welcome to your 2013 enova benefits...
TRANSCRIPT
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Welcome to your 2013 Enova Benefits Plan! As many Enova Associates know, US health care topics are taking a front row seat on Capitol Hill and in the media. New legislation places a significant financial burden on you as individuals and on Enova. Our Associates are our greatest asset so, beginning July 1st, we immediately began monitoring the performance of the plans adopted from Cash America. Many changes and improvements in our 2013 plans have been made to best balance cost and coverage, many of which are due to your feedback on what is important to you. Enova is committed to taking proactive steps each year to continue to provide Associates with access to quality health care, while maintaining a reasonable cost structure. I am pleased to announce in 2013, we will begin offering dependent health care benefits for same-sex domestic partners and their children. Associates may also select a new value-based medical plan where enrolled Associates will have access to a Health Reimbursement Arrangement funded by Enova. Depending on the coverage elected, $500 or $1,000 will be available to be used for qualified services and unused balances may be rolled over each year. You’ll also see other new benefits like in vitro fertilization, hearing aid coverage, speech therapy for dependents, removal of the prescription coverage annual deductible and expanded access to vision services through VSP’s new retail network. Cost of medical coverage is a critical piece of the puzzle. Many of your friends and colleagues around Chicago will experience increases between 7%-10% to their medical costs in 2013. Your healthy lifestyle choices and careful planning have allowed Enova to offer enhanced medical coverage at no additional cost for the 2013 plan year. This means that your medical per-pay premiums will not be going up from 2012 to 2013, which is truly a win for Enova Associate’s considering today’s insurance trends. Both the Ceridian and Enova benefits teams are available to help you make your 2013 elections and support you throughout the year when needs arise, so you may be well, be healthy and be your best.
Ron Torrance Benefits Manager
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TABLE OF CONTENTS
ENOVA VISION, MISSION AND VALUES ........................................................................................................ 5
CONTACT INFORMATION ............................................................................................................................. 6
I. The Enova Benefits and Payroll Contact Center .......................................................................................................... 6
II. The Enova Benefits Department ................................................................................................................................. 6
III. Benefit Carrier Contacts .............................................................................................................................................. 7
I.D. CARDS ................................................................................................................................................... 9
A CLOSER LOOK AT HEALTHCARE REFORM ................................................................................................. 10
TIMELINE SUMMARY OF BENEFITS ELIGIBILITY FOR NEW HIRES ................................................................. 11
ELIGIBILITY FOR BENEFITS .......................................................................................................................... 12
EFFECTIVE DATE OF BENEFITS .................................................................................................................... 12
LIFE EVENTS ............................................................................................................................................... 13
IRC SECTION 125 ........................................................................................................................................ 13
CIGNA MEDICAL COVERAGE ....................................................................................................................... 14
HEALTH REIMBURSEMENT ACCOUNT (HRA) FAQs ...................................................................................... 16
TELADOC ................................................................................................................................................... 17
CIGNA DENTAL COVERAGE......................................................................................................................... 18
VSP VISION COVERAGE .............................................................................................................................. 19
COMMUTER AND PARKING TAX SAVINGS BENEFIT..................................................................................... 20
FLEXIBLE SPENDING ACCOUNTS ................................................................................................................. 21
Health Care Flexible Spending Account ............................................................................................................................ 21
Dependent Care Flexible Spending Account ..................................................................................................................... 23
BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE ...................................................... 24
SUPPLEMENTAL LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE....................................... 25
DEPENDENT SUPPLEMENTAL LIFE INSURANCE ........................................................................................... 25
EVIDENCE OF INSURABILITY (EOI) .............................................................................................................. 26
DISABILITY COVERAGE ............................................................................................................................... 27
Basic Short-Term & Basic Long-Term Disability ................................................................................................................ 27
Buy-Up Short-Term Disability ........................................................................................................................................... 27
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Buy-Up Long-Term Disability ............................................................................................................................................ 27
PRE-PAID LEGAL ........................................................................................................................................ 28
ASSOCIATE ASSISTANCE PROGRAM ........................................................................................................... 28
NO COST BENEFITS .................................................................................................................................... 29
WILL PREP (No Cost) ......................................................................................................................................................... 29
SECURE TRAVEL SERVICE (No Cost)................................................................................................................................... 29
HEALTHY REWARDS (No Cost) .......................................................................................................................................... 29
TAXATION AND PAYMENT OF BENEFITS ..................................................................................................... 30
Pre-tax Deductions ............................................................................................................................................................ 30
Post-tax Deductions .......................................................................................................................................................... 30
RETIREMENT – 401(K) ................................................................................................................................ 31
LEGAL NOTICES .......................................................................................................................................... 32
MEDICARE PART D NOTICE ............................................................................................................................................... 32
NOTICE OF PRIVACY PRACTICES ........................................................................................................................................ 35
WHCRA ENROLLMENT NOTICE ......................................................................................................................................... 44
SPECIAL ENROLLMENT NOTICE ......................................................................................................................................... 45
NEWBORNS’ ACT DISCLOSURE .......................................................................................................................................... 47
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ....................................................................... 48
INITIAL PREEXISTING CONDITION NOTICE ........................................................................................................................ 52
IMPORTANT NOTICE
This newsletter contains highlights of the Enova International, Inc. Benefit Plan and the Enova International, Inc. 401(k) Savings Plan (collectively the “Plan”). Although every attempt has been made to ensure this overview accurately reflects the Plan, the information in this summary does not supersede the actual provisions of the Plan or the policies or contracts related to the Plan. If there are discrepancies in this summary, your benefit will be determined in accordance with the Plan documents. Please refer to your Summary Plan Descriptions for additional benefits information. The Company may amend or terminate the benefits under the Plan at any time. For a copy of the appropriate Summary Plan Description or Plan Policy Documents, please refer to the Forms and Documents section of the Ceridian Self-Service Knowledge Base. Participation in the Plan is not an offer or guarantee of employment or an employment contract. Receipt of this communication should not be considered to mean that you are a participant or eligible to participate in the Plan or benefit programs described in this summary document if you do not otherwise meet the eligibility requirements set forth in the documents which govern the Plan.
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VISION
Closing the world’s credit gap
MISSION
Helping hardworking people fulfill their financial responsibilities with fast, trustworthy credit.
VALUES
ENOVA VISION, MISSION AND VALUES
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CONTACT INFORMATION
You always have two points of contact when you have questions about your benefits or your online benefits enrollment system. Please refer to the contact information listed below when you have questions regarding your benefits.
I. The Enova Benefits and Payroll Contact Center
Phone: 855-246-4111 (7am – 7pm Central Time, Monday-Friday) Email: [email protected] Fax: 727-865-3120
Contact the Enova Benefits and Payroll Contact Center when you: Have questions about the on-line enrollment system, Have username or password issues with the Ceridian Self-Service website, Need to initiate a benefit-related Life Event, Have a question about your payroll deductions as they relate to your benefits, Need additional high-level information on the Enova Benefit Plans.
Refer to the Ceridian Self-Service Knowledge Base to get answers to most of your benefit and enrollment questions.
II. The Enova Benefits Department Phone: 312-564-7BEN (312-564-7236) Email: [email protected]
Contact the Enova Benefits Department when you:
Have questions about specific plans or coverages, Have questions about Leave of Absence, Need to confirm eligibility or need temporary medical ID cards
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III. Benefit Carrier Contacts
MEDICAL
CIGNA (Open Access Plus Network) Group# 3335418 Phone: 800-CIGNA24 (800-244-6224) Web: www.myCIGNA.com
TELADOC
Phone: 800-TelaDoc (800-835-2362) Web: www.teladoc.com
DENTAL
CIGNA (Radius Network) Group# 3335418 Phone: 800-CIGNA24 (800-244-6224) Web: www.myCIGNA.com
VISION
VSP (Signature Network) Group# 30030608 Phone: 800-877-7195 Web: www.vsp.com
FSA’s – HEALTH CARE AND DEPENDENT CARE
WageWorks Group# 26524 Phone: 877-WageWorks (877-924-3967) Web: www.wageworks.com
PRE-PAID LEGAL
Legal Shield Group# 151461 Phone: 800-654-7757 Web: www.legalshield.com
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COMMUTER/PARKING PRE-TAX BENEFIT
WageWorks Phone: 877-WageWorks (877-924-3967) Web: www.wageworks.com
LIFE INSURANCE, AD&D INSURANCE, DISABILITY INSURANCE
CIGNA Life Group# FLX964654, Accident Group# OK066242 Short Term Disability Group# LK751136, Long Term Disability Group# FLK960629 Phone: 800-CIGNA24 (800-244-6224) Web: www.myCIGNA.com
REPORTING A LEAVE OF ABSENCE, DISABILITY OR FMLA CLAIM
CIGNA Group# FML751136 Phone: 888-842-4462 (888-84-CIGNA) Web: www.myCIGNA.com
Associate Assistance Program (AAP)
Phone: 888-538-3543 Web: www.cignabehavioral.com/CGI
Click on the Healthy Rewards link to access discount information: User name: rewards Password: savings
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I.D. CARDS
NEW HIRES CIGNA Medical ID cards should arrive 14-21 calendar days after a participant enrolls in coverage on the Benefits Self-Service enrollment website. If you require an ID card sooner, a temporary ID card can be printed at www.MyCigna.com around 7-10 calendar days after the enrollment is completed.
OPEN ENROLLMENT
IMPORTANT NOTE REGARDING OPEN ENROLLMENT MEDICAL ID CARDS
New CIGNA Medical ID cards will only be sent to those who are changing their medical coverage option for 2013 (i.e. moving from Standard Plan to HRA Value Plan), adding coverage for the first time or adding new dependents onto the plan for 2013. If you make one of these changes to your Medical election during open enrollment, ID cards should arrive around the last week of December or first week of January.
ALL EMPLOYEES
CIGNA Dental and VSP Vision do not require identification cards.
For CIGNA DENTAL: Be sure to access www.MyCigna.com to find a CIGNA In-Network dentist. When you schedule an appointment, simply tell your dentist that you have CIGNA dental and they will be able to process your claim using your Social Security Number.
For VSP VISION: Be sure to access www.vsp.com to find a VSP In-Network eye care professional. When you schedule an appointment, simply tell your eye care professional that you have VSP Vision and they will be able to process your claim using your Social Security Number.
In-Network doctors, dentists, and vision care professionals have partnered with CIGNA and VSP to offer exceptional services at a cost savings to Associates.
Flexible Spending Account (FSA) – HealthCare FSA Debit Cards should arrive 14-21 days after enrolling in the benefit. If expenses are incurred before a card is issued, participants will have to pay out of pocket and submit a claim reimbursement to WageWorks. Claims for the Dependent Care FSA are handled on a reimbursement basis only.
- All cards are mailed to the Associate’s home address as listed in Ceridian -
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A CLOSER LOOK AT HEALTHCARE REFORM
Healthcare Reform-What It Means For You
What’s already in place (2012)…
Dependents Covered through Age 26
Preventative Care Covered at 100%
No Lifetime limits on essential benefits
Restricted Annual limits on essential benefits
No Pre-existing condition exclusions for enrollees under age 19
User-friendly Summary of Benefits and Coverages
What’s Coming (2013)…
Reporting the total value of medical coverage on employee’s 2012 W-2
FDA-approved contraceptives for women covered at 100%
Health Care FSA contributions limited to $2,500
What’s Coming (2014)…
State-based exchanges
Guarantee issue and renewal rules
No pre-existing condition exclusions for any enrollee
No Annual limits on essential benefits
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TIMELINE SUMMARY OF BENEFITS ELIGIBILITY FOR NEW HIRES
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ELIGIBILITY FOR BENEFITS
Full Time associates working a minimum of 30 hours per week If you enroll in coverage, you may enroll your Eligible Dependents in coverage. Your Eligible
Dependents include your: Legal Spouse - meaning the one person of the opposite sex to whom you are legally married
under the laws of the state in which you reside. Common Law Spouse. Domestic Partner – meaning the one person of the same sex with whom you are in a
committed relationship, provided: (i) you currently share the same residence and have shared the same residence for at least six months, (ii) you are both 18 years or older, (iii) you are not related by blood or in any manner closer than permitted by state law for marriage, and (iii) neither of you are married or in a civil union with another person. You must submit a Domestic Partnership Affidavit in order to enroll your Domestic Partner in coverage.*
Dependent children to the age of 26 - meaning your direct offspring, stepchildren, foster children, legally adopted children, children placed with you for the purpose of adoption, and children of your Domestic Partner who live with you. You must enroll your Domestic Partner in coverage in order to enroll the children of your Domestic Partner in coverage.*
You may be required to submit proof of eligibility in order to enroll your Eligible Dependents in coverage.
* Domestic Partners and the children of Domestic Partners are not eligible dependents for purposes of the Health Care FSA or Dependent Care FSA.
EFFECTIVE DATE OF BENEFITS The employee benefit plans you choose as a new hire and during the Open Enrollment period are effective for the entire benefit plan year. If you are newly eligible for benefits, you must enroll no later than 31 days from your date of hire or you will be enrolled in Basic Life & Basic Accidental Death & Dismemberment (AD&D) ONLY.
The following are effective on your date of hire:
Medical / Prescription Drug Dental Vision
Health Care Flexible Spending Account Dependent Care Flexible Spending Account Basic Life and Basic AD&D
Supplemental Employee Life Supplemental Dependent Life Supplemental AD&D
Commuter/Parking Associate Assistance Program Legal Services
The following are effective 1st of the month following 1 year of employment:
Basic Short-Term Disability Basic Long-Term Disability
Supplemental (Buy-Up) Short Term Disability
Supplemental (Buy-Up) Long Term Disability
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LIFE EVENTS If you do not enroll in the applicable plans during the Open Enrollment period or your initial eligibility, you will not be able to enroll (or make changes) until the next Open Enrollment period, unless you experience a special enrollment right or a qualifying event such as:
Marriage, new domestic partnership*, divorce or dissolution of domestic partnership.
Birth, adoption, or change in custody of your child(ren)
Death of your spouse/domestic partner or child(ren)
Change in your spouse’s or domestic partner’s employment status
Child(ren)’s loss of dependent status
A change in your residence that affects benefit coverage
Qualified Medical Child Support Order
*See ELIGIBILITY FOR BENEFITS on previous page for additional details on domestic partner eligibility.
If you experience a qualifying event, you must initiate a life event within 30 days by contacting the Enova Benefits and Payroll Contact Center and providing the appropriate documentation. You may also have the right to make changes to your benefits if you experience a special enrollment right. Refer to the Special Enrollment Rights Notice included in this packet for a description of special enrollment rights and the enrollment timeframes.
Enova requires employees to submit proof of eligibility when a qualifying event is initiated. Depending on the type of qualifying event, you will need to supply proof such as marriage certificate, domestic partner affidavit, common law certification, birth certificate, court documents or loss of other coverage certification (HIPAA Notice).
IRC SECTION 125 The Internal Revenue Code Section 125 allows Payroll to deduct certain benefit contributions on a pre-tax basis, which reduces your taxable income.
You can also defer pre-tax money into a Flexible Spending Account (FSA) for qualified medical and/or dependent care expenses
Once enrolled, you cannot make any changes unless you experience a special enrollment right or qualifying event.
Benefit contributions for the medical, dental, and vision coverage provided to your Domestic Partner and children of your Domestic Partner cannot be deducted on a pre-tax basis, unless your Domestic Partner and the children of your Domestic Partner qualify as your tax dependents.
If your Domestic Partner qualifies as your tax dependent, you will need to complete and return the Domestic Partnership Affidavit (for Tax Treatment Determination) in order to receive pre-tax treatment of the medical, dental, and vision coverage provided to your Domestic Partner or the child(ren) of your Domestic Partner.
If your Domestic Partner does not qualify as your tax dependent, benefit contributions made for your Domestic Partner or the child(ren) of your Domestic Partner will be deducted on a post-tax basis. In addition, per IRS rules, you will be required to pay Imputed Income on the fair market value of health coverage provided to your Domestic Partner (less any post-tax benefit contributions made by you). You will see the appropriate amount reflected as income on your pay stub and then it will be taxed accordingly.
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CIGNA MEDICAL COVERAGE Cigna Major Medical and Prescription Drug There are five (5) coverage level options available to you under the Medical plan.
Value HRA - New for 2013!
Basic
Standard
Premier
Premier Plus
Below are the 2013 Bi-Weekly (Per Pay Period) costs for Medical coverage.
NEW FOR 2013-VALUE HRA PLAN The Value HRA (Health Reimbursement Account) Plan is a lower-cost (aka lower per pay premium), high-deductible medical plan for which Enova contributes funds to the account each calendar year ($500 for Associate Only coverage and $1,000 for Associate plus Spouse, Child(ren) or Family coverage). Your HRA fund will be used to pay 100% of your eligible health care expenses until the money is used up. The money used from your HRA counts toward your deductible, reducing your cost when you utilize services. You can track your account balance by logging on to www.mycigna.com. Please refer to the HRA FAQ Section in this guide for more detailed information on how the HRA plan works, as well as examples.
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Medical Benefit Coverage Summary:
Below are the 2013 costs for Prescription coverage. (Prescription coverage is included with your Medical plan.)
***Note: RX deductible no longer applies effective 1/1/2013!
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HEALTH REIMBURSEMENT ACCOUNT (HRA) FAQs At the start of the plan year (January 1st), Enova deposits a specific dollar amount into an HRA ($500 for
employee or $1,000 for Employee + Spouse, Child or Family).
The dollars in your HRA are used to pay eligible health care expenses. The money used counts toward your deductible (the amount of money you pay out of pocket before the plan starts to pay).
Your HRA dollars are used first. After the money in your account is used up, you pay for all of your health care expenses up to your annual deductible amount.
When you reach your deductible, you and your plan share the costs (coinsurance) for covered services.
Money not used during the plan year may roll over to your account the next year (up to the annual deductible amount).
Preventative care is covered at no cost to you when received by an in-network provider. (This means that approved preventative care services will NOT come out of your HRA dollars. This includes annual physicals, pap smears, breast cancer screenings, etc.)
You are protected by an out-of-pocket maximum and once you meet the maximum, your plan pays eligible expenses at 100%.
If you leave employment or you do not re-elect the HRA Value plan the next plan year, any balance in your HRA account will be forfeited.
EXAMPLE George is a 35-year-old single man who is healthy, with the exception of an occasional sports injury. He enrolled in the Value HRA plan with a $500 health fund (funded by Enova), a $2,200 deductible and a coinsurance of 20% for in-network services. Here is how the plan worked for George:
Year 1 George receives an annual preventative care exam that is covered 100% by the medical plan $0 He also receives care for his sports injuries:
Visit to Urgent Care Center $70
Visits to a Sports Medicine Specialist $160
Prescriptions $165 Total Medical Expenses $395 The HRA pays first -$395 George pays $0 George’s fund balance to carry over to next year’s HRA $105 ($500 - $395) Year 2 George receives an annual preventative care exam that is covered 100% by the medical plan $0 He also receives care for his sports injuries:
Visit to a Specialist (2 visits) $320
Prescriptions $75 Total Medical Expenses $395 The HRA pays first -$395 George pays $0 George’s fund balance to carry over to next year’s HRA $210
($105 bal from prev. year + $500 for current yr - $395)
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TELADOC You are automatically eligible for TelaDoc with your enrollment in the Medical Plan. TelaDoc services are available to your spouse, domestic partner, and child(ren) if they are covered in the Medical Plan. TelaDoc is a national network of board certified physicians providing cross coverage consultations 24 hours a day, 365 days a year. TelaDoc physicians use medical records and telephone or video consultations to:
Diagnose
Recommend treatment
Write short-term prescriptions when appropriate Examples of treatable conditions include:
Sinus Infections
Allergies
Sore Throat
Cold or Flu TelaDoc is a cost-effective alternative for minor medical problems. For a fee of $10.00, you can call TelaDoc when:
Your physician is not available
You are on vacation or on a business trip
You need assistance after your primary care physician’s hours of operation Before receiving a consultation with TelaDoc: Complete the Medical History Disclosure at www.TelaDoc.com (Medical History Disclosure must be completed separately for each enrolled subscriber and dependent in order to request a consultation. An additional charge will apply if the disclosure is completed by phone.) Note: This service is not currently available in Oklahoma.
For more information or to request a consultation after you enroll in the Medical Plan call: 1-800-TelaDoc (1-800-835-2362)
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CIGNA DENTAL COVERAGE
Below are the 2013 Bi-Weekly (Per Pay Period) costs for Dental coverage.
** You can elect Dental coverage separately from Medical and Prescription Drug coverage.
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VSP VISION COVERAGE
1. Applied to lenses and frames 2. Polycarbonate, tints and photochromic lenses are covered in full by a VSP provider 3. The allowance is in addition to the 15 percent discount on the contact lens exam. Any costs exceeding this allowance are the patient’s responsibility.
NOTE: Contact lenses are instead of lenses and frames.
New for 2013-Retail Chain Affiliate Providers!
In addition to the VSP Preferred Providers, you now have the option of retail providers. VSP’s retail chain affiliate providers give you added convenience and additional retail locations. Retail chain affiliate providers include Costco Optical, Eye Care Centers of America/Visionworks, Eyemasters, Hour Eyes, Wisconsin Eye & Heartland Vision.
To find a listing of retail providers in your area, logon to www.VSP.com, go to Doctor Directory/Search, then select the Signature Network and then click “include affiliate providers”. If you are having trouble, you can always get this information from VSP Customer Service by calling 1-800-877-7195.
Below are the 2013 Bi-Weekly (Per Pay Period) costs for Vision coverage.
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COMMUTER AND PARKING TAX SAVINGS BENEFIT The WageWorks commuter and parking benefit gives Enova Associates a way to lower cost of living expenses by reducing the costs of commuting to work. With enrollment in the WageWorks commuter and parking plan, Associates can save up to 40% off commuting and parking expenses. The money that pays for the transit pass and/or parking comes from your paycheck and is taken out before federal income tax, FICA, and state income tax (in most states) are deducted. Because Associates do not pay taxes on this money, savings are seen each month in the form of reduced tax withholding.
You are eligible to enroll in the benefit on your date of hire.
If you enroll by 11pm Central Time on the 5th of the month, you will be eligible for reimbursement or your pre-paid transit card will be funded on the first of the following month.
For Example:
Enrolled Date = May 3rd First day to receive transit card funding or be eligible for reimbursement = June 1st
OR
Enrolled Date = May 7th (After 5th of the month deadline) First day to receive transit card funding or be eligible for reimbursement = July 1st
You can enroll in the WageWorks Commuter and Parking plan by logging on to www.wageworks.com.
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FLEXIBLE SPENDING ACCOUNTS
Health Care Flexible Spending Account The annual maximum amount you can contribute to the Health Care FSA is $2,500.
Do you need help paying for copays, deductibles or coinsurance? If so, a flexible spending account may be able to help you! You can set up a spending account through WageWorks, which will allow you to set aside pre-tax dollars from your paycheck. You can use the money from this account to pay for eligible medical, dental and vision expenses. How It Works The average household spends $185 in over-the-counter items alone each year. It is up to you to estimate your own expenses and make sure you elect the right amount to set aside for the year. Start by estimating the out-of-pocket medical expenses (copay(s), deductible(s) or coinsurance) you anticipate spending for yourself and/or dependents for the coming year.
You do not have to participate in Enova’s medical, dental or vision plans to be eligible for the flexible spending account.
Some Eligible Expenses Include
Visit www.wageworks.com for a complete list of eligible expenses. Important Rules
You cannot change your election during the year unless you experience a qualifying event.
Only expenses for services received in the plan year (January 1, 2013 - December 31, 2013) or its related grace period (January 1, 2014 – March 15, 2014) and while you are covered under the Health Care FSA, can be reimbursed by the contributions you make in 2013.
Domestic Partners and the children of Domestic Partners are not eligible dependents for purposes of the Health Care FSA.
YOU LOSE WHAT YOU DON’T USE!
Any expenses not incurred by March 15, 2014 will be forfeited, as required by the IRS! (Be sure to plan your annual contribution accordingly.)
Claims that are incurred by March 15, 2014 can be filed for reimbursement up to April 30, 2014.
Acupuncture
Artificial Limb
Contact Lenses & Solutions
Chiropractic Services
Copays
Coinsurance
Crutches
Medical or Dental Deductibles
Dental Treatments
Hearing Aids
Hospital Charges
LASIK Eye Surgery
Orthodontia
Physical Therapy
Prescription Drugs
Psychiatric Care
Smoking Cessation Programs
Vaccines
Vision Care
Well-baby Care
Wheelchairs & X-Rays
Over-the-counter Medications-Prescribed by a Physician Used for Treatment of Illness or Injury
*You may not use the account to pay for cosmetic expenses or to benefit your general well-being.
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WageWorks® Visa® Health Care Card The WageWorks Visa Health Care Card makes funds immediately available to you for payment of eligible health care services, goods and prescriptions. You can also use your Card at qualified merchants to pay for eligible over-the-counter (OTC) items. The WageWorks Flex Spending Account (FSA) makes it easy to access your money. Below are some examples of how to access your Health Care FSA Account:
Swipe your WageWorks Visa Health Care Card wherever it’s accepted to have eligible expenses deducted directly from your health care FSA. Use your card at your doctor, dentist, vision center, qualified pharmacy or other qualified merchants.
Sign up to schedule (Pay My Provider) payments from your Health Care FSA online.
Send in traditional (Pay Me Back) claims for quick reimbursement. You will need to hold on to your receipts for tax purposes. Go to www.getwageworks.com/fsa to learn more!
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Dependent Care Flexible Spending Account The maximum annual amount you can elect for the Dependent Care Flexible Spending Account is $5,000. ($2,500 if married, but file separate tax returns)
Enova offers you a way to pay for your dependent day care expenses with pre-tax dollars through a Dependent Care Flexible Spending Account. You may voluntarily set aside from each paycheck pre-tax dollars that can be used to pay for dependent care expenses incurred so that you can work. Through this account, you can pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents such as dependent parents.
To be eligible, you must be a single parent or your spouse must be employed outside the home, disabled or a full-time student. The dependent care provider cannot be your child under age 19 or anyone who is your dependent for income tax purposes.
Important Rules You cannot change your election during the year unless you experience a qualifying event.
Only expenses for services received in the plan year (January 1, 2013 - December 31, 2013) or its related grace period (January 1, 2014 – March 15, 2014) and while you are covered under the Dependent Care FSA, can be reimbursed by the contributions you make in 2013.
Domestic Partners and the children of Domestic Partners are not eligible dependents for purposes of the Dependent Care FSA.
Expenses Eligible For Reimbursement
Adult Day Care
Au Pair
After-school Program
Before-school Program
Baby-sitting (work-related, in your home or someone else’s, but not provided by your own dependent)
Child Care
Custodial Elder Care (work-related)
Dependent or Elder Care (work-related)
Educational Services (for preschool, but not kindergarten or above)
Extended Care (supervised program before or after school)
Nanny
Nursery School
Payroll Taxes Related to Eligible Care
Preschool
Senior Day Care
Sick Child Care
Summer Day Camp (but not overnight camp)
Transportation To and From Eligible Care (provided by your care provider)
Filing for Reimbursement
Online Claim You can pay for many of your eligible dependent care expenses directly from you FSA account by logging on to www.wageworks.com and selecting “Pay My Provider.”
Paper Claim If you prefer to submit a paper claim form to request reimbursement for your eligible expenses, choose the “Pay Me Back” option at www.wageworks.com.
YOU LOSE WHAT YOU DON’T USE! Any expenses not incurred by March 15, 2014 will be forfeited, as required by the IRS!
(Be sure to plan your annual contribution accordingly.)
Claims that are incurred by March 15, 2014 can be filed for reimbursement up to April 30, 2014.
For questions on either the Health Care or Dependent Care Flexible Spending Accounts, please call WageWorks at 1-877-924-3967.
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BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Enova automatically provides you with Basic Life and Basic Accidental Death & Dismemberment Insurance at no cost to you. Benefits will be payable to the person(s) you designate as your beneficiary in the event of your death.
Beneficiary designations can be made during your New Hire Enrollment or during Open Enrollment (in the fall). You may also update your Life and AD&D beneficiaries at anytime throughout the year by contacting The Enova Benefits and Payroll Contact Center (Email: [email protected] or Phone: 855-246-4111).
Note: Coverage amounts for Life Insurance and AD&D are based on your salary as of January 1st, the year the benefit becomes effective (1/1 of each plan year).
IMPUTED INCOME
If your Basic Life Insurance amount exceeds $50,000, the IRS requires Imputed Income to be paid on the amount that exceeds $50,000. The following illustrates an example of how this is calculated:
Basic Life Insurance Volume: $75,000 Age: 37
You will see the appropriate amount reflected as income on your pay stub and then it will be taxed accordingly. It is this tax that you are required to pay to satisfy the IRS Imputed Income requirement. For more information on Imputed Income, go to www.irs.gov and search for “Group-Term Life Insurance”.
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SUPPLEMENTAL LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
Note: Your cost and coverage amounts for Life Insurance and AD&D are based on your age and salary as of January 1st, the year the benefit becomes effective (1/1 of each plan year).
DEPENDENT SUPPLEMENTAL LIFE INSURANCE You may also cover your dependents by electing Dependent Supplemental Life Insurance. You are automatically the beneficiary if your spouse, domestic partner or dependent child dies. Your options for coverage are outlined in the chart below:
Spouse/Domestic Partner Supplemental Life Insurance
Child Supplemental Life Insurance*
Increments of $5,000 up to a maximum of $50,000 $2,000 $4,000 $8,000 $10,000
*Live birth to six (6) months – $2,000
*Foster children cannot be covered under Dependent Life Insurance.
Important Note: You must elect Supplemental Life Insurance for yourself in order to be eligible to elect coverage for dependents under this plan. In addition, the amount you elect for your dependent(s) may not exceed 100% of your total life insurance coverage (Basic and Supplemental combined).
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EVIDENCE OF INSURABILITY (EOI) Depending on your election in Supplemental Employee and/or Dependent Life, you may be required to complete Evidence of Insurability in order to be approved for the coverage amount you have elected. Please refer to the chart below to determine if EOI will be required for your election. If EOI is required for any benefit, the confirmation page of your on-line benefits enrollment portal will reflect the approved amount in force right away, as well as the portion that is pending and requires EOI. CIGNA will mail you the necessary EOI information automatically within 2-4 weeks after your on-line benefits enrollment is completed. If approved, Enova will automatically be notified and will process the approved or denied amount to your benefit and any changes to your payroll deductions will be handled accordingly. (Deductions will increase to cover the approved amount or deductions will remain the same if denied and the denied coverage amount will not be applied.) Please be sure to read all mail received from CIGNA and to follow the instructions carefully. You must meet all deadlines and all communication must be made directly with CIGNA. Due to the private nature of the health information disclosed in the EOI process, the Enova Benefits Department CANNOT assist you with the completion or mailing of required documentation.
**FOR 2013 OPEN ENROLLMENT: New enrollments for Domestic Partner Supplemental Life will NOT require EOI since this will be the first time that Domestic Partners will be allowed coverage under the plan.
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DISABILITY COVERAGE Enova automatically provides you with Basic Short-Term Disability and Basic Long-Term Disability coverage as a result of a non-occupational injury or illness. Both of these plans replace a percentage of your income if you are unable to work. You may elect Supplemental Short-Term and/or Long-Term Disability coverage to increase your salary replacement.
Basic Short-Term & Basic Long-Term Disability
Basic Short-Term Disability
You are automatically enrolled on the first of the month following 1 year of employment. Benefits begin after you’ve been disabled
seven (7) consecutive days while under the care of a physician and continue, if medically necessary, for up to 25 weeks.
Replaces 60% of your weekly salary to a maximum of $2,500.
Paid 100% by Enova.
Basic Long-Term Disability
You are automatically enrolled on the first of the month following 1 year of employment. Benefits begin after six (6) months of
continuous disability while under the care of a physician and continue to age 65.
Replaces 40% of your monthly salary to a maximum of $3,000.
Paid 100% by Enova.
Buy-Up Short-Term Disability
You are eligible to elect supplemental or “buy-up” short-term disability coverage the first month following 1 year of employment. The buy-up is an additional 40% of coverage that, if elected, is added to your basic short-term disability coverage.
This would provide you with a total of 100% of your WEEKLY salary to a maximum of $2,500 (combined Basic & Buy-Up benefit) for the first 12 weeks and 85% of your monthly salary up to a maximum of $2,500 (combined Basic & Buy-Up benefit) for the last 13 weeks.
Buy-Up Long-Term Disability
You are eligible to elect supplemental or “buy-up” long-term disability coverage the first of the month following 1 year of employment. The buy-up is an additional 20% of coverage that, if elected, is added on to your basic long-term disability coverage.
This would provide you with a total of 60% of your MONTHLY salary to a maximum of $5,000. (40% Basic + 20% Buy-Up = 60% Total)
Note: You can elect the Buy-Up STD and Buy-Up LTD plans separately. You are NOT required to enroll in both.
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PRE-PAID LEGAL
Comprehensive Group Legal Plan (Option 1) $ 6.80 Per Pay Period
Comprehensive Group Legal Plan with ID Shield (Option 2) $11.40 Per Pay Period
Option 1 The Comprehensive Group Legal Plan offers toll-free phone consultations on any legal issue that might arise, such as home purchases, will preparation, child support, divorce, credit matters, bankruptcy, guardianship and DUI. In addition, the Comprehensive Group Legal Plan offers representation by your Provider Law Firm for uncontested legal separation or uncontested civil annulment, uncontested divorce, uncontested adoption, power of attorney or a living will. Option 2 The Comprehensive Group Legal Plan with ID Shield offers all of the benefits of Option 1, with an added Identity Theft benefit. A professional thief can assume your identity in just a few hours, but it can take years for you to restore your good name. ID Shield helps you with your credit report, identity restoration and provides continuous credit monitoring. You may contact Pre-Paid Legal Services at 1-800-654-7757 for additional information.
Benefits Include:
Toll-free Phone Consultations on Any Subject
Phone Calls & Letters on Your Behalf
Contract & Document Review
Mortgage Document Assistance
In-office Consultations
Child Support
Credit Matters
Will Preparation
Bankruptcy
Guardianship
DUI / DWI
Uncontested Divorce / Adoption
ASSOCIATE ASSISTANCE PROGRAM An Associate Assistance Program is provided to all Associates through CIGNA. Through this confidential service, you and your immediate family members have unlimited access to consultants by telephone, resources and tools online and up to three face-to-face visits with counselors for help with a short-term problem.
Ease the stress of any uncomfortable situation by calling and speaking with master’s level consultants when you or your family members need help and information with issues such as:
Problems with a manager or Associate
Improving your health or controlling a chronic condition Coping with stress, anxiety and depression
Getting out of debt and managing your finances
Organization tips and prioritization ideas
Dealing with a family member who has an addiction
Caring for an elderly relative or finding senior
assistance
Relationship/Marital issues Raising children and finding child care in your area
Legal issues... and much more!
CONTACT THE CIGNA AAP By Phone: 888-538-3543, or on the Web: www.cignabehavioral.com/CGI
Click on the Healthy Rewards link to access discount information: User name: rewards Password: savings
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NO COST BENEFITS
WILL PREP (No Cost)
CIGNA makes it easy to take charge of legal decisions regarding your life and your health with its Will Preparation
program. Available online, the program allows you to complete essential legal documents at no cost to you. It is state-
specific and tailored to your situation, so there’s no need to hesitate in planning for your future.
For more information please visit www.CIGNAWillCenter.com.
Services Include:
SECURE TRAVEL SERVICE (No Cost)
Whether your travel is for business or pleasure, CIGNA’s worldwide emergency travel assistance program is there to
help you when an unexpected emergency occurs. With only one phone call anytime of the day or night, you, your
spouse and dependent children can get immediate assistance anywhere in the world.
Services Include: Emergency Medical Evacuation
24-Hour Multilingual Assistance
Pre-trip Planning Services, Including Foreign Travel
Medical Referrals
Prescription Refill Services
Assistance With Lost or Stolen Items
Translation and Interpretation Services
Emergency Travel Services
Repatriation of Remains
Provide up to $10,000 upfront guarantee of payment for needed medical expenses so you can get necessary care or treatment. You are responsible for repaying these funds to CIGNA Secure Travel because this program does not pay for medical expenses.
HEALTHY REWARDS (No Cost) From spin and yoga classes to natural supplements, CIGNA's Healthy Rewards provides discounts of up to 60% on health programs and services as part of CIGNA’s ongoing effort to promote wellness. There’s no time limit or maximum for enjoying these instant savings when you visit a participating provider or shop online. No referrals or claim forms needed.
The following Healthy Rewards programs are available: • Weight Management and Nutrition • Mind/Body • Vision and Hearing Care • Fitness • Tobacco Cessation • Vitamins and other health and wellness products • Alternative Medicine
You can learn more about Healthy Rewards by visiting cigna.com/rewards (password: savings) or by calling 1.800.258.3312.
Last Will and Testament
Living Will
Healthcare Power of Attorney
Financial Power of Attorney
For more information on CIGNA’s Secure Travel
program, you may contact CIGNA at 1-888-226-4567 for
U.S. or Canada. For all other locations please call collect
at 202-331-7633. ID cards are available by contacting the
Enova Benefits Department by email at
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TAXATION AND PAYMENT OF BENEFITS
Pre-tax Deductions Your cost for coverage under some benefits will be paid on a pre-tax basis through payroll deductions. This means your premiums are deducted from your paycheck before taxes are calculated on the remaining income. This results in tax savings for you each pay period for most federal and state income taxes and Social Security taxes.
Benefit contributions for your Domestic Partner and children of your Domestic Partner who do not qualify as your tax dependents cannot be deducted on a pre-tax basis.
Post-tax Deductions Some coverages are deducted on a post-tax basis, which means you are taxed on your income before the premiums are deducted from your paycheck. The chart below illustrates who is paying for your benefit and how deductions will be taxed on your paycheck.
BENEFIT WHO PAYS THE COST? HOW IS IT TAXED TO YOU? Medical / Prescription Drug Enova & Associate Pre-tax* Dental Associate Pre-tax* Vision Associate Pre-tax* Commuter/Parking Associate Pre-Tax Health Care Flexible Spending Account Associate Pre-tax** Dependent Care Flexible Spending Account Associate Pre-tax** Basic Life and Basic AD&D Enova No Cost Supplemental Employee Life Associate Post-tax Supplemental Dependent Life Associate Post-tax Supplemental AD&D Associate Post-tax Basic Short-Term Disability Enova No Cost Basic Long-Term Disability Enova No Cost Supplemental (Buy-Up) Short Term Disability Associate Pre-tax Supplemental (Buy-Up) Long Term Disability Associate Pre-tax Legal Services Associate Post-tax Associate Assistance Program Enova No Cost
*Benefit contributions for your Domestic Partner and the Children of your Domestic Partner who do not qualify as your tax dependents are deducted on a post-tax basis. ** Domestic Partners and the children of Domestic Partners are not eligible dependents for purposes of the Health Care FSA or Dependent Care FSA.
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RETIREMENT – 401(K) You will be automatically enrolled in the Enova 401(k) savings plan on the first payroll coincident with or following the first day of the month after completing 30 days of employment. The automatic enrollment contribution percentage is 3% of your base salary. You may change your contribution percentage at any time up to a maximum of 75%. The Company will match 50% up to 5% of your eligible pay (2.5% maximum match) You can contact Diversified any time after 8 days of employment to change or cancel your contribution to the 401(k) plan. All changes will be processed as soon as administratively possible, however please note that depending on the day and time of day that you request a change, there is a possibility that it may or may not make the next payroll due to predetermined processing schedules. Every effort is made to ensure that your changes are applied to the next possible payroll. If you make changes before you are eligible for the plan, but before the administrative payroll cutoff, your changes will take effect on the first payroll following the 1st of the month following 30 days of employment.
Please call Diversified Direct Customer Service at 800-755-5801 to:
Initiate a Rollover from your previous 401(k) plan into the Enova 401(k) plan, or to
Change your contribution percentage or opt out of the 401(k) plan altogether.
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LEGAL NOTICES
MEDICARE PART D NOTICE
Important Notice from Enova International, 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 Enova International, Inc. Benefit Plan (the “Plan”) and about your options under Medicare’s prescription drug coverage. The prescription drug benefits under the Plan are administered by Connecticut General. 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 coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Enova International, Inc. has determined that the prescription drug coverage offered by the Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered “Creditable Coverage.” Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
______________________________________________________________________
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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 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 coverage under the Plan will not be affected. A description of the prescription drug coverage offered by the Plan can be found in the Plan’s summary plan description.
If you do decide to join a Medicare drug plan and drop your current coverage under the Plan, be aware that you and your dependents may not be able to get this coverage back unless you enroll during annual enrollment, during a HIPAA special enrollment period or you experience another event that would permit you to enroll in this coverage during the plan year.
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 under the Plan 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 prescription drug coverage that is Creditable 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 19 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.
For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year during the Plan’s open enrollment period. You will also get it if the prescription drug coverage under the 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. If you are eligible for Medicare, you’ll get a copy of the
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handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about 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).
Date: January 1, 2013 Name of Entity/Sender: Enova International, Inc. Contact--Position/Office: Benefits Department Address: 200 Jackson Blvd. Suite 500 Chicago, IL 60606 Phone Number: 312-648-6251
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ENOVA INTERNATIONAL, INC. BENEFIT PLAN
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.
Why am I receiving this Notice?
Enova International, Inc. (the “Company”) sponsors the Enova International, Inc. Benefit Plan (the “Plan”), which offers an array of welfare benefits to certain Company employees, including medical, prescription drug, dental, vision, and health care flexible spending account programs (“health benefits”). The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), and the rules to carry out this law (“Privacy Rules”), require health plans to notify participants and beneficiaries about the policies and practices the Plan has adopted to protect the confidentiality of their health information, including health care payment information.
This Notice describes the privacy policies of the portion of the Plan that provides the health benefits. These policies protect medical information relating to your past, present and future medical conditions, health care treatment and payment for that treatment that is created, received by or maintained by the Plan (“Protected Health Information” or “PHI”).
This Notice does not cover:
health information that does not identify you and for which there is no reasonable basis to believe that the information could be used to identify you; or
health information that the Company can have under applicable law (e.g., the Family and Medical Leave Act, the Americans with Disabilities Act, workers’ compensation, federal and state occupational health and safety laws, as well as other state and federal laws), or that the Company properly can get for employment-related purposes through sources other than the Plan and that is kept as part of your employment records (e.g., pre-employment physicals, drug testing, fitness for duty examinations, etc.).
The law requires the Plan to maintain the privacy of your PHI, to provide you with this Notice of its legal duties, and to abide by the terms of this Notice. In general, the Plan may
36
only use and/or disclose your PHI where required or permitted by law or when you authorize the use or disclosure. The Plan may also only use the minimum amount of your PHI that is necessary to accomplish the intended purpose of the use or disclosure as permitted by HIPAA.
Some health benefits are provided through insurance, where the Company does not obtain access to PHI. If you are enrolled in any insured arrangement, including any insured HMO option under the Plan, you will receive a separate privacy notice from your insurer or HMO. That notice applies to the insurer’s privacy practices under that option.
When will the Plan use or disclose my PHI?
The Plan must:
give your PHI to you or your legal representative when you ask for information; give your PHI to the U.S. Department of Health and Human Services (“DHHS”), if
necessary, to make sure your privacy is protected; and use or give out your PHI where otherwise required by applicable law.
The Plan and the individuals who administer it may use, receive or disclose your PHI for the following purposes:
Treatment. The Plan does not provide medical treatment directly, but it may disclose your PHI to a health care provider who is giving treatment. For example, the Plan may disclose the types of prescription drugs you currently take to an emergency room physician, if you are unable to provide your medical history due to an accident.
Payment. The Plan may disclose your PHI, as needed, to pay for your medical, dental or vision benefits. For example, receiving claims or bills from your health care providers, processing payments, sending explanations of benefits (“EOBs”), precertifying hospital admissions or otherwise reviewing the medical necessity of services, conducting claims appeals and coordinating benefit payments under the Plan.
Health Care Operations. The Plan may use and disclose your PHI to make sure the Plan is well run, administered properly and does not waste money. For example, the Plan may use information about your claims to project future benefit costs or audit the accuracy of its claims processing functions. The Plan may also disclose your PHI for a claim under a stop-loss or re-insurance policy. Among other things, the Plan may also use your PHI to undertake underwriting,
37
premium rating and other insurance activities relating to changing health insurance contracts or health benefits. However, federal law prohibits the Plan from using or disclosing PHI that is genetic information (e.g. family medical history) for underwriting purposes which include eligibility determinations, calculating premiums, application of any preexisting conditions, exclusions and any other activities related to the creation, renewal, or replacement of a health insurance contract or health benefits.
Treatment Alternatives of Health-Related Benefits and Services. The Plan may use and disclose your PHI to provide you with appointment (or treatment) reminders, information about treatment alternatives, or information about other health-related benefits and services that may be of interest to you.
Business Associates. Our Plan contracts with other businesses for certain administrative services. These “business associates” maintain and use most of the PHI under the Plan, and must agree in writing to protect the privacy of your information. In addition to performing services for the Plan, business associates may use PHI for their own management and legal responsibilities, for purposes of aggregating data for Plan design and for other health care operations.
To the Company. In certain cases, the Plan, insurers or HMOs may disclose your PHI to the Company.
Some of the people who administer the Plan work for the Company. Before your PHI can be used by or disclosed to these Company employees, the Company must certify that it has: (1) amended the Plan documents to explain how your PHI will be protected; (2) identified the Company employees who need your PHI to carry out their duties to administer the Plan; and (3) separated the work of these employees from the rest of the workforce so that the Company cannot use your PHI for employment-related purposes or to administer other benefit plans. For example, these designated employees will be able to contact an insurer or third-party administrator to find out about the status of your benefit claims without your specific authorization.
The Plan may disclose information to the Company that summarizes the claims experience of Plan participants as a group, but without identifying specific individuals, to get new benefit insurance or to change or terminate
38
the Plan. For example, if the Company wants to consider adding or changing organ transplant benefits, it may receive this summary health information to assess the costs of those services.
The Plan may also disclose limited health information to the Company in connection with the enrollment or disenrollment of individuals into or out of the Plan.
Other Covered Entities. The Plan and their business associates may disclose PHI to certain other entities (including other health plans and health care providers) for the other entity’s treatment, payment or health care operations purposes.
To Individuals Involved with Your Care or Payment for Your Care. The Plan may disclose your PHI to adult members of your family or another person identified by you who is involved with your care or payment for your care if: (1) you authorize the Plan to do so; (2) the Plan informs you that it intends to do so and you do not object; or (3) the Plan infers from the circumstances, based upon professional judgment, that you do not object to the disclosure. The Plan will, whenever possible, try to get your written objection to these disclosures (if you wish to object), but in certain circumstances it may rely on your oral agreement or disagreement to disclosures to family members.
To Personal Representatives. The Plan may disclose your PHI to someone who is your personal representative. Before the Plan will give that person access to your PHI or allow that person to take any action on your behalf, it will require him/her to give proof that he/she may act on your behalf; for example, a court order or power of attorney granting that person such power. Generally, the parent of a minor child will be the child’s personal representative. In some cases, however, state law allows minors to obtain treatment (e.g., sometimes for pregnancy or substance abuse) without parental consent, and in those cases the Plan may not disclose certain information to the parents. The Plan may also deny a personal representative access to PHI to protect people, including minors, who may be subject to abuse or neglect.
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Under what other circumstances will my PHI be used or disclosed?
The Plan is also permitted to use or disclose your PHI in the following circumstances:
For certain required public health activities (such as reporting disease outbreaks);
To prevent serious harm to you or other potential victims, where abuse, neglect or domestic violence is involved;
To a health oversight agency for oversight activities authorized by law;
For judicial or administrative proceedings (such as in response to a court order or subpoena and discovery request, but only if the Plan has received adequate assurances that the information to be disclosed will be protected);
For a law enforcement purpose to a law enforcement official (such as providing limited information to locate a missing person);
To a coroner, medical examiner or funeral director;
For certain organ, eye or tissue donations;
For research studies (such as research related to the prevention of disease or disability) that meet all privacy law requirements;
To avert a serious threat to the health or safety of you or any other person;
For specified government functions, such as intelligence activities;
To the extent necessary to comply with laws and regulations related to workers’ compensation or similar programs;
To organizations engaged in emergency and disaster relief efforts for emergencies or disaster relief; and
When otherwise required by law.
These uses and disclosures may be subject to special legal requirements.
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What if the circumstances described above do not apply?
If the circumstances described above do not apply, the Plan may not use or disclose your PHI unless you authorize the use or disclosure in writing on a prescribed form. You may take back your written authorization at any time, except if the Plan has already acted based on your authorization. You may not, however, cancel your authorization if it was obtained as a condition for obtaining insurance coverage and if your cancellation will interfere with the insurer’s right to contest your claims for benefits under the insurance policy. You may obtain an authorization form by contacting the Plan’s Information Contact.
If you have questions or a problem relating to a claim, a network provider or other health care matter, you will generally be directed to a contact person with the relevant business associate to resolve the matter.
What are my individual rights with respect to my PHI?
You have the right to:
Copy or Access Your PHI. See and get a copy of the PHI held by the Plan; except for information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding. Your request should be made in writing. Certain cost-based fees may apply. The Plan may deny you access to your PHI in the Plan’s records. You may, under some circumstances, request a review of that denial.
Amend. Request that the Plan amend your PHI or record if you believe the information is incorrect or incomplete. The Plan may deny your request if the information in its records: (1) was not created by the Plan; (2) is not part of the Plan’s records; (3) would not be information to which you would have a right of access; or (4) is deemed by the Plan to be complete and accurate as it then exists.
Accounting of Disclosures. At your request, the Plan must provide you with the Plan’s disclosures of your PHI made within the six-year period before your request, except for disclosures made:
for purposes of treatment, payment or health care operations;
directly to you or close family members involved in your care;
for purposes of national security;
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incidental to otherwise permitted or required disclosures;
as part of a limited data set;
to correctional institutions or law enforcement officials; and
with your express authorization.
You may request one accounting, which the Plan must provide at no charge, within a single 12-month period. If you request more than one within the same 12-month period, the Plan may charge you a reasonable fee.
Paper Copy of This Notice. Get a paper copy of this Notice at any time.
Request Restrictions on Uses and Disclosures of Your PHI. Request the Plan to limit how it uses and gives out your PHI. You will be required to provide specific information as to the disclosures that you wish to restrict and the reasons for your request. Please note that the Plan may not be able to agree to your request. A restriction cannot prevent uses or disclosures that are required by the Secretary of DHHS to determine or investigate the Plan’s compliance with the Privacy Rules, or that are otherwise required by law. You may also request that your health care provider not disclose your PHI for a health care item or service to the Plan for payment or health care operations if you have paid for the item or service out-of-pocket in full. Please note if your health care provider does not disclose the item or service to the Plan, the amount you paid for the item or service will not count toward your annual deductible or any out-of-pocket maximums under the Plan. The provider may also charge you the out-of-network rate for the item or service.
Request Restrictions and Confidential Communications. Request that the Plan’s confidential communications of your PHI be sent to you at another location or by alternative means. The Plan will accommodate your request if it is reasonable and you state clearly that disclosure of all or part of the information could endanger you. Any alternative used must still allow for payment information to be effectively communicated and for payments to be made.
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As most of your PHI under the Plan is held by a claims administrator or insurance carrier (or HMO), you may wish to contact that entity directly to exercise your individual rights. To exercise your individual rights with respect to enrollment and other information, you should contact the Plan’s Information Contact. Certain administrative or other rules may apply to these individual rights.
How do I make a complaint if I think my rights have been violated?
You may file a complaint with the Plan’s Information Contact and with the Secretary of DHHS if you believe the Plan has violated your privacy rights. If your complaint is with an insurer or HMO, you may file a complaint with the individual named in their Notice of Privacy Practices to receive complaints. If your complaint is with the Plan, you may submit your complaint to the Information Contact at the address at the end of this Notice.
To file a complaint with the Secretary of the DHHS, you must submit your complaint in writing, either on paper or electronically, within 180 days of the date you knew or should have known that the violation occurred. You must state who you are complaining about and the acts or omissions you believe are violations of the Privacy Rules. Complaints sent to the Secretary must be addressed to the regional office of the DHHS’ Office of Civil Rights (OCR) for the state in which the alleged violation occurred. For information on which regional office at which you must file your complaint, and the address of that regional office, go to the OCR web site at www.hhs.gov/ocr/hipaa/. You will not be retaliated against for filing a complaint.
Who is the Plan’s Information Contact?
If you have any questions about this Notice, please contact the Information Contact:
Enova International, Inc. Benefits Department 200 Jackson Blvd. Suite 500 Chicago, IL 60606 Phone: 312-648-6251
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What is the effective date of this updated Notice?
The effective date of this updated Notice is July 2012.
How can this Notice be changed?
The Plan reserves the right to change the terms of this Notice with respect to its privacy and information practices and to make the new provisions effective for all PHI it maintains. Any revisions to the Notice, or an amended Notice, will be provided to you electronically or on paper, as appropriate.
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WHCRA ENROLLMENT NOTICE
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (“WHCRA”). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, the deductibles and coinsurance as noted in your Summary Plan Description may apply. If you would like more information on WHCRA benefits, call your plan administrator at the number listed on the back of your medical plan identification card.
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SPECIAL ENROLLMENT NOTICE
You and your eligible dependents may enroll in the medical benefit program offered under the Enova International, Inc. Benefit Plan (the “Plan”) under the following circumstances:
• Individuals Losing Other Coverage. If you declined coverage under the medical benefit program when it was first available because of other health coverage, and that coverage is later lost on account of:
• exhaustion of COBRA continuation coverage,
• Lost Eligibility for Other Coverage, or
• termination of employer contributions toward the other coverage,
you and your eligible dependents may enroll in the medical benefit program on or before the date that is 30 days after the date you lost that other coverage. Your enrollment will take effect no later than the first of the month following your loss of coverage and your timely request to enroll.
“Lost Eligibility for Other Coverage” includes a loss of other health coverage as a result of your legal separation or divorce, a dependent’s loss of dependent status, death, termination of employment or reduction in number of hours of employment, meeting or exceeding a lifetime limit on health benefits, or you no longer reside, live or work in the service area of a health maintenance organization in which you participated.
• New Eligible Dependents. If you initially declined enrollment for yourself or your eligible dependents and you later have a new eligible dependent because of marriage, birth, adoption, or placement for adoption, you may enroll yourself and your new eligible dependents (including an eligible dependent spouse if you have a new eligible dependent child) as long as you request enrollment on or before the date that is 30 days after the marriage, birth, adoption, or placement for adoption. For example, if you and your eligible dependent spouse have a child, you may enroll yourself, your eligible dependent spouse and your new child in the medical benefit program, even if you were not previously enrolled. You will not, however, be able to enroll existing eligible dependent children for whom coverage has been waived in the past. For birth, adoption, or placement for adoption, your or your eligible dependent’s participation will start as of the date of the birth, adoption, or
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placement for adoption, as long as you timely requested enrollment. For marriage, your or your eligible dependent’s participation will start no later than the first of the month following the date of the marriage, as long as you request enrollment and submit proof of dependent status on or before the date that is 30 days after the marriage.
• Medicaid and CHIP. If you or your eligible dependent children are eligible for, but not enrolled in, the medical benefit program and you or your eligible dependent children:
• lose coverage under Medicaid or a State child health plan (“CHIP”), or • become eligible for a premium assistance subsidy through Medicaid or CHIP,
you and your eligible dependent children may enroll in the medical benefit program, as long as you request enrollment on or before the date that is 60 days after the loss of coverage or the date you or your eligible dependent children became eligible for the premium subsidy. Your enrollment will take effect no later than the first of the month following your timely request for enrollment.
These 30-day and 60-day periods are “Special Enrollment Periods.”
To request special enrollment or obtain more information, contact:
Enova International, Inc. Benefits Department 200 Jackson Blvd. Suite 500 Chicago, IL 60606 Phone: 312-648-6251
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NEWBORNS’ ACT DISCLOSURE
The Enova International, Inc. Benefit Plan (the “Plan”) 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, the Plan and insurance issuers may not, under federal law, require that a provider obtain authorization from the Plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
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MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) Offer Free or Low-Cost Health Coverage To Children And Families
If you are eligible for health coverage from Enova International, Inc., but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. 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, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 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, 2012. You should contact your State for further information on eligibility –
ALABAMA – Medicaid COLORADO – Medicaid
Website: http://www.medicaid.alabama.gov Phone: 1-855-692-5447
Medicaid Website: http://www.colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943
ALASKA – Medicaid
Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529
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ARIZONA – CHIP FLORIDA – Medicaid
Website: http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 1-877-764-5437
Phone (Maricopa County): 602-417-5437
Website: https://www.flmedicaidtplrecovery.com/
Phone: 1-877-357-3268
GEORGIA – Medicaid
Website: http://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 1-800-869-1150
IDAHO – Medicaid and CHIP MONTANA – Medicaid
Medicaid Website: www.accesstohealthinsurance.idaho.gov Medicaid Phone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Phone: 1-800-926-2588
Website: http://medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml Phone: 1-800-694-3084
INDIANA – Medicaid NEBRASKA – Medicaid
Website: http://www.in.gov/fssa Phone: 1-800-889-9949
Website: www.ACCESSNebraska.ne.gov Phone: 1-800-383-4278
IOWA – Medicaid NEVADA – Medicaid
Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562
Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900
KANSAS – Medicaid
Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884
KENTUCKY – Medicaid NEW HAMPSHIRE – Medicaid
Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218
LOUISIANA – Medicaid NEW JERSEY – Medicaid and CHIP
Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 1-800-356-1561 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
MAINE – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741
MASSACHUSETTS – Medicaid and CHIP NEW YORK – Medicaid
Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120
Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831
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MINNESOTA – Medicaid NORTH CAROLINA – Medicaid
Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone: 1-800-657-3629
Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100
MISSOURI – Medicaid NORTH DAKOTA – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-800-755-2604
OKLAHOMA – Medicaid and CHIP UTAH – Medicaid and CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
Website: http://health.utah.gov/upp Phone: 1-866-435-7414
OREGON – Medicaid and CHIP VERMONT– Medicaid
Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-877-314-5678
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
PENNSYLVANIA – Medicaid VIRGINIA – Medicaid and CHIP
Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462
Medicaid Website: http://www.dmas.virginia.gov/rcp-HIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.famis.org/ CHIP Phone: 1-866-873-2647
RHODE ISLAND – Medicaid WASHINGTON – Medicaid
Website: www.ohhs.ri.gov Phone: 401-462-5300
Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm Phone: 1-800-562-3022 ext. 15473
SOUTH CAROLINA – Medicaid WEST VIRGINIA – Medicaid
Website: http://www.scdhhs.gov Phone: 1-888-549-0820
Website: www.dhhr.wv.gov/bms/ Phone: 1-877-598-5820, HMS Third Party Liability
SOUTH DAKOTA - Medicaid WISCONSIN – Medicaid
Website: http://dss.sd.gov Phone: 1-888-828-0059
Website: http://www.badgercareplus.org/pubs/p-10095.htm Phone: 1-800-362-3002
TEXAS – Medicaid WYOMING – Medicaid
Website: https://www.gethipptexas.com/ Phone: 1-800-440-0493
Website: http://health.wyo.gov/healthcarefin/equalitycare Phone: 307-777-7531
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To see if any more States have added a premium assistance program since July 31, 2012, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) Document31-877-267-2323, Ext. 61565
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INITIAL PREEXISTING CONDITION NOTICE The medical benefit program offered under the Enova International, Inc. Benefit Plan (the “Medical Benefit Program”) imposes a preexisting condition exclusion. This means that if you have a medical condition before coming to the Medical Benefit Program, you might have to wait a certain period of time before the Medical Benefit Program will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a three-month period that ends the day before your participation in the Medical Benefit Program begins. The preexisting condition exclusion does not apply to pregnancy or to an individual who is under 19 years of age. This exclusion may last up to 12 months from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage.” Most prior health coverage is creditable coverage and can be used to reduce the preexisting condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month exclusion period by your creditable coverage, you should provide a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating creditable coverage. All questions about the preexisting condition exclusion and creditable coverage should be directed to the Benefits Department.