2020 Benefits Open Enrollment Guide
ST. ELMO UNION EMPLOYEES
2020 Open Enrollment
November 4-15, 2019
Take a fresh look at your 2020 Conagra benefits
At Conagra Brands, we strive to help you be at your best in all areas of life: health, wealth, professional growth, and work/life balance. We provide tools and resources that support your wellbeing, but you are in the driver’s seat for your Conagra Experience – meaning it’s up to you to take full advantage of these programs.
Open Enrollment: November 4-15
This is your once-a-year opportunity to choose your benefits for the coming year using Workday, our online benefits tool. Please review your benefit coverage options and complete elections by Nov. 15. Enrolling online is easy with Workday by following the step-by-step process in this guide. You can enroll using your work or home computer, mobile device or a kiosk at your work location.
Open Enrollment is the only time you can change your benefit elections, unless you experience a qualified life event such as getting married, divorced or having a child. If one of these situations applies to you, you must make changes within 31 days of the event.
For Workday mobile app installation instructions, go to AnswerSource > Open Enrollment.
To review full plan details, including Summary Plan Descriptions (SPDs), Medical Summary of Benefits and Coverages (SBCs) and required legal notices, go to AnswerSource > Benefits.
New and notable items to keep in mind
Here are key updates and things to keep in mind as you consider your 2020 benefit elections:
|Voluntary Medical Supplemental Benefits||
|Flexible Spending Account||
|Life and Accidental Death and
|Short Term Disabilit||
|Voluntary Long-Term Disability||
To be eligible for Conagra Brands, Inc. Health and Welfare benefit plans, you must be classified as a full-time hourly employee and regularly scheduled to work 30 hours or more per week. An employee may not be covered as both an employee and a dependent if both are employed by Conagra Brands. Furthermore, an employee’s eligible dependent(s) may only be covered under one employee.
Eligible Dependents include your:
- Legal Spouse/Domestic Partner.
- Eligible Dependent Children up to age 26 including: biological children, stepchildren, legally adoptedchildren, foster children, children for whom you have been awarded legal custody/guardianship andbiological children of a Domestic Partner.
- Disabled child over the age of 26 who meet the requirements outlined in your Summary Plan Description(SPD).
When adding new Eligible Dependents, you must provide documentation showing proof of dependency (marriage certificate, birth certificate, legal papers, Affidavit of Domestic Partnership (with supporting documentation)) within 31 days of enrollment.
The Conagra Brands Domestic Partnership Policy and Affidavit of Domestic Partnership are located in mypantry. If you meet the requirements of a Domestic Partnership as detailed in the Conagra Brands Domestic Partnership Policy and submit a completed Affidavit of Domestic Partnership, with required supporting documentation, you may enroll your Eligible Domestic Partner and Eligible Domestic Partner’s child(ren) in the Conagra Brands health plans, upon approval of the submitted Affidavit of Domestic Partnership.
Tax Treatment of Domestic Partner coverage under Conagra Brands Health or Welfare plans:
In accordance with IRS regulations, the value of employer-provided health or welfare coverage for Domestic Partners and children of Domestic Partners is subject to imputed income. Imputed income is the value of a service or benefit provided by employers to employees that is considered a fringe benefit by the IRS and must be treated as taxable income. The value of the fringe benefit is added to taxable wages to properly withhold income and employment taxes. The imputed income will be reported on paychecks, as well as on Federal W-2 tax forms. Please note, the share of the employee’s contribution that covers a Domestic Partner and his/her children must be paid through an after-tax payroll deduction
Electing Health & Welfare Benefits Coverage
- Follow the easy step-by-step process in this guide to make your elections.
- To view and search medical plan providers, visit UnitedHealthcare’s pre-enrollment site at www.welcometouhc.com/conagra, or go to www.myuhc.com and search the Choice Plus Network.
- Everyone Must Enroll through Workday, Conagra’s online HRIS platform.
All employees should review their benefit coverage options and complete their elections by March 1. Enrolling onlineis easy with Workday, just follow the step-by-step process in this guide and be sure to utilize the Open EnrollmentQuick Reference Guide located on mypantry.
- Elect your health and welfare benefits online in Workday using your work or home computer from February 18 to March 1.To log into Workday to complete your enrollment, you will click the “Hourly Employees” button on the Workday homepage. Your Username will be your Workday Employee ID and your Password will be Brand$ followed by the last fourdigits of your Social Security Number. Example, if the last four digits of your Social Security Number are 1234, yourpassword will be Brand$1234.
- Confirm your elections: After you complete your elections, remember to save/print your confirmation page. Ifnecessary, complete EOI requirement for Supplemental Life or Dependent Life coverage.
- Confirm payroll deductions to verify they’re correct.
|Electing Health & Welfare Benefits|
|Benefit||What Happens If You Don’t Enroll for 2020
|Voluntary Medical Supplemental Benefits||No coverage|
|Flexible Spending Account – Health Care & Dependent Care (FSA)||No funds to use|
|Flexible Spending Account||Elections will continue as mapped|
|Supplemental Life and AD&D||No coverage|
|MetLaw (Hyatt Legal)||No coverage|
Medical / Prescription Drugs
The prescription drug plan uses the Advanced Control Formulary Drug List. Check both lists, located on mypantry, to see if your medications are included.
If you elect coverage for your Spouse/Domestic Partner, and he/she is eligible for coverage through his/her employer but elects to enroll in Conagra’s benefits, you will incur a $50 monthly spousal surcharge added to your medical costs. The surcharge will be deducted from your paycheck on a pre-tax basis based on your pay frequency.
Certify annually in Workday that your covered Spouse/Domestic Partner is eligible for coverage through his/her employer.
An employee may not be covered as both an employee and a dependent if both are employed by Conagra.
If you and your Spouse/Domestic Partner enroll in Conagra’s medical plan and use a tobacco product (cigarettes, cigars, chew dip or smokeless tobacco such as electronic cigarettes or vapor pens), you will be assessed a $50 per month tobacco surcharge each unless you and your Spouse/Domestic Partner enroll in and complete a Conagra approved Tobacco Cessation Program through Conagra’s medical vendor. You must certify annually for yourself and your Spouse/Domestic Partner that you are either a non-tobacco user or have completed a Tobacco Cessation Program to avoid the $50.00 ($100 for both) per month tobacco surcharge. The surcharge will be deducted from your paycheck on a pre-tax basis based on your pay frequency.
Tobacco Cessation Program
Call 866-QUIT-4-LIFE to enroll in the Quit for Life telephonic tobacco cessation program. Upon completion of the program, the surcharge will be refunded to you retroactively to the start of the plan year or your medical plan effective date, whichever is later. In addition, you may wish to speak to your doctor about nicotine replacement therapy as this can greatly improve your chances of quitting. These products are generally 100% covered through the CVS Caremark prescription drug plan.
Voluntary Medical Supplemental Benefits
Medical voluntary supplemental coverage is provided at group rates through MetLife. These plans pay you a cash benefit* if you experience a specific covered loss in addition to any medical plan benefits. If you choose to enroll in one or all three plans, you’ll pay the full cost through after-tax payroll deductions.
- Hospital insurance
- Critical illness insurance
- Accident insurance
|Medical Supplemental Options**|
Pays you up to $500 per hospitaladmission, plus $100 per day up to31 days
Pays you up to $1,000 per ICUadmission, plus $200 per day up to31 days
|Pays you up to $10,000 for each covered critical illness occurrence||
Pays you $15 to $5,000 per covered accidental injury and related medical treatment
Benefit amount depends on the specific injury, treatment or service
|*The medical voluntary supplemental benefits may be subject to pre-existing conditions. Contact MetLife at 800-438-6388 for moreinformation.
**Additional information on the medical voluntary supplemental benefits can be found in mypantry
Flexible Spending Accounts
How Your Flexible Spending Account (FSA) options:
- General Purpose Health Care FSA (HCFSA)
- Dependent Care FSA (DCFSA)
- Waive coverage
Pre-Tax Spending Accounts
A pre-tax spending account allows you the opportunity to set aside money on a pre-tax basis via payroll deduction to pay for certain eligible Out-of-pocket expenses as defined by the IRS. By paying for these expenses with pre-tax dollars, you reduce the amount of your taxable income and increase your take home pay. Conagra Brands offers two different Flexible Spending Accounts (FSA) and two different Transportation Spending Accounts (TSA). To elect Transportation Spending Accounts, visit the WageWorks site at www.wageworks.com.
It is important to plan carefully when electing any pre-tax spending account. Any unused balances have “use-it-or-lose-it” rules that vary by plan, as noted below.
How FSAs Work
General Purpose Health Care FSA
A General-Purpose Health Care FSA (HCFSA) is used to pay eligible health care expenses including unreimbursed medical, dental, vision and certain over the counter medications and heath care supplies as well as any Annual Deductibles, Co-payments and Co-insurance. You may only make elections during Annual Enrollment, within 31 days of becoming eligible for benefits, or if you experience a qualifying life event.
- It CANNOT be used if you are enrolled in a Health Care HSA.
- You may elect up to the $2,700 IRS annual limit.
- You may use the entire annual election immediately (even if payroll deductions have not occurred).
- Expenses are paid by a UHC issued FSA Debit Card or you can get reimbursement by submitting a paper claim form.
- Expenses for your 2019 election may be incurred through December 31, 2019 and must be claimed by April 30, 2020 or your outstanding annual balance will be forfeited per IRS rules.
Dependent Care FSA
A Dependent Care FSA (DCFSA) is used to reimburse eligible daycare and eldercare expenses for dependents when both parents (or if a single parent) are working or are considered full time students. An eligible dependent is defined as:
- Your children under the age of 13.
- Your handicapped child of any age.
- Your dependent parent(s) who are unable to take care of themselves.
If you elect the Dependent Care FSA, the following rules apply to your election.
- You may elect up to the $5,000 IRS annual limit.
- You may only use the amount deducted from your pay and funded to your account.
- Reimbursement is on-line or by a paper claim form.
- Expenses for your 2019 election may be incurred through December 31, 2019 and must be claimed by April 30, 2020 or your outstanding annual balance will be forfeited per IRS rules.
Health Savings Account
If you enroll in the Core or the Basic Plans for medical coverage, you are eligible to participate in the Health Savings Account (HSA). You need to re-elect your HSA contributions each year. If you are enrolling for the first time, an account will be opened at Optum Bank in your name. You will receive a welcome letter which will include your Optum Bank HSA card. If you receive correspondence asking for additional information, please respond as failure to do so may delay account set up. You can transfer your HSA balance with Connect Your Care/UMB Bank once your Optum Bank account is open or you can leave your balance with Connect Your Care/UMB Bank, but you may be charged a monthly maintenance fee.
Core and Basic Plans with HSA: The Advantages Stack Up
A Health Savings Account (HSA) is a unique tax-advantaged account that allows you to pay for current or future IRS-qualified medical, prescription, dental and vision expenses, as well as health care plan Copayments, Annual Deductibles and Coinsurance for yourself and your eligible dependents.
- You are eligible to contribute pre-tax dollars into an HSA if:
- You are enrolled in an eligible high-deductible health plan, like the Conagra Core or Basic Plan.
- You are not covered by another medical plan (i.e., your Spouse’s plan) that is not a high-deductible health plan.
- You are not covered by any government plan, such as Medicare, Tricare and Veterans Affairs.
- You are not enrolled in or covered by a general-purpose health care flexible spending account.
If you are, or will be, age 55 or older in 2019, you are eligible to deposit an additional $1,000 in catch-up contributions. For 2019, the HSA limits are:
|Tier Level||Contribution Limit||Age 55+ Contribution Limit|
|Employee + 1 or more||$7,000||$8,000|
Your HSA also gives you the following benefits:
- Contributions to your HSA can be made with pre-tax dollars via payroll deduction, which reduces your taxable income (contributions are subject to state taxes in AL, CA and NJ).
- You can change or stop your contributions at any time throughout the year.
- You may deposit after-tax contributions then, when you file your taxes, and these amounts are tax deductible.
- HSA balances rollover from year to year; there’s no “use-it-or-lose-it” policy.
- Your HSA funds are portable and go with you, even if you leave the company.
- HSA funds earn tax-free interest and when used for qualified medical expenses are also tax-free (non-qualified expenses may be subject to taxes and/or penalties).
- You can direct how your HSA account balance is invested.
- After the age of 65, you can use the funds for non-qualified expenses without penalty.
Please note that it is your responsibility to track your contributions and those that are placed in your account through earned incentives, so that you are compliant with the IRS limits noted above.
Health Savings Account and Medicare
Once an individual enrolls in Medicare, he/she is no longer eligible to contribute to an HSA and must prorate the annual contribution limit (including any employee catch-up contribution) based on the number of months he/she was eligible during that year. For example, if an individual turns 65 and enrolls in Medicare as of July 1, he/she would need to prorate the annual contribution limit (including any employee catch-up contribution) by 6/12 since he/she is only eligible for six out of the 12 months during that calendar year.
If an individual has reached age 65, an HSA distribution to reimburse the Medicare premium deduction is a qualified medical expense. If an individual has not reached age 65, Medicare premiums are generally not qualified medical expenses. An individual who is not enrolled in Medicare Part A, Part B or Part D may contribute to an HSA until the month that he/she is enrolled in Medicare. For additional details, look for the ‘HSA, Medicare and You’ document in mypantry.
Health Reimbursement Account
A Health Reimbursement Account (HRA) is an account solely funded by Conagra and is automatically set up for you only if you enroll in the Enhanced Plan with HRA and participate in the Wellness Incentive Program. With an HRA, it’s important to focus on your medical care choices to ensure you’re spending your dollars wisely.
If you have unused funds at the end of the plan year, your HRA dollars will roll over to the next year as long as you remain enrolled in the Enhanced Plan with HRA. If you choose to enroll in an HSA Plan the following year, you will need to use your HRA funds before the end of the plan year. Any funds remaining in your HRA will be forfeited and will not roll over to your HSA. If you have a balance in your HRA and leave Conagra, you forfeit the remaining balance.
Using HRA Dollars to Pay for Care
You can use your HRA to pay for expenses that count toward your deductible and coinsurance, including doctor visits, hospital care, lab tests, X-rays and prescription drugs. Generally, elective cosmetic treatments (e.g., facelift, tattoo removal, liposuction) are not eligible unless they are deemed medically necessary. An HRA will be established in your name and a UHC HRA card will be mailed to your home, giving you a convenient way to pay for care:
Present your health insurance card along with your HRA card to pay for eligible expenses. You can use your HRA card to pay for any copays, deductibles or coinsurance. If you are asked to pay additional charges, do not pay your provider until the claim is processed by your health plan and you receive your Explanation of Benefits (EOB).
When you use your HRA card, your account will be verified to ensure you have sufficient funds for the full amount due. If not, your transaction will be denied. You can then swipe the card for the amount left in your account and pay the difference using another form of payment. Swipe your card as “credit” if asked, so you won’t have to enter a PIN.
If you forget your HRA card, or if for any reason you are unable to use your it, you may pay for expenses out-of-pocket and submit a claim for reimbursement online at www.myuhc.com.
How Your HRA and FSA Work Together
If you also participate in a Health Care FSA, you can use both accounts to cover eligible medical, dental, vision and
prescription drug expenses. However, your HRA will automatically pay first when you use your payment card. Once your HRA funds have been depleted, your card will automatically begin to draw on any available FSA funds.
Life and Accidental Death and Dismemberment (AD&D) Insurance
Conagra Brands pays the full cost of Basic Life and AD&D coverage equal to two times your annual salary. If your death is the result of a covered accident, your beneficiary will receive double the basic life insurance amount. If you need more coverage, you may elect Supplemental Life and AD&D coverage at your own cost. If you need more coverage, you may elect Supplemental Life and AD&D coverage at your own cost.
Your Supplemental Life options:
- Supplemental coverage for you
- Supplemental coverage for your Eligible Dependents
- Waive coverage
|Supplemental Life Coverage Options|
|Who is Covered||Amount||Evidence of Insurability (EOI) Requirements|
|For you||Up to $1 million in $10,000 increments (not to exceed 5x your annual salary)||
Required for amounts over $300,000 (if you enroll when first eligible) or any amount if you enroll after you are first eligible
You may increase coverage by $10,000 (up to $300,000) during open enrollment without EOI
|Spouse/Domestic Partner||Up to $150,000 in $10,000 increments||
Required for any amount over $50,000 (if you enroll when first eligible) or any amount if you enroll after you are first eligible
You may increase coverage by $10,000 (up to $50,000) during open enrollment without EOI
|Child(ren)||$10,000 per child (coverage limited
to $1,000 for children birth to six months)
You may choose to purchase additional AD&D insurance coverage for yourself up to $500,000 in $50,000 increments. If you purchase additional AD&D insurance for yourself, you can also purchase family AD&D insurance which provides benefits as follows:
|Supplemental Life Coverage Options|
|Who is Covered||Amount|
|Spouse/Domestic Partner||60% of your full policy amount if you don’t have children
50% of your full policy amount if you have children
|Child(ren)||20% of your full policy amount (up to $50,000) if you do not cover a Spouse/Domestic Partner
15% of your full policy amount (up to $50,000) if you do cover a Spouse/Domestic Partner
Conagra Brands offers short-term and long-term disability benefits at no cost to you, with the option to buy-up additional voluntary long-term disability coverage. This disability coverage helps provide you and your family with income protection when you need it most—when you are unable to work because of an extended illness or injury.
Short-term disability (STD)
Aetna will continue to provide services for all continuous events initiated before April 1, 2019 but any absences on or after April 1, 2019, will be administered by Sedgwick.
|Short Term Disability|
|Duration of benefits||
Long-term disability (LTD)
If you remain disabled for more than 26 weeks, you may be eligible to receive Long Term Disability benefits which replace a portion of your salary (subject to approval by the insurance company). You are eligible for this coverage the first of the month after 12 months of service if you are working at least 30 hours per week.
If you experience an eligible illness or injury, you may receive up to 50% of your monthly salary, not to exceed $15,000 per month. You must satisfy a 180-day elimination period before Long Term Disability benefits begin. Benefits will be paid for the duration of the disability, up to the date you reach normal social security retirement age.
Voluntary long-term disability (LTD)
Long-term disability benefits can replace a portion of your salary if your disability extends beyond 26 weeks (subject to approval by the insurance company). Employees working at least 30 hours per week are eligible for this benefit the first of the month after 4 months of service. During annual enrollment, you may purchase long-term disability coverage of 60% of base salary, up to $15,000 per month. You may be subject to a pre-existing condition clause if you enroll in long-term disability benefits. Contact Cigna for more information. The cost of this coverage is based on your salary. You can make this election during annual enrollment and the exact cost of this coverage will be available online. Your cost for coverage is deducted on an after-tax basis, so a portion of the benefit you may receive is tax free. The maximum benefit duration is the Normal Social Security Retirement Age.
Evidence of insurability is required if coverage is not elected when first eligible. You may be subject to a pre-existing
condition clause if you enroll in long-term disability benefits
MetLaw (Hyatt Legal) Limited Identity Theft Protection
Manage everyday legal matters with MetLaw, a MetLife Company. For a low monthly rate, conveniently deducted from your paycheck after taxes, you have access to more than 14,000 plan attorneys nationwide to represent you on a variety of covered legal matters. MetLaw is available to enrolled employees and their Spouse/Domestic Partner. Dependents who are unmarried or disabled under the age of 26, or disabled over the age of 26 provided they are totally dependent on the parents, are covered for certain features.
MetLaw legal coverage has been expanded to include a component of Identity Theft protection, at no additional cost to you! Identity Theft Management Services are provided through CyberScout. CyberScout offers full-service resolution assistance 24 hours a day, seven days a week. The identity protection service is available to enrolled employees, their Spouse/Domestic Partner, and dependents who are unmarried or disabled under the age of 26 or disabled over the age of 26 provided they are totally dependent on the parents.
Protection for Your Auto, Home and Pet
Conagra also offers options for home, auto and pet insurance, through MetLife. You can enroll in these coverages at any time during the year by calling MetLife directly at 1-800-438-6388.
InfoArmor Identity Theft Protection
InfoArmor’s identity theft protection includes proactive identity monitoring AND credit monitoring, offering you the most comprehensive solution to fight today’s identity fraud issues. For a low monthly rate, conveniently deducted from your paycheck after taxes, you will have access to:
- Identity credit monitoring
- Credit report each year and a score each month
- Password management solution
- Full-service identity restoration
- $1,000,000 identity theft insurance policy
InfoArmor is available to enrolled employees and their family members. Family members are defined as such: if the family member is supported financially by the employee or if the family member lives under the employee’s roof.
As a reminder, please take this time to re-elect your beneficiary designations for Life Insurance, HSA and 401(k), as applicable. Otherwise, the plan provisions or your state’s law determines who will receive the benefits if you die and it may not be the way you intended.
Life Insurance – Workday
Please refer to the Dependent and Beneficiary Changes/Demographics Quick Reference Guide located in mypantry.
HSA – Optum Bank
Once you receive a welcome letter which will include your Optum Bank HSA card, log in to your Optum Bank account by visiting www.optumbank.com or by visiting www.myuhc.com.
- Under Dashboard, click on Manage Beneficiaries.
- Click on Add a New Beneficiary.
- Fill out the Beneficiary Information and click Continue.
- Submit your Beneficiary Election.
- Once you have added a beneficiary, you can designate the beneficiary type (primary or contingent) and the distribution percentage.
401(k) – Merrill Lynch
Log in to your Merrill Lynch account by visiting www.benefits.ml.com.
- Go to My Accounts and click on Conagra Retirement Income Savings Plan.
- Under the Current Elections tab, select Beneficiary Designation/Updates.
- If you are married, your Spouse will automatically be your primary beneficiary. If you would like someone other than your Spouse, you must complete a Beneficiary Designation Form which includes spousal consent.
- If you are single, enter the required beneficiary information.
A Final Word (applicable to all Conagra Brands Health and Welfare provided benefits)
This communication is intended to provide only basic information. For detailed information, refer to your Summary Plan Description (SPD). Every attempt was made to communicate as accurately as possible. However, if a discrepancy exists between this and the official plan documents, the plan documents will govern.
Contacts and Resources
If you have any general questions regarding your Health and Welfare benefits, please contact the Conagra Brands HR & Employee Service Center at:
- (866) 275-4722 Monday through Friday from 7:30 a.m. to 4:30 p.m. CT
- Fax (402) 516-0368
- Email: ASKBenefits@conagra.com
- Mail: Eleven Conagra Drive, 11-150, Omaha, NE 68102
|Contacts & Resources|
(includes 24 hour virtual visits and 24 hour nurse line)
(Second Opinion, health care referrals)
(Vision Service Plan)
|UHC Health Care / Dependent Care Flexible Spending Accounts||844-219-3643||www.myuhc.com|
(Life & AD&D)
(Short-term disability & FML)
(Voluntary medical supplemental benefits, Auto/home/pet & MetLaw)
(Identity Theft Coverage)
(Transportation Spending Accounts)
(Employee Assistance Program (EAP) and Advocacy Services)
(CRISP 401(k) and ESPP)
Required Health and Welfare Notices
Medicare Part D Notice
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Conagra Brands, Inc. and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
- Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
- Conagra Brands, Inc. has determined that the prescription drug coverage offered under the Conagra Brands, Inc. Welfare Benefit Wrap Plan (the “Plan”) is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered “creditable” prescription drug coverage. This is important for the reasons described below.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare drug plan, as long as you later enroll within specific time periods.
Enrolling in Medicare – General Rules
As some background, you can join a Medicare drug plan when you first become eligible for Medicare. If you qualify for Medicare due to age, you may enroll in a Medicare drug plan during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. If you qualify for Medicare due to disability or end-stage renal disease, your initial Medicare Part D enrollment period depends on the date your disability or treatment began. For more information, you should contact Medicare at the telephone number or web address listed below.
Late Enrollment and the Late Enrollment Penalty
If you decide to wait to enroll in a Medicare drug plan you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from Oct.15 through Dec. 7. But as a general rule, if you delay your enrollment in Medicare Part D, after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
If after your initial Medicare Part D enrollment period you go 63 continuous days or longer without “creditable” prescription drug coverage (that is, prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage), your monthly Part D premium may go up by at least 1% of the premium you would have paid had you enrolled timely, for every month that you did not have creditable coverage.
For example, if after your Medicare Part D initial enrollment period you go nineteen months without coverage, your premium may be at least 19% higher than the premium you otherwise would have paid. You may have to pay this higher premium for as long as you have Medicare prescription drug coverage. However, there are some important exceptions to the late enrollment penalty.
Special Enrollment Period Exceptions to the Late Enrollment Penalty
There are “special enrollment periods” that allow you to add Medicare Part D coverage months or even years after you first became eligible to do so, without a penalty. For example, if after your Medicare Part D initial enrollment period you lose or decide to leave employer-sponsored or union-sponsored health coverage that includes “creditable” prescription drug coverage, you will be eligible to join a Medicare drug plan at that time.
In addition, if you otherwise lose other creditable prescription drug coverage (such as under an individual policy) through no fault of your own, you will be able to join a Medicare drug plan, again without penalty. These special enrollment periods end two months after the month in which your other coverage ends.
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting the Conagra Brands Employee Service Center at (866) 275-4722.
Coordinating Other Coverage With Medicare Part D
Generally, if you decide to join a Medicare drug plan while covered under the Plan due to your employment (or someone else’s employment, such as a spouse or parent), your coverage under the Plan will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan’s summary plan description or contact Medicare at the telephone number or web address listed below. If you do decide to join a Medicare drug plan and drop your prescription drug coverage under the Plan, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
For more information about this notice or Your current prescription drug coverage…
Contact the person listed below for further information.
NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Conagra Brands, Inc. changes.
You may also request a copy.
For more information about your options under Medicare prescription drug coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
- Visit www.medicare.gov
- Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help,
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about thus extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0788).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show if you have maintained creditable coverage and if you are required to pay a higher premium (a penalty).
Name of Entity/Sender: Conagra Brands, Inc.
Contact – Position/Office: Cynthia Wessel, Manager – Health & Welfare, Wellness
Eleven Conagra Drive, 11-120
Omaha, NE 68102
Phone Number: 402-240-4582
Nothing in this notice gives you or your dependents a right to coverage under the Plan. Your (or your dependents’) right to coverage under the Plan is determined solely under the terms of the Plan.
Additional Notices from Conagra Brands, Inc.
HIPAA is a federal law that focuses on the portability of health benefits and the privacy and security of your and your dependent’s health information. HIPAA protects you and your dependents by:
- Providing new rights that allow individuals to enroll for health coverage when they lose other health coverage, get married or add a new dependent;
- Prohibiting discrimination in enrollment and in premiums charged based on health status-related factors; and
- Ensuring the privacy of your and your dependent’s protected health information.
The confidentiality of your health information is important. The Plan is required to maintain the confidentiality of your information and has policies and procedures and other safeguards to help protect your information from improper use and disclosure. Contact the Plan Administrator to receive a copy of the Notice of Privacy Practices that describes your privacy rights.
Women’s Health and Cancer Rights Notice
The health benefits available through the Plan will comply with the Women’s Health and Cancer Rights Act of 1998, which requires the provision of coverage for breast reconstruction in connection with mastectomy as follows, subject to plan deductibles and coinsurance, if any:
- Reconstruction of the breast on which the mastectomy has been performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
- Prosthesis and treatment of physical complications of all stages of mastectomy, including lymphedemas.
CHIPRA Special Enrollment Rights Notice
CHIPRA provides you with a 60-day special enrollment right to enroll in a Component Benefit that is a group health plan under the following two circumstances: (1) your coverage or coverage of your dependent under Medicaid or a state-sponsored children’s health insurance program (“CHIP”) terminates due to loss of eligibility; and (2) you or your dependent becomes eligible for state financial assistance under Medicaid or CHIP to help pay for coverage under DFA’s group health plan.
Newborns’ and Mothers’ Health Protection Act (NMPHA)
NMHPA is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. In general, group health plans and health insurance issuers that are subject to NMHPA may NOT restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section.
If you deliver your baby in the hospital, the 48-hour (or 96-hour) period starts at the time of delivery. If you deliver your baby outside the hospital and you are later admitted to the hospital in connection with childbirth (as determined by the attending provider), the period begins at the time of the hospital admission.
If the attending provider, in consultation with the mother, determines that either the mother or the newborn child can be discharged before the 48-hour (or 96-hour) period, the group
health plan or health insurance issuer does not have to continue covering the stay for the one ready for discharge. An attending provider is an individual, licensed under State law, who is directly responsible for providing maternity or pediatric care to the mother or the newborn child. In addition to physicians, an individual such as a nurse midwife, physician assistant, or nurse practitioner may be an attending provider. A health plan, hospital, or insurance company would NOT be an attending provider.
It is important to note that the coverage subject to NMHPA is the mother’s coverage, regardless of whether the newborn is covered separately.
Conagra Brands’ Medical Plan has been designed to be compliant with NMPHA.
Glossary of Health and Medical Terms
This glossary of Health and Medical Terms lists the common definition of many health care related definitions. It is not meant to alter or amend the definitions provided within the plan documents, and the plan documents will always govern.
Allowed Amount Maximum The amount on which your payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate”. If you go to an In-network provider and you are charged more than the Allowed Amount Maximum, you will never pay any portion above the Allowed Amount Maximum. If you go to an Out-of-network provider, you may be responsible for 100% of the amount in excess of the Allowed Amount Maximum (see Balance Billing).
Annual Deductible The amount you pay for doctor’s visits, prescription drugs, and any other medical services before both you and the plan start to share in the health care cost through Coinsurance.
Balance Billing When a provider bills you for the difference
between the provider’s charge and the Allowed Amount Maximum. For example, if you go to an Out-of-network provider and the charge is $100 for services with an Allowed Amount Maximum of $70, the provider may bill you for the remaining $30. An In-network provider may not balance bill you for covered services.
Co-insurance Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) up to the Allowed Amount Maximum for the service. You are responsible for the Co-insurance portion of the covered health care service once the Annual Deductible has been met. The dollar amount of the covered health care service above and beyond the Annual Deductible is subject to Co-insurance up to the Out-of-pocket Maximum for the year.
Co-insurance In-network The percent you pay, up to the Allowed Amount Maximum, for covered health care services to providers who contract with your health insurance plan. The In-network Co-insurance you have to pay is 20% for your plan. You will generally pay less for In-network Providers than for Out-of-network Providers.
Co-insurance Out-of-network The percent you pay for covered health care services to providers who do not contract with your health insurance plan. The minimum Out-of-network Co-insurance you have to pay is up to 40% of the Allowed Amount Maximum plus any Balance Billing. Out-of-network emergency services will be covered at 20% Co-insurance.
Evidence of Insurability An application process in which you provide information on the condition of your health or your dependent’s health in order to be considered for certain types of insurance coverage.
Out-of-Pocket Maximum The most you pay during the plan year before your health insurance plan begins to pay 100% of the allowed health care services. This limit never includes your payroll contributions or balance-billed charges for non-covered health care services.
Pharmacy Co-payment A fixed amount (for example, $15) or a percentage of the cost (for example, 30%) you pay for a 30-day supply of prescription drugs at a retail pharmacy after you have met the Annual Deductible. The Pharmacy Co-payment amount varies based on the tier of prescription drug that is prescribed (see Pharmacy: How the Rx Benefit Works section of this booklet).
Pharmacy Co-payment Mail Order A fixed amount (for example, $30) or a percentage of the cost (for example, 30%) you pay for a 31-90-day supply of prescription drugs that you order through your pharmacy plan’s mail order services. The co-payment amount varies based on the tier of prescription drug that is prescribed (see Pharmacy: How the Rx Benefit Works section of this booklet).
Prior Authorization / Preauthorization A decision by your health plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary and covered by the plan. Your health plan may require Preauthorization for certain services before you receive them. It is always recommended to obtain Preauthorization by calling the number on the back of your medical ID card prior to receiving any non-emergency treatment or service.
Provider In-network A provider who has a contract with your health plan to provide services to you at a discount.
Provider Out-of-network A provider who does not have a contract with your health plan to provide services to you.
Prescription Drug Coverage Prescription plan offered to you through your pharmacy plan that helps pay for prescription drugs and medications.
Prescription Drugs Drugs and medications that by law require a prescription.
Primary Care Provider A physician, who provides, coordinates or helps a patient access a range of health care services.
Provider A physician, health care professional or health care facility licensed, certified or accredited as required by state law.
Specialist A physician specialist focuses on a specific area of
medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.