How To Get A Disability Check From The State Of Georgia

(1)

Customer Service Information . . . 1

Participating Employers. . . 1

Benefit Plans. . . 2

Core Benefits. . . 2

Supplemental Insurance Benefits. . . 2

Retirement Benefits. . . 2

Flexible Benefits. . . 2

Value-added Benefits . . . 2

Eligibility and Enrollment Processes . . . 3

Core Benefits. . . 3

Supplemental Insurance Benefits. . . 3

Retirement Benefits. . . 3

Eligible Dependents . . . 3

Guidelines for Dependents 19 and Older. . . 4

Guidelines for Stepchildren. . . 4

Guidelines for Employees at High Risk. . . 4

Open Enrollment. . . 4

Qualifying Events. . . 5

Coordination of Insurance Benefits. . . 5

Premiums. . . 5

Notification of Changes in Family Status . . . 6

Benefits During Leaves of Absence. . . 6

Core and Supplemental Benefits . . . 6

Other Benefits . . . 6

Military Leaves of Absence . . . 6

Termination of Coverage . . . 6

Medical / Life . . . 6

Continuation Coverage — COBRA (Medical) . . . 7

Continuing Life Insurance Coverage. . . 7

Family Survivor Benefit. . . 8

Protection for You and Your Benefits. . . 8

Benefit Administration . . . 10

Subrogation. . . 10

Claims Review & Appeal Procedures. . . 10

Definitions and Exclusions. . . 11

Notification of Discretionary Authority. . . 11

Notification of Benefit Changes . . . 11

General Information Table of Contents

GENERAL INFORMATION

• Make sure you know how to reach

us if you need help

• Understand the specifics of

eligibility and enrollment

• Review a snapshot of your entire

benefits package

• See what’s available in the future

coverage in the pa_{st, you ca} n enroll d_{uring op}

en enrollment without m_{eeting D}

eseret M_{utual’s he} alth stan_{dards. You} may also enroll yo

ur eligible dependents. Unrestric_{ted open}

enrollm_{ent applie} s to med_{ical and d}

ental coverage _{only. It d}

oes not a_{pply to a} ny life insurance or Disability_coverage. Of course_{, you may}

apply for Group T erm Life i_{nsurance or} Disability_coverage

at any tim_{e if you d} on’t alrea_{dy have it.} But you m

ust meet our health_standard s to qualif_{y. If you’re} interested_{, go to th}

e forms li brary on our websit_{e or contact} us for a D_eclaration

of Insura_{bility form}

.

QUALIFY_{ING EVENTS}

Major fam ily events may qua

lify you to_{enroll at} times oth_{er than} during open enro_{llment or}

as a new_employe e. These_include: • marriage •birth •_adoption •_{change in}

employm_{ent statu} s (such as_{going fro}

m part-time to full-tim_{e employ}

ment)

•_involunta

ry loss of eligibility_{for other} medical _insurance

•_{spouse h}

as a change in em_ploymen t status a_{nd no lo}

nger qualifies for health_insuranc

e through_{his or he} r employer Coordin_{ation of}

Insuran_{ce Benefits} The Coo_rdination

of Benefi_{ts (COB} ) provisio

n applies when you or your d_ependen

ts have m_{edical or} dental co_{verage fro}

m more than one health b_{enefit plan.} The purp_{ose of co}

ordinatin g benefits is to avo

id duplic_{ation of} insurance_paymen

ts. It inv olves dete_{rmining w}

hich insurer is required to pay ben_{efits as th}

e primary_{payer, w} hich insurer must pay_{as the se}

condary payer, and_{so on, u} ntil all insurers are considere_{d in the c}

orrect pa_{yment order.} You must inform D_{eseret M}

utual of o_{ther med} ical and/o_{r dental} coverage _{in force a}

t the tim_{e of enro} llment or_{when an}

y other coverage _becomes

effective a_{fter your} initial en_rollment.

If applicable, you m_{ay be req}

uired to s_{ubmit co} urt orders or decrees. Y_{ou must a}

lso keep Deseret M_{utual info} rmed of any changes i_{n the stat}

us of the _{other coverage.}

COORDIN_{ATION O} F BENEF_{ITS RULES}

When D_{eseret M} utual is the primary_{plan, elig}

ible bene_{fits are}

paid befo_{re those o} f the oth_{er health}

benefit plan and w_ithout considering the oth_{er health}

plan’s benefits. When Deseret M

utual is the second ary plan, Deseret M

utual calculates_{the amo}

unt of eligible ben_{efits it w} ould normally pay in the absence of o_{ther cove}

rage, incl_{uding th} e applica_{tion of} credits to

any policy maxim_{ums, and} applies t_{he payab}

le amount to unpaid

covered c_{harges after eligible} benefits have been paid by the pr_{imary plan.} This amount incl_{udes ded}

uctibles and copay_{ments yo} u may owe. Deseret M

utual will use its o_{wn dedu} ctible an_{d copaym}

ents to calculate _{the amou}

nt it wou_{ld have p} aid in the absence_{of other} coverage._{In no ev}

ent will D_{eseret M} utual pay_{more th}

an the member is responsible to pa_{y after th}

e primary_{carrier h} as paid. Please no

te, we generally coo_{rdinate b} enefits be_{tween all group} health plans (Deser_{et Choice}

, Deseret Choice H_{awaii, D} eseret Select, D_{eseret Pre}

mier, Deseret Va lue, and Deseret Pro_{tect). We} also coordinate ben_{efits betw}

een our g_{roup den} tal plans (Deseret Dental an_{d Desere}

t Dental PLUS).

Premiums

Core Benefits:

Your employer pa_{ys the m} ajority of_{your m}

onthly premiums and you_{are resp}

onsiblefor the re maining balance. For supp_lemental

insurance_{and valu} e-added b_{enefits, o}

n the other hand, you pa

y the entire cost of_{the prem} iums for the coverage y_{ou choose}

. The ad_{vantage o} f supplem_{ental cov}

erage is that it’s available a_{t reasona}

ble group rates. For the c_{ore benef}

its, monthly prem_{iums are} divided into three categories. These _{include c}

overage for:

•

you (the employee) only

•

you and one dependent

•

you and two or m_{ore depen} dents

Supplemental In_surance Benefits:_Premium

s vary depending on your a_{ge and th}

e options you cho_{ose. Plea} se refer to the appropriate Life In_{surance se}

ction of y_{our Bene} fits Handbook for more info_rmation.

Retirem_{ent Benefits:}

These be_{nefits do} not have any associated premium_{s. Your e}

mployer fully fund_{s the Reti} rement PLUS Plan benefit. For _{the Thrif}

t Plan, yo_{u determ} ine your contribu_{tion am}

ount and_{your em} ployer m_{akes a m} atching contribution in yo ur behalf. Premium_Adjustm ents: _{Please be} aware th_{at premium} adjustments beca_{use of en}

rollment changes o_{r errors a} re limited Premiums Coordin_{ation of} Insuran_{ce Bene} fits General _Informa tion 2015 PAGE 5 GIATB2 Eligibility and Enrollment Processes

When you meet the eligibility requirements of your employe r and you have actively started work for your pa

rticipating employer, you are eligible to participate in the benefit progr

am. You must be actively on the job before your b

enefits begin.

You can enroll in nearly all the benefit progr ams online on our website at www.dmba.com. So it’s conven

ient and easy. For help, work with your employer directly or you’re welcome to call Deseret Mutual’s Member Services. If you’re

enrolling for the first time and you need help, call 1-801-578-5620 or 1-800-333-9742. Here’s a general outline of the requirements f

or the different benefit plans.

CORE BENEFITS Some insurance benefits (Medical and Group Term Life insurance) are available to you and your eligib

le dependents (see

Eligible Dependentsbelow). Enrolling in the core benefit program within 30 days after

your eligibility date is very important. You may also enroll up to

90 days before your eligibility date but you are not covered until your eligibility date. Each year thereafter, you may r eview your enrollment decisions and possibly chan

ge coverage during open enrollment (see Open Enrollmenton page 7). Please note that in most cases, you cannot disenroll midyea

r. But during the next open enrollment you can dis

enroll or choose another medical plan. If you do not enroll within 30 days of your eligibility date,

you cannot apply for medical or dental coverage u

ntil the next annual open enrollment, with coverage beginning th

e first day of the following year. Exceptions may apply (see Protecting You: HIPAA

on page 12). Also, if you enroll after 30 days, you must m

eet Deseret Mutual’s health standards for any Group Term Life. And remember, you may choose: •the entire core benefits package •the Life Only option (waive medical coverage) •to waive all benefits

As a new employee, coverage begins on your eligibility date . With open enrollment, coverage begins the fi

rst day of the following year. If you apply for Group Term Life insurance after 30 days, coverage begins on the first of the month after Deseret Mutual approves your application.

SUPPLEMENTAL INSURANCE BENEFITS You may apply anytime for Supplemental Group Term Life

or enroll in 24-H

our Accidental Death & Dismemberment online at www.dmba.com. Also, you and/or your dependents must complete the health questionnaire if you’re applying for Supplemental Group Term Life insurance. Coverage begins the first day of the month aft

er Deseret Mutual approves your application.

RETIREMENT BENEFITS Retirement benefits are available to you (the employee). You

r dependents are not eligible for their own reti

rement benefits through your employment with a participating employer. As an eligible employee, you’re automatically enrolled in the

Retirement PLUS Plan.

For the Thrift Plan, you’re also automatically enrolled if you don’t enroll within 30 days of becoming eligible. But the so oner you enroll, the better opportunity you have t

o take advantage of investment time and compounding interest, and the sooner y ou start receiving your employer’s matching con

tribution.

ELIGIBLE DEPENDENTS Your eligible dependents include your spouse and dependen

t children. The following dependents may be

covered:

•Natural children (including infants from the date of birth) who are younger than 26 •Legally-adopted children and stepchildren who are younger

than 26 •A grandchild who is the child of your covered

, unmarried, dependent child. The unmarried dependent child and the grandchild must live in your home and depen

d primarily on you for support. For the grandchild to be

covered, a direct lineal relationship must exist between you and the grandchild (or a direct line created through a

doption). The grandchild may be covered to age 18 Eligibility and Enrollment Processes

General Information

2015

PAGE 3

GIATB2

Customer Servi ce Information

To answer yo ur questions and

help you with yo ur benefits, w e have a staff o f qualified represent atives who ar e here to help. We

also have useful tools and inform

ation on our web site. And we

have experts in various fi

elds, such as registere d nurses and financial planne rs, who are availab le to you. So plea se let us help you maxim ize your benefits.

Our office h ours are from 8 a.m. to 5

p.m. (Mountain Tim e)

weekdays, except on Wednesdays w

hen office hours begin at 9

a.m. You’re welcome to c

hat live onli ne during of

fice hours. Or

you can visit ou r website —

24 hours a day, se ven days a w

eek —

for a wealth of inform ation. Our telephone

numbers and

website add ress are: Salt La ke City area . . . . . . . 1-801-5 78-5600 Toll fre e . . . . . . . 1-800-777-3622 Website. . . . . . . www.dmba.com If your hearing is imp aired, please conta

ct us using a relay

service. For your inf

ormation, w e record inco

ming teleph one calls to

ensure the quality of the infor

mation you rece ive.

If you want to visit us in

person, our offices are loc

ated at 150

Social Hall Avenue, Suite 170, in d owntown Salt Lake C

ity. You

can make an app ointment or

simply drop by d uring office

hours.

Our mailing address is:

Deseret Mu tual P. O. Box 45530 Salt Lake City, Utah 841 45-0530

Participatin g Employ

ers

In 1970, The Ch urch of Jesus Ch

rist of Latter-day Saints, a long

with other companies owned and o

perated by t he Church,

formed a priv ate employer trus

t to administ er benefits f

or its

employees. And Deseret Mutua

l Benefit Ad ministrators

, or

Deseret Mu tual for short, admin

isters those benef its for you. Deseret Mu

tual is not a n insurance compan

y. Rather, it’ s a

private, non -profit trust t

hat administ ers health and pension

benefits exclusiv ely for empl

oyees of the Church and

its related

organizations. O ur purpose

— or missio n — is to im

prove

your health and financia l security.

You should look to Deseret Mutua

l as your pa rtner in making

important h ealth-care de

cisions, as well as decisions that affect

your financial future , especially r etirement. Deseret Mu tual’s participati ng employer s include: •AgReser ves, Inc. •Benefici

al Financial Group

•Bonneville Inter national Corporatio

n

•Brigham Young University

•Brigham Young U niversity — Haw

aii

•Brigham Young U niversity — Idah

o

•City Creek Reser ves, Inc. •Corporation of the Presid ent •Corpora tion of the P residing Bishop

•Deseret

Book Comp any

•Deseret

Digital Med ia

•Deseret

Management Corporatio n

•Deseret

Mutual Benefit Adm inistrators

•Deseret New s

•Deseret Tru st Company

•East Central Flor ida Services

•Ensign Peak

•Hawaii Reserves, Inc.

•LDS Business Co llege

•LDS Family Services

•Polynesian C ultural Center

•Property Res erve, Inc. •Suburba n Land Reserve, I nc. •Taylor C reek Manage ment •Temple S quare Hospi tality Corporatio n •Utah Property M anagement Assoc

iates

Participatin g Employ

ers Customer Servi

ce Information

2015 PAGE 1 Your Ge neral Inf ormatio n Owner’ s Manual .. .

General Info rmation The insuran ce and retirement be nefits availa ble to you a re a vital and substa ntial part of your total c ompensatio n from your employer.

And Deseret Mu tual Benefit Administrators, o

r Deseret Mu tual, admin

isters these benefits for you.

To help you become fam

iliar with your bene fits, your Benefits Hand

book includ es a complete descri

ption of eac h of the plans i n your benefit pr ogram as of Janua ry 1, 2015. And this section of your Han

dbook outlines general infor mation.

(2)

Customer Service Information

To answer your questions and help you with your benefits, we have a staff of qualified representatives who are here to help. We also have useful tools and information on our website. And we have experts in various fields, such as registered nurses and financial planners, who are available to you. So please let us help you maximize your benefits.

Our office hours are from 8 a.m. to 5 p.m. (Mountain Time) weekdays, except on Wednesdays when office hours begin at 9 a.m. You’re welcome to chat live online during office hours. Or you can visit our website — 24 hours a day, seven days a week — for a wealth of information. Our telephone numbers and website address are:

Salt Lake City area . . . 1-801-578-5600 Toll free . . . 1-800-777-3622

Website. . . www.dmba.com

If your hearing is impaired, please contact us using a relay service.

For your information, we record incoming telephone calls to ensure the quality of the information you receive.

If you want to visit us in person, our offices are located at 150 Social Hall Avenue, Suite 170, in downtown Salt Lake City. You can make an appointment or simply drop by during office hours. Our mailing address is:

Deseret Mutual P. O. Box 45530 Salt Lake City, Utah 84145-0530

Participating Employers

In 1970, The Church of Jesus Christ of Latter-day Saints, along with other companies owned and operated by the Church, formed a private employer trust to administer benefits for its employees. And Deseret Mutual Benefit Administrators, or Deseret Mutual for short, administers those benefits for you.

Deseret Mutual is not an insurance company. Rather, it’s a private, non-profit trust that administers health and pension benefits exclusively for employees of the Church and its related organizations. Our purpose — or mission — is to improve

your health and financial security.

You should look to Deseret Mutual as your partner in making important health-care decisions, as well as decisions that affect your financial future, especially retirement.

Deseret Mutual’s participating employers include:

• AgReserves, Inc.

• Beneficial Financial Group

• Bonneville International Corporation

• Brigham Young University

• Brigham Young University — Hawaii

• Brigham Young University — Idaho

• City Creek Reserves, Inc.

• Corporation of the President

• Corporation of the Presiding Bishop

• Deseret Book Company

• Deseret Digital Media

• Deseret Management Corporation

• Deseret Mutual Benefit Administrators

• Deseret News

• Deseret Trust Company

• East Central Florida Services

• Ensign Peak

• Hawaii Reserves, Inc.

• LDS Business College

• LDS Family Services

• Polynesian Cultural Center

• Property Reserve, Inc.

• Suburban Land Reserve, Inc.

• Taylor Creek Management

• Temple Square Hospitality Corporation

• Utah Property Management Associates

Participating Employers

Customer Service Information

General Information

The insurance and retirement benefits available to you are a vital and substantial part of your total compensation from your employer. And Deseret Mutual Benefit Administrators, or Deseret Mutual, administers these benefits for you.

(3)

Benefit Plans

Deseret Mutual’s benefit program includes the following plans:

• Core benefits

— Medical (several options)

• Deseret Protect

• Deseret Value (includes the Living Healthy

Wellness Program and either Deseret Dental or Deseret Dental PLUS)

— Group Term Life (GTL) insurance

— Occupational Accidental Death & Dismemberment (OAD&D) insurance

— Disability insurance

• Supplemental benefits

— Supplemental Group Term Life (SGTL) insurance — 24-Hour Accidental Death & Dismemberment

(24-Hour AD&D) insurance

• Retirement benefits

— Thrift Plan

— Retirement PLUS Plan

• Flexible benefits

— Flexible Spending Account (FSA) program — Premium Only Plan (POP)

• Value-added benefits

— VSP (Vision Service Plan)

— Group Auto and Homeowner’s insurance If you have questions about other benefits offered by your employer, such as vacations, holidays, or premium payroll deductions, contact your employer directly.

For an overview of the plans, eligibility requirements, enrollment guidelines, and when your coverage begins or your benefits are available, please see the details in the pages that follow. And for complete information about your benefit plans, please review the applicable sections in your Benefits Handbook.

CORE BENEFITS

The core benefit plans include Medical and Group Term Life insurance (available to you and your eligible dependents). You may choose:

• the entire core benefits package

• the Life Only option (waive medical coverage)

• to waive all benefits

Please keep in mind, your employer pays a large portion of the core premium on your behalf; you pay the remainder of the premium.

SuPPLEMENTAL INSuRANCE BENEFITS

Supplemental Group Term Life and 24-Hour Accidental Death & Dismemberment insurance are available to you and your

eligible dependents (see the appropriate Life Insurance section of your Benefits Handbook). With supplemental benefits, you pay the entire premium.

RETIREMENT BENEFITS

Each eligible employee may participate in the Thrift Plan (see the Thrift Plan section of your Benefits Handbook). The Thrift Plan is a defined contribution plan where both you and your employer make regular contributions.

Also, each eligible employee is automatically enrolled in the

Retirement PLUS Plan (see the Retirement PLUS Plan section of

your Benefits Handbook). The Retirement PLUS Plan is a profit sharing plan and is fully funded by your employer. In other words, you don’t pay a cent for this valuable benefit.

FLExIBLE BENEFITS

These programs may provide tax advantages to you. See the Flexible Benefits section of your Benefits Handbook to learn about the Flexible Spending Account program and the Premium

Only Plan.

VALuE-AddEd BENEFITS

Deseret Mutual offers several value-added benefits. They’re called “value-added” because we simply offer programs and discounts to add value to your benefits package. When applicable, you pay the entire cost for these benefits.

Value-added benefits may change at any time without notice. Companies and discounts may also change. These benefits are available to members who choose to use these services on a voluntary basis, separate and apart from the benefits program administered by Deseret Mutual.

For the most current information about Deseret Mutual’s value-added benefits, visit our website or call Member Services.

(4)

Eligibility and Enrollment Processes

When you meet the eligibility requirements of your employer and you have actively started work for your participating employer, you are eligible to participate in the benefit program. You must be actively on the job before your benefits begin. You can enroll in nearly all the benefit programs online on our

website at www.dmba.com. So it’s convenient and easy. For

help, work with your employer directly or you’re welcome to call Deseret Mutual’s Member Services. If you’re enrolling for the first time and you need help, call 1-801-578-5620 or 1-800-333-9742.

Here’s a general outline of the requirements for the different benefit plans.

CORE BENEFITS

Some insurance benefits (Medical and Group Term Life insurance) are available to you and your eligible dependents (see

Eligible Dependentsbelow).

Enrolling in the core benefit program within 30 days after your eligibility date is very important. You may also enroll up to 90 days before your eligibility date but you are not covered until your eligibility date. Each year thereafter, you may review your enrollment decisions and possibly change coverage during

open enrollment (see Open Enrollmenton page 7).

Please note that in most cases, you cannot disenroll midyear. But during the next open enrollment you can disenroll or choose another medical plan.

If you do not enroll within 30 days of your eligibility date, you cannot apply for medical or dental coverage until the next annual open enrollment, with coverage beginning the first day of the

following year. Exceptions may apply (see Protecting You: HIPAA

on page 9).

Also, if you enroll after 30 days, you must meet Deseret Mutual’s health standards for any Group Term Life.

And remember, you may choose:

• the entire core benefits package

• the Life Only option (waive medical coverage)

• to waive all benefits

As a new employee, coverage begins on your eligibility date. With open enrollment, coverage begins the first day of the following year. If you apply for Group Term Life insurance after 30 days, coverage begins on the first of the month after

Deseret Mutual approves your application.

SuPPLEMENTAL INSuRANCE BENEFITS

You may apply anytime for Supplemental Group Term Life or enroll in 24-Hour Accidental Death & Dismemberment online at www.dmba.com. Also, you and/or your dependents must complete the health questionnaire if you’re applying for Supplemental Group Term Life insurance.

Coverage begins the first day of the month after Deseret Mutual approves your application.

RETIREMENT BENEFITS

Retirement benefits are available to you (the employee). Your dependents are not eligible for their own retirement benefits through your employment with a participating employer. As an eligible employee, you’re automatically enrolled in the

Retirement PLUS Plan.

For the Thrift Plan, you’re also automatically enrolled if you don’t enroll within 30 days of becoming eligible. But the sooner you enroll, the better opportunity you have to take advantage of investment time and compounding interest, and the sooner you start receiving your employer’s matching contribution.

ELIGIBLE dEPENdENTS

Your eligible dependents include your spouse and dependent children. The following dependents may be covered:

• Natural children (including infants from the date of birth)

who are younger than 26

• Legally-adopted children and stepchildren who are younger

than 26

• A grandchild who is the child of your covered, unmarried,

dependent child. The unmarried dependent child and the grandchild must live in your home and depend primarily on you for support. For the grandchild to be covered, a direct lineal relationship must exist between you and the grandchild (or a direct line created through adoption). The grandchild may be covered to age 18

(5)

• Dependents who are added because of a full and complete guardianship, but they’re only eligible to be covered to age 18

• A child placed with you under the direction of a licensed

child placement agency while awaiting adoption. The child is only covered to age 18

• Your unmarried child who is 26 or older and incapable of

self-support because of mental or physical incapacity that existed before the child reached 26, and who is primarily dependent on you for support and must reside in your home. The child must be an eligible dependent according to IRS guidelines and must have been covered on your Deseret Mutual policy before age 26

To apply for this coverage, submit proof of these circumstances within 60 days from the end of the month when the child reaches 26. Any requests made more than 60 days after the end of the month when coverage terminated will not be considered. Please contact Deseret Mutual for a copy of the Application for Dependent Coverage After Age 26

If one of your dependents is hospitalized before benefits are effective and the dependent is in the hospital on the date benefits become effective, medical benefits do not begin for the dependent until the day after he/she is discharged from the hospital. If the child is adopted, coverage is effective the date of placement. Remember, you have 60 days to enroll a new dependent who is younger than 26 or you must wait until the next open

enrollment (see Protecting You: HIPAAon page 9).

GuIdELINES FOR dEPENdENTS 19 ANd OLdER

Your dependent children 19 and older are eligible to be covered by your medical, dental, and most life insurance policies.

Eligible dependent children may continue coverage until they turn 26.

Re-enrollment: If a dependent younger than 26 loses eligibility

for his or her own medical coverage, you can re-enroll the dependent within 60 days of the end of the coverage.

Surviving Spouses and dependents: This policy applies to

everyone enrolled in the Family Survivor Benefit (see Family

Survivor Benefiton page 8). If medical coverage is available,

coverage with Deseret Mutual ends.

But if the surviving spouse or dependent child loses medical coverage, this eligible dependent is allowed to re-enroll in the Family Survivor Benefit within 60 days of the end of the other coverage.

GuIdELINES FOR STEPCHILdREN

You may enroll your stepchild as an eligible dependent. Just as for all other dependent children, coverage may continue until the stepchild turns 26.

You may enroll your eligible stepchild if you do so at your eligibility date or within 60 days after your marriage to the child’s parent. If you do not enroll the stepchild within 60 days, you may not enroll the child until the next open enrollment. In cases of divorce, we may request a copy of the divorce decree for the purposes of coordinating insurance benefits.

GuIdELINES FOR EMPLOYEES AT HIGH RISk

If you apply for Group Term Life or Supplemental Group Term Life insurance and Disability coverage after 30 days from your eligibility date and you do not meet our health standards, you may be classified as high risk. This applies to your spouse, too. In this situation, coverage may be reduced or declined:

• Group Term Life insurance: $25,000 (or 50% of coverage)

• Supplemental Group Term Life insurance: Not available

• Disability Plan: Not available

OPEN ENROLLMENT

Generally, open enrollment is held annually during the fall. Changes in coverage are then effective January 1 of the following year.

During open enrollment, you may change from your current medical or dental plan to another plan available in your area if you meet plan guidelines. You can also enroll in Flexible Spending or any value-added benefits.

To see which medical plans are available to you, visit our website, contact your employer, or call Deseret Mutual Member Services.

• unrestricted Open Enrollment

(6)

coverage in the past, you can enroll during open enrollment without meeting Deseret Mutual’s health standards. You may also enroll your eligible dependents.

Unrestricted open enrollment applies to medical and dental coverage only. It does not apply to any life insurance or Disability coverage.

Of course, you may apply for Group Term Life insurance or Disability coverage at any time if you don’t already have it. But you must meet our health standards to qualify. If you’re interested, go to the forms library on our website or contact us for a Declaration of Insurability form.

QuALIFYING EVENTS

Major family events may qualify you to enroll at times other than during open enrollment or as a new employee. These include:

• marriage

• birth

• adoption

• change in employment status (such as going from part-time

to full-time employment)

• involuntary loss of eligibility for other medical insurance

• spouse has a change in employment status and no longer

qualifies for health insurance through his or her employer

Coordination of Insurance Benefits

e Coordination of Benefits (COB) provision applies when you or your dependents have medical or dental coverage from more than one health benefit plan.

e purpose of coordinating benefits is to avoid duplication of insurance payments. It involves determining which insurer is required to pay benefits as the primary payer, which insurer must pay as the secondary payer, and so on, until all insurers are considered in the correct payment order.

You must inform Deseret Mutual of other medical and/or dental coverage in force at the time of enrollment or when any other coverage becomes eﬀective after your initial enrollment. If applicable, you may be required to submit court orders or decrees. You must also keep Deseret Mutual informed of any changes in the status of the other coverage.

COORdINATION OF BENEFITS RuLES

When Deseret Mutual is the primary plan, eligible benefits are

paid before those of the other health benefit plan and without considering the other health plan’s benefits.

When Deseret Mutual is the secondary plan, Deseret Mutual calculates the amount of eligible benefits it would normally pay in the absence of other coverage, including the application of credits to any policy maximums, and applies the payable amount to unpaid covered charges after eligible benefits have been paid by the primary plan.

is amount includes deductibles and copayments you may owe. Deseret Mutual will use its own deductible and copayments to calculate the amount it would have paid in the absence of other coverage. In no event will Deseret Mutual pay more than the member is responsible to pay after the primary carrier has paid. Please note, we generally coordinate benefits between all group health plans (Deseret Choice, Deseret Choice Hawaii, Deseret Select, Deseret Premier, Deseret Value, and Deseret Protect). We also coordinate benefits between our group dental plans (Deseret Dental and Deseret Dental PLUS).

Premiums

Core Benefits: Your employer pays the majority of your monthly

premiums and you are responsible for the remaining balance. For supplemental insurance and value-added benefits, on the other hand, you pay the entire cost of the premiums for the coverage you choose. The advantage of supplemental coverage is that it’s available at reasonable group rates.

For the core benefits, monthly premiums are divided into three categories. These include coverage for:

• you (the employee) only

• you and one dependent

• you and two or more dependents

Supplemental Insurance Benefits: Premiums vary depending

on your age and the options you choose. Please refer to the appropriate Life Insurance section of your Benefits Handbook for more information.

Retirement Benefits: These benefits do not have any associated

premiums. Your employer fully funds the Retirement PLUS Plan benefit. For the Thrift Plan, you determine your contribution amount and your employer makes a matching contribution in your behalf.

Premium Adjustments: Please be aware that premium

adjustments because of enrollment changes or errors are limited

Premiums

(7)

to 15 months immediately preceding the date Deseret Mutual receives evidence that such adjustments should be made. These adjustments can be either returned premium dollars or

additional premium charges.

In the case of a dependent’s death, if you do not notify Deseret Mutual within 15 months, we still refund any extra premium you paid back to the date of the dependent’s death.

Notification of Changes in Family Status

To make sure your benefits are provided quickly and efficiently, please make sure your records at Deseret Mutual are accurate. If any of the following changes occur, contact your employer and Deseret Mutual immediately:

• Address

• Marriage (for you and/or your dependent children)

• Birth

• Adoption

• Placement of a foster child (full and complete guardianship)

• Death

• Divorce

• Name

• Dependent status

• You or any of your dependents qualify for Medicare

• You or any of your dependents acquire other medical or

dental insurance

• Any other situation that may affect your participation in the

benefit program

Benefits during Leaves of Absence

Depending on the type of leave, benefits may continue to an employee on a leave of absence. Please contact Deseret Mutual for more information. To qualify, the leave must be officially approved by your employer and the clear intent must be for you to return to work for the participating employer.

CORE ANd SuPPLEMENTAL BENEFITS

You may continue your benefits during certain types of leaves of absence. But limitations apply as to how long your benefits may continue and how long your employer continues to contribute to the premium for your coverage. For information about a specific leave of absence, please contact your employer or Deseret Mutual.

If you’re outside your medical plan’s service area during your leave, you can choose a plan in your new area for the duration of your leave. Then when you return, you can re-enroll in your original medical plan.

You may continue Supplemental Group Term Life insurance if you keep basic Group Term Life insurance. You may also continue your 24-Hour Accidental Death & Dismemberment insurance.

If you discontinue your coverage while you’re on leave, then you can reinstate coverage that was in effect before an employer-approved leave of absence (such as full-time military service, professional development leave, or family leave) if you:

• were enrolled for at least six months immediately before the

leave

• return to active employment within three months after

release or the end of the designated leave

• request your benefits to be reinstated within 60 days after

your return to work

You may have to meet Deseret Mutual’s health standards to continue life insurance benefits.

OTHER BENEFITS

If you are on a paid leave, you may continue to contribute to the Thrift Plan, as well as participate in the Flexible Spending Account program.

But if you are on an unpaid leave, you cannot participate in the Thrift Plan. If you’re on unpaid leave and enrolled in Flexible Spending, you may be able to contribute on an after-tax basis. Please contact Deseret Mutual’s Member Services about your options.

MILITARY LEAVES OF ABSENCE

Special provisions apply to military leaves. Please contact your employer and Deseret Mutual for more information.

Termination of Coverage

MEdICAL / LIFE INSuRANCE

Your coverage automatically ends on the earliest of the following dates:

• Last day of the month for which premium is paid

Benefits during Leaves of Absence

Notification of Changes in Family Status

(8)

• Last day of the month in which you end employment and you do not qualify to continue benefits

• Last day of the month in which you are no longer eligible

for benefits

• Date you enter active duty in the armed forces of any

country, except for life insurance (please contact Deseret Mutual for more information about military leaves)

• Date of termination of the plan

In addition, your dependent’s coverage automatically ends on the earliest of the following dates:

• Last day of the month in which your dependent no longer

qualifies as an eligible dependent

• Last day of the month you are divorced (your spouse’s and

stepchildren’s coverage ends but your dependent children’s — natural or adopted — coverage may not end)

• Date your dependent enters active duty in the armed forces

of any country, except for life insurance (please contact Deseret Mutual for more information about military leaves) If you or your dependent is in the hospital on the date your coverage ends, you may extend medical benefits for the individual solely for the injury or illness for which you or your dependent was admitted.

In your case, coverage ends on the date of your release from the hospital. In the case of your dependents, coverage ends on the date of release from the hospital or no longer than 30 days from the date insurance eligibility ends, whichever comes first.

Continuation Coverage — COBRA

(Medical / dental)

“COBRA” stands for the Consolidated Omnibus Budget Reconciliation Act. It allows individuals and their dependents to continue their medical group coverage for a limited time after a qualifying event causes them to lose their group coverage. With COBRA, you or your dependent pays 102% of the monthly premium.

To be eligible for COBRA, you and your dependents must be enrolled in a Deseret Mutual medical plan when a qualifying event occurs as listed below:

• If your employment with a participating employer ends (for

reasons other than gross misconduct on your part) or you lose eligibility for coverage, you and your dependents may be covered for up to 18 months. If you acquire new dependents, they may be added to your COBRA coverage.

You must enroll them within 60 days after marriage, birth, or adoption

• You may also be able to continue participating in Flexible

Spending on an after-tax basis

• If you get divorced, your former spouse (and any stepchildren,

if applicable) may be covered for up to 36 months. You must notify us of the divorce

• If a dependent child exceeds the maximum age for coverage

as your dependent, your dependent may be covered for up to 36 months

If you lose eligibility or end employment and qualify for COBRA coverage, your employer notifies Deseret Mutual. We then send you a notice of your COBRA eligibility and information about how to enroll. You have 60 days from the date Deseret Mutual sends you notification to enroll in COBRA continuation coverage.

COBRA coverage may end for any of the following reasons:

• Failure to make timely payment of COBRA premiums

• The employer ceases to provide any group health plan to

any employee

• The qualified beneficiary becomes covered by another group

health plan (subject to a preexisting condition rule) after electing COBRA

• The qualified beneficiary becomes covered by Medicare after

electing COBRA

• A disabled qualified beneficiary whose disability extends the

maximum coverage period to 29 months is determined not to be disabled before the end of the extended period

• The qualified beneficiary’s COBRA coverage is terminated

for cause (for example, for submitting fraudulent claims) on the same basis as would apply to a similarly situated non-COBRA beneficiary in the plan

Continuing Life Insurance Coverage

If part or all of your Group Term Life or Supplemental Group Term Life insurance ends because you end employment (other than retirement) or you lose membership in an eligible class of employment, you may be able to purchase a continuing individual policy from The Hartford without having to meet health standards.

You must apply for this policy and pay the initial premium within 31 days from the time your group insurance benefits end. Please contact Deseret Mutual’s Member Services for an

application.

Continuation Coverage — COBRA

(Medical)

(9)

Family Survivor Benefit

The family survivor benefit provides a one-year period of continuation of medical insurance at no cost to your survivors. Then after one year, your dependents may continue to receive medical coverage depending on your length of service before your death.

When you die, your surviving dependents who are covered on the date of your death may continue medical and dental coverage with Deseret Mutual. In fact, we’ll automatically enroll any dependents who were covered before your death. Surviving dependents may also continue some Supplemental Group Term Life insurance if they choose to do so (see the applicable Life Insurance section of your Benefits Handbook).

If your surviving dependents choose to continue coverage, they must notify Deseret Mutual within 60 days of the date of your death.

Consider the following guidelines:

• If employment-based medical coverage is available, either

through the individual’s own employment or through the surviving parent’s employment, coverage with Deseret Mutual ends. But if the surviving spouse or dependent child loses employment-based medical coverage, this dependent is allowed to re-enroll in the Family Survivor Benefit within 60 days of the end of the coverage. This applies to survivors who enrolled in health insurance offered by their employers, as well as those who previously elected not to enroll in their employers’ plans. Surviving dependents who have not enrolled in their employers’ plans have at least 30 days to do so, beginning the date their Deseret Mutual coverage ends (one year from the time of your death).

For your information, employers are required by law to offer eligible employees this window to enroll when they lose eligibility for the other insurance they had when they originally declined enrolling in the employer’s group plan. If at some time in the future your surviving spouse loses eligibility for insurance with his or her current employer, he or she has 60 days to re-enroll with Deseret Mutual.

• Surviving spouses who were enrolled in a Deseret Mutual

dental plan or the Senior Dental Plan may enroll in or remain enrolled in the Senior Dental Plan (at their own expense). Call Deseret Mutual for more information.

• If your surviving spouse is eligible for other coverage and

that policy covers any of your dependents, the dependents are no longer eligible for coverage from Deseret Mutual. In this case, the same window applies to your eligible dependents to enroll for coverage with the surviving spouse’s current employer.

• Other eligible survivors (unemployed survivors or survivors

working for employers who do not offer them health insurance) may continue to be covered by Deseret Mutual until they obtain employment that offers health insurance or they otherwise no longer qualify as dependents.

Note: Newly acquired dependents of your survivors may not be added to the survivor coverage.

For more information, please see Eligibility and Enrollment

Processeson page 3.

Protection for You and Your Benefits

PROTECTING YOuR PRIVACY

Protected Health Information

Deseret Mutual does not disclose your personal, protected health information without your express permission. So if you would like other individuals (including your spouse or other family members) to have access to your protected health information, you must submit a Privacy Authorization Form to Deseret Mutual. Your dependents 18 and older must also submit a Privacy Authorization Form before you can access their protected health information.

Protected health information is a HIPAA provision. “HIPAA” stands for the Health Insurance Portability and Accountability Act.

For more information about HIPAA, see Protecting You: HIPAA

on page 10.

deseret Mutual Identification Number

We are committed to protecting the confidentiality of the personal information we receive — either from or about you. So although we use your Social Security number when communicating financial information to the federal government, generally we do not use your Social Security number to identify you. We use a number that is specific to you — your personal Deseret Mutual identification number.

All physicians, dentists, and any other business partners must use your Deseret Mutual identification number. Otherwise, your claims may be delayed or denied.

For added security when accessing your information on our website, we ask you to provide a Web password to accompany your Deseret Mutual identification number. Of course, you choose your own password.

The combination of your Deseret Mutual ID, password, and a

Family Survivor Benefit

(10)

security phrase you specify provides access to all of your personal health and financial information on file at Deseret Mutual. You can protect your private information by safeguarding these items. If you give your information to anyone, or if you suspect someone else knows your information, please contact us immediately.

PROTECTING YOu: HIPAA

The following regulations of the Health Insurance Portability & Accountability Act (HIPAA) apply to your Deseret Mutual medical/dental benefits:

Special Enrollment Periods for Qualifying Events

HIPAA requires insurers to offer special enrollment periods to individuals who initially decline enrollment because they have other insurance and subsequently or involuntarily lose eligibility for the other coverage. A special enrollment period must also be offered to you if you gain a new dependent, either through

marriage, birth, or adoption. (See Qualifying Eventson page 5.)

If you waive medical coverage and later want to enroll with Deseret Mutual, you must provide a Certificate of Creditable Coverage or other legal documentation of the qualifying event. HIPAA prohibits group plans from using health criteria to determine an individual’s eligibility to enroll. But special enrollment in Deseret Mutual’s medical plans is only allowed if:

• you had other insurance and you subsequently lost eligibility

for the other coverage. In this case, you and your

dependents may enroll within 60 days after losing the other coverage. This also applies to your eligible dependents who had and lost other coverage

• you gain a newly eligible dependent. You may also enroll

within 60 days after acquiring the dependent. In this case, you may enroll any other eligible dependents who are not currently enrolled

All other plan provisions and requirements apply to eligibility for medical benefits.

PROTECTING YOuR BENEFITS: ERISA

As a participant in the benefit program, you are entitled to certain rights and protections from the Employee Retirement Income Security Act (ERISA). ERISA provides that all participants be entitled to:

• Examine, without charge — and at the program

administra-tor’s and/or employer’s offices — all program documents including insurance contracts, collective bargaining agreements, and copies of all documents filed by the program with the U.S. Department of Labor, such as annual reports and plan descriptions (Deseret Mutual is the program administrator)

• Obtain copies of all program documents and other program

information upon written request to Deseret Mutual. Deseret Mutual may charge a reasonable fee for the copies

• Receive a summary of the program’s annual financial

report. Deseret Mutual is required by law to furnish each participant with a copy of this summary financial report Your employer may not fire you or discriminate against you to prevent you from obtaining a benefit or for exercising your rights under ERISA.

If your claim for benefits is denied, in whole or in part, Deseret Mutual sends you a written explanation of the reason for the denial. You have the right to have Deseret Mutual review and reconsider your claim. Under ERISA, you can take steps to enforce the above rights.

For instance, if you request materials from Deseret Mutual and you do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require Deseret Mutual to provide the materials and pay you up to $100 a day until you receive the materials, unless the materials were not sent because of reasons beyond Deseret Mutual’s control.

If you have a claim for benefits denied or ignored, in whole or in part, you may file suit in federal court after you’ve exhausted

all administrative remedies. If program fiduciaries misuse the program’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor or you may file suit in federal court.

The court decides who pays court costs and legal fees. If you are successful, the court may order the party you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees if, for example, it finds your claim to be frivolous.

If you have questions about the program, contact Deseret Mutual. If you have questions about this statement or about your rights under ERISA, contact the nearest Area Office of the U.S. Department of Labor.

PROTECTING dESERET MuTuAL: FRAud POLICY

(11)

of defrauding Deseret Mutual. An application for insurance or statement of claim containing any materially false or misleading information may lead to reduction, denial, or termination of benefits or coverage from the policy and recovery of any amounts Deseret Mutual may have paid.

In extremely rare situations, a member may seek to either bypass or ignore appropriate medical advice in an attempt to abuse the health-care system. This may include, but is not limited to, changing from physician to physician, going from emergency room to emergency room, or seeking medications from multiple sources.

In these situations, Deseret Mutual has the right to place the member on what’s called a medical compliance plan. That person will then be instructed to receive care from certain providers and/or facilities that are specifically named in the compliance plan (except in an emergency), as determined by Deseret Mutual. In other words, the member must comply with medically appropriate advice and care.

If the member then chooses to receive care from providers and/or facilities that are not included in the compliance plan, benefits will be denied and the participant will be responsible for all costs associated with this care.

Benefit Administration

SuBROGATION

If you have an injury or illness that is the liability of another party and you have the right to recover damages, Deseret Mutual requires reimbursement for any amount it has paid when damages are recovered from the third party. Deseret Mutual is reimbursed:

• first

• from any claim against the third party, the third party’s

liability insurer, including Workers’ Compensation, or your uninsured or underinsured motorist insurer

• whether the recovery is obtained by settlement, judgment,

or any other source

• regardless of how the settlement is allocated by the third

party or insurer

• regardless of whether the settlement is considered to have

recovered full compensation or damages

In addition, if you do not attempt to recover damages from the third party as described above, Deseret Mutual has the right to act in your place and initiate legal action against the liable third party to recover the amount it has paid for your injuries.

Your accep tance of Deseret Mutual benefits for the injury gives Deseret Mutual the right to subrogate. You need to provide all information Deseret Mutual requests for subrogation purposes. If you do not, we will withhold the payment of your benefits and you will be responsible for reimbursing all costs and expenses paid by Deseret Mutual for the injury.

Claims Review & Appeal Procedures

If Deseret Mutual denies your claim and you want to appeal because you think it was denied inappropriately, or if you have other claim concerns or complaints, please bring them to our attention. You must submit your appeals within 12 months

from the date we send your benefit decision notification. What if I need help understanding a denial? Call us at

1-801-578-5600 or 1-800-777-3622.

How do I file an appeal? When you log in at www.dmba.com,

go to the Medical/Dental/Rx tab and click on a claim number to view an Explanation of Benefits (EOB). Below the benefit details, you’ll see the statement, “You have the right to appeal this claim within 12 months from the date paid shown above. Click here for more details ...” Go ahead and click to get the appeal form. Complete your appeal form and send it to Deseret Mutual’s appeals coordinator at the address listed below.

What if my situation is urgent? If your situation meets the

definition of urgent by law, your review will typically be

conducted within 72 hours. Generally, an urgent situation is one in which your health may be in serious jeopardy or, in the opinion of your physician, you may experience pain that cannot be adequately controlled while you wait for a decision on your appeal. If you believe your situation is urgent, you may request an expedited appeal by following the instructions above for filing an internal appeal and also checking the boxes requesting an urgent appeal. Urgent appeals aren’t available for disputes involving services you’ve already received.

Who may file an appeal? You, or someone you name to act for

you as your authorized representative, may file an appeal. Contact Deseret Mutual’s appeals coordinator at 1-801-578-5648 or 1-800-777-3622, ext. 5648, for information about how to authorize another person to represent you.

Can I provide additional information about my claim? Yes,

you may supply additional information. Include copies of all documents that support your position, such as doctor’s letters, operative reports, bills, medical records, Explanation of Benefits (EOB) statements, written comments, and any other

information relating to the claim for benefits.

Can I request copies of information relevant to my claim? Yes,

you can request copies (free of charge). is includes billing and

Benefit Administration

(12)

diagnosis codes. Send a request in writing to Deseret Mutual’s appeals coordinator at the address listed below.

What happens next? If you appeal, we will review our decision and provide you with a written determination. If your appeal is denied and you still disagree with the decision, you can resubmit it to Deseret Mutual’s appeals coordinator at the address below, requesting a second level of appeal. You are also entitled to bring a civil action under ERISA Section 502(a) to appeal an adverse benefit determination based on the review of an earlier determination.

What timelines apply? You will have 12 months following an

adverse benefit determination to appeal. Because this plan provides two levels of appeal to Deseret Mutual, you will receive notification about any one of the two appeals for (i) preservice claims no later than 15 days after Deseret Mutual receives your appeal; and (ii) post-service claims no later than 30 days after we receive your appeal.

Submit all claims review or appeal communications to:

Deseret Mutual, Attention: Appeals Coordinator P.O. Box 45530

Salt Lake City, Utah 8414

definitions and Exclusions

Each benefit plan has unique limitations and exclusions. Please pay particular attention to the exclusions in each section, as well as the Definitions section of your Benefits Handbook.

Notification of discretionary Authority

Deseret Mutual has full discretionary authority and the sole right to interpret the plans and to determine benefit eligibility. All Deseret Mutual decisions relating to plan terms or eligibility for benefits are binding and conclusive.

Notification of Benefit Changes

Deseret Mutual is subject to the Employee Retirement Income Security Act (ERISA) and reserves the right to amend or terminate this plan at any time. If benefits change, we will notify you at least 30 days before the effective date of change.

definitions and Exclusions

Notification of discretionary Authority

Notification of Benefit Changes

(13)

Claims Review Procedures

urgent Care Health Claims Pre-service Health Claims Post-service Health Claims Health Claims for disability

Deseret Mutual must

provide a notice of the initial claim denial within ...

72 hours after receiving

your claim, if it was properly completed

48 hours (1) after

receiving completed claim or (2) after the 48-hour claimant deadline, whichever is earlier

15 days after receiving

your initial claim

the claim if we need more information and we provide an extension notice during the initial 15-day period

your initial claim

provide an incomplete claim notice and ask for additional information within ...

24 hours after receiving

your claim

your claim, extended 15

days from the date we

receive the required information

your claim, extended 30

days from the date we

receive the required information

You must complete the

claim within ...

Not applicable 45 days after receiving

the notice to provide information

You must appeal the

decision within ...

12 months after

receiving the claim denial

12 months after

provide a notice of the decision of appeal within ...

72 hours after your

request for review (either verbal or written)

30 days. Two levels of

review are available: the CMRC responds within

15 days of written

request and the CRC responds within 15 days of request (either verbal or written)

60 days. Two levels of

review are available: the CMRC responds within

30 days of written

request and the CRC responds within 30 days of request (either verbal or written)

45 days after your

request for review

your appeal if we need an extension