EMPLOYEE BENEFITS SUMMARY Selfhelp Community Services offers a comprehensive health and life insurance benefits package to employees. All employees who work a regular schedule of at least 20 hours per week are eligible for health and life insurance benefits. Coverage is effective the first of the month following two months of eligible employment. Selfhelp pays most of premium costs for a full-time, regular employee's individual coverage. Full-time employees must contribute $1.00 toward the cost of their health insurance coverage on a bi-weekly basis. Employees who work a regular schedule of at least 20 but less than 35 hours per week are responsible for the pro-rated percentage of the individual premium costs. Employees may elect family coverage at a cost of 50% of the premium for such coverage. Employees will be responsible for premium payments while on paid or unpaid leaves of absence, including Family and Medical Leave. Employees who are eligible to elect family coverage who do not choose medical coverage for themselves or their families when first eligible, may only be covered subsequently during the annual open enrollment period in December, unless there is a life event, e.g. loss of coverage, birth of a child, increase in premiums. If there is a life event, the Human Resources department must be notified within 30 days from the day of the event (i.e. loss of coverage) in order to enroll into our health insurance plans. Eligible employees who do not elect dental coverage for themselves or their dependents when first eligible will be subject to a 6 month waiting period for regular services and a 24 month waiting period for periodontal and special services. During the 6-month waiting period for regular services only routine oral exams and x-rays are covered with employees retaining responsibility for applicable deductible and co-payments. The health and life insurance plans offered by Selfhelp are: Choice of primary medical coverage between Oxford-Freedom Access-POS, Oxford-EPO and HIP/POS. Dental plan through Aetna US Health Care. Life Insurance and Accidental Death and Dismemberment Insurance through CIGNA Group Insurance. The above health insurance coverage are in effect for injuries/illnesses not compensable under NYS Workers Compensation or (in most circumstances) under mandatory automobile no-fault benefits. Before giving further details about each plan's benefits, it is important to distinguish between an HMO (Health Maintenance Organization) and an Indemnity Plan. HMOs provide a comprehensive network of health services within established facilities or through participating physicians and hospitals. Generally, individuals covered by HMO's have fewer out-of-pocket costs and few, if any, claim forms to file. One need not necessarily suspect or be symptomatic of illness in order to take advantage of HMO services. Not all physicians and hospitals, however, participate in HMO's; therefore, one does not have total freedom in choosing doctors and hospitals for medical services. Indemnity health insurance plans are more traditional plans offering some reimbursement of medically necessary services after certain conditions (determined by the insurance carrier) are met. Typically individuals covered by indemnity plans must first satisfy a deductible before any reimbursement of services begins. Once the deductible is met, some reimbursement of services takes place; normally the covered individual is responsible for a percentage of medical costs until he/she meets an established limit at which time the insurance carrier may start to reimburse at 100%. The insurance carrier would reimburse per its schedule to the extent it deems charges to be reasonable and customary. It is necessary in most cases for claim forms to be filed for reimbursement. One does, however, have total freedom in choosing doctors and hospitals for medical services. MEDICAL INSURANCE OXFORD-FREEDOM ACCESS-POS PLAN As a combined HMO/Indemnity Plan, this plan offers a covered individual the choice of receiving medical services through the HMO network or from any medical service provider outside the Oxford Freedom network. This Plan gives access to 73,000 Freedom network physicians and other providers in the tri-state area, and 99% of the doctors and specialist are either board-certified or board-eligible. The HMO provisions of coverage cover in-network services and out-of-network services are covered on an indemnity basis. Unlimited days per year are covered for hospitalization provided Oxford authorizes such hospitalization. Oxford requires pre-certification of planned hospitalizations and certain services; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. If a covered individual uses the HMO portion of the Oxford/Pos plan, he/she need not meet a deductible nor usually file claim forms for benefits. Generally, a covered individual's care is rendered or coordinated by a participating primary physician within his/her private office. Co-payments of $20.00 are required for visits to one's primary care physician, and 35.00 for a specialist. There is no charge for preventive care within the Oxford network; however the benefit is limited when you go out of network. A member does not need a referral to visit an in-network specialist. Co-payments apply also for hospital emergency room services and hospitalization and urgent care facilities and home physician visits. Outpatient mental health services for out-of-network coverage are subject to the deductible and 30% (coinsurance) of the usual and customary amount, while in-network services require a $35.00 co-pay per visit (up to a maximum of 30 visits/ year). In-patient mental health care, for up to 30 days for biological based services, is provided with$250 co-pay; out-of-network is subject to the deductible and coinsurance. Outpatient care for drug/alcohol addiction is subject to the deductible and coinsurance when out-of-network and no charge (up to a maximum of 60 visits/ year) for in-network coverage. In-patient care for drug/alcohol addiction, for up to 30 days, is provided with$250 co-pay; out-of-network is subject to the deductible and 50% coinsurance. When utilizing the indemnity portion of the health plan, a deductible of $1000.00 per person per calendar year (to a maximum of $13000.00 per family) is applied before a 70% reimbursement of reasonable and customary covered expenses begins. A covered individual is responsible for 30% (coinsurance) of reasonable and customary covered expenses after meeting the deductible until s/he has paid $4000 out of pocket (including the deductible to maximum of $12,000.00 per family). Any physician may render medical treatment. Oxford’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for Oxford are follows: $15 for Tier I Drugs $25 for Tier II Drugs $50 for Tier III Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." The prescription tiers described above are based on cost. You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Medco. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for Oxford is provided for two co-pays for a three months supply. For Emergency care, covered employees are responsible for $100.00 co-pay (waived if admitted). For hospitalization in-network, employees are responsible for $250.00 co-pay, out of network the services are subject to the deductible and 30% coinsurance. Additionally, Oxford has Wellness programs designed to encourage a healthy life style. Oxford promotes the following Wellness Programs: Quit Smoking, Lose Weight, Emotional Health, Health& Fitness, Family and work, Financial and Legal and ask our Expert. Oxford also has a Fitness Center Discount Program, where Oxford subscribers receive up to $200 per six-month period and for spouse100.00 every six-month period when you visit a gym that promotes cardiovascular wellness. The Gym reimbursement form is enclosed with the Oxford enrollment package. Keep in mind that the facility must provide a cardiovascular exercise program and at least one of the two services: Pool, treadmill, rowing machine, elliptical cross trainer, bicycle, group exercise, and step machine, walking or running group, tennis / racquetball courts. OXFORD-EPO PLAN The Oxford Exclusive Provider Organization offers a covered individual medical services through the HMO network; from any medical service provider within the Oxford Freedom network only. This Plan gives you access to 73,000 Freedom network physicians and other providers in the tri-state area, and 99% of the doctors and specialist are either board-certified or boar-eligible. The HMO provisions of coverage cover in-network only, you must choose your provider and hospitals that are within the Freedom Network; otherwise you will be responsible for services received out-of- the network. Unlimited days per year are covered for hospitalization provided Oxford authorizes such hospitalization. Oxford requires pre-certification of planned hospitalizations and certain services; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. When the covered individual uses the Freedom Network doctors and physicians he/she need not meet a deductible nor usually file claim forms for benefits. Generally, a covered individual's care is rendered or coordinated by a participating primary physician within his/her private office; however you do not have to choose a primary care physician. Co-payments of $15.00 are required for visits to one's primary care physician, and 30.00 for a specialist. There is no charge for preventive care within the Oxford network. A covered member does not need a referral to visit an in-network specialist. Co-payments apply also for hospital emergency room services and hospitalization and urgent care facilities and home physician visits. Outpatient in-network mental health services require $30.00 co-pay per visit (up to a maximum of 30 visits/ year). In-patient mental health care, for up to 30 days for biological based services, is provided with $250 co-pay. Outpatient care for drug/alcohol addiction is provided with a co-pay of 30.00 per visit. In-patient care for drug/alcohol addiction, for up to 30 days, is provided with$250 co-pay. Oxford’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for Oxford are follows: $15 for Tier I Drugs $25 for Tier II Drugs $50 for Tier III Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." The prescription tiers described above are based on cost. You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Medco. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for Oxford is provided for two co-pays for a three months supply. For Emergency care, covered employees are responsible for $100.00 co-pay (waived if admitted). For hospitalization in-network, employees are responsible for $250.00 co-pay. Additionally, Oxford has Wellness programs designed to encourage a healthy life style. Oxford promotes the following Wellness Programs: Quit Smoking, Lose Weight, Emotional Health, Health& Fitness, Family and work, Financial and Legal and ask our Expert. Oxford also has a Fitness Center Discount Program, where Oxford subscribers receive up to $200 per six-month period and for spouse100.00 every six-month period when you visit a gym that promotes cardiovascular wellness. The Gym reimbursement form is enclosed with the Oxford enrollment package. Keep in mind that the facility must provide a cardiovascular exercise program and at least one of the two services: Pool, treadmill, rowing machine, elliptical cross trainer, bicycle, group exercise, and step machine, walking or running group, tennis / racquetball courts. HIP/POS HIP/POS provides comprehensive umbrella coverage for hospitalization, medical treatment and services and for psychiatric/psychotherapeutic treatment and services; HIP/POS coverage also extends to preventive care services. As a standard, no deductible is applied to covered services nor are claim forms filed, unless services are provided out of network. As a combined HMO/POS, HIP offers a covered individual the choice of receiving medical services through the HMO network or from any medical service provider outside the HIP network. The HMO provisions of coverage cover in-network services and out-of-network services are covered on an indemnity basis. Unlimited days per year are covered for hospitalization provided HIP authorizes such hospitalization. HIP requires pre-certification of planned hospitalizations; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. Please review in detail the plan summary enclosed. The out-of-network cost is very high you should use the HMO/in-network part of the plan in order to maximize savings. As long as you stay within the network there are no co pays and no deductible, however when you go out-of network the deductibles are $2,500 individual, $5000 for family, 50% coinsurance up to $7,000, and 14,000 for family and a maximum life time coverage of 5,000,000 per member. Some services are only provided within the network. HIP’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for HIP’s are follows: $15 for Generic Drugs $25 for Brand Name (formulary) Drugs $40 for Brand Name (non-formulary) Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Express Scripts. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for HIP are covered up to 50% of the total co-pay cost for a three month supply for formulary drugs only. HIP non-formulary drugs are not discounted. For example, for a HIP three months supply of a generic drug you will pay $22.50. A limited number of days of hospitalization benefits per calendar year are allowed for: treatment of mental or nervous disorders; abused substance detoxification; purposes of physical therapy or rehabilitation. Routine foot care is covered for a maximum of 4 visits in a calendar year. For other covered medical services or procedures, there is no limit to the number of days allowed. In all cases, with the exception of certain defined emergency situations, the covered employee’s HIP physician must make hospitalization arrangements. Many medical services are covered by HIP frequently within the confines of a member's selected HIP Center. Among provided services are: general and specialist care including consultations on inpatient and outpatient bases; diagnostic tests including lab and x-rays; routine checkups; well-baby care including nursery; eye examinations; ambulance service; prescriptions; dialysis. HIP also offers a Preventive Dental Plan. Under the HIP Preventive Dental Plan you are entitled to the following preventive dental services: -One cleaning per calendar year for each family member at a cost of $5.00 per member. -The following services are $5.00 per member for any or all of these services during the same visit. - One application of fluoride per calendar year for children up to and including age 15. - Two oral examinations per calendar year for each family member. - Two bitewing x-rays every six months. Services are provided by HIP participating dentists. Keep in mind the dental plan offered under HIP is for preventive and diagnostic services only and should not be viewed as a replacement for the dental plan offered through Aetna Dental. A new HIP enrollee must select a HIP Center or doctor; covered services, with the exception of in-hospital surgical services and dental services, would be received primarily through the selected center or doctor. You can choose to change the center or your doctor at any time by contacting HIP directly. Surgical services are provided within HIP member hospitals. HIP has special guidelines pertaining to emergency care. HIP/POS also has a Mental Health Service Program through which short-term psychotherapeutic treatment including preliminary diagnosis is provided in HIP's own Mental Health Centers. Individuals covered by HIP/POS may fill drug prescriptions through participating pharmacies. DENTAL INSURANCE AETNA DMO/PPO The Aetna Dental Plan, though broadly referred to as the Aetna DMO, incorporates both a traditional reimbursement mechanism called Passive PPO and a dental maintenance organization mechanism called DMO. Covered employees may elect to utilize either side of the plan initially and may change from one side of the plan to the other by notifying Aetna. You must notify Aetna before the 15th of the month in order to the wish to change coverage type. One cannot be insured under both coverage types at the same time. Passive PPO Dental Coverage provides some reimbursement for eligible dental care costs subject to a deductible, co-payments and a calendar year maximum of $2,000 per covered individual. Reimbursement begins once a $100.00 deductible is satisfied (family members must satisfy a $100.00 deductible per person to a maximum of $300.00 for 3 family members). Under the PPO preventive services are covered 100%, basic services are covered 80%, and major services are covered 50%. A covered employee is free to seek dental treatment from the dentist of his/her choice. Claim forms must be completed and it is strongly suggested that pre-treatment estimates be obtained prior to submitting large claims. The Passive PPO Dental Coverage also offers a plan enhancement referred to as the Preferred Provider Organization (PPO). The PPO provides a network of participating dentists whose charges are based on a reduced fee schedule that Aetna U.S HealthCare has negotiated with the PPO participating dentists. These savings are then passed on to you. Under DMO Dental Coverage participating dentists provide dental care. There is no deductible or annual maximum for covered services; there are co-payments, however, for certain services. Under the DMO preventive services are covered 100%, basic services are covered100%, and major services are covered 50%. There are some dental services that are excluded under both sides of the plan. Eligible employees who do not elect dental coverage for themselves or their dependents when first eligible will be subject to a 6 month waiting period for regular services and a 24 month waiting period for periodontal and special services. During the 6-month waiting period for regular services only routine oral exams and x-rays are covered with employees retaining responsibility for applicable deductible and co-payments. LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D) CIGNA GROUP INSURANCE A covered employee carries life and accidental death & dismemberment insurance each with a value equal to one times the employee's annual salary rounded to the next higher thousand; as an individual's salary increases, so do the values of your coverage. Established criteria exist with regard to qualifying circumstances and exact amounts of the benefits. By law, once a covered employee has reached age 65, the value of your Life and AD&D insurance will be gradually reduced through age 75 as follows: LIFE and AD&D Values AT AGE DECREASED BY 65 35% 70 60% 75 75% You must provide us with the name, SS# and address of your beneficiary when completing the enrollment form. You can change your beneficiaries at any time. PENSION PLAN UNITED JEWISH APPEAL-FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK(UJA-FOJP) Our pension plan is sponsored by the United Jewish Appeal-Federation of Jewish Philanthropies and administered by USI Consulting Inc. This is a defined benefit plan, which means that your pension is calculated based on your salary and the years of service, and will not increase or decrease based on market conditions. This plan is noncontributory, which means that employees does not contribute to the pension plan, Selfhelp solely funds the plan. Enrollment takes place after one year of complete service with Selfhelp, in which you have worked at least 1000 hours. You are vested after 5 years of service with Selfhelp, in which you have worked 1000 hours in each year. You will receive a pension after you are vested, based on your years of service and your annual salaries. After enrollment in the plan, you will receive an annual statement denoting whether you are vesting and the monthly benefit you are entitled to. You may receive credit towards vesting if you have worked with any organization that belongs to UJA-FOJP or affiliated agencies. Normal retirement age is 65, and early retirement can start at age 50 (keep in mind that if you retire early your benefit will be reduced). FLEXIBLE SPENDING PLAN (FSP) Most health insurance plans require payment or some form of out-of-pocket expense. In order to reduce the impact to your income resulting from these costs, Selfhelp established a Flexible Spending Plan for all benefits eligible employees. The plan is the result of our continuing efforts to find ways to help you get the most for your earnings. A Flexible Spending Plan is designed to increase your take home pay by allowing you to pre-tax certain unreimbursable premiums, medical, dental and dependent care expenses. There are three accounts to Selfhelp's Flexible Spending Plan. They are as follows: 1) Premium Expense Account 2) Health Care Reimbursement Account 3) Dependent Care Assistance Account. The following is a brief summary of how the plan will work for you. HOW THE PLAN WORKS Certain benefits, which are traditionally paid with after-tax dollars, can be paid with before-tax dollars under the Flexible Spending Plan. Through a Flexible Spending Plan, you can voluntarily redirect a portion of your salary to be used to pay for eligible expenses before your salary is taxed. Your W-2 tax statement at the end of the year will show the new reduced amount of your wages since part of your gross salary is redirected, Federal and State (except Pennsylvania and New Jersey) and Social Security taxes are lower. The net effect of the salary redirection is more spendable income for you now. THREE SEPARATE ACCOUNTS There are three separate accounts. You may elect to participate in one, two or all three accounts based on your personal circumstances. The following provides a basic description of the three accounts. You are encouraged to review the relevant Summary Plan Description for more comprehensive information. 1. PREMIUM EXPENSE ACCOUNT This plan allows you to pre-tax your contributions toward payment of premiums in our sponsored health plans. As indicated on page 1, employees working 35 hours per week would have their individual coverage fully paid. Employees who elect health coverage for their families or who work less than 35 hours per week and/or elect health coverage for themselves and their family will be responsible for the cost of their health coverage. 2. HEALTH CARE REIMBURSEMENT ACCOUNT The Health Care Reimbursement Account enables you to pay for expenses, which are not covered, or are partially covered, by Selfhelp medical or dental insurance and save taxes at the same time. The account allows you to be reimbursed for out-of-pocket medical, dental and vision expenses incurred by you and your IRS eligible dependents. In order to participate in the plan, you must estimate your expenses for the plan year (January through December) and pay them through payroll deduction. The expenses that qualify are those permitted by Section 213 of the Internal Revenue Code. A list of covered expenses is attached. You may put money aside to cover expenses for dependents, even if they are not covered by your Selfhelp medical/dental plans. You may not, however, be reimbursed for the premium cost of other health care coverage maintained outside Selfhelp's Plan. The most that you can contribute to your Health Care Reimbursement Account each Plan Year is $5,000.00. In order to be reimbursed for a health care expense, you must submit a claim form to the Administrator along with an itemized bill from the service provider. Claim forms are available in the Human Resources Department at Central Office. 3. DEPENDENT CARE ASSISTANCE ACCOUNT The Dependent Care Assistance Account enables you to pay for out-of-pocket, work-related dependent day-care costs with pre-tax dollars through payroll deduction. If you are married, you can use the account if you and your spouse both work or, in some situations, if your spouse goes to school full-time. Single employees can also use the account. The most you can contribute to your Dependent Care Assistance Account is $5,000.00 in one plan year ($2,500 if married and filing individual tax returns). Please note that eligible expenses under this account require that your arrangements for dependent care be formalized. THE FSP ENROLLMENT PROCESS You will be eligible to participate in the Flexible Spending Plan when you become eligible to participate in our health benefits (the first of the month following two months of continuous employment). The first year of participation will be a short plan year (unless you become eligible for benefits in January). In subsequent plan years your calculation will be based on a calendar year, from January to December. The open enrollment period is normally in December of each year. During the orientation you will have an opportunity to ask questions and enroll in the plan if you wish to do so. WHAT YOU WILL NEED TO DO You will need to calculate on an annual basis how much of your paycheck you estimate will be spent on premiums, health and dental coverage, co-payments, dependent care and other unreimbursable medical expenses. This estimate will be divided into equal amounts based on the number of pay periods remaining in the plan year. The divided amount will then be deducted automatically from each of your remaining paychecks for that plan year BEFORE IT IS TAXED. This money will be later returned to you to cover you and your family's unreimbursable health and/or dependent care expenses, as you submit appropriate claim forms. This plan is in full accordance with Federal Tax laws and therefore requires that you only submit IRS acceptable deductible expenses for reimbursement. All claims must be submitted to: APA Partner Inc., P.O Box 1506, Latham, NY 12110 . You must submit your claim for the plan year by March 31, of the following year and you have until May 15th of the following year to incur the FSP allowable expenses. We also have also the MBI Benefits Card which allows you to pay for eligible products and services at the point of sale without submitting claim forms or waiting for reimbursement. You can use the card at any eligible location where MasterCard or Visa is accepted. Some examples of eligible locations include: hospitals, physician offices, dental offices, vision service locations, and pharmacies (retail and online). All employees enrolled in the Flexible Spending, Healthcare Reimbursement Account will receive an MBIcard with instructions to activate the card. Research indicates that over 90% of all FSP transactions are electronic, however in some instances, you may have to "go back to the old way" and pay with cash or check and submit a manual claim. You can both use the card and/or submit paper claims, it is up to you. All paper claims should be sent directly to APA Partners Inc. Keep in mind that only eligible Flexible Spending Plan expenses should be purchased with MBIcard. Should you pay for ineligible services or items with the card, you will have to pay back the funds. Although there is no requirement for you to complete claim forms with the MBIcard, additional documentation may be requested in some cases in order to confirm the eligibility of some debit card purchases, therefore you should keep your receipts. The card can be used for up to 3 years. Qualified Transportation Plan (QTE) Selfhelp’s Qualified Transportation Plan provides savings on transportation costs to and from work. By taking advantage of this plan, Mass Transit Commuting and Parking become more affordable. With this plan money may be set-aside on a pre-tax basis for transportation costs, thereby increasing your take home pay. You may set aside up to $115 for Mass Transit and $220for parking expenses may be deducted on a monthly basis. Employees can enroll into this plan during new employee orientation or during open enrollment in the months of June effective July 1st or November, effective January 1st. Participating in the QTE plan has just become easier; you can now get the eTRAC MasterCard® and pay for transportation expenses without having to submit a claim form. You also have the option to continue submit claims instead of using the card, it is up to you. You will use the card like any other credit card to pay only for transportation expenses, you can’t withdraw cash from the card and any non eligible expenses will be denied. Deductions will be made on a bi-weekly basis and sent to our third party administrator: Benefit Resources, Inc. 2320 Brighton-Henrietta TL Rd., Rochester, NY 14623-2782. Claims must be submitted by six months from the end of the month in order to be reimbursed. Should you not submit your claim by the allotted time frame you will not be reimbursed for that month, however you can increase the following month’s claims to get back your deductions or you can decrease your deductions. RETIREMENT SAVINGS PLAN TAX-DEFERRED-ANNUITY 403 (b) Plan Each employee at Selfhelp may elect to save and invest some of his/her salary on a pre-tax basis through tax deferred annuity (TDA) arrangements. Selfhelp does not sponsor the TDA plans. The organizations’ purpose is to provide a payroll deduction mechanism to employees which allows them to voluntarily participate, through payroll deductions, in a TDA plan, The Agency does not administer, recommend or provide on-going information on the various plans. Employees are expected to individually research any information on the Plans including their comparative benefits, current interest rates, tax implications, etc. Your responsibility as a participant, in addition to making a prudent TDA choice, is to assure that you do not exceed certain contribution limits set by the IRS, and any other tax law requirements. The rules of permitted contributions are complicated. Generally your maximum allowable contribution is 15,500 for the current year. In addition, if you are over 50 years old and/or have worked for Selfhelp for 15 years you can contribute an additional $5000 for this year. The maximum catch-up deferral is $15,000. There are, however, other factors, including your Pension Plan benefit that may either reduce this amount or allow you to contribute more. You should work closely with your TDA investment company and your financial/tax adviser to determine you maximum allowable contribution and other necessary compliance requirements of the tax law. The IRS also requires that participants begin to take distributions of their money by the April in the year following their 70 1/2 birthday. In order to assist you in the gathering of information, election and/or change of plans, the following procedures are in effect: Employees may enroll, change his or her contribution or change your carrier of your TDA plan at any time. Human Resources will supply employees (upon request) with information booklets fromvarious TDA plan carriers for employee review. If an employee wishes to stop contributing into his/her Plan, (at any time), a signed memo or an Election/change form should be forwarded to the Human Resources authorizing the cessation of contributions. Please note: when making the decision to invest toward your retirement there are a few factors you should consider: 1- Tolerance for risk: Should you invest on a mutual fund that is risky vs. a guaranteed account. 2-Performance: How are the funds performing now, within the last month, years and from inception. 3-Administrative fees: The fees should not be high and exceed any earnings. Selfhelp offers presently five TDA plans available to employees for payroll deduction. If you have any questions not covered in the booklet regarding contributions, distributions or other provisions of TDA arrangements, contact the TDA plan at the toll-free numbers listed below. Calvert Group (800) 368-2748 www.calvertgroup.com Mutual of America (800) 468-3785 www.mutualofamerica.com American Funds Group* (800) 421-9900 www.americanfunds.com Fidelity Group (800) 343-0860 www.fidelity.com Lincoln Financial Group (866) 367-1776 www.lincolnlife.com Employee Assistance Program (EAP) The employee Assistance program provides employees and loved ones with confidential consultation and referral services for a wide range of issues. The EAP is designed to assist you with situations encountered in every day life. Attempting to resolve a problem can sometimes be stressful and may cause anxiety. The EAP is great resource available to you and your family. The EAP is located at 136 East 57th Street, 4th fl. New York, NY 10022. To Schedule an appointment, simply call 212-935-3030 or 800-327-9092 outside of New York. Citibank at Work/Direct Deposit We are encouraging all employees to sign-up for direct deposit. It is our policy and the preferred medium through which to pay our employees due to the advantages to both the employer and the employee. The Advantages of Direct Deposit are the following: · The employee receives their money directly into their checking. · No more lost or stolen checks. · No more hassle to go to the bank on payday to cash the check. · No special arrangements have to be made when employee is away from home. For those of you who don't have a checking account, you can open one through the Citibank at Work Program. The Citibank at Work program provides for financial and banking services when you have your paycheck directly deposited into a Citibank checking account. If you already have a checking account with Citibank you must advise us of your interest to participate in this program in order for you to receive these discounts. If you already have an account, you can have your salary direct deposited into that account. Citibank at Work is a great benefit provided to Selfhelp employees. By opening a checking account with Citibank and direct-depositing your salary into that account you will receive the following benefits: · Citibank checking with no monthly service charges for 12 months · Mortgage origination discounts · Citibank AutoSave · Free first order of checks · No ATM charge on Citibank ATM transactions; no Citibank ATM charge on non Citibank ATMs for at least 12 months Complimentary top-rated PC banking and free automated bill payment service. · CitiPhone Banking available 24 hours a day, 7 days a week. Sign up for direct deposit into a Citibank Account and also receive a complimentary Citipro Financial Needs Analysis. For more information please contact: The Human Resource Department or Piedad Alvarez at 212-290-7714 at Citibank or visit the Citibank branch at 201 West 34th St. New York City. GENERAL INFORMATION Employees have the opportunity to change their primary medical coverage during each plan's open enrollment period (currently during December of each year with changes effective January 1). All benefits descriptions in this summary are synopses of established benefits offered to eligible employees of Selfhelp Community Services. The synopses are provided as a benefits overview and also as a means of assisting Selfhelp employees faced with benefits choices. More specific details of benefits may be found in corresponding Summary Plan Descriptions. The information contained herein should in no way be interpreted as either comprehensive or as a contract. New employees will be provided with a discussion of benefits as a segment of the New Employee Orientation Session. The Human Resources Division conducts the New Employee Orientation Session monthly.
EMPLOYEE BENEFITS SUMMARY
Selfhelp Community Services offers a comprehensive health and life insurance benefits package to employees. All employees who work a regular schedule of at least 20 hours per week are eligible for health and life insurance benefits. Coverage is effective the first of the month following two months of eligible employment. Selfhelp pays most of premium costs for a full-time, regular employee's individual coverage. Full-time employees must contribute $1.00 toward the cost of their health insurance coverage on a bi-weekly basis. Employees who work a regular schedule of at least 20 but less than 35 hours per week are responsible for the pro-rated percentage of the individual premium costs. Employees may elect family coverage at a cost of 50% of the premium for such coverage. Employees will be responsible for premium payments while on paid or unpaid leaves of absence, including Family and Medical Leave. Employees who are eligible to elect family coverage who do not choose medical coverage for themselves or their families when first eligible, may only be covered subsequently during the annual open enrollment period in December, unless there is a life event, e.g. loss of coverage, birth of a child, increase in premiums. If there is a life event, the Human Resources department must be notified within 30 days from the day of the event (i.e. loss of coverage) in order to enroll into our health insurance plans.
Eligible employees who do not elect dental coverage for themselves or their dependents when first eligible will be subject to a 6 month waiting period for regular services and a 24 month waiting period for periodontal and special services. During the 6-month waiting period for regular services only routine oral exams and x-rays are covered with employees retaining responsibility for applicable deductible and co-payments.
The health and life insurance plans offered by Selfhelp are:
The above health insurance coverage are in effect for injuries/illnesses not compensable under NYS Workers Compensation or (in most circumstances) under mandatory automobile no-fault benefits. Before giving further details about each plan's benefits, it is important to distinguish between an HMO (Health Maintenance Organization) and an Indemnity Plan. HMOs provide a comprehensive network of health services within established facilities or through participating physicians and hospitals. Generally, individuals covered by HMO's have fewer out-of-pocket costs and few, if any, claim forms to file. One need not necessarily suspect or be symptomatic of illness in order to take advantage of HMO services. Not all physicians and hospitals, however, participate in HMO's; therefore, one does not have total freedom in choosing doctors and hospitals for medical services. Indemnity health insurance plans are more traditional plans offering some reimbursement of medically necessary services after certain conditions (determined by the insurance carrier) are met. Typically individuals covered by indemnity plans must first satisfy a deductible before any reimbursement of services begins. Once the deductible is met, some reimbursement of services takes place; normally the covered individual is responsible for a percentage of medical costs until he/she meets an established limit at which time the insurance carrier may start to reimburse at 100%. The insurance carrier would reimburse per its schedule to the extent it deems charges to be reasonable and customary. It is necessary in most cases for claim forms to be filed for reimbursement. One does, however, have total freedom in choosing doctors and hospitals for medical services.
MEDICAL INSURANCE
As a combined HMO/Indemnity Plan, this plan offers a covered individual the choice of receiving medical services through the HMO network or from any medical service provider outside the Oxford Freedom network. This Plan gives access to 73,000 Freedom network physicians and other providers in the tri-state area, and 99% of the doctors and specialist are either board-certified or board-eligible. The HMO provisions of coverage cover in-network services and out-of-network services are covered on an indemnity basis. Unlimited days per year are covered for hospitalization provided Oxford authorizes such hospitalization. Oxford requires pre-certification of planned hospitalizations and certain services; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply.
If a covered individual uses the HMO portion of the Oxford/Pos plan, he/she need not meet a deductible nor usually file claim forms for benefits. Generally, a covered individual's care is rendered or coordinated by a participating primary physician within his/her private office. Co-payments of $20.00 are required for visits to one's primary care physician, and 35.00 for a specialist. There is no charge for preventive care within the Oxford network; however the benefit is limited when you go out of network. A member does not need a referral to visit an in-network specialist. Co-payments apply also for hospital emergency room services and hospitalization and urgent care facilities and home physician visits. Outpatient mental health services for out-of-network coverage are subject to the deductible and 30% (coinsurance) of the usual and customary amount, while in-network services require a $35.00 co-pay per visit (up to a maximum of 30 visits/ year). In-patient mental health care, for up to 30 days for biological based services, is provided with$250 co-pay; out-of-network is subject to the deductible and coinsurance. Outpatient care for drug/alcohol addiction is subject to the deductible and coinsurance when out-of-network and no charge (up to a maximum of 60 visits/ year) for in-network coverage. In-patient care for drug/alcohol addiction, for up to 30 days, is provided with$250 co-pay; out-of-network is subject to the deductible and 50% coinsurance.
When utilizing the indemnity portion of the health plan, a deductible of $1000.00 per person per calendar year (to a maximum of $13000.00 per family) is applied before a 70% reimbursement of reasonable and customary covered expenses begins. A covered individual is responsible for 30% (coinsurance) of reasonable and customary covered expenses after meeting the deductible until s/he has paid $4000 out of pocket (including the deductible to maximum of $12,000.00 per family). Any physician may render medical treatment.
Oxford’s prescription drug benefit offers a covered individual two ways of filling prescriptions:
The prescription co-pays for Oxford are follows:
A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." The prescription tiers described above are based on cost.
You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Medco. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for Oxford is provided for two co-pays for a three months supply.
For Emergency care, covered employees are responsible for $100.00 co-pay (waived if admitted). For hospitalization in-network, employees are responsible for $250.00 co-pay, out of network the services are subject to the deductible and 30% coinsurance.
Additionally, Oxford has Wellness programs designed to encourage a healthy life style. Oxford promotes the following Wellness Programs: Quit Smoking, Lose Weight, Emotional Health, Health& Fitness, Family and work, Financial and Legal and ask our Expert. Oxford also has a Fitness Center Discount Program, where Oxford subscribers receive up to $200 per six-month period and for spouse100.00 every six-month period when you visit a gym that promotes cardiovascular wellness. The Gym reimbursement form is enclosed with the Oxford enrollment package. Keep in mind that the facility must provide a cardiovascular exercise program and at least one of the two services: Pool, treadmill, rowing machine, elliptical cross trainer, bicycle, group exercise, and step machine, walking or running group, tennis / racquetball courts. OXFORD-EPO PLAN The Oxford Exclusive Provider Organization offers a covered individual medical services through the HMO network; from any medical service provider within the Oxford Freedom network only. This Plan gives you access to 73,000 Freedom network physicians and other providers in the tri-state area, and 99% of the doctors and specialist are either board-certified or boar-eligible. The HMO provisions of coverage cover in-network only, you must choose your provider and hospitals that are within the Freedom Network; otherwise you will be responsible for services received out-of- the network. Unlimited days per year are covered for hospitalization provided Oxford authorizes such hospitalization. Oxford requires pre-certification of planned hospitalizations and certain services; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. When the covered individual uses the Freedom Network doctors and physicians he/she need not meet a deductible nor usually file claim forms for benefits. Generally, a covered individual's care is rendered or coordinated by a participating primary physician within his/her private office; however you do not have to choose a primary care physician. Co-payments of $15.00 are required for visits to one's primary care physician, and 30.00 for a specialist. There is no charge for preventive care within the Oxford network. A covered member does not need a referral to visit an in-network specialist. Co-payments apply also for hospital emergency room services and hospitalization and urgent care facilities and home physician visits. Outpatient in-network mental health services require $30.00 co-pay per visit (up to a maximum of 30 visits/ year). In-patient mental health care, for up to 30 days for biological based services, is provided with $250 co-pay. Outpatient care for drug/alcohol addiction is provided with a co-pay of 30.00 per visit. In-patient care for drug/alcohol addiction, for up to 30 days, is provided with$250 co-pay. Oxford’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for Oxford are follows: $15 for Tier I Drugs $25 for Tier II Drugs $50 for Tier III Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." The prescription tiers described above are based on cost. You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Medco. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for Oxford is provided for two co-pays for a three months supply. For Emergency care, covered employees are responsible for $100.00 co-pay (waived if admitted). For hospitalization in-network, employees are responsible for $250.00 co-pay. Additionally, Oxford has Wellness programs designed to encourage a healthy life style. Oxford promotes the following Wellness Programs: Quit Smoking, Lose Weight, Emotional Health, Health& Fitness, Family and work, Financial and Legal and ask our Expert. Oxford also has a Fitness Center Discount Program, where Oxford subscribers receive up to $200 per six-month period and for spouse100.00 every six-month period when you visit a gym that promotes cardiovascular wellness. The Gym reimbursement form is enclosed with the Oxford enrollment package. Keep in mind that the facility must provide a cardiovascular exercise program and at least one of the two services: Pool, treadmill, rowing machine, elliptical cross trainer, bicycle, group exercise, and step machine, walking or running group, tennis / racquetball courts. HIP/POS HIP/POS provides comprehensive umbrella coverage for hospitalization, medical treatment and services and for psychiatric/psychotherapeutic treatment and services; HIP/POS coverage also extends to preventive care services. As a standard, no deductible is applied to covered services nor are claim forms filed, unless services are provided out of network. As a combined HMO/POS, HIP offers a covered individual the choice of receiving medical services through the HMO network or from any medical service provider outside the HIP network. The HMO provisions of coverage cover in-network services and out-of-network services are covered on an indemnity basis. Unlimited days per year are covered for hospitalization provided HIP authorizes such hospitalization. HIP requires pre-certification of planned hospitalizations; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. Please review in detail the plan summary enclosed. The out-of-network cost is very high you should use the HMO/in-network part of the plan in order to maximize savings. As long as you stay within the network there are no co pays and no deductible, however when you go out-of network the deductibles are $2,500 individual, $5000 for family, 50% coinsurance up to $7,000, and 14,000 for family and a maximum life time coverage of 5,000,000 per member. Some services are only provided within the network. HIP’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for HIP’s are follows: $15 for Generic Drugs $25 for Brand Name (formulary) Drugs $40 for Brand Name (non-formulary) Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Express Scripts. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for HIP are covered up to 50% of the total co-pay cost for a three month supply for formulary drugs only. HIP non-formulary drugs are not discounted. For example, for a HIP three months supply of a generic drug you will pay $22.50. A limited number of days of hospitalization benefits per calendar year are allowed for: treatment of mental or nervous disorders; abused substance detoxification; purposes of physical therapy or rehabilitation. Routine foot care is covered for a maximum of 4 visits in a calendar year. For other covered medical services or procedures, there is no limit to the number of days allowed. In all cases, with the exception of certain defined emergency situations, the covered employee’s HIP physician must make hospitalization arrangements. Many medical services are covered by HIP frequently within the confines of a member's selected HIP Center. Among provided services are: general and specialist care including consultations on inpatient and outpatient bases; diagnostic tests including lab and x-rays; routine checkups; well-baby care including nursery; eye examinations; ambulance service; prescriptions; dialysis. HIP also offers a Preventive Dental Plan. Under the HIP Preventive Dental Plan you are entitled to the following preventive dental services: -One cleaning per calendar year for each family member at a cost of $5.00 per member. -The following services are $5.00 per member for any or all of these services during the same visit. - One application of fluoride per calendar year for children up to and including age 15. - Two oral examinations per calendar year for each family member. - Two bitewing x-rays every six months. Services are provided by HIP participating dentists. Keep in mind the dental plan offered under HIP is for preventive and diagnostic services only and should not be viewed as a replacement for the dental plan offered through Aetna Dental. A new HIP enrollee must select a HIP Center or doctor; covered services, with the exception of in-hospital surgical services and dental services, would be received primarily through the selected center or doctor. You can choose to change the center or your doctor at any time by contacting HIP directly. Surgical services are provided within HIP member hospitals. HIP has special guidelines pertaining to emergency care. HIP/POS also has a Mental Health Service Program through which short-term psychotherapeutic treatment including preliminary diagnosis is provided in HIP's own Mental Health Centers. Individuals covered by HIP/POS may fill drug prescriptions through participating pharmacies. DENTAL INSURANCE AETNA DMO/PPO The Aetna Dental Plan, though broadly referred to as the Aetna DMO, incorporates both a traditional reimbursement mechanism called Passive PPO and a dental maintenance organization mechanism called DMO. Covered employees may elect to utilize either side of the plan initially and may change from one side of the plan to the other by notifying Aetna. You must notify Aetna before the 15th of the month in order to the wish to change coverage type. One cannot be insured under both coverage types at the same time. Passive PPO Dental Coverage provides some reimbursement for eligible dental care costs subject to a deductible, co-payments and a calendar year maximum of $2,000 per covered individual. Reimbursement begins once a $100.00 deductible is satisfied (family members must satisfy a $100.00 deductible per person to a maximum of $300.00 for 3 family members). Under the PPO preventive services are covered 100%, basic services are covered 80%, and major services are covered 50%. A covered employee is free to seek dental treatment from the dentist of his/her choice. Claim forms must be completed and it is strongly suggested that pre-treatment estimates be obtained prior to submitting large claims. The Passive PPO Dental Coverage also offers a plan enhancement referred to as the Preferred Provider Organization (PPO). The PPO provides a network of participating dentists whose charges are based on a reduced fee schedule that Aetna U.S HealthCare has negotiated with the PPO participating dentists. These savings are then passed on to you. Under DMO Dental Coverage participating dentists provide dental care. There is no deductible or annual maximum for covered services; there are co-payments, however, for certain services. Under the DMO preventive services are covered 100%, basic services are covered100%, and major services are covered 50%. There are some dental services that are excluded under both sides of the plan. Eligible employees who do not elect dental coverage for themselves or their dependents when first eligible will be subject to a 6 month waiting period for regular services and a 24 month waiting period for periodontal and special services. During the 6-month waiting period for regular services only routine oral exams and x-rays are covered with employees retaining responsibility for applicable deductible and co-payments. LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D) CIGNA GROUP INSURANCE A covered employee carries life and accidental death & dismemberment insurance each with a value equal to one times the employee's annual salary rounded to the next higher thousand; as an individual's salary increases, so do the values of your coverage. Established criteria exist with regard to qualifying circumstances and exact amounts of the benefits. By law, once a covered employee has reached age 65, the value of your Life and AD&D insurance will be gradually reduced through age 75 as follows: LIFE and AD&D Values AT AGE DECREASED BY 65 35% 70 60% 75 75% You must provide us with the name, SS# and address of your beneficiary when completing the enrollment form. You can change your beneficiaries at any time. PENSION PLAN UNITED JEWISH APPEAL-FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK(UJA-FOJP) Our pension plan is sponsored by the United Jewish Appeal-Federation of Jewish Philanthropies and administered by USI Consulting Inc. This is a defined benefit plan, which means that your pension is calculated based on your salary and the years of service, and will not increase or decrease based on market conditions. This plan is noncontributory, which means that employees does not contribute to the pension plan, Selfhelp solely funds the plan. Enrollment takes place after one year of complete service with Selfhelp, in which you have worked at least 1000 hours. You are vested after 5 years of service with Selfhelp, in which you have worked 1000 hours in each year. You will receive a pension after you are vested, based on your years of service and your annual salaries. After enrollment in the plan, you will receive an annual statement denoting whether you are vesting and the monthly benefit you are entitled to. You may receive credit towards vesting if you have worked with any organization that belongs to UJA-FOJP or affiliated agencies. Normal retirement age is 65, and early retirement can start at age 50 (keep in mind that if you retire early your benefit will be reduced). FLEXIBLE SPENDING PLAN (FSP) Most health insurance plans require payment or some form of out-of-pocket expense. In order to reduce the impact to your income resulting from these costs, Selfhelp established a Flexible Spending Plan for all benefits eligible employees. The plan is the result of our continuing efforts to find ways to help you get the most for your earnings. A Flexible Spending Plan is designed to increase your take home pay by allowing you to pre-tax certain unreimbursable premiums, medical, dental and dependent care expenses. There are three accounts to Selfhelp's Flexible Spending Plan. They are as follows: 1) Premium Expense Account 2) Health Care Reimbursement Account 3) Dependent Care Assistance Account. The following is a brief summary of how the plan will work for you. HOW THE PLAN WORKS Certain benefits, which are traditionally paid with after-tax dollars, can be paid with before-tax dollars under the Flexible Spending Plan. Through a Flexible Spending Plan, you can voluntarily redirect a portion of your salary to be used to pay for eligible expenses before your salary is taxed. Your W-2 tax statement at the end of the year will show the new reduced amount of your wages since part of your gross salary is redirected, Federal and State (except Pennsylvania and New Jersey) and Social Security taxes are lower. The net effect of the salary redirection is more spendable income for you now. THREE SEPARATE ACCOUNTS There are three separate accounts. You may elect to participate in one, two or all three accounts based on your personal circumstances. The following provides a basic description of the three accounts. You are encouraged to review the relevant Summary Plan Description for more comprehensive information. 1. PREMIUM EXPENSE ACCOUNT This plan allows you to pre-tax your contributions toward payment of premiums in our sponsored health plans. As indicated on page 1, employees working 35 hours per week would have their individual coverage fully paid. Employees who elect health coverage for their families or who work less than 35 hours per week and/or elect health coverage for themselves and their family will be responsible for the cost of their health coverage. 2. HEALTH CARE REIMBURSEMENT ACCOUNT The Health Care Reimbursement Account enables you to pay for expenses, which are not covered, or are partially covered, by Selfhelp medical or dental insurance and save taxes at the same time. The account allows you to be reimbursed for out-of-pocket medical, dental and vision expenses incurred by you and your IRS eligible dependents. In order to participate in the plan, you must estimate your expenses for the plan year (January through December) and pay them through payroll deduction. The expenses that qualify are those permitted by Section 213 of the Internal Revenue Code. A list of covered expenses is attached. You may put money aside to cover expenses for dependents, even if they are not covered by your Selfhelp medical/dental plans. You may not, however, be reimbursed for the premium cost of other health care coverage maintained outside Selfhelp's Plan. The most that you can contribute to your Health Care Reimbursement Account each Plan Year is $5,000.00. In order to be reimbursed for a health care expense, you must submit a claim form to the Administrator along with an itemized bill from the service provider. Claim forms are available in the Human Resources Department at Central Office. 3. DEPENDENT CARE ASSISTANCE ACCOUNT The Dependent Care Assistance Account enables you to pay for out-of-pocket, work-related dependent day-care costs with pre-tax dollars through payroll deduction. If you are married, you can use the account if you and your spouse both work or, in some situations, if your spouse goes to school full-time. Single employees can also use the account. The most you can contribute to your Dependent Care Assistance Account is $5,000.00 in one plan year ($2,500 if married and filing individual tax returns). Please note that eligible expenses under this account require that your arrangements for dependent care be formalized. THE FSP ENROLLMENT PROCESS You will be eligible to participate in the Flexible Spending Plan when you become eligible to participate in our health benefits (the first of the month following two months of continuous employment). The first year of participation will be a short plan year (unless you become eligible for benefits in January). In subsequent plan years your calculation will be based on a calendar year, from January to December. The open enrollment period is normally in December of each year. During the orientation you will have an opportunity to ask questions and enroll in the plan if you wish to do so. WHAT YOU WILL NEED TO DO You will need to calculate on an annual basis how much of your paycheck you estimate will be spent on premiums, health and dental coverage, co-payments, dependent care and other unreimbursable medical expenses. This estimate will be divided into equal amounts based on the number of pay periods remaining in the plan year. The divided amount will then be deducted automatically from each of your remaining paychecks for that plan year BEFORE IT IS TAXED. This money will be later returned to you to cover you and your family's unreimbursable health and/or dependent care expenses, as you submit appropriate claim forms. This plan is in full accordance with Federal Tax laws and therefore requires that you only submit IRS acceptable deductible expenses for reimbursement. All claims must be submitted to: APA Partner Inc., P.O Box 1506, Latham, NY 12110 . You must submit your claim for the plan year by March 31, of the following year and you have until May 15th of the following year to incur the FSP allowable expenses. We also have also the MBI Benefits Card which allows you to pay for eligible products and services at the point of sale without submitting claim forms or waiting for reimbursement. You can use the card at any eligible location where MasterCard or Visa is accepted. Some examples of eligible locations include: hospitals, physician offices, dental offices, vision service locations, and pharmacies (retail and online). All employees enrolled in the Flexible Spending, Healthcare Reimbursement Account will receive an MBIcard with instructions to activate the card. Research indicates that over 90% of all FSP transactions are electronic, however in some instances, you may have to "go back to the old way" and pay with cash or check and submit a manual claim. You can both use the card and/or submit paper claims, it is up to you. All paper claims should be sent directly to APA Partners Inc. Keep in mind that only eligible Flexible Spending Plan expenses should be purchased with MBIcard. Should you pay for ineligible services or items with the card, you will have to pay back the funds. Although there is no requirement for you to complete claim forms with the MBIcard, additional documentation may be requested in some cases in order to confirm the eligibility of some debit card purchases, therefore you should keep your receipts. The card can be used for up to 3 years. Qualified Transportation Plan (QTE) Selfhelp’s Qualified Transportation Plan provides savings on transportation costs to and from work. By taking advantage of this plan, Mass Transit Commuting and Parking become more affordable. With this plan money may be set-aside on a pre-tax basis for transportation costs, thereby increasing your take home pay. You may set aside up to $115 for Mass Transit and $220for parking expenses may be deducted on a monthly basis. Employees can enroll into this plan during new employee orientation or during open enrollment in the months of June effective July 1st or November, effective January 1st. Participating in the QTE plan has just become easier; you can now get the eTRAC MasterCard® and pay for transportation expenses without having to submit a claim form. You also have the option to continue submit claims instead of using the card, it is up to you. You will use the card like any other credit card to pay only for transportation expenses, you can’t withdraw cash from the card and any non eligible expenses will be denied. Deductions will be made on a bi-weekly basis and sent to our third party administrator: Benefit Resources, Inc. 2320 Brighton-Henrietta TL Rd., Rochester, NY 14623-2782. Claims must be submitted by six months from the end of the month in order to be reimbursed. Should you not submit your claim by the allotted time frame you will not be reimbursed for that month, however you can increase the following month’s claims to get back your deductions or you can decrease your deductions. RETIREMENT SAVINGS PLAN TAX-DEFERRED-ANNUITY 403 (b) Plan Each employee at Selfhelp may elect to save and invest some of his/her salary on a pre-tax basis through tax deferred annuity (TDA) arrangements. Selfhelp does not sponsor the TDA plans. The organizations’ purpose is to provide a payroll deduction mechanism to employees which allows them to voluntarily participate, through payroll deductions, in a TDA plan, The Agency does not administer, recommend or provide on-going information on the various plans. Employees are expected to individually research any information on the Plans including their comparative benefits, current interest rates, tax implications, etc. Your responsibility as a participant, in addition to making a prudent TDA choice, is to assure that you do not exceed certain contribution limits set by the IRS, and any other tax law requirements. The rules of permitted contributions are complicated. Generally your maximum allowable contribution is 15,500 for the current year. In addition, if you are over 50 years old and/or have worked for Selfhelp for 15 years you can contribute an additional $5000 for this year. The maximum catch-up deferral is $15,000. There are, however, other factors, including your Pension Plan benefit that may either reduce this amount or allow you to contribute more. You should work closely with your TDA investment company and your financial/tax adviser to determine you maximum allowable contribution and other necessary compliance requirements of the tax law. The IRS also requires that participants begin to take distributions of their money by the April in the year following their 70 1/2 birthday. In order to assist you in the gathering of information, election and/or change of plans, the following procedures are in effect: Employees may enroll, change his or her contribution or change your carrier of your TDA plan at any time. Human Resources will supply employees (upon request) with information booklets fromvarious TDA plan carriers for employee review. If an employee wishes to stop contributing into his/her Plan, (at any time), a signed memo or an Election/change form should be forwarded to the Human Resources authorizing the cessation of contributions. Please note: when making the decision to invest toward your retirement there are a few factors you should consider: 1- Tolerance for risk: Should you invest on a mutual fund that is risky vs. a guaranteed account. 2-Performance: How are the funds performing now, within the last month, years and from inception. 3-Administrative fees: The fees should not be high and exceed any earnings. Selfhelp offers presently five TDA plans available to employees for payroll deduction. If you have any questions not covered in the booklet regarding contributions, distributions or other provisions of TDA arrangements, contact the TDA plan at the toll-free numbers listed below. Calvert Group (800) 368-2748 www.calvertgroup.com Mutual of America (800) 468-3785 www.mutualofamerica.com American Funds Group* (800) 421-9900 www.americanfunds.com Fidelity Group (800) 343-0860 www.fidelity.com Lincoln Financial Group (866) 367-1776 www.lincolnlife.com Employee Assistance Program (EAP) The employee Assistance program provides employees and loved ones with confidential consultation and referral services for a wide range of issues. The EAP is designed to assist you with situations encountered in every day life. Attempting to resolve a problem can sometimes be stressful and may cause anxiety. The EAP is great resource available to you and your family. The EAP is located at 136 East 57th Street, 4th fl. New York, NY 10022. To Schedule an appointment, simply call 212-935-3030 or 800-327-9092 outside of New York. Citibank at Work/Direct Deposit We are encouraging all employees to sign-up for direct deposit. It is our policy and the preferred medium through which to pay our employees due to the advantages to both the employer and the employee. The Advantages of Direct Deposit are the following: · The employee receives their money directly into their checking. · No more lost or stolen checks. · No more hassle to go to the bank on payday to cash the check. · No special arrangements have to be made when employee is away from home. For those of you who don't have a checking account, you can open one through the Citibank at Work Program. The Citibank at Work program provides for financial and banking services when you have your paycheck directly deposited into a Citibank checking account. If you already have a checking account with Citibank you must advise us of your interest to participate in this program in order for you to receive these discounts. If you already have an account, you can have your salary direct deposited into that account. Citibank at Work is a great benefit provided to Selfhelp employees. By opening a checking account with Citibank and direct-depositing your salary into that account you will receive the following benefits: · Citibank checking with no monthly service charges for 12 months · Mortgage origination discounts · Citibank AutoSave · Free first order of checks · No ATM charge on Citibank ATM transactions; no Citibank ATM charge on non Citibank ATMs for at least 12 months Complimentary top-rated PC banking and free automated bill payment service. · CitiPhone Banking available 24 hours a day, 7 days a week. Sign up for direct deposit into a Citibank Account and also receive a complimentary Citipro Financial Needs Analysis. For more information please contact: The Human Resource Department or Piedad Alvarez at 212-290-7714 at Citibank or visit the Citibank branch at 201 West 34th St. New York City. GENERAL INFORMATION Employees have the opportunity to change their primary medical coverage during each plan's open enrollment period (currently during December of each year with changes effective January 1). All benefits descriptions in this summary are synopses of established benefits offered to eligible employees of Selfhelp Community Services. The synopses are provided as a benefits overview and also as a means of assisting Selfhelp employees faced with benefits choices. More specific details of benefits may be found in corresponding Summary Plan Descriptions. The information contained herein should in no way be interpreted as either comprehensive or as a contract. New employees will be provided with a discussion of benefits as a segment of the New Employee Orientation Session. The Human Resources Division conducts the New Employee Orientation Session monthly.
OXFORD-EPO PLAN The Oxford Exclusive Provider Organization offers a covered individual medical services through the HMO network; from any medical service provider within the Oxford Freedom network only. This Plan gives you access to 73,000 Freedom network physicians and other providers in the tri-state area, and 99% of the doctors and specialist are either board-certified or boar-eligible. The HMO provisions of coverage cover in-network only, you must choose your provider and hospitals that are within the Freedom Network; otherwise you will be responsible for services received out-of- the network. Unlimited days per year are covered for hospitalization provided Oxford authorizes such hospitalization. Oxford requires pre-certification of planned hospitalizations and certain services; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. When the covered individual uses the Freedom Network doctors and physicians he/she need not meet a deductible nor usually file claim forms for benefits. Generally, a covered individual's care is rendered or coordinated by a participating primary physician within his/her private office; however you do not have to choose a primary care physician. Co-payments of $15.00 are required for visits to one's primary care physician, and 30.00 for a specialist. There is no charge for preventive care within the Oxford network. A covered member does not need a referral to visit an in-network specialist. Co-payments apply also for hospital emergency room services and hospitalization and urgent care facilities and home physician visits. Outpatient in-network mental health services require $30.00 co-pay per visit (up to a maximum of 30 visits/ year). In-patient mental health care, for up to 30 days for biological based services, is provided with $250 co-pay. Outpatient care for drug/alcohol addiction is provided with a co-pay of 30.00 per visit. In-patient care for drug/alcohol addiction, for up to 30 days, is provided with$250 co-pay. Oxford’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for Oxford are follows: $15 for Tier I Drugs $25 for Tier II Drugs $50 for Tier III Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." The prescription tiers described above are based on cost. You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Medco. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for Oxford is provided for two co-pays for a three months supply. For Emergency care, covered employees are responsible for $100.00 co-pay (waived if admitted). For hospitalization in-network, employees are responsible for $250.00 co-pay. Additionally, Oxford has Wellness programs designed to encourage a healthy life style. Oxford promotes the following Wellness Programs: Quit Smoking, Lose Weight, Emotional Health, Health& Fitness, Family and work, Financial and Legal and ask our Expert. Oxford also has a Fitness Center Discount Program, where Oxford subscribers receive up to $200 per six-month period and for spouse100.00 every six-month period when you visit a gym that promotes cardiovascular wellness. The Gym reimbursement form is enclosed with the Oxford enrollment package. Keep in mind that the facility must provide a cardiovascular exercise program and at least one of the two services: Pool, treadmill, rowing machine, elliptical cross trainer, bicycle, group exercise, and step machine, walking or running group, tennis / racquetball courts. HIP/POS HIP/POS provides comprehensive umbrella coverage for hospitalization, medical treatment and services and for psychiatric/psychotherapeutic treatment and services; HIP/POS coverage also extends to preventive care services. As a standard, no deductible is applied to covered services nor are claim forms filed, unless services are provided out of network. As a combined HMO/POS, HIP offers a covered individual the choice of receiving medical services through the HMO network or from any medical service provider outside the HIP network. The HMO provisions of coverage cover in-network services and out-of-network services are covered on an indemnity basis. Unlimited days per year are covered for hospitalization provided HIP authorizes such hospitalization. HIP requires pre-certification of planned hospitalizations; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply. Please review in detail the plan summary enclosed. The out-of-network cost is very high you should use the HMO/in-network part of the plan in order to maximize savings. As long as you stay within the network there are no co pays and no deductible, however when you go out-of network the deductibles are $2,500 individual, $5000 for family, 50% coinsurance up to $7,000, and 14,000 for family and a maximum life time coverage of 5,000,000 per member. Some services are only provided within the network. HIP’s prescription drug benefit offers a covered individual two ways of filling prescriptions: The prescription co-pays for HIP’s are follows: $15 for Generic Drugs $25 for Brand Name (formulary) Drugs $40 for Brand Name (non-formulary) Drugs A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs." You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Express Scripts. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for HIP are covered up to 50% of the total co-pay cost for a three month supply for formulary drugs only. HIP non-formulary drugs are not discounted. For example, for a HIP three months supply of a generic drug you will pay $22.50. A limited number of days of hospitalization benefits per calendar year are allowed for: treatment of mental or nervous disorders; abused substance detoxification; purposes of physical therapy or rehabilitation. Routine foot care is covered for a maximum of 4 visits in a calendar year. For other covered medical services or procedures, there is no limit to the number of days allowed. In all cases, with the exception of certain defined emergency situations, the covered employee’s HIP physician must make hospitalization arrangements. Many medical services are covered by HIP frequently within the confines of a member's selected HIP Center. Among provided services are: general and specialist care including consultations on inpatient and outpatient bases; diagnostic tests including lab and x-rays; routine checkups; well-baby care including nursery; eye examinations; ambulance service; prescriptions; dialysis. HIP also offers a Preventive Dental Plan. Under the HIP Preventive Dental Plan you are entitled to the following preventive dental services: -One cleaning per calendar year for each family member at a cost of $5.00 per member. -The following services are $5.00 per member for any or all of these services during the same visit. - One application of fluoride per calendar year for children up to and including age 15. - Two oral examinations per calendar year for each family member. - Two bitewing x-rays every six months. Services are provided by HIP participating dentists. Keep in mind the dental plan offered under HIP is for preventive and diagnostic services only and should not be viewed as a replacement for the dental plan offered through Aetna Dental. A new HIP enrollee must select a HIP Center or doctor; covered services, with the exception of in-hospital surgical services and dental services, would be received primarily through the selected center or doctor. You can choose to change the center or your doctor at any time by contacting HIP directly. Surgical services are provided within HIP member hospitals. HIP has special guidelines pertaining to emergency care. HIP/POS also has a Mental Health Service Program through which short-term psychotherapeutic treatment including preliminary diagnosis is provided in HIP's own Mental Health Centers. Individuals covered by HIP/POS may fill drug prescriptions through participating pharmacies. DENTAL INSURANCE AETNA DMO/PPO The Aetna Dental Plan, though broadly referred to as the Aetna DMO, incorporates both a traditional reimbursement mechanism called Passive PPO and a dental maintenance organization mechanism called DMO. Covered employees may elect to utilize either side of the plan initially and may change from one side of the plan to the other by notifying Aetna. You must notify Aetna before the 15th of the month in order to the wish to change coverage type. One cannot be insured under both coverage types at the same time. Passive PPO Dental Coverage provides some reimbursement for eligible dental care costs subject to a deductible, co-payments and a calendar year maximum of $2,000 per covered individual. Reimbursement begins once a $100.00 deductible is satisfied (family members must satisfy a $100.00 deductible per person to a maximum of $300.00 for 3 family members). Under the PPO preventive services are covered 100%, basic services are covered 80%, and major services are covered 50%. A covered employee is free to seek dental treatment from the dentist of his/her choice. Claim forms must be completed and it is strongly suggested that pre-treatment estimates be obtained prior to submitting large claims. The Passive PPO Dental Coverage also offers a plan enhancement referred to as the Preferred Provider Organization (PPO). The PPO provides a network of participating dentists whose charges are based on a reduced fee schedule that Aetna U.S HealthCare has negotiated with the PPO participating dentists. These savings are then passed on to you. Under DMO Dental Coverage participating dentists provide dental care. There is no deductible or annual maximum for covered services; there are co-payments, however, for certain services. Under the DMO preventive services are covered 100%, basic services are covered100%, and major services are covered 50%. There are some dental services that are excluded under both sides of the plan. Eligible employees who do not elect dental coverage for themselves or their dependents when first eligible will be subject to a 6 month waiting period for regular services and a 24 month waiting period for periodontal and special services. During the 6-month waiting period for regular services only routine oral exams and x-rays are covered with employees retaining responsibility for applicable deductible and co-payments. LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D) CIGNA GROUP INSURANCE A covered employee carries life and accidental death & dismemberment insurance each with a value equal to one times the employee's annual salary rounded to the next higher thousand; as an individual's salary increases, so do the values of your coverage. Established criteria exist with regard to qualifying circumstances and exact amounts of the benefits. By law, once a covered employee has reached age 65, the value of your Life and AD&D insurance will be gradually reduced through age 75 as follows: LIFE and AD&D Values AT AGE DECREASED BY 65 35% 70 60% 75 75% You must provide us with the name, SS# and address of your beneficiary when completing the enrollment form. You can change your beneficiaries at any time. PENSION PLAN UNITED JEWISH APPEAL-FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK(UJA-FOJP) Our pension plan is sponsored by the United Jewish Appeal-Federation of Jewish Philanthropies and administered by USI Consulting Inc. This is a defined benefit plan, which means that your pension is calculated based on your salary and the years of service, and will not increase or decrease based on market conditions. This plan is noncontributory, which means that employees does not contribute to the pension plan, Selfhelp solely funds the plan. Enrollment takes place after one year of complete service with Selfhelp, in which you have worked at least 1000 hours. You are vested after 5 years of service with Selfhelp, in which you have worked 1000 hours in each year. You will receive a pension after you are vested, based on your years of service and your annual salaries. After enrollment in the plan, you will receive an annual statement denoting whether you are vesting and the monthly benefit you are entitled to. You may receive credit towards vesting if you have worked with any organization that belongs to UJA-FOJP or affiliated agencies. Normal retirement age is 65, and early retirement can start at age 50 (keep in mind that if you retire early your benefit will be reduced). FLEXIBLE SPENDING PLAN (FSP) Most health insurance plans require payment or some form of out-of-pocket expense. In order to reduce the impact to your income resulting from these costs, Selfhelp established a Flexible Spending Plan for all benefits eligible employees. The plan is the result of our continuing efforts to find ways to help you get the most for your earnings. A Flexible Spending Plan is designed to increase your take home pay by allowing you to pre-tax certain unreimbursable premiums, medical, dental and dependent care expenses. There are three accounts to Selfhelp's Flexible Spending Plan. They are as follows: 1) Premium Expense Account 2) Health Care Reimbursement Account 3) Dependent Care Assistance Account. The following is a brief summary of how the plan will work for you. HOW THE PLAN WORKS Certain benefits, which are traditionally paid with after-tax dollars, can be paid with before-tax dollars under the Flexible Spending Plan. Through a Flexible Spending Plan, you can voluntarily redirect a portion of your salary to be used to pay for eligible expenses before your salary is taxed. Your W-2 tax statement at the end of the year will show the new reduced amount of your wages since part of your gross salary is redirected, Federal and State (except Pennsylvania and New Jersey) and Social Security taxes are lower. The net effect of the salary redirection is more spendable income for you now. THREE SEPARATE ACCOUNTS There are three separate accounts. You may elect to participate in one, two or all three accounts based on your personal circumstances. The following provides a basic description of the three accounts. You are encouraged to review the relevant Summary Plan Description for more comprehensive information. 1. PREMIUM EXPENSE ACCOUNT This plan allows you to pre-tax your contributions toward payment of premiums in our sponsored health plans. As indicated on page 1, employees working 35 hours per week would have their individual coverage fully paid. Employees who elect health coverage for their families or who work less than 35 hours per week and/or elect health coverage for themselves and their family will be responsible for the cost of their health coverage. 2. HEALTH CARE REIMBURSEMENT ACCOUNT The Health Care Reimbursement Account enables you to pay for expenses, which are not covered, or are partially covered, by Selfhelp medical or dental insurance and save taxes at the same time. The account allows you to be reimbursed for out-of-pocket medical, dental and vision expenses incurred by you and your IRS eligible dependents. In order to participate in the plan, you must estimate your expenses for the plan year (January through December) and pay them through payroll deduction. The expenses that qualify are those permitted by Section 213 of the Internal Revenue Code. A list of covered expenses is attached. You may put money aside to cover expenses for dependents, even if they are not covered by your Selfhelp medical/dental plans. You may not, however, be reimbursed for the premium cost of other health care coverage maintained outside Selfhelp's Plan. The most that you can contribute to your Health Care Reimbursement Account each Plan Year is $5,000.00. In order to be reimbursed for a health care expense, you must submit a claim form to the Administrator along with an itemized bill from the service provider. Claim forms are available in the Human Resources Department at Central Office. 3. DEPENDENT CARE ASSISTANCE ACCOUNT The Dependent Care Assistance Account enables you to pay for out-of-pocket, work-related dependent day-care costs with pre-tax dollars through payroll deduction. If you are married, you can use the account if you and your spouse both work or, in some situations, if your spouse goes to school full-time. Single employees can also use the account. The most you can contribute to your Dependent Care Assistance Account is $5,000.00 in one plan year ($2,500 if married and filing individual tax returns). Please note that eligible expenses under this account require that your arrangements for dependent care be formalized. THE FSP ENROLLMENT PROCESS You will be eligible to participate in the Flexible Spending Plan when you become eligible to participate in our health benefits (the first of the month following two months of continuous employment). The first year of participation will be a short plan year (unless you become eligible for benefits in January). In subsequent plan years your calculation will be based on a calendar year, from January to December. The open enrollment period is normally in December of each year. During the orientation you will have an opportunity to ask questions and enroll in the plan if you wish to do so. WHAT YOU WILL NEED TO DO You will need to calculate on an annual basis how much of your paycheck you estimate will be spent on premiums, health and dental coverage, co-payments, dependent care and other unreimbursable medical expenses. This estimate will be divided into equal amounts based on the number of pay periods remaining in the plan year. The divided amount will then be deducted automatically from each of your remaining paychecks for that plan year BEFORE IT IS TAXED. This money will be later returned to you to cover you and your family's unreimbursable health and/or dependent care expenses, as you submit appropriate claim forms. This plan is in full accordance with Federal Tax laws and therefore requires that you only submit IRS acceptable deductible expenses for reimbursement. All claims must be submitted to: APA Partner Inc., P.O Box 1506, Latham, NY 12110 . You must submit your claim for the plan year by March 31, of the following year and you have until May 15th of the following year to incur the FSP allowable expenses. We also have also the MBI Benefits Card which allows you to pay for eligible products and services at the point of sale without submitting claim forms or waiting for reimbursement. You can use the card at any eligible location where MasterCard or Visa is accepted. Some examples of eligible locations include: hospitals, physician offices, dental offices, vision service locations, and pharmacies (retail and online). All employees enrolled in the Flexible Spending, Healthcare Reimbursement Account will receive an MBIcard with instructions to activate the card. Research indicates that over 90% of all FSP transactions are electronic, however in some instances, you may have to "go back to the old way" and pay with cash or check and submit a manual claim. You can both use the card and/or submit paper claims, it is up to you. All paper claims should be sent directly to APA Partners Inc. Keep in mind that only eligible Flexible Spending Plan expenses should be purchased with MBIcard. Should you pay for ineligible services or items with the card, you will have to pay back the funds. Although there is no requirement for you to complete claim forms with the MBIcard, additional documentation may be requested in some cases in order to confirm the eligibility of some debit card purchases, therefore you should keep your receipts. The card can be used for up to 3 years. Qualified Transportation Plan (QTE) Selfhelp’s Qualified Transportation Plan provides savings on transportation costs to and from work. By taking advantage of this plan, Mass Transit Commuting and Parking become more affordable. With this plan money may be set-aside on a pre-tax basis for transportation costs, thereby increasing your take home pay. You may set aside up to $115 for Mass Transit and $220for parking expenses may be deducted on a monthly basis. Employees can enroll into this plan during new employee orientation or during open enrollment in the months of June effective July 1st or November, effective January 1st. Participating in the QTE plan has just become easier; you can now get the eTRAC MasterCard® and pay for transportation expenses without having to submit a claim form. You also have the option to continue submit claims instead of using the card, it is up to you. You will use the card like any other credit card to pay only for transportation expenses, you can’t withdraw cash from the card and any non eligible expenses will be denied. Deductions will be made on a bi-weekly basis and sent to our third party administrator: Benefit Resources, Inc. 2320 Brighton-Henrietta TL Rd., Rochester, NY 14623-2782. Claims must be submitted by six months from the end of the month in order to be reimbursed. Should you not submit your claim by the allotted time frame you will not be reimbursed for that month, however you can increase the following month’s claims to get back your deductions or you can decrease your deductions. RETIREMENT SAVINGS PLAN TAX-DEFERRED-ANNUITY 403 (b) Plan Each employee at Selfhelp may elect to save and invest some of his/her salary on a pre-tax basis through tax deferred annuity (TDA) arrangements. Selfhelp does not sponsor the TDA plans. The organizations’ purpose is to provide a payroll deduction mechanism to employees which allows them to voluntarily participate, through payroll deductions, in a TDA plan, The Agency does not administer, recommend or provide on-going information on the various plans. Employees are expected to individually research any information on the Plans including their comparative benefits, current interest rates, tax implications, etc. Your responsibility as a participant, in addition to making a prudent TDA choice, is to assure that you do not exceed certain contribution limits set by the IRS, and any other tax law requirements. The rules of permitted contributions are complicated. Generally your maximum allowable contribution is 15,500 for the current year. In addition, if you are over 50 years old and/or have worked for Selfhelp for 15 years you can contribute an additional $5000 for this year. The maximum catch-up deferral is $15,000. There are, however, other factors, including your Pension Plan benefit that may either reduce this amount or allow you to contribute more. You should work closely with your TDA investment company and your financial/tax adviser to determine you maximum allowable contribution and other necessary compliance requirements of the tax law. The IRS also requires that participants begin to take distributions of their money by the April in the year following their 70 1/2 birthday. In order to assist you in the gathering of information, election and/or change of plans, the following procedures are in effect: Employees may enroll, change his or her contribution or change your carrier of your TDA plan at any time. Human Resources will supply employees (upon request) with information booklets fromvarious TDA plan carriers for employee review. If an employee wishes to stop contributing into his/her Plan, (at any time), a signed memo or an Election/change form should be forwarded to the Human Resources authorizing the cessation of contributions. Please note: when making the decision to invest toward your retirement there are a few factors you should consider: 1- Tolerance for risk: Should you invest on a mutual fund that is risky vs. a guaranteed account. 2-Performance: How are the funds performing now, within the last month, years and from inception. 3-Administrative fees: The fees should not be high and exceed any earnings. Selfhelp offers presently five TDA plans available to employees for payroll deduction. If you have any questions not covered in the booklet regarding contributions, distributions or other provisions of TDA arrangements, contact the TDA plan at the toll-free numbers listed below. Calvert Group (800) 368-2748 www.calvertgroup.com Mutual of America (800) 468-3785 www.mutualofamerica.com American Funds Group* (800) 421-9900 www.americanfunds.com Fidelity Group (800) 343-0860 www.fidelity.com Lincoln Financial Group (866) 367-1776 www.lincolnlife.com Employee Assistance Program (EAP) The employee Assistance program provides employees and loved ones with confidential consultation and referral services for a wide range of issues. The EAP is designed to assist you with situations encountered in every day life. Attempting to resolve a problem can sometimes be stressful and may cause anxiety. The EAP is great resource available to you and your family. The EAP is located at 136 East 57th Street, 4th fl. New York, NY 10022. To Schedule an appointment, simply call 212-935-3030 or 800-327-9092 outside of New York. Citibank at Work/Direct Deposit We are encouraging all employees to sign-up for direct deposit. It is our policy and the preferred medium through which to pay our employees due to the advantages to both the employer and the employee. The Advantages of Direct Deposit are the following: · The employee receives their money directly into their checking. · No more lost or stolen checks. · No more hassle to go to the bank on payday to cash the check. · No special arrangements have to be made when employee is away from home. For those of you who don't have a checking account, you can open one through the Citibank at Work Program. The Citibank at Work program provides for financial and banking services when you have your paycheck directly deposited into a Citibank checking account. If you already have a checking account with Citibank you must advise us of your interest to participate in this program in order for you to receive these discounts. If you already have an account, you can have your salary direct deposited into that account. Citibank at Work is a great benefit provided to Selfhelp employees. By opening a checking account with Citibank and direct-depositing your salary into that account you will receive the following benefits: · Citibank checking with no monthly service charges for 12 months · Mortgage origination discounts · Citibank AutoSave · Free first order of checks · No ATM charge on Citibank ATM transactions; no Citibank ATM charge on non Citibank ATMs for at least 12 months Complimentary top-rated PC banking and free automated bill payment service. · CitiPhone Banking available 24 hours a day, 7 days a week. Sign up for direct deposit into a Citibank Account and also receive a complimentary Citipro Financial Needs Analysis. For more information please contact: The Human Resource Department or Piedad Alvarez at 212-290-7714 at Citibank or visit the Citibank branch at 201 West 34th St. New York City. GENERAL INFORMATION Employees have the opportunity to change their primary medical coverage during each plan's open enrollment period (currently during December of each year with changes effective January 1). All benefits descriptions in this summary are synopses of established benefits offered to eligible employees of Selfhelp Community Services. The synopses are provided as a benefits overview and also as a means of assisting Selfhelp employees faced with benefits choices. More specific details of benefits may be found in corresponding Summary Plan Descriptions. The information contained herein should in no way be interpreted as either comprehensive or as a contract. New employees will be provided with a discussion of benefits as a segment of the New Employee Orientation Session. The Human Resources Division conducts the New Employee Orientation Session monthly.
The Oxford Exclusive Provider Organization offers a covered individual medical services through the HMO network; from any medical service provider within the Oxford Freedom network only. This Plan gives you access to 73,000 Freedom network physicians and other providers in the tri-state area, and 99% of the doctors and specialist are either board-certified or boar-eligible. The HMO provisions of coverage cover in-network only, you must choose your provider and hospitals that are within the Freedom Network; otherwise you will be responsible for services received out-of- the network.
Unlimited days per year are covered for hospitalization provided Oxford authorizes such hospitalization. Oxford requires pre-certification of planned hospitalizations and certain services; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply.
When the covered individual uses the Freedom Network doctors and physicians he/she need not meet a deductible nor usually file claim forms for benefits. Generally, a covered individual's care is rendered or coordinated by a participating primary physician within his/her private office; however you do not have to choose a primary care physician. Co-payments of $15.00 are required for visits to one's primary care physician, and 30.00 for a specialist. There is no charge for preventive care within the Oxford network. A covered member does not need a referral to visit an in-network specialist. Co-payments apply also for hospital emergency room services and hospitalization and urgent care facilities and home physician visits.
Outpatient in-network mental health services require $30.00 co-pay per visit (up to a maximum of 30 visits/ year). In-patient mental health care, for up to 30 days for biological based services, is provided with $250 co-pay. Outpatient care for drug/alcohol addiction is provided with a co-pay of 30.00 per visit. In-patient care for drug/alcohol addiction, for up to 30 days, is provided with$250 co-pay.
For Emergency care, covered employees are responsible for $100.00 co-pay (waived if admitted). For hospitalization in-network, employees are responsible for $250.00 co-pay.
Additionally, Oxford has Wellness programs designed to encourage a healthy life style. Oxford promotes the following Wellness Programs: Quit Smoking, Lose Weight, Emotional Health, Health& Fitness, Family and work, Financial and Legal and ask our Expert. Oxford also has a Fitness Center Discount Program, where Oxford subscribers receive up to $200 per six-month period and for spouse100.00 every six-month period when you visit a gym that promotes cardiovascular wellness. The Gym reimbursement form is enclosed with the Oxford enrollment package. Keep in mind that the facility must provide a cardiovascular exercise program and at least one of the two services: Pool, treadmill, rowing machine, elliptical cross trainer, bicycle, group exercise, and step machine, walking or running group, tennis / racquetball courts.
HIP/POS
HIP/POS provides comprehensive umbrella coverage for hospitalization, medical treatment and services and for psychiatric/psychotherapeutic treatment and services; HIP/POS coverage also extends to preventive care services. As a standard, no deductible is applied to covered services nor are claim forms filed, unless services are provided out of network.
As a combined HMO/POS, HIP offers a covered individual the choice of receiving medical services through the HMO network or from any medical service provider outside the HIP network. The HMO provisions of coverage cover in-network services and out-of-network services are covered on an indemnity basis. Unlimited days per year are covered for hospitalization provided HIP authorizes such hospitalization. HIP requires pre-certification of planned hospitalizations; failure to do so may result in a reduction of the payable benefit, which increases the covered individual's financial liability under these circumstances. Coverage relating to the treatment of mental, nervous, or substance abuse disorders and also for purposes of physical therapy, medicine and/or rehabilitation exists; however, in accordance with the diagnosis, there are limitations in the number of covered days (in-patient) or covered visits/sessions (outpatient) that apply.
Please review in detail the plan summary enclosed. The out-of-network cost is very high you should use the HMO/in-network part of the plan in order to maximize savings. As long as you stay within the network there are no co pays and no deductible, however when you go out-of network the deductibles are $2,500 individual, $5000 for family, 50% coinsurance up to $7,000, and 14,000 for family and a maximum life time coverage of 5,000,000 per member. Some services are only provided within the network.
HIP’s prescription drug benefit offers a covered individual two ways of filling prescriptions:
The prescription co-pays for HIP’s are follows:
A formulary is a list of prescription drugs that a health plan has approved for use by doctors. Health plans that have formularies develop their own unique list of "approved drugs."
You can save time and money on your maintenance prescription drugs through a mail service prescription program. This program is being offered through Express Scripts. With this service, you will be able to obtain up to a 90-day supply of certain maintenance medications for the appropriate co-payment. Drugs used to treat certain medical conditions will be available for up to a 90-day supply and three refills, via the Mail Order Program. The medical conditions are listed in your health information package. Mail order prescription coverage for HIP are covered up to 50% of the total co-pay cost for a three month supply for formulary drugs only. HIP non-formulary drugs are not discounted. For example, for a HIP three months supply of a generic drug you will pay $22.50.
A limited number of days of hospitalization benefits per calendar year are allowed for: treatment of mental or nervous disorders; abused substance detoxification; purposes of physical therapy or rehabilitation. Routine foot care is covered for a maximum of 4 visits in a calendar year. For other covered medical services or procedures, there is no limit to the number of days allowed. In all cases, with the exception of certain defined emergency situations, the covered employee’s HIP physician must make hospitalization arrangements.
Many medical services are covered by HIP frequently within the confines of a member's selected HIP Center. Among provided services are: general and specialist care including consultations on inpatient and outpatient bases; diagnostic tests including lab and x-rays; routine checkups; well-baby care including nursery; eye examinations; ambulance service; prescriptions; dialysis.
HIP also offers a Preventive Dental Plan. Under the HIP Preventive Dental Plan you are entitled to the following preventive dental services:
-One cleaning per calendar year for each family member at a cost of $5.00 per member.
-The following services are $5.00 per member for any or all of these services during the same visit.
- One application of fluoride per calendar year for children up to and including age 15.
- Two oral examinations per calendar year for each family member.
- Two bitewing x-rays every six months.
Services are provided by HIP participating dentists. Keep in mind the dental plan offered under HIP is for preventive and diagnostic services only and should not be viewed as a replacement for the dental plan offered through Aetna Dental.
A new HIP enrollee must select a HIP Center or doctor; covered services, with the exception of in-hospital surgical services and dental services, would be received primarily through the selected center or doctor. You can choose to change the center or your doctor at any time by contacting HIP directly. Surgical services are provided within HIP member hospitals.
HIP has special guidelines pertaining to emergency care. HIP/POS also has a Mental Health Service Program through which short-term psychotherapeutic treatment including preliminary diagnosis is provided in HIP's own Mental Health Centers. Individuals covered by HIP/POS may fill drug prescriptions through participating pharmacies.
DENTAL INSURANCE
AETNA DMO/PPO
The Aetna Dental Plan, though broadly referred to as the Aetna DMO, incorporates both a traditional reimbursement mechanism called Passive PPO and a dental maintenance organization mechanism called DMO. Covered employees may elect to utilize either side of the plan initially and may change from one side of the plan to the other by notifying Aetna. You must notify Aetna before the 15th of the month in order to the wish to change coverage type. One cannot be insured under both coverage types at the same time.
Passive PPO Dental Coverage provides some reimbursement for eligible dental care costs subject to a deductible, co-payments and a calendar year maximum of $2,000 per covered individual. Reimbursement begins once a $100.00 deductible is satisfied (family members must satisfy a $100.00 deductible per person to a maximum of $300.00 for 3 family members). Under the PPO preventive services are covered 100%, basic services are covered 80%, and major services are covered 50%. A covered employee is free to seek dental treatment from the dentist of his/her choice. Claim forms must be completed and it is strongly suggested that pre-treatment estimates be obtained prior to submitting large claims. The Passive PPO Dental Coverage also offers a plan enhancement referred to as the Preferred Provider Organization (PPO). The PPO provides a network of participating dentists whose charges are based on a reduced fee schedule that Aetna U.S HealthCare has negotiated with the PPO participating dentists. These savings are then passed on to you.
Under DMO Dental Coverage participating dentists provide dental care. There is no deductible or annual maximum for covered services; there are co-payments, however, for certain services. Under the DMO preventive services are covered 100%, basic services are covered100%, and major services are covered 50%. There are some dental services that are excluded under both sides of the plan.
LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D) CIGNA GROUP INSURANCE
A covered employee carries life and accidental death & dismemberment insurance each with a value equal to one times the employee's annual salary rounded to the next higher thousand; as an individual's salary increases, so do the values of your coverage. Established criteria exist with regard to qualifying circumstances and exact amounts of the benefits.
By law, once a covered employee has reached age 65, the value of your Life and AD&D insurance will be gradually reduced through age 75 as follows:
LIFE and AD&D Values
AT AGE DECREASED BY
65
35%
70
60%
75
75%
You must provide us with the name, SS# and address of your beneficiary when completing the enrollment form. You can change your beneficiaries at any time.
PENSION PLAN
UNITED JEWISH APPEAL-FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK(UJA-FOJP)
Our pension plan is sponsored by the United Jewish Appeal-Federation of Jewish Philanthropies and administered by USI Consulting Inc. This is a defined benefit plan, which means that your pension is calculated based on your salary and the years of service, and will not increase or decrease based on market conditions. This plan is noncontributory, which means that employees does not contribute to the pension plan, Selfhelp solely funds the plan.
Enrollment takes place after one year of complete service with Selfhelp, in which you have worked at least 1000 hours. You are vested after 5 years of service with Selfhelp, in which you have worked 1000 hours in each year. You will receive a pension after you are vested, based on your years of service and your annual salaries. After enrollment in the plan, you will receive an annual statement denoting whether you are vesting and the monthly benefit you are entitled to.
You may receive credit towards vesting if you have worked with any organization that belongs to UJA-FOJP or affiliated agencies. Normal retirement age is 65, and early retirement can start at age 50 (keep in mind that if you retire early your benefit will be reduced).
FLEXIBLE SPENDING PLAN (FSP)
Most health insurance plans require payment or some form of out-of-pocket expense. In order to reduce the impact to your income resulting from these costs, Selfhelp established a Flexible Spending Plan for all benefits eligible employees. The plan is the result of our continuing efforts to find ways to help you get the most for your earnings.
A Flexible Spending Plan is designed to increase your take home pay by allowing you to pre-tax certain unreimbursable premiums, medical, dental and dependent care expenses.
There are three accounts to Selfhelp's Flexible Spending Plan. They are as follows: 1) Premium Expense Account 2) Health Care Reimbursement Account 3) Dependent Care Assistance Account.
The following is a brief summary of how the plan will work for you.
HOW THE PLAN WORKS
Certain benefits, which are traditionally paid with after-tax dollars, can be paid with before-tax dollars under the Flexible Spending Plan. Through a Flexible Spending Plan, you can voluntarily redirect a portion of your salary to be used to pay for eligible expenses before your salary is taxed. Your W-2 tax statement at the end of the year will show the new reduced amount of your wages since part of your gross salary is redirected, Federal and State (except Pennsylvania and New Jersey) and Social Security taxes are lower. The net effect of the salary redirection is more spendable income for you now.
THREE SEPARATE ACCOUNTS
There are three separate accounts. You may elect to participate in one, two or all three accounts based on your personal circumstances. The following provides a basic description of the three accounts. You are encouraged to review the relevant Summary Plan Description for more comprehensive information.
1. PREMIUM EXPENSE ACCOUNT
This plan allows you to pre-tax your contributions toward payment of premiums in our sponsored health plans. As indicated on page 1, employees working 35 hours per week would have their individual coverage fully paid. Employees who elect health coverage for their families or who work less than 35 hours per week and/or elect health coverage for themselves and their family will be responsible for the cost of their health coverage.
2. HEALTH CARE REIMBURSEMENT ACCOUNT
The Health Care Reimbursement Account enables you to pay for expenses, which are not covered, or are partially covered, by Selfhelp medical or dental insurance and save taxes at the same time. The account allows you to be reimbursed for out-of-pocket medical, dental and vision expenses incurred by you and your IRS eligible dependents. In order to participate in the plan, you must estimate your expenses for the plan year (January through December) and pay them through payroll deduction. The expenses that qualify are those permitted by Section 213 of the Internal Revenue Code. A list of covered expenses is attached. You may put money aside to cover expenses for dependents, even if they are not covered by your Selfhelp medical/dental plans.
You may not, however, be reimbursed for the premium cost of other health care coverage maintained outside Selfhelp's Plan. The most that you can contribute to your Health Care Reimbursement Account each Plan Year is $5,000.00. In order to be reimbursed for a health care expense, you must submit a claim form to the Administrator along with an itemized bill from the service provider. Claim forms are available in the Human Resources Department at Central Office.
3. DEPENDENT CARE ASSISTANCE ACCOUNT
The Dependent Care Assistance Account enables you to pay for out-of-pocket, work-related dependent day-care costs with pre-tax dollars through payroll deduction. If you are married, you can use the account if you and your spouse both work or, in some situations, if your spouse goes to school full-time. Single employees can also use the account. The most you can contribute to your Dependent Care Assistance Account is $5,000.00 in one plan year ($2,500 if married and filing individual tax returns). Please note that eligible expenses under this account require that your arrangements for dependent care be formalized.
THE FSP ENROLLMENT PROCESS
You will be eligible to participate in the Flexible Spending Plan when you become eligible to participate in our health benefits (the first of the month following two months of continuous employment). The first year of participation will be a short plan year (unless you become eligible for benefits in January). In subsequent plan years your calculation will be based on a calendar year, from January to December. The open enrollment period is normally in December of each year. During the orientation you will have an opportunity to ask questions and enroll in the plan if you wish to do so.
WHAT YOU WILL NEED TO DO
You will need to calculate on an annual basis how much of your paycheck you estimate will be spent on premiums, health and dental coverage, co-payments, dependent care and other unreimbursable medical expenses. This estimate will be divided into equal amounts based on the number of pay periods remaining in the plan year. The divided amount will then be deducted automatically from each of your remaining paychecks for that plan year BEFORE IT IS TAXED. This money will be later returned to you to cover you and your family's unreimbursable health and/or dependent care expenses, as you submit appropriate claim forms. This plan is in full accordance with Federal Tax laws and therefore requires that you only submit IRS acceptable deductible expenses for reimbursement.
All claims must be submitted to: APA Partner Inc., P.O Box 1506, Latham, NY 12110 .
You must submit your claim for the plan year by March 31, of the following year and you have until May 15th of the following year to incur the FSP allowable expenses.
We also have also the MBI Benefits Card which allows you to pay for eligible products and services at the point of sale without submitting claim forms or waiting for reimbursement. You can use the card at any eligible location where MasterCard or Visa is accepted. Some examples of eligible locations include: hospitals, physician offices, dental offices, vision service locations, and pharmacies (retail and online).
All employees enrolled in the Flexible Spending, Healthcare Reimbursement Account will receive an MBIcard with instructions to activate the card. Research indicates that over 90% of all FSP transactions are electronic, however in some instances, you may have to "go back to the old way" and pay with cash or check and submit a manual claim. You can both use the card and/or submit paper claims, it is up to you. All paper claims should be sent directly to APA Partners Inc.
Keep in mind that only eligible Flexible Spending Plan expenses should be purchased with MBIcard. Should you pay for ineligible services or items with the card, you will have to pay back the funds. Although there is no requirement for you to complete claim forms with the MBIcard, additional documentation may be requested in some cases in order to confirm the eligibility of some debit card purchases, therefore you should keep your receipts. The card can be used for up to 3 years.
Qualified Transportation Plan (QTE)
Selfhelp’s Qualified Transportation Plan provides savings on transportation costs to and from work. By taking advantage of this plan, Mass Transit Commuting and Parking become more affordable. With this plan money may be set-aside on a pre-tax basis for transportation costs, thereby increasing your take home pay. You may set aside up to $115 for Mass Transit and $220for parking expenses may be deducted on a monthly basis. Employees can enroll into this plan during new employee orientation or during open enrollment in the months of June effective July 1st or November, effective January 1st.
Participating in the QTE plan has just become easier; you can now get the eTRAC MasterCard® and pay for transportation expenses without having to submit a claim form. You also have the option to continue submit claims instead of using the card, it is up to you. You will use the card like any other credit card to pay only for transportation expenses, you can’t withdraw cash from the card and any non eligible expenses will be denied.
Deductions will be made on a bi-weekly basis and sent to our third party administrator:
Benefit Resources, Inc. 2320 Brighton-Henrietta TL Rd., Rochester, NY 14623-2782.
Claims must be submitted by six months from the end of the month in order to be reimbursed. Should you not submit your claim by the allotted time frame you will not be reimbursed for that month, however you can increase the following month’s claims to get back your deductions or you can decrease your deductions.
RETIREMENT SAVINGS PLAN
TAX-DEFERRED-ANNUITY 403 (b) Plan
Each employee at Selfhelp may elect to save and invest some of his/her salary on a pre-tax basis through tax deferred annuity (TDA) arrangements.
Selfhelp does not sponsor the TDA plans. The organizations’ purpose is to provide a payroll deduction mechanism to employees which allows them to voluntarily participate, through payroll deductions, in a TDA plan, The Agency does not administer, recommend or provide on-going information on the various plans. Employees are expected to individually research any information on the Plans including their comparative benefits, current interest rates, tax implications, etc.
Your responsibility as a participant, in addition to making a prudent TDA choice, is to assure that you do not exceed certain contribution limits set by the IRS, and any other tax law requirements. The rules of permitted contributions are complicated. Generally your maximum allowable contribution is 15,500 for the current year. In addition, if you are over 50 years old and/or have worked for Selfhelp for 15 years you can contribute an additional $5000 for this year. The maximum catch-up deferral is $15,000. There are, however, other factors, including your Pension Plan benefit that may either reduce this amount or allow you to contribute more. You should work closely with your TDA investment company and your financial/tax adviser to determine you maximum allowable contribution and other necessary compliance requirements of the tax law. The IRS also requires that participants begin to take distributions of their money by the April in the year following their 70 1/2 birthday.
In order to assist you in the gathering of information, election and/or change of plans, the following procedures are in effect:
Employees may enroll, change his or her contribution or change your carrier of your TDA plan at any time. Human Resources will supply employees (upon request) with information booklets fromvarious TDA plan carriers for employee review.
If an employee wishes to stop contributing into his/her Plan, (at any time), a signed memo or an Election/change form should be forwarded to the Human Resources authorizing the cessation of contributions.
Please note: when making the decision to invest toward your retirement there are a few factors you should consider:
1- Tolerance for risk: Should you invest on a mutual fund that is risky vs. a guaranteed account. 2-Performance: How are the funds performing now, within the last month, years and from inception. 3-Administrative fees: The fees should not be high and exceed any earnings.
Selfhelp offers presently five TDA plans available to employees for payroll deduction. If you have any questions not covered in the booklet regarding contributions, distributions or other provisions of TDA arrangements, contact the TDA plan at the toll-free numbers listed below.
Calvert Group (800) 368-2748 www.calvertgroup.com
Mutual of America (800) 468-3785 www.mutualofamerica.com
American Funds Group* (800) 421-9900 www.americanfunds.com
Fidelity Group (800) 343-0860 www.fidelity.com
Lincoln Financial Group (866) 367-1776 www.lincolnlife.com
Employee Assistance Program (EAP)
The employee Assistance program provides employees and loved ones with confidential consultation and referral services for a wide range of issues. The EAP is designed to assist you with situations encountered in every day life. Attempting to resolve a problem can sometimes be stressful and may cause anxiety. The EAP is great resource available to you and your family. The EAP is located at 136 East 57th Street, 4th fl. New York, NY 10022. To Schedule an appointment, simply call 212-935-3030 or 800-327-9092 outside of New York.
Citibank at Work/Direct Deposit
We are encouraging all employees to sign-up for direct deposit. It is our policy and the preferred medium through which to pay our employees due to the advantages to both the employer and the employee.
The Advantages of Direct Deposit are the following:
· The employee receives their money directly into their checking.
· No more lost or stolen checks.
· No more hassle to go to the bank on payday to cash the check.
· No special arrangements have to be made when employee is away from home.
For those of you who don't have a checking account, you can open one through the Citibank at Work Program. The Citibank at Work program provides for financial and banking services when you have your paycheck directly deposited into a Citibank checking account. If you already have a checking account with Citibank you must advise us of your interest to participate in this program in order for you to receive these discounts. If you already have an account, you can have your salary direct deposited into that account.
Citibank at Work is a great benefit provided to Selfhelp employees. By opening a checking account with Citibank and direct-depositing your salary into that account you will receive the following benefits:
· Citibank checking with no monthly service charges for 12 months
· Mortgage origination discounts
· Citibank AutoSave
· Free first order of checks
· No ATM charge on Citibank ATM transactions; no Citibank ATM charge on non Citibank ATMs for at least 12 months Complimentary top-rated PC banking and free automated bill payment service.
· CitiPhone Banking available 24 hours a day, 7 days a week.
Sign up for direct deposit into a Citibank Account and also receive a complimentary Citipro Financial Needs Analysis. For more information please contact: The Human Resource Department or Piedad Alvarez at 212-290-7714 at Citibank or visit the Citibank branch at 201 West 34th St. New York City.
GENERAL INFORMATION
Employees have the opportunity to change their primary medical coverage during each plan's open enrollment period (currently during December of each year with changes effective January 1).
All benefits descriptions in this summary are synopses of established benefits offered to eligible employees of Selfhelp Community Services. The synopses are provided as a benefits overview and also as a means of assisting Selfhelp employees faced with benefits choices. More specific details of benefits may be found in corresponding Summary Plan Descriptions. The information contained herein should in no way be interpreted as either comprehensive or as a contract.
New employees will be provided with a discussion of benefits as a segment of the New Employee Orientation Session. The Human Resources Division conducts the New Employee Orientation Session monthly.
