U.S. Benefits Decision Guide · When it comes to healthcare, one size does not fit all. That’s why we’re offering a selection of medical plans designed to let you choose ex-actly

U.S. Benefits Decision GuideMay 1, 2017 – April 30, 2018

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Your Benefits. Your Choice.The Mercer Marketplace helps you take control of your

healthcare spending by:

• Showing the costs associated with each plan.

• Offering a range of options at different prices.

• Helping you find the most cost-effective plan for your needs.

• Offering income tax-saving opportunities through health and

dependent care spending accounts.

• Giving you access to group discounts on additional benefit

options, like auto and home insurance, identity theft protection,

pet insurance and more.

Welcome to Your Benefits!You have access to a range of core benefits such as medical, dental and vision, as well as voluntary

benefits like critical illness insurance, accident insurance and hospital indemnity coverage. Plus,

online tools and resources will be available to help you make confident healthcare decisions. These

options allow you to build a customized package that meets the needs of you and your family. It’s all

part of your easy-to-use benefits experience

— Point. Click. Healthy!

Decision Guide in a Nutshell This Decision Guide will help you understand the benefit options available to you and your

family, so you can start thinking about the plans that meet your overall healthcare needs. You’ll also

learn how to use the Mercer Marketplace, which features built-in decision support to guide you

through the benefits selection process — one step at a time.

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months,

a federal law gives you more choices for your prescription drug coverage. Please see the Creditable Prescription Drug

Coverage and Medicare Notice in the legal notices section of this guide for more details.

What’s inside?Health Benefits ..........................................................................................2

Flexible Spending Accounts................................................................. 12

401(k) Plan .............................................................................................. 13

Life and AD&D Insurance ...................................................................... 14

Disability Insurance ................................................................................ 16

Additional Benefit Options ................................................................... 17

It’s Easy to Enroll .................................................................................... 18

Questions? .............................................................................................. 19

Glossary .................................................................................................. 20

Legal Notices .......................................................................................... 21

What’s in Store?Being a smart healthcare shopper means making sure you know what you’re getting and what it’s going to cost.

The Mercer Marketplace is set up like an online benefits store so you can easily view coverage details and costs for each plan before de-ciding what to put in your shopping cart. When you check out, you’ll have a chance to review your selections and see your total cost — it’s as simple as Point. Click. Healthy!

Your OptionsYour selection of benefit options include:

Medical plans — Choose from a PPO Plan or three High Deductible Health Plans with health savings account (HSA) options that can help you save on healthcare expenses.

Supplemental medical insurance — Protect yourself from the high cost of a critical illness, accident or hospital stay. Sometimes a traditional medical plan isn’t enough.

Health Savings Account (HSA) — If you enroll in the $1,500 Deductible Plan, $2,850 Deductible Plan or $4,500 Deductible Plan, you automatically receive access to a triple-tax advantaged HSA.

Dental and vision plans — Select dental and vision coverage to meet your specific needs.

Flexible Spending Accounts (FSAs) — Save on taxes by contributing to an FSA for healthcare, combination (dental and vision) and/or dependent care expenses.

Life and disability insurance — Life’s unpredictable. Protect your family’s finances with a range of life and disability coverage op-tions.

More benefits — Find additional benefits including auto and home insurance, a legal plan, identity theft protection and pet insurance.

Questions?

Mercer Marketplace Call Center Licensed benefit counselors are available by phone to answer general questions about your benefits, provide personalized support and help walk you through the enrollment process. They can even advise on which benefit plan may best meet the needs of you and your family. Call the Mercer Marketplace at (844) 287-9495.

HoursMonday – Friday, 7 a.m. to 9 p.m. Eastern Time.

Don’t forget the Mercer Marketplace is available 7 days a week, 24 hours a day with online resources to help answer enrollment questions at www.mercermarketplace.com/Radial.

GlossaryCheck out the Glossary on page 20 for definitions to terms used through-out this guide.

Hablas español?Llame al (844) 287-9495 y seleccione 9 para conectar con un consejero de beneficios que puede ayudar.

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Health Benefits

When it comes to healthcare, one size does not fit all. That’s why we’re offering a selection of medical plans designed to let you choose ex-actly the coverage you need — at a cost that’s right for your budget.

Through the Mercer Marketplace, you have a choice of medical, supple-mental medical, dental, and vision plans, as well as tax- advantaged healthcare spending accounts that can save you money.

MedicalMedical coverage offers valuable benefits to help you stay healthy and pay for care if you or your covered family members become sick or injured.

Start with standard coverage: Then, you may choose to add:

Medical plans

Enroll in core coverage for peace of mind.

Choose from:

• $800 Deductible PPO Plan

• $1,500 Deductible Plan with HSA



Supplemental medical plans

Supplement your core medical plan to protect yourself from significant or unexpected out-of-pocket expenses.

Choose from:

• Critical Illness Insurance

• Accident Insurance

• Hospital Indemnity Insurance

It’s the Law!

As part of the Healthcare Reform law, most Americans must have medical insurance or pay a federal tax penalty. Be sure you’re covered, either through one of the company plans or through another option available to you, such as your spouse’s/domestic partner’s employer benefits.

Summary of Benefits and Coverage

You have access to a Summary of Benefits and Coverage (SBC) for each of your medical plan options. These documents provide detailed information about coverage and costs to help you compare plans and make informed decisions. To access the SBCs, visit the Mercer Marketplace at www.mercermarketplace.com/Radial.

Finding Providers is Easy!

You can see any provider you choose, but keep in mind you’ll typically pay less when you visit a UnitedHealthcare in-network provider. UnitedHealthcare has negotiated discounted rates for most services. To see if your provider is in-network, visit www.myuhc.com, and select Find Physician, Laboratory or Facility, next click All UnitedHealthcare Plans, then choose the Choice Plus Network. Or call (844) 255-3066.

Your May 1, 2017 - April 30, 2018 U.S. Benefits Decision Guide

Your Medical Plan Options Your medical plan options are offered through UnitedHealthcare.

$800 Deductible PPO Plan

You pay a portion of the covered expenses before the plan begins to pay for certain benefits — this amount is called the deductible. At the time of service, you’ll pay out-of-pocket for certain services — this is called a copay.

Once your deductible is met, you’ll pay a percentage of covered medical expenses — this percentage is called coinsurance. If your share of medical expenses reaches the out-of-pocket maximum, you won’t have to pay anything for the rest of the plan year.

Compatible with: Healthcare FSA and Dependent Care FSA.

$1,500 Deductible Plan with HSA$2,850 Deductible Plan with HSA$4,500 Deductible Plan with HSAThe $1,500 Deductible Plan, $2,850 Deductible Plan and $4,500 Deductible Plan are designed to encourage you to know your treatment options and the costs associated with your choices. With these plans:

• You have a higher deductible.

• You get a tax-free HSA. Money in your HSA can be carried forward from year to year and is always yours to keep, even if you leave the company or retire.

• Your lower monthly contributions can help you cover out-of- pocket costs.

Compatible with: HSA, Combination FSA and Dependent Care FSA.

A Note About Eligibility

Regular employees on the U.S. payroll working 20 (or more) hours a week on a continuous basis will be eligible for benefits. You’re eligible for coverage on the 1st of the month following 60 days of employment and the elections made during new hire enrollment will remain in effect for the entire benefit plan year unless you have a qualifying life event (see Changing Your Benefit Selections on page 18). New hires have 31 days to make their benefit elections once they become eligible.

Plan Features

All of these medical plans include:

1. In-network preventive care provided at no cost. Services like annual physicals and well-woman exams, immunizations, and routine cancer screenings are cov-ered at 100%. That means you pay noth-ing for these services.

2. Annual deductible. You pay for initial medical and prescription drug costs out-of-pocket until you meet your annual deductible. For the $1,500 Deductible Plan, $2,850 Deductible Plan and $4,500 De-ductible Plan, contributions to your HSA can help you pay for your out-of-pocket costs.

3. Coinsurance. Once the deductible is met, you and the plan share any further health expenses during the plan year until you meet your out-of-pocket maximum. This is known as coinsurance.

4. Out-of-pocket maximum. The plan protects you by limiting the total amount you’ll pay each plan year for medical care. Once you meet your out-of-pocket maxi-mum, the plan pays 100% of your eligible expenses for the rest of the plan year.

What Will You Pay?

Your specific benefit costs will be provided as you’re enrolling on the Mercer Marketplace at www.mercermarketplace.com/Radial.

Prescription Drugs

When you enroll in one of our medical plan options, you receive prescription drug coverage through CVS/caremark. With over 7,000 locations, CVS/caremark is one of America’s largest prescription drug retailers.

Health Benefits continued

HSA: What’s Eligible?

You can use your HSA for eligible out-of-pocket expenses like:

• Deductibles

• Office visits

• Prescription drugs

• Hospital stays and lab work

• Speech/occupational/physical thera-py

• Dental and vision care

For a complete list of eligible expenses, visit www.irs.gov and see Publication 502.

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A Closer Look at the Health Savings Account (HSA)With the $1,500 Deductible Plan, $2,850 Deductible Plan, and $4,500 Deductible Plan, you’re eligible to open and contribute money to an HSA available through Discovery. The HSA is a tax-advantaged savings account you can use to help cover the costs of your healthcare.

HSA features:

• Works like a bank account. Use account funds to pay for eligible healthcare expenses by using your plan-provided HSA debit card at the point of service after you receive care, or reimburse yourself for payments you’ve made (up to the available balance in the account).

• Change your contribution amount at any time. You decide how much to contribute to the HSA and can change that amount at any time. Contribute up to the annual (January 1 – December 31) IRS limit of $3,400 for individuals or $6,750 for family coverage (this amount includes the company’s contribution, as appropriate). Employees age 55 and older can make an additional $1,000 catch-up contribution.

If you currently own an HSA, and have already made all or part of your total HSA contribution for 2017, you will need to factor in your prior contributions to avoid going over the calendar year limit. Contact the Mercer Marketplace Center at (844) 287-9495 for more information.

• It’s tax-advantaged. Contributions are made from your paycheck on a pretax basis, and the money will never be taxed when used for eligible medical expenses.

• It’s your money. Unused funds can be carried over each year and invested for the future — you can earn tax-free interest on your HSA balance. You can even take the account with you if you leave the company, or save it to use during retirement.

• Can be paired with a Combination FSA. Combine the HSA with this account for additional tax savings. Use the funds to pay for eligible dental and vision expenses. When you meet the IRS statutory deductible, then eligible medical expenses are also allowed. The IRS statutory de-ductible is $1,300 for individual coverage or $2,600 for family cover-age. See the Mercer Marketplace for more details.

How the $1,500 Deductible Plan, $2,850 Deductible Plan and $4,500 Deductible Plans Work Together with the HSA

CoinsuranceYou and the plan share a percentage of the cost of services until you meet the out-of-pocket maximum.

DeductibleYou pay 100%. Once you meet the deduct-ible, coinsurance kicks

in.

Out-of-Pocket Maximum

Once you reach this, the plan pays 100% of in-network costs.

Preventive Care

The plan pays 100%.

Health Savings Account (HSA)Your contributions to the Health Savings Account

can cover your deductible and coinsurance


How the Medical Plans Compare


$1,500 Deductible Plan with HSA



HSA Eligible No Yes Yes Yes

Preventive Care Covered 100% in-network

In-Network

Employee Only/ Family Deductible

$800/$1,600 $1,500/$3,000 $2,850/$5,700 $4,500/$9,000

Employee Only/Family Out-of-Pocket Maximum

$2,400/$4,800 $3,000/$6,000 $5,500/$11,000 $6,550/$13,100

Plan Coinsurance Plan pays 80%, after de-ductible

Plan pays 80%, after deductible



Office Visit (primary care/specialist)

$20/$35 copay Plan pays 80%, after deductible



Prescription Drug Coverage

Retail Prescriptions

Generic $10 copay, Tier One1 Plan pays 80%, after deductible4

Plan pays 70%, after deductible4


Formulary2 Plan pays 70%, Tier Two (min. $25/max. $50)1,3




Non-formulary Plan pays 55%, Tier Three (min. $40/max. $80)1,3




Mail Order Prescriptions

Generic $25 copay, Tier One1 Plan pays 80%, after deductible4



Formulary2 Plan pays 70%, Tier Two (min. $62.50/max. $125)1,3




Non-formulary Plan pays 55%, Tier Three (min. $100/max. $200)1,3




1 Deductible does not apply.

2 Formulary prescriptions are brand name drugs that generally save you money over other brand name drugs because they are on the CVS/caremark Prescription Drug List. These medications typically fall under Tier 2 of the prescription drug list (PDL) and are considered your moderate cost option.

3 Formulary (Tier Two) and Non-formulary (Tier Three) drug costs are based on coinsurance. You are required to pay at least the minimum amount for a prescription drug, but you will never pay more than the maximum coinsurance amount for a prescription.

4 Preventive Prescriptions (as defined under ACA regulations) ffor the $1,500, $2,850 and $4,500 Deductible Plans are covered at 100%, prior to the deductible. Maintenance medications are covered at the coinsurance level and the deductible is waived.

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Supplemental Medical Supplemental Medical Insurance through Voya can help protect you from significant expenses not covered by your medical plan. In fact, based on your situation, you may be able to save money by adding a supplemental plan to a lower cost medical plan. Be sure to consider your anticipated medical needs for the coming year — for example, a major surgery — and the cost of the insurance plans available to you.

Keep in MindSupplemental medical plans are intended to supplement your primary medical plan. On their own, they don’t provide the minimum level of medical coverage needed to meet Affordable Care Act (ACA) requirements.

Critical Illness InsuranceWhen a serious illness strikes, Critical Illness Insurance through Voya can provide financial support to help you through a difficult time. It protects against the financial impact of certain illnesses, such as a heart attack or cancer. You receive a lump-sum benefit to cover out-of-pocket expenses for your treatment that are not covered by your medical plan. You can also use the money to take care of your everyday living expenses like housekeeping services, special transportation and daycare. Critical Illness Insurance is available to employees, their spouse/domestic partner and child(ren); however, you must enroll in coverage for yourself before you can enroll a dependent.

Benefits are paid:• Directly to you, unless assigned to someone else.• As a lump sum.

How Critical Illness Insurance Coverage WorksLet’s say, three months after enrolling, you are diagnosed with a cancer. Three years later you suffer a stroke. In both cases, Critical Illness insurance would provide you with a lump-sum payment to use however you see fit. Benefits are not paid for any critical illness diagnosed before the coverage effective date. As the example below shows, the full benefit may be paid up to once per year.

Voya would pay you:

Cancer (100%) – year 1 $15,000

Stroke (100%) – year 3 $15,000

Total benefit paid directly to you $30,000

Critical Illness Overview

Carrier Voya

Coverage You: $15,000, $30,000 Spouse: $10,000, $15,000 Child(ren): $5,000, $10,000

Employee must elect coverage for the spouse and/or child(ren) to elect coverage.

Cost Paid by you.



Accident Insurance Accidents happen — but you can help protect yourself from accident-related costs that can strain your budget. Voya Accident Insurance supplements your medical plan by providing a cash benefit in case of accidental injury. As you recov-er, use this money to help pay for:

• Medical expenses not covered by your medical plan, such as your deductible or coinsurance.• Ongoing living expenses, such as your mortgage or rent.

Accident Insurance coverage is available to employees, their spouse/domestic partner and child(ren); however, you must enroll in coverage for yourself before you can enroll a dependent.

Benefits are paid:• Directly to you, unless assigned to someone else.• As a lump sum.• In addition to any other coverage, like medical or an Accidental Death & Dismemberment (AD&D) plan.

The policy pays you a benefit up to a specific amount for:• Accidental death• Dismemberment• Dislocation or fracture• Initial hospital confinement

The benefit amount depends on the type of injuries you have and the medical services you need.

How Accident Insurance Coverage WorksLet’s suppose you are involved in a bicycle accident. You suffer a fractured leg and a dislocated wrist, and also need stitches. You take an ambulance to the emergency room, receive X-rays and spend two days in the hospital. Although your medical plan pays most of the medical expenses, you are still responsible for a remainder of the cost. That’s where Accident Insurance can help, as shown in the example below.

Voya would pay you:

ER services, physician fees, and medical equipment $300

Fractured leg requiring surgery $1,600

Large (greater than 6”) laceration requiring stitches $400

Dislocated wrist requiring surgery $600

Ambulance $100

Blood, plasma, platelets $300

Follow-up doctor treatment $50

Hospital admission $900

Hospital confinement (plan pays $225 a day up to 365 days) $450 (two days)

Physical therapy (six treatments) $150


• Intensive care• Ambulance• Medical expenses• Outpatient physician’s treatment

Key Things to Know • If you choose to cover your

dependents, the covered spouse/domestic partner and child benefit amount is 100% of your benefit amount with certain exceptions.

• You can take your Accident Insurance coverage with you if you leave the company.

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Hospital Indemnity InsuranceA trip to the hospital can be stressful — so can the bills. Even with a medical plan, you may still be responsible for copays, deductibles and other out-of-pocket costs. A Hospital Indemnity Insurance plan through Voya provides supplemental payments that you can use to cover expenses that your medical plan doesn’t cover for hospital stays, ambulance service, surgery, and certain inpatient or outpatient treatments. Hospital Indemnity Insurance coverage is available to employees, their spouse/domestic partner and child(ren); however, you must enroll in coverage for yourself before you can enroll a dependent.

Benefits are paid:• Directly to you, unless assigned to someone else.• As a lump-sum or on a benefit schedule.

How Hospital Indemnity Insurance Coverage WorksLet’s say your appendix ruptures, and your recovery keeps you in the hospital for five days.

Voya would pay you:

Hospital admission benefit $500

Daily hospital confinement benefit (plan pays $100 per day) $500 (five days)


Learn More For additional plan details, including out-of-network benefits, visit the Mercer Marketplace at www.mercermarketplace.com/Radial.


What’s Your Best Fit?

If this describes you…

Then consider…

Why?$800 Deductible PPO Plan

$1,500, $2,850 or $4,500

Deductible Plan with HSA

Supplemental Plans

You expect your need for medical care to be relatively low (preventive visits, occasional illnesses).

The $1,500, $2,850, and $4,500 Deductible Plans with HSAs have the lowest premiums, so you’ll pay less per paycheck. Since you don’t expect to need a lot of care, these plans could save you money.

You want to keep your costs for receiving medical care to a minimum.

The $800 Deductible PPO Plan has the lowest deductible, so you’ll pay the least amount out of your pocket when you receive care.

You want to lower your taxable income while saving for healthcare expenses — using the money only when you need to.

These plans have an HSA, which allows you to save money for healthcare expenses and save money on your taxes as well.

In the event of an expensive illness or injury, you aren’t confident that you could afford to pay bills not covered by your medical plan.

Critical Illness, Accident and Hospital Indemnity Insurance provide benefits that can pay for medical bills your medical plan doesn’t cover — and even for other expenses, depending on the plan. Keep in mind, these plans are meant to supplement your primary medical insurance, not to serve as your only insurance.

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Finding Providers is EasyTo search for providers in the Delta Dental network or VSP network, go to:

Dental Healthy teeth and gums are important to your overall health. Learn about the dental plans available to you through Delta Dental.

Enhanced Plan Basic Plan

Annual Maximum Benefit $2,000 $750

In-Network

Employee Only/Family Deductible (waived for preventive services)

$50/$150 $50/$150

Preventive Services Plan pays 100% Plan pays 90%

Basic Services Plan pays 80% Plan pays 70%

Major Services Plan pays 50% Not covered

Orthodontia Services* Plan pays 50% Not covered

Orthodontia Lifetime Maximum (in-network and out-of-network)

$1,500 Not covered

* Orthodontia coverage under the enhanced plan is available to adults and children (up to age 26).


Delta Dental: www.deltadentalins.com

VSP: www.vsp.com

Learn More For additional plan details, including out-of-network benefits, visit the Mercer Marketplace at www.mercermarketplace.com/Radial.

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Vision You can enroll in vision coverage to save money on eligible vision care expenses, such as eye exams, glasses, and con-tact lenses. Learn about the vision plans available to you through VSP.

Enhanced Plan Standard Plan

In-Network

Copay Frequency Copay Frequency

Exam $10 Every 12 months $10 Every 12 months

Lenses $10 Every 12 months $25 Every 12 months

Retail Allowance Frequency Retail Allowance Frequency

Frames $175 Every 12 months $130 Every 24 months

Contact Lenses (in lieu of frames and lenses)

Covered up to $175 Every 12 months Covered up to $130 Every 12 months

Contact Lens Fitting Covered in full with a copay not to exceed $60

Every 12 months in lieu of frames and lenses

Covered in full with a copay not to exceed $60

Every 12 months in lieu of frames and lenses

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Flexible Spending AccountsFlexible Spending Accounts (FSAs)Save money on your healthcare and/or dependent care expenses by using a tax-advantaged FSA. The money you contribute comes from your paycheck pretax (lowering your taxable income). And withdrawals for eligible expenses are also tax-free.

Healthcare FSA$800 Deductible PPO Plan • Contribute up to $2,600 annually to help cover qualified medical, vision and dental expenses. For a complete list

of eligible expenses, visit www.irs.gov and see Publication 502.

• Choose your contribution amount once a year (if your personal situation changes, such as getting married or having a baby, you may be able to change your election during the year).

• Use a plan-provided debit card to pay for your eligible expenses.

• Your entire annual contribution is available to you at the beginning of the plan year.

• You can carry forward up to $500 in unused funds each year. Anything not used over $500 at the end of the year will be forfeited.

Dependent Care FSA Any medical plan• Contribute up to $5,000 a year to reimburse yourself for qualified dependent care (child or adult) expenses.

For a complete list of eligible expenses, visit www.irs.gov and see Publication 503.

• Eligible expenses include child care and care for dependent elders.

• Cannot be used toward medical expenses for yourself or dependents.

• Unused money does not carry forward at the end of each year — you must “use it or lose it.”

Healthcare FSA Reimbursement Reimbursement requests for eligible healthcare expenses that are incurred between your initial plan year start date (the date your flexible spending account and medical coverage became effective) through April 30, 2018, must be submitted no later than July 31, 2018 to receive reimbursement.

Combination FSA $1,500 Deductible Plan, $2,850 Deductible Plan and $4,500 Deductible Plan• Contribute up to $2,600 annually.

• Only dental and vision expenses can be paid with the Combination FSA until you have met the IRS statutory deductible for medical expenses — $1,300 for individual coverage or $2,600 for family coverage. After you have met the statutory deductible, then eligible medical expenses are allowed.

• Use a plan-provided debit card to pay for your eligible expenses.

• Your entire annual contribution is available to you at the beginning of the plan year.

• Unused money does not carry forward at the end of each year — you must “use it or lose it.”

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Take a Look: HSA vs. FSAs See how these accounts compare.

HSA Healthcare FSA Combination FSA Dependent Care FSA

Available if you enroll in the:

• $1,500 Deductible Plan







All medical plans

Annual contributions:

You can contribute up to:

Employee Only: $3,400Family: $6,750

You can contribute up to $2,600

You can contribute up to $2,600

You can contribute up to $5,000 (per individual

or married couple)

“Use it or lose it”?

No, the money in your account is yours to keep

Yes, but you can carry forward up to $500 in

unused funds each year

Yes, money cannot be carried forward to the

next year

Yes, money cannot be carried forward to the

next year

Learn More For additional details about the HSA and FSAs, visit the Mercer Marketplace at www.mercermarketplace.com/Radial.

The 401(k) Plan helps you build savings for an active, healthy and financially stable future. Employees may participate in the 401(k) Plan once they meet eligibility requirements. Please visit the Benefits page (under the Human Resources tab) on the Intranet for more information.

401(k) Plan

Your May 2017 – April 2018 U.S. Benefits Decision Guide | 13

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What Will You Pay?Your specific benefit costs will be displayed as you’re enrolling on the Mercer Marketplace at www.mercermarketplace.com/Radial.

Life and AD&D InsuranceFor Your Financial Wellbeing Life and disability insurance provide important financial protection for you and your family. You can choose from several different levels of coverage to meet your needs.

Basic Life InsuranceBecause life can suddenly take an unexpected turn, it’s good to know you’re covered if the worst occurs. The company provides basic life insurance through MetLife to assist you and your family in the event of a death. This benefit is fully paid for by the company, and you do not need to enroll to receive coverage.

The basic life insurance benefit is equal to 1.5 times your annual salary, up to $2,000,000.

Supplemental Life and AD&D Insurance You also can choose to purchase additional life insurance for yourself, your spouse/domestic partner, and your child(ren). You pay the full cost of any supplemental life insurance and/or supplemental AD&D insurance coverage. See the following page for more information about supplemen-tal life and AD&D insurance.

Evidence of Insurability (EOI)Life insurance over a certain amount may require Evidence of Insurability (EOI) — amounts greater than the guaranteed issue amount of $300,000 and spouse term life elections greater than $50,000. After electing coverage, you will receive more information if you need to take further action to enroll.

Select a BeneficiaryIt’s important to choose a beneficiary or beneficiaries to receive the policy’s benefit payment in the event of the insured person’s death. You should designate your beneficiary(ies) on the Mercer Marketplace. The employee is automati-cally the beneficiary for spouse/domestic partner and child(ren) coverage.

An Important NoteIf electing life insurance, you must be actively at work on the plan effective date with a valid Social Security number or U.S. government issued ID for your coverage to begin.

Learn More For more coverage details, visit the Mercer Marketplace at www.mercermarketplace.com/Radial.

Questions?For general questions related to disability benefits, contact the Mercer Marketplace at (844) 287-9495.


Your Supplemental Life and AD&D Options Type of coverage Purchase for How it works

Employee Term Life Yourself • To supplement the coverage provided by the company, you can purchase additional term life insurance.

• This coverage is tied to your employment and ends if you leave the company.• Depending on the amount of coverage you choose, this benefit can be be-

tween one and six times your annual salary, up to $2,000,000.• The guaranteed issue amount for this benefit is $300,000 — this means you

are guaranteed to be insured up to this amount without having to provide evidence of insurability (EOI).

Spouse Term Life Your spouse/ domestic partner

• This coverage is tied to your employment and ends if you leave the company.• $25,000 increments, up to the lesser of 50% of employee term life amount

or $250,000.• You are guaranteed coverage of up to $50,000 without having to provide EOI.

Child Term Life Your child(ren) • This coverage is tied to your employment and ends if you leave the company.• Depending on the amount of coverage you choose, this benefit can be

$5,000, $10,000, $15,000 or $20,000.• You are guaranteed coverage of up to $20,000 without having to provide EOI.• Child(ren) can be covered up to age 26.

Supplemental Accidental Death & Dismemberment (AD&D)

Yourself • You can purchase AD&D insurance for yourself.• Depending on the amount of coverage you choose for yourself, you can

receive a benefit between one and six times your annual salary, up to $2,000,000, without having to provide EOI.

Spouse/Domestic Partner and Child Supplemental AD&D

Your spouse/ domestic partner and child(ren)

• If you elect supplemental AD&D insurance for yourself then you also can purchase AD&D insurance for your spouse or domestic partner and your child(ren).

• The benefits differ depending on the amount of coverage you choose for your spouse or domestic partner (or spouse/domestic partner and child(ren)).

• You can elect up to the maximum coverage without having to provide EOI.

Covered person

Your spouse/domestic partner

Child(ren)

Spouse/domestic partner AND Child(ren) (up to age 26)

Benefit

50% of employee’s AD&D election.

15% of the employee’s AD&D election.

• Spouse/domestic partner: 40% of employee’s AD&D election.

• Child(ren):10% of employee’s AD&D election.

Disability InsuranceDisability Insurance If you become ill or injured and need to miss work for an extended time, disability insurance can replace a percentage of your lost income (up to a maximum benefit).

Short-Term DisabilityThis benefit is completely paid by the company. Short-term disability provides a weekly benefit amount of 60% of your salary, up to $2,500 per week, for a maximum duration of 90 days. Short-term disability coverage begins after seven days of disability.

Supplemental Short-Term DisabilityYou also have the opportunity to increase your short-term disability coverage by purchasing “buy-up coverage.” This benefit is paid for by you and the cost of the plan is based on your age and annual earnings. Supplemental short-term disability provides a weekly benefit amount of 70% of your salary (60% employer-paid short-term disability plus 10% employee-paid supplemental short-term disability), up to $6,500 per week, for a maximum of 90 days.

Long-Term DisabilityThe company also provides long-term disability coverage if you have been disabled for a continuous period of 90 days. Long-term disability provides a monthly benefit amount of 60% of your salary, up to $15,000 per month, for a maximum duration up to the Social Security Normal Retirement Age.

An Important NoteIf electing disability coverage, you must be actively at work on the plan effective date with a valid Social Security number or U.S. government issued ID for your coverage to begin.

Learn More For more coverage details, visit the Mercer Marketplace at www.mercermarketplace.com/Radial.

Questions?For general questions related to disability benefits, contact the Mercer Marketplace at (844) 287-9495.

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Additional Benefit OptionsYou also have the option of enrolling in additional benefits through the Mercer Marketplace. Keep in mind that the enrollment window for the following benefits may be separate from your open enrollment period. These benefits are offered at competitive group rates, which could save you money compared to purchasing them on your own.

Benefit What is it? Why would I need it?

Identity Theft Protection

Services from InfoArmor that monitor your identity, detect fraud, and restore your identity in the event of theft. You can enroll in this benefit during the new hire eligibility period and during annual Open Enrollment.

• Get peace of mind by protecting yourself against the damage of identity theft.

• Certified privacy advocates act on your behalf to resolve identity theft issues.

Legal Benefits Hyatt Legal Assistance Plan offers economical access to attorneys for legal services such as will preparation, estate planning and family law. You can enroll in this benefit during the new hire eligibility period and during annual Open Enrollment.

• Give yourself, your spouse/domestic partner, and your dependents access to a nationwide network of 13,000 attorneys.

• Legal advice is a phone call away.• Representatives help you find an attorney in

your area.

Auto & Home Insurance

MetLife gives you access to personal insurance policies including home landlord’s rental dwell-ing, condo, recreational vehicle and boat.

• Save up to 15% by purchasing this coverage through the Mercer Marketplace.

• No-obligation quotes and cost comparisons.• Enroll any time of year.

Pet Insurance Nationwide Pet Insurance provides coverage to help you cover the costs of veterinary care. Available for dogs, cats, birds and exotic animals.

• Protect against the financial impact of veterinary care while using any veterinarian worldwide.

• You are eligible to receive a discount of 5% or more on premiums.

• Enroll any time of year.

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The Mercer Marketplace takes you through your benefits shopping one decision at a time, providing helpful education and decision support every step of the way. Enroll for your benefits via the website or the Mercer Marketplace Call Center at (844) 287-9495.

Log InFrom the intranet: Visit the Human Resources page and click “Mercer Marketplace.”

From an external computer: Start by visiting www.mercermarketplace.com/Radial. The first time you visit the Mercer Marketplace, select “Create an Account.” Next, enter your Social Security number, last name, and date of birth. Then, you’ll select a unique user name and password to use whenever you come back to the site.

Start ShoppingTo select your benefits, click on the “Get Started” button and then follow the simple enrollment steps.

1. Profile• Review your personal information.• If you have dependents and are extending coverage to them, you

will need to add your dependents in the Mercer Marketplace.

2. Enrollment • Answer some questions to help identify the best coverage for

you and your family’s needs. • Compare plan features and costs.• Use the educational resources to learn more.• Select the benefits you want to enroll in.

3. Confirmation• Review the benefits summary and confirm your enrollment

selections. Last, print a copy of your confirmation statement for your records.

Mercer Marketplace Call CenterA benefit counselor can walk you through the enrollment process and advise you on what plan options they think are the best fit. Call (844) 287-9495 to speak with a counselor Monday – Friday, 7 a.m. to 9 p.m. Eastern Time. Spanish-speaking counselors are also available.

If You Don’t Enroll, You Won’t Have CoverageNew employees are eligible for benefits on the 1st of the month following 60 days of employment. New employees have 31 days from the day they become eligible to make benefit elections. If you do not enroll for benefits during this 31-day window, you will not have another opportunity to enroll until the next open enrollment period, or unless you have a qualifying life event as described below. For more information, contact Mercer Marketplace at (844) 287-9495.

Changing Your Benefit SelectionsIn accordance with IRS regulations, you can only make changes to some benefits (such as medical and dental insurance) during the employer’s Open Enrollment period, or if you have a qualifying life event. For example, if you get married or have a baby, you can add coverage for your spouse/domestic partner or new child. You can learn more about which situations allow you to change your benefits and how to make changes by visiting the Mercer Marketplace or calling a benefits counselor. If you experience a family status change, please contact Mercer Marketplace within 31 days of the event. Other benefits, such as the HSA or Pet Insurance, can be started, stopped, or changed at any time during the year.

It’s Easy to Enroll


Questions?As you use the Mercer Marketplace for the first time, you may have questions. And that’s okay, because there’s a team of licensed, English- and Spanish-speaking benefits counselors ready to help you. They’re specially trained at helping employees understand their healthcare options and figuring out the best choices for your and your family’s unique needs and budget. Simply call the toll-free number to receive personal support from a benefits counselor.

Benefit Administrator Phone Number Website Policy #

Medical UnitedHealthcare (844) 255-3066 www.myuhc.com 907804

Prescription Drug Services

CVS/caremark (844) 297-0510 www.caremark.com 1182

Flexible Spending and Health Saving Accounts (FSAs/HSAs) (Discovery Benefits)

Marketplace (877) 248-0510 www.mercermarketplace.com/Radial Not Required

Supplemental Medical (Critical Illness, Accident Insurance, Hospital Indemnity)

Voya Financial (866) 448-7351 http://foremployers.voya.com 694410

Dental Delta Dental (800) 932-0783 www.deltadentalins.com 18317

Vision VSP (800) 877-7195 www.vsp.com 30066569

Life and AD&D MetLife (800) 523-2894 www.metlife.com/mercermarketplace 00164439

Disability/ Leave Administrator

Cigna Claim intake: 888-84CignaMedical underwriter: (800) 732-1603

radial.iamselfservice.com Not Required

Legal MetLaw (Hyatt Legal)

(800) 438-6388 www.legalplans.com Access code: GETLAW

609/1279

Auto & Home MetLife (800) 438-6388 www.metlife.com/group-auto/mpe 9164439

Identity Theft InfoArmor (800) 789-2720 www.infoarmor.com/exchange 1259

Pet Insurance Nationwide (877) 738-7874 www.petinsurance.com 4732

Employee Assistance Program (EAP)

Magellan (800) 424-4485 www.magellanhealth.com/member Radial Holdings

Mercer Marketplace Call Center (844) 287-9495

Monday – Friday, 7 a.m. to 9 p.m. Eastern Time

Hablas español?Llame al (844) 287-9495 y seleccione 9 para conectar con un consejero de beneficios que puede ayudar.

Coinsurance: The way in which you and the company share healthcare costs after you meet the plan’s deductible, but before you meet the out-of-pocket maximum.

Copay: A flat dollar amount you pay for a covered service each time you use that service.

Deductible: The amount you pay toward your medical insurance plan before the plan begins to share in the cost of covered benefits.

Flexible Spending Accounts (FSAs): A type of account that lets you use pretax funds to pay for eligible medical, dental and vision expenses, and/or dependent care expenses.

Health Savings Account (HSA): An account that lets you use pretax funds to pay for eligible healthcare expenses.

Out-of-Pocket Costs: Expenses you pay yourself, such as deductibles, copays and services not covered by your medical plan.

Out-of-Pocket Maximum: The maximum amount you pay for covered healthcare services during a plan year.

Prescriptions:

• Generic medications contain the same active ingredients as more costly alternatives, but are not sold using a brand name.

• Formulary medications are brand name drugs that are available at a lower cost to you.• Non-formulary medications may be purchased at a higher cost to you.

Glossary

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Legal NoticesThe official plan document and summary plan description for the Radial Commerce, Inc. Group Welfare Benefits Plan and their respective coverage options provide more complete details regarding the terms of the plan. If there is any conflict between the statements in this guide and the official plan documents, the terms of the plan documents will govern all rights and obligations of plan participants, beneficiaries, and fiduciaries of Radial Commerce, Inc. The plan administrator (or its delegate) has the sole discretion to interpret and apply the terms and conditions of the plan described in this guide. Radial Commerce, Inc. reserves the right to amend or terminate these benefits or change the cost of coverage at any time and for any reason.

The Benefits Decision Guide, combined with these legal notices, provides an overview of the benefits available to you and your family. In the event of a discrepancy between the information presented in the Benefits Decision Guide and official plan documents, the official plan documents will govern.

Statement of Material Modifications (ERISA Plans)This enrollment guide constitutes a summary of modifications to the employer’s group health plan. It is meant to supplement and/or replace certain information in the existing plan descriptions. Please share these materials with your covered family members.

Summary of Benefits CoverageA Summary of Benefits Coverage (SBC) for each of the employer-sponsored medical plans is available at www.mercermarketplace.com/Radial. You may also request a paper copy by calling the Mercer Marketplace Call Center at (844) 287-9495.

Important Notice from Radial Commerce, Inc. about Creditable Prescription Drug Coverage and MedicareThe purpose of this notice is to advise you that the prescription drug coverage listed below under the Radial Commerce, Inc. medical plan is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2017. This is known as “creditable coverage.” Why this is important: if you or your covered dependent(s) are enrolled in any prescription drug coverage during 2017 listed in this notice and are or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty — as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.

If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you.

Please read the notice below carefully. It has information about prescription drug coverage with Radial Commerce, Inc. and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.

Notice of creditable coverageYou may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium.

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Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period.

If you are covered by one of the Radial Commerce, Inc. prescription drug plans listed below, you’ll be interested to know that coverage is, on average, at least as good as standard Medicare prescription drug coverage for 2017. This is called creditable coverage. Coverage under one of these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare prescription drug plan.

• $800 Deductible PPO Plan• $1,500 Deductible Plan with HSA• $2,850 Deductible Plan with HSA• $4,500 Deductible Plan with HSA

If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case, the employer plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription drug plan. If you waive or drop Radial Com-merce, Inc. coverage, Medicare will be your only payer. You can re-enroll in the employer plan at annual enrollment or if you have a special enrollment event for the Radial Commerce, Inc. plan.

You should know that if you waive or leave coverage with Radial Commerce, Inc. and you go 63 days or longer without creditable prescription drug coverage (once your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month that you did not have creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll in Part D.

You may receive this notice at other times in the future — such as before the next period you can enroll in Medicare prescription drug coverage, if this Radial Commerce, Inc. coverage changes, or upon your request.

For more information about your options under Medicare prescription drug coverageMore detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You hand-book. Medicare participants will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. Here’s how to get more information about Medicare prescrip-tion drug plans:

Visit www.medicare.gov for personalized help.

Call your state Health Insurance Assistance Program (see a copy of the Medicare & You handbook for the telephone number).

Call (800) MEDICARE ((800) 633-4227). TTY users should call (877) 486-2048.

For people with limited income and resources, extra help paying for a Medicare prescription drug plan is avail-able. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov or call (800) 772-1213 (TTY (800) 325-0778).

Legal Notices continued


Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enroll-ment period ends, you may need to provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.

For more information about this notice or your prescription drug coverage, contact:

Radial Commerce, Inc.Attn: HIPAA Privacy Officer935 First AvenueKing of Prussia, PA 19406(610) 491-7000 [email protected]

HIPAA Special Enrollment NoticeNotice of special enrollment rights for health plan coverageIf you decline enrollment in a Radial Commerce, Inc. health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in a Radial Commerce, Inc. health plan without waiting for the next Open Enrollment period if you:

• Lose other health insurance or group health plan coverage. You must request enrollment within 31 days after the loss of other coverage.

• Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request health plan enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

• Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage.

If you request a change due to a special enrollment event within the 31 day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in a Radial Commerce, Inc. medical plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. Please see the section entitled “CHIP/MEDICAID NOTICE” below for further information.

Note: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current cov-erage or change to another health plan. Any other currently covered dependents may also switch to the new plan in which you enroll.

Women’s Health And Cancer Rights Act (WHCRA) NoticeIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed.• Surgery and reconstruction of the other breast to produce a symmetrical appearance.• Prostheses.• Treatment of physical complications of the mastectomy, including lymphedema.

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These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call UnitedHealthcare at (844) 255-3066.

Newborns’ and Mothers’ Health Protection Act (NMHPA or “Newborns’ Act”) NoticeGroup health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hos-pital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call UnitedHealthcare at (844) 255-3066.

CHIP/Medicaid NoticePremium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium as-sistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your depen-dents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial (877) KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligi-ble for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call (866) 444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2015. Please visit the Benefits page on Radial Central for an updated list. Contact your State for more information on eligibility.


ALABAMA – Medicaid

Website: www.myalhipp.com Phone: (855) 692-5447

ALASKA – Medicaid

Website: http://health.hss.state.ak.us/dpa/programs/medicaid Phone (Outside of Anchorage): (888) 318-8890Phone (Anchorage): (907) 269-6529

COLORADO – Medicaid

Medicaid Website: http://www.colorado.gov/hcpfMedicaid Customer Contact Center: (800) 221-3943

FLORIDA – Medicaid

Website: http://www.flmedicaidtplrecovery.com/ Phone: (877) 357-3268

GEORGIA – Medicaid

Website: http://dch.georgia.gov – Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: (404) 656-4507

INDIANA – Medicaid

Website: http://www.in.gov/fssa Phone: (800) 889-9949

IOWA – Medicaid

Website: www.dhs.state.ia.us/hipp Phone: (888) 346-9562

KANSAS – Medicaid

Website: http://www.kdheks.gov/hcf/ Phone: (800) 792-4884

KENTUCKY – Medicaid

Website: http://chfs.ky.gov/dms/default.htm Phone: (800) 635-2570

LOUISIANA – Medicaid

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: (888) 695-2447

MAINE – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: (800) 977-6740 TTY: (800) 977-6741

MASSACHUSETTS – Medicaid and CHIP

Website: http://www.mass.gov/MassHealth Phone: (800) 462-1120

MINNESOTA – Medicaid

Website: http://www.dhs.state.mn.us/id_006254 Click on Health Care, then Medical AssistancePhone: (800) 657-3739

MISSOURI – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: (573) 751-2005

MONTANA – Medicaid

Website: http://medicaid.mt.gov/member Phone: (800) 694-3084

NEBRASKA – Medicaid

Website: www.ACCESSNebraska.ne.gov Phone: (855) 632-7633

NEVADA – Medicaid

Medicaid Website: http://dwss.nv.gov Medicaid Phone: (800) 992-0900

NEW HAMPSHIRE – Medicaid

Website: http://www.dhhs.nh.gov/oii/documents/ hippapp.pdf Phone: (603) 271-5218

NEW JERSEY – Medicaid and CHIP

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid Medicaid Phone: (609) 631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: (800) 701-0710

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NEW YORK – Medicaid

Website: http://www.nyhealth.gov/health_care/medicaid Phone: (800) 541-2831

NORTH CAROLINA – Medicaid

Website: http://www.ncdhhs.gov/dma Phone: (919) 855-4100

NORTH DAKOTA – Medicaid

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: (800) 755-2604

OKLAHOMA – Medicaid and CHIP

Website: http://www.insureoklahoma.org Phone: (888) 365-3742

OREGON – Medicaid

Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov

Phone: (800) 699-9075

PENNSYLVANIA – Medicaid

Website: http://www.dpw.state.pa.us/hipp Phone: (800) 692-7462

RHODE ISLAND – Medicaid

Website: http://www.eohhs.ri.gov/Phone: (401) 462-5300

SOUTH CAROLINA – Medicaid

Website: http://www.scdhhs.gov Phone: (888) 549-0820

SOUTH DAKOTA - Medicaid

Website: http://dss.sd.gov Phone: (888) 828-0059

TEXAS – Medicaid

Website: http://www.gethipptexas.com/ Phone: (800) 440-0493

UTAH – Medicaid and CHIP

Website: Medicaid: http://health.utah.gov/medicaid CHIP: http://health.utah.gov/chip Phone: (866) 435-7414

VERMONT– Medicaid

Website: http://www.greenmountaincare.org/ Phone: (800) 250-8427

VIRGINIA – Medicaid and CHIP

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: (800) 432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: (855) 242-8282

WASHINGTON – Medicaid

Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx Phone: (800) 562-3022 ext. 15473

WEST VIRGINIA – Medicaid

Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx Phone: (877) 598-5820, HMS Third Party Liability

WISCONSIN – Medicaid

Website: http://www.badgercareplus.org/pubs/p-10095.htmPhone: (800) 362-3002

WYOMING – Medicaid

Website: https://wyequalitycare.acs-inc.com/ Phone: (307) 777-7531

To see if any other states have added a premium assistance program since July 31, 2015, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration www.dol.gov/ebsa (866) 444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov (877) 267-2323, Menu Option 4, Ext. 61565



HIPAA Privacy Notice

Please carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this information.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on the use and disclosure of individual health information by Radial Commerce, Inc. health plans. This information, known as protected health information (PHI), includes almost all individually identifiable health information held by a plan — whether received in writing, in an electronic medium, or as an oral communication. This notice describes the privacy practices of these plans: Medical, Dental, and Vision. The plans covered by this notice may share health information with each other to carry out treatment, payment, or healthcare operations. These plans are collectively referred to as the Plan in this notice, unless specified otherwise.

The Plan’s duties with respect to health information about youThe Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. If you participate in an insured plan option, you will receive a notice directly from the Insurer. It’s important to note that these rules apply to the Plan, not Radial Commerce, Inc. as an employer — that’s the way the HIPAA rules work. Different policies may apply to other Radial Commerce, Inc. programs or to data unrelated to the Plan.

How the Plan may use or disclose your health informationThe privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of healthcare treatment, payment activities, and healthcare operations. Here are some examples of what that might entail:

• Treatment includes providing, coordinating, or managing healthcare by one or more healthcare providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals be-tween providers. For example, the Plan may share your health information with physicians who are treating you.

• Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations, and provide reimbursement for healthcare. This can include determining eligibility, reviewing services for medical necessity or appropriateness, engaging in utilization management activities, claims management, and billing; as well as performing “behind the scenes” plan functions, such as risk adjustment, collection, or reinsurance. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.

• Health care operations include activities by this Plan (and, in limited circumstances, by other plans or providers), such as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal grievance resolution. Health care operations also include evaluating vendors; engaging in credentialing, training, and accreditation activities; performing underwriting or premium rating; arranging for medical review and audit activities; and conducting business planning and development. For example, the Plan may use information about your claims to audit the third parties that approve payment for Plan benefits.

The amount of health information used, disclosed or requested will be limited and, when needed, restricted to the minimum necessary to accomplish the intended purposes, as defined under the HIPAA rules. If the Plan uses or discloses PHI for un-derwriting purposes, the Plan will not use or disclose PHI that is your genetic information for such purposes.

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How the Plan may share your health information with Radial Commerce, Inc.The Plan, or its health insurer or HMO, may disclose your health information without your written authorization to Radial Commerce, Inc. for plan administration purposes. Radial Commerce, Inc. may need your health information to administer benefits under the Plan. Radial Commerce, Inc. agrees not to use or disclose your health information other than as permitted or required by the Plan documents and by law. The Radial Commerce, Inc. Benefits Department (including the Chief Human Resources Officer, Compensation, Benefits, Human Resources Operations, and the HIPAA Privacy Officer are the only Radial Commerce, Inc. employees who will have access to your health information for plan administration functions.

Here’s how additional information may be shared between the Plan and Radial Commerce, Inc., as allowed under the HIPAA rules:

• The Plan, or its insurer or HMO, may disclose “summary health information” to Radial Commerce, Inc., if requested, for purposes of obtaining premium bids to provide coverage under the Plan or for modifying, amending, or terminating the Plan. Summary health information is information that summarizes participants’ claims information, from which names and other identifying information have been removed.

• The Plan, or its insurer or HMO, may disclose to Radial Commerce, Inc. information on whether an individual is participating in the Plan or has enrolled or disenrolled in an insurance option or HMO offered by the Plan.

In addition, you should know that Radial Commerce, Inc. cannot and will not use health information obtained from the Plan for any employment-related actions. However, health information collected by Radial Commerce, Inc. from other sources — for example, under the Family and Medical Leave Act, Americans with Disabilities Act,or workers’ compensation programs — is not protected under HIPAA (although this type of information may be protected under other federal or state laws).

Other allowable uses or disclosures of your health informationIn certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care. Information about your location, general condition, or death may be provided to a similar person (or to a public or private entity authorized to assist in disaster relief efforts). You’ll generally be given the chance to agree or object to these disclosures (although exceptions may be made — for example, if you’re not present or if you’re incapacitated). In addition, your health information may be disclosed without authorization to your legal representative. The Plan also is allowed to use or disclose your health information without your written authorization for the following activities:

Workers’ compensation Disclosures to workers’ compensation or similar legal programs that provide benefits for work-related injuries or illness without regard to fault, as authorized by and neces-sary to comply with the laws

Necessary to prevent serious threat to health or safety

Disclosures made in the good-faith belief that releasing your health information is neces-sary to prevent or lessen a serious and imminent threat to public or personal health or safety, If made to someone reasonably able to prevent or lessen the threat (or to the target of the threat); includes disclosures to help law enforcement officials identify or apprehend an individual who has admitted participation in a violent crime that the Plan reasonably believes may have caused serious physical harm to a victim, or where it appears the individual has escaped from prison or from lawful custody

Public health activities Disclosures authorized by law to persons who may be at risk of contracting or spreading a disease or condition; disclosures to public health authorities to prevent or control disease or report child abuse or neglect; and disclosures to the Food and Drug Admin-istration to collect or report adverse events or product defects



Victims of abuse, neglect, or domestic violence

Disclosures to government authorities, including social services or protected services agencies authorized by law to receive reports of abuse, neglect, or domestic violence, as required by law or if you agree or the Plan believes that disclosure is necessary to prevent serious harm to you or potential victims (you’ll be notified of the Plan’s disclo-sure if informing you won’t put you at further risk)

Judicial and administrative proceedings

Disclosures in response to a court or administrative order, subpoena, discovery re-quest, or other lawful process (the plan may be required to notify you of the request or receive satisfactory assurance from the party seeking your health information that efforts were made to notify you or to obtain a qualified protective order concerning the information)

Law enforcement purposes Disclosures to law enforcement officials required by law or legal process, or to identify a suspect, fugitive, witness, or missing person; disclosures about a crime victim if you agree or if disclosure is necessary for immediate law enforcement activity; disclosures about a death that may have resulted from criminal conduct; and disclosures to pro-vide evidence of criminal conduct on the plan’s premises

Decedents Disclosures to a coroner or medical examiner to identify the deceased or determine cause of death; and to funeral directors to carry out their duties

Organ, eye, or tissue donation Disclosures to organ procurement organizations or other entities to facilitate organ, eye, or tissue donation and transplantation after death

Research purposes Disclosures subject to approval by institutional or private privacy review boards, subject to certain assurances and representations by researchers about the necessity of using your health information and the treatment of the information during a research project

Health oversight activities Disclosures to health agencies for activities authorized by law (audits, inspections, investigations, or licensing actions) for oversight of the healthcare system, government benefits programs for which health information is relevant to beneficiary eligibility, and compliance with regulatory programs or civil rights laws

Specialized government functions Disclosures about individuals who are armed forces personnel or foreign military personnel under appropriate military command; disclosures to authorized federal officials for national security or intelligence activities; and disclosures to correctional facilities or custodial law enforcement officials about inmates

HHS investigations Disclosures of your health information to the Department of Health and Human Ser-vices to investigate or determine the Plan’s compliance with the HIPAA privacy rule

Except as described in this notice, other uses and disclosures will be made only with your written authorization. For example, in most cases, the Plan will obtain your authorization before it communicates with you about products or programs if the Plan is being paid to make those communications. If we keep psychotherapy notes in our records, we will obtain your authorization in some cases before we release those records. The Plan will never sell your health information unless you have authorized us to do so.

You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization with respect to disclosures the Plan has already made. You will be notified of any unauthorized access, use, or disclosure of your unsecured health information as required by law.

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The Plan will notify you if it becomes aware that there has been a loss of your health information in a manner that could compromise the privacy of your health information.

Your individual rightsYou have the following rights with respect to your health information the Plan maintains. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right.

Right to request restrictions on certain uses and disclosures of your health information and the Plan’s right to refuseYou have the right to ask the Plan to restrict the use and disclosure of your health information for treatment, payment, or healthcare operations, except for uses or disclosures required by law. You have the right to ask the Plan to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the Plan to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to the Plan must be in writing.

The Plan is not required to agree to a requested restriction. If the Plan does agree, a restriction may later be terminated by your written request, by agreement between you and the Plan (including an oral agreement), or unilaterally by the Plan for health in-formation created or received after you’re notified that the Plan has removed the restrictions. The Plan may also disclose health information about you if you need emergency treatment, even if the Plan has agreed to a restriction.

An entity covered by these HIPAA rules (such as your healthcare provider) or its business associate must comply with your request that health information regarding a specific healthcare item or service not be disclosed to the Plan for purposes of payment or healthcare operations if you have paid out of pocket and in full for the item or service.

Right to receive confidential communications of your health informationIf you think that disclosure of your health information by the usual means could endanger you in some way, the Plan will accom-modate reasonable requests to receive communications of health information from the Plan by alternative means or at alternative locations.

If you want to exercise this right, your request to the Plan must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.

Right to inspect and copy your health informationWith certain exceptions, you have the right to inspect or obtain a copy of your health information in a “designated record set.” This may include medical and billing records maintained for a healthcare provider; enrollment, payment, claims adjudication, and case or medical management record systems maintained by a plan; or a group of records the Plan uses to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. The Plan may deny your right to access, although in certain circumstanc-es, you may request a review of the denial.

If you want to exercise this right, your request to the Plan must be in writing. Within 30 days of receipt of your request (60 days if the health information is not accessible on site), the Plan will provide you with one of these responses:

• The access or copies you requested.

• A written denial that explains why your request was denied and any rights you may have to have the denial reviewed or file a complaint.

• A written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.



You may also request your health information be sent to another entity or person, so long as that request is clear, conspicuous, and specific. The Plan may provide you with a summary or explanation of the information instead of access to or cop-ies of your health information, if you agree in advance and pay any applicable fees. The Plan also may charge reasonable fees for copies or postage. If the Plan doesn’t maintain the health information but knows where it is maintained, you will be informed where to direct your request.

If the Plan keeps your records in an electronic format, you may request an electronic copy of your health information in a form and format readily producible by the Plan. You may also request that such electronic health information be sent to another entity or person, so long as that request is clear, conspicuous, and specific. Any charge that is assessed to you for these copies must be reasonable and based on the Plan’s cost.

Right to amend your health information that is inaccurate or incompleteWith certain exceptions, you have a right to request that the Plan amend your health information in a designated record set. The Plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the designated record set, or is not available for inspection (e.g., psychotherapy notes or information com-piled for civil, criminal, or administrative proceedings).

If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the Plan will take one of these actions:

• Make the amendment as requested.

• Provide a written denial that explains why your request was denied and any rights you may have to disagree or file a complaint.

• Provide a written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

Right to receive an accounting of disclosures of your health informationYou have the right to a list of certain disclosures of your health information the Plan has made. This is often referred to as an “account-ing of disclosures.” You generally may receive this accounting if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the table earlier in this notice, unless otherwise indicated below.

You may receive information on disclosures of your health information for up to six years before the date of your request. You do not have a right to receive an accounting of any disclosures made in any of these circumstances:

• For treatment, payment, or healthcare operations.

• To you about your own health information.

• Incidental to other permitted or required disclosures.

• Where authorization was provided.

• To family members or friends involved in your care (where disclosure is permitted without authorization).

• For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances.

• As part of a “limited data set” (health information that excludes certain identifying information).

In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.

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If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of the request, the Plan will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request. You may make one request in any 12-month period at no cost to you, but the Plan may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request.

Right to obtain a paper copy of this notice from the Plan upon requestYou have the right to obtain a paper copy of this privacy notice upon request. Even individuals who agreed to receive this notice elec-tronically may request a paper copy at any time.

Changes to the information in this noticeThe Plan must abide by the terms of the privacy notice currently in effect. This notice takes effect on May 1, 2017. However, the Plan reserves the right to change the terms of its privacy policies, as described in this notice, at any time and to make new provisions effective for all health information that the Plan maintains. This includes health information that was previously creat-ed or received, not just health information created or received after the policy is changed. If changes are made to the Plan’s privacy policies described in this notice, you will be provided with a revised privacy notice by email or U.S. Postal Service (USPS) mail to your home address on file.

ComplaintsIf you believe your privacy rights have been violated or your Plan has not followed its legal obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. To file a complaint, send an email detailing your concerns to the Privacy Officer at [email protected].

ContactFor more information on the Plan’s privacy policies or your rights under HIPAA, send an email detailing your request and/or concerns to the Privacy Officer at [email protected].


Documents

U.S. Benefits Decision Guide · When it comes to healthcare, one size does not fit all. That’s why we’re offering a selection of medical plans designed to let you choose ex-actly