Page 28 - American Advisors Group Benefit Guide 2_NonCA

EMPLOYEE BENEFITS 28

IMPORTANT NOTICES

ADA Wellness Notice: Plan Administrator
Your health plan is committed to helping you achieve your best American Advisors Group Human Resources
health. Rewards for participating in a wellness program are available 3800 W. Chapman Avenue Orange, CA 92868
to all employees. If you think you might be unable to meet a 866.948.0003
standard for a reward under this wellness program, you might qualify
for an opportunity to earn the same reward by different means. HIPAA Privacy Official
Contact your HR Department and we will work with you (and if you
wish with your doctor) to find a wellness program with the same Ari Sanchez
reward that is right for you in light of your health status. Benefits & Compensation Manager
949.224.3727
NOTICE REGARDING WELLNESS PROGRAM
American Advisors Group Wellness program is a voluntary wellness HIPAA Special Enrollment Deadline
program available to all employees. The program is administered 30 days
according to federal rules permitting employer-sponsored wellness
programs that seek to improve employee health or prevent Members of Organized Health Care Arrangement
disease, including the Americans with Disabilities Act of 1990, the » American Advisors Group
Genetic Information Nondiscrimination Act of 2008, and the Health
Insurance Portability and Accountability Act, as applicable, among » Cigna Healthcare
others. If you choose to participate in the wellness program you will » HSABank
be asked to complete a voluntary health risk assessment or “HRA”
that asks a series of questions about your health-related activities » Gallagher Benefit Services
and behaviors and whether you have or had certain medical
conditions (e.g., cancer, diabetes, or heart disease). You will also Women’s Health and Cancer Rights Notice
be asked to complete a biometric screening, which will include a The Company is required by law to provide you with the following
blood test for a fasting expanded profile. You are not required to notice: The Women’s Health and Cancer Rights Act of 1998
complete the HRA or to participate in the blood test or other (“WHCRA”) provides certain protections for individuals receiving
medical examinations.
mastectomy- related benefits. Coverage will be provided in a
However, employees who choose to participate in the wellness manner determined in consultation with the attending physician
program will receive an incentive of being entered in a raffle for and the patient, for:
giveaways provided by insurance carriers. Although you are not
required to complete the HRA or participate in the biometric » All stages of reconstruction of the breast on which the
screening, only employees who do so will receive the entry to the mastectomy was performed;
raffle. » Surgery and reconstruction of the other breast to produce a
If you are unable to participate in any of the health-related symmetrical appearance;
activities or achieve any of the health outcomes required to earn » Prostheses; and
an incentive, you may be entitled to a reasonable » Treatment of physical complications of the mastectomy,
accommodation or an alternative standard. You may request a
reasonable accommodation or an alternative standard by including lymphedemas, in a manner determined in
contacting your HR Department. consultation with the attending physician and the patient.
The information from your HRA and the results from your biometric Such coverage may be subject to annual deductibles and
screening will be used to provide you with information to help you coinsurance provisions as may be deemed appropriate and are
understand your current health and potential risks, and may also be consistent with those established for other benefits under the plan
used to offer you services through the wellness program. You also are or coverage. Written notice of the availability of such coverage
encouraged to share your results or concerns with your own doctor. shall be delivered to the participant upon enrollment and annually
thereafter.
Company Name (the “Company”)
The Company’s plan(s) provide medical coverage for
American Advisors Group mastectomies and the related procedures listed above, subject to
the same deductibles and coinsurance applicable to other
Effective Date medical and surgical benefits provided under this plan.

January 1, 2020 If you would like more information on WHCRA benefits, please refer
to your Summary Plan Description/Policy booklet or contact the
Creditable Plan Name(s) Plan Administrator.
American Advisors Group Welfare Benefits Plan or the “Plan”