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Legal Notices
General Information: New York State Notices:
NY COBRA Extension
This law increases the coverage period under the Consolidated Omnibus Reconciliation Act (COBRA) and NY State Continuation (SC) from 18 months to 36 months for all qualifying events.
NY Young Adult Option Extension to Age 29 – In General*
This New York law provides for an expansion of coverage for adult children who age off the plan at age 26 to continue coverage through age 29 if certain requirements are met. The child will continue coverage under a separate single contract. Under the law, the parent must be covered for the child to become or remain covered. The child does not have to live with a parent, be financially dependent on a parent, or be a student to be covered. He or she must meet all the following criteria:
• Be less than 30 years of age;
• Be unmarried;
• Live, work or reside in New York state, or in the insurer’s network
service area for the plan;
• Not be eligible for coverage as participant of any other New York-
insured or self-insured employee health plan; and
• Not be covered under Medicare.
Dependent children can sign up for young adult coverage:
• Within 60 days after reaching the maximum age
• Within 60 days of experiencing a qualifying life status change • During a future open enrollment period held for the group plan
Generally, coverage is prospective and will begin within 30 days after notice of your election and premium payment is received. For a child reaching the maximum age, coverage will be retroactive to the date coverage termed.
To enroll, you must notify HR in writing, complete the required forms and pay the premium. The cost of coverage is the single employee rate.
*Consider whether COBRA or the NY Young Adult Option will best meet your child’s needs. If the NY extension to age 29 is elected, COBRA will not apply.
Legal Notices
Dragados reserves the right to change, amend, or terminate any benefits plan at any time for any reason. Participation in a benefit plan is not
a promise or guarantee of future employment. Receipt of benefits documents does not constitute eligibility.
Statement of Material Modifications
This enrollment guide constitutes a Summary of Material Modifications (SMM) or Summary of Material Reductions (SMR), as applicable, to the Dragados Health and Welfare Plan Summary Plan Description (SPD). It
is meant to supplement and/or replace certain information in the SPD, so retain it for future reference along with your SPD. Please share these materials with your covered family members.
Summary of Benefits Coverage
A Summary of Benefits Coverage (SBC) for each of the employer- sponsored medical plans may be requested by calling UnitedHealthcare at: 1-800-UnitedHealthcare24 (1-800-244-6224). You may also request a paper copy of SBC by contacting UnitedHealthcare.
Summary Annual Report for Dragados USA Health Plans
This is a summary of the annual report of the DRAGADOS USA HEALTH PLAN, EIN 20-3902316, Plan No. 502, for period 01/01/2019 through 12/31/2019. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Insurance Information: The plan has contracts with CIGNA HEALTH AND LIFE INSURANCE COMPANY,VISION SERVICE PLAN, CIGNA BEHAVIORAL HEALTH, INC., and CIGNA LIFE INSURANCE COMPANY OF NEW YORK to pay Medical, Dental, Vision, Life Insurance, Short-term Disability, Long- term Disability, Accidental Death and Dismemberment, and Employee
Assistance Program claims incurred under the terms of the plan. The total premiums paid for the plan year ending 12/31/2019 were $29,100,031. Because they are so called “experience-rated” contracts, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the plan year ending 12/31/2019, the premiums paid under such “experience-rated” contracts were $20,792,406 and the total of all benefit claims paid under these contracts during the plan year was $18,972,273..
Your Rights To Additional Information: You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: insurance information, including sales commissions paid by insurance carriers; To obtain a copy of the full annual report, or any part thereof, write or call the office of Dragados USA Group at 810 7th Avenue, 9th floor, New York, NY, 10019 or by telephone at 212-779-0900. You also have the legally protected right to examine the annual report at the main office of the plan (Dragados USA Group, 810
7th Avenue, 9th floor, New York, NY, 10019) and at the U.S. Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room, Room N1513, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20220.
Important Notice From Dragados About Creditable Prescription Drug Coverage and Medicare
The purpose of this notice is to advise you that the prescription drug coverage listed below under the Dragados medical plan is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2021. This is known as “creditable coverage.”
Why this is important?
If you or your covered dependent(s) are enrolled in any prescription drug coverage during 2021 listed in this notice and are or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty —as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.
If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you.
Please read the notice below carefully. It has information about prescription drug coverage with Dragados and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.
Notice of Creditable Coverage
You may have heard about Medicare’s prescription drug coverage
(called Part D), and wondered how it would affect you. Prescription
drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals leaving employer coverage may be eligible for a Medicare Special
Enrollment Period.
If you are covered by one of the Dragados prescription drug plans listed below, you’ll be interested to know that coverage is, on average, at least as good as standard Medicare prescription drug coverage for 2019. This
is called creditable coverage. Coverage under one of these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare prescription drug plan.
—UnitedHealthcare EPO Plan $1000 Deductible —UnitedHealthcare OAP Plan $500 Deductible —UnitedHealthcare HSA Qualified Plan $1500 Deductible
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