BENEFITS GUIDE 2022 Ability One - January 1-December 31, 2022
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1 2022 Ability One BENEFITS GUIDE January 1—December 31, 2022
Welcome 2
Inside
Your benefits are an important part of your overall Medical
compensation. We are pleased to offer a
Dental
comprehensive array of valuable benefits to protect
your health, your family and your way of life. This guide Vision
answers some of the basic questions you may have Flexible Spending
about your benefits. Please read it carefully, along with Accounts (FSAs)
any supplemental materials you receive.
Life and AD&D
Disability
Eligibility Choose Carefully
Employee Assistance
You are eligible for benefits if you work 30 or Due to IRS regulations, you cannot
more hours per week. You may also enroll change your elections until the next Program (EAP)
your eligible family members under certain annual Open Enrollment period, unless
plans you choose for yourself. Eligible family you have a qualified life event during Voluntary Benefits
members include: the year. Following are examples of the
Your legally married spouse
most common qualified life events: Valuable Extras
Marriage or divorce
Your registered domestic partner (RDP) Cost of Benefits
and/or their children, where applicable Birth or adoption of a child
by state law
Child reaching the maximum Contact information
Your children who are your biological age limit
children, stepchildren, adopted children
Death of a spouse, RDP, or child
or children for whom you have legal
custody (age restrictions may apply). You lose coverage under your
Enrollment
Disabled children age 26 or older who spouse’s/RDP’s plan
meet certain criteria may continue on
You gain access to state coverage
your health coverage.
under Medicaid or CHIP
Making Changes
Visit http://
When Coverage Begins
To make changes to your benefit
hubenroll.employee
New Hires: You must complete the
enrollment process within 30 days of
elections, you must contact Human navigator.com and login
Resources within 31 days of the
your date of hire. If you enroll on time,
qualified life event (including using your user name &
coverage is effective on the first of the
month following 60 days of employment.
newborns). Be prepared to show password.
documentation of the event such as a
If you fail to enroll on time, you will NOT marriage license, birth certificate or a Unique Company Identifier:
have benefits coverage (except for divorce decree. If changes are not
company-paid benefits). submitted on time, you must wait until mokangoodwill
the next Open Enrollment period to
Open Enrollment: Changes made
make your election changes.
during Open Enrollment are effective
January 1 - December 31, 2022.
Required Information—When you enroll, you will be required to enter a Social Security number
(SSN) for all covered dependents. The Affordable Care Act (ACA), otherwise known as health
care reform, requires the company to report this information to the IRS each year to show that you
and your dependents have coverage. This information will be securely submitted to the IRS and
Medical 3
We are proud to offer you a choice of 5 medical plans that
provide comprehensive medical and prescription drug
coverage. The plans also offer many resources and tools to
help you maintain a healthy lifestyle. Following is a brief
description of each plan.
BlueKC 3000 PPO Broad Plan
(Preferred Care Blue)
This is a plan design with premium savings, but still utilizing the
Blue Network Savings. This plan gives you the freedom to seek
care from the provider of your choice. However, you will
maximize your benefits and reduce your out-of-pocket costs if
you choose a provider who participates in the Preferred-Care
Blue network. The calendar-year deductible must be met before
certain services are covered.
BlueKC 3000 PPO Optimized Plan
(BlueSelect Plus)
This is a plan with premium savings, but still utilizing the Blue
Network Savings. This plan gives you the freedom to seek care
from the provider of your choice. However, you will maximize
your benefits and reduce your out-of-pocket costs if you choose
a provider who participates in the Blue Select network. The
calendar-year deductible must be met before certain services are
covered. Plan Definitions:
BlueKC 6500 Value PPO Broad Plan Annual Deductible: You must meet the entire
(Preferred Care Blue) annual deductible before the plan starts to pay for
non-preventive medical and prescription drug
This plan gives you the freedom to seek care from the provider of
expenses.
your choice. However, you will maximize your benefits and
reduce your out-of-pocket costs if you choose a provider who Coinsurance: Once you’ve met the plan’s annual de-
participates in the Preferred-Care Blue network. The calendar- ductible, you are responsible for a percentage of your
year deductible must be met before certain services are covered. medical expenses, which is called coinsurance. For
BlueKC 6500 Value PPO Optimized Plan example, the plan may pay 80 percent and you may
pay 20 percent.
(BlueSelect Plus)
This is a plan design with premium savings, but still utilizing the Out-of-Pocket Maximum: Once your deductible and
Blue Network Savings. This plan gives you the freedom to seek coinsurance add up to the plan’s annual out-of-pocket
care from the provider of your choice. However, you will maximum, the plan will pay 100 percent of all eligible
maximize your benefits and reduce your out-of-pocket costs if covered services for the rest of the calendar year.
you choose a provider who participates in the BlueSelect Plus
network. The calendar-year deductible must be met before
certain services are covered.
BlueKC 3000 SpiraCare EPO Plan
(Exclusive Provider Organization)
SpiraCare is built on an Exclusive Provider Organization (EPO)
insurance model. While this plan is ideal for members who
utilize the no-additional-cost primary and paediatric care at the
Care Centers, members still have access to more than 3,000
providers in the BlueSelect Plus network. Members will also
have the nationwide coverage of the BlueCard network outside
of the 32-county Blue KC service area.
Medical Plans
4
Following is a high-level overview of the coverage available. For complete coverage details, please refer to certificate or the Summary Plan
Description (SPD) located at www.mokangoodwill.org.benefits.
Note-Only full-time employees working 30 or more hours per week are eligible to enroll in the medical plans.
Preferred Care Blue BlueSelect Plus Preferred Care Blue BlueSelect Plus
BlueSelect Plus 3000
3000 PPO Broad 3000 PPO Optimized 6500 Value PPO 6500 Value PPO
SpiraCare EPO Plan
Plan Plan Broad Plan Optimized Plan
Key Medical Benefits
In-Network Only In-Network Only In-Network Only In-Network Only In-Network Only
Deductible (per calendar year)
Individual / Family $3,000 / $9,000 $3,000 / $9,000 $6,500 / $13,000 $6,500 / $13,000 $3,000 / $9,000
Out-of-Pocket Maximum (per calendar year)
Individual / Family $3,000 / $9,000 $3,000 / $9,000 $6,500 / $13,000 $6,500 / $13,000 $3,000 / $9,000
Covered Services
Office Visits (physician/specialist) $20 / $60 copay $20 / $60 copay Deductible Deductible Deductible
SpiraCare Visit
N/A N/A N/A N/A No charge
(physician/specialist/Urgent Care)
Routine Preventive Care No charge No charge No charge No charge No charge
Outpatient Diagnostic (lab/X-ray) Deductible Deductible Deductible Deductible Deductible
Complex Imaging Deductible Deductible Deductible Deductible Deductible
Hi Tech Diagnostic (lab/x-ray) Deductible Deductible Deductible Deductible Deductible
Emergency Room Deductible Deductible Deductible Deductible Deductible
Urgent Care Facility $60 copay $60 copay Deductible Deductible Deductible
Inpatient Hospital Stay Deductible Deductible Deductible Deductible Deductible
Outpatient Surgery Deductible Deductible Deductible Deductible Deductible
Prescription Drugs (Tiers 1 /2 / 3): Optum Rx
$12 / 100% after $12 / 100% after
Retail Pharmacy (34-day supply) $5 / $30 / $50 $5 / $30 / $50 $15 / $50 / Deductible
deductible Tier 2 & 3 deductible Tier 2 & 3
$30 / 100% after $30 / 100% after
Mail Order (102-day supply) $12.50 / $75 / $125 $12.50 / $75 / $125 $15 / $125 / Deductible
deductible Tier 2 & 3 deductible Tier 2 & 3
Out of Pocket Maximum includes deductible, coinsurance and copays
Coinsurance percentages and copay amounts shown in the above chart represent what the member is responsible for paying.
If you use an out of network provider, you will be responsible for any charges above the maximum allowed amount.
SpiraCare Enrollment:
You must live in one of the following counties to be eligible for the SpiraCare plan:
Kansas (Johnson & Wyandotte) Missouri (Jackson, Clay, Cass, Clinton, DeKalb, Johnson, Lafayette, Ray, Caldwell and Platte).
Hospitals Include: Children’s Mercy Hospital, Children’s Mercy Hospital-South, Liberty Hospital, North Kansas City Hospital, Olathe Health-Olathe
Medical Center, Truman Medical Center-Hospital Hill, Truman Medical Center-Lakewood, Shawnee Mission Medical Center, The University of
Kansas Health System.
SpiraCare Clinic Locations include: Crossroads, Lee’s Summit, Liberty, Olathe, Shawnee, Wyandotte, Tiffany Springs and Overland Park.
5
6
7
8
RATES
2022 Goodwill of Western Missouri and Eastern Kansas
EMPLOYEE CONTRIBUTIONS
January1, 2022- December 31, 2022
Your contributions toward the cost of medical, dental and vision coverage are automatically deducted from your
paycheck before taxes.
MEDICAL COVERAGE
AbilityOne Employee Contribution
Medical: 3000 PPO Broad Plan Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $429.36 $987.56 $815.80 $1,202.24
Medical: 3000 Optimized PPO Plan Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $386.43 $888.80 $734.22 $1,082.01
Medical: 6500 Value PPO Broad Plan Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $354.33 $814.97 $675.32 $992.13
Medical: 6500 Value PPO Optimized Plan Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $318.90 $733.48 607.78 892.92
Medical: 3000 SpiraCare EPO Plan Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $316.28 $727.47 $600.94 $885.61
DENTAL COVERAGE
AbilityOne Employee Contribution
Dental Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $16.31 $31.79 $30.42 $46.39
VISION COVERAGE
AbilityOne Employee Contribution
Vision Employee Employee + Spouse Employee + Child(ren) Family
Employee Semi-Monthly Rates $4.12 $8.20 $8.83 $13.03
Dental 9
We are proud to offer you a dental plan.
Delta Dental PPO: This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will maximize your
benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the Delta Dental Premier and/or PPO network.
Following is a high-level overview of the coverage available.
Delta Dental PPO
Key Dental Benefits
In-Network Only Out-of-Network1
Deductible (per calendar year)
Individual / Family $50 / $150
Benefit Maximum (per calendar year; Preventive, Basic, and Major Services combined)
Per Individual $1,500
Right Start 4 Kids (RS4K)
No charge, for all services covered under this plan, excluding
Kids 12 and under
Orthodon cs, when seen by a in‐network provider.
Covered Services
No charge
Diagnostic / Preventive Services Includes Unlimited Cleanings (regular, prophylaxis & periodontal
maintenance cleanings)
Basic Services (endo/periodontic, composite filings, oral surgery) 20%*
Major Services (crowns, bridges, root canal) 50%*
Orthodontia (Child under age 19) 50%* / $1,000 Maximum Benefit
Coinsurance percentages shown in the above chart represent what the member is responsible for paying.
*Benefits with an asterisk ( * ) require that the deductible be met before the Plan begins to pay.
1. If you use an out-of-network provider, you will be responsible for any rges above the maximum allowed amount.
Vision
We are proud to offer you a vision plan.
The SunLife vision plan gives you the freedom to seek care from the provider
of your choice. However, you will maximize your benefits and reduce your
out-of-pocket costs if you choose a provider who participates in the Vision
Service Provider (VSP) network.
Following is a high-level overview of the coverage available.
Key Vision Benefits In-Network
Exam Copay (once every 12 months) $10
Materials Copay $25
Lenses (once every 12 months)
Single Vision
No charge after
Bifocal
materials copay
Trifocal
$130 Allowance + 20% off
Frames (once every 24 months)
remaining balance
Contact Lenses
$130 Allowance
(once every12 months; in lieu of glasses)
10
Flexible Spending Accounts
FSA Rules
We provide you with an opportunity to participate in up to two different flexible
spending accounts (FSAs) administered through Ameriflex. FSAs allow you to set YOU MUST ENROLL EACH
aside a portion of your income, before taxes, to pay for qualified health care and/or YEAR TO PARTICIPATE
dependent care expenses. Because that portion of your income is not taxed, you pay
less in federal income, Social Security and Medicare taxes. Because FSAs can give you a
significant tax advantage, they must
Health Care FSA be administered according to specific
IRS rules:
For 2022, you may contribute up to $2,750 to cover qualified health care expenses
incurred by you, your spouse and your children up to age 26. Some qualified
expenses include:
Health care FSA: Unused funds up to
Coinsurance Prescriptions Eye exams/eyeglasses
$500 from one year can carry over to
Copayments Dental treatment Lasik eye surgery
the following year. Carryover funds
Deductibles Orthodontia
will not count against or offset the
For a complete list of eligible expenses, visit www.irs.gov/pub/irs-pdf/p502.pdf. amount that you can contribute
annually. Unused funds over $500
Dependent Care FSA will NOT be returned to you or carried
over to the following year.
For 2022, you may contribute up to $5,000 (per family) to cover eligible dependent care
expenses ($2,500 if you and your spouse file separate tax returns). Some qualified
expenses include:
Care of a dependent child under the age of 13 by babysitters, nursery schools, pre-
school or daycare centers
Care of a household member who is physically or mentally incapable of caring for
him/herself and qualifies as your federal tax dependent
For a complete list of eligible expenses, visit www.irs.gov/pub/irs-pdf/p503.pdf.
Life and AD&D Insurance
Life/AD&D Insurance Supplemental Life/AD&D (100% Employee-paid)
Life Insurance provides your named beneficiary(ies) with a This benefit is provided through MetLife for all full-time eligible
benefit in the event of your death. employees. If you determine you need more than the basic coverage,
Accidental Death and Dismemberment (AD&D) Insurance you may purchase additional coverage through MetLife for yourself and
provides specified benefits to you in the event of a covered your eligible family members.
accidental bodily injury that directly causes dismemberment
(i.e., the loss of a hand, foot, or eye). In the event that your
death occurs due to a covered accident, both the Life and Benefit Option Guaranteed Issue1
the AD&D benefit would be payable. Up to 5x base salary to a
Employee maximum of $500,000; $10,000 $150,000
Basic Life/AD&D (100% Employee-paid) increments
This benefit is provided through USAble for all eligible full-time &
Up to $250,000 (not to exceed
part-time employees..
Spouse 50% of your additional life $50,000
coverage); $5,000 increments
Group Life/AD&D (100% Employer-paid)
This benefit is provided through MetLife for all eligible full-time Child(ren) $1,000 / $5,000 / $10,000
employees..
1. During your initial eligibility period only, you can receive coverage up to the Guaranteed
Issue amounts without having to provide Evidence of Insurability (EOI, or information about
Basic Life/AD&D Benefit Amount $10,000 maximum your health). Coverage amounts that require EOI will not be effective unless approved by
the insurance carrier.
1x annual salary up to
Group Life AD&D Benefit Amount
$150,000 maximumDisability Voluntary Benefits
11
Disability insurance provides benefits that replace part of your lost Our benefit plans are here to help you and your family live well—and
income when you become unable to work due to a covered injury stay well. But did you know that you can strengthen your coverage
or illness. Note-only full-time employees working 30 or more hours even further? It’s true! Our voluntary benefits through SunLife are
per week are eligible. designed to complement your health care coverage and allow you to
customize our benefits to you and your family’s needs. The best
Voluntary Short-Term Disability part? Benefits from these plans are paid directly to you! Coverage is
Provided at an affordable group rate through MetLife also available for your spouse and dependents.
Benefit Percentage 60% You can enroll in these plans during Open Enrollment—they’re
completely voluntary, which means you are responsible for paying for
Weekly Benefit Maximum $1,000
coverage at affordable group rates.
When Benefits Begin 15th day of accident or sickness
Maximum Benefit Duration Up to 11 weeks Accident Insurance
Accident insurance can soften the financial impact of an accidental
Employer Paid Long-Term Disability
injury by paying a benefit to you to help cover the unexpected out-of-
Provided at NO COST to you through MetLife pocket costs related to treating your injuries.
Benefit Percentage 60%
Monthly Benefit Maximum $6,000 Critical Illness including a $50 Wellness Benefit
Did you know that the average total out-of-pocket cost related to
When Benefits Begin After 90th day of disability
treating a critical illness is over $7,000? With critical illness
Maximum Benefit Duration Social Security Retirement Age insurance, you’ll receive a lump-sum benefit if you are diagnosed
with a covered condition that you can use however you would like,
Employee Assistance including to help pay for: treatment (e.g. experimental), prescriptions,
travel, increased living expenses, and more.
Program (EAP)
Valuable Extras
Life is full of challenges, and sometimes balancing it is difficult. We
are proud to provide a confidential program dedicated to supporting
the emotional health and well-being of our employees and their
families. The employee assistance program (EAP) is provided at
NO COST to you through Personal Assistance Program.
This program can help with the following issues, among others:
Mental health
Relationships or marital conflicts
Child and eldercare
Substance abuse
Grief and loss
Legal or financial issues
Personal Assistance Service Benefits:
Assistance for you and your household members
Up to 6 short term sessions with a counselor per issue, per year,
per individual
Unlimited toll-free phone access and online resources using
Goodwill code: 0534 or wayforward app code: goodwill mokan We also offer the following additional benefits:
Volunteer Time Off Education Assistance
Paid Time Off Pet Insurance
Paid Parental Leave Helping Hands Fund
401 (a) & 403(b) Retirement Plans Discount Opportunities12
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Coverage available up to $500,000 depending on employee salary. To calculate rate, multiply available rate by your desired
election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies.
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Your Resource for Life’s Questions
Each of us experiences demands for our time and energy, both on and off the job. In
addition to our responsibilities at work, we also seek to fulfill our family responsibilities,
meet our financial obligations, enjoy personal interests, and maintain a healthy family
and social life. The key to balancing it all is having access to the right tools, resources
and support.
Through PAS you have access to:
Personal Assistance Services
• Elder care managers
(PAS) provides you with
• Child care specialists
a wealth of confidential,
• Certified child development and parenting professionals
professional services that can • Organization and time management specialists
help you address challenges • Retirement coaches
and strengthen your work and • Career coaches
home life. • Tobacco cessation coaches
• Master’s level licensed counselors
This is a pre-paid benefit • Registered and licensed dietitians
funded completely by your • Certified financial counselors
employer and free to you and • Attorneys
your dependents. The EAP • Life coaches
is confidential - PAS does • Health coaches
not disclose information • Self-paced cognitive behavioral therapy through the
to anyone about your wayForward digital app
participation unless you give • Downloadable resources, financial tools, legal forms and
your consent to do so (except more on the PAS website
as required by law).
website: https://www.paseap.com
To register, use organization code: 0534
wayForward app code: goodwill mokan
Free & Confidential Clickk here
Cli h or scan
© Personal Assistance Services 800.356.0845 • www.paseap.com to download the wayForward app16
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Healthcare Is Complicated.
HealthJoy Makes It Simple.
No Smartphone? No Worries.
HealthJoy is the first stop for all your healthcare
and employee benefits needs. We make everything
simple, quick and painless. Don’t try and navigate your
healthcare alone. HealthJoy makes the right decision
the easy decision. We’ll save you time, money and a ton
of aggravation.
Talk with us today by calling (877) 500-3212
500-3212
or via email at groups@healthjoy.com.17
HealthJoy is the first stop for all your healthcare and
How to Download and employee benefits needs. Getting started is simple, all
you need to do is activate your HealthJoy account and
Activate HealthJoy download our app.
You’ll receive a welcome message in two ways: email and text
messages to your smartphone (when supplied by your company).
SMS Email
Step 1: Receive Activation Email
To activate, click the web link in either message from your
smartphone. The link will take you to an activation screen
where you can create an account.
Step 2: Create Password
You’ll be taken to a web page asking you to create
an 8 character password (minimum).
Step 3: Add Family Members
Adding family members is free, and we encourage you
to invite all members of your immediate family that are
over 18 years old. They will get access to all the same
services including access to free healthcare Concierges
and online doctors.18
Step 4: Download the App
Next download, install and log into the
HealthJoy app. The app is available for
Android, iPhone, and iPad and requires
an Internet connection. Just click the
download button at the end of the setup
process and will be taken to our app
within your smartphone’s app store.
Step 5: Log In
Finally, after you download the HealthJoy app, all you need to do is log in to the app with the
email address where you received your invitation and the password you created. JOY, your virtual
healthcare assistant, will welcome you to the app. You can start using the app within seconds.
Did you forget your password or missed your activation email?
Forgot password — If you forgot your password, all you need
to do is open the HealthJoy app and tap the “Forgot Password?”
If you have any other
link at the bottom of the login screen. We will send you a link to
issue with activation or
create a new password to the email your company supplied us.
logging into our system,
please call or email us at:
New Activation Email — If you can’t find or accidentally
deleted our activation email, click “Set up your account” at the groups@healthjoy.com
bottom of the login screen to request a new one. We will ask (877) 500-3212
you for your email address, and our Concierge will confirm your
eligibility. We’ll send a new activation email as soon as possible.19
HealthJoy Services
Healthcare Concierge Online Medical Consultaons
Confused about your benefits? Don’t worry — we Not feeling well? Connect with a doctor anytime,
are here to help. We can explain deductibles, anywhere - 24/7/365. We can even write
formularies, out-of-pocket expenses, co-insurance, prescriptions. Give us a call.
preauthorization, copays and more.
Provider Recommendaons Rx Savings Review
Need an awesome doctor or facility that takes your Want to save money on your prescriptions? We’ll
insurance? Our Concierge will extensively research review your medications and identify lower-
every recommendation and call to confirm cost alternatives. Let our team help reduce your
in-network participation and availability. medication spend.
Medical Bill Review
Got a medical bill that’s confusing? Our team of
Health Spending Accounts
experts can answer questions, explain how billing Trying to understand your HSA, HRA or FSA? We
works, and negotiate with providers to save you can explain what’s a qualified expense including
money. Just email us your bill at medical, dental, vision and prescription spending.
groups@healthjoy.com.20
Nationw ide ®pet insurance
My Pet Protection®plan sum m ary
Nat ionw id e p et insurance help s you cover vet erinary exp enses so you can p rovid e your p et s
w it h t he b est care p ossib le w it hout w orrying ab out t he cost .
My Pet Prot ect ion coverag e hig hlig ht s
We off er a choice of reim b ursem ent op t ions so you can fi nd coverag e t hat fi t s your b ud g et . A ll p lans have a $250 annual
d ed uct ib le and $7,50 0 m axim um annual b enefi t . Coverag e includ es*:
• Accid ent s • Dent al d iseases
• Illnesses • Behavioral t reat m ent s
• Hered it ary and cong enit al cond it ions • Rx t herap eut ic d iet s and sup p lem ent s
• Cancer • A nd m ore
Plus, every My Pet Prot ect ion p olicy includ es t hese ad d it ional b enefi t s t o m axim ize your value:
• Lost p et ad vert ising and rew ard exp ense • Loss d ue t o t heft
• Em erg ency b oard ing • Mort alit y b enefi t
Includ ed w it h every p olicy
• 24/ 7 access t o vet erinary exp ert s ($110 value) • Save t im e and m oney by fi lling p et p rescrip t ions at
• Availab le via p hone, chat and em ail p art icip at ing in-st ore ret ail p harm acies across t he U.S.
• Unlim it ed help for everyt hing from g eneral p et • Rx claim s sub m it t ed d irect ly t o Nat ionw id e
q uest ions t o id ent ifying urg ent care need s • More t han 4 ,70 0 p harm acy locat ions
Ad d it ional hig hlig ht s
• Exclusive p rod uct for em p loyer g roup s only • Mult ip le-p et d iscount s
• Preferred p ricing for em p loyees • Guarant eed issuance
Get a fast , no-ob lig at ion q uot e t od ay.
PetsNationwide.com • 877-738-7874
*Som e exclusions m ay ap p ly. Cert ain coverag es m ay b e exclud ed d ue t o p re-exist ing cond it ions. See p olicy d ocum ent s for a
com p let e list of exclusions.
Prod uct s und erw rit t en by Vet erinary Pet Insurance Com p any (CA ), Colum b us, OH; Nat ional Casualt y Com p any (all ot her st at es),
Colum b us, OH. A g ency of Record : DVM Insurance Ag ency. A ll are sub sid iaries of Nat ionw id e Mut ual Insurance Com p any. Sub ject
t o und erw rit ing g uid elines, review and ap p roval. Prod uct s and d iscount s not availab le t o all p ersons in all st at es. Insurance
t erm s, d efi nit ions and exp lanat ions are int end ed for inform at ional p urp oses only and d o not in any w ay rep lace or m od ify t he
d efi nit ions and inform at ion cont ained in ind ivid ual insurance cont ract s, p olicies or d eclarat ion p ag es, w hich are cont rolling .
Nat ionw id e, t he Nat ionw id e N and Eag le, vet helpline, and Nat ionw id e is on your sid e are service m arks of Nat ionw id e Mut ual
Insurance Com p any. ©20 21Nat ionw id e. 21PMC830 2E_GRP21
Pet insurance
from Nationwide®
With two budget-friendly options, there’s
never been a better time to protect your pet.
Our popular My Pet Protection® pet insurance plans now feature more choices
and more flexibility
Get cash back on eligible vet bills: Choose your reimbursement level of 50% or 70%1
Available exclusively for employees: Plans with preferred pricing only offered through your company
Use any vet, anywhere: No networks, no pre-approvals
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of coverage with
50%
reimbursement
70%
reimbursement
My Pet Protection®
$20-$35/month2 $27-$47/month2
How to use your
pet insurance plan
1 Visit any vet,
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Get a fast, no-obligation quote today at PetsNationwide.com
1Some exclusions may apply. Certain coverages may be subject to pre-existing exclusion. See policy
documents for a complete list of exclusions. Reimbursement options may not be available in all
states.
2Starting prices indicated. Final cost varies according to plan, species and ZIP code. Nationwide
onwide
de is on your
you side
Products underwritten by Veterinary Pet Insurance Company (CA), Columbus, OH; National
Casualty Company (all other states), Columbus, OH. Agency of Record: DVM Insurance Agency.
All are subsidiaries of Nationwide Mutual Insurance Company. Nationwide, the Nationwide N and
Eagle, and Nationwide is on your side are service marks of Nationwide Mutual Insurance Company.
©2021 Nationwide. 21GRP8274C22
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Helping Hand Fund
Contribution Election Form
The Employee Emergency Needs Fund (The Helping Hand Fund) was created by the Agency to
aid employees who need financial assistance in significant hardship situations. A committee
composed of employees representing each division administers the fund. The committee
establishes the eligibility requirements, the procedures for the distribution of funds and
determines whether the requests meet the established guidelines.
If you would like to become a contributor to the Employee Emergency Fund, please
contact the Human Resources Department or complete this election form. Contributions
to the Fund are made via payroll deductions and employees may contribute any amount
between $1.00 and $10.00 per paycheck. Contributions are not tax deductible.
Contributing employees will be allowed a 35% discount at any local Goodwill store.
I understand contributions to the fund are voluntary and will be automatically deducted from my
paycheck until I request otherwise, in writing. Please return this to your manager or HR.
Employee name _________________________________________________________
Location: _______________________________________________________________
I would like to donate ________ per paycheck.
Contributions are not tax deductible and will not be returned upon separation from the Agency.
Signature _________________________________________ Date _________________
For information on applying to receive assistance from the fund, please visit www.mokangoodwill.org/benefits.
Please return to Human Resources via fax (816-842-7616) or scan to benefits@mokangoodwill.orgCost of Benefits 32
Your contributions toward the cost of benefits are automatically deducted from your pay check before taxes. The
amount will depend upon the plan you select and if you choose to cover eligible family members.
Contact Information
Coverage Carrier Phone # Website/Email
BCBS of KC (816) 395-2950 www.bluekc.com
Medical
SpiraCare (913) 297-7472 www.spiracare.com
Dental Delta Dental of KS (800) 733-5823 www.deltadentalks.com
Vision & Voluntary Benefits SunLife (800) 733-7879 www.sunlife.com
Flexible Spending Accounts (FSAs) Ameriflex (888) 868-3539 www.myameriflex.com
Basic Life/AD&D USAble (800) 370-5856 www.usable.com
Voluntary Life / /AD&D & Disability MetLife (800) 638-5433 www.metlife.com
Employee Assistance Program (EAP) Personal Assistance Service (800) 356-0845 www.paseap.com / Code 0534
HealthJoy HealthJoy (877) 500-3112 www.groups@healthjoy.com
Pet Insurance Nationwide (877) 263-6008 Www.petinsurance.com
Our benefits website
www.mokangoodwill.org/work-for-
goodwill/your-benefits.com can be
accessed anytime you want additional
information on our benefit programs or
you can call (816) 842-7425 x123
Questions?
If you have additional questions, you
may also contact:
Jen Boylan
(816)708-4671
jen.boylan@hubinternational.com
Carri Guinn
(816)708-4658
carri.guinn@hubinternational.com
Claims Advocacy
(816)708-4666
Hub-kc.ebclaims@hubinternational.com
DISCLAIMER: The material in this benefits brochure is
for informational purposes only and is neither an offer of coverage or medical or legal advice. It contains only a partial description of plan or program bene-
fits and does not constitute a contract. Please refer to the Summary Plan Description (SPD) for complete plan details. In case of a conflict between your
plan documents and this information, the plan documents will always govern. Annual Notices: ERISA and various other state and federal laws require that
employers provide disclosure and annual notices to their plan participants. The company will distribute all required notices annually.You can also read
