Employee Benefits 2003 - 2004 Plan Year

Employee Benefits2003 - 2004 Plan Year

Strategic Forecasting, Inc.

Gallagher Romine

Table of Contents

• Gallagher Romine Contact Information 1

• Benefits and Customer Service Information 2

• Open Enrollment 3

• Notice Regarding the Women’s Health & Cancer Act 4

• HMO Terms & Conditions 5

• HMO Benefits 6 - 7

• HMO Prescription Drug Incentive 8

• PPO Terms & Conditions 9

• PPO Benefits 10 - 11

• PPO Prescription Drug Incentive 12

• Myths & Facts about Generic Drugs 13

• Dental Benefits 14

• Vision Benefits 15

• Group Term Life & AD&D Benefits 16

• Long Term Disability Benefits 17

Benefit SpecialistGallagher Romine:

Contact Information

Gallagher Romine: We’re Here to Help!

Gallagher Romine is here to act as a liaison in your dealings with insurance carriers. If you are having problems getting claims paid or have questions regarding your coverage, let us deal with the insurance company for you! Please contact anyone at Gallagher Romine with questions regarding your employee benefits package.

Account Manager: Valerie Seymour

Claims Representatives: Jeanne HolyNikki LambertyCheri DillardLydia Lara

Phone: (512) 499-8005 / (800) 492-8005Fax: (512) 499-0412

E-mail: [email protected][email protected][email protected][email protected] [email protected]

The Insurance Company

Gallagher Romine YOU!

Page 1

Benefits & Customer Service Information

The following benefits are offered through Blue Cross Blue Shield:

Medical Insurance HMO Group #: 08807N

PPO Group #: 08807

Customer Service: 800-521-2227

www.bcbstx.com

The following benefits are offered through Jefferson Pilot (formerly Guarantee Life):

Dental Insurance Group #: 01-D005425


www.jpfinancial.com

The following benefits are offered through VSP:

Vision Insurance Group #: 12182159


www.vsp.com

The following benefits are offered through Hartford:

Life Insurance Group #: GLT-707173 Long Term Disability Insurance


www.hartfordlife.com

Page 2

Open Enrollment

The open enrollment period for eligible employees of Strategic Forecasting will be October 1, 2003 to October 31, 2003. The new benefit plan will be effective November 1, 2003. An eligible employee is one who works 30 or more hours per week. Employees are encouraged to add dependents or make any changes to their current level of benefits during this time. Individuals are able to make changes or add dependents without having to provide evidence of insurability. The open enrollment for this plan year will apply to Medical coverage. The open enrollment period is the only time employees may enroll in the above listed coverages or make modifications without the occurrence of a qualifying event (see definition below). Credit will be given towards the satisfaction of the pre-existing limitation clause, if you and/or your dependents have maintained continuous coverage for the past 12 months with no more than a 63 day lapse in coverage. You and/or your dependents will receive a HIPAA certificate at termination from your previous carrier to provide proof of prior coverage. Qualifying Event - an event or change in status which allows an individual to make changes to their level of coverage, outside the open enrollment period, without a penalty. The following are examples of qualifying events: Marriage Divorce Death of a spouse or dependent Birth Adoption Commencement or termination of a spouse’s employment Change from full-time to part-time employment, or vice versa, of employee or spouse Commencement of unpaid leave of absence by employee or spouse Substantial change in insurance coverage of employee or spouse due to spouse’s employment

IRS regulations require that for enrollment due to a qualifying event, change forms must be submitted to your benefits office within 31 days of that qualifying event. Contact your Human Resources office for these forms. This summary of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage. Please refer to your Certificate of Coverage for a complete listing of services, limitations and exclusions. The Certificate of Coverage prevails in the event of discrepancies.

Page 3

Notice Regarding the Women’s Health & Cancer Rights Act of 1998

Under federal law, group health plans and health insurance issuers providingbenefits for a mastectomy must also provide, in connection with themastectomy for which the participant or beneficiary is receiving benefits,coverage for:

reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical

appearance; and prostheses and physical complications of mastectomy, including

lymphedemas;

These benefits must be provided in a manner determined in consultationbetween the attending physician and the patient. These benefits may be subjectto annual deductibles and coinsurance provisions that are appropriate and consistent with other benefits under your plan or coverage.

This summary of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage. Please refer to your Certificate of Coverage for a complete listing of services, limitations and exclusions. The Certificate of Coverage prevails in the event of discrepancies. Page 4

HMO Terms and Conditions

Pre-Existing Condition Limitations: This does not apply to the HMO benefit. You will receive the full benefit regardless of past medical coverage. Non-Network Benefits: The HMO does not offer Non-Network benefits except in the case of life or limb threatening emergencies. Primary Care Physician (PCP): You must seek care from your selected PCP. Women may select an OB/GYN as a secondary PCP. Each family member may utilize a different physician. Copayments: Deductibles do not apply. You will pay a copayment for services. Out-of-Pockets: Copayments apply to the Out-of-Pocket Maximum. Dependent Age Limitation: Your dependent children are eligible for coverage on your medical plan until the age of twenty-five.

This summary of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage. Please refer to your Summary of Benefits for a complete listing of services, limitations and exclusions. The Summary of Benefits prevails in the event of discrepancies.

Page 5

Blue Cross Blue Shield - HMO Generic Prescription Drug Incentive

The “generic incentive” program requires plan participants and their doctors to choose a generic equivalent (when available) over a brand name drug. If a plan participant chooses to purchase a brand name drug when there is a generic equivalent available, they will be charged the co-pay for the generic drug plus the cost difference between the brand and generic drug. Please note that this program will apply even if the prescribing doctor writes the prescription “dispense as written”.

Page 8

PPO Terms and Conditions

Note: Pre-Existing Condition Limitations do not apply to current Strategic Forecasting employees who have been enrolled on the health plan for 12 months.

Pre-Existing Condition Limitations: Conditions treated or diagnosed 6 months prior to your hire date will not be covered for 12 months unless you have maintained continuous coverage for the past 12 months with no more than a 63-day gap in coverage. You should receive a HIPAA certificate at termination from your current carrier to provide proof of coverage. It is important that you keep this certificate and/or complete this section on the new carrier’s application to avoid future claims being denied.

Benefit Payments: For benefits received in the Network, you are responsible only for your copayment or deductible amount and coinsurance. Your provider will file the claim. Benefits for Non-Network visits are payable on a reimbursement basis only. You can be subject to additional charges over the reasonable and customary allowed amount.

Copayment: Copayments for Office visits and Prescription drugs do not count toward the deductible or out-of-pocket maximum.

Dependent Age Limitation: Your dependent children are eligible for coverage on your medical plan until the age of twenty-five.


Page 9

Blue Cross Blue Shield - PPO Generic Prescription Drug Incentive

The “generic incentive” program requires plan participants and their doctors to choose a generic equivalent (when available) over a brand name drug. If a plan participant chooses to purchase a brand name drug when there is a generic equivalent available, they will be charged the co-pay for the brand name drug plus the cost difference between the brand and generic drug. Please note that this program will apply even if the prescribing doctor writes the prescription “dispense as written”.

Page 12

Myths and Facts about Generic DrugsMyth: Generics take longer to act in the

body.Fact: The firm seeking to sell a generic drug

must show that its drug delivers the same amount of active ingredient in the same timeframe as the original product.

Myth: Generics are not as potent as brand-name drugs.

Fact:: The FDA requires generics to have the same quality, strength, purity and stability as brand-name drugs.

Myth: Generics are not as safe as brand-name drugs.

Fact: The FDA requires that all drugs be safe and effective and that their benefits outweigh their risks. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same risk-benefit profile as their brand-name counterparts.

Myth: Brand-name drugs are made in modern manufacturing facilities, and generics are often made in sub-standard facilities.

Fact: The FDA won’t permit drugs to be made in substandard facilities. It conducts about 3,500 inspections a year in all firms to ensure standards are met. Generic firms have facilities comparable to those of brand-name firms. In fact, brand-name firms account for an estimated 50% of generic drug production. They frequently make copies of their own or other brand-name drugs but sell them without the brand name.

Myth: Generic drugs are likely to cause more side effects.

Fact: There is no evidence of this. The FDA monitors reports of adverse drug reactions and has found no difference between generic and brand-name drugs.

FDA Requirements for Brand-Name

and Generic Drugs

For reformulations of a brand-name drug or generic versions of a drug,

FDA reviews data showing the drug

is bioequivalent to the one used in the original safety and efficacy testing.

FDA evaluates the manufacturer’s adherence to good manufacturing practices before the drug is marketed.

FDA reviews the active and inactive ingredients used in the formulation before the drug is marketed.

FDA reviews the actual drug product.

FDA reviews the drug’s labeling.

Manufacturer must seek FDA approval before making major manufacturing changes or reformulating the drug.

Manufacturer must report adverse reactions and serious adverse health effects.

FDA periodically inspects manufacturing plants.

FDA monitors drug quality after approval.

Page 13

Dental Benefits

Deductible: $50 (3 per family)

Preventive Care: 100% (deductible waived)Diagnostic X-raysCLeanings and Examinations (limited to 2 per Cal. Year)Fluoride Treatment (up to age 19; limit 1 per Cal. year)Space Maintainers

Basic Care: 80% after deductibleEmergency TreatmentFillingsDental Sealants (up to age 17)Non-Surgical ExtractionsOral SurgeryEndodontic ServicesPeriodontic Services

Major Care: 50% after deductibleProsthodontic ServicesRestorative Services

Calendar Year Maximum: $1,500

Orthodontia: 50% (deductible waived)(children under age 19)

Orthodontia Lifetime Maximum: $1,500

This summary of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage. Please refer to your Certificate of Coverage for a complete listing of services, limitations and exclusions. The Certificate of Coverage prevails in the event of discrepancies.

Page 14

Group Term Life and AD&D Benefits

Benefit: 1 x Annual Salary

Benefit Maximum: $250,000

Guarantee Issue Amount: $150,000

Age Reductions: 35% at age 6535% at age 7035% at age 7525% at age 8025% at age 85

Age Reductions - the life benefit will be reduced by the respective percentageamounts shown above once an individual has attained age 65, 70, 75,80 and again at 85.

Accidental Death& Dismemberment: 1 x Annual Salary


Page 16

Long Term Disability Insurance

Monthly Benefit: 60% of income

Maximum Monthly Benefit: $10,000

Elimination Period: 90 days

Maximum Benefit Duration: Social Security Normal Retirement Age

Own Occupation: 24 months

Mental / Nervous Limitation: 24 months

Substance Abuse Limitation: 24 months

Benefits Integration: Full Family Direct

Pre-existing Conditions: 3/3/12


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Employee Benefits 2003 - 2004 Plan Year

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