Welcome to WCS - Waterford Country School



1

Who is Eligible?

All full time employees working 32 or more hours are eligible to enroll for the medical and dental insurance programs the first of the month following 60 days of employment. The following family members are eligible for these benefits through Waterford Country School:

Employee

Spouse/Domestic Partner

Child(ren)

Other legal child guardianship dependents

How to Enroll

This year we will have information meetings scheduled Wednesday, May 28, 2014, and Thursday, May 29, 2014. Please check with your supervisor for the times the sessions will be held at your location. The medical plan offered this year will be with CIGNA and will be similar to the benefits offered previously. The dental plan offered through Cigna will remain the same. The current payroll deductions for medical and dental have increased slightly. You will need to come to Open Enrollment on Thursday, June 12, 2014 and Friday, June 13, 2014 to sign new payroll authorizations even if you wish to have all current elections remain the same. If you are adding or deleting dependents, newly enrolling, terminating coverage, or making other changes, then you will also need to complete the appropriate carrier paperwork. The benefits you elect during Open Enrollment will be effective from July 1, 2014 through June 30, 2015. If you have any questions during the process, please contact Lynn Morey.

How to Make Changes

Now is the time to make changes to your medical and dental benefits. If you do not make any changes during this open enrollment period, you will not be able to do so until the next open enrollment period, unless you have a qualified change in status. Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in spouse’s benefits or employment status. You must notify us in writing within 30 days of a change in status.

This open enrollment guide is intended as a summary of the benefits offered. Please refer to complete benefit summaries from the individual carrier for detailed provisions on each benefit program elected.

Medical Insurance being offered by

CIGNA

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A REVIEW OF YOUR MEDICAL PLAN

After a thorough market review, a decision was made to renew the Waterford Country School medical insurance program with a new insurance company, CIGNA, effective July 1, 2014. Cigna will administer our health plan with relatively minor changes to our current benefits.

A few plan highlights:

• We will now offer CIGNA’s Open Access Plus network with a $5,000/10,000 annual deductible. Waterford Country School employees will still enjoy the benefit of having a portion of the deductible be reimbursed by the school for hospital inpatient and outpatient deductible expenses. Waterford Country School employees will be responsible for the first $300 if a single or the first $600 if a family, of the deductible. In order to process claims you must bring a copy of your CIGNA Explanation of Benefits (EOB) and bill to Lynn Morey and WCS will pay the provider’s directly.

• You will also have the freedom to visit doctors or use facilities that are not part of the Cigna network, however your costs will be higher and you may need to file a claim.

A few examples of preventive care coverage are as follows:

| |In-Network Providers |Out of Network Providers |

|Well-Child Care Exams (per schedule) |100% coverage |Plan pays 50% after the deductible is met |

|Routine Adult Physical Exams (per schedule) |100% coverage | |

|Routine GYN Exams |100% coverage | |

| | | |

| 2014 – CIGNA Medical Plan |

|  |Cigna |

|  |Basic Plan |

| |$5,000/$10,000 |

|  |$30/45 Open Access Plus Plan |

|In Network Benefits |  |

|Referral Required? |No |

|In-Network Plan Year Deductible |$5,000/$10,000 |

|Preventative Pediatric- |$0 |

|Preventative Adult- |$0 |

|Preventative Gynecological Exam |$0 |

|Office Visit - Illness/Injury |$30 |

|Specialist Visit |$45 |

|Inpatient Hospital |Subject to deductible. Employee responsible |

| |for the first $300S/600F, WCS funds the |

| |remaining balance. |

|Outpatient Surgical | |

|Emergency Room |$150 |

|Urgent Care Center |$75 |

|X-Ray & Diagnostic Testing |No Charge |

|Advanced Radiology (MRI, MRA, CAT, CTA, PET, SPECT |$75 copayment per service, $375 copayment max |

|scans) |per member per plan year |

|Prescriptions: |  |

|Generic |$15 |

|Preferred Brand |$25 |

|Non-Preferred Brand |$40 |

|Mail Order: |$30/$50/$80 |

|Out-of-Network Benefits |  |

|Out-of-Network Deductible |$10,000/$20,000 |

|Co-Insurance |50% |

|Out-of-Pocket Maximum |$30,000/$60,000 |

|Employee Bi-Weekly Contributions | |

|Single |$ 25.89 |

|Employee+ Spouse |$168.30 |

|Employee+ Child(ren) |$113.49 |

|Employee + Family |$268.07 |

Dental Carrier

Our dental insurance program will continue with Cigna effective July 1, 2014. The dental plan design remains the same as the current plan. We will continue to offer a PPO dental plan design which provides coverage for both in network and out of network dentist visits.

Employee contributions have increased slightly and the biweekly amounts are reflected in the chart below .

|2014 Cigna Dental Plan |  |

|Plan Design |  |  |PPO |

|In-Network Deductible |  |$0 |

|Out-of-Network Deductible |$50 (3xFamily) |

|Waived for Preventative |  |Yes |

|Calendar Year Maximum |  |$2,000 |

|  |  |  |  |In Network |Out of Network |

|Type I Preventative & Diagnostic |  |  |

|Routine Exams |  |  |100% |100% |

|Teeth Cleaning |  |  |100% |100% |

|Routine X-Rays |  |  |100% |100% |

|Fluoride |  |  |  |100% |100% |

|Sealants |  |  |  |100% |100% |

|Space Maintainers |  |100% |100% |

|  |  |  |  |  |  |

|Type II Basic |  |  |  |

|Simple Extractions |  |100% |80% |

|Minor Oral Surgery |  |100% |80% |

|Fillings |  |  |  |100% |80% |

|Periodontics |  |  |100% |80% |

|Root Canals |  |  |100% |80% |

|  |  |  |  |  |  |

|Type III Major |  |  |  |

|Crowns |  |  |  |60% |50% |

|Inlays/Onlays |  |  |60% |50% |

|Dentures |  |  |60% |50% |

|Bridges |  |  |  |60% |50% |

|Employee Bi- Weekly Contributions |

|Single |$8.18 |

|Family |$31.66 |

| |

|This is intended only as a general summary of benefits. For a detailed description of benefits, terms, |

|limitations and exclusions, see group certificate |

| |

COMPANY PAID LIFE/AD&D INSURANCE

Waterford Country School provides all benefit eligible employees with a core life insurance benefit of one times salary to a maximum of $100,000. This benefit is paid for 100% by Waterford Country School. Please be sure to check the beneficiary you have on file and provide updates if needed.

VOLUNTARY LIFE INSURANCE

All employees have the opportunity to purchase voluntary life insurance which would be 100% employee paid. Employees can purchase up to $300,000 in $10,000 increments, with a Guaranteed Issue (GI) amount of $150,000. For Spouses, employees can purchase up to $150,000 in $10,000 increments with a GI amount of $25,000. For Children employees can purchase up to $10,000 in $5,000 increments, with the GI amount of $10,000. Please be sure to check the beneficiary you have on file and provide updates if needed. An enrollment form and Evidence of Insurability (EOI) must be completed if you wish to purchase additional life insurance or are enrolling for the first time.

COMPANY PAID LONG TERM DISABILITY INSURANCE

Waterford Country School provides all benefit eligible employees with a long term disability benefit of the lesser of 60% of salary to a maximum of $3,000 per month. The benefit waiting period is the 1st of the month following 60 days of employment. This benefit is paid for 100% by Waterford Country School.

ADDITIONAL VALUE ADDED SERVICE WITH ANTHEM LIFE/AD&D & LTD

As an employee of Waterford Country School enrolled in the Life/AD&D and LTD insurance Anthem BCBS provides access to:

▪ EAP with 3 face-to-face visits

▪ Travel Assistance

▪ Will Prep

▪ ID Theft Protection

▪ Beneficiary Companion

VOLUNTARY OFFERINGS OF ACCIDENT, CANCER & STD INSURANCE

All employees have the opportunity to purchase voluntary products through Aflac. Rates and plan design are based on individual needs. These benefits are 100% employee paid.

FLEXIBLE SPENDING ACCOUNTS (FSA)

The plan year for the FSA is now on a plan year, July 1, 2014 – June 30, 2015. Employees will continue to have the opportunity to participate in a healthcare flexible spending account and dependent care accounts. This valuable benefit allows you to save money on a pre-tax basis to pay for eligible medical and dependent care expenses. You will not have to pay Federal, State or FICA taxes on any amount you contribute to these accounts. This can save you up to 30-40% on these expenses. The annual maximum contribution is $2,500 for the medical FSA and $5,000 for the Dependent Care Account.

New this year is a new IRS regulation which enables members to roll remaining funds up to a maximum of $500 forward to the next year. The FSA plan will no longer contain the ‘use it or lose it’ provision.

Just a reminder, over the counter medications are no longer eligible expenses without a prescription from a physician. Please see FSA enrollment packet that contains a list of other eligible expenses under the plan.

BENEFIT RESOURCE CENTER

The Benefit Resource Center (BRC) will be available to the employees of Waterford Country School to assist with questions on any of the benefits offered to you. The BRC offers a toll-free hotline specifically designed to act as a single point of contact for all benefit questions and claims issues.

The Benefit Resource Center is staffed with experienced professionals who are well versed in Waterford Country School employee benefits. They are committed to providing superior customer service and participant advocacy ranging from eligibility questions to resolving claims questions.

The BRC is available to you and your dependents. The Personal Benefit Advocates will be able to:

• Answer your benefit plan/policy questions

• Assist you with eligibility and claim problems with carriers

• Provide claims appeals information and explain the process

• Explain allowable family status election changes (adding newborns, marriage,

divorce, etc.)

• Provide vendor plan contact information

CONTACT US:

Hours: Monday - Friday

8:00 AM - 5:00 PM EST

Email: BRCEast@ Phone: 855-USI-6699

GENERAL OPEN ENROLLMENT PARTICIPANT NOTICES:

Notice of Opportunity to Enroll

In Connection with Extension of Dependent Coverage to Age 26

Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in CIGNA. Dependent children eligible for the plan regardless of whether or not they have coverage available through their own employer or, if the adult child is married, through their spouse’s employer.

Lifetime Limit No Longer Applies and Enrollment Opportunity

The lifetime limit on the dollar value of benefits under CIGNA no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan.

General Notice of Special Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or 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 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 of the marriage, birth, adoption, or placement for adoption.

General Notice of Preexisting Condition Exclusion

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Under HIPAA, a “preexisting condition” is a condition for which medical advice; diagnosis, care, or treatment was recommended and received within the six-month period ending on the enrollment date in a health plan (the look-back period). Taking prescription medications during the look-back period constitutes receiving treatment.

This plan does not impose preexisting condition exclusion to members who elect during his/her initial eligibility, coming on mid year with proof of loss of other coverage and/or during the annual open enrollment. A genetic condition without advice, care, or treatment is not a preexisting condition.

This preexisting condition exclusion does not apply to a pregnancy or to a newborn child or adopted child under age 18 who becomes covered within 30 days of birth or adoption.

This preexisting condition exclusion does not apply to any enrollee under the age of 19.

Notice of Women’s Health and Cancer Rights (WHCRA)

As required by the Women’s Health and Cancer Rights Act (WHCRA) of 1998, this plan provides coverage for:

1. All stages of reconstruction of the breast on which the mastectomy has been performed;

2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

3. Prostheses and physical complications of mastectomy, including lymphedemas, in a manner

determined in consultation with the attending physician and the patient.

Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage.

Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter.

Newborn’s and Mothers’ Health Protection Act Notice

MATERNITY BENEFITS

Under federal and state law you have certain rights and protections regarding your maternity benefits under the Plan.

Under federal law known as the “Newborns’ and Mothers’ Health Protection Act of 1996” (Newborns’ Act) group health plans and health insurance issuers generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Summary of Benefit and Coverage

The Summary of Benefit and Coverage (SBC) will be provided by the insurance company. The SBC will detail what the insurance plan covers and what it costs.  If you require more detail about your coverage and costs, you can obtain the complete terms in the plan document.

Important Notice from Waterford Country School 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 Waterford Country School 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. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Waterford Country School has determined that the prescription drug coverage offered by the Waterford Country School Benefit Plans is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current Waterford Country School coverage will not be affected. You can keep your Waterford Country School coverage and this plan will coordinate with Part D coverage.

If you do decide to join a Medicare drug plan and drop your current Waterford Country School coverage, be aware that you and your dependents will be able to get this coverage back at the next open enrollment.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Waterford Country School and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 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 (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact CIGNA or our Human Resources Department. 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 Waterford Country School 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

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 , or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice.

If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

General Information About Your COBRA Continuation Coverage Rights

Please read for general information on COBRA rights excerpted from the Department of Labor. You will receive detailed information on your specific COBRA rights once your benefits terminate.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as 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 must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:

• Your hours of employment are reduced, or

• Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

• 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.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

• 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 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. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the 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.

How is COBRA 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. When the qualifying event is the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage - If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total 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 continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage - If your family experiences another qualifying event while receiving 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 notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

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 ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), 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 the EBSA website at ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)

Keep Your Plan Informed of Address Changes

In order to protect your family’s rights, you should keep the Plan Administrator informed of 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.

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 are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not 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, you can contact the Department of Labor electronically at askebsa. or by calling toll-free 1-866-444-EBSA (3272).

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2014. You should contact your State for further information on eligibility –

|ALABAMA – Medicaid |COLORADO – Medicaid |

| | |

|Website: |Medicaid Website: |

| | |

|Phone: 1-855-692-5447 |Medicaid Phone (In state): 1-800-866-3513 |

| |Medicaid Phone (Out of state): 1-800-221-3943 |

| | |

|ALASKA – Medicaid | |

| | |

|Website: | |

| | |

|Phone (Outside of Anchorage): 1-888-318-8890 | |

| | |

|Phone (Anchorage): 907-269-6529 | |

|ARIZONA – CHIP |FLORIDA – Medicaid |

| | |

|Website: |Website: |

| | |

| |Phone: 1-877-357-3268 |

|Phone (Outside of Maricopa County): 1-877-764-5437 | |

|Phone (Maricopa County): 602-417-5437 | |

| | |

| | |

| | |

| |GEORGIA – Medicaid |

| | |

| |Website: |

| |Click on Programs, then Medicaid, then Health Insurance Premium Payment |

| |(HIPP) |

| | |

| |Phone: 1-800-869-1150 |

|IDAHO – Medicaid |MONTANA – Medicaid |

| | |

|Medicaid Website: |Website: |

| |

|510/Default.aspx | |

| |Phone: 1-800-694-3084 |

|Medicaid Phone: 1-800-926-2588 | |

| | |

|INDIANA – Medicaid |NEBRASKA – Medicaid |

| | |

|Website: |Website: ACCESSNebraska. |

| | |

|Phone: 1-800-889-9949 |Phone: 1-800-383-4278 |

| | |

|IOWA – Medicaid |NEVADA – Medicaid |

| | |

|Website: dhs.state.ia.us/hipp/ |Medicaid Website: |

| | |

|Phone: 1-888-346-9562 |Medicaid Phone: 1-800-992-0900 |

| | |

|KANSAS – Medicaid | |

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|Website: | |

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|Phone: 1-800-792-4884 | |

|KENTUCKY – Medicaid |NEW HAMPSHIRE – Medicaid |

| | |

|Website: |Website: |

| | |

|Phone: 1-800-635-2570 |Phone: 603-271-5218 |

|LOUISIANA – Medicaid |NEW JERSEY – Medicaid and CHIP |

| | |

|Website: |Medicaid Website: |

| |dmahs/clients/medicaid/ |

|Phone: 1-888-695-2447 | |

| |Medicaid Phone: 609-631-2392 |

| | |

| |CHIP Website: |

| | |

| |CHIP Phone: 1-800-701-0710 |

| | |

|MAINE – Medicaid | |

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|Website: | |

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|Phone: 1-800-977-6740 | |

|TTY 1-800-977-6741 | |

|MASSACHUSETTS – Medicaid and CHIP |NEW YORK – Medicaid |

| | |

|Website: |Website: |

| | |

|Phone: 1-800-462-1120 |Phone: 1-800-541-2831 |

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|MINNESOTA – Medicaid |NORTH CAROLINA – Medicaid |

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|Website: |Website: |

| | |

|Click on Health Care, then Medical Assistance |Phone: 919-855-4100 |

| | |

|Phone: 1-800-657-3629 | |

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|MISSOURI – Medicaid |NORTH DAKOTA – Medicaid |

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|Website: |Website: |

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|Phone: 573-751-2005 |Phone: 1-800-755-2604 |

| | |

|OKLAHOMA – Medicaid and CHIP |UTAH – Medicaid and CHIP |

| |Website: |

|Website: | |

| |Phone: 1-866-435-7414 |

|Phone: 1-888-365-3742 | |

|OREGON – Medicaid |VERMONT– Medicaid |

| | |

| |Website: |

|Website: | |

| |Phone: 1-800-250-8427 |

| | |

|Phone: 1-800-699-9075 | |

|PENNSYLVANIA – Medicaid |VIRGINIA – Medicaid and CHIP |

| | |

|Website: |Medicaid Website: |

|Phone: 1-800-692-7462 | |

| |Medicaid Phone: 1-800-432-5924 |

| | |

| |CHIP Website: |

| | |

| |CHIP Phone: 1-866-873-2647 |

|RHODE ISLAND – Medicaid |WASHINGTON – Medicaid |

| | |

|Website: ohhs. | |

| |Website: |

|Phone: 401-462-5300 | |

| | |

| |Phone: 1-800-562-3022 ext. 15473 |

|SOUTH CAROLINA – Medicaid |WEST VIRGINIA – Medicaid |

| | |

|Website: |Website: dhhr.bms/ |

| |Phone: 1-877-598-5820, HMS Third Party Liability |

|Phone: 1-888-549-0820 | |

|SOUTH DAKOTA - Medicaid |WISCONSIN – Medicaid |

|Website: | |

|Phone: 1-888-828-0059 |Website: |

| | |

| |Phone: 1-800-362-3002 |

|TEXAS – Medicaid |WYOMING – Medicaid |

| | |

|Website: |Website: |

| | |

|Phone: 1-800-440-0493 |Phone: 307-777-7531 |

To see if any more States have added a premium assistance program since January 31, 2014, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor U.S. Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare & Medicaid Services

ebsa cms.

1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 10/31/2016)

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Waterford Country School

Employee Benefits

2014 Open Enrollment Guide

Waterford Country School offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.

EFFECTIVE FOR PLAN YEAR: July 1, 2014 through June 30, 2015

fdffdfdf EFFECTIVE FOR PLAN YEAR: July 1, 2013 through June 30, 2014

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