Benefits Guide. 2022 Please read thoroughly.
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Benefits Guide. 2022 This publication contains important information about your employee benefit program. Please read thoroughly.
At HALO, we are committed to a comprehensive
employee benefit program to help our employees
stay healthy, feel secure, and maintain
a work/life balance.
This guide offers information on each benefit
available to you through HALO, contact information
for the providers, and instructions on how to enroll.
Please read through it carefully and keep it for
reference when enrolling in and utilizing your
benefits in the future.
2
Benefits Guide • 2022
Table of contents
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 • Life and Disability Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 • Short Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
10
• Long Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Staying Healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
• Voluntary Critical Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
• Medical Highlights—CDHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
• Voluntary Hospital Indemnity . . . . . . . . . . . . . . . . . . . . . . . . 27
• Medical Highlights—PPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
• Voluntary Group Accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
• Tools and Resources with BCBSIL . . . . . . . . . . . . . . . . . . . . . 15
• 401(k) Savings Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
• Dental Plan Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
• Work/Life Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
• Vision Plan Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
• Access Your Maternity and Family Benefits—BCBSIL . 33
Feeling Secure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
HALO Benefits Information Contact . . . . . . . . . . . . . . . . . . 34
• Health Savings Account (HSA) . . . . . . . . . . . . . . . . . . . . . . . . 19
• Flexible Spending Accounts (FSA) . . . . . . . . . . . . . . . . . . . . . 20 Important Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3
01 Eligibility
Benefits Guide • 2022
Eligibility
Who is Eligible?
Employee Eligibility
• Actively employed administrative
employees scheduled to work a minimum
of 30 hours per week.
• Actively employed (commissions only)
account executives booking a minimum
of $40,000 in commissions in the prior
calendar year (amount will be estimated
or prorated for new hires with mid-year
enrollments). The minimum booking
threshold is subject to change at the
company’s discretion every calendar year.
Dependent Eligibility
Legal spouses, civil union, or domestic
partners of eligible employees are ineligible
for coverage in our plans if they are eligible
for coverage through their employer and
their employer pays at least 50% of the cost.
Legal certification of marriage/civil union/
domestic partnership must be provided
if covering a spouse, civil union,
or domestic partner.
Children of eligible employees are eligible
for coverage in the health/dental/vision
plans up to the age 26, regardless of student,
marital, or employment status. Coverage
will automatically terminate at the end
of the month of the dependent’s 26th
birthday. Supplemental child life coverage
terminates at the end of the month
of the dependent child’s 19th birthday.
5
Benefits Guide • 2022
When Are
You Eligible?
Newly Eligible Employees
Your benefits become effective the first of the
month coincident with or following 30 days
of employment in an eligible classification.
NOTE: You have 30 days from your date
of hire or change to eligible status to enroll
in or waive coverage.
Annual Open Enrollment
You may make changes to your benefit
elections during your open enrollment
period for a September 1st effective date.
Qualified Change
in Status
Your benefit elections will remain in effect
for the entire year unless you experience
a qualifying life event. You may make benefit
changes within 30 days of a qualified event.
Examples of qualifying life events include:
marriage, civil union, divorce, birth, adoption,
death of a dependent, or loss of other
coverage, such as spouse/partner losing
coverage as a result of a job loss or change.
Note: This is only a summary of the
benefit plans; refer to the Summary Plan
Descriptions or Certificates for each benefit
to view full details on coverage, maximums,
limitations, and exclusions. If there is any
conflict between this document and the
official plan documents, the official plan
documents govern the plan.
6
Benefits Guide • 2022
What Benefits
Note:
Are Available? Your basic life and AD&D, short term disability,
and long term disability insurance will only be
As you consider your plans for the year,
provided by HALO if you elect medical coverage.
refer to this chart of coverage and enrollment
information for the various benefit programs
offered through HALO.
• If you do not enroll in medical coverage,
but to enroll in these benefits, you will pay 100% of the cost.
• Basic life and AD&D, short term disability, and long term
Reminder: Coverage begins the first of the disability must be elected all together. You cannot elect only
month coincident with or following 30 days 1 or 2 of these benefits separately.
of employment in an eligible classification.
Benefit Plan Vendor Do I Need to Enroll?
Health Plans
Medical Blue Cross Blue Shield of Illionnis Yes
Dental Delta Dental of Illinois Yes
Vision BCBSIL + EyeMed Yes
Health Savings Account 5th/3rd Bank Yes
Flexible Spending Accounts Discovery Benefits Yes
Life and AD&D Insurance
Enrolled in medical: No
Basic Life and AD&D Insurance New York Life
Not enrolled in medical: Yes
Voluntary Life
New York Life Yes
(for you and your dependents)
Disability Insurance
Enrolled in medical: No
Short Term Disability New York Life
Not enrolled in medical: Yes
Enrolled in medical: No
Long Term Disability New York Life
Not enrolled in medical: Yes
Voluntary Options
Critical Illness Cigna Yes
Hospital Indemnity Cigna Yes
Accident Cigna Yes
Additional Programs
401(k) Savings Plans Bank of Oklahoma No
7
02 Enrollment
Benefits Guide • 2022
Enrollment
Enrollment
Checklist
Ready to Enroll?
Follow These Steps
01 Write down big things happening
next year for your family, do any
of these things relate to your benefits?
• Planning to bring home a new baby?
• Anyone have a big expense coming
(orthodontia, major surgery, etc.)?
• If something happened to you,
does your life insurance provide
enough money to your family?
ould you benefit from any of
02 W
the voluntary products we offer?
• C
ritical illness, accident,
hospital indemnity
id you know you can access your
03 D
ID cards, find network providers
and more via mobile apps?
Download them today!
• Blue Access for Members
• Delta Dental’s mobile app
• EyeMed Members
How to Enroll:
Enroll on access.paylocity.com/
Instructions on how to enroll can be found
HERE
9
03 Staying Healthy
Benefits Guide • 2022
Staying Healthy
Medical Plan CDHP Plan
Features In-Network Out-of-Network
Highlights—CDHP Coinsurance 80% 60%
HALO offers two medical plans plan with Deductible
access to a comprehensive national network
Individual $2,000 $6,000
(Blue Edge) to cover your medical needs from
preventive care to emergency situations. Family $4,000 $12,000
Account Funding (HSA)
You must meet your deductible below
before coinsurance begins. If you meet your Individual $500
out-of-pocket maximum, you will not pay
Family $1,000
any more for the cost of your care for the
rest of the year. Note that your deductible Out-of-Pocket Max (includes deductible)
and out-of-pocket maximum renew on
Individual $4,000 $12,000
a calendar year basis.
Family $6,850 $24,000
How the Family Deductible Covered Services
and Out-of-Pocket Preventive Care 100% Deductible and coinsurance
Maximums Work
Office visit Deductible and coinsurance Deductible and coinsurance
• The plan will not begin cost sharing
Specialist Deductible and coinsurance Deductible and coinsurance
for any family member until the family
deductible is met
Urgent Care Deductible and coinsurance Deductible and coinsurance
• Any combination of one or more family Emergency Room Deductible and coinsurance Same as in-network
members can incur expenses to meet
the family deductible Prescription Drug
• All family members’ out-of-pocket Generic Deductible and coinsurance
expenses count towards the
You pay 25%
family deductible Preferred Deductible and coinsurance
of the eligible
• The family out-of-pocket maximum must Non-Preferred Deductible and coinsurance
amount after
20% coinsurance
be met by any combination of one or more
family members before plan will begin to Speciality Deductible and coinsurance
cover in-network expenses at 100%
11Benefits Guide • 2022
Staying Healthy
Medical Highlights—PPO
Diagnostic visits are covered at 100% after a copay of $30 or $50 at
the time of service at network facilities. All other in-network services
are covered at 80% after you meet an annual deductible of $1,000
if you are single, or $2,000 if you have more than one person on the
plan. Once you reach your out-of-pocket maximum of $2,000 if you
are single, or $4,000 if you have more than one person on the plan, all
eligible expenses are covered at 100%. Prescriptions are covered at
100% after a copay of $15, $30, or $50 (depending on the tier).
How the Family Deductible Plan PPO Plan
and Out-of-Pocket Features In-Network Out-of-Network
Maximums Work Coinsurance 80% 60%
• A single member of a family does not have Deductible
to meet the full family deductible before
Individual $1,000 $4,000
the after-deductible benefits kick in
• Individual family members only need Family $2,000 $8,000
to meet the individual deductible for
Out-of-Pocket Max (includes deductible)
the after-deductible benefits to kick in
• The money that is paid toward the
Individual $2,000 $8,000
individual deductible and out-of-pocket Family $4,000 $16,000
maximums is also credited toward
Covered Services
the family deductible and
out-of-pocket maximums Preventive Care 100% Deductible and coinsurance
• Once several different family members Office visit $30 Deductible and coinsurance
have each paid enough in individual
deductibles that meet the family Specialist $50 Deductible and coinsurance
deductible in total, benefits will begin
Urgent Care $50 Deductible and coinsurance
to be paid for the entire covered family
• When family members have paid enough Emergency Room $150
in out-of-pocket maximums to complete Prescription Drug
the family out-of-pocket maximum,
Generic $15
the plan will begin covering in-network
expenses at 100% You pay 25% of
Preferred $30
the eligible amount
minus the in-network
Non-Preferred $50
copay amount
Speciality $50
12Benefits Guide • 2022
Staying Healthy
Cost for Medical Medical Plan Contributions
Coverage CDHP Bi-Weekly Contributions
Tobacco User/Smoker Rates
You have the opportunity to engage in HALO’s
1 smoker 2 smokers
wellness initiative to take advantage of
lower per-pay period medical costs. See next Compliant
page for information on how to participate Single $57.92 $75.23 -
and receive the lower medical premiums. EE + Spouse $184.62 $201.93 $219.24
EE + Child(ren) $144.69 $162.00 -
If you and/or your spouse or domestic partner
are a tobacco user, you will be required to Family $260.23 $277.54 $294.85
pay a surcharge on your medical premiums. Non-Compliant
While making your elections within the
Single $83.58 $100.89 -
Paylocity portal, you will be asked to
EE + Spouse $239.89 $257.20 $274.51
complete an affidavit for tobacco use.
EE + Child(ren) $177.38 $194.69 -
Family $323.15 $340.46 $357.77
PPO Bi-Weekly Contributions
Tobacco User/Smoker Rates
1 smoker 2 smokers
Compliant
Single $78.56 $95.87 -
EE + Spouse $224.10 $241.40 $258.71
EE + Child(ren) $181.02 $198.33 -
Family $334.99 $352.30 $369.61
Non-Compliant
Single $104.23 $121.54 -
EE + Spouse $279.36 $296.67 $313.98
EE + Child(ren) $213.71 $231.02 -
Family $397.90 $415.21 $432.52
Bi-Weekly Smoker Surcharge
1 Smoker $17.31
2 Smokers $34.62
13Benefits Guide • 2022
Staying Healthy
How to Engage Well onTarget
in Wellness with HALO Access the Well onTarget Member Wellness
If you want to pay the lower compliant portal at www.wellontarget.com. In the
rates on the medical plan, you will need Wellness portal, you will have access to a
to take action. Tasks completed from wide array of wellness resources, including:
9/1/2021 – 8/31/2022 will apply towards • Challenges that occur year-round on
your Wellness Compliance status for a variety of topics like managing money,
the plan year starting 9/1/2022.: sleep, healthy eating, etc.
Complete one task from each of
• Coaching will provide you access to
a credentialed expert to support you
the three categories shown below: in your unique wellness journey
• Digital self-management programs
01 V isit your physician for a physical, on a wide range of topics like tobacco
or any of the following screenings: use, weight management, stress, sleep,
Biometric, Cervical Cancer, and more
• Blue Points Rewards – Get rewarded
Mammogram, or Colon Cancer
• If getting a physical or biometric
for completing healthy activities! Use
screening, you should tell your provider
this a routine service to ensure your Blue Points in an online marketplace
it is covered at 100% through your Well onTarget account.
• Get rewarded for completing Health
02 C omplete a Health Risk Assessment Assessments, Self-Management Program,
on the Well onTarget portal Fitness Programs, connecting a compatible
fitness device or app to the portal,
03 omplete a Corporate Challenge or
C and much more!
Coaching program within the Well
onTarget portal or provide HR@halo.com
with COVID vaccination documentation
14Benefits Guide • 2022
Staying Healthy
Tools and resources
with BCBSIL
Virtual Visits with MDLIVE!
Speak With a Physician or No copay on the PPO plan and no cost
for CDHP participants after deductible
Therapist—Anytime, Anywhere
is met for MDLIVE medical and
MDLIVE allows you to access board-certified behavioral health visits.
physicians or therapists 24/7/365 from any
location, whether you are on the road, at
work or in the comfort of your own home. This
service is available for both physical and
behavioral health visits. You may access
MDLIVE by mobile app, online video or over
Blue Access for
the phone. Getting sick after hours or on the
weekends used to mean a long, costly trip to
Members (BAM)
the emergency room or urgent care center. Healthcare at Your Fingertips
But with your virtual visits benefit provided With BAM, you can:
• Use the Provider Finder tool to search for a
by Blue Cross Blue Shield of Illinois and
powered by MDLIVE, you may access care at
healthcare provider, hospital, or pharmacy
a location convenient to you. Virtual visits are
for non-emergency situations such as: • Request or print your ID card
• Allergies • Ear infections • Check the status or history of a claim
• Anxiety • Pink eye • View or print Explanation
• Asthma • Rashes of Benefits statements
• Cold/flu • Stress • Use the Cost Estimator tool to find
• Depression
the price of hundreds of tests,
management
treatments, and procedures
If needed, through MDLIVE, you can get a To get started, visit www.bcbsil.com/member
prescription called into your local pharmacy. and use the information on your ID card to
create an account.
To set up an account, you may:
• Call MDLIVE at 866.676.4204
• Go to www.MDLIVE.com/BCBSIL BCBSIL App
• Text BCBSIL to 635.483 Stay connected with BCBSIL and access
• Download the MDLIVE app important health benefit information
wherever you are by using the BCBSIL app.
Text BCBSILAPP to 33633 to get the app.
15Benefits Guide • 2022
Staying Healthy
Dental Plan Dental Coverage
Highlights Reminders
There are two dental plans available for you • Two routine dental cleanings
to choose from, the Low Plan and the High per benefit year
Plan. As a reminder, getting care from
an in-network provider will be lower cost
• Annual maximum is the most your plan
will pay towards your dental services
for you than if you were to visit an
in the benefit year
out-of-network provider. For more details,
• A
pplies to each covered
see the dental plan summaries.
person on the plan
Plan Design High Plan Low Plan
• Orthodontia limit of $2,000 on the
High Plan is a lifetime maximum
Individual
$50 $100 • T
his is the most your plan will
Deductible
pay for orthodontia services
Family Deductible $150 $300 per member per lifetime
Maximum $1,000 $1,000 • D
oes not “reset” each year
like your annual maximum
Preventive 100% 90%
Basic 80% 70%
Dental Plan
Major 50% 50%
Contributions
Orthodontia 50% N/A
Orthodontia Children
N/A Delta Dental of
Eligibility under 19
IL—Bi-Weekly Contributions
Orthodontia
$2,000 N/A
Lifetime Maximum High Plan Low Plan
Single $11.56 $9.95
Pay Less by Using an EE + Spouse $20.81 $17.91
In-Network Provider
EE + Child(ren) $33.63 $24.56
Click here to find an in-network
provider near you. Family $45.19 $34.52
16Benefits Guide • 2022
Staying Healthy
Vision Plan Highlights
Your vision coverage is offered through BCBSIL. BCBSIL provides you
with affordable care options and gives you access to a range of
discounts on glasses, frames, lenses, and laser vision correction.
BCBSIL vision partners with EyeMed to provide you with an extensive
network of optometrists, ophthalmologists and opticians in private
practices and at optical retailers including Walmart, Bard Optical,
All About Eyes, Target, LensCrafters, and more! For more details
on your vision coverage and exclusive savings and promotions,
visit member.eyemedvisioncare.com/bcbsilhalo or download
the EyeMed Members Mobile App.
To locate an in-network provider, visit eyedoclocator.
eyemedvisioncare.com/bcbsilhalo/en.
Visit Glasses.com to access a huge selection
BCBSIL Vision Plan of frames and lenses with your benefits using
3-D virtual try-on technology!
Out-of-Network
In-Network
Reimbursement Vision Plan Contributions
Frequency
12/12/24
(Exams/Lens/Frames) BCBSIL Vision—Bi-Weekly
Exam $10 copay Up to $45 Contributions
Single $2.76
Spectacle Lens
• Single Vision $25 copay Up to $30
EE + 1 $4.35
• Bifocal
EE + 2 or more $7.80
$25 copay Up to $50
• Trifocal $25 copay Up to $65
• Lenticular $25 copay Up to $100
You do not need ID cards to receive services.
Standard Progressive Lens $25 copay Up to $50
BCBSIL will send you two ID cards showing
$140 with 20% off for only the employee’s name, no matter who
Allowance Up to $70
balances over $140 is covered. To download additional ID
Elective Contact cards visit member.eyemedvisioncare.com/
$40 max copay
Lens—Fitting and Evaluation bcbsilhalo or the EyeMed app.
Up to $105
Elective Contact Lens $140 allowance
1704 Feeling Secure
Benefits Guide • 2022
Feeling Secure
Health Savings
Account (HSA)
An HSA is an individually owned savings
account that accompanies a qualified high
deductible health, and the funds may be
used towards future eligible medical
expenses or retirement. Your HSA funds
may be rolled over from year to year.
HSAs offer a triple tax advantage:
• Contributions are pre-tax or tax-deductible
• Earnings on the balance
and investments are not taxed
• Funds withdrawn for qualified
medical expenses are not taxed
The IRS has a limit on how much you can
contribute to your HSA on an annual
basis, these limits are outlined below.
Employees age 55 and older may contribute
an additional $1,000 annually in catch-
up contributions. The maximum HSA
contributions are:
• Single: $3,600
• Non-single: $7,200
You have the option to invest your HSA funds
up to $2,000 annually. For more information,
visit www.account.53hsa.com.
HALO contributes to your HSA, employees
with single coverage receive $500/year and
employees with all other coverage receive
$1,000/year. This is free money and the
funds are yours to keep. You must open your
account in order for HALO to be able to make
these contributions.
19Benefits Guide • 2022
Feeling Secure
Flexible Spending
Accounts (FSA)
These are administered through Discovery
Benefits. The FSA allows you to contribute
pre-tax funds from each paycheck to
be used towards eligible healthcare
and/or dependent care expenses.
You may also contribute to a commuter FSA,
for eligible transit/parking expenses
for your work commute.
IRS rules state you cannot contribute
more than the following amounts:
• Healthcare FSA: $2,750 annually
• Dependent care FSA: $5,000 annually
• Commuter FSA: $270 monthly
At the end of the year, remaining money up
to $500 will be rolled over to the following
year for you to continue using. If you have
a balance above $500, that money will be
forfeited, so choose your FSA election
amount wisely.
20Benefits Guide • 2022
Feeling Secure
Healthcare Flexible The dependent care FSA should be used
on expenses incurred to work, seek work,
Spending Account
or attend school. Dependent must be
NOTE: You are ineligible to contribute to the under age 13 or incapable of self-care.
medical FSA if you are enrolled in the medical
HDHP with HSA plan. The dependent care FSA includes
a grace period and run-out period,
The healthcare FSA can be utilized for any here’s how they work:
of the following types of expenses incurred
by you and your family:
• Grace period—This allows you to continue
to incur claims through March 15 following
• Copays the close of the plan year
• Coinsurance • Run-out period—Claims for the prior year
• Some services not covered by medical and incurred during the grace period can
or dental insurance, vision care, be filed through March 31
and prescription copays
Commuter FSA
Dependent Care FSA Commuter FSAs pre-tax funds can be used
The dependent care FSA allows you towards expenses related to commuting to
to use pre-tax funds towards eligible and from work for mass transit, vanpooling,
expenses such as: and work-related parking costs.
• Daycare This includes:
• Preschool • Transit passes, tokens
• Babysitting • Fare cards, vouchers
• Summer day camp • Parking passes
• Dependent adult daycare Reminder: Unused funds over $500
at the end of the plan year will not be
refunded. There are no exceptions to this;
it is an IRS regulation.
21Benefits Guide • 2022
Feeling Secure
Life and
Disability Benefits
Our life and accident insurance plans provide
financial protection in the event of the death
of a covered person or upon certain other
losses suffered as the result of an accident.
Life and Disability Reminders
• If you are enrolled in medical,
the company will provide your basic
life and AD&D coverage
• If you are not enrolled in medical,
you must purchase the basic life and AD&D
• Basic life and AD&D, short term disability,
and long term disability must
be purchased all together and enrollment
in one or two plans is not permitted
Your basic life and AD&D coverage is two
times your annual salary up to a maximum
of $250,000. Employee benefits are reduced
by 50% at age 70.
Plan Design
HALO
Features
Benefit 2x annual salary
Lesser of 2x annual
Maximum Benefit
salary or $250,000
22Benefits Guide • 2022
Feeling Secure
Supplemental Life Supplemental Life
You have the option to purchase additional
Contributions—Employee
Life coverage for yourself, your spouse and and Spouse
your dependent children. Premiums for
Bi-Weekly Contributions
employee and spouse/partner vary based
(based on units of $1,000)
on your age and will increase according
to the age ranges below and your age on Under Age 29 $0.037
September 1 of every calendar year.
• Employee coverage is available
Age 30–34 $0.051
in $10,000 increments up to $400,000 Age 35–39 $0.055
• Employee benefits reduce Age 40–44 $0.069
by 50% at age 70
• Spouse/partner coverage is available Age 45–49 $0.106
in $5,000 increments up to $50,000 Age 50–54 $0.175
• S
pouse/partner coverage cannot
exceed 50% of employee coverage Age 55–59 $0.309
• S
pouse/partner supplemental Age 60–64 $0.485
life coverage terminates at age 70
• S
pouse/partner rates are Age 65–69 $0.637
based upon employee age
• Child coverage of $10,000 is available
Age 70+ $1.431
for children over 6 months
• The guaranteed issue amounts
To calculate bi-weekly cost—($ amount of
requested additional insurance/$1,000) × rate
are $200,000 for employee and
(table above) = bi-weekly cost.
$30,000 for spouse/partner
• To purchase coverage over these Dependent Child Life
amounts or after initial eligibility,
you will be required to submit an
Insurance Contribution
evidence of insurability (EOI) form
which will be reviewed and Bi-Weekly Contributions
approved/rejected by New York Life
$0.0508 per $1,000
23Benefits Guide • 2022
Feeling Secure
Short Term Long Term
Disability Disability
Short term disability (STD) replaces Long term disability (LTD) protects your
your weekly income while you are out income by providing you with a percentage
of work following a non-work-related of your income while you are disabled.
accident or illness. Benefits begin after 90 days of a qualified
• Benefits go into effect on the disability until age 65.
8th day of a qualified disability
• Maximum of 11 weeks with New York Life
doctor certification
LTD Benefits
• If you are enrolled in the medical plan,
short term disability will be provided
Benefit Percentage 60%
by the company
• If you are not enrolled in the medical plan Monthly Benefit Maximum $10,000
and wish to be covered you must purchase
Benefits Waiting Period 90 days
the plan along with long term disability
and basic life and disability insurance
New York Life
STD Benefits
Benefit Percentage 66.67%
Weekly Benefit Maximum $1,500
8th day accident
Benefits Begin
8th day sickness
Benefits Duration 11 weeks
24Benefits Guide • 2022
Feeling Secure
Voluntary Critical You may choose group critical
illness insurance as follows:
Illness, Hospital • Employee coverage can be elected
in increments of $10,000 up to $30,000
Indemnity, and • Spouse coverage can be elected in
Group Accident
increments of $5,000 up to $15,000,
election cannot exceed 50% of the
employee coverage amount
If you’re concerned about the financial
impact large medical expenses can have on
• Child coverage can be elected in
increments of $5,000 up to $15,000
you and your family or they are diagnosed
with a serious illness or sustain a serious
injury resulting in a hospital visit, consider Guaranteed Issue
enrolling for critical illness, group hospital If you are a new hire, you are not required
indemnity, or group accident insurance to provide proof of good health if you enroll
coverage through Cigna. during your employer’s eligibility waiting
period and you choose an amount of
Voluntary Critical Illness coverage up to and including the guaranteed
issue amount. If you apply for an amount
The critical illness group plan pays a lump-
of coverage greater than the guaranteed
sum benefit if a covered person is diagnosed
issue amount, coverage in excess of the
with a heart attack, stroke, cancer or many
guaranteed issue amount will not be issued
other conditions. It can help cover out-of-
until the insurance company approves
pocket medical expenses for treatments that
acceptable proof of good health.
aren’t covered by your medical plan, such as
deductibles and coinsurance.
25Benefits Guide • 2022
Feeling Secure
Critical Illness Contributions
Age Band $10,000 $20,000 $30,000
Employee (EE)—Bi-Weekly ContributionsBenefits Guide • 2022
Feeling Secure
Voluntary Voluntary
Hospital Indemnity Group Accident
The hospital indemnity insurance program The group accident insurance plan helps
pays a cash benefit to you for covered offset your out-of-pocket expenses in the
hospital stays, outpatient surgery costs, event of an accident, such as copays,
intensive care stays, and post hospital skilled coinsurance, and other medical expenses.
nursing facility care. This cash payment can This plan covers accidents that occur off
be used however you choose. the job and includes a range of incidents
from common injuries to more serious events.
Hospital Indemnity You may elect the following group
accident insurance:
Contributions
Bi-Weekly Contributions Group Accident
Contributions
Single $9.21
EE + Spouse $18.37
Bi-Weekly Contributions
EE + Child(ren) $16.52
Single $5.58
Family $25.16
EE + Spouse $8.65
EE + Child(ren) $10.97
Family $14.04
27Benefits Guide • 2022
Feeling Secure
401(k) Savings Plan
Bank of Oklahoma (BOK Financial)
administers our 401(k) plan. This benefit
allows you to save money for your retirement.
Contributing is a convenient way to invest
in your future by building a source of income
for your retirement.
Eligibility
You must be 18 years of age and are eligible
the first of the month following 30 days of
employment to contribute to the 401(k).
Auto-Enrollment
An automatic deferral amount of 3% of your
compensation will be withheld from each
of your paychecks. The automatic deferral
amount will be contributed as a pre-tax
elective deferral to the plan.
Contributions
You can choose to contribute a percentage of your income
(1%-100% in whole percentages only) or a specified dollar amount
to the plan biweekly on either a pre-tax or an after-tax (Roth) basis.
Contributions are deducted from each biweekly pay check. You are
allowed to change, stop, or restart the amount of your contribution
at the next reasonable pay period.
Company Match
The company may offer an annual match of 50% on the first $1,000
of your contributions (maximum match of $500 annually). The match
is made in January for the previous year’s contributions. You must work
at least 1,000 hours and be employed on the last day of the calendar
year to be eligible for the match.
28Benefits Guide • 2022
Feeling Secure
Automatic
Enrollment
The eligible automatic contribution If automatic deferrals are
arrangement (EACA) provisions apply to
withheld from my paycheck
the Plan. This type of automatic enrollment
allows the plan administrator to enroll
can I take that money out of
employees in the Plan. the Plan right away?
Yes, you may request that your automatic
What happens when I deferrals and any earnings on those
become eligible for the Plan? deferrals be distributed to you as long as you
make the request in writing within 90 days
If you are eligible to make elective deferrals
of when the automatic deferrals were first
and meet the requirements below and you
withheld from your paycheck. Any matching
do not make a deferral election by your
contributions associated with the automatic
entry date, the plan administrator will begin
deferrals that you take from the Plan by the
deducting automatic deferrals from each
deadline will be forfeited. After that deadline
of your paychecks and will submit those
has passed you will only be able to take the
amounts to the Plan (automatic deferrals)
automatic deferrals out of the Plan when
on your behalf.
elective deferrals can be distributed.
An automatic deferral amount of 3% of your
compensation will be withheld from each
Do the Plan’s automatic
of your paychecks. The automatic deferral enrollment features apply
amount will be contributed as a pre-tax to me if I have already
elective deferral to the Plan. made a deferral election?
No, if you have already made a deferral
If you do not wish to have automatic
election that amount will continue to be
deferrals withheld from each of your
withheld from each of your paychecks until
paychecks or if you want to change the
you make a new election.
amount withheld, you must make a deferral
election. If automatic deferrals have already
started, you may make a deferral election to
change the amount being withheld or to stop
the deferrals entirely.
29Benefits Guide • 2022
Feeling Secure
Elective Deferrals
Your elective deferrals are amounts that
you chose to (or are assumed to have chosen
to) have withheld from your paycheck and
contributed to the Plan in your name. Please
see the section of your SPD titled “Eligibility
for Participation” to determine if you are
eligible to make elective deferrals and
“Contributions to the Plan” for the type of
compensation you may defer into the Plan.
How do I make or change
my deferral election?
You may make or change your deferral
election by going to the following web site
or calling the voice response unit at the
following number: www.startright.bokf.com
or calling 800.876.9557.
Once I make a deferral
election, how often can
I change, stop, or re-start
the election?
You may change or re-start your deferral
election as of the next reasonable pay
period. You may stop your deferrals
at any time.
30Benefits Guide • 2022
Feeling Secure
Elective Deferrals
If I make a deferral election
is the amount withheld from
my paychecks taxed?
You will have the option to decide if the The plan administrator may establish
amount you elect to defer into the Plan additional rules you will need to follow when
is taxed or not. If you chose to have your making your deferral election. Your deferral
elective deferrals go into the Plan as pre-tax election is only effective for compensation
elective deferrals, you will not be taxed until you have not received yet. The plan
you take the money out of the Plan. If you administrator may also reduce or totally
chose to have your elective deferrals go into suspend your election if they determine that
the Plan as Roth elective deferrals, you will your election may cause the Plan to fail
be taxed on that money when it is taken out to satisfy any of the requirements of the
of your paycheck, but it will not be taxed Internal Revenue Code.
again when you take it out of the Plan. The
earnings on those Roth elective deferrals may How will my account
be taken out tax-free if certain conditions are
balances be invested
met. Please see the SPD for more information
on Roth elective deferrals.
if I do not make an
investment election?
Are there any limits The Plan’s default investments are
to how much I can defer intended to meet the requirements to be a
qualified default investment alternative
into the Plan?
(QDIA). If you do not make an investment
Your elective deferrals are subject election your account balances will be
to the following limits: placed in investments selected by the plan
• Your total amount of deferrals administrator. See the attached Qualified
cannot be more than $19,500 Default Investment Alternative information
• If you are age 50 or over, you may which provides information on the default
fund you will be invested in if you fail to
defer an additional amount, called a
make an investment election.
“catchup contribution,” of up to $6,500
31Benefits Guide • 2022
Feeling Secure
Work/Life Balance
Employee
Assistance Program Achieve Work/Life Balance
Whether your needs are big or small, your life For help handling life’s challenges go on line
assistance and work/life support program is for articles and resources including on family,
there for you. It can help you and your family care giving, pet care, aging, grief, balancing,
finds solutions and restore your peace of working smarter, and more.
mind. You and your family may access the life
assistance program 24/7 on the phone at no Legal Consultation
extra cost to you. An advocate can help you
and Referrals*
assess your needs and develop a solution.
Receive a free 30-minute consultation with a
He or she can also direct you to community
network attorney. And up to a 25% discount
resources and online tools.
on select fees.
Visit a Specialist
You have three face-to-face sessions with a Financial Consultations
behavioral counselor available to you—and Receive a free 30-minute consultation
your household members. Call New York Life and 25% discount on tax planning and
to request a referral. preparation.
Monthly Webinars The life assistance program is available
Educational seminars on a variety of to you at no additional cost. For more
relevant topics such as managing your life, information on 24/7 support, call
work, money and health are available in a 800.538.3543 or visit www.cignalap.com.
quarterly calendar of monthly webcasts
distributed to your employer.
32Benefits Guide • 2022
Feeling Secure
Access Your Maternity
and Family Benefits—BCBSIL
Ovia Health provides maternity and family apps to support enrolled members through
your entire parenthood journey. These apps are included in your health plan benefits,
offered through Blue Cross and Blue Shield of Illinois (BCBSIL).
Follow These Easy Steps to With Ovia Health, You’ll
Download Ovia and Launch Have Access to Enhanced,
Your Account: Personalized Health and
01 Download the app that’s right for you Wellness Features:
• Ovia Fertility—Health & Fertility Health Assessment
• Ovia Pregnancy—Pregnancy & Postpartum and Symptom Tracking
• Ovia Parenting—Family & Working Parents Receive alerts and predictive, personal
coaching when Ovia detects a potential
02 When signing up, choose “I have Ovia medical issue.
Health as a benefit” before tapping “Sign
up” and make sure to select BCBSIL as Over Fifty Physician-Developed
your health plan and enter your employer Clinical Programs to Help You
name (optional).
be as Healthy As Possible
Engage with personalized health and
03 Already have an Ovia app on your phone?
wellness programs to help you navigate
• O
pen your app and tap “Health” to take
infertility, sexual health, birth planning,
the Ovia Health Assessment.
preterm delivery, mental health,
• T
ap “Update my healthcare information”
breastfeeding, and more.
and select BCBSIL as your health plan and
enter your employer name (optional).
Unlimited 1-on-1 Coaching
If You Do Not Indicate BCBSIL Message instantly with Registered Nurse
As Your Health Plan, You’ll Only health coaches to ask all your questions.
Be Able To Access Some Of The
Career and
Features Available To You: Return-to-Work Programs
• Health and menstrual cycle tracker Find coaching and career advice for
• Pregnancy calendar & daily baby updates preparing for maternity leave, returning
• Child’s development checklist to work, and being a working parent.
• Daily health and wellness content
• Data & symptom feedback
3305 HALO Benefits Contact Information
Benefits Guide • 2022
HALO Benefits
Contact Information
General Benefits Life and Disability
Questions New York Life (formerly Cigna)
Matt Barbian 800.362.4462
HR@halo.com newyorklife.com/group-benefit-solutions
Group #s:
Medical and Pharmacy Basic Life: FLX966896
Basic AD&D: OK968384
Blue Cross Blue Shield of Illinois
Supplemental Voluntary Life: FLX966876
800.676.BLUE (2583)
STD:LK751865
bcbsil.com
LTD: LK964719
HDHP Group #PI3985
PPO Group #PI4019
Life Assistance Program
MDLIVE Virtual Visits Cigna
800.538.3543
888.676.4204
cignalap.com
MDLIVE.com/bcbsil
401(k)
Health Savings
Account (HSA) Bank of Oklahoma
800.876.9557
Fifth Third Bank startright.bokf.com
888.350.5353
www.53.com
Accident
Code: FTB- 149704
Cigna
Flexible Spending 800.351.9214
Account (FSA) my.cigna.com
Group #AI961176P
Wex (formerly Discovery Benefits)
866.451.3399
Critical Illness
www.wex.com
Cigna
Dental 800.351.9214
my.cigna.com
Delta Dental of Illinois Group #CI96113P
800.323.1743
www.deltadentalil.com
Hospital Indemnity
Group #20210
Cigna
Vision 800.351.9214
my.cigna.com
Blue Cross Blue Shield of Illinois Group #HC960527P
855.362.5539
member.eyemedvisioncare.com/
bcbsilhalo
Group #281298
35HALO Branded Solutions, Inc.
HEALTH PLAN NOTICES
TABLE OF CONTENTS
1. Medicare Part D Creditable Coverage Notice
2. HIPAA Comprehensive Notice of Privacy Policy and Procedures
3. Notice of Special Enrollment Rights
4. General COBRA Notice
5. Women’s Health and Cancer Rights Notice
IMPORTANT NOTICE
This packet of notices related to our health care plan includes a notice
regarding how the plan’s prescription drug coverage compares to
Medicare Part D. If you or a covered family member is also enrolled in
Medicare Parts A or B, but not Part D, you should read the Medicare
Part D notice carefully. It is titled, “Important Notice From HALO
Branded Solutions, Inc. About Your Prescription Drug Coverage and
Medicare.”MEDICARE PART D CREDITABLE COVERAGE NOTICE
IMPORTANT NOTICE FROM HALO BRANDED SOLUTIONS, INC. ABOUT YOUR PRESCRIPTION DRUG
COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription
drug coverage with HALO Branded Solutions, Inc. and about your options under Medicare’s prescription drug coverage. This
information can help you decide whether 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.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or your
dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should
qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
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. HALO Branded Solutions, Inc. has determined that the prescription drug coverage offered by the HALO Branded Solutions,
Inc. Employee Health Care Plan (“Plan”) is, on average for all plan participants, expected to pay out as much as standard
Medicare prescription drug coverage pays and is considered “creditable” prescription drug coverage. This is important for the
reasons described below. ____________________________________________________________
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep
this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare drug plan, as long as you later
enroll within specific time periods.
Enrolling in Medicare—General Rules
As some background, you can join a Medicare drug plan when you first become eligible for Medicare. If you qualify for
Medicare due to age, you may enroll in a Medicare drug plan during a seven-month initial enrollment period. That period begins
three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. If you
qualify for Medicare due to disability or end-stage renal disease, your initial Medicare Part D enrollment period depends on the
date your disability or treatment began. For more information you should contact Medicare at the telephone number or web
address listed below.
Late Enrollment and the Late Enrollment Penalty
If you decide to wait to enroll in a Medicare drug plan you may enroll later, during Medicare Part D’s annual enrollment
period, which runs each year from October 15 through December 7. But as a general rule, if you delay your enrollment in
Medicare Part D, after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
If after your initial Medicare Part D enrollment period you go 63 continuous days or longer without “creditable”
prescription drug coverage (that is, prescription drug coverage that’s at least as good as Medicare’s prescription drug
coverage), your monthly Part D premium may go up by at least 1 percent of the premium you would have paid had you
enrolled timely, for every month that you did not have creditable coverage.
For example, if after your Medicare Part D initial enrollment period you go 19 months without coverage, your premium
may be at least 19% higher than the premium you otherwise would have paid. You may have to pay this higher premium
for as long as you have Medicare prescription drug coverage. However, there are some important exceptions to the late
enrollment penalty.Special Enrollment Period Exceptions to the Late Enrollment Penalty
There are “special enrollment periods” that allow you to add Medicare Part D coverage months or even years after you
first became eligible to do so, without a penalty. For example, if after your Medicare Part D initial enrollment period you
lose or decide to leave employer-sponsored or union-sponsored health coverage that includes “creditable” prescription
drug coverage, you will be eligible to join a Medicare drug plan at that time.
In addition, if you otherwise lose other creditable prescription drug coverage (such as under an individual policy) through
no fault of your own, you will be able to join a Medicare drug plan, again without penalty. These special enrollment
periods end two months after the month in which your other coverage ends.
Compare Coverage
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs
of the plans offering Medicare prescription drug coverage in your area. See the HALO Branded Solutions, Inc. Plan’s
summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get
one by contacting us at the telephone number or address listed below.
Coordinating Other Coverage With Medicare Part D
Generally speaking, if you decide to join a Medicare drug plan while covered under the HALO Branded Solutions, Inc.
Plan due to your employment (or someone else’s employment, such as a spouse or parent), your coverage under the
HALO Branded Solutions, Inc. Plan will not be affected. For most persons covered under the Plan, the Plan will pay
prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue
of what program pays first and what program pays second, see the Plan’s summary plan description or contact Medicare
at the telephone number or web address listed below.
If you do decide to join a Medicare drug plan and drop your HALO Branded Solutions, Inc. prescription drug coverage,
be aware that you and your dependents may not be able to get this coverage back. To regain coverage you would have to
re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan
description to determine if and when you are allowed to add coverage.
For More Information About This Notice or Your Current Prescription Drug Coverage…
Contact the person listed below for further information, or call 815-548-9101. 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 HALO Branded
Solutions, Inc. changes. You also may request a copy.
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.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For
information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-
1213 (TTY 1-800-325-0778).Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may
be required to provide a copy of this notice when you join to show whether or not you have maintained creditable
coverage and whether or not you are required to pay a higher premium (a penalty).
Date: September 1, 2021
Name of Entity/Sender: Matt Barbian
Contact—Position/Office: Benefits Specialist
Address: 1500 HALO Way
Sterling, IL 61081
Phone Number: 815-548-9101
Nothing in this notice gives you or your dependents a right to coverage under the Plan. Your (or your dependents’)
right to coverage under the Plan is determined solely under the terms of the Plan.HIPAA COMPREHENSIVE NOTICE OF PRIVACY POLICY
AND PROCEDURES
HALO BRANDED SOLUTIONS, INC.
IMPORTANT NOTICE
COMPREHENSIVE NOTICE OF PRIVACY POLICY AND PROCEDURES
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.
This notice is provided to you on behalf of:
HALO Branded Solutions, Inc. Welfare Benefit Plan*
* This notice pertains only to healthcare coverage provided under the plan.
The Plan’s Duty to Safeguard Your Protected Health Information
Individually identifiable information about your past, present, or future health or condition, the provision of health care to
you, or payment for the health care is considered “Protected Health Information” (“PHI”). The Plan is required to extend
certain protections to your PHI, and to give you this notice about its privacy practices that explains how, when, and why
the Plan may use or disclose your PHI. Except in specified circumstances, the Plan may use or disclose only the minimum
necessary PHI to accomplish the purpose of the use or disclosure.
The Plan is required to follow the privacy practices described in this notice, though it reserves the right to change those
practices and the terms of this notice at any time. If it does so, and the change is material, you will receive a revised
version of this Notice either by hand delivery, mail delivery to your last known address, or some other fashion. This
notice, and any material revisions of it, will also be provided to you in writing upon your request (ask your Human
Resources representative, or contact the Plan’s Privacy Official, described below), and will be posted on any website
maintained by HALO Branded Solutions, Inc. that describes benefits available to employees and dependents.
You may also receive one or more other privacy notices from insurance companies that provide benefits under the Plan.
Those notices will describe how the insurance companies use and disclose PHI and your rights with respect to the PHI
they maintain.
How the Plan May Use and Disclose Your Protected Health Information
The Plan uses and discloses PHI for a variety of reasons. For its routine uses and disclosures it does not require your
authorization, but for other uses and disclosures, your authorization (or the authorization of your personal representative
(e.g., a person who is your custodian, guardian, or has your power-of-attorney) may be required. The following offers
more description and examples of the Plan’s uses and disclosures of your PHI.
• Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.
• Treatment: Generally, and as you would expect, the Plan is permitted to disclose your PHI for purposes of your
medical treatment. Thus, it may disclose your PHI to doctors, nurses, hospitals, emergency medical technicians,
pharmacists, and other health care professionals where the disclosure is for your medical treatment. For example,
if you are injured in an accident, and it’s important for your treatment team to know your blood type, the Plan
could disclose that PHI to the team in order to allow it to more effectively provide treatment to you.
• Payment: Of course, the Plan’s most important function, as far as you are concerned, is that it pays for all or
some of the medical care you receive (provided the care is covered by the Plan). In the course of its payment
operations, the Plan receives a substantial amount of PHI about you. For example, doctors, hospitals, and
pharmacies that provide you care send the Plan detailed information about the care they provided, so that they can
be paid for their services. The Plan may also share your PHI with other plans in certain cases. For example, if you
are covered by more than one health care plan (e.g., covered by this Plan and your spouse’s plan or covered by theplans covering your father and mother), we may share your PHI with the other plans to coordinate payment of
your claims.
• Health care Operations: The Plan may use and disclose your PHI in the course of its “health care operations.”
For example, it may use your PHI in evaluating the quality of services you received or disclose your PHI to an
accountant or attorney for audit purposes. In some cases, the Plan may disclose your PHI to insurance companies
for purposes of obtaining various insurance coverages. However, the Plan will not disclose, for underwriting
purposes, PHI that is genetic information.
• Other Uses and Disclosures of Your PHI Not Requiring Authorization. The law provides that the Plan may use
and disclose your PHI without authorization in the following circumstances:
• To the Plan Sponsor: The Plan may disclose PHI to the employers (such as HALO Branded Solutions, Inc.) who
sponsor or maintain the Plan for the benefit of employees and dependents. However, the PHI may only be used
for limited purposes, and may not be used for purposes of employment-related actions or decisions or in
connection with any other benefit or employee benefit plan of the employers. PHI may be disclosed to: the human
resources or employee benefits department for purposes of enrollments and disenrollments, census, claim
resolutions, and other matters related to Plan administration; payroll department for purposes of ensuring
appropriate payroll deductions and other payments by covered persons for their coverage; information technology
department, as needed for preparation of data compilations and reports related to Plan administration; finance
department for purposes of reconciling appropriate payments of premium to and benefits from the Plan, and other
matters related to Plan administration; internal legal counsel to assist with resolution of claim, coverage, and other
disputes related to the Plan’s provision of benefits.
• To the Plan’s Service Providers: The Plan may disclose PHI to its service providers (“business associates”) who
perform claim payment and plan management services. The Plan requires a written contract that obligates the
business associate to safeguard and limit the use of PHI.
• Required by Law: The Plan may disclose PHI when a law requires that it report information about suspected
abuse, neglect, or domestic violence, or relating to suspected criminal activity, or in response to a court order. It
must also disclose PHI to authorities that monitor compliance with these privacy requirements.
• For Public Health Activities: The Plan may disclose PHI when required to collect information about disease or
injury, or to report vital statistics to the public health authority.
• For Health Oversight Activities: The Plan may disclose PHI to agencies or departments responsible for
monitoring the health care system for such purposes as reporting or investigation of unusual incidents.
• Relating to Decedents: The Plan may disclose PHI relating to an individual’s death to coroners, medical
examiners, or funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations
or transplants.
• For Research Purposes: In certain circumstances, and under strict supervision of a privacy board, the Plan may
disclose PHI to assist medical and psychiatric research.
• To Avert Threat to Health or Safety: In order to avoid a serious threat to health or safety, the Plan may disclose
PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
• For Specific Government Functions: The Plan may disclose PHI of military personnel and veterans in certain
situations, to correctional facilities in certain situations, to government programs relating to eligibility and
enrollment, and for national security reasons.
• Uses and Disclosures Requiring Authorization: For uses and disclosures beyond treatment, payment, and
operations purposes, and for reasons not included in one of the exceptions described above, the Plan is required to
have your written authorization. For example, uses and disclosures of psychotherapy notes, uses and disclosures of
PHI for marketing purposes, and disclosures that constitute a sale of PHI would require your authorization. Your
authorization can be revoked at any time to stop future uses and disclosures, except to the extent that the Plan has
already undertaken an action in reliance upon your authorization.
• Uses and Disclosures Requiring You to Have an Opportunity to Object: The Plan may share PHI with your
family, friend, or other person involved in your care, or payment for your care. We may also share PHI with these
people to notify them about your location, general condition, or death. However, the Plan may disclose your PHI only
if it informs you about the disclosure in advance and you do not object (but if there is an emergency situation and you
cannot be given your opportunity to object, disclosure may be made if it is consistent with any prior expressed wishes
and disclosure is determined to be in your best interests; you must be informed and given an opportunity to object to
further disclosure as soon as you are able to do so).You can also read
