Page 2 - 2013-14 MFCU benefits & Notices
P. 2
Members First CU 2013-14
Table of Contents
Introduction ........................................................................................................................................ 3
Changing Your Benefits ....................................................................................................................... 3
Newborns’ & Mothers’ Health Protection ............................................................................................ 4
Women’s Health & Cancer Rights Act (WHCRA) ................................................................................... 4
Protecting Your Privacy ....................................................................................................................... 4
Michelle’s Law .................................................................................................................................... 4
New Health Insurance Marketplace Coverage Options and Your Health Coverage................................ 5
Medical Coverage ............................................................................................................................... 8
Waiver of Medical Coverage – Opt Out Option .................................................................................... 8
Dental Coverage ............................................................................................................................... 10
Vision Coverage ................................................................................................................................ 11
Health Reimbursement Arrangement (HRA) ...................................................................................... 12
Flexible Spending Accounts (FSA) ....................................................................................................... 13
Basic Life/Accidental Death & Dismemberment (AD&D) Coverage ..................................................... 15
Short Term Disability (STD) Coverage ................................................................................................ 15
Long Term Disability (LTD) Coverage ................................................................................................. 16
Voluntary Supplemental Insurance Plans ........................................................................................... 17
Employee Contributions .................................................................................................................... 18
For More Information About Our Coverage ....................................................................................... 18
General Notice of COBRA Continuation Coverage Rights .................................................................... 19
Notice of Creditable Coverage for Medicare Rx .................................................................................. 23
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) ................. 25
Summary of Benefits Coverage – Active Employee Plan PPO 14/0 ...................................................... 28
Summary of Benefits Coverage – Special Retiree Plan SB PPO 2500 .................................................... 36
Information about Medicare
If you have Medicare or will become eligible for Medicare within the next 12 months, a new Federal law gives you more
choices about your prescription drug coverage. Please see pages 23-24 for details.
Important Note
This Benefits Enrollment Guide is only a brief summary of your benefits. It is not intended to provide a complete description of each plan.
Please refer to the Summary Plan Description and any other official documents for complete information about each benefit. We have tried to
ensure its accuracy but if there is any discrepancy between the benefits discussed in the guide and the official plan documents, the official plan
documents will rule. The company reserves the right to amend or terminate the Plan at any time and for any reason. The information in the
guide and accompanying materials applies to the Members First Credit Union Employee Benefit Plan, Plan Number 501, and meets the
requirements for a Summary of Material Modification as required by the Employee Retirement Income Security Act (ERISA).
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