Page 12 - 2013 Salus Group Benefits and Notices

Benefits Partner, LLC dba Salus Group 2013

Waiver of Medical Coverage – Opt Out Option

You may elect to waive medical coverage from Salus Group if you have
and can provide proof of existing coverage from another source (spouse,
parent, etc). When proof of coverage is provided to Human Resources and
validated, you will be eligible to enroll in the dental and/or vision plans. The
Opt Out Option provides a monetary subsidy to the eligible employee.
Please see Human Resources for the opt out subsidy amount for this
enrollment period.

Should you suffer a HIPAA status change event, you may be added to
Salus Group’s medical plan mid-year only if notification is given to Human
Resources no later than 30 days of the event.

Summary of Benefits & Coverage

In accordance with the changes mandated by federal health care reform effective the first plan year
following 09/23/2012, this is your Summary of Benefits & Coverage (SBC) for our medical plan.

The purpose of the SBC is to provide an explanation of your medical and prescription benefits (if any) in
an easy to read format. The SBC should look the same for any health plan from any employer since the
format, developed by the federal Department of Labor (DOL), a mandatory.

The SBC should be used in conjunction with the benefit table in the Medical Coverage section of this
booklet and the benefit guide found in the Member Section of the carrier’s website or click HERE to
access it now.

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