hours an employee will accumulate per month for sick
end of the summer school term. Vacation begins accruing at leave will equal one “working day.” A “working day” is equal
the beginning of the fall term. Full-time teaching staff who to eight hours (pro-rated for employees who work at least 20
leave the agency before the end of the school year will hours per week, but less than 40). Employees will begin
receive pro-rated vacation pay. accumulating sick time on the first of the next month in which
they were hired.
Kiefer School and Academy for Autism Holidays
All full-time employees will be granted time off with pay
according to the ISBE-approved school calendar.

Voluntary
Life/AD&D
In addition to the basic life insurance benefit provided by the
agency, you have the opportunity to purchase supplemental
Life and Accidental Death & Dismemberment (AD&D)
coverage through MetLife. AD&D coverage provides an
additional benefit on top of the Life Insurance if death is
caused by a covered accident or if you suffer a covered
dismemberment even if it does not result in death.
If you elect additional coverage for yourself, you may then

purchase life and AD&D for your spouse and dependent
children.
Voluntary Life/AD&D
Employee: Elect up to a maximum of Definition of “Eligible Dependents”
$150,000 – in $10,000 increments. • Spouse – eligibility may terminate at Spouse age 70.
Spouse: Elect up to 50% of employee • Child – eligibility terminates earliest of age 26, married, or employed full
Life and AD&D time, or no longer a Full Time Student. Terms may vary for children with
coverage, between $5,000 and $25,000 special needs.
Coverage – in $5,000 increments.
Amounts Important – Please Read!
Dependent Child(ren): • New Enrollees must be actively at work on the effective date for coverage
Options of $1,000, $2,000, $4,000, to be in force. If not, enrolled coverage will become effective upon return
$5,000 or $10,000 to Active at Work/eligible status.
• Dependents may have a delayed effective date based on his/her health
Employee: $150,000 status at time of enrollment. Please refer to the policy certificate or HR for
Guarantee more details.
Spouse: $25,000 • It is the responsibility of the employee to ensure dependents are eligible
Issue Amount1
for coverage under these policies. Please refer to the policy certificate or
Dependent Child(ren): $10,000 HR for more information.
Reduction There is no age-based reduction in Please review the full plan documents for plan details including exclusions
Schedule benefits. and limitations. This plan highlight is a summary provided to help you
understand your insurance coverage. Details may differ from state to state. If
Conversion & Portability (On Life); the terms of this plan highlight summary or your certificate differ from your
Seatbelt benefit, Airbag Benefit, policy, the policy will govern.
Additional
Common Carrier Benefit, Travel
Features Benefits may be reduced for employees over age 65 per ADEA.
Assistance, Identity Theft Solutions (on
AD&D) AD&D pays a benefit for loss of life or dismemberment resulting from a
covered accidental bodily injury. Your beneficiary may receive up to 100% of
Benefit Cost Log on to ADP for rates the AD&D amount if you die as the result of a covered accidental injury. You
may receive an accidental dismemberment benefit for losses to a hand, a
foot, or the sight of an eye due to an accidental injury. See the policy for
exact schedule of losses and benefits.
1
If you enroll when first offered, you receive up to the listed amount without
having to answer medical questions.

Disability Insurance
Children’s Home Association of Illinois believes in the importance of protecting your income and is happy to partner with MetLife to
offer Short Term and Long-Term disability income replacement paid for by the agency! Without disability coverage, you and your
family may struggle to get by if you miss work due to an injury or illness.
Children’s Home Association of Illinois is now providing full-time employees with the opportunity to purchase NEW short-term
disability income benefits.
In the event that you become disabled from a non-work-related injury or sickness, disability income benefits may provide a partial
replacement of lost income. Please note, though, that you are not eligible to receive short-term disability benefits for work-related
disabilities.
Short-Term Disability Coverage Highlights
Weekly Benefit Amount 60% of monthly earnings up to $1,000 per month
Elimination Period 14 days for accident/sickness
Benefit Duration Please see CHAIL HR for the duration of the benefit for your job classification.
You may not be eligible for benefits for a Disability that results from a Pre-existing
Condition, if you have been Actively at Work for less than 12 consecutive months
Pre-Existing Condition Limitations after this coverage becomes effective.
A pre-existing condition is one which you were diagnosed, treated, or prescribed
medication for during the 3 months prior to this policy taking effect.
Long-Term Disability Coverage Highlights
Monthly Benefit Amount 60% of monthly earnings up to $5,000 per month
Elimination Period 90 days for illness/injury
Benefit Duration Please see CHAIL HR for the duration of the benefit for your job classification.
You may not be eligible for benefits for a Disability that results from a Pre-existing
Condition, if you have been Actively at Work for less than 12 consecutive months
Pre-Existing Condition Limitations after this coverage becomes effective.
A pre-existing condition is one which you were diagnosed, treated, or prescribed
medication for during the 3 months prior to this policy taking effect.
Important – Please Read!

• New Enrollees must be actively at work on the effective date for coverage to be in force. If not, enrolled coverage will become effective upon return to Active at
Work/eligible status.
Please review the full plan documents for plan details including exclusions and limitations. This plan highlight is a summary provided to help you understand your insurance coverage.
Details may differ from state to state. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern.

Supplemental
Health
MetLife
The following benefits may protect your financial security in

the event of an unexpected medical expense.
Get paid for taking
Accident care of your health!
Helps cover the cost of expenses if you are injured in a
non-work-related, covered accident. If you are enrolled in coverage, you can receive a
wellness benefit payment each year when you have a
Benefit amounts vary by severity. qualifying screening or test.
Benefit Amount
See schedule of benefits for details.
Wellness Benefit $100 per calendar year
Common Dislocations Concussions Hospital Indemnity

Covered Injuries Fractures Lacerations Helps cover the cost of hospital stays—including pregnancy
and childbirth.
Ambulance Surgical benefits
Emergency Follow-up $1,000 hospital admission benefit
Common Benefit Amount
room visits treatments $100 daily confinement
Medical Services
Hospital Wellness Benefit $100 per calendar year
admission
Accidental
To view your personalized
Other Benefits Lodging death and
Supplemental Health rates, log in to ADP. Refer to
dismemberment
Cost your benefit highlight sheet
or intranet for details.
Critical Illness Actively-at-Work Requirement:
New Enrollees must be actively at work on the effective date for coverage to
Helps cover the cost of expenses if you are diagnosed with be in force. If not, enrolled coverage will become effective upon return to
a covered condition. Active-at-Work/eligible status.
Employee: Max of $50,000 Dependent Delayed Effective Date:

Dependents may have a delayed effective date based on his/her health
Spouse: 50% of Employee Initial status at time of enrollment. Please refer to the policy certificate or HR for
Benefit Amount Benefit more details.
Child: 50% of Employee Initial Please review the full plan documents for plan details including exclusions
Benefit and limitations. This plan highlight is a summary provided to help you
understand your insurance coverage. Details may differ from state to state. If
Wellness Benefit $100 Per Calendar Year the terms of this plan highlight summary or your certificate differ from your
policy, the policy will govern
Kidney Invasive Cancer
Common Failure
Covered Conditions
Heart attack

401(k) Retirement
Children’s Home Association of Illinois is pleased to offer our employees access to a
401(k) Retirement Savings Plan through Fidelity. This is a valuable benefit that gives
you an instant tax-break when you set aside a percentage of each paycheck for
retirement. The money you elect to contribute to your 401(k) is deducted from your
paycheck PRE-TAX, which lowers your taxable income during the year and grows tax-
free until retirement.
On top of that, Children’s Home Association of Illinois will match your contribution
dollar for dollar up to a maximum of 4% of your paycheck. That means, when you
contribute 4% of your salary, CHAIL also contributes 4%. So if you do not
contribute 4% to the 401(k) once you’re eligible, it’s like turning
down a 4% bonus each year!
Eligibility
Employees are eligible to participate in the company 401(k) immediately upon hire.
After 1 year of employment (1000 hours minimum worked) Children’s Home will
begin matching contributions up to 4%.
Employee Contributions
You may defer between 1% and 60% of your salary to your 401(k) each year - Vesting
provided your contributions do not exceed the IRS limit of $18,000 per year, as of
2015. Employees over age 50 may contribute an additional $6,000 per year as a You are always 100% vested in the
“catch up” amount. contributions you make from your
payroll. You will be fully vested in the
Example of Matching Contributions agency matching money after 5 years.
The schedule below shows the
If You percentage of agency matching funds
0% 1% 2% 3% 4% 5% or more
Contribute you would get to keep if you
The Agency separated from the agency before
0% 1% 2% 3% 4% 4% reaching 100% vestment.
Contributes
Total 0% 2% 4% 6% 8% Your Percent of
Contribution of your of your of your of your of your contribution Years of Service
Vestment in
to 401(k) salary salary salary salary salary plus 4% Completed
Agency Funds
Less than 1 year 0%
1 year but less
20%
than 2 years
2 years but less
40%
than 3 years
3 years but less
60%
than 4 years
4 years but less
80%
than 5 years
5 years 100%

Children’s Home Association of Illinois:

Important Disclosures & Notices
Michelle’s Law Notice Program
If an Employee or his/her dependents are Website: http://dhcs.ca.gov/hipp
If the Plan provides for dependent coverage
already enrolled in Medicaid or CHIP and they Phone: 916-445-8322
that is based on a dependent’s full-time
live in a State listed below, they may contact Fax: 916-440-5676
student status, then this Michelle’s Law Notice
the State Medicaid or CHIP office to find out if Email: [email protected]
applies. If there is a medically necessary leave
premium assistance is available.
of absence from a post-secondary educational
COLORADO – Health First Colorado
institution or other change in enrollment that:
If an Employee or his/her dependents are NOT (Colorado’s Medicaid Program) & Child Health
(1) begins while a dependent child is suffering
currently enrolled in Medicaid or CHIP, and Plan Plus (CHP+)
from a serious illness or injury; (2) is certified by
they think they (or any of their dependents) Health First Colorado Website:
a physician as being medically necessary; and
might be eligible for either of these programs, https://www.healthfirstcolorado.com/
(3) causes the dependent child to lose student
they can contact the State Medicaid or CHIP Health First Colorado Member Contact Center:
status for purposes of coverage under the plan,
office or dial 1-800-221-3943 / State Relay 711
that child may maintain dependent eligibility
1-877-KIDS NOW or visit CHP+ Website: https://www.colorado.gov/
for up to one year. If the treating physician
www.insurekidsnow.gov to find out how to pacific/hcpf/child-health-plan-plus
does not provide written documentation when
apply. If they qualify, ask if the state has a CHP+ Customer Service:
requested by the Plan Administrator that the
program that might help pay the premiums for 1-800-359-1991 / State Relay 771
serious illness or injury has continued, making
an employer-sponsored plan. Health Insurance Buy-In Program (HIBI)
the leave of absence medically necessary, the
Website:
plan will no longer provide continued coverage.
If an Employee or his/her dependents are https://www.colorado.gov/pacific/hcpf/health-
❖
eligible for premium assistance under Medicaid insurance-buy-program
or CHIP, as well as eligible under their employer HIBI Customer Service: 1-855-692-6442
Benefits during a Leave plan, the employer must allow the Employee to
of Absence enroll in the employer plan if they are not FLORIDA – Medicaid
Your health benefits may be protected and already enrolled. This is called a “special Website:
enrollment” opportunity, and the Employee https://www.flmedicaidtplrecovery.com/
maintained during a leave of absence, such as a
leave qualifying under the Family Medical Leave must request coverage within 60 days of being flmedicaidtplrecovery.com/hipp/index.html
Act. Other leaves of absence may, however, determined eligible for premium assistance. If Phone: 1-877-357-3268
the Employee has questions about enrolling in
render you ineligible to participate in the health
plan. If coverage is lost due to a leave of the employer’s plan, contact the Department of GEORGIA – Medicaid
absence, you may be eligible to continue Labor at www.askebsa.dol.gov or call 1-866- GA HIPP Website:
444-EBSA (3272). https://medicaid.georgia.gov/health-insurance-
coverage under COBRA. Similarly, if you
become ineligible for health benefits due to a premium-payment-program-hipp
Employees living in one of the following Phone: 678-564-1162, Press 1
leave of absence for military reasons, you may
be eligible to continue that coverage under States, may be eligible for assistance paying GA CHIPRA Website:
USERRA. Please contact your Human Resources employer health plan premiums. The following https://medicaid.georgia.gov/programs/third-
list of States is current as of July 31, 2022. The party-liability/childrens-health-insurance-
Department or your manager for more
information regarding what benefits are most recent CHIP notice can be found at program-reauthorization-act-2009-chipra
protected and maintained during a leave of https://www.dol.gov/agencies/ebsa/laws- Phone: (678) 564-1162, Press 2
absence and for more information about FMLA, and-regulations/laws/chipra. Contact the
COBRA and USERRA. ❖ respective State for more information on INDIANA – Medicaid
eligibility – Healthy Indiana Plan for low-income adults 19-
64 Website: http://www.in.gov/fssa/hip/
Premium Assistance under ALABAMA – Medicaid Phone: 1-877-438-4479
Medicaid and The Children’s Website: http://myalhipp.com/ All other Medicaid
Phone: 1-855-692-5447 Website: https://www.in.gov/medicaid/
Health Insurance Program Phone 1-800-457-4584
(CHIP) ALASKA – Medicaid
If an Employee or an Employee’s children are AK Health Insurance Premium Payment IOWA – Medicaid and CHIP (Hawki)
Program Medicaid Website:
eligible for Medicaid or CHIP and are eligible for
health coverage from an employer, the state Website: http://myakhipp.com/ https://dhs.iowa.gov/ime/members
may have a premium assistance program that Phone: 1-866-251-4861 Medicaid Phone: 1-800-338-8366
Email: [email protected] Hawki Website: http://dhs.iowa.gov/Hawki
can help pay for coverage, using funds from
their Medicaid or CHIP programs. If the Medicaid Eligibility: Hawki Phone: 1-800-257-8563
https://dhss.alaska.gov/dpa/Pages/default.aspx HIPP Website: https://dhs.iowa.gov/
Employee or his/her children are not eligible for
Medicaid or CHIP, they will not be eligible for ime/members/medicaid-a-to-z/hipp
these premium assistance programs but they ARKANSAS – Medicaid HIPP Phone: 1-888-346-9562
Website: http://myarhipp.com/
may be able to buy individual insurance
coverage through the Health Insurance Phone: 1-855-MyARHIPP (855-692-7447) KANSAS – Medicaid
Marketplace. For more information, visit Website: https://www.kancare.ks.gov/
www.healthcare.gov. CALIFORNIA – Medicaid Phone: 1-800-792-4884
Health Insurance Premium Payment (HIPP)

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP WASHINGTON – Medicaid
Kentucky Integrated Health Insurance Premium Medicaid Website: http://www.state.nj.us/ Website: https://www.hca.wa.gov/
Payment Program (KI-HIPP) Website: humanservices/dmahs/clients/medicaid/ Phone: 1-800-562-3022
https://chfs.ky.gov/agencies/dms/member/Pag Medicaid Phone: 609-631-2392
es/kihipp.aspx CHIP Website: WEST VIRGINIA – Medicaid and CHIP
Phone: 1-855-459-6328 http://www.njfamilycare.org/index.html Website: https://dhhr.wv.gov/bms/
Email: [email protected] CHIP Phone: 1-800-701-0710 http://mywvhipp.com/
KCHIP Website: Medicaid Phone: 304-558-1700
https://kidshealth.ky.gov/Pages/index.aspx NEW YORK – Medicaid CHIP Toll-free phone:
Phone: 1-877-524-4718 Website: https://www.health.ny.gov/ 1-855-MyWVHIPP (1-855-699-8447)
Kentucky Medicaid Website: https://chfs.ky.gov health_care/medicaid/
Phone: 1-800-541-2831 WISCONSIN – Medicaid and CHIP
LOUISIANA – Medicaid Website: https://www.dhs.wisconsin.gov/
Website: www.medicaid.la.gov or NORTH CAROLINA – Medicaid badgercareplus/p-10095.htm
www.ldh.la.gov/lahipp Website: https://medicaid.ncdhhs.gov/ Phone: 1-800-362-3002
Phone: 1-888-342-6207 (Medicaid hotline) or Phone: 919-855-4100
1-855-618-5488 (LaHIPP) WYOMING – Medicaid
NORTH DAKOTA – Medicaid Website: https://health.wyo.gov/
MAINE – Medicaid Website: http://www.nd.gov/ healthcarefin/medicaid/programs-and-
Enrollment Website: https://www.maine.gov/ dhs/services/medicalserv/medicaid/ eligibility/
dhhs/ofi/applications-forms Phone: 1-844-854-4825 Phone: 1-800-251-1269
Phone: 1-800-442-6003
TTY: Maine Relay 711 OKLAHOMA – Medicaid and CHIP To see if any other States have added a
Private Health Insurance Premium Webpage: Website: http://www.insureoklahoma.org premium assistance program since July 31,
https://www.maine.gov/dhhs/ofi/applications- Phone: 1-888-365-3742 2022, or for more information on special
forms enrollment rights, contact either:
Phone: 1-800-977-6740 OREGON – Medicaid
TTY: Maine Relay 711 Website: U.S. Department of Labor
http://healthcare.oregon.gov/Pages/index.aspx Employee Benefits Security Administration
MASSACHUSETTS – Medicaid and CHIP Phone: 1-800-699-9075 www.dol.gov/agencies/ebsa
Website: 1-866-444-EBSA (3272)
https://www.mass.gov/masshealth/pa PENNSYLVANIA – Medicaid
Phone: 1-800-862-4840 Website: https://www.dhs.pa.gov/ U.S. Department of Health and Human Services
TTY: (617) 886-8102 Services/Assistance/Pages/HIPP-Program.aspx Centers for Medicare & Medicaid Services
Phone: 1-800-692-7462 www.cms.hhs.gov
MINNESOTA – Medicaid 1-877-267-2323, Menu Option 4, Ext. 61565 ❖
Website: https://mn.gov/dhs/people-we- RHODE ISLAND – Medicaid and CHIP Patient Protection Notice
serve/children-and-families/health-care/health- Website: http://www.eohhs.ri.gov/
If the The Children’s Home Association of
care-programs/programs-and-services/other- Phone: 1-855-697-4347 or
Illinois generally requires the designation of a
insurance.jsp 401-462-0311 (Direct RIte Share Line)
primary care provider, you have the right to
Phone: 1-800-657-3739
designate any primary care provider who
SOUTH CAROLINA – Medicaid
participates in our network and who is available
MISSOURI – Medicaid Website: https://www.scdhhs.gov
to accept you or your family members. If the
Website: http://www.dss.mo.gov/ Phone: 1-888-549-0820
plan or health insurance coverage designates a
mhd/participants/pages/hipp.htm
primary care provider automatically, you will be
Phone: 573-751-2005 SOUTH DAKOTA – Medicaid
able to designate a new provider. For
Website: http://dss.sd.gov
information on how to select a primary care
MONTANA – Medicaid Phone: 1-888-828-0059
provider, and for a list of the participating
Website: http://dphhs.mt.gov/
primary care providers, contact
MontanaHealthcarePrograms/HIPP TEXAS – Medicaid
Human Resources. ❖
Phone: 1-800-694-3084 Website: http://gethipptexas.com/
Email: [email protected] Phone: 1-800-440-0493
Women’s Health and Cancer
NEBRASKA – Medicaid UTAH – Medicaid and CHIP Rights Act of 1998
Website: http://www.ACCESSNebraska.ne.gov Medicaid Website: https://medicaid.utah.gov/
If you have had or are going to have a
Phone: 1-855-632-7633 CHIP Website: http://health.utah.gov/chip
mastectomy, you may be entitled to certain
Lincoln: 402-473-7000 Phone: 1-877-543-7669
benefits under the Women’s Health and Cancer
Omaha: 402-595-1178
Rights Act of 1998 (WHCRA). For individuals
VERMONT – Medicaid
receiving mastectomy-related benefits,
NEVADA – Medicaid Website: http://www.greenmountaincare.org/
coverage will be provided in a manner
Medicaid Website: http://dhcfp.nv.gov Phone: 1-800-250-8427
determined in consultation with the attending
Medicaid Phone: 1-800-992-0900
physician and the patient for:
VIRGINIA – Medicaid and CHIP
• All stages of reconstruction of the breast
NEW HAMPSHIRE – Medicaid Website:
on which the mastectomy was performed.
Website: https://www.dhhs.nh.gov/programs- https://www.coverva.org/en/famis-select
services/medicaid/health-insurance-premium- https://www.coverva.org/en/hipp • Surgery and reconstruction of the other
program Medicaid Phone: 1-800-432-5924 breast to produce a symmetrical
appearance.
Phone: 603-271-5218 CHIP Phone: 1-800-432-5924
Toll-free number for the HIPP program: • Prostheses.
1-800-852-3345, ext. 5218 • Treatment of physical complications of
the mastectomy, including lymphedema.

and Your Health Coverage Employee payments for coverage through the
These benefits will be provided subject to the Marketplace are made on an after-tax basis.
same deductibles and coinsurance applicable to
PART A: General Information
other medical and surgical benefits provided How Can Individuals Get More Information?
When key parts of the health care law took
under this plan. ❖ For more information about coverage offered
effect in 2014, a new way to buy health
by the Employer, please check the summary
insurance became available: the Health
Newborns’ and Mothers’ plan description or contact Human Resources.
Insurance Marketplace. To assist Employees as
Health Protection Act they evaluate options for themselves and their
The Marketplace can help when evaluating
family, this notice provides some basic
Group health plans and health insurance issuers coverage options, including eligibility for
information about the new Marketplace and
offering group health insurance coverage coverage through the Marketplace and its cost.
employment-based health coverage offered by
generally may not, under federal law, restrict Please visit HealthCare.gov for more
their employer.
benefits for any hospital length of stay in information, including an online application for
connection with childbirth for the mother or health insurance coverage and contact
What is the Health Insurance Marketplace?
newborn child to less than 48 hours following a information for a Health Insurance Marketplace
The Marketplace is designed to help individuals
normal vaginal delivery, or less than 96 hours in the area.
and families find health insurance that meets
following a cesarean section. However, federal
their needs and fits their budget. The
law generally does not prohibit the mother’s or *An employer-sponsored health plan meets the
Marketplace offers "one-stop shopping" to find
newborn’s attending provider, after consulting "minimum value standard" if the plan's share of
and compare private health insurance options.
with the mother, from discharging the mother the total allowed benefit costs covered by the
Employees may also be eligible for a new kind
or her newborn earlier than 48 or 96 hours, as plan is no less than 60% of such costs. ❖
of tax credit that lowers their monthly premium
applicable. Additionally, no group health plan
right away. The open enrollment period for
or issuer may require that a provider obtain Special Enrollment Rights
health insurance coverage through the
authorization from the Plan or insurance issuer
Marketplace began on Nov. 1st, and ended on If an employee declines enrollment for
for prescribing a length of stay not in excess of
Dec. 15. Individuals must have enrolled or him/herself or for their dependents (including
48 hours (or 96 hours). ❖
changed plans prior to Dec. 15, for coverage their spouse) because of other health insurance
starting as early as Jan. 1st. After Dec. 15th, coverage, they may be able to enroll
Medical Child Support Orders individuals can get coverage through the him/herself or their dependents in this Plan in
A Component Benefit Plan must recognize Marketplace only if they qualify for a special the future, provided they request enrollment
certain legal documents presented to the Plan enrollment period. within 30 days after their other coverage ends.
Administrator by participants or their Coverage will begin under this Plan no later
representatives. The Plan Administrator may be Can individuals Save Money on Health than the first day of the first month beginning
presented court orders which require child Insurance Premiums in the Marketplace? after the date the plan receives a timely
support, including health benefit coverage. The Individuals may qualify to save money and request for enrollment.
Plan Sponsor must recognize a Qualified lower monthly premiums, but only if their
Medical Child Support Order (QMCSO), within employer does not offer coverage, or offers If an employee acquires a new dependent as a
the meaning of ERISA section 609(a)(2)(B), coverage that doesn't meet certain standards. result of marriage, birth, adoption, or
under any Component Benefit Plan providing The savings on premiums depends on placement for adoption, they may be able to
health benefit coverage. household income. enroll him/herself and their dependents
provided that they request enrollment within
A QMCSO is a state court or administrative Does Employer Health Coverage Affect 30 days after the marriage, birth, adoption, or
agency order that requires an employer’s Eligibility for Premium Savings through the placement for adoption. If an employee adds
medical plan to provide benefits to the child of Marketplace? coverage under these circumstances, they may
an employee who is covered, or eligible for Yes. If the Employee has an offer of health add coverage mid-year. For a new spouse or
coverage, under the employer’s plan. QMCSOs coverage from his/her employer that meets dependent acquired by marriage, coverage is
usually apply to a child who is born out of certain standards, they will not be eligible for a effective no later than the first day of the first
wedlock or whose parents are divorced. If a tax credit through the Marketplace and may month beginning after the date the plan
QMCSO applies, the employee must pay for the wish to enroll in their employer's health plan. receives a timely request for the enrollment.
child’s medical coverage and will be required to However, an individual may be eligible for a tax When a new dependent is acquired through
join the Plan if not already enrolled. credit that lowers their monthly premium, or a birth, adoption, or placement for adoption,
reduction in certain cost-sharing if their coverage will become effective retroactive to
The Plan Administrator, when receiving a employer does not offer coverage at all or does the date of the birth, adoption, or placement
QMCSO, must promptly notify the employee not offer coverage that meets certain for adoption. The plan does not permit mid-
and the child that the order has been received standards. If the cost of a plan from an year additions of coverage except for newly
and what procedures will be used to determine employer that would cover the Employee (and eligible persons and special enrollees.
if the order is “qualified.” If the Plan not any other members of their family) is more
Administrator determines the order is qualified than 9.61% of household income for the year, Individuals gaining or losing Medicaid or State
and the employee must provide coverage for or if the coverage the employer provides does Child Health Insurance Coverage (SCHIP)
the child pursuant to the QMCSO, contributions not meet the "minimum value" standard set by If an employee or their dependent was:
for such coverage will be deducted from the the Affordable Care Act, the Employee may be 1. covered under Medicaid or a state child
employee’s paycheck in an amount necessary eligible for a tax credit.* health insurance program and that
to pay for such coverage. The affected coverage terminated due to loss of
employee will be notified once it is determined Note: If a health plan is purchased through the eligibility, or
the order is qualified. Participants and Marketplace instead of accepting health 2. becomes eligible for premium assistance
beneficiaries can obtain a copy of the coverage offered by an employer, then the under Medicaid or state child health
procedure governing QMCSO determinations Employee may lose the employer contribution insurance program, a special enrollment
from the Plan Administrator without charge. ❖ (if any) to the employer-offered coverage. Also, period under this Plan will apply.
this employer contribution - as well as the
New Health Insurance employee contribution to employer-offered The employee must request coverage under
coverage - is often excluded from income for this Plan within 60 days after the termination of
Marketplace Coverage Options Federal and State income tax purposes. Any such Medicaid or SCHIP, or within 60 days of

becoming eligible for the premium assistance health information (PHI)), as
from Medicaid or the SCHIP. Coverage under
the plan will become effective on the date of defined by HIPAA’s privacy rule) 4. Health Oversight Activities:
termination of eligibility for Medicaid/state for: To a health oversight agency for
child health insurance program, or the date of
activities such as audits,
eligibility for premium assistance under
Medicaid or SCHIP. ❖ 1. Payment and Health Care investigations, inspections,
Operations: In order to make licensure, and other proceedings
HIPAA Notice of coverage determinations and related to the oversight of the
payment (including, but not health plan.
Privacy Practices limited to, billing, claims
management, subrogation, and 5. Threats to Health or Safety:
THIS NOTICE DESCRIBES HOW plan reimbursement). For As required by law, to public
INDIVIDUAL MEDICAL example, the Plan may provide health authorities if the Plan, in
INFORMATION MAY BE USED information regarding an good faith, believes the disclosure
AND DISCLOSED AND HOW TO individual’s coverage or health is necessary to prevent or lessen a
GET ACCESS TO THIS care treatment to other health serious or imminent threat to an
INFORMATION. PLEASE REVIEW plans to coordinate payment of individual’s health or safety or to
IT CAREFULLY. benefits. Health information may the health and safety of the
also be used or disclosed to carry public.
HIPAA Notice of Privacy Practices out Plan operations, such as the
The The Children’s Home administration of the Plan and to 6. Judicial and Administrative
Association of Illinois Group provide coverage and services to Proceedings: In the course of any
Medical Plan (the “Plan”), which the Plan’s participants. For administrative or judicial
includes medical, dental, and example, the Plan may use health proceeding in response to an
flexible spending coverages information to project future order from a court or
offered under the The Children’s benefit costs, to determine administrative tribunal, in
Home Association of Illinois Plans, premiums, conduct or arrange for response to a subpoena, discovery
are required by law (under the case management or medical request or other similar process.
Administrative Simplification review, for internal grievances, for The Plan will make a good faith
provision of the Health Insurance auditing purposes, business attempt to provide written notice
Portability and Accountability Act planning and management to the individual to allow them to
of 1996 HIPAA’s privacy rule) to activities such as planning related raise an objection.
take reasonable steps to ensure analysis, or to contract for stop-
the privacy of personally loss coverage. Pursuant to the 7. Law Enforcement Purposes:
identifiable health information. Genetic Information Non- To a law enforcement official for
This Notice is being provided to Discrimination Act (GINA), the certain enforcement purposes,
inform employees (and any of Plan does not use or disclose including, but not limited to, the
their dependents) of the policies genetic information for purpose of identifying or locating
and procedures The Children’s underwriting purposes. a suspect, fugitive, material
Home Association of Illinois has witness or missing person.
implemented and their rights 2. Disclosure to the Plan Sponsor:
under them, as well as under As required, in order to administer 8. Coroners, Medical Examiners,
HIPAA. These policies are meant benefits under the Plan. The Plan or Funeral Directors: For the
to prevent any unnecessary may also provide health purpose of identifying a deceased
disclosure of individual health information to the plan sponsor to person, determining a cause of
information. allow the plan sponsor to solicit death or other duties as
premium bids from health authorized by law.
Use and Disclosure of individually insurers, to modify the Plan, or to
identifiable Health Information by amend the Plan. 9. Organ or Tissue Donation:
the Plan that Does Not Require If the person is an organ or tissue
the Individual’s Authorization: The 3. Requirements of Law: donor, for purposes related to
plan may use or disclose health When required to do so by any that donation.
information (that is protected federal, state or local law.
10. Specified Government treatment communications; (iii) copying, assembling costs and
Functions: For military, national disclosures that constitute a sale postage, if applicable, associated
security and intelligence activities, of PHI; and (iv) other uses and with their request.
protective services, and disclosures not described in this
correctional institutions notice. Right to Amend Your Health
and inmates. Information: You may request the
Individual Rights with Respect to Plan to amend your health
11. Workers’ Compensation: Personal Health Information: information if you feel that it is
As necessary to comply with Each individual has the following incorrect or incomplete. The Plan
workers’ compensation or other rights under the Plan’s policies has 60 days after the request is
similar programs. and procedures, and as required made to make the amendment. A
by HIPAA’s privacy rule: single 30-day extension is allowed
12. Distribution of Health-Related if the Plan is unable to comply
Benefits and Services: To provide Right to Request Restrictions on with this deadline. A written
information to the individual on Uses and Disclosures: An request must be provided to
health-related benefits and individual may request the Plan to HIPAA Privacy Officer, at The
services that may be of interest restrict uses and disclosures of Children’s Home Association of
to them. their health information. The Plan Illinois, 2130 N. Knoxville Ave,
will accommodate reasonable Peoria, IL 61603, 1-309-685-1047.
Notice in Case of Breach requests; however, it is not The request may be denied in
The Children’s Home Association required to agree to the request, whole or part and if so, the Plan
of Illinois is required to maintain unless it is for services paid will provide a written explanation
the privacy of PHI; to provide completely by the individual out of of the denial.
individuals with this notice of the their own pocket. A wish to
Plan’s legal duties and privacy request a restriction must be sent Right to an Accounting of
practices with respect to PHI; and in writing to HIPAA Privacy Officer, Disclosures: An individual may
to notify individuals of any breach at The Children’s Home request a list of disclosures made
of their PHI. Association of Illinois, 2130 N. by the Plan of their health
Knoxville Ave, Peoria, IL 61603, 1- information during the six years
Use and Disclosure of Individual 309-685-1047. prior to their request (or for a
Health Information by the Plan specified shorter period of time).
that Does Require Individual Right to Inspect and Copy However, the list will not include
Authorization: Other than as Individual Health Information: An disclosures made: (1) to carry out
listed above, the Plan will not use individual may inspect and obtain treatment, payment or health care
or disclose without your written a copy of their individual health operations; (2) disclosures made
authorization. You may revoke information maintained by the prior to April 14, 2004; (3) to
your authorization in writing at Plan. The requested information individuals about their own health
any time, and the Plan will no will be provided within 30 days if information; and (4) disclosures
longer be able to use or disclose the information is maintained on for which the individual provided a
the health information. However, site or within 60 days if the valid authorization.
the Plan will not be able to take information is maintained offsite.
back any disclosures already made A single 30-day extension is A request for an accounting form
in accordance with the allowed if the Plan is unable to must be used to make the request
Authorization prior to its comply with the deadline. A and can be obtained by contacting
revocation. The following uses and written request must be provided the HIPAA Privacy Officer at The
disclosures will be made only with to HIPAA Privacy Officer at The Children’s Home Association of
authorization from the individual: Children’s Home Association of Illinois, 2130 N. Knoxville Ave,
(i) most uses and disclosures of Illinois, 2130 N. Knoxville Ave, Peoria, IL 61603, 1-309-685-1047.
psychotherapy notes (if recorded Peoria, IL 61603, 1-309-685-1047. The accounting will be provided
by a covered entity); (ii) uses and If the individual requests a copy of within 60 days from the
disclosures of PHI for marketing their health information, the Plan submission of the request form.
purposes, including subsidized may charge a reasonable fee for An additional 30 days is allowed if
this deadline cannot be met. with the Plan, they must contact about where you can get
the HIPAA Contact Person, at The
Right to Receive Confidential Children’s Home Association of
help to make decisions
Communications: An individual Illinois, 2130 N. Knoxville Ave, about your prescription
may request that the Plan Peoria, IL 61603, 1-309-685-1047. drug coverage is at the end
communicate with them about They may also file a complaint of this notice.
their health information in a with the Secretary of Health and
certain way or at a certain location Human Services if they believe
if they feel the disclosure could their privacy rights have There are two important
endanger them. The individual been violated. ❖ things you need to know
must provide the request in about your current
writing to the HIPAA Privacy Important Notice from
Officer at The Children’s Home coverage and Medicare’s
Association of Illinois, 2130 N.
The Children’s Home prescription
Knoxville Ave, Peoria, IL 61603, 1- Association of Illinois drug coverage:
309-685-1047. The Plan will about Your Prescription
attempt to honor all Drug Coverage and
reasonable requests. 1. Medicare prescription
Medicare drug coverage became
Right to a Paper Copy of this (Creditable Coverage) available in 2006 to
Notice: Individuals may request a
everyone with Medicare.
paper copy of this Notice at any Please read this notice
time, even if they have agreed to You can get this coverage if
carefully and keep it where
receive this Notice electronically. you join a Medicare
They must contact their HIPAA you can find it. This notice
Prescription Drug Plan or
Privacy Officer at The Children’s has information about
Home Association of Illinois, 2130 join a Medicare Advantage
your current prescription
N. Knoxville Ave, Peoria, IL 61603, Plan (like an HMO or PPO)
1-309-685-1047 to make
drug coverage with The
that offers prescription
this request. Children’s Home
drug coverage. All
Association of Illinois and
The Plan’s Duties: The Plan is Medicare drug plans
about your options under
required by law to maintain the provide at least a standard
privacy of individual health
Medicare’s prescription
level of coverage set by
information as related in this drug coverage. This
Medicare. Some plans may
Notice and to provide this Notice information can help you
of its duties and privacy practices. also offer more coverage
decide whether or not you
The Plan is required to abide by for a higher
the terms of this Notice, which want to join a Medicare
monthly premium.
may be amended from time to drug plan. If you are
time. The Plan reserves the right considering joining, you
to change the terms of this Notice 2. The Children’s Home
and to make the new Notice
should compare your
Association of Illinois has
provisions effective for all health current coverage, including
determined that the
information that it maintains. which drugs are covered at
prescription drug coverage
what cost, with the
Complaints and Contact Person: offered by the The
If an individual wishes to exercise
coverage and costs of the
Children’s Home
their rights under this Notice, plans offering Medicare
Association of Illinois Plan
communicate with the Plan about prescription drug coverage
its privacy policies and is, on average for all plan
in your area. Information
procedures, or file a complaint
under Medicare Prescription Drug Coverage
participants, expected to If you do decide to join a Medicare drug plan More detailed information about Medicare
pay out as much as and drop your current The Children’s Home
Association of Illinois coverage, be aware that
plans that offer prescription drug coverage is in
the “Medicare & You” handbook. You’ll get a
standard Medicare you and your dependents will be able to get copy of the handbook in the mail every year
this coverage back. from Medicare. You may also be contacted
prescription drug coverage directly by Medicare drug plans.
When Will You Pay A Higher Premium
pays and is therefore (Penalty) To Join A Medicare Drug Plan? For more information about Medicare
considered Creditable You should also know that if you drop or lose
your current coverage with The Children’s
prescription drug coverage:
• Visit www.medicare.gov
Coverage. Because your Home Association of Illinois and don’t join a • Call your State Health Insurance
Medicare drug plan within 63 continuous days Assistance Program (see the inside back
existing coverage is after your current coverage ends, you may pay cover of your copy of the “Medicare &
a higher premium (a penalty) to join a Medicare You” handbook for their telephone
Creditable Coverage, you drug plan later. number) for personalized help
can keep this coverage and If you go 63 continuous days or longer without
• Call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048.
not pay a higher premium creditable prescription drug coverage, your
monthly premium may go up by at least 1% of If you have limited income and resources, extra
(a penalty) if you later the Medicare base beneficiary premium per help paying for Medicare prescription drug
month for every month that you did not have
decide to join a Medicare that coverage. For example, if you go nineteen
coverage is available. For information about
this extra help, visit Social Security on the web
drug plan. months without creditable coverage, your
premium may consistently be at least 19%
at www.socialsecurity.gov, or call them at 1-
800-772-1213 (TTY 1-800-325-0778).
higher than the Medicare base beneficiary
When Can You Join A Medicare Drug Plan? premium. You may have to pay this higher Remember: Keep this Creditable Coverage
You can join a Medicare drug plan when you premium (a penalty) as long as you have notice. If you decide to join one of the
first become eligible for Medicare and each Medicare prescription drug coverage. In Medicare drug plans, you may be required to
year from October 15th to December 7th. addition, you may have to wait until the provide a copy of this notice when you join to
following October to join. show whether or not you have maintained
However, if you lose your current creditable creditable coverage and, therefore, whether
prescription drug coverage, through no fault of For More Information about this Notice or or not you are required to pay a higher
your own, you will also be eligible for a two (2) Your Current Prescription Drug Coverage premium (a penalty).
month Special Enrollment Period (SEP) to join a Contact the person listed below for further
Medicare drug plan. information. NOTE: You’ll get this notice each Date: 11/06/2023
year. You will also get it before the next period Name of Entity/Sender: The Children’s Home
What Happens To Your Current Coverage If you can join a Medicare drug plan, and if this Association of Illinois
You Decide to Join A Medicare Drug Plan? coverage through The Children’s Home Contact--Position/Office: Human Resources
If you decide to join a Medicare drug plan, your Association of Illinois changes. You also may Address: 2130 N. Knoxville Ave, Peoria, IL
current The Children’s Home Association of request a copy of this notice at any time. 61603
Illinois coverage will not be affected. Phone Number: 1-309-685-1047 ❖
For More Information about Your Options

Notes

Notes


2024 CHAIL Benefit Guide

Uploaded by

Copyright:

Available Formats

2024 CHAIL Benefit Guide

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2024 CHAIL Benefit Guide

Uploaded by

Copyright:

Available Formats

Benefits Guide Children’s Home Association of Illinois | 2024

Human Resources Page 1

Human Resources Page 2

Coverage/Service Carrier Contact

Voluntary Hospital Indemnity

Human Resources Page 3

Definition of “Eligible Dependents”

Working Spouse Provision

Human Resources Page 4

New this Year!

• Company Paid Life/AD&D: Children's Home Association of

• NEW! Accident: Now offered through MetLife! This

Human Resources Page 5

How My Medical Plan Works

Human Resources Page 6

Human Resources Page 7

FSA Frequently Asked Questions

What are the annual contribution limits?

Human Resources Page 8

Health Savings Account (HSA)

• It saves you money. HDHPs have lower monthly

Watch the video below for more information:

Human Resources Page 9

Generic Drugs $10 Copay $20 Copay 20% after Ded.

Human Resources Page 10

How to Find a Medical Provider

Just Follow These Steps to Find a

• Go to: UMR.com – available 24/7/365.

Human Resources Page 11

Virtual Doctor Visits

Teladoc can be a great alternative to visiting your normal

How Does It Work?

Teladoc Contact Information

*Prescription services may not be available in all states.

Common Conditions We Treat

Human Resources Page 12

Prescription Drug Program

Human Resources Page 13

To locate a participating dentist please see www.metlife.com.

Per-Paycheck (26) Employee Only $15.78

Human Resources Page 14

Locate a Preferred Provider at www.metlife.com.

Contact Lenses $100 allowance Up to $80 allowance

Employee Only $3.39

Human Resources Page 15

Basic Group Life

Basic Group Life

Benefits may be reduced for employees over age 65 per ADEA.

Important – Please Read!

Human Resources Page 16

Employee Assistance Program

• Marital and family conflicts

Phone Based Support In-Person or Telehealth Counseling Telephonic Life Coaching

Human Resources Page 17

PTO & Sick Leave

0-2 15 120 hours 15 90 hours 15 60 hours

Holidays Kiefer School & Academy for Autism PTO

Human Resources Page 18

If you elect additional coverage for yourself, you may then

Human Resources Page 19