2017 Focus on Benefits
WHAT’S INSIDE
WELCOME TO YOUR BENEFITS ______________________________________________________________________ 2
2017 BENEFIT OVERVIEW ___________________________________________________________________________ 2
CHANGING BENEFIT ELECTIONS _____________________________________________________________________ 3
ELIGIBILITY _______________________________________________________________________________________ 4
YOUR BENEFITS IN DETAIL
HEALTH PLAN OPTIONS_____________________________________________________________________________ 5
HEALTH PLAN OPTIONS AND FEATURES ______________________________________________________________ 6
REALTIME TELEMEDICINE __________________________________________________________________________ 17
DENTAL PLAN BENEFITS AND FEATURES _____________________________________________________________ 19
MY BENEFITS COMMUNICATION ____________________________________________________________________ 21
WHAT ARE THESE GOVERNMENT NOTICES ALL ABOUT? _______________________________________________ 22
HIPAA PORTABILITY NOTICE________________________________________________________________________ 23
CONTINUATION COVERAGE RIGHTS UNDER COBRA ___________________________________________________ 24
NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGE_____________ 27
NOTICE OF PRIVACY PRACTICE _____________________________________________________________________ 32
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ______ 37
NOTICE OF RIGHTS UNDER THE WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 _____________________ 40
We encourage you to read the entire enrollment guide before you enroll.
This is a summary of your benefits only. Certain restrictions and exclusions apply. For exact terms and
conditions, please refer to your Summary Plan Description or Certificate of Coverage. If information in
this summary differs from the Summary Plan Description or Certificate of Coverage, the Summary Plan
Description or Certificate of Coverage is the ruling document.
1
WELCOME TO YOUR BENEFITS
At Manpower, we value our employees and are committed to providing a comprehensive and competitive
benefits package. Since the benefits provided to you are an important part of your total compensation as an
employee of Manpower, you are encouraged to take some time to read this Focus on Benefits and become
familiar with its contents. This guide gives you a brief description of the benefits offered and is not intended to be
a complete source of information on the plans. For more detailed information on each of the plans, please refer to
the Summary Plan Descriptions and Certificate of Coverage.
2017 BENEFIT OVERVIEW
The chart below provides an overview of the basic benefits and optional coverages offered to you and your
eligible dependents (as defined on page 4).
Benefit
Your options
Coverage levels
Cost sharing
Medical
1. MEC (Minimum
Essential Coverage
2. MEC Preferred
(Minimum Essential
Coverage plus additional
Indemnity coverage)
Employee
Employee + Spouse
Employee + Child(ren)
Family
100% Employee Paid
Dental
TransSmile
Employee
Employee + Spouse
Employee + Child(ren)
Family
100% Employee Paid
2
CHANGING BENEFIT ELECTIONS
Making changes to your coverage during the plan
year
To protect the tax advantages of your benefits, Manpower is
required to follow certain IRS rules. These rules effect when you
may change your benefits and what changes you may make.
You may change your benefit elections mid-year for
the following events:
• The addition of dependents due to the birth or adoption of a
child
• Your marriage
• The death of one of your dependents
• A change in the employment status of your spouse or
dependent, including the termination or commencement of
employment, loss of work due to a strike or lockout
• The commencement or return from an unpaid leave of
absence
• Your dependent loses or gains benefit eligibility of an employer’s benefit plan
• Your spouse or dependent's employer’s open enrollment
• Your divorce, legal separation, annulment
Notification must be made within 30 days of the event.
3
ELIGIBILITY
If you are an employee working with Manpower for at least 60 days and 130 or more hours per month you are
eligible to sign up for health insurance benefits.
Your eligible dependents can enroll in some benefits as well. Eligible dependents include:
• Your legal spouse.
• Dependent children up to the age of 26.
• Your physically or mentally disabled children beyond age 26 if meeting specific criteria established by
insurance company.
Ultimately determination of eligibility is based on the terms, conditions and limitation of the plan document. For
more information contact Manpower Human Resources Department.
When coverage begins and ends
The benefit options you choose during this open enrollment are effective February 1, 2017 through January 31,
2018.
New employee benefits become effective first of the month following 60 days of employment and are effective
through January 31, 2018.
Remember, due to Internal Revenue Service (IRS) regulations, changes can only be made to your enrollment
elections during open enrollment or if you experience a qualifying event that allows you to make a change midyear (see page 3).
4
HEALTH PLAN OPTIONS
Manpower is pleased to offer the following medical plans to choose from:
1. Plan option 1 – MEC Plan - Minimum Essential Coverage that provides you with basic coverage required to
satisfy the Individual Mandate of the Affordable Care Act.
2. Plan option 2 – MEC Preferred Plan – Combines the basic coverage of the MEC to satisfy the Individual
Mandate and supplements that coverage with an indemnity policy underwritten by Transamerica Life
Insurance Company.
5
Minimum Essential Coverage
Self-Insured by your employer, this coverage is designed to
satisfy the individual mandate under Health Care Reform
Minimum Essential Coverage (MEC) covers
100% of the CMS-listed Preventative and
Wellness benefits when you visit a network
provider (40% out-of-network).
An Employee can prevent being taxed the
“Individual Mandate” coverage penalty by
purchasing Minimum Essential Coverage
through his/her employer. Beginning in 2014,
Employees will face a tax of the greater of 1%
of adjusted household income or $95 per adult
plus $47.50 per child; in 2015, the greater of
2% of adjusted household income or $325 per
adult plus $162.50 per child; thereafter, the
greater of 2.5% of adjusted household income
or $695 per adult plus $347.50 per child.
PPO Network
The MEC plan utilizes the Multiplan
PPO network for discounts on medical
services. Multiplan provides access to
over 525,000 healthcare professionals,
3,800 hospitals and more than 66,000
ancillary care facilities in every state
contract directly to participate. Multiplan
is the largest independent primary PPO in
the nation.
First dollar coverage with access to one of the
largest national provider networks available
(simple web portal for member’s local or outof-town provider look up) with great discount
savings for MEC benefits. Network savings can
be used for services not covered by MEC.
The PPO discounts continue to apply to
the member’s medical bills even after
your benefits have been exhausted.
Information on accessing either of
these networks will be included in the
fulfillment package that each insured
Employee receives from KBA.
Cost of Coverage
The rates for this insurance are detailed in the
Cost Summary on page 11 of this guide.
To check if your provider is in the
network, go to www.multiplan.com
or speak to a representative at
1-866-680-7427.
6
Minimum Essential Coverage
Descriptions of covered services
23 Covered Preventive Services for Women,
Including Pregnant Women
19 Covered Preventive Services for Adults
1. Abdominal Aortic Aneurysm one time screening
for age 65-75
2. Alcohol Misuse screening and counseling
3. Aspirin use for men ages 45-79 and women ages 55-79 to
prevent CVD when prescribed by a physician
4. Blood Pressure screening
5. Cholesterol screening for adults
6. Colorectal Cancer screening for adults starting at age 50
limited to one every 5 years
7. Depression screening
8. Type 2 Diabetes screening
9. Diet Counseling
10. HIV Screening
11. Immunizations vaccines (Hepatitis A & B, Herpes Zoster,
Human Papillomavirus, Influenza (flu shot), Measles, Mumps,
Rubella, Meningococcal, Pneumococcal, Tetanus, Diptheria,
Pertussis, Varicella)
12. Obesity screening and counseling
13. Sexually Transmitted Infection (STI) prevention counseling
14. Tobacco Use screening and cessation interventions
15. Syphilis screening
16. Hepatitis B screening for non-pregnant adolescents
and adults.
17. Lung Cancer screening- 55-80 years old who smoke 30 packs
a year.
18. Fall Prevention – Physical therapy and vitamin D for 65 and
older at risk for falling
19. Hepatitis C screening for high risk individuals and a onetime
screening for HCV infection if born between 1945-1965.
1. Anemia screening on a routine basis for pregnant
women
2. Bacteriuria urinary tract or other infection screening for
pregnant women
3. BRCA counseling and genetic testing for women at
higher risk
4. Mammogram screenings every other year for women
ages 50 - 74
5. Breast Cancer Chemo Prevention counseling
6. Breastfeeding comprehensive support and counseling
from trained providers, as well as access to breastfeeding
supplies, for pregnant and nursing women.
7. Cervical Cancer screening
8. Chlamydia Infection screening
9. Contraception: Food and Drug Administrationapproved contraceptive methods, sterilization procedures,
and patient education and counseling, not including
abortifacient drugs
10. Domestic and interpersonal violence screening and
counseling for all women
11. Folic Acid supplements for women who may become
pregnant when prescribed by a physician
12. Gestational diabetes screening
13. Gonorrhea screening
14. Hepatitis B screening for pregnant women
15. Human Immunodeficiency Virus (HIV) screening and
counseling
16. Human Papillomavirus (HPV) DNA Test: HPV DNA
testing every three years for women with normal cytology
results who are 30 or older
17. Osteoporosis screening over age 60
18. Rh Incompatibility screening for all pregnant women
and follow-up testing
19. Tobacco Use screening and interventions and
expanded counseling for pregnant tobacco users
20. Sexually Transmitted Infections (STI) counseling
21. Syphilis screening
22. Well-woman visits to obtain recommended preventive
services
23. Aspirin for Preeclampsia prevention or if prescribed
by a physician, for adults aged 50 - 59, to prevent
Cardiovascular Disease and Colorectal Cancer
* Includes routine prenatal visits for pregnant women
7
Minimum Essential Coverage
Descriptions of Covered Services (continued)
29 Covered Preventive Services for Children
1. Alcohol and Drug Use assessments
2. Autism screening for children limited
to two screenings up to 24 months
3. Behavioral assessments for children limited to 5
assessments up to age 17
4. Blood Pressure screening
5. Cervical Dysplasia screening
6. Congenital Hypothyroidism screening
for newborns
7. Depression screening for adolescents
age 12 and older
8. Developmental screening for children under age 3, and
surveillance throughout childhood
9. Dyslipidemia screening for children
10. Fluoride Chemo Prevention supplements for children
without fluoride in their water source when prescribed by a
physician
11. Gonorrhea preventive medication for the eyes of all
newborns
12. Hearing screening for all newborns
13. Height, Weight and Body Mass Index measurements
for children
14. Hematocrit or Hemoglobin screening for children
15. Hemoglobinopathies or sickle cell screening for
newborns
16. HIV screening for adolescents
17. Immunization vaccines for children from birth to age 18;
doses, recommended ages, and recommended populations
vary: Diphtheria, Tetanus, Pertussis, Hepatitis A & B,
Human Papillomavirus, Inactivated Poliovirus, Influenza
(Flu Shot), Measles, Mumps, Rubella, Meningococcal,
Pneumococcal, Rotavirus, Varicella, Haemophilus influenzae
type b
18. Iron supplements for children up to 12 months when
prescribed by a physician
19. Lead screening for children
20. Medical History for all children throughout development
ages: 0 to 11 months,
1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
21. Obesity screening and counseling
22. Oral Health risk assessment for young children up to age
10
23. Phenylketonuria (PKU) screening in newborns
24. Sexually Transmitted Infection (STI) prevention
counseling and screening
for adolescents
25. Tuberculin testing for children
26. Vision screening for all children under the age of 5
27. Skin Cancer Behavioral Counseling – age 10-24 for
exposure to sun
28. Tobacco intervention and counseling for children
29. Fluoride varnish for primary teeth through age 5.
8
Optional Hospital Indemnity Insurance
Underwritten by Transamerica Life Insurance Company
TransChoice® Advance:
Plan 1
Group Limited Benefit Hospital Indemnity Insurance
Daily In-Hospital Indemnity Benefit
Pays per day, up to a max of 31 days per confinement
$100
$50
Outpatient Physician Office Visit Indemnity Benefit
Pays per day, up to max days per calendar year per covered person
Outpatient Diagnostic X-Ray and Laboratory Indemnity Benefit
Pays benefit per day; 2 days per calendar year for Advanced Studies, 2 days per calendar
year for Select Diagnostic tests, 3 days per calendar year for Diagnostic Laboratory tests.
6 day max
Advance Studies
Select Diagnostic
Diagnostic Laboratory
$200
$50
$10
Hospital Confinement
1 day of confinement per year
$500
Daily Inpatient Drug and Alcohol Indemnity Benefit
Pays per day, up to a max of 31 days per year
$100
Daily Inpatient Mental and Nervous Indemnity Benefit
Pays per day, up to a max of 31 days per year
$100
Off-the-Job Accidental Injury Benefit
Pays benefit per day of accident treatment (5 days per calendar year)
$100
Ambulance Indemnity Benefit
Per day in an ambulance, amount listed is for ground ambulance. Benefit pays 3x benefit in air ambulance
$100
Critical Illness Indemnity Benefit and Subsequent Critical Illness Indemnity Benefit
Lump sum benefit for the initial diagnosis of a covered critical illness and an additional
lump-sum benefit of the same amount for subsequent and separate covered critical illness
$5,000
Additional Benefits
Employee
Spouse
Child(ren)
Group Term Life Insurance Policy with
Accidental Death and Dismemberment Rider (AD&D)
AD&D not available to dependent children
$5,000
$2,500
$2,500
Non-Insurance Benefits Included
Employee Discount Card - Offered by New Benefits, LTD
Provides access to a discount Vision plan, Nurses Hotline, Counseling Services, and discounts on Hearing Aids
Patient Advocacy - Offered by The Karis Group
Services that provide employees with unparalleled diligence and dedication to find the best solutions for resolving their
outstanding medical bills
This is a brief summary of TransChoice® Advance Group Limited Benefit Hospital
Indemnity Insurance underwritten by Transamerica Life Insurance Company,
Cedar Rapids, IA. Policy form series CPGHI400 and CCGHI400. Forms and form
numbers may vary. Coverage may not be available in all jurisdictions. Limitations
and exclusions apply. Refer to the policy, certificate and riders for complete
details. THIS IS NOT MAJOR MEDICAL INSURANCE AND IS NOT A
SUBSTITUTE FOR MAJOR MEDICAL INSURANCE.
Note: You will receive a separate ID card for this product. Claims administration
and customer service will be provided by Key Benefit Administrators. See the back
of this guide for claim filing information. An explanation of benefits (EOB) will be
provided on each claim to explain how it was processed.
9
Cost of Insurance
The rates for this insurance are
detailed in the Cost Summary
on page 16 of this guide.
EBD INTOOK 1114
Optional Hospital Indemnity Insurance
Summary of Benefits for TransChoice® Advance: Group Limited Benefit Hospital Indemnity Insurance
underwritten by Transamerica Life Insurance Company
Daily In-Hospital Indemnity Benefit
When a covered person is confined in a hospital as a result of
an accident or sickness, this benefit pays the benefit amount
for each day the insured is confined in a hospital, up to a
maximum of 31 days per confinement.
Off-the-Job Accidental Injury Benefit
This benefit pays the selected amount per day accident
(maximum of 5 days per covered person per calendar year), for
x-rays used to diagnose an accidental injury and for treatment
of a covered accident by a physician in the physician’s office,
clinic, urgent care facility, or hospital emergency room.
Treatment must be received within 96 hours of the accident
for benefits to be payable.
Hospital Confinement
This benefit pays an additional benefit per covered person per
calendar year when he/she receives treatment or surgery while
confined to a hospital as an inpatient as a result of a covered
accident or sickness.
Daily Inpatient Drug and Alcohol Indemnity Benefit
This benefit pays per day if a covered person is confined as an
inpatient in a rehabilitation facility for substance abuse. The
maximum benefit per covered person per calendar year is 31
days. The lifetime maximum for this benefit is $30,000.
Daily Inpatient Mental and Nervous Indemnity Benefit
This benefit pays per day if a covered person is confined
as an inpatient in a rehabilitation facility for a mental or
nervous condition. The maximum benefit per covered person
per calendar year is 31 days. The lifetime maximum for this
benefit is $30,000.
Outpatient Physician Office Visit Indemnity Benefit
This benefit pays the amount shown for the day of a
physician’s office visit as a result of a sickness or accident.
Benefits are payable for a maximum number of days per
calendar year per person.
Outpatient Diagnostic X-Ray
and Laboratory Indemnity Benefit
This benefit pays the amount shown per testing day for tests
performed for the purpose of diagnosis of a covered sickness
or accident as indicated by symptoms that would suggest an
injury or sickness had occurred. The benefit is limited to a
number of days of testing per calendar year per covered person
and is not payable while the insured is confined in a hospital
(i.e. it applies to outpatient services only).
Ambulance Indemnity Benefit
This benefit pays per day of using an air or ground ambulance.
Treatment must be received within 72 hours of the accident
or onset of sickness, and must be provided by a licensed
ambulance company for benefits to be payable.
EBD INTOOK 1114
10
Optional Hospital Indemnity Insurance
Summary of Benefits for TransChoice® Advance: Group Limited Benefit Hospital Indemnity Insurance
underwritten by Transamerica Life Insurance Company
Critical Illness Indemnity Benefits and Subsequent Critical Illness Indemnity Benefit
When an insured person is diagnosed with a covered critical illness, the selected amount will be paid. This amount is payable up to
two times for each insured person, once under the Critical Illness Indemnity Benefit and once under the Subsequent Critical Illness
Indemnity Benefit, and is paid in addition to any other benefits paid by the TransChoice policy. The Subsequent Critical Illness
Indemnity Benefit is paid if the insured person is diagnosed as having a subsequent and separate covered critical illness more than
sixty (60) days after the first covered illness.
For example: If an insured person is diagnosed for the first time with a heart attack, and then is diagnosed with a stroke for the first
time more than sixty (60) days later, he or she will receive the benefit amount selected for each illness. This benefit is payable one
time for each insured person. The Subsequent Critical Illness Indemnity Benefit is not payable for Skin Cancer or Carcinoma in Situ.
100% of the benefit amount is payable for:
- Cancer (including leukemia and Hodgkin’s Disease, except Stage 1 Hodgkin’s Disease)
- Heart Attack (diagnosis must be based on EKG changes consistent with injury elevation of cardiac enzymes, and
confirmatory neuroimaging studies)
- Stroke (diagnosis must be based on documented neurological deficits and confirmatory neuroimaging studies)
- End Stage Renal Failure (chronic, irreversible failure of the function of both kidneys, such that an insured person must undergo
regular hemodialysis or peritoneal dialysis at least weekly)
- Major Organ Transplant (undergoing surgery as a recipient of a transplant of a human heart, lung, liver, kidney, or pancreas)
5% of the benefit amount is payable for:
- Skin cancer including basal cell epitheloma or squamous cell carcinoma; does not include malignant melanoma or mycosis
fungoides
- Carcinoma In Situ (cancer that is confined to the site of origin without having invaded neighboring tissue)
* Dependent insurance equal to 50% of this benefit
11
EBD INTOOK 1114
Optional Hospital Indemnity Insurance
Additional Benefit Descriptions
Group Term Life Insurance Policy with Accidental Death and Dismemberment Rider
Policy Form Series CP100200 and CP100400
This policy pays the benefit amount shown upon the death of the insured, subject to any limitations/exclusions. The AD&D benefit
amount will match the amount of group term life insurance.
Exclusions
We will not pay any benefits if the loss, directly or indirectly,
results from any of the following, even if the means or cause of
the loss is accidental:
- suicide or intentionally self-inflicted injury, while sane or
insane;
- commission of or attempt to commit an assault or felony;
- sickness or mental illness, disease of any kind, or medical or
surgical treatment for any sickness, illness or disease;
- injuries received while under the influence of alcohol, a
controlled substance or other drugs as defined by the laws of
the State where the accident occurs, except as prescribed by a
doctor;
- any poison or gas voluntarily taken, administered, absorbed, or
inhaled (except in the course of employment);
- flight in any kind of aircraft, except as a fare paying passenger
on a regularly scheduled commercial aircraft;
- any bacterial or viral infection;
- declared or undeclared war, or any act of war; and
- taking part in an insurrection.
Under the AD&D Rider, when a covered accident results in
any of the following losses, benefits are paid for the following
specified percentages of the coverage amount subject to any
limitations and exclusions.
Age Reduction
Death benefits automatically reduce to the following
percentages, or flat amount, on the Group Master policy
Anniversary Date that follows the applicable birthday, as follows:
Only one such amount will be paid as a result of a single covered accident
This Rider stops on the Employee’s/member’s 70th birthday.
Schedule
65% of pre-age 65 death benefit
65th
70th
25% of pre-age 65 death benefit
75th
The lesser of $5,000 or 25% of pre-age 65
death benefit
80th
Percentage
Paid
Loss of life or loss of two or more members
(hand, foot, sight of an eye)
100%
Quadriplegia
(total and permanent paralysis of both upper and lower
limbs)
100%
Loss of speech AND hearing in both ears
100%
Paraplegia (loss or paralysis of both lower limbs)
75%
Loss of one member, or loss of speech, or loss of hearing in
both ears
50%
Hemiplegia (total and permanent paralysis
of the upper and lower limbs of one side of the body)
50%
Loss of hearing of one ear, or loss of thumb
and index finger of same hand
25%
This is a brief summary of Group Term Life Insurance
underwritten by Transamerica Life Insurance Company,
Cedar Rapids, Iowa 54299. Policy form series CP100200 and
CC100400; Rider form series CR101100. Forms and form
numbers may vary. Coverage may not be available in all
jurisdictions. Limitations and exclusions apply. Refer to the
policy, certificate, and riders for complete details.
Birthday
50% of pre-age 65 death benefit
EBD INTOOK 1114
Loss
12
Optional Hospital Indemnity Insurance
Non-Insurance Benefit Descriptions
Employee Discount Card
This discount card is provided by New Benefits, LTD. It offers
Employees access to a discount Vision Plan, a Nurses Hotline,
Counseling Services and benefits for Hearing Aids. This is
not an insurance plan. The discount Vision Plan through
the Coast to Coast network allows the Employee to receive
discounts of 20% to 60% on eyeglasses, non-prescription
sunglasses, contact lenses (including disposables) and frames
from over 10,000 independent retail optical locations
nationwide. Providers include independent practitioners,
regional chains, department store opticals, and the largest
chains in the U.S. Some of these providers are LensCrafters,
Pearle Vision, Sears Optical and JC Penney Optical
(among others).*
Patient Advocacy
Even with exceptional PPO discounts and rich reimbursement
schedules, employees of limited benefit medical plans may
be left with unpaid medical bills in years when medical
bills approach $3,500 or more. For these individuals, Karis’
Patient Advocacy service becomes the critical missing piece
and an invaluable benefit for customers. Since we treat each
employee, locality and provider as a unique combination
of variables that leads to a customized solution for each
employee, Karis delivers a customized and comprehensive
solution that goes far beyond the benefits of a one size fits
all PPO network discount. When reimbursement limits
are reached, our services kick in and provide employees
with unparalleled diligence and dedication to find the best
solutions for resolving their outstanding medical bills.
The Nurses Hotline allows access to experienced registered
nurses 24 hours a day, 7 days a week, 365 days a year. These
hotline nurses are an immediate, reliable and caring source of
health information, education and support. Services provided
by this plan include:
For employees who find themselves unable to pay bills that
exceed Limited Benefit Medical plan reimbursements, Karis
can come alongside to advocate on their behalf, working
with every provider to find a mutually agreeable solution.
Karis’ highly trained and experienced “Employee Advocates”
guide employees through the tangled maze of medical billing.
Initially, we research the availability of entitlement or
financial assistance programs in an effort to locate outside
funding sources to help pay their bills. If an employee qualifies
for such programs, their Employee Advocate will hold their
hand throughout what can be a lengthy process and will
do everything for the employee from acquiring necessary
paperwork to chasing decision makers. If an employee does
not qualify for entitlement or financial assistance programs,
their Employee Advocate will try to negotiate a reduced
settlement or reduced/extended payment plan with providers
that is acceptable to all parties.
o General information on all types of health concerns
o Information based on physician-approved guidelines
o Answers about medication usage and interaction
o Information on non-medical support groups
o Translation services for non-English speaking callers
o Full time medical director on staff
The Counseling Services benefit allows the Employee
to speak with a counselor 24 hours a day, 7 days a week
regarding any personal problems they may be facing. In
addition, if the Employee is referred to one of the 27,000
counseling providers nationwide, they will receive discounts
of 25% to 30% off the normal billing charges from those
providers.*
Catamaran Rx Card
The Catamaran Managed Rx Card offers savings on
prescription drugs, as well as healthcare services. It is designed
to help people afford their prescription drug costs. Our card
offers members a solution to keep medication costs down at
leading pharmacies throughout the country. Save up to
85% on both brand-name and generic medications. All
medications are eligible for discounts, including OTC
medications as well as diabetes supplies and pet medications
(where there is a human equivalent). It is accepted at more
than 60,000 pharmacies throughout the country, including
nearly every major pharmacy chain as well as thousands of
independent pharmacies.
The Hearing Aid benefit provides savings of up to 15% off
the retail cost on over 70 models of hearing aids, and a free
hearing test when utilizing one of the 1,200 participating
Beltone® locations nationwide. Or, the Employees can realize
savings of up to 50% off suggested retail price on over 90
models of hearing aids in over 1,000 locations nationwide.*
Information on how to access the benefits of the Employee
Discount card will be included in the fulfillment package that
each insured Employee receives from KBA.
* Discounts on professional services are not available
where prohibited by law.
13
EBD INTOOK 1114
Optional Hospital Indemnity Insurance
Limitations & Exclusions for TransChoice® Advance: Group Limited Benefit Hospital Indemnity Insurance
underwritten by Transamerica Life Insurance Company
Confinement for the same or related condition within 30 days of discharge will be treated as a continuation of the prior confinement.
Successive confinements separated by more than 30 days will be treated as a new and separate confinement.
No benefits under this contract will be payable as the result of the following:
• Suicide or attempted suicide, whether while sane or insane.
• Intentionally self-inflicted injury.
• Rest care or rehabilitative care and treatment.
• Immunization shifts and routine examinations such as: physical examinations, mammograms, Pap smears, immunizations, flexible sigmoidoscopy,
prostate-specific antigen tests and blood screenings (unless Wellness Indemnity Benefit Rider is included).
• Any pregnancy of a dependent child including confinement rendered to her child after birth.
• Routine newborn care (unless Wellness Indemnity Benefit Rider is included).
• A covered person’s abortion, except for medically necessary abortions performed to save the mother’s life
• Treatment of mental or emotional disorder (unless Inpatient Mental and Nervous Disorder Indemnity Benefit Rider is included).
• Treatment of alcoholism or drug addiction (unless Inpatient Drug and Alcohol Addiction Indemnity Benefit Rider is included).
• Participation in a felony, riot, or insurrection.
• Any accident caused by the participation in any activity or event, including the operation of a vehicle, while under the influence of a controlled
substance (unless administered by a physician or taken according to the physician’s instructions) or while intoxicated (intoxicated means that
condition as defined by the law of the jurisdiction in which the accident occurred).
• Dental care or treatment, except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident and
except for dental care or treatment necessary due to congenital disease or anomaly.
• Sex change, reversal of tubal ligation or reversal of vasectomy.
• Artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications or physician’s services, unless
required by law.
• Committing, attempting to commit, or taking part in a felony or assault, or engaging in an illegal occupation.
• Traveling in or descending from any vehicle or device for aerial navigation, except as a fare-paying passenger in an aircraft operated by a
commercial airline (other than a charter airline) on a regularly scheduled passenger trip.
• Any loss incurred on active duty status in the armed forces. (If you notify us of such active duty, we will refund any premiums paid for any period
for which no coverage is provided as a result of this exception.)
• An accident or sickness arising out of or in the course of any occupation for compensation, wage or profit or for which benefits may be payable
under an Occupational Disease Law or similar law, whether or not application for such benefits has been made.
• Involvement in any war or act of war, whether declared or undeclared
Termination of Insurance
The insurance terminates on the earliest of:
• The insured’s death.
• The premium due date when we fail to receive a premium,
subject to the grace period.
• The date of written notice to cancel coverage.
• The date the policy terminates, subject to the portability option.
• The date the insured ceases to be eligible for coverage.
Extension of Benefits
Whenever termination of coverage under this section occurs
due to termination of Your employment or membership, such
termination will be without prejudice to:
Dependent coverage ends on the earliest of:
• The date the insured’s coverage terminates for any of the reasons above.
• The date the dependent no longer meets the definition of a dependent.
• The premium due date when we fail to receive a premium,
subject to the grace period.
• The date of written notice to cancel coverage.
• The date the policy is modified so as to exclude dependent coverage.
The insurance company has the right to terminate the coverage of any
insured who submits a fraudulent claim. Termination will not impact any
claim which begins before the date of termination.
EBD INTOOK 1114
14
1. Any Hospital Confinement which commenced while
coverage was in force, with respect to Daily In-Hospital
Indemnity Benefits; or,
2. Any covered treatment or service for which benefits would
be provided and which commenced while coverage was
in force; provided, however, that the Covered Person is and
continues to be Hospital Confined or Disabled.
Such Extension of Benefits will continue for up to the earlier of:
1. 30 days; or
2. The date on which the Covered Person is no longer disabled.
This product aloneDOES NOT MEET
MINIMUM CREDITABLE COVERAGE
STANDARDS and WILL NOT SATISFY the
Affordable Care Act individual mandate
that you have health insurance.
Cost
Summary
Minimum Essential Coverage
Self-Insured by your employer, this coverage is designed to satisfy the
individual mandate under Health Care Reform
Monthly Cost†
Employee
Employee + Spouse
Employee + Child(ren)
MEC
$58.23
$87.71
$149.55
Family
$179.03
Optional TransChoice® Advance:
Group Limited Benefit Hospital Indemnity Insurance
underwritten by Transamerica Life Insurance Company
* This alone does not satisfy the individual mandate under Health Care Reform
Monthly Cost†
Employee
Employee + Spouse
Employee + Child(ren)
Family
Plan 1
$47.56
$87.54
$64.12
$97.90
This policy alone does
not satisfy the ACA
individual mandate
Manpower requires you to purchase KeySolution Minimum
Essential Coverage to be eligible to purchase the
TransChoice® Advance Hospital Indemnity Insurance,
your total cost will be
Monthly Cost† Combined
Employee $105.79
Employee + Spouse $175.25
Employee + Child(ren) $213.67
Family $276.93
† Rates assume premiums are currently and will continue to be remitted in advance of the effective date.
Rates shown include insurance premiums and administrative fees for continuation and billing costs.
15
Frequently Asked Questions
How Can You Participate?
All employees working 130 hours a month or more
are eligible to enroll after a minimum 30 day
waiting period. You will be effective the first of
the month following 60 days of eligibility. Eligible
dependents include spouses and children or
stepchildren, under age 26.
What if I do not enroll?
Group health benefits have been offered to
you through an open enrollment. If you do not
affirmatively elect benefits during this open
enrollment, you will be unable to elect such
insurance until the next open enrollment period
unless you experience a change in status that
entitles you to a special enrollment period.
How Are Premium Payments Made?
Premiums will be taken through payroll deduction.
The first month’s premium is taken in full the last
pay date of the month preceding coverage effective
date. Example, coverage starts February 1st, 2017,
the total February premium will be taken the last
pay date in January. Then starting with the first
pay date in February we will take weekly
deductions. Example $58.23 monthly equals $13.44
weekly.
Can I Sign Up For Insurance At Any Time?
No. You must sign up for insurance in the first
30 days of becoming eligible. If you do not elect
to enroll in the first 30 days, you will not be able
to enroll until the next open enrollment period
unless you experience a qualifying event.
Can I Cancel Insurance At Any Time?
Premiums are paid with pre-tax dollars through
payroll deductions as part of a Section 125
Savings Plan. You will not be able to change
these elections until the next annual enrollment
period, unless you have a qualifying event.
When Will My Insurance End?
Your insurance will end when you no longer qualify
or when your premium payments end, whichever
comes first. Insurance on dependents ends on either
the date they no longer meet the definition of a
dependent or, the date your insurance terminates,
whichever comes first.
When can I expect to receive the Member Kit?
The member kit will typically be mailed to you
approximately 7-10 business days after your first
payroll deduction. Please allow three weeks for
this kit to arrive in your mailbox.
What Is An Indemnity Benefit?
It means that the insurance company will pay a set
amount each time the insured receives a covered
service. The same amount is paid regardless of the
fees charged by the provider.
Is my doctor in the network?
To check if your provider is in the network, go to
www.multiplan.com or speak to a representative at
1-866-680-7427.
EBD INTOOK 1114
16
RealTime Telemedicine
17
RealTime Telemedicine
18
TransSmile®
Group Dental Insurance
Underwritten by Transamerica Life Insurance Company, Home Office Cedar Rapids, IA.
Choose any dentist! Routine, preventative services are available from the first day of coverage. Access to responsive, professional
customer care personnel for assistance with claims questions. Use the extensive network of highly qualified providers to enjoy significant
savings on out of pocket costs associated with dental services. Automated claims processing results in an average turnaround time of less
than four days!
Deductible Limitations
- Deductible does not apply to Type 1 Services
- $50 Per Person Each Calendar Year on Type 2 and 3 Services.
Annual Individual Benefit Maximum
- $1,000 Per Person Per Calendar Year
Waiting Periods
- Employees may enroll in the dental plan after they have satisfied
the group’s probation period. However, there are waiting periods
for certain services. The probation period is the amount of time
employees must be employed before becoming eligible to enroll.
- Type 3 Services will not be covered until after a person is enrolled
in the dental plan for 12 consecutive months.
Your Dental Plan:
- Type 1 - Diagnostic and Preventative Services - Pays 80%
- Type 2 - Basic Restorative Services - Pays 50%
- Type 3 - Major Restorative Services - Pays 50%
Policy Form Series CPDEN100 and CCDEN100
Type 1 - Diagnostic and Preventative Services - Pays 80%
- Routine periodic examinations not more than once in any six
consecutive month period, inclusive of an initial oral examination.
- Prophylaxis (cleaning) not more than once in any six consecutive
month period.
- Topical application of fluoride once in any 12 consecutive month
period for dependent children 15 years of age and under.
- Bitewings one set in any 12 consecutive month period.
- Sealants once per tooth on permanent maxillary and mandibular
first and second molars with no caries (decay) on the occlusal
surface, for dependent children 14 years of age or under.
- Space maintainers for prematurely lost teeth of eligible dependent
children 13 years of age and under.
Type 3 - Major Restorative Services - Pays 50%
- Endodontics includes pulpal therapy and root canal filling.
- Oral Surgery, including pre- and post-operative care and surgical
and simple extractions, except TMJ surgery.
- Surgical Periodontics includes surgical procedures for the
disease of the gums and bone supporting the teeth.
- Non-Surgical Periodontics includes surgical procedures for the
disease of the gums and bone supporting the teeth.
- Periodontal Maintenance once in any six-month consecutive
benefit period following active periodontal treatment.
- Stainless Steel Crowns used as a restoration to natural teeth for
dependent children 15 years of age and under when the teeth
cannot be restored with a filling material.
- Crowns, Inlays, Onlays, and Veneers are benefits for the
treatment of visible decay and fractures of tooth structure
when teeth are so badly damaged they cannot be restored with
amalgam or composite restorations.
- Complete or Partial Denture Reline chair side or laboratory
procedure to improve the fit of the appliance to the tissue (gums).
- Complete or Partial Denture Rebase laboratory replacement of
the acylic base of the appliance.
- Repairs to Complete and Partial Dentures
- Prosthodontics procedures for construction of fixed bridges,
partial or complete dentures.
- Implants are payable as a less expensive alternative benefit to
prosthodontics and only to replace a tooth or teeth that were
extracted while covered under the Policy.
Type 2 - Basic Restorative Services - Pays 50%
- Minor emergency treatment for the relief of pain as needed by
the Participant.
- Amalgam (silver) and composite/resin (white) fillings
(composites are not a covered benefit on molars).
- Periapical X-rays four in any 12 consecutive month period.
- Full-mouth X-rays once in any five year period.
- Simple Extractions
Monthly Premiums
Employee
Employee + Spouse
Employee + Child(ren)
Family
$21.67
$42.21
$45.91
$70.94
Employee participation in the Group Hospital Indemnity plan
is required to elect this coverage
19
TransSmile®
Group Dental Insurance
Underwritten by Transamerica Life Insurance Company, Home Office Cedar Rapids, IA.
Limitations and Exclusions:
Covered Dental Expenses do not include, and no benefits are provided, for the following:
1. Services which are not included in the List of Covered Dental Services; which are not necessary; or for which a charge would not have been
made in the absence of insurance.
2. Any Service which may not reasonably be expected to successfully correct the Insured Person’s dental condition for a period of at least 3 years,
as determined by Us.
3. Any Service provided primarily for cosmetic purposes. Facings on crowns or bridge units on molar teeth and composite resin restorations on
molar teeth will always be considered cosmetic.
4. Implants; charges for the insertion of implants or related appliances; or the surgical removal of implants (unless the Policy includes the Implant
Benefits Rider).
5. Athletic mouth guards; myofunctional therapy; infection control; precision or semi-precision attachments; denture duplication; oral hygiene
instruction; separate charges for acid etch; broken appointments; treatment of jaw fractures; orthognathic surgery; completion of claim forms;
exams required by a third party other than Transamerica Life Insurance Company; personal supplies (e.g., water pik, toothbrush, floss holder,
etc.); or replacement of lost or stolen appliances.
6. Charges for travel time; transportation costs; or professional advice given on the phone.
7. Orthodontic treatment (unless the Policy includes the Orthodontic Benefits Rider).
8. Services that are a covered expense under any other plan that is provided by the Policyholder and under which You are eligible for coverage.
9. Services performed by a Dentist who is member of the Insured Person’s family. Insured Person’s family is limited to a spouse, siblings, parents,
children, grandparents, and the spouse’s siblings and parents.
10. Any charges, including ancillary charges, made by a hospital, ambulatory surgical center or similar facility.
11. Any Service required directly or indirectly to diagnose or treat a muscular, neural, or skeletal disorder, dysfunction, or disease of the
temporomandibular joints or their associated structures (unless the Policy includes the TMJ Benefits Rider).
12. Any charge for a Service performed outside of theUnited Statesother than for Emergency Treatment. Benefits for Emergency Treatment
performed outside of the United Statesare limited to a maximum of $100 per year per Insured Person.
13. Any charge for a Service required as a result of disease or injury that is due to war or an act of war (whether declared or undeclared); taking
part in an insurrection or riot; the commission or attempted commission of a crime; an intentionally self-inflicted injury or attempted suicide
while sane or insane.
14. Any charge for a Service for which benefits are available under Worker’s Compensation or an Occupational Disease Act or Law, even if the
Insured Person did not purchase the coverage that is available.
15. Any Service for which the Insured Person is not required to pay, unless the payment of benefits is mandated by law and then only to the extent
required by law.
16. Benefits to correct congenital or developmental malformations.
17. Charges for services when a claim is received for payment more than 12 months after services are rendered.
18. Charges for complete occlusal guards, enamel microabrasion, odontoplasty, and bleaching.
19. For specialized techniques that entail procedure and process over and above that which is normally adequate, any additional fee is the
Participant’s responsibility.
20. Behavior management.
21. Charges for general anesthesia/intravenous sedation are not covered, except when administered in conjunction with covered oral surgery and
unusual medical circumstances require the use of general anesthesia as determined by Our Administrator’s dental consultants.
22. Charges for desensitizing medicines, home care medicines, premedications, stress breakers, coping, office visits before or after regularly
scheduled hours, case presentations, and hospital-related services.
23. Charges for treatment by other than a Dentist except that a licensed hygienist may perform services in accordance with applicable law. Services
must be under the supervision and guidance of the Dentist in accordance with generally accepted dental standards.
24. Benefits for services or appliances Started prior to the date the Person became eligible under this plan, including, but not limited to,
restorations, prosthodontics, and orthodontics.
25. Services for increasing the vertical dimension or for restoring tooth structure lost by attrition, for rebuilding or maintaining occlusal services,
or for stabilizing the teeth.
26. Experimental and/or investigational services, supplies, care and treatment which do not constitute accepted medical practice within the range
of appropriate medical practice under the standards of the case and under the standards of a qualified, responsible, relevant segment of the
medical and dental community or government oversight agencies at the time services were rendered. Drugs are considered experimental if
they are not commercially available for purchase or are not approved by the Food and Drug Administration for general use.
27. Services for the replacement of a Missing Tooth.
20
MY BENEFITS COMMUNICATION
The My Benefits Communication tool allows you to listen to the benefits presentation at your convenience. You
can access the presentation right from your Employee Access site. This is currently available for all employees
and can be viewed 24/7. You can also use this to help inform your dependents of key information about your
benefits.
Accessing your My Benefits Communication
1. Go to https://www.associatedbrc.com/Employee-Access-Login
2. On the left side of the page, click on Employee Access Login.
3. Enter the username and password, and click Login.
Username: Associates123
Password: Manpower!2017
Answer to Security Question: Who is your employer? Manpower
4. On left menu select “Presentation”
5. Select “2017 Benefits Presentation”
6. Select 2017 Recorded Associates Benefits Presentation”
7. Presentation will begin
8. On the left menu select “Forms” all Enrollment Guides and Forms can be found there
21
WHAT ARE THESE GOVERNMENT NOTICES ALL ABOUT?
Following this page, are several notices that the federal government requires us to give individuals who are
covered under our group health plan(s). The purpose of these notices is to inform you of certain rights you and
your family may have under federal law. In addition to rights under federal law, you may have rights under state
law.
You may find it helpful to review this information as you make your benefit enrollment decisions. Please keep
this information with your other written plan materials.
1. HIPAA Portability Notice (new hires)
2. Initial COBRA Notice (new hires)
3. Notice of Exchange (new hires)
4. HIPAA Notice of Privacy Practices (open enrollment)
5. CHIP Notice (open enrollment)
6. WHCRA Notice (open enrollment)
22
HIPAA PORTABILITY NOTICE
Our records show that you are eligible to participate in the company’s Group Health Plan (to actually participate,
you must complete an enrollment form and pay your share of the premium). A federal law called HIPAA
requires that we notify you about some important provisions in the plan.
Special enrollment rights
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health
insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if
you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards
your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or
your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you
may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after
the marriage, birth, adoption, or placement for adoption.
If you are declining enrollment because you and/or your dependents are covered under a Medicaid plan or state
Child Health Plan (CHIP) and that coverage is terminated due to a loss of eligibility, you may be able to enroll
yourself and your dependents in this plan. However, you must request enrollment within 60 days after the date
that termination of such coverage occurred and meet certain other important conditions described in the
Summary Plan Description.
If you and/or your dependents are determined to be eligible under a state’s Medicaid plan or state Child Health
Plan (CHIP) for premium subsidy assistance, you may be able to enroll yourself and your dependents in this
plan. However, you must request enrollment within 60 days of the determination of eligibility for premium
subsidy assistance for you or your dependents and meet certain other important conditions as described in the
respective Summary Plan Description.
To request special enrollment or obtain more information, contact Manpower Human Resources Department.
23
CONTINUATION COVERAGE RIGHTS UNDER COBRA
Introduction
You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice
has important information about your right to COBRA continuation coverage, which is a temporary extension of
coverage under the Plan. This notice explains COBRA continuation coverage, when it may become
available to you and your family, and what you need to do to protect your right to get it. When you become
eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA
continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other
members of your family when group health coverage would otherwise end. For more information about your
rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan
Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may
be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage
through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket
costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for
which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life
event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a
qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified
beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage
under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA
continuation coverage may be required to pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of
the following qualifying events:
• Your hours of employment are reduced, or
• Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the
Plan because of the following qualifying events:
• Your spouse dies;
• Your spouse’s hours of employment are reduced;
• Your spouse’s employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.
24
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the
following qualifying events:
• The parent-employee dies;
• The parent-employee’s hours of employment are reduced;
• The parent-employee’s employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator
has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the
following qualifying events:
• The end of employment or reduction of hours of employment;
• Death of the employee;
• The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent
child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within
60 days after the qualifying event occurs. You must provide this notice to your Human Resources
Department.
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage
will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to
elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of
their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to
employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event
during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled
and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to
get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The
disability would have to have started at some time before the 60th day of COBRA continuation coverage
and must last at least until the end of the 18-month period of COBRA continuation coverage.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation
coverage, the spouse and dependent children in your family can get up to 18 additional months of
COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the
25
second qualifying event. This extension may be available to the spouse and any dependent children
getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to
Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent
child stops being eligible under the Plan as a dependent child. This extension is only available if the
second qualifying event would have caused the spouse or dependent child to lose coverage under the
Plan had the first qualifying event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and
your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options
(such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost
less than COBRA continuation coverage. You can learn more about many of these options at
www.healthcare.gov.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact
or contacts identified below. For more information about your rights under the Employee Retirement Income
Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws
affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s
Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa (addresses and
phone numbers of Regional and District EBSA Offices are available through EBSA’s website). For more
information about the Marketplace, visit www.HealthCare.gov.
Keep your plan informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family
members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Plan contact information
Manpower, Human Resources Department – 1119 Regis Court STE 260, Eau Claire, WI 54701
26
NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND
YOUR HEALTH COVERAGE
PART A: General information
Since 2014, individuals can purchase health insurance through the Health Insurance Marketplace. To assist you
as you evaluate options for you and your family, this notice provides some basic information about the
Marketplace and employment-based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The
Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be
eligible for a tax credit that lowers your monthly premium right away. Open enrollment for health insurance
coverage through the Marketplace begins in November for coverage starting as early as January 1st.
Can I save money on my health insurance premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer
coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're
eligible for depends on your household income.
Does employer health coverage affect eligibility for premium savings through the
Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be
eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan.
However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain costsharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain
standards. If the cost of a plan from your employer that would cover you (and not any other members of your
family) is more than 9.5% of your household income for the year, or if the coverage your employer provides
does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax
credit 1.
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by
your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also,
this employer contribution -as well as your employee contribution to employer-offered coverage- is often
excluded from income for Federal and State income tax purposes. Your payments for coverage through the
Marketplace are made on an after-tax basis.
How can I get more information?
For more information about your coverage offered by your employer, please check your summary plan
description or contact Manpower Human Resources Department.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through
the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application
for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
1
An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of
such costs.
27
PART B: Information about health coverage offered by your employer
This section contains information about any health coverage offered by your employer. If you decide to
complete an application for coverage in the Marketplace, you will be asked to provide this information. This
information is numbered to correspond to the Marketplace application.
1.
Employer name: Manpower
2.
Employer Identification Number (EIN):
Wisconsin / Minnesota – D Mark Group 39-1303150
Florida – J Mark Group 59-3114570
Iowa – Manpower of Des Moines 42-0731249
3.
Employer address: 1119 Regis Court STE 260, Eau Claire, WI 54701
4.
Employer phone number: 715.552.9126
5.
Who can we contact about employee health coverage at this job?: Manpower Human Resources Department
Here is some basic information about health coverage offered by this employer
As your employer, we offer a health plan to:
All full time employees.
Some employees.
With respect to dependents:
We do offer coverage.
We do not offer coverage.
If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is
intended to be affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium
discount through the Marketplace. The Marketplace will use your household income, along with other
factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary
from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are
newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
28
Important Notice from D Mark Group Inc., dba Manpower 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 D Mark Group Inc., dba Manpower and about your options under Medicare’s
prescription drug coverage. This information can help you decide whether or not you want to join a Medicare
drug plan. Information about where you can get help to make decisions about your prescription drug coverage is
at the end of this notice.
There are three 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. D Mark Group Inc., dba Manpower has determined that the prescription drug coverage offered by the Key
Benefit Administrator Minimum Essential Coverage (MEC) and the MEC Preferred is, on average for all
plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays.
Therefore, your coverage is considered Non-Creditable Coverage. This is important because, most likely,
you will get more help with your drug costs if you join a Medicare drug plan, than if you only have
prescription drug coverage from the MEC or MEC Preferred This also is important because it may mean that
you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become
eligible.
3. You can keep your current coverage from Key Benefit Administrators. However, because your coverage is
non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how
much you pay for that coverage, depending on if and when you join a drug plan. When you make your
decision, you should compare your current coverage, including what drugs are covered, with the coverage
and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully it explains your options.
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
through December 7th.
However, if you decide to drop your current coverage with D Mark Group Inc., dba Manpower since it is
employer sponsored group coverage, you will be eligible for a two (2) month Special Enrollment Period (SEP) to
join a Medicare drug plan; however you also may pay a higher premium (a penalty) because you did not have
creditable coverage under the MEC or MEC Preferred
If the status of the MEC or MEC Preferred has changed from creditable to non-creditable, you are also eligible
for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan from the date of the change or
the date of this notice, whichever is later.
29
When will you pay a higher premium (penalty) to join a Medicare drug plan?
Since the coverage under MEC or MEC Preferred is not creditable, depending on how long you go without
creditable prescription drug coverage, you may pay a penalty to join a Medicare drug plan. Starting with the end
of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if you go 63 continuous
days or longer without prescription drug coverage that’s creditable, your monthly premium may go up by at least
1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage.
For example, if you go nineteen months without creditable coverage, your premium may consistently be at least
19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (penalty) as
long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following
October to join.
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 D Mark Group Inc., dba Manpower coverage will not in most cases, enrolling in a Medicare drug plan will not affect a participant’s benefits under your health plan be
affected.
If you do decide to join a Medicare drug plan and drop your current D Mark Group Inc., dba Manpower
coverage, be aware that you and your dependents may not be able to get this coverage back right away or at all.
Please review the D Mark Group Inc., dba Manpower health plan documents for details regarding eligibility and
enrollment rights.
For more information about this notice or your current prescription drug coverage…
Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also
get it before the next period you can join a Medicare drug plan and if this coverage through D Mark Group Inc.,
dba Manpower changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare &
You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be
contacted directly by Medicare 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.
30
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).
Date: 02-01-2017
Name of Entity/Sender: D Mark Group Inc., dba Manpower
Contact--Position/Office: Cheryl Johnson – Benefits Specialist
Address: 1119 Regis Court, Suite 260 Eau Claire, WI 54701
Phone Number: (715) 552-9126
31
NOTICE OF PRIVACY PRACTICE
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access
to this information. Please review it carefully.
Your rights
You have the right to:
• Get a copy of your health and claims records
• Correct your health and claims records
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
Your choices
You have some choices in the way that we use and share information as we:
• Answer coverage questions from your family and friends
• Provide disaster relief
• Market our services and sell your information
Our uses and disclosures
• We may use and share your information as we:
• Help manage the health care treatment you receive
• Run our organization
• Pay for your health services
• Administer your health plan
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests and work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
32
Your rights
When it comes to your health information, you have certain rights. This section explains your rights and
some of our responsibilities to help you.
Get a copy of health and claims records
• You can ask to see or get a copy of your health and claims records and other health information we have
about you. Ask us how to do this.
• We will provide a copy or a summary of your health and claims records, usually within 30 days of your
request. We may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us
how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a
different address.
• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do
not.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to
the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and
certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but
will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice
electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can
exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
33
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by
sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775 or
visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
Your choices
For certain health information, you can tell us your choices about what we share. If you have a clear
preference for how we share your information in the situations described below, talk to us. Tell us what you
want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in payment for your care
• Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share
your information if we believe it is in your best interest. We may also share your information when needed to
lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
Our uses and disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional
services.
Run our organization
• We can use and disclose your information to run our organization and contact you when necessary.
• We are not allowed to use genetic information to decide whether we will give you coverage and the price of
that coverage. This does not apply to long-term care plans.
Example: We use health information about you to develop better services for you.
Pay for your health services
We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your dental plan to coordinate payment for your dental work.
34
Administer your plan
We may disclose your health information to your health plan sponsor for plan administration.
Example: Your company contracts with us to provide a health plan, and we provide your company with certain
statistics to explain the premiums we charge.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the
public good, such as public health and research. We have to meet many conditions in the law before we can
share your information for these purposes. For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health
and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
• We can share health information about you with organ procurement organizations.
• We can share health information with a coroner, medical examiner, or funeral director when an individual
dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a
subpoena.
35
Our responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your
information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If
you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the terms of this notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The
new notice will be available upon request, on our web site, and we will mail a copy to you.
Other instructions for this notice
• Notice effective 2/1/17
36
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH
INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your
employer, your state may have a premium assistance program that can help pay for coverage, using funds from
their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be
eligible for these premium assistance programs but you may be able to buy individual insurance coverage
through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact
your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a
program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under
your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already
enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of
being determined eligible for premium assistance. If you have questions about enrolling in your employer
plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health
plan premiums. The following list of states is current as of July 31, 2016. Contact your State for more
information on eligibility –
ALABAMA – Medicaid
FLORIDA – Medicaid
Website: http://myalhipp.com/
Phone: 1-855-692-5447
Website: http://flmedicaidtplrecovery.com/hipp/
Phone: 1-877-357-3268
ALASKA – Medicaid
GEORGIA – Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/
Phone: 1-866-251-4861
Email: [email protected]
Medicaid Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Website: http://dch.georgia.gov/medicaid
- Click on Health Insurance Premium Payment (HIPP)
Phone: 404-656-4507
ARKANSAS – Medicaid
INDIANA – Medicaid
Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.hip.in.gov
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone 1-800-403-0864
COLORADO – Medicaid
IOWA – Medicaid
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Contact Center: 1-800-221-3943
Website: http://www.dhs.state.ia.us/hipp/
Phone: 1-888-346-9562
37
KANSAS – Medicaid
NEW HAMPSHIRE – Medicaid
Website: http://www.kdheks.gov/hcf/
Phone: 1-785-296-3512
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 603-271-5218
KENTUCKY – Medicaid
NEW JERSEY – Medicaid and CHIP
Website: http://chfs.ky.gov/dms/default.htm
Phone: 1-800-635-2570
Medicaid Website:
http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
LOUISIANA – Medicaid
NEW YORK – Medicaid
Website:
http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-888-695-2447
Website: http://www.nyhealth.gov/health_care/medicaid/
Phone: 1-800-541-2831
MAINE – Medicaid
NORTH CAROLINA – Medicaid
Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html
Phone: 1-800-442-6003
TTY: Maine relay 711
Website: http://www.ncdhhs.gov/dma
Phone: 919-855-4100
MASSACHUSETTS – Medicaid and CHIP
NORTH DAKOTA – Medicaid
Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120
Website:
http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-844-854-4825
MINNESOTA – Medicaid
OKLAHOMA – Medicaid and CHIP
Website: http://mn.gov/dhs/ma/
Phone: 1-800-657-3739
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
MISSOURI – Medicaid
OREGON – Medicaid
Website:
http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
Website: http://healthcare.oregon.gov/Pages/index.aspx
http://www.oregonhealthcare.gov/index-es.html
Phone: 1-800-699-9075
MONTANA – Medicaid
PENNSYLVANIA – Medicaid
Website:
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Website: http://www.dhs.pa.gov/hipp
Phone: 1-800-692-7462
NEBRASKA – Medicaid
RHODE ISLAND – Medicaid
Website:
http://dhhs.ne.gov/Children_Family_Services/AccessNebras
ka/Pages/accessnebraska_index.aspx
Phone: 1-855-632-7633
Website: http://www.eohhs.ri.gov/
Phone: 401-462-5300
NEVADA – Medicaid
SOUTH CAROLINA – Medicaid
Medicaid Website: http://dwss.nv.gov/
Medicaid Phone: 1-800-992-0900
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
38
SOUTH DAKOTA - Medicaid
WASHINGTON – Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
Website: http://www.hca.wa.gov/free-or-low-cost-healthcare/program-administration/premium-payment-program
Phone: 1-800-562-3022 ext. 15473
TEXAS – Medicaid
WEST VIRGINIA – Medicaid
Website: http://gethipptexas.com/
Phone: 1-800-440-0493
Website:
http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Page
s/default.aspx
Phone: 1-877-598-5820, HMS Third Party Liability
UTAH – Medicaid and CHIP
WISCONSIN – Medicaid and CHIP
Website:
Medicaid: http://health.utah.gov/medicaid
CHIP: http://health.utah.gov/chip
Phone: 1-877-543-7669
Website:
https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Phone: 1-800-362-3002
VERMONT– Medicaid
WYOMING – Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
Website: https://wyequalitycare.acs-inc.com/
Phone: 307-777-7531
VIRGINIA – Medicaid and CHIP
Medicaid Website:
http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website:
http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
To see if any other states have added a premium assistance program since July 31, 2016, or for more information
on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
39
NOTICE OF RIGHTS UNDER THE WOMEN’S HEALTH AND CANCER
RIGHTS ACT OF 1998
On October 21, 1998, the federal government enacted the Women’s Health and Cancer Rights Act. This law
requires that all group health plans that provide coverage for mastectomies must also provide coverage for breast
reconstruction surgery in connection with that mastectomy. This memo is intended to provide participants and
beneficiaries with notice of their rights under the Women’s Health and Cancer Rights Act
Participants and beneficiaries who receive benefits under the group health plan in connection with a mastectomy
and elect breast reconstruction surgery in connection with that mastectomy are entitled to coverage for that
reconstruction in a manner determined in consultation with the attending physician and the patient. Such
coverage includes:
1. Reconstruction of the breast on which the mastectomy was performed
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance
3. Prostheses and physical complications at all stages of the mastectomy, including lymphedemas.
These benefits may be subject to deductibles and coinsurance limitations consistent with those established for
similar benefits under the group health plan.
Please contact the Human Resources Department or the company’s health insurance carrier directly for more
information on your rights under the Women’s Health and Cancer Rights Act.
40
This Focus on Benefits provides a brief summary of your benefits. It does not
contain all of the details described in the official plan documents and contracts. If
there is any discrepancy between what is summarized here or any verbal
descriptions of the plan and the official plan documents and contracts, the plan
documents and contracts will govern.
Manpower, reserves the right to change, amend, suspend, or terminate any or all
of the plans described in the guide at any time and for any reason. This Focus on
Benefits is not a contract, and participation in any of the plans does not guarantee
employment.