Page 2 - Sumitomo EE Guide 06-19 Final - English

Welcome to Sumitomo Rubber North America, Inc!

This guide provides a summary of your benefit options and is designed to help you make choices and enroll for coverage. If you
would like more information about any of the benefits described here please contact the Human Resources Department.

CONTENTS

Important Information ………………………………………… 2 Travel Accident …………………………………………………… 15

Enrollment Information ……………………………………….. 3 Disability Insurance …………………………………………….. 15
Online Benefits Enrollment ………………………………….. 4 Employee Assistance Program ……………………………. 16

Employee Contributions ………………………………………. 5 Value-Added Programs ………………………………………. 16
Resources and Contacts ………………………………………. 6 Flexible Spending Accounts ………………………………… 17
Medical Insurance ……………………………………………….. 7 Voluntary Benefits …………………….……………………….. 18
Dental Insurance …………………………………………………. 12 Retirement Planning …………………………………………… 18

Vision Insurance ………………………………………………….. 13 Paid-Time Off ……………………………………………………... 19
Life and AD&D Insurance …………………………………….. 14 Whistleblower Hotline ……….………………………………. 20

IMPORTANT INFORMATION

THE AFFORDABLE CARE ACT AND YOU

The Affordable Care Act (ACA) requires applicable large employers to make affordable coverage available to their employees or risk
paying a penalty. Although the individual mandate is no longer effective beginning January 1, 2019, it is important that you
understand your options for health insurance coverage. You may consider these options below:
• Enroll in a medical plan offered by Sumitomo Rubber North America, Inc. (SRNA) or another group plan
• Purchase coverage through a health insurance marketplace
• Enroll in coverage through a government sponsored program

Because SRNA’s medical plans are considered affordable and meet minimum value under Health Care Reform, you will not
generally see lower premiums or out-of-pocket costs through the marketplace. In addition, employer contributions to your medical
benefits will be lost if you choose to purchase coverage through the marketplace, and your portion of medical premiums will no
longer be paid via payroll deductions on a pre-tax basis.

FOR MORE INFORMATION
Go to www.healthcare.gov

ANNUAL NOTICES

Various state and federal laws require that employers provide disclosure and annual notices to their plan participants. SRNA has
posted all federally required annual notices on Paycom for you to download and read at your convenience.

The following is a list of the annual notices:
• Medicare Part D Notice of Creditable Coverage • Medicaid & Children’s Health Insurance Program
• Women's Health and Cancer Rights Act (WHCRA) • HIPAA Notice of Privacy Practices
• Newborns’ and Mothers’ Health Protection Act • Summary of Benefits and Coverage (SBC)
• Special Enrollment Rights

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