Page 8 - KEMBA CHARLESTON FCU

KEMBA CHARLESTON FCU 2017-18

Benefits Provided to Our Employees

✓ Medical Coverage

✓ Dental Coverage
✓ Vision Coverage

✓ Group Life Insurance
✓ Group Accidental Death and Dismemberment (AD&D) Insurance

✓ Group Supplemental Life for Spouse/Dependents
✓ Short-Term Disability (STD) Insurance

✓ Long-Term Disability (LTD) Insurance

Waiver of Medical Coverage – Opt Out Option

You may elect to waive medical coverage from Kemba Charleston FCU 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 no monetary subsidy to the
eligible employee.

Should you suffer a HIPAA status change event, you may be added to
Kemba Charleston FCU’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), is mandatory.

The SBC should be used in conjunction with the benefit summary of your medical coverage from Kemba
Charleston FCU and the benefit guide found in the Member Section of the carrier’s website. Click here to
view your SBC.

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