2016 employee benefits guide · 2015-10-25 · this guide is a quick reference to help answer most...

2016 EMPLOYEEBENEFITS GUIDE

HOURLY EMPLOYEES

Featuring:

2 Hourly Employee Benefits Guide 2016

2016 Annual EnrollmentAn Annual Enrollment Newsletter for Denny’s Salaried Employees

November 2011

2012 Annual Enrollment News

Enrollment Period – Monday, Nov. 14, 2011 – Wednesday, Nov. 30, 2011

Don’t forget to enroll for 2012 to continue or change your benefits. Benefits will NOT

automatically roll over. The 2012 enrollment period is November 14, 2011 through

November 30, 2011. If you have any questions about your benefits or the 2012 Annual

Enrollment process, please call the Denny’s Employee Benefits Department at

1-800-859-2244 Monday to Friday from 8:00 AM to 5:00 PM ET.

Dear Denny’s Team Member,

It is that time of year again to review your benefit needs – and the healthy choices you

should make for you and your family’s long-term health. Denny’s will continue to provide

comprehensive benefits – and I encourage you to take an active role in your health and well-

being. There are several important things you should know as you prepare to enroll for 2012.

As you know, healthcare costs continue to rise and companies are struggling to find ways to

keep their medical costs down. Denny’s costs for benefits are also rising at an increase of

9.6% for 2012. I know you’ve had your share of premium increases in the past, with employee

medical premiums increasing between 6% and 12% each year over the past five years. For

2012, we’ve calculated that the average employee increase in premiums will be 11%.

However, I am extremely excited to tell you that your actual increase for medical benefits

for 2012 will be ZERO! Yes, you read this correctly, we are NOT increasing your medical

premiums for 2012. Denny’s will be paying for the entire cost of the medical plan increases.

This is nearly a $1 million increase to the Company, but I believe it is an important investment

in our employees. I recognize the challenging economic times that we’ve all been through, but

more importantly, I want you to know how strongly I feel about each of you and the health

of you and your families.

But you must also do your part to control rising costs. One way that each of you can help

is to become more aware of your own health by taking the Simple Steps Health Assessment.

In addition, Denny’s, in conjunction with Aetna, will be implementing a Healthy Lifestyle

Coaching Program for 2012. I encourage you to take advantage of this great opportunity to

learn more about your health and how to achieve a healthier lifestyle. The payoff in the long

run will equate to healthier employees, which equals less medical claims, which leads to lower

premium increases each year.

Important information containing the details of this program, and the details of all of your

benefits, can be found in this newsletter.

There are no other significant changes to your benefit offerings for 2012. However, we have

made a slight enhancement to the dental coverage. If you elect to enroll in the Aetna Dental

$25 deductible plan, your annual benefit will increase from $1,000 annually to $1,500 annually.

This will create a small increase of up to $9.27 bi-weekly based on your coverage level.

I am looking forward to a great year for Denny’s in 2012 and I want you to be a happy, healthy,

and productive part of that success!

2016 Benefits Enrollment

At Denny’s, we are committed to providing quality benefits for our employees at an

affordable cost. The well-being of our employees is very important to me. As you make

your benefit selections, we encourage you to review your current benefits package and

consider whether it still meets the health and financial needs of you and your family.

The financial challenges facing the healthcare industry continue to lead to changes in

our benefit costs. Denny’s has done its best to keep the impact as minimal as possible to

you, and we continue to shoulder the majority of the cost of benefits.

We are excited to announce that medical premiums did not increase for 2016. We are

also pleased to offer life insurance for all hourly employees who have worked with the

company for one year. Hourly employees who have worked at least six months with the

company are now eligible for Dental and Vision benefits regardless of the number of

hours worked.

We will again offer several health care plans from which to choose - including a

traditional preferred provider plan and consumer-focused, high-deductible plans. In

addition, you will also have the option of adding benefits such as dental and vision

coverage, flexible spending (FSA) or health savings accounts (HSA), plus voluntary life,

accident and critical illness policies.

Signing up for benefits is easy - you can enroll online through our enrollment website,

or, if you have questions or need additional assistance, you can simply call a toll-free

number and speak with a specially trained counselor who can help you select the

offerings that best fit your needs.

I encourage you to review this guide carefully for details on the benefits available to

you, including the benefit changes summarized on the next page. Thank you for the

talents you bring to our company, and I look forward to a healthy and successful 2016!

Sincerely,

John Miller

President and CEO of Denny’s, Inc.

3This guide is a quick reference to help answer most of your questions.

Annual Enrollment Begins Soon!

Denny’s Annual Enrollment period is being held October 26, 2015 through November 11, 2015. This is your once-a-year opportunity to elect, change or waive benefits coverage. The elections you make during this Annual Enrollment will be effective January 1 through December 31, 2016.

You can make enrollment elections online by going to www.benefitsgo.com/Dennys15. In addition to the enrollment website, benefits counselors will be avilable to answer questions and conduct one-on-one enrollment sessions over the phone.

To ensure a smooth enrollment process, please complete the enclosed Benefits Contribution Worksheet before completing your enrollment.

How to enroll:There are two ways to elect, change or waive benefits coverage for 2016:

• Online at www.benefitsgo.com/Dennys15

• Click on “Enroll”

• On the next screen, enter the following information:

Username: Your birth date (MMDDYYYY) + Last four digits of your Social Security Number

Password: Your birth date (MMDDYYYY)

• By telephone. Speak directly to a benefits counselor by calling the Denny’s BenefitsEnrollment Center at 1-855-874-0439. See the suggested enrollment schedule below. If youmiss your recommended window, please call in as soon as possible before November 11.

Spanish-speaking counselors will be available.

Denny’s Benefits Enrollment Center CalendarHours of Operation: Monday – Friday, 10 a.m. to 7 p.m. (ET)

Phone Number: 1-855-874-0439

If your last name begins with: Your call-in dates are:

A to H 10/26, 10/27, 10/28

I to Q 10/29, 10/30, 11/02

R to U 11/03, 11/04, 11/05

V to Z 11/06, 11/09, 11/10, 11/11

Upon completion of your benefit elections, carefully review your online confirmation statement to be sure all the information is correct.

You Must Enroll Online or Call the Enrollment Center and Actively Enroll. If you do not enroll, you will not have coverage through the Denny’s plan in

2016. If you recently enrolled as a new hire/newly eligible employee, you will still need to re-enroll for 2016.

YOU MUST RE-ENROLL. (YOUR CURRENT BENEFITS WILL NOT ROLL OVER)


Contents

CO

NT

EN

TS

2016 BENEFIT HIGHLIGHTS

Enrollment and Eligibility ............................................................................................................................... 5

Medical Plan Descriptions ...............................................................................................................................6

Medical Plan Terms to Know ........................................................................................................................ 7

Medical Plan Comparison ...............................................................................................................................8

Prescription Drug Benefit ...............................................................................................................................9

Hawaii Medical Plan .......................................................................................................................................... 10

Hawaii Prescription Drug Benefit ............................................................................................................... 11

Dental ........................................................................................................................................................................12

Vision .........................................................................................................................................................................13

Health Savings Account .................................................................................................................................14

Flexible Spending Account...........................................................................................................................15

Life Insurance Options .....................................................................................................................................16

Travel Insurance ............................................................................................................................................17-18

401(k) Plan Highlights ......................................................................................................................................19

Medicare Notice ................................................................................................................................................20

Important Notices .............................................................................................................................................21

Rally Program ..................................................................................................................................................... 24

Voluntary Worksite Benefits .......................................................................................................................25

• The annual maximum family contribution for the Health Savings Account (HSA) has increased to $6,750.

• The annual maximum for the Flexible Spending Account (FSA) has increased to $2,550.

• The deductibles for the High Deductible Plans have decreased.

• The maximum out-of-pocket for the PPO family plan has decreased.

• We are now part of the BCBS Vaccine Network, which is included in the Pharmacy benefit. The VaccineNetwork has almost 62,000 pharmacies nationwide. It covers flu shots, including high-dose Fluzone, Intra-nasal flu vaccine (FluMist), Intradermal flu vaccine, adults over 65, and pediatric pneumonia vaccine. Thereis no co-payment for members who receive the flu or pneumonia vaccines from an in-network pharmacy.


Enrollment and Eligibility

Annual EnrollmentThe 2016 annual enrollment period is Oct. 26 - Nov. 11, 2015. BENEFITS WILL NOT AUTOMATICALLY ROLL OVER. You must enroll or you will not have coverage for the 2016 Plan Year.

Annual enrollment is the period each year to make changes to your benefits. You can change plans as well as add or drop dependent coverage provided your dependent(s) meet all eligibility requirements. Any changes made during annual enrollment must remain until the following annual enrollment period, unless you experience a qualifying life event.

New HiresYou are eligible for full benefits if you have at least one year of service and are averaging a minimum of 30 hours per week during a rolling 52-week period. You are eligible for dental and vision benefits if you have six months of service, regardless of hours. If you average more than 20 hours per week, you may enroll in voluntary benefits.

IRS Section 125 guidelines allow you to pay certain benefit premiums before any taxes are deducted from your pay; therefore you pay fewer taxes.

Eligible DependentsYou also have the option to enroll your eligible dependents in some of these plans. Eligible dependents may include:

• Spouse - Your legally married spouse as recognized under any state law.

• Domestic Partner - Your spousal equivalent in whichyou may be required to provide a copy of a domestic partnership affidavit or other documentationproving domestic partnership eligibility.

•Your dependent children up to age 26* or whenapplicable, your unmarried children of any age whoare incapable of self-support due to a mental orphysical disability and who are totally dependent onyou.

When Can I Make Changes?During each annual enrollment period, you have the opportunity to review your benefit elections and make changes for the coming plan year. For most benefits you may only make changes to your elections during the year if you have a change in a qualifying life event. Life events include: marriage, divorce; gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, marriage, or reaching the dependent child age limit; changes in your spouse’s employment affecting benefit eligibility; changes in your spouse’s benefit coverage with another employer that affects benefit eligibility; changes in employee work status.

The change to your benefit elections must be consistent with the life event. You have 31 days from the date of the life event to submit an enrollment change form and documentation of the event to the Employee Benefits Department. Your election will become effective the day of the life event once paperwork is received. Otherwise, you must wait until the next annual enrollment period to make a change to your elections.

If you have any questions about your benefits or the 2016 Annual Enrollment process, please call the Employee Benefits Department at 1-800-859-2244.

*Certain limitations apply.

Employees that have completed 12 months of employment and have worked an average of 30 hours per week (within the past year) are eligible for the

following benefits:

Employees that have completed 6 Months of employment are eligible

for the following benefits:

Employees that have completed 6 Months of employment and have worked an average of 20 hours per week (within the past six months) are eligible for the

following benefits:

*All Coverage Effective 1st Of Month Following…(eligibility date)Medical x

Dental x x x

Vision x x x

Basic Life x

Supplemental Life x

Dependent Life x

FSA x x x

HSA x

Voluntary Plans (through Aflac & TransAmerica)

x NOT ELIGIBLE FOR VOLUNTARY BENEFITS

x


Medical Plan Descriptions

Preferred Provider Organization (PPO)PPOs offer coverage within a network of doctors and hospitals, but you do not have to choose a primary care physician. You can see a specialist when medically necessary - usually without a referral. You may seek care outside the network, but you will pay a higher cost.

With the PPO plan, you must pay a portion of costs through co-pays and co-insurance. If you stay within the Blue Cross Blue Shield network of providers, your co-pays for doctors’ visits are $25 for primary care and $40 for specialists. For other services, you must pay the cost of services in-full until you reach the deductible, then the plan covers 80% of costs until you reach the maximum out-of-pocket limit. The deductibles and out-of-pocket limits differ for in-network and out-of-network care. The PPO carries the highest premium cost to you, but it limits your total out-of-pocket expenses.

You may set aside pre-tax dollars to pay for certain out-of-pocket healthcare expenses through a flexible spending account (FSA). To find out how you can use an FSA to save money with your PPO plan, see page 15.

High Deductible Health Plans (HDHP)Our high-deductible plans, as the names suggest, carry a higher deductible than the PPO. Essentially, HDHPs are another type of medical plan where you pay a set amount of out-of-pocket costs before the health insurance begins to pay. In exchange, your premiums in the HDHP plans are lower than in the PPO plan. The deductibles and out-of-pocket limits differ for in-network and out-of-network care. In the HDHP I plan, you pay the full cost of doctors’ visits and medical services until you reach the deductible. After that, the plan covers 80% of costs until you reach the maximum out-of-pocket limit ($6,250 for an individual, $12,500 for family).

The HDHP II plan is similar, and it covers 60% of costs once the deductible is met. The maximum out-of-pocket limit is the same as with the HDHP I plan.

There are no co-pays in the HDHP Plans.

The HDHP options save you money up front through lower premiums than the PPO. To see how you can save even more money, flip to page 14 for information about a Health Savings Account.

Denny’s has designed its medical plan options to give you the opportunity to reduce your total cost of health-care. Benefit-eligible employees can choose between:

• A Preferred Provider Organization (PPO)• Two High Deductible Health Plans (HDHP)

All three plans are similar in that they provide access to the Blue Cross Blue Shield network of medical providers, which represents the best doctors and medical facilities in your region. They differ in how much you pay in premiums and how much you pay out-of-pocket for services. You pay the lowest cost for services when you stay in the network.

Giving You Options to Reduce Your Total Cost of Healthcare

HOW THE PLANS STACK UP

Highest Premium

Lowest Out-of-Pocket

Expense

Lowest Premium

Highest Out-of-Pocket

Expense

Higher Premium

Higher Out-of-Pocket

Expense

PPO PLAN HDHP 1 PLAN HDHP 2 PLAN

If you anticipate you will use a lot of medical services, this plan will limit your out-of-pocket exposure, but the up-front cost is high.

This plan has a lower premium in exchange for higher out-of-pocket costs.

If you anticipate minimal use of medical services, this plan will save you the most money.

You pay 20% once deductible is met

You pay 20% once deductible is met You pay 40% once

deductible is met


What’s my Total Cost of Healthcare?Your Total Cost of Healthcare is how much you pay in premiums (the contribution taken out of your earnings each pay period) and how much you pay out-of-pocket when you see a doctor or other provider.

The truth is, many people pay more than they need to for healthcare. A healthy person can take advantage of lower premiums to lower his/her total healthcare cost and even save money for medical expenses down the road in future years.

Here are some definitions that may help as you familiarize yourself with each of the plan offerings:

Co-payA fixed amount you pay each time you use medical services until you reach your out-of-pocket maximum. Example: You may pay the co-pay for doctor’s visits or if you get a prescription filled.

DeductibleThe amount you pay for medical services before your health insurance plan begins to pay. Not everything you pay for (including your premium and co-pays) counts toward your deductible.

Co-insuranceThe percentage you pay after you meet your deductible. Example: After your deductible is met, you might pay 20% of a bill and your plan pays 80%. But once you meet the annual out-of-pocket maximum, your plan pays 100% of your costs for covered services.

PremiumThe amount deducted biweekly from your paycheck for the coverages you elected.

Out-of-Pocket ExpensesThe maximum amount you will have to pay. This is your deductible and co-insurance maximum. Once this amount is met, covered expenses are paid at 100% of the allowed charges for the rest of the year.

Terms to Know

Your Share of the Premium(the money deducted from

your paycheck)

Your Out-of-Pocket Costs(co-insurance, co-pays, deductibles, etc.)

YOUR TOTAL COST OF HEALTHCARE

+

Preventive care includes such services as annual physical exams, mammograms, pap smears, prostate screenings, and colonoscopies.

Based on federal Healthcare Reform Guidelines, preventive care is covered at 100% under all plans. For more information, visit www.healthcare.gov.


Medical Plan Comparison

Contact: BCBS at www.southcarolinablues.com 1-800-760-9290 (M-F 8am-6pm ET)PPO HDHP I HDHP IIIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Deductible $1,000 individual/$3,000 family

$2,000 individual/$6,000 family




$8,000individual/$16,000 family

Out-of-Pocket Maximum


$8,000 individual/ $16,000 family



$6,250 individual/12,500 family


Co-insurance 80% 60% 80% 50% 60% 40%

Primary Care Physician/ Specialist

$25 co-pay/ $40 copay

60% afterDeductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible

Preventive Services 100% Not Covered 100% Not Covered 100% Not Covered

Sustained Health Services

$25 co-pay$300 max. N/A 100%

$300 max. N/A 100%$300 max. N/A

Inpatient Facility Charges

$250 co-pay, then 80% after

Deductible


Deductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible

Skilled Nursing Facilities Charges

80% afterDeductible

60% afterDeductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible

Outpatient Facility Charges

80% afterDeductible

60% afterDeductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible

Independent Lab and X-rays 100% 60% after

Deductible80% after

Deductible50% after

Deductible60% after Deductible

40% afterDeductible

Chiropractic Benefits

80% afterDeductible$500 max.


80% afterDeductible$500 max




Ambulance 80% afterDeductible

80% afternetwork

Deductible

80% afterDeductible

80% afterDeductible

60% afterDeductible

60% after Deductible

Urgent Care (not outpatient hospital)

$25 or $40 co-pay based on place of

service


80% afterDeductible

50% afterDeductible

60% afterDeductible


Emergency Room Facility


Deductible


Deductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible

Emergency Room Professional

80% afterDeductible

60% afterDeductible

80% afterDeductible


60% afterDeductible

40% afterDeductible

PPO HDHP I HDHP IIIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Deductible $1,000 individual/ $3,000 family











$6,250 individual/ 12,500 family


Co-insurance 80% 60% 80% 50% 60% 40%










$25 co-pay$300 max. N/A 100%

$300 max. N/A 100%$300 max. N/A



Deductible


Deductible




















Deductible80% after

Deductible50% after


40% afterDeductible


80% after Deductible$500 max.


80% after Deductible$500 max




Ambulance 80% after Deductible

80% after network

Deductible







service








Deductible


Deductible













Prescription Drug Benefit

Your Share of the PremiumYour share of the premium is deducted from your earnings. You share this cost with Denny’s, which pays a majority of the medical insurance premium.

Preferred PPO HDHP I HDHP II

In-Network Out-of- Network In-Network Out-of-

Network In-Network Out-of- Network

RETAIL

Generic $1531-day supply N/A

80% after deductible




Preferred Brand $4031-day supply N/A





Non-Preferred Brand $7031-day supply N/A





MAIL ORDER (90-day supply)

Generic $25 N/A80% after deductible




Preferred Brand $90 N/A80% after deductible




Non-Preferred Brand $175 N/A80% after deductible




Specialty DrugMember Provider #: 1-800-237-2767.

$12531-day supply N/A


31-day supply


31-day supply


31-day supply


31-day supply

PPO HDHP I HDHP IIIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Deductible $1,000 individual/$3,000 family





$8,000individual/$16,000 family






$6,250 individual/12,500 family


Co-insurance 80% 60% 80% 50% 60% 40%



60% afterDeductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible



$25 co-pay$300 max. N/A 100%

$300 max. N/A 100%$300 max. N/A



Deductible


Deductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible


80% afterDeductible

60% afterDeductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible


80% afterDeductible

60% afterDeductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible


Deductible80% after

Deductible50% after


40% afterDeductible




80% afterDeductible$500 max




Ambulance 80% afterDeductible

80% afternetwork

Deductible

80% afterDeductible

80% afterDeductible

60% afterDeductible




service


80% afterDeductible

50% afterDeductible

60% afterDeductible




Deductible


Deductible

80% afterDeductible

50% afterDeductible

60% afterDeductible

40% afterDeductible


80% afterDeductible

60% afterDeductible

80% afterDeductible


60% afterDeductible

40% afterDeductible

Bi-Weekly Medical Premium Rates

Medical Plan PPO HDHP 1 HDHP 2

EmployeeContribution



Employee $80.46 $59.54 $41.98

Employee & Spouse $169.62 $138.00 $116.77

Employee & Child(ren) $153.63 $113.08 $98.77

Employee & Family $266.55 $166.15 $146.31

Contact: BCBS at www.southcarolinablues.com 1-800-760-9290 (M-F 8am-6pm ET)


Medical (Hawaii Residents Only)

KAISER HAWAII

BENEFIT MEMBER PAYS

Deductible None

Annual Supplemental Charges Maximum per Calendar Year $2,500/$7,500

Outpatient Services

Office visits $20 per visit

Routine obstetrical (maternity) care No charge

Inpatient Services

Hospital room and board, doctors' medical and surgical services, and anesthesia services

10% of applicable charges including observation & maternity stay

Laboratory, Imaging, and Testing Services

Inpatient lab, imaging, and testing See Inpatient Services Co-pay

Outpatient lab, imaging, and testing$10 per day OR

10% of applicable charges for: specialty lab tests, specialty imaging, specialty testing & radiation therapy

Mental Health Services

Outpatient office visits $20 per visit

Hospital inpatient care 10% of applicable charges

Day treatment or partial hospitalization services $20 per visit

Non-hospital residential services 10% of applicable charges

Chemical Dependency Services

Outpatient office visits $20 per visit

Hospital inpatient care 10% of applicable charges

Day treatment or partial hospitalization services $20 per visit

Non-hospital residential services 10% of applicable charges

Emergency Services (for initial treatment only)

Within the Hawaii service area $100 per visit

Outside the Hawaii service area $100 per visit

Ambulance Services 20% of applicable charges

Diabetes Equipment and Internal Prosthetics, Devices, and Aids

Diabetes equipment 50% of applicable charges

Internal prosthetics, devices, and aids No charge

External Prosthesis/Durable Medical Equipment (with additional hearing aid allowance; see rider for details) 20% of applicable charges

Contact: Kaiser at www.kp.org 1-800-966-5955 (M-F 8am-5pm and Sat 8am-12pm)


Medical (Hawaii Residents Only)

This Plan is a Health Maintenance Organization (HMO)This HMO provides access to the Kaiser Permanente network of physicians and other medical providers.

With an HMO, all care is coordinated through your primary care physician (PCP) – typically referred to as your family doctor. You pay a co-pay for all primary care and specialist visits. Other services require either a co-pay or small percentage of applicable charges.

You need a referral from your PCP to visit a specialist, receive tests and access any other type of service (except for emergency situations).

The HMO does not cover care outside the network, except for emergencies.

The plan will pay for emergency care if you are visiting outside the network’s region (for instance, if you’re on vacation).

Your Share of the Premium

Your share of the premium is deducted from your earnings. You share this cost with Denny’s, which pays a majority of the medical insurance premium.

Prescription Drug Coverage

Contact: Kaiser at www.kp.org 1-800-966-5955 (M-F 8am-5pm and Sat 8am-12pm)

Kaiser HMO

In-Network

RETAIL

Generic $5

Preferred Brand $10

Non-Preferred Brand $45

MAIL ORDER (90-DAY SUPPLY)

Generic $10

Preferred Brand $20

Non-Preferred Brand $90

Bi-Weekly Medical Premium Rates

Employee Contribution

Employee Only 1.5% of biweekly salary

Employee & Spouse $115.26

Employee & Child(ren) $109.50

Employee & Family $207.39


Dental

Delta Dental PPO Providers offer deep discounts from standard charges without charging amounts in excess of deductibles and plan maximums.

Delta Dental Premier Providers offer lesser discounts than PPOs but have the assurance of not charging amounts in excess of co-insurance, deductibles, and plan maximums.

Non-Network Providers are not contracted with Delta Dental. The benefit payment for services will be based on the amount charged by the majority of dentists. If the dentist’s fee is higher, you will be responsible for the balance.

Delta Dental$25 Deductible Plan $50 Deductible Plan

Delta Dental PPO & Premier

Non-Participating

Providers

Part-Time Employees

Delta Dental PPO & Premier

Non-Participating

Providers

Part-Time Employees

Contract Year Deductible $25 individual $25 individual $25 individual $50 individual $50 individual $50 individual

Annual Maximum $1,500 $1,500 $1,500 $750 $750 $750

Preventive Services 100% 100%100% Benefits

available immediately

100% 100%100% Benefits

available immediately

Basic Services 80% 80%

80% Benefits available after 6 months on the

plan

80% 80%


plan

Major Services 50% 50%


plan

N/A N/A N/A

Orthodontia **Part-time employees must be enrolled for 12 months before becoming eligible for the Orthodontia Benefit

50% up to $2,000 lifetime maximum, no

deductible

50% up to $2,000 lifetime maximum, no

deductible

50% up to $2,000 lifetime maximum, no deductible**

N/A N/A N/A

Preventive Services Exams, bitewing x-rays, full mouth x-rays (once every three years), cleanings, topical fluoride (dependent children under 19 years of age), space maintainers (under the age of 19 – once per benefit period), sealants for dependent children under age 19 (once every five years), and emergency palliative treatment

Basic ServicesFillings, non-surgical periodontics, surgical periodontics, endodontics, simple extractions, surgical extractions, general anesthesia, and oral surgery

Major ServicesBridge and dentures (once every five years), crowns, and inlays and onlays (once every five years)

Contact: Delta Dental at www.deltadentalsc.com 1-800-335-8266 (M-F 8am-6pm ET)

While our dental plan design remains the same for 2016, our provider network has expanded, helping you save on out-of-pocket dental costs. Both plan options pay a percentage of covered charges. The share you pay is determined by the plan you choose. The plan will not pay charges above reasonable and customary (R&C). The plan continues paying a percentage of your covered services until you reach the calendar year maximum for benefits for the plan year, January 1, 2016 through December 31, 2016.

About Delta Dental Networks

Bi-Weekly Rates (per pay period)$25

Deductible Plan

$50 Deductible

Plan

Employee Only $18.22 $10.09

Employee & Spouse $37.25 $20.65

Employee & Child(ren) $40.54 $20.49

Employee & Family $63.90 $32.93


Vision

Contact: VSP at www.VSP.com 1-800-877-7195 (M-F 8am- 11pm ET, Sat 9am-8pm ET)

VSP CHOICE PLAN

Provider NetworkVSP Network 27,000 providers 46,000 access points

Frequency Exam every 12 months Lenses every 12 months Frame every 24 months

Co-pay $10 Exam and $10 Materials

WellVision Exam Comprehensive WellVision Exam covered in full

Contact Lens Exam (fitting and evaluation) Standard fit & Premium fit: Covered in full after co-pay. Member receives 15% off of contact lens exam services; Member’s co-pay will never exceed $60.

Lenses

Lens Options

Frames

Glass or plastic, single vision, lined bifocal, lined trifocal, or lenticular prescription lenses are covered in full (less any applicable co-pay).

Guaranteed pricing on all lens options, saving our members an average of 20-25%.

Dependent children are eligible for covered in full polycarbonate prescription lenses.

Frames are covered in full (less any applicable co-pay) up to the retail allowance of $150.

20% off any amount above the allowance.

Frame allowance backed by a wholesale guarantee, meaning VSP fully covers more frames compared to retail allowance plans.

Contact Lenses 15% off contact lens services, not materials.

Instead of eyeglasses, elective contact lens material are covered up to $150 toward any prescription contact lenses.

Necessary contact lenses are covered in full (less any applicable co-pay) for specific conditions for which contact lenses provide better visual correction.

Diabetic Eyecare ProgramProvides additional coverage through medical diagnosis and procedure codes specifically targeted toward Type 1 and 2 diabetics - Co-pay $20.

Eye Health Management Program

Includes member materials, care from VSP providers, and data that supports your wellness initiatives.

Laser VisionCare Program

Discounts only available from VSP contracted facilities

Discounts averaging 15-20% off or 5% off a promotional offer for laser surgery including PRK, LASIK, and Custom LASIK (Using wavefront technology with the microketatome surgical device only).

Value-added Benefits 20% off unlimited additional pairs of prescription glasses and/or non-prescription sunglasses.

OPEN ACCESS REIMBURSEMENT SCHEDULE

Eye Exam $45

Single Vision Lined Bifocal Lined Trifocal

Lenticular Progressive

Frames

$30 $50 $65 $100

$50

$70

Elective ContactNecessary Contact

$105

$210

Bi-Weekly Vision Rates

Employee $3.55

Employee & Spouse $5.14

Employee & Child(ren) $6.19

Employee & Family $9.90


Health Savings Account (HSA)

Denny’s has teamed up with HSA Bank to create an affordable health coverage option that helps you save on healthcare expenses while protecting your health and finances. It combines a high-deductible health plan from your insurance provider with a tax-advantage health savings account (HSA). Together, they offer you health, savings, and tax advantages that a traditional plan cannot duplicate.

Your HSA can be used to pay for eligible medical expenses such as:

• deductibles / co-insurance• prescriptions• dental and vision care• premiums for COBRA

Some of the Advantages Include:• Funds roll over year after year. There’s no “use it or

lose it” philosophy.

• Your HSA is portable – the funds follow you if youleave your employer or change health insurance.

• The account has the potential to build more savingsthrough investing. You may choose a variety of HSAself-directed investment options.

• After age 65, funds can be withdrawn for any purpose without penalty.

• The maximum contribution for 2016 =Single $3,350; Family $6,750.

• If over age 55, you can do a catch-up contributionnot to exceed $1,000.

Contact: HSA Bank at www.hsabank.com 1-800-357-6246 (M-F 7am-9pm CT)

MEDICAL EXPENSES HDHP WITH HSA PLAN TRADITIONAL PLAN $4,000 Annual Deductible $1,500 Annual Deductible

8 Doctor Visits $568 $200

4 Preventive Care Visits $0 $0

2 Urgent Care Visits $254 $150

1 Outpatient Surgery (Ear Tube Placement) $903 $903

Total Medical Expenses $1,725 $1,253

COST COMPARISONEmployee’s Annual Premium $3,076 $4,072

Total Medical Expenses $1,725 $1,253

Federal Tax Savings -$259 $0

Social Security and Medicare (FICA) Tax Savings -$132 $0

State Tax Savings -$69 $0

Out-of-Pocket Expenses $4,341 $5,325

SAVINGS WITH AN HDHP/HSA PLAN $984

Compare and See the HSA Advantage!Annually, this typical family of four will face these medical expenses:

You can use the savings to fund your HSA account


WORD TO THE WISE...USE IT OR LOSE IT.Remember to calculate your expenses conservatively when making FSA elections. IRS regulations require that you forfeit any money left in your account after the claims submission deadline.

Flexible Spending Account (FSA)

REMEMBER... • Keep all of your receipts.• You might be required to submit receipts to verify expense eligibility.• The card is only valid at eligible merchants.• The card can be used up to the amount available in your account up to a daily maximum limit of $2,000.• Transactions over the available amount will be denied.• You have 24/7 access to account information at www.myrsc.com.

Contact: Benefit Coordinators at www.myrsc.com or 1-800-951-1012

Flexible spending accounts (FSAs) enable you to put aside money for important expenses and help you reduce your income taxes at the same time. Denny’s offers two types of flexible spending accounts — a healthcare flexible spending account and a dependent care flexible spending account.* These accounts allow you to set aside pre-tax dollars to pay for certain out-of-pocket healthcare or dependent care expenses.

1. Each year, during the annual enrollment period, or as a new employee, you decide how much to set aside for healthcareand/or dependent care expenses.

2. Your contributions are deducted from your paycheck on a before-tax basis in equal installments throughout the calendaryear.

3. You will receive a MasterCard debit card that you will use to pay for eligible expenses.

4. Your mySourceCard operates through programmed merchant codes that include doctors, hospitals, dentists/orthodontists,vision providers, pharmacies, and more.

5. Simply present your mySourceCard when paying for eligible expenses, and the funds will be paid directly from yourreimbursement account. The available credit on your card will be the available balance in your account up to a dailymaximum amount of $5,000.

6. The mySourceCard works just like any other debit card; but, there are five major differences:

• Limited to specific merchants deemed eligible by your plan

• Limited to expenses deemed eligible by your plan

• Card cannot be used at the ATM

• Card will not allow “cash back” with a purchase

• There is no PIN

*Please note that these accounts are separate — you may choose to participate in one, both, or neither. You cannot use money from thehealthcare FSA to cover expenses eligible under the dependent care FSA or vice versa.

Plan Annual Maximum Contribution Examples of Covered Expenses

Healthcare Flexible Spending Account $2,550 Co-pays, deductibles, orthodontia, prescription medications, etc.

Dependent Care Flexible Spending Account$5,000 ($2,500 if married and filing separate tax returns)

Daycare, nursery school, elder care expenses, etc.


Life Insurance Options

Contact: Prudential at www.prudential.com/mybenefits 1-800-524-0542

Basic Life InsuranceDenny’s provides Basic Life Insurance coverage equal to $5,000.

Supplemental Life InsuranceDenny’s also offers supplemental life insurance for yourself and your dependents.

SUPPLEMENTAL COVERAGE FOR: COVERAGE AMOUNTS AVAILABLE

You Additional $5,000, $10,000 or $15,000

Spouse and Dependent Children $5,000 or $10,000

Voluntary Accidental Death and Dismemberment (AD&D)

FAMILY MEMBER BENEFIT EQUAL TO A % OF YOUR COVERAGE AMOUNT

Spouse 60% of your coverage

Spouse and children 50% of your coverage for spouse plus 15% for each child

Children only 20% of your coverage for each child

Voluntary Accidental Death and Dismemberment (AD&D) coverage pays benefits upon death or a specified physical loss caused by an accident, such as the loss of hands, feet, sight, speech or hearing. This plan provides coverage for accidents occurring on or off the job, in or away from the home, or while traveling.

You can choose coverage for yourself only, in one of the following amounts: $10,000; $20,000; $30,000; $40,000; $50,000.

You can also choose coverage for you and your family. When you choose family coverage, your spouse and eligible dependent children are automatically covered and receive a percentage of your coverage amount.

The benefit you, or your family members, receive is based on the amount of coverage you choose and your family make-up at the time of the accident, as illustrated below.


Travel Insurance

Contact: On Call International in the US at 1-800-565-9320/Worldwide 1-312-935-3654

You now have access to the AXA Travel Assistance Program, an essential service provided by AXA Assistance USA, Inc. This service offers you and your dependents medical and travel assistance services, 24 hours a day, 365 days a year. Participants have access to assistance services when faced with an emergency while traveling internationally, or domestically when more than 100 miles away from home; you and your dependents are eligible to access these services for up to 120 consecutive days for any given trip.* With one single phone call to (800) 565-9320 within the U.S. and +1 (312) 935-3654 outside the U.S. (collect), you and your dependents (whether traveling together or separately) will haveimmediate access to a broad range of travel assistance services.

Through this program, you will be connected to a global network of:• Over 600,000 service providers• Air and ground ambulance services• Trained multilingual personnel who can assist you quickly and professionally in a travel emergency

MEDICAL SERVICES

Medical and Dental ReferralsWith a worldwide network of providers at our fingertips, this service is able to offer you referrals to primary care physicians, dentists, clinics and hospitals.

Coordinate Hospital AdmissionThis service will assist with pre-certification for admission and elective outpatient surgical intervention. In the event that a hospital does not recognize your medical insurance, we will assist in guaranteeing hospital admission for you or your dependents by validating your health coverage and/or assisting with arrangements to advance funds.

Critical Care MonitoringDuring your hospitalization, our medical professionals will remain in regular communication with the treating facility to monitor your care.

Emergency Medical EvacuationWhenever adequate medical facilities are not available locally, our medical professionals will recommend and arrange the appropriate method of transportation, equipment and personnel to evacuate you to the nearest facility capable of providing proper care.

Medical RepatriationIf you need medical assistance to return home, our medical professionals will determine the appropriate transportation method and assist with all necessary travel arrangements based upon your medical condition.

Transportation to Join PatientIf you are traveling alone and expected to be hospitalized for more than seven days, this service will provide round-trip common carrier transportation to the place of hospitalization for a designated family member or companion.

Return of Dependent ChildrenIf a minor child is left unattended as a result of an accident or illness, this service will provide assistance with arranging transportation, with attendants if required, to return home.

Return of Mortal RemainsThis service will arrange the transportation, and offer reasonable assistance in legal formalities, for the return of mortal remains.

Vehicle Return ServicesIn the event that you need to be medically repatriated or evacuated to your home, this service will coordinate and manage all arrangements needed for the return of your unattended vehicle.

Escort ServicesIn the event that you need to be medically repatriated or evacuated, this service will arrange for a family member or companion who is traveling with you, to escort you to your destination.

Transportation of Travel CompanionIf you need to be evacuated or repatriated, this service will coordinate all arrangements for a family member or companion to join you. If our medical professionals cannot adequately assess the need for medical transport or evacuation, we will dispatch a physician to your location to make an assessment.

Dispatch of Prescription MedicationIf you forget or lose a prescribed medication, this service will assist with replacement medication. If the medication is not available locally, we will coordinate the dispatch of prescription medication, when possible and legally permissible, or provide you with an appointment with a physician in order to re-establish the prescription. This service is also available for medical devices, eye glasses and contact lenses.


Travel Insurance

* Applicable laws or policy terms may limit available coverage and benefits.Travel assistance services are independently offered and administered byAXA Assistance USA, Inc. (AXA). Insurance benefits for the program are

underwritten by a third party licensed insurance company.

Contact: On Call International in the US at 1-800-565-9320/Worldwide 1-312-935-3654

TRAVEL SERVICES Lost Document and Lost Article AssistanceThis service will assist with arrangements to replace or forward copies of lost or stolen documents, including passports, driver’s licenses and credit cards, as well as assist with procedures to file loss reports and to recover lost or stolen articles such as luggage.

Pet Housing and ReturnThis service can assist with pet-friendly hotel accommodations, boarding facilities and travel home for pets.

Emergency Cash and Bail AssistanceIf your wallet is stolen, this service can help arrange an emergency cash advance. This service can also provide assistance in obtaining bail bonds, where available.

Legal ReferralsThis service will provide referrals to an interpreter or legal personnel to you as necessary.

Arrangement for Political EvacuationThis service can arrange for the repatriation on political grounds for all covered travelers located in countries when their home country government calls for evacuation.

Urgent Message RelayThis service will relay emergency messages on the member’s behalf.

Online General Travel InformationBefore you travel, this service can provide information about visa, passport, immunization requirements and local customs. You can also obtain 24-hour pre-departure information on weather, currency or holidays. This service can be provided 24/7 over the phone by our Assistance Coordinators and also through an online tool.

HOW TO ACCESS SERVICESNext time you or your family members are traveling and need assistance, remember to use the phone number on the back of your Travel Assistance ID card. Be sure to carry the card with you at all times. One simple phone call to the Response Center puts you in touch with trained staff that will ensure your call is handled in an appropriate and timely fashion.

EXCLUSIONSTravel Assistance Services will not be provided or available for any loss or injury that is caused by, or results from:

• Suicide, attempted suicide or any intentionally self-inflictedinjury while sane or insane (in Missouri, sane only).

• Act of declared or undeclared war (political evacuation notsubject to this exclusion.)

• Participating in, or practicing for, professional sports.

• Piloting or learning to pilot or acting as a member of the crew

of any aircraft.

• The commission of or attempt to commit a felony by theInsured Person or the Insured Person’s being engaged in anillegal occupation as a contributory cause.

• Normal childbirth, normal pregnancy (except Complications ofPregnancy) or voluntary induced abortion.

• Mental or nervous condition, unless hospitalized.

• Participating in maneuvers or training exercises of an armedservice, except while participating in weekend or summertraining for the reserve forces of the United States, includingthe National Guard.

NOTEThe maximum benefit per person for costs associated with medical evacuations, repatriations or the return of mortal remains is $150,000 USD per occurrence. All additional costs associated with these or other medical and travel services will be the responsibility of the member.

Contact your primary health insurance carrier for considerationof coverage for medical expenses.

Additional travel assistance services will be provided by AXA Assistance USA, Inc. at no extra cost. AXA Assistance USA, Inc. is not responsible for third party costs associated with these services. Please remember that the Response Center needs to be contacted to activate these services.

Treatment must be authorized and arranged by AXA’s designated personnel to be eligible for services under this program. All services must be provided by or coordinated through AXA Assistance USA, Inc. No claims for reimbursement will be accepted.

For your convenience, please cut out the card below and always carry it with you while traveling.


401(k) Plan Highlights

When can I enroll?You must be 21 years of age and have 6 months of service with the employer. Plan entry dates are the first day of any payroll period.The following employees are not eligible to join this plan:

• Employees covered by a collective bargaining agreement• Non-resident aliens• Leased employees• Employees whose basic compensation is not paid by Denny’s.

How much can I contribute to my 401(k) account?

You may contribute to your account with pre-tax and/or Roth contributions. Together, both contribution types are subject to the annual dollar limit on deferrals. You may contribute from 1% to 25% up to the IRS limit of $18,000 for 2016.

If you are age 50 or over by the end of the calendar year, you may qualify to make additional pre-tax or “catch-up” deferrals of up to $6,000 in 2016.

When can I change or stop my contributions?

You may change or stop your plan contributions anytime.

Does Denny’s make any contributions?

Effective 2016, Denny’s will make a safe harbor matching contribution for participants equal to 100% (on a dollar-for-dollar basis) of the first 3% of the pretax or Roth 401(k) contributions that you defer from your eligible compensation plus 50% (50¢ for each $1) of the next 2% deferred from your eligible compensation for the plan year. You can receive matching contributions in accordance with the following table:

Prior to 2016 certain employees previously were excluded from receiving a matching contribution under the plan in order for the plan to meet certain IRS compliance requirements. Effective 2016, the plan will provide safe harbor matching contributions. All employees who are eligible to make deferrals to the plan also are eligible for the safe harbor matching contributions.

Vesting. What does this mean to my 401(k) account?

“Vested” means you have ownership rights to a certain percentage of the amounts in your plan accounts. You are always 100% vested in your pretax 401(k) and Roth 401(k) contributions accounts, and you are always 100% vested in your safe harbor matching contributions account. The employer does not currently make any other types of contributions to the plan. If any other contributions are made, they generally will be 100% after your third complete year of service.

Can I roll over money into my 401(k) account?

You may roll over money into your account from the following sources:• 403(b) plans• 457 plans• Other qualified plans

See your Summary Plan Description or Plan Administrator for rollover details.

How do I enroll and/or obtain information about my account?

You may enroll in the plan or access your account via the Internet at wellsfargo.com or the Wells Fargo Retirement Service Center at 1-800-728-3123 (toll-free nationwide). For Spanish press option 2. Once you enroll in the plan, you will receive quarterly account statements.

May I borrow money from my account?

You may borrow up to $50,000 or 50% of your vested balance, whichever is less. The minimum loan amount is $1,000. You may be charged a loan set-up fee of $50. You may have one loan outstanding at a time. Residential loans are not allowed. For more information on plan loans, including other loan requirements and the current interest rate, call the Wells Fargo Retirement Service Center at 1-800-728- 3123 (toll-free nationwide). For Spanish press option 2.

To request more information or an enrollment kit, contact the Wells Fargo Retirement Service Center at 1-800-728-3123. Retirement Service Center representatives are available Monday through Friday from 6

a.m. to 10 p.m. Central Time.

PARTICIPANT DEFERRAL

COMPANY MATCH

1% 1%

2% 2%

3% 3%

4% 3.5%

5% or more 4%


Medicare NoticeApplies to drug plans through your medical insurance carrier

IMPORTANT NOTICE FROM DENNY’S INC. ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Denny’s Inc. medical plan 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. If you are considering joining, 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. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coveragebecame available in 2006 to everyonewith Medicare. You can get thiscoverage if you join a MedicarePrescription Drug Plan or join aMedicare Advantage Plan (like an HMOor PPO) that offers prescription drugcoverage. All Medicare drug plansprovide at least a standard level ofcoverage set by Medicare. Some plansmay also offer more coverage for ahigher monthly premium.

2. Denny’s Inc. has determined that theprescription drug coverage offeredby our Health Plan is, on average forall plan participants, expected to payout as much as standard Medicareprescription drug coverage pays andis therefore considered CreditableCoverage. Because your existingcoverage is Creditable Coverage, youcan keep this coverage and not pay ahigher premium (a penalty) if you laterdecide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current Denny’s Inc. coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current Denny’s, Inc. coverage, be aware that you and your dependents will be able to get this coverage back if you re-enroll in the employer plan at annual enrollment or if you have a special enrollment event for the Denny’s, Inc. group insurance plan.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Denny’s, Inc. and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

Summary of Options for Medicare Eligible Employees (and/ or Dependents)

Medical and prescription drug coverage are offered as a package under the Denny’s Inc. plan (you cannot elect medical coverage without prescription drug coverage).

1. Continue medical and prescription drug coverage under the Denny’s Inc. Planand do not elect Medicare D coverage.Impact – your claims continue to bepaid by the Denny’s Inc. plan.

2. Continue medical and prescriptiondrug coverage under the Denny’s Inc.plan and elect Medicare D coverage.Impact - As an active employee (ordependent of an active employee)the Denny’s Inc. plan continues to payprimary on your claims (pays beforeMedicare D).

3. Drop the Denny’s Inc. plan coverageand elect Medicare Part D coverage.Impact – Medicare is your primarycoverage. You will not be able to rejointhe Denny’s Inc. plan until the nextopen enrollment period unless youexperience a qualified life event.

For More Information About This Notice Or Your Current Prescription Drug Coverage Contact…

Denny’s Employee Benefits Department 203 East Main Street Spartanburg, SC 29319 1-800-859-2244

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 Denny’s Inc. prescription plan changes. You also may request a copy of this notice at any time.

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 prescription drug plans.

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov

• Call your State Health InsuranceAssistance Program (see the insideback cover of your copy of the“Medicare & You” handbook for theirtelephone number) for personalizedhelp.

• 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 this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

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 whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Creditable Coverage October 2015


DENNY’S INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTSLoss of Other Coverage- If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. You will be required to submit a signed statement that this other coverage is the reason for waiving enrollment originally. To be eligible for this special enrollment opportunity you must request enrollment within 30 days after your other coverage ends or after the employer stops contributing towards the other coverage.

New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption- If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Medicaid Coverage- Denny’s group health plan will allow an employee or dependent who is eligible, but not enrolled for coverage, to enroll for coverage if either of the following events occur:

1. TERMINATION OF MEDICAID OR CHIP COVERAGE- If theemployee or dependent is covered under a Medicaid plan or undera State child health plan (SCHIP) and coverage of the employeeor dependent under such a plan is terminated as a result of loss ofeligibility.

2. ELIGIBILITY FOR PREMIUM ASSISTANCE UNDER MEDICAID ORCHIP- If the employee or dependent becomes eligible for premiumassistance under Medicaid or SCHIP, including under any waiveror demonstration project conducted under or in relation to sucha plan. This is usually a program where the state assists employedindividuals with premium payment assistance for their employer’sgroup health plan rather than direct enrollment in a state Medicaidprogram.

To be eligible for this special enrollment opportunity you must request coverage under the group health plan within 60 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP or the date you or your dependent’s Medicaid or state-sponsored CHIP coverage ends.

To request special enrollment or obtain more information, please contact the Employee Benefits Department at 1-800-859-2244.

PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

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

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

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

ALABAMA – Medicaid Website: www.myalhipp.com Phone: 1-855-692-5447

ALASKA – Medicaid Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529ARIZONA – CHIP Website: http://www.azahcccs.gov/applicants/default.aspx Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437

FLORIDA – Medicaid Website: https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268

COLORADO – Medicaid Medicaid Website: http://www.colorado.gov/hcpf Medicaid Customer Contact Center: 1-800-221-3943

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

IOWA – Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562

INDIANA – Medicaid Website: http://www.in.gov/fssa Phone: 1-800-889-9949

KANSAS – Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884

KENTUCKY – Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570

LOUISIANA – Medicaid Website:http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447

MAINE – Medicaid Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741

Important Notices


MASSACHUSETTS – Medicaid and CHIP Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120

MINNESOTA – Medicaid Website: http://www.dhs.state.mn.us/id_006254 Click on Health Care, then Medical Assistance Phone: 1-800-657-3739

MISSOURI – Medicaid Website:http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

MONTANA- Medicaid Website: http://medicaid.mt.gov/member Phone: 1-800-694-3084

NEBRASKA – Medicaid Website: www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633

NEVADA – Medicaid Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900

NEW HAMPSHIRE – Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218

NEW JERSEY – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

NEW YORK – Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831

NORTH CAROLINA – Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100

NORTH DAKOTA – Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-800-755-2604

OKLAHOMA – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

OREGON – Medicaid Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075

PENNSYLVANIA – Medicaid Website: http://www.dhs.state.pa.us/hipp Phone: 1-800-692-7462

RHODE ISLAND – Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300

SOUTH CAROLINA – Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA- Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059

TEXAS – Medicaid Website: http://gethipptexas.com/ Phone: 1-800-440-0493

UTAH – Medicaid and CHIP Website: Medicaid: http://health.utah.gov/medicaid CHIP: http://health.utah.gov/chip Phone: 1-866-435-7414

VERMONT– Medicaid Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

VIRGINIA – Medicaid and CHIP Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282

WASHINGTON – Medicaid Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx Phone: 1-800-562-3022 ext. 15473

WEST VIRGINIA – Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx Phone: 1-877-598-5820, HMS Third Party Liability

WISCONSIN – Medicaid and CHIP Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

WYOMING – Medicaid Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

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

U.S. Department of Labor Employee Benefits Security Administration http://www.dol.gov/ebsa/ 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services https://www.cms.gov/ 1-877-267-2323, Menu Option 4, Ext. 61565

HIPAA PRIVACY NOTICEProtecting Your Health Information Privacy Rights

The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. Please contact your medical plan carrier to request a copy of the Notice.

NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT (NMHPA)Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and insurers may not, under Federal law, require that a provider obtain authorization from the plan or the insurer for prescribing a length of stay not more than 48 hours (or 96 hours).

Important Notices


NOTICE REGARDING THE WOMEN’S HEALTH AND CANCER RIGHTS ACT

On October 21, 1998, Congress passed a bill called the Women’s Health and Cancer Rights Act. This new law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services.

These services include:•Reconstruction of the breast upon which the mastectomy has been performed,•Surgery/reconstruction of the other breast to produce a symmetrical appearance,•Prostheses, and•Treatment of physical complications during all stages of mastectomy, including lymphedemas.

In addition, the plan may not:• Interfere with a woman’s rights under the plan to avoid these requirements, or• Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the

requirements of the law.

However, the plan may apply deductibles and co-pays consistent with other coverage provided by the plan.

If you have any questions about the current plan coverage, please contact the Employee Benefits Department at 1-800-859-2244.

REPORT ELIGIBILITY CHANGES IN A TIMELY MANNER

It is your responsibility to notify the Benefits Department when a dependent becomes eligible or ceases to be eligible for coverage under our benefit plans. All eligibility changes should be reported within 30 days of the event. Failure to report changes in a timely manner can impact your ability to add newly eligible dependents or discontinue pre-tax premium contributions on ineligible dependents.

In addition, failure to report a loss of eligibility due to legal separation or divorce or a dependent that has otherwise ceased to be eligible, such as a child reaching the maximum dependent child age limit, can impact your dependent’s rights for group health plan coverage under the federal law known as COBRA. If you fail to report the loss of eligibility within 60 days of the event, your dependents may be left with no continuation coverage under our plan. Please see your COBRA notice or your group health plan summary plan description for additional information.

The information contained in this summary should in no way be construed as a promise or guarantee of employment or benefits. The company reserves the right to modify, amend, suspend, or terminate any plan at any time for any reason. If there is a conflict between the information in this brochure and the actual plan documents or policies, the documents or policies will always govern. Complete details about the benefits can be obtained by reviewing current plan descriptions, contracts, certificates, policies and plan documents available from Human Resources.

Important Notices


Rallysm can help you get healthier, one small step at a time.We’ll show you how to make simple changes to your dailyroutine, set smart goals for yourself, and stay on target. You’ll getpersonalized recommendations to get you moving more, eatingbetter, feeling happier — and you’ll have fun doing it.

Start with our quick Health Survey. We’ll tell you your Rally Age, ameasure of your overall health, and recommend Missions for you— simple activities designed to immediately improve your diet, yourfitness, and your mood. Start easy, and level up when you’re ready.

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Rally is a product of Rally Health Inc., an independent company that offers a health management program on behalf of yourhealth plan. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.Rally Health, Inc.™ © 2015. All Rights Reserved.

A service for members of

WHAT IS RALLY?RallyTM can help you get healthier, one step at a time! With Rally we will show you how to make simple changes to your daily routine, set smart goals for yourself, and stay on target for better health. You’ll get personalized recommendations to get you moving more, eating better, feeling happier, and guess what? You’ll have fun doing it!

HOW DOES IT WORK?Start by taking the quick Health Survey. The results will tell you your Rally Age, a measure of your overall health, and recommend Missions for you - simple activities design to immediately improve your diet, your fitness, and your mood. Start easy, and then level up when you’re ready!

Plus, on Rally there are lots of ways to earn Rally Coins, which you can use for a chance to win awesome rewards! Rack up coins for joining Missions, pushing yourself in a Challenge - even for something simple like logging in every day! BCBS of SC aims to bring health and wellness to the masses, and Rally is a fun way to get started!

GET STARTED!It’s time to Rally. Register now at Go.WeRally.com

Rally is a product of Rally Health Inc., an independent company that offers a health management program on behalf of your health plan. BlueCross BlueShield of South Carolina is an independent license of the Blue Cross and Blue Shield Association. Rally Health, Inc.TM ©2015 All Rights Reserved.

Rally Program

This guide is a quick reference to help answer most of your questions.

Voluntary Worksite Benefits

25 25This guide is a quick reference to help answer most of your questions.

AFLAC AND TRANSAMERICA VOLUNTARY BENEFITSThe following benefits are offered to you by Aflac and TransAmerica. Choosing to elect coverage is completely voluntary. You will decide which benefits, if any, are suitable to your situation. Denny’s, Inc. does not sponsor or endorse these benefits, contribute to the cost of coverage or profit as a result of offering these benefits to you. Our sole functions as they relate to these voluntary benefits are limited to permitting Aflac and TransAmerica to publicize the benefits to you, collecting premiums through after-tax payroll deductions and remitting those premiums to Aflac and TransAmerica. Denny’s, Inc. is not responsible for ensuring the accuracy or completeness of the information provided to you by Aflac and TransAmerica. If you have questions or concerns about any of these benefits or how a claim is handled, youwill need to contact Aflac and TransAmerica directly.

Denny’s is still offering three new voluntary benefits, including policies for accidents and critical illness through Aflac and a whole life insurance policy through TransAmerica. Because they are voluntary, you pay the full cost of the premiums through convenient payroll deductions. These benefits are individually owned and portable, which means you can take your policy with you if you retire or leave the company, with certain stipulations

Group Accident InsuranceContact: Aflac at www.aflacgroupinsurance.com or 1-800-433-3036Voluntary accident insurance provides benefits for covered injuries and specified accident-related expenses for an individual or family. Since health insurance only covers certain expenses (and plan limits can apply), this plan is designed to help cover the out-of-pocket expenses that result from a covered accident.

• This is a voluntary benefit. You pay the full cost of the premium.

• The benefit amount is determined by the type of injury and its severity.

• All benefits are paid directly to you, unless you choose otherwise.

Plan Features:• Benefits are paid for accidents that occur on or off the job, so you have 24-hour coverage.

• You can also elect to cover your spouse and children.

• There are no health questions or physical exams required.

• Benefits are payable regardless of any other insurance programs.

• Coverage is guaranteed-issue, provided the applicant is eligible for coverage.

• The plan features benefits for both in-patient and out-patient treatment of covered accidents.

• Benefits are available for spouses and/or dependent children.

• There’s no limit on the number of claims an insured can file.

• Premiums are paid by convenient payroll deduction.

• Coverage is effective on the first of the month following the enrollment form approval date, provided payrolldeductions begin during that month.

Group Critical Illness InsuranceContact: Aflac at www.aflacgroupinsurance.com or 1-800-433-3036The out-of-pocket costs of a serious illness can be severe, even if you have medical insurance.

Critical illness insurance pays a lump sum benefit directly to you (unless otherwise assigned) if you are diagnosed with a covered condition. You use this money however you choose: help cover expenses your family incurs to be by your side, help replace lost earnings from being out of work, or to help cover deductibles and co-insurance.

You choose a benefit amount when you enroll. You can choose a benefit amount between $5,000 and $30,000 in increments of $5,000. Your premium will be determined by the benefit amount you choose, your age and tobacco status.

Covered Illnesses Include:• Heart Attack • End Stage Renal (Kidney) Failure

• Stroke • Coronary Artery Bypass Surgery *

• Major Organ Transplant • Cancer and Carcinoma in Situ *


Critical Illness Insurance Plan Features:• Lump-sum benefits paid directly to the insured (unless otherwise assigned) following the diagnosis of each

covered critical illness.

• Payroll deduction – premiums are paid through convenient payroll deduction.

• Guaranteed-Issue coverage is available

• Spouse coverage is available.

• Each dependent child is covered at 50% of the primary insured amount at no additional charge.

• Annual health screening benefits are included.

• The plan is portable with certain stipulations.

• Level premium rates are based upon the applicant’s age at the time of application. Rates cannot be individuallyincreased on a particular insured due to a change in age, health or individual claim.

• Immediate effective date – coverage will be effective the date the employee signs the application.

The benefits counselor will provide plan details and rates during your enrollment session. Rates will vary depending on your age, tobacco use, and the amount of coverage you elect.

*Carcinoma in Situ and Coronary Artery Bypass Surgery benefits are paid at 25% of the chosen benefit amount. Payment of the Carcinoma in Situ benefit will reduce the benefit for cancer 25%. Payment of the Coronary Artery Bypass Surgery benefit will reduce the benefit for a heart attack by 25%.

This is a brief product overview only. The plan has limitations and exclusions that effective benefits payable. Please refer to the plan for complete limitations and exclusions.

Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands.

Continental American Insurance Company • 2801 Devine Street • Columbia, South Carolina 29205 AGC1500236 IV (9/15)

Whole Life InsuranceContact: Transamerica at www.transamericaemployeebenefits.com or 1-888-763-7474Whole life insurance is designed to provide a death benefit to your beneficiaries if you pass away, but it can also build cash value that you can use while you are still alive. At an affordable premium, you can have the added financial protection you and your family may need during times of uncertainty.

• You have the ability to purchase whole life insurance for yourself, your spouse, your children and/or grandchildren.

• Whole life insurance is voluntary, which means you purchase the amount of coverage that best fits your needs.

• No physical exams are required to apply for coverage (although health questions may be asked).

• Benefits are in addition to any other life insurance benefits you may receive.

• You pay for the coverage through convenient payroll deductions.

• Level premiums never change.

• Guaranteed interest rate at 4%.

The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations that may affect any benefits payable.

You can receive detailed information on the plan and costs during your enrollment session. Your enrollment counselor can help you calculate the cost of the benefit, which will vary depending upon your age, the amount of coverage you elect, the amount of dependent coverage you choose, and other such factors.



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2016 employee benefits guide · 2015-10-25 · this guide is a quick reference to help answer most...

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