Page 11 - 2015 Four Seasons Non-Medical Enrollment Guide
P. 11
2015 Open Enrollment
Summaries of Benefits and Coverage
As a result of the Patient Protection and Affordable Care Act (PPACA)
and Health Care Reform legislation, summaries of beneits and coverage 2013 Summary Annual Report
(SBCs) for the medical options and Employee Assistance Program are
available online. We encourage you to read and keep a copy of the SBC Available in November
for future reference. To access the SBCs online, visit the My Four Seasons The 2013 Summary Annual Report
Beneits website at https://fsbeneits.fourseasons.com. Then, click on the (SAR) for the Four Seasons beneit
Beneits tab, and then the Health Plans tab. If you would like a printed copy plans will be available in November. To
mailed to your home, please call the My Four Seasons Beneits Center at access the SAR online, visit the My Four
1-866-672-0435 (toll free) and speak with a representative. Seasons Beneits website beginning in
The SBC requirement is intended to standardize the description of medical November. Then, click on the Forms
options in the United States so that individuals can easily compare medical and Materials tab. If you would like a
option choices. While the SBC is a concise “snapshot” of each available printed copy mailed to your home,
medical option, the SBC is not intended to take the place of the Summary please call the My Four Seasons
Plan Description. Your eligibility and beneits will only be determined in Beneits Center and speak with a
accordance with and subject to the Summary Plan Description. representative.
Summary Plan Descriptions Available
To help you better understand your health and welfare beneits as well
as your rights and responsibilities under the Four Seasons beneit plans, New Out of Pocket
Four Seasons has updated the Summary Plan Descriptions (SPDs) for the Maximum Limit for In-
plans available to you and your eligible dependents. We encourage Network Services
you to read and keep a copy of the SPD for future reference. To access
the SPDs online, visit the My Four Seasons Beneits Center website at The Affordable Care Act requires a
https://fsbeneits.fourseasons.com. Then, click on the Beneits tab, and then limit on your medical out-of-pocket
the Health Plans tab. If you would like a printed copy, please call the My maximum. The medical out-of-pocket
Four Seasons Beneits Center at 1-866-672-0435 (toll free) and speak with a limit takes into account all cost-
representative. sharing amounts you pay for medical
and prescription drugs under the
Medicare Part D Notice medical plan. Deductibles, copays,
coinsurance, and similar charges count
The Medicare Part D Notice is not included in the Open Enrollment Guide as toward your out-of-pocket maximum.
it was mailed to your home on October 1, 2014. For a copy of the notice in However, this does not include charges
English or Spanish, please log onto the My Four Seasons Beneits website at for non-covered services, amounts you
https://fsbeneits.fourseasons.com. Then, click on the Forms and Materials pay for out-of-network claims, provider
tab. To request a printed copy be mailed to your home, call the My Four balance-billed amounts, amounts
Seasons Beneits Center at 1-866-672-0435 (toll free). you pay above any reference price,
amounts you pay when you do not
receive services at a network location,
or network provider speciically
designated for your services, or special
charges and penalties.
11
Summaries of Benefits and Coverage
As a result of the Patient Protection and Affordable Care Act (PPACA)
and Health Care Reform legislation, summaries of beneits and coverage 2013 Summary Annual Report
(SBCs) for the medical options and Employee Assistance Program are
available online. We encourage you to read and keep a copy of the SBC Available in November
for future reference. To access the SBCs online, visit the My Four Seasons The 2013 Summary Annual Report
Beneits website at https://fsbeneits.fourseasons.com. Then, click on the (SAR) for the Four Seasons beneit
Beneits tab, and then the Health Plans tab. If you would like a printed copy plans will be available in November. To
mailed to your home, please call the My Four Seasons Beneits Center at access the SAR online, visit the My Four
1-866-672-0435 (toll free) and speak with a representative. Seasons Beneits website beginning in
The SBC requirement is intended to standardize the description of medical November. Then, click on the Forms
options in the United States so that individuals can easily compare medical and Materials tab. If you would like a
option choices. While the SBC is a concise “snapshot” of each available printed copy mailed to your home,
medical option, the SBC is not intended to take the place of the Summary please call the My Four Seasons
Plan Description. Your eligibility and beneits will only be determined in Beneits Center and speak with a
accordance with and subject to the Summary Plan Description. representative.
Summary Plan Descriptions Available
To help you better understand your health and welfare beneits as well
as your rights and responsibilities under the Four Seasons beneit plans, New Out of Pocket
Four Seasons has updated the Summary Plan Descriptions (SPDs) for the Maximum Limit for In-
plans available to you and your eligible dependents. We encourage Network Services
you to read and keep a copy of the SPD for future reference. To access
the SPDs online, visit the My Four Seasons Beneits Center website at The Affordable Care Act requires a
https://fsbeneits.fourseasons.com. Then, click on the Beneits tab, and then limit on your medical out-of-pocket
the Health Plans tab. If you would like a printed copy, please call the My maximum. The medical out-of-pocket
Four Seasons Beneits Center at 1-866-672-0435 (toll free) and speak with a limit takes into account all cost-
representative. sharing amounts you pay for medical
and prescription drugs under the
Medicare Part D Notice medical plan. Deductibles, copays,
coinsurance, and similar charges count
The Medicare Part D Notice is not included in the Open Enrollment Guide as toward your out-of-pocket maximum.
it was mailed to your home on October 1, 2014. For a copy of the notice in However, this does not include charges
English or Spanish, please log onto the My Four Seasons Beneits website at for non-covered services, amounts you
https://fsbeneits.fourseasons.com. Then, click on the Forms and Materials pay for out-of-network claims, provider
tab. To request a printed copy be mailed to your home, call the My Four balance-billed amounts, amounts
Seasons Beneits Center at 1-866-672-0435 (toll free). you pay above any reference price,
amounts you pay when you do not
receive services at a network location,
or network provider speciically
designated for your services, or special
charges and penalties.
11
