Benefit Enrollment Guide - Popeyes Benefits Enrollment

Benefit
2016 Enrollment Guide
Global Support Center & Restaurant Management
Table of
Contents
What’s New?
•Vision Benefits
are changing
to Cigna
•Employee
Assistance
Program (EAP)
•The outof-pocket
maximums
on Plan C are
changing to
$3,275 for
individual and
to $6,550 for
family
•Lockton
BenefitLink
Username: Popeyes Management
Password: Chicken
Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Eligibility & Enrollment. . . . . . . . . . . . . . . . . . . . . . . . 5
Medical Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Pharmacy Benefits. . . . . . . . . . . . . . . . . . . . . . . . . 11
Dental Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Vision Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Health Savings Account (HSA). . . . . . . . . . . . . . . . 18
Flexible Spending Accounts (FSAs). . . . . . . . . . . . . 20
Survivor Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Income Protection . . . . . . . . . . . . . . . . . . . . . . . . . 25
Retirement Planning. . . . . . . . . . . . . . . . . . . . . . . . 26
Additional Benefits. . . . . . . . . . . . . . . . . . . . . . . . . 28
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Required Notices. . . . . . . . . . . . . . . . . . . . . . . . . . 32
Important Contacts. . . . . . . . . . . . . . . . . . . . . . . . . 34
Lockton BenefitLink Mobile App. . . . . . . . . . . . . . . 34
See page 32 for important information concerning
Medicare Part D coverage.
In this Guide, we use the term Company to refer to Popeyes Louisiana Kitchen, Inc. This Guide is intended to describe the
eligibility requirements, enrollment procedures and coverage effective dates for the benefits offered by the Company. It is not a
legal plan document and does not imply a guarantee of employment or a continuation of benefits. While this Guide is a tool to
answer most of your questions, full details of the plans are contained in the Summary Plan Descriptions (SPDs), which govern
each plan’s operation. Whenever an interpretation of a plan benefit is necessary, the actual plan documents will be used.
3
Welcome
At Popeyes, we are committed to your health and well-being. We are proud to provide
you and your family with valuable and significant benefits. This Guide is an overview
of the benefits available to you and their impact on your compensation as a whole.
Please read it carefully in order to make the best choices for you and your family in
the 2016 Plan Year.
Have a Smartphone?
This Benefit Guide is equipped with mobile-friendly barcodes. These barcodes are more commonly
referred to as “Quick Response” codes, or QR codes. Scanning these codes will take you to a
separate site on your phone, allowing you to see new content. They might show you a website,
video or article. They can take you anywhere — you just have to scan them first.
So How Do I Scan Them?
First, you’ll need one of the many free QR Reader Apps available for smartphones or tablets.
After the download, just open your new App and follow the directions to scan the QR code.
The App will read it and immediately take you to that code’s content.
4
Eligibility &
Enrollment
Tip
You cannot change your benefit selections during
the Plan Year unless you have a Qualifying Life
Event, such as the birth or adoption of a child.
You and your family have unique needs, which is why Popeyes offers a variety of benefit plans from which
you may choose. Consider your spouse’s benefits through his or her place of employment and your
dependents’ eligibility when weighing each option.
Eligibility
If you are a Global Support Center or Restaurant Management team member of Popeyes who is regularly scheduled to work
a minimum of 20 hours a week, you are eligible to participate in the Medical, Dental, Vision, Life and Disability Plans, along
with the Flexible Spending Accounts (FSAs) and additional benefits.
When Does Coverage Begin?
New Hire
The elections you make are effective on the first of the month following 30 days of continuous employment. Due to IRS
regulations, once you have made your choices, you won’t be able change your benefits until the next enrollment period unless
you experience a Qualifying Life Event.
Open Enrollment Period
The elections you make, during open enrollment, are effective January 1, 2016 and cannot be changed until the next
enrollment period unless you experience a Qualifying Life Event.
Eligible Dependents
Dependents eligible for coverage in the Popeyes benefits plans include:
• Your legal spouse (or common-law spouse in states which recognize common-law marriages).
• Children up to age 26 (includes birth children, stepchildren, legally adopted children, children placed for adoption,
foster children, and children for whom legal guardianship has been awarded to you or your spouse).
• Dependent children, regardless of age, provided he or she is incapable of self-support due to a mental or physical
disability, is fully dependent on you for support as indicated on your federal tax return, and is approved by your Medical
Plan to continue coverage past age 26.
Verification of dependent eligibility will be required upon enrollment.
5
Things to Consider
Curious about
Qualifying Life
Events and
how they may
affect your
coverage?
Take the following situations into account before you enroll to make sure you have the
right coverage.
• Does your spouse have benefits coverage available through another employer?
• Did you get married, divorced or have a baby recently? If so, do you need to add or remove
any dependent(s) and/or update your beneficiary designation?
• Did any of your covered children reach their 26th birthday this year? If so, they are no longer
eligible for benefits unless they meet specific criteria. Additional details can be found in the
Eligible Dependents section of this Guide.
Qualifying Life Events
When one of the following events occurs, you have 30 days from the date of the event to notify
the Benefit Department and/or request changes to your coverage.
• Change in your legal marital status (marriage, divorce or legal separation)
• Change in the number of your dependents (for example, through birth or adoption, or if
a child is no longer an eligible dependent)
• Change in your spouse’s employment status (resulting in a loss or gain of coverage)
• Change in your employment status from full time to part time, or part time to full time,
resulting in a gain or loss of coverage
• Entitlement to Medicare or Medicaid
• Change in your address or location that may affect the coverage for which you are eligible
Your change in coverage must be consistent with your change in status. You may be eligible for
coverage through the Marketplace or Popeyes. Please direct questions regarding specific life
events and your ability to request changes to Benefit Department.
Preparing to Enroll
Popeyes provides its team members the best coverage possible. As a committed partner in your
health, Popeyes will be absorbing a significant amount of the costs. Your share of the contributions
for Medical, Dental, Vision, FSA and HSA Benefits are deducted on a pre-tax basis, which lessens
your tax liability.
Please note that team member contributions for Medical, Dental and Vision coverage vary
depending on the level of coverage you select. In general, the more coverage you have, the higher
your team member contribution will be.
Keep in mind that you may select any combination of Medical, Dental and/or Vision plan coverage
categories. For example, you could select Medical coverage for you and your entire family, but
select Dental and Vision coverage only for yourself. The only requirement is that you, as an eligible
team member of Popeyes, must elect coverage for yourself in order to elect any dependent
coverage. You have the option to select coverage from the following categories:
• Employee Only
• Employee + 1
• Employee + Family
Be sure to have the Social Security numbers and birthdates for any eligible dependent(s) that you
plan to enroll. You cannot enroll your dependent(s) without this information.
6
Enrollment is Easy with
!
Information You Will Need to Register
Employee Number (this is not your Social Security Number but rather the employee number assigned to you
when you were hired. You can get the number by logging into Employee Self Service (ESS) or contacting the
Popeyes Benefits Service Center at 844-219-6070.
1. Launch web browser and go to https://enroll.popeyes.com.
2. Read the 2016 Global Support Center & Restaurant Management Open Enrollment Guide.
3. Click on the PDF icon for instructions on how to use the Benefitsolver website.
4. Click on the www.benefitsolver.com link. If you are already registered with Benefitsolver, login.
Otherwise, you will need to register and then follow the steps.
5. Begin enrollment by clicking on “Start Here” and follow the instructions to confirm, enroll or
waive coverage.
Already know what you want? Click on the “Pick my own plans” link.
Need help with your benefit choices? Click on the “Next” button to use the MyChoise Selection tool. This
tool will provide recommendations based who you want covered.
CIGNA Pre-Enrollment Support Center
The pre-enrollment support center is also available during Open Enrollment. This 24/7 pre-enrollment line
is staffed with trained customer services associates to answer questions specific to Popeyes benefit plans
such as:
• What’s covered?
• Is my doctor in the network?
• How do I determine which tier my prescription drug falls under?
You may reach the pre-enrollment line by calling 800-401-4041.
7
Medical
Benefits
Scan here to learn
about a variety of
topics, including
heart health.
Save money by seeing in-network physicians and taking
advantage of preventive care services offered by your Plan.
Tip
Our Medical coverage helps you maintain your well‑being through preventive care
and access to an extensive network of providers, as well as affordable prescription
medication. Medical benefits are offered through Cigna. It is up to you to choose the
Plan that best matches your needs. Please keep in mind that the option you elect will
be in place for all of the 2016 Plan Year, unless you have a Qualifying Life Event.
Medical Premiums
Premium contributions for Medical will be deducted from your paycheck on a pre-tax basis.
Your level of coverage will determine your contributions.
Please note that Plan D is available for employee-only coverage. You may not elect to cover
dependents under this Plan.
Tier 1
Bands 7 through 11
Sample Position: Director, Vice President, Executive Staff
Plan A
Plan B
Plan C
Plan D
BIWEEKLY CONTRIBUTIONS
8
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$82.78
$227.21
$121.57
$222.54
$79.37
$201.29
$230.78
$153.85
EMPLOYEE + 1
$184.97
$406.25
$271.78
$384.28
$150.32
$385.77
N/A
N/A
EMPLOYEE + FAMILY
$244.08
$643.98
$357.85
$627.47
$225.21
$580.50
N/A
N/A
Tier 2
Bands 5 & 6
Sample Position: Manager, Area Manager, Business Consultant,
Restaurant Consultant, Training Consultant, Specialist
Plan A
Plan B
Plan C
Plan D
BIWEEKLY CONTRIBUTIONS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$79.23
$230.76
$117.89
$226.23
$76.56
$204.10
$192.31
$192.31
EMPLOYEE + 1
$175.97
$415.25
$263.78
$392.28
$142.62
$393.47
N/A
N/A
EMPLOYEE + FAMILY
$233.95
$654.11
$347.35
$637.97
$216.88
$588.84
N/A
N/A
Tier 3
Bands 3 & 4
Sample Position: Assistant, Administrator, Coordinator
Plan A
Plan B
Plan C
Plan D
BIWEEKLY CONTRIBUTIONS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$74.49
$235.50
$113.16
$230.96
$72.24
$208.42
$41.54
$343.09
EMPLOYEE + 1
$164.72
$426.49
$252.28
$403.78
$132.17
$403.92
N/A
N/A
EMPLOYEE + FAMILY
$217.08
$670.98
$331.61
$653.72
$204.03
$601.68
N/A
N/A
Tier 3
Bands 3 & 4
Sample Position: Restaurant Manager, Assistant Restaurant Manager, Manager Candidate
Plan A
Plan B
Plan C
Plan D
WEEKLY CONTRIBUTIONS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$37.25
$117.75
$56.58
$115.48
$36.12
$104.21
$20.77
$171.54
EMPLOYEE + 1
$82.36
$213.25
$126.14
$201.89
$66.08
$201.96
N/A
N/A
EMPLOYEE + FAMILY
$108.54
$335.49
$165.80
$326.86
$102.01
$300.84
N/A
N/A
How to Find a Provider
To see a current list of Cigna network providers online, go to www.mycigna.com. If you do not have
internet access, please call Cigna Customer Care at 800-244-6224 for assistance.
9
Medical Plan Summary
The chart below gives a summary of the 2016 Medical coverage provided by Cigna. All covered services are subject to
Medical necessity as determined by the Plan. Please be aware that all out-of-network services are subject to Reasonable
and Customary (R&C) limitations.
Plan A
IN-NETWORK
Plan B
OUT-OF-NETWORK
Plan C
Plan D
IN-NETWORK
OUT-OF-NETWORK
IN-NETWORK
OUT-OF-NETWORK
IN-NETWORK
OUT-OF-NETWORK
$6,350
$6,350
CALENDAR YEAR DEDUCTIBLE
INDIVIDUAL
$3,500
$7,000
$500
$1,000
$1,500
$3,000
FAMILY
$7,000
$14,000
$1,500
$3,000
$4,500
$9,000
COINSURANCE (PLAN
PAYS)
100%*
70%*
90%*
70%*
80%*
60%*
N/A
100%
70%
CALENDAR YEAR OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE, COINSURANCE AND COPAYS)
INDIVIDUAL
$3,500
$8,000
$2,500
$5,000
$3,275
$6,550
FAMILY
$7,000
$16,000
$7,500
$15,000
$9,000
$18,000
LIFETIME MAXIMUM
Unlimited
Unlimited
$6,350
$6,350
N/A
Unlimited
Unlimited
COPAYS/COINSURANCE (YOU PAY)
PREVENTIVE CARE
0%
30%*
0%
30%*
0%
30%*
0%*
30%*
PRIMARY CARE VISIT
$30 copay
30%*
$15 copay
30%*
20%*
40%*
0%*
30%*
SPECIALIST VISIT
$40 copay
30%*
$30 copay
30%*
20%*
40%*
0%*
30%*
INPATIENT
0%*
30%*
$500 per
admission,
then 10%*
30%*
20%*
40%*
0%*
30%*
OUTPATIENT
0%*
30%*
10%*
30%*
20%*
40%*
0%*
30%*
EMERGENCY ROOM
$150 copay
$150 copay
20%*
0%*
URGENT CARE
$35 copay
$35 copay
20%*
0%*
LAB & X-RAY
(PHYSICIANS OFFICE, OUTPATIENT
FACILITY, OR INDEPENDENT LAB)
ADVANCE RADIOLOGY
IMAGING
(MRI, MRA, CT, PET SCAN, ETC.)
0%
Physician's
Office: 0%
Outpatient
Facility: 0%*
30%*
0%
30%*
20%*
40%*
0%*
30%*
30%*
Physician's
Office: 0%
Outpatient
Facility: 10%*
30%*
20%*
40%*
0%*
30%*
*After Deductible
Please note: Pre-certification is required for some inpatient and outpatient services; please contact Cigna at 800-244-6224
for further information or refer to your Health Plan booklet for more details.
Urgent Care Centers vs. Freestanding Emergency Rooms
Freestanding emergency rooms look a lot like the urgent care centers you are likely used to, but the costs and services
can be drastically different. In general, consider an urgent care center as an extension of your primary care physician, while
freestanding emergency rooms should be used for health conditions that require a high level of care. Research the options
in your area and determine which ones are covered by your insurance plan’s network; note that balance billing may apply.
Choosing an urgent care center for everyday health concerns could save you hundreds of dollars.
10
Pharmacy
Benefits
Need
additional
generic
drug facts?
Prescription Drug Coverage for Medical Plans
Our Prescription Drug Program is coordinated through Cigna. That means you will only have one ID card
for both Medical care and prescriptions. You may find information on your benefits coverage and search for
network pharmacies by logging on to www.mycigna.com or by calling the Customer Care number on your
ID Card.
Your cost is determined by the tier assigned to the prescription drug product. All products on the list are
assigned as Generic, Preferred or Non-Preferred.
Plan A
IN-NETWORK
OUT-OF-NETWORK
Plan B
IN-NETWORK
OUT-OF-NETWORK
Plan C
IN-NETWORK
OUT-OF-NETWORK
Plan D
IN-NETWORK
OUT-OF-NETWORK
RETAIL RX (30-DAY SUPPLY)
GENERIC
You pay the lesser
of $10 or 100%
You pay the lesser
of $10 or 100%
20%*
0%*
PREFERRED
You pay the lesser
of $100 or 30%
You pay the lesser
of $100 or 30%
20%*
0%*
NON-PREFERRED
You pay the lesser
of $200 or 40%
You pay the lesser
of $200 or 40%
20%*
0%*
MAIL ORDER RX (90-DAY SUPPLY)
GENERIC
You pay the lesser
of $20 or 100%
You pay the lesser
of $20 or 100%
20%*
0%*
PREFERRED
You pay the lesser
of $200 or 30%
You pay the lesser
of $200 or 30%
20%*
0%*
NON-PREFERRED
You pay the lesser
of $400 or 40%
You pay the lesser
of $400 or 40%
20%*
0%*
*After Deductible
11
Q&A: Generic Drugs
What is a generic drug?
When a new, FDA-approved drug goes on the market, it may have patent or exclusivity protection that enables the
manufacturer to sell the drug exclusively for a period of time. When those expire or no longer serve as a barrier to
approval, other companies can make it in generic form.
Are generic drugs as effective as preferred and non-preferred drugs?
Yes. A generic drug is the same as a preferred and non-preferred drug in dosage, safety, strength, quality, the way it
works, the way it is taken and the way it should be used. The FDA requires generic drugs have the same high quality,
strength, purity and stability as preferred and non-preferred drugs.
Are generic drugs as safe as preferred and non-preferred drugs?
Yes. The FDA must approve the generic drug before it can be marketed.
Are generic drugs that much cheaper than preferred and non-preferred medications?
Yes. On average, the cost of a generic drug is 80% to 85% lower than the preferred and non-preferred equivalent.
Is there a generic equivalent for my preferred and non-preferred drug?
To find out if there is a generic equivalent for your preferred and non-preferred drug, visit www.fda.gov to view a catalog
of FDA-approved drug products, as well as drug labeling information.
Source: www.fda.gov
12
Dental
Benefits
Brush up on
caring for
your teeth.
Routine preventive care such as regular Dental checkups can help lower your risk of
stroke and heart disease. Popeyes’ Dental coverage will provide you and your family
affordable options for overall health. Coverage is available from Cigna.
Network Dentists
Your Plan’s in‑network dentists have agreed to charge lower fees, which helps keep money in
your pocket. If you choose to use a dentist who doesn’t participate in your Plan’s network, your
out‑of‑pocket costs will be higher, and you are subject to any charges beyond the Reasonable
and Customary (R&C). To find a network dentist, visit Cigna at www.mycigna.com.
Dental Premiums
Premium contributions for Dental will be deducted from your paycheck on a pre-tax basis. Your tier
of coverage will determine your premium.
Tier 1
Bands 7 through 11
Sample Position: Director, Vice President, Executive Staff
PPO High
PPO Low
DHMO
BIWEEKLY CONTRIBUTIONS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$8.00
$12.12
$4.05
$11.87
$2.67
$7.84
EMPLOYEE + 1
$17.17
$26.60
$8.89
$26.07
$4.84
$14.20
EMPLOYEE + FAMILY
$25.47
$40.71
$13.62
$39.95
$8.39
$24.60
13
Tier 2
Bands 5 & 6
Sample Position: Manager, Area Manager, Business Consultant,
Restaurant Consultant, Training Consultant, Specialist
PPO High
PPO Low
DHMO
BIWEEKLY CONTRIBUTIONS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$7.78
$12.34
$3.83
$12.09
$2.53
$7.98
EMPLOYEE + 1
$16.70
$27.08
$8.41
$26.55
$4.58
$14.46
EMPLOYEE + FAMILY
$24.74
$41.44
$12.89
$40.68
$7.94
$25.05
Tier 3
Bands 3 & 4
Sample Position: Assistant, Administrator, Coordinator
PPO High
PPO Low
DHMO
BIWEEKLY CONTRIBUTIONS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$7.49
$12.63
$3.54
$12.38
$2.34
$8.18
EMPLOYEE + 1
$16.06
$27.72
$7.77
$27.18
$4.23
$14.81
EMPLOYEE + FAMILY
$23.76
$42.42
$11.91
$41.66
$7.33
$25.66
Tier 3
Bands 3 & 4
Sample Position: Restaurant Manager, Assistant Restaurant
Manager, Manager Candidate
PPO High
PPO Low
DHMO
WEEKLY CONTRIBUTIONS
14
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE PAYS
POPEYES PAYS
EMPLOYEE ONLY
$3.75
$6.32
$1.77
$6.19
$1.17
$4.09
EMPLOYEE + 1
$8.03
$13.86
$3.89
$13.59
$2.12
$7.41
EMPLOYEE + FAMILY
$11.88
$21.21
$5.95
$20.83
$3.67
$12.83
Dental Plan Summary
Dental Plan benefits are available to you on a voluntary basis. The chart below gives a summary of the 2016 Dental coverage
provided by Cigna. All out-of-network services are subject to Reasonable and Customary (R&C) limitations.
PPO Low
In-Network
ANNUAL MAXIMUM BENEFIT
(CLASS I, II, AND III EXPENSES)
ANNUAL DEDUCTIBLE
(CLASS II AND III EXPENSES)
Out-of-Network
PPO High
In-Network
Out-of-Network
$1,000
$2,000
With the DHMO Plan, there is no
annual deductible and no benefit
maximum. You simply pay the
prescribed rate for dental services as
dictated by the plan. The following is
a summary of some of the services
covered by the DHMO Plan.
Individual $75
Family $225
Individual $50
Family $150
Preventive Care:
Cleanings, Fluoride, Sealants,
Bitewing/Full-mouth X-rays
CLASS I EXPENSES:
PREVENTIVE AND DIAGNOSTIC CARE
BITEWING X-RAYS, CLEANINGS (2 PER
CALENDAR YEAR), FLUORIDE APPLICATION,
FULL MOUTH X-RAYS, ORAL EXAMS, PANORAMIC
X-RAYS, SEALANTS, SPACE MAINTAINERS
CLASS II EXPENSES:
BASIC RESTORATIVE CARE
FILLINGS, EMERGENCY CARE FOR PAIN RELIEF,
ORAL SURGERY, SIMPLE EXTRACTIONS,
MINOR PERIODONTICS, MAJOR PERIODONTICS
Plan Pays 100%
Deductible Waived
Plan Pays 100%
Deductible Waived
Plan Pays 80%
After Deductible
Plan Pays 80%
After Deductible
Plan Pays 50%
After Deductible
Plan Pays 70%
After Deductible
CLASS III EXPENSES:
MAJOR RESTORATIVE CARE
CROWNS, DENTURES, ROOT CANAL/
THERAPY, BRIDGES, ANESTHETICS, ORAL
SURGERY, ALL EXPECT SIMPLE EXTRACTIONS,
SURGICAL EXTRACTIONS OF IMPACTED TEETH,
REPAIRS - BRIDGES, CROWNS, INLAYS, DENTURES
CLASS IV EXPENSES: ORTHODONTIA
LIFETIME MAXIMUM BENEFIT
(CLASS IV, ORTHODONTIA)
ORTHODONTIA COVERAGE:
ELIGIBLE CHILDREN AND ADULTS
Tip
Basic Care:
Composite Fillings, Resin Fillings,
Amalgam Fillings
Major Services:
Crowns, Bridges, Dentures, Root
Canals, Oral Surgery, Extractions,
Treatment for Gum Disease
Specialty Care:
Covered at same fee as general care,
but requires a referral
Orthodontic Care:
Braces for Children and Adults
General Anesthesia:
Covered when medically necessary
$1,500
$2,000
$75
$75
(CLASS IV, ORTHODONTIA)
ANNUAL DEDUCTIBLE
DHMO
Plan Pays 50%
After Orthodontia Deductible
Plan Pays 70%
After Orthodontia Deductible
Teeth Whitening:
Covers take-home bleaching trays
and gels
For more details and a full
description of service fees,
see the DHMO Benefit
Summary (found in the
Benefitsolver Reference Center)
Flossing isn’t fun, but it can go a long way toward preventing gum disease.
15
Vision
Benefits
Set your eyes
on a few ways
to maintain
your vision.
Vision Benefits
are changing
to Cigna effective
January 1. There
will be two plan
offerings: Select
and Premier. If
you are currently
enrolled in the
UHC Low or
Medium option,
you will be
automatically
moved to the
Cigna Select
option. If you are
in the UHC High
option, you will
be automatically
moved to the
Cigna Premier
option.
16
If you wear glasses or contacts, chances are you already have a steady appointment with
an eye doctor. But even those with perfect eyesight should have their Vision checked on
a regular basis. To ensure that you and your family have access to quality Vision care,
Popeyes offers a comprehensive Vision benefit provided by Cigna.
Vision Premiums
Premium contributions for Vision will be deducted from your paycheck on a pre-tax basis.
Select
Premier
EMPLOYEE ONLY
$3.00
$3.19
EMPLOYEE + FAMILY
$7.88
$8.07
EMPLOYEE ONLY
$1.50
$1.60
EMPLOYEE + FAMILY
$3.94
$4.03
BIWEEKLY CONTRIBUTIONS
WEEKLY CONTRIBUTIONS
Vision Plan Summary
Vision Plan benefits are available to you on a voluntary basis. The chart below gives a summary of the 2016 Vision coverage
provided by Cigna. All out-of-network services are subject to Reasonable and Customary (R&C) limitations. In-network copays
are paid directly to the provider. Out-of-network services will be reimbursed up to the scheduled amounts below.
Select
Premier
IN-NETWORK
OUT-OF-NETWORK
IN-NETWORK
OUT-OF-NETWORK
EXAMINATION
$10 copay
Up to $45
$10 copay
Up to $45
MATERIALS
$25 copay
See covered
materials
$25 copay
See covered
materials
SINGLE VISION LENSES
100% After copay
Up to $32
100% After copay
Up to $32
BIFOCAL LENSES
100% After copay
Up to $55
100% After copay
Up to $55
TRIFOCAL LENSES
100% After copay
Up to $65
100% After copay
Up to $65
$130 Allowance
Up to $71
$150 Allowance
Up to $83
ELECTIVE
$130 Allowance
Up to $105
$150 Allowance
Up to $120
NECESSARY
Covered at 100%
Up to $210
Covered at 100%
Up to $210
COPAYS
COVERED MATERIALS
LENSES
FRAMES
RETAIL FRAME EQUIVALENT
CONTACTS
BENEFIT FREQUENCY
ELECTIVE
12 months
12 months
LENSES
12 months
12 months
FRAMES
CONTACTS
24 months
24 months
12 months
12 months
(IN LIEU OF LENSES AND FRAMES)
Tip
According to the Centers of Disease Control and
Prevention, approximately 14 million Americans
12 and older have self-reported visual impairment
(defined as 20/50 or worse).
17
Calculate
your tax
savings from
an HSA.
Health Savings
Account
Take charge of your health care spending with a Health Savings Account (HSA).
Contributions to an HSA are tax free, and no matter what, the money in the account
is yours. Use it to pay for eligible Medical expenses when you are enrolled in an
HSA-eligible plan like Plan C or Plan D.
Your HSA can be used for qualified expenses, including those of your spouse and/or dependent(s),
even if they are not covered by your Plan.
Cigna will issue you a debit card, giving you direct access to your account balance. When you have
a qualified Medical expense, you can use your debit card to pay. You must have a balance to use
your debit card. There are no receipts to submit for reimbursement.
Eligible expenses include doctors’ office visits, eye exams, prescription expenses and LASIK surgery.
IRS Publication 502 provides a complete list of eligible expenses and can be found on www.irs.gov.
Eligibility
You are eligible to open and fund an HSA if:
• You are enrolled in Plan C or Plan D
• You are not covered by your spouse’s health plan, health care flexible spending account
or health reimbursement account.
• You are not eligible to be claimed as a dependent on someone else’s tax return.
• You are not enrolled in Medicare, Medicaid or TRICARE for medical insurance.
• You have not received Department of Veterans Affairs Medical benefits in the past 90 days.
Individually Owned Account
18
You own and administer your Health Savings Account. You determine how much you’ll contribute
to the account, when to use the money to pay for qualified Medical expenses, and when to
reimburse yourself. Like a bank account, you must have a balance in order to be reimbursed.
Although receipts are not required for reimbursement, we recommend that you keep receipts for tax
documentation. HSAs allow you to save and roll over money if you do not spend it in the calendar
year. The money in this account is portable, even if you change plans or jobs. There are no vesting
requirements or forfeiture provisions.
How to Enroll
You must elect either elect Plan C or Plan D. Information on how to open an HSA account can be found by
visiting https://enroll.popeyes.com, clicking on the Benefitsolver link and going to the Reference Center. You can
also call the Popeyes Benefit Service Center at 844-219-6070 or email benefits@popeyes.com.
Maximize Your Tax Savings
Contributions to an HSA are tax free when made through payroll deduction on a pre-tax basis and when you
open an account with JP Morgan Chase (through Cigna). If your health savings account is with another financial
institution, you can make after-tax contributions and take the tax credit at the end of the year when you file
your taxes.
• The money in this account (including interest earnings) grows tax free.
• As long as the funds are used to pay for qualified medical expenses, they are spent tax free.
HSA Funding and Limits
Each year, the IRS places a limit on the maximum amount that can be contributed to HSA accounts. For 2016,
contributions (which include any employer contribution) are limited to the following:
HSA Funding Limits
EMPLOYEE
$3,350
FAMILY
$6,750
CATCH-UP CONTRIBUTION
(AGES 55+)
$1,000
If you enroll in the Plan C, Popeyes will “seed” your HSA account with an employer contribution.
“Seed” Money for Plan C HSA Option ONLY
EMPLOYEE
FAMILY
$750
$1,500
Important! Before you can receive “seed” money, you must first open your HSA account with JP Morgan Chase
(through Cigna). “Seed” money will be deposited biweekly ($28.85 for individual and $57.70 for family).
Tip
Funds in your HSA will roll over from year to
year, allowing you to save money for future
Medical expenses.
19
Flexible Spending
Accounts
Learn more about
FSA limits, grace
periods and
rollovers.
Flexible Spending Accounts (FSAs) let you set aside pre-tax money for eligible
expenses. There are two types of FSAs: health care spending account and dependent
care spending account — each one covers different types of expenses.
Health Care Flexible Spending Account
You may contribute up to $2,550 to your account (pre-tax) and can use the money to reimburse
yourself for eligible Medical expenses not covered by your Medical, Dental or Vision Plans for
yourself, your spouse or anyone who qualifies as a dependent on your federal tax return — even if
you don’t cover them on your Popeyes’ benefits.
Please note: Over-the-counter (OTC) drugs are not eligible for reimbursement through an FSA
without a doctor’s prescription.
Dependent Care Flexible Spending Account
In addition to the Health Care FSA, you may opt to participate in the Dependent Care FSA as
well — whether or not you elect any other benefits. The Dependent Care FSA allows you to set
aside pre-tax funds to help pay for expenses associated with caring for elder or child dependents.
Unlike the Health Care FSA, reimbursement from your Dependent Care FSA is limited to the total
amount that is deposited in your account at that time. This account reimburses you for dependent
care expenses that allow you to work or attend school full-time; it does NOT reimburse you for
dependent health care expenses.
• With the Dependent Care FSA, you are allowed to set aside up to $5,000 to pay for child or
elder care expenses on a pre-tax basis.
• Eligible dependents include children younger than the age of 13 and dependents
of any age who are incapable of caring for themselves.
• Expenses are reimbursable as long as the provider is not anyone considered your dependent
for income tax purposes.
• In order to be reimbursed, you must provide the tax identification number or Social Security
number of the party providing care.
20
General Rules and Restrictions
In exchange for the tax advantages that FSAs offer, the IRS has imposed the following rules and restrictions for both
Health Care and Dependent Care FSAs:
• Your expenses must be incurred during the 2016 Plan Year.
• Your dollars cannot be transferred from one FSA to another.
• You cannot participate in Dependent Care FSA and claim a dependent care tax deduction at the same time.
• Up to $500 may be rolled over to the next Plan Year at the end of 2015 for Health Care FSAs. Any funds over $500
will be forfeited.
• You cannot change your FSA election in the middle of the Plan Year unless you experience a Qualifying Life Event like
marriage, divorce or birth of a child.
Important note: If you enroll in the Plan C HSA option or Plan D CDHP option and open an HSA account, you
will have access to a limited purpose health care spending account for Dental and Vision expenses only.
For more information, including restrictions, instructions for reimbursement and a complete listing of covered expenses,
go to Benefitsolver.
Tip
You cannot use FSA funds to pay for insurance premiums.
21
Survivor
Benefits
Need help
choosing the
right life
insurance plan?
Discussing what might happen to your family if you were not around to provide for
them isn’t always the easiest conversation, but it is necessary. Survivor benefits provide
financial assistance in an absence and can help you plan for the unexpected. If you
have Life insurance now, chances are you can take comfort in knowing that those who
depend on you will be provided for.
Basic Life and Accidental Death and Dismemberment
(AD&D) Insurance
Life and AD&D benefits are essential to the financial security of you and your family. As such, it is
important to understand how your Plan works and what benefits you will receive.
Basic Life and AD&D benefits are provided to you as a part of your basic coverage. Popeyes
provides team members with Basic Life and AD&D insurance through The Hartford, which
guarantees that loved ones, such as a spouse or other designated survivor(s), continue to receive
part of an team member’s benefits after death.
Your Basic Life and AD&D insurance benefit is one times your base salary, up to $125,000
($20,000 for Assistant Restaurant Managers). If you are a Global Support Center & Restaurant
Management team member, you automatically receive Life and AD&D insurance even if you elect
to waive other coverage.
22
Beneficiary Designation
A beneficiary is the person you designate to receive your Life insurance benefits in the event of your
death. This includes any benefits payable under Basic Life and AD&D offered by Popeyes. Benefits
payable for a dependent’s death under The Hartford insurance are payable to you.
It is important that your beneficiary designation is clear so there is no question as to your intentions.
It is also important that you name a primary and contingent beneficiary. When naming your
beneficiary(ies), please indicate their full name, address, Social Security number, relationship, date of
birth and distribution percentage.
If you name more than one beneficiary with unequal shares, please show the amount of insurance
to be paid to each beneficiary in percentages.
For example:
Primary
Mary J. Doe, Wife (34%)
Jane Doe, Daughter (33%)
John Doe, Son (33%)
Contingent
Joseph W. Doe, Son (50%)
Jane Doe, Daughter (50%)
OR
Estate of the Insured (100%)
If you need assistance, contact Popeyes Benefits Service Center at 844-219-6070 or your own legal
counsel.
Tip
Be sure to check state-specific rules if you designate someone other
than your spouse as your Life insurance beneficiary.
23
Survivor Benefits
Life and AD&D Insurance
Eligible team members may purchase Supplemental Life and AD&D insurance for themselves and their families. Premiums are
paid through post‑tax payroll deductions.
BASIC LIFE/AD&D
COVERAGE AMOUNT
1x your base salary
WHO PAYS
Basic Life and AD&D benefits are paid by the Company
BENEFITS PAYABLE
If you die, lose a limb or suffer paralysis in an accident
MAXIMUM BENEFIT
$125,000 ($20,000 for Asst. Rest. Managers)
SUPPLEMENTAL EMPLOYEE LIFE/AD&D
COVERAGE AMOUNT
Up to 5x your base salary ($20,000 increments for Assistant Restaurant Managers)
WHO PAYS
This coverage is available to you on a voluntary basis. The cost is paid at 100% by the team
member through payroll deductions
BENEFITS PAYABLE
If you die while covered under the plan. This benefit is in addition to your Basic Life benefit.
MAXIMUM BENEFIT
$750,000 ($100,000 for Assistant Restaurant Managers)
EVIDENCE OF INSURABILITY (EOI) REQUIRED
When making elections greater than $250,000
SUPPLEMENTAL DEPENDENT LIFE
COVERAGE AMOUNT
WHO PAYS
BENEFITS PAYABLE
MAXIMUM BENEFIT
EVIDENCE OF INSURABILITY (EOI) REQUIRED
Spouse: Option 1 $10,000; Option 2 $25,000; Option 3 $50,000
Child: Option 1 $5,000; Option 2 $10,000
This coverage is available to you on a voluntary basis. The cost is paid at 100% by the team
member through payroll deductions
If your dependent dies while covered under the Plan.
Spouse: $50,000
Child: $500 for child younger than 6 months old; $10,000 for child older than 6 months
When making elections greater than $10,000 for spouse
SUPPLEMENTAL EMPLOYEE LIFE INSURANCE
24
SUPPLEMENTAL DEPENDENT LIFE
EMPLOYEE AGE
AS OF JANUARY 1, 2016
RATE PER $1,000 MONTHLY
Spouse Option 1
$0.80 / $1,000 (Monthly)
Under 25
$0.07
Spouse Option 2
$2.00 / $1,000 (Monthly)
25–29
$0.07
Spouse Option 3
$4.00 / $1,000 (Monthly)
30–34
$0.08
35–39
$0.11
Child Option 1
$0.40 / $1,000 (Monthly)
40–44
$0.16
Child Option 2
$0.80 / $1,000 (Monthly)
45–49
$0.28
50–54
$0.48
55–59
$0.87
60–64
$0.99
65–69
$1.48
70–74
$2.73
75+
$4.63
Income
Protection
Discover free resources, tips
and data on disabilities here.
Popeyes offers disability coverage to protect you against an unfortunate or debilitating
injury or illness. This insurance protects a portion of your income until you can return to
work or until you reach retirement age.
Short Term Disability (STD) Insurance
STD insurance protects a portion of your income if you become partially or totally disabled for a
short period of time. It replaces 60% of your income, up to a maximum weekly benefit of $1,500,
depending on your current annual earnings. You must be sick or disabled for at least 15 days before
you can receive a benefit payment. Payments may last up to 11 weeks. Certain exclusions, along
with any pre-existing condition limitations, may apply. You are not required to make contributions for
this benefit; Popeyes pays 100% of the premium. Please refer to your Summary Plan Description for
details or contact Benefit Department for specific benefits.
Long Term Disability (LTD) Insurance
LTD insurance protects a portion of your income if you become partially or totally disabled for an
extended period of time. This insurance replaces 60% of your income, up to a maximum of $5,000
per month, depending on your current annual earnings. You must be sick or disabled for at least 90
continuous days before you can receive a benefit payment. Payments will last for as long as you are
disabled or until you reach your Social Security Normal Retirement Age, whichever is sooner. Certain
exclusions, along with any pre-existing condition limitations, may apply. You are not required to make
contributions for this benefit; Popeyes pays 100% of the premium. Please refer to your Summary
Plan Description for details or contact Benefit Department for specific benefits.
Long Term Care (LTC) Insurance
LTC helps pay for the care you need when you can no longer care for yourself. It pays $1,000 to a
facility. Payments may last up to three years. The lifetime maximum is $36,000.
Tip
Disability insurance can replace up to 60% of your income if
you are unable to work.
25
Retirement
Planning
Set retirement
goals. Need
more advice?
It’s never too early — or too late — to start planning for your retirement. Making
contributions to a 401(k) account is the first step toward achieving financial security
later in life. The Popeyes 401(k) Savings Plan provides you with the tools and flexibility
you need to retire comfortably and securely.
Team members can invest for retirement while receiving certain tax advantages. Administrative and
record-keeping services for this Plan are provided by MassMutual.
Contributing to the Plan
You may contribute 1–75% each pay period. Deferred contributions are based on a flat dollar
amount not to exceed Plan limits set by the IRS. The limit for 2016 is $18,000.
Catch-up Contributions
If you are or will be age 50 or older during this calendar year and you already contribute the
maximum allowed to your 401(k) account, you may also make a “catch-up contribution.” This
additional deposit of funds accelerates your progress toward your retirement goals. The maximum
catch-up contribution is $6,000 for 2016. See your Plan Administrator for more details.
Popeyes Company Match
Popeyes provides a discretionary annual match at 50% up to 5% of eligible compensation.
26
Changing or Stopping Your Contributions
You may change the amount of your contributions any time. All changes will become effective as soon as administratively
feasible and will remain in effect until you modify them. You may also discontinue your contributions any time. Once you stop
making contributions, you may start again at any time.
Consolidating Your Retirement Savings
If you have an existing qualified retirement plan (pre-tax) with a previous employer, you may transfer or roll over that account
into the Plan any time. To initiate a rollover into your Plan, contact MassMutual at 800-854-0647 for details.
Investing in the Plan
You decide how to invest the assets in your account. The Popeyes 401(k) Savings Plan offers a selection of investment
options for you to choose from. You may change your investment choices any time. For more details, refer to your 401(k)
Enrollment Guide.
For more information, you may visit www.massmutual.com/corp or call 800-854-0647.
Tip
Don’t forget to account for future health care costs when you are
considering how much money you will need during retirement.
27
Additional
Benefits
Popeyes knows the value of well-rounded, balanced team members,
which is why we offer additional benefits to help you manage your life.
Employee Assistance Program
ComPsych
CALL ANYTIME
Call: 877-809-3204
TDD: 800-697-0353
Online: www.guidanceresources.com
Your Company Web ID: POPEYES
Popeyes cares about you and your family’s total health management—mental,
emotional and physical. For that reason, we provide an Employee Assistance
Program (EAP) at no cost to you.
This service connects you with the best mental health and counseling services.
Whether you are interested in work/life resources, mental health assistance, or
legal and financial advice, the EAP service can connect you and members of
your household with a variety of professionals. With just one phone call, at any
hour of the day or night, you can have access to helpful resources. The EAP
benefit includes three face-to-face visits per issue with a licensed professional.
All services provided are confidential and will not be shared with Popeyes. You
may also access information, benefits, educational materials and more either by
phone at 877-809-3204 or online at www.GuidanceResources.com.
The Program provides referrals to help with:
28
• Emotional Health and Well-Being
• Job Pressures
• Alcohol or Drug Dependency
• Stress, Anxiety, Depression
• Marriage or Family Relationship
Problems
• Grief and Loss
• Financial or Legal Advice
UNUM Voluntary Products
Accident Insurance
Benefits that pay for covered accidents while you are on the road to recovery. Unum’s coverage provides a lump-sum benefit
based on the type of injury (or covered incident) you sustain or the type of treatment you need.
Critical Illness Insurance
Critical illness insurance can pay a lump-sum benefit at the diagnosis of a critical illness. You can choose the level of coverage
from $5,000 to $50,000 — and you can use the money any way you see fit.
Whole Life Insurance
Whole Life Insurance provides much more than a death benefit — it offers valuable “living benefits” that you can use during
times of need. And you can keep your Whole Life coverage after you retire, making it an essential complement to Term Life.
29
Glossary
Coinsurance – Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the
allowed amount for the service, typically after you meet your deductible. For instance, if your plan’s allowed amount for an
office visit is $100 and you’ve met your deductible (but haven’t yet met your out-of-pocket maximum), your coinsurance
payment of 20% would be $20. Your plan sponsor or employer would pay the rest of the allowed amount.
Consumer-Driven Health Plan (CDHP) – Plan option that provides choice, flexibility and control when it comes to
spending money on health care. Preventive care is covered at 100% with in-network providers, there are no copays,
and all qualified employee-paid Medical expenses count toward your deductible and your out-of-pocket maximum.
Copay – The fixed amount, as determined by your insurance plan, you pay for health care services received.
Deductible – The amount you owe for health care services before your health insurance or plan sponsor (employer) begins
to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you’ve met your $1,000
deductible for covered health care services. This deductible may not apply to all services, including preventive care.
Employee Contribution – The amount you pay for your insurance coverage.
Explanation of Benefits (EOB) – A statement sent by your insurance carrier that explains which procedures and
services were provided, how much they cost, what portion of the claim was paid by the plan, and what portion is your
liability, in addition to how you can appeal the insurer’s decision. These statements are also posted on the carrier’s
website for your review.
Flexible Spending Accounts (FSAs) – An option that allows participants to set aside pre-tax dollars to pay for certain
qualified expenses during a specific time period (usually a 12-month period). There are two types of FSAs: the Health Care
FSA and the Dependent Care FSA.
• Health Care FSA – With the Health Care FSA, participants can use their accounts to cover eligible Medical
expenses such as copays, eye exams, prescriptions and more. All expenses must be qualified as defined in
Section 213(d) of the Internal Revenue Code. Please note that over-the-counter medications are not eligible for
reimbursement without a doctor’s prescription with the Health Care FSA.
• Dependent Care FSA – A Dependent Care FSA helps to reimburse participants for eligible expenses associated
with caring for a qualified dependent, such as a dependent younger than age 13 or another dependent that may be
incapable of self-care. For additional information on eligible expenses, refer to Publication 503 on the IRS website.
Both accounts are “use it or lose it,” meaning that funds not used by the end of the plan year will be lost.
Health Care Cost Transparency – Also known as Market Transparency or Medical Transparency. Health care provider
costs can vary widely, even within the same geographic area. To make it easier for you to get the most cost-effective
health care products and services, online cost transparency tools, which are typically available through health insurance
carriers, allow you to search an extensive national database to compare costs for everything from prescription drugs and
office visits to MRIs and major surgeries.
30
Health Savings Account (HSA) – A personal health care bank account funded by your or your employer’s tax-free
dollars to pay for qualified Medical expenses. You must be enrolled in a HDHP to open an HSA. Funds contributed to
an HSA roll over from year to year and the account is portable, meaning if you change jobs your account goes
with you.
High Deductible Health Plan (HDHP) – Plan option that provides choice, flexibility and control when it comes to
spending money on health care. Preventive care is covered at 100% with in network providers, there are no copays, and
all qualified employee-paid Medical expenses count toward your deductible and your out-of-pocket maximum.
In-Network – In-network providers are doctors, hospitals and other providers that contract with your insurance
company to provide health care services at discounted rates.
Out-of-Network – Out-of-network providers are doctors, hospitals and other providers that are not contracted with your
insurance company. If you choose an out-of-network doctor, services will not be provided at a discounted rate.
Out-of-Pocket Maximum – The most you pay during a policy period (usually a 12-month period) before your health
insurance or plan begins to pay 100% of the allowed amount. This limit does not include your premium, charges beyond
the Reasonable & Customary, or health care your plan doesn’t cover. Check with your health insurance carrier to confirm
what payments apply to the out-of-pocket maximum.
Over-the-Counter (OTC) Medications – Medications typically made available without a prescription.
Prescription Medications – Medications prescribed to you by a doctor. Cost of these medications is determined by
their assigned tier: Generic, Preferred or Non-Preferred.
• Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to
corresponding Preferred or Non-Preferred versions. The color or flavor of a Generic medicine may be different, but
the active ingredient is the same. Generic drugs are usually the most cost-effective version of any medication.
• Preferred Drugs – Brand-name drugs on your provider’s list of approved drugs. You can check online with your
provider to see this list.
• Non-Preferred Drugs – Brand-name drugs not on your provider’s list of approved drugs. These drugs are typically
newer and have higher copays.
Reasonable and Customary Allowance (R&C) – Also known as an eligible expense or the Usual and Customary
(U&C). The amount your insurance company will pay for a Medical service in a geographic region based on what
providers in the area usually charge for the same or similar Medical service.
Summary of Benefits and Coverage (SBC) – Mandated by health care reform, your insurance carrier or plan sponsor
will provide you with a clear and easy to follow summary of your benefits and plan coverage.
31
Required Notices
When Will You Pay A Higher Premium (Penalty) To Join
A Medicare Drug Plan?
Important Notice from Popeyes Louisiana Kitchen, Inc
About Your Prescription Drug Coverage and Medicare
under the Cigna A, B and C Plan(s)
You should also know that if you drop or lose your current coverage with
Popeyes Louisiana Kitchen, Inc 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.
Please read this notice carefully and keep it where you can find it. This notice
has information about your current prescription drug coverage with Popeyes
Louisiana Kitchen, Inc 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.
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.
There are two important things you need to know about your current coverage
and Medicare’s prescription drug coverage:
1.
2.
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.
Popeyes Louisiana Kitchen, Inc has determined that the prescription
drug coverage offered by the Cigna A, B and C plan(s) 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.
Important Notice from Popeyes Louisiana Kitchen, Inc.
About Your Prescription Drug Coverage and Medicare
under the Cigna D Plan(s)
Please read this notice carefully and keep it where you can find it. This notice
has information about your current prescription drug coverage with Popeyes
Louisiana Kitchen, Inc. and about your options under Medicare’s prescription
drug coverage. This information can help you decide whether or not you want
to join a Medicare drug plan. Information about where you can get help to make
decisions about your prescription drug coverage is at the end of this notice.
There are three important things you need to know about your current coverage
and Medicare’s prescription drug coverage:
1.
Medicare prescription drug coverage became available in 2006
to everyone with Medicare. You can get this coverage if you join a
Medicare Prescription Drug Plan or join a Medicare Advantage Plan
(like an HMO or PPO) that offers prescription drug coverage. All
Medicare drug plans provide at least a standard level of coverage set
by Medicare. Some plans may also offer more coverage for a higher
monthly premium.
2.
Popeyes Louisiana Kitchen, Inc. has determined that the prescription
drug coverage offered by the Cigna D plan is, on average for all plan
participants, NOT expected to pay out as much as standard Medicare
prescription drug coverage pays. Therefore, your coverage is considered
Non-Creditable Coverage. This is important because, most likely, you
will get more help with your drug costs if you join a Medicare drug plan,
than if you only have prescription drug coverage from the Popeyes
Louisiana Kitchen, Inc. plan. This also is important because it may mean
that you may pay a higher premium (a penalty) if you do not join a
Medicare drug plan when you first become eligible.
3.
You can keep your current coverage from Popeyes Louisiana Kitchen,
Inc. However, because your coverage is non-creditable, you have
decisions to make about Medicare prescription drug coverage that
may affect how much you pay for that coverage, depending on if and
when you join a drug plan. When you make your decision, you should
compare your current coverage, including what drugs are covered,
with the coverage and cost of the plans offering Medicare prescription
drug coverage in your area. Read this notice carefully - it explains your
options.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare
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. You may also enroll each year from October 15th
through 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 Popeyes Louisiana
Kitchen, Inc coverage 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
herein.
If you do decide to join a Medicare drug plan and drop your current Popeyes
Louisiana Kitchen, Inc coverage, be aware that you and your dependents will not
be able to get this coverage back.
32
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare
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. You may also enroll each year from October 15th
through December 7th.
However, if you decide to drop your current coverage with Popeyes Louisiana
Kitchen, Inc., since it is employer/union sponsored group coverage, you will be
eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare
drug plan; however you also may pay a higher premium (a penalty) because you
did not have creditable coverage under the Popeyes Louisiana Kitchen, Inc. 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 Popeyes Louisiana
Kitchen, Inc. coverage 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
herein.
If you do decide to join a Medicare drug plan and drop your current Popeyes
Louisiana Kitchen, Inc. coverage, be aware that you and your dependents will
not be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join
A Medicare Drug Plan?
Since the coverage under Popeyes Louisiana Kitchen, Inc. is not creditable,
depending on how long you go without creditable prescription drug coverage
you may pay a penalty to join a Medicare drug plan. Starting with the end of the
last month that you were first eligible to join a Medicare drug plan but didn’t join,
if you go 63 continuous days or longer without prescription drug coverage that’s
creditable, your monthly premium may go up by at least 1% of the Medicare
base beneficiary premium per month for every month that you did not have that
coverage. For example, if you go nineteen months without creditable coverage,
your premium may consistently be at least 19% higher than the Medicare base
beneficiary premium. You may have to pay this higher premium (penalty) as long
as you have Medicare prescription drug coverage. In addition, you may have to
wait until the following October to join.
For More Information about This Notice or Your
Current Prescription Drug Coverage…
Contact the person listed at the end of these notices for further information.
NOTE: You’ll get this notice each year. You will also get it before the next period
you can join a Medicare drug plan, and if this coverage through Popeyes
Louisiana Kitchen, Inc changes. You also may request a copy of this notice at
any time.
For More Information about Your Options under
Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug
coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook
in the mail every year from Medicare. You may also be contacted directly by
Medicare drug plans.
For more information about Medicare prescription drug coverage:
»»
Visit www.medicare.gov
»»
Call your State Health Insurance Assistance Program (see the inside
back cover of your copy of the “Medicare & You” handbook for their
telephone number) for personalized help
»»
Call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048
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 Medicare Part D 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).
Date:
January 1, 2016
Name of Entity/Sender:
Popeyes Louisiana Kitchen, Inc
Contact—Position/Office:
Benefit Department
Address:
400 Perimeter Center Terrace, Suite 1000
Atlanta, GA 30346
Phone Number:
800-735-0330 Option 4
Women’s Health and Cancer Rights Act
The Women’s Health and Cancer Rights Act of 1998 was signed into law on
October 21, 1998. The Act requires that all group health plans providing medical
and surgical benefits with respect to a mastectomy must provide coverage for
all of the following:
»»
Reconstruction of the breast on which a mastectomy has been
performed
»»
Surgery and reconstruction of the other breast to produce a symmetrical
appearance
»»
Prostheses
»»
Treatment of physical complications of all stages of mastectomy,
including lymphedema
This coverage will be provided in consultation with the attending physician and
the patient, and will be subject to the same annual deductibles and coinsurance
provisions which apply for the mastectomy. For deductibles and coinsurance
information applicable to the plan in which you enroll, please refer to the summary
plan description or contact Benefit Department at 800-735-0330 Option 4.
HIPAA Privacy and Security
The Health Insurance Portability and Accountability Act of 1996 deals with how
an employer can enforce eligibility and enrollment for health care benefits, as
well as ensuring that protected health information which identifies you is kept
private. You have the right to inspect and copy protected health information
that is maintained by and for the plan for enrollment, payment, claims and
case management. If you feel that protected health information about you is
incorrect or incomplete, you may ask your benefits administrator to amend the
information. The Notice of Privacy Practices has been recently updated. For
a full copy of the Notice of Privacy Practices, describing how protected health
information about you may be used and disclosed and how you can get access
to the information, contact Benefit Department at 800-735-0330 Option 4.
33
HIPAA Special Enrollment Rights
If you are declining enrollment for yourself or your dependents (including your spouse)
because of other health insurance or group health plan coverage, you may be able to
later enroll yourself and your dependents in this plan if you or your dependents lose
eligibility for that other coverage (or if the employer stops contributing towards your or
your dependents’ other coverage).
Loss of eligibility includes but is not limited to:
»»
Loss of eligibility for coverage as a result of ceasing to meet the plan’s eligibility
requirements (i.e. legal separation, divorce, cessation of dependent status, death
of an employee, termination of employment, reduction in the number of hours of
employment);
»»
Loss of HMO coverage because the person no longer resides or works
in the HMO service area and no other coverage option is available
through the HMO plan sponsor;
»»
Elimination of the coverage option a person was enrolled in, and another option is
not offered in its place;
»»
Failing to return from an FMLA leave of absence; and
»»
Loss of coverage under Medicaid or the Children’s Health Insurance Program
(CHIP).
Unless the event giving rise to your special enrollment right is a loss of coverage
under Medicaid or CHIP, you must request enrollment within 30 days after your or your
dependent’s(s’) other coverage ends (or after the employer that sponsors that coverage
stops contributing toward the coverage).
If the event giving rise to your special enrollment right is a loss of coverage under
Medicaid or the CHIP, you may request enrollment under this plan within 60 days of the
date you or your dependent(s) lose such coverage under Medicaid or CHIP. Similarly, if
you or your dependent(s) become eligible for a state-granted premium subsidy towards
this plan, you may request enrollment under this plan within 60 days after the date
Medicaid or CHIP determine that you or the dependent(s) qualify for the subsidy.
In addition, if you have a new dependent as a result of marriage, birth, adoption, or
placement for adoption, you may be able to enroll yourself and your dependents.
However, you must request enrollment within 30 days after the marriage, birth, adoption,
or placement for adoption.
To request special enrollment or obtain more information, contact Benefit Department at
800-735-0330 Option 4.
34
Important
Contacts
COVERAGE
Directly access Popeyes’s benefits information with
CONTACT
MEDICAL, PHARMACY
& DENTAL
Cigna
800-244-6224
www.mycigna.com
Group #: 3330036
VISION
Cigna
877-478-7557
www.mycigna.com
HEALTH SAVINGS
ACCOUNT
Cigna
800-244-6224
www.mycigna.com
the Lockton BenefitLink Mobile App. You’ll be
immediately connected to provider websites and
phone numbers. You can even capture and store
FLEXIBLE SPENDING
ACCOUNTS
important information
like ID cards, your
LIFE AND AD&D
The Hartford
800-523-2233
www.thehartfordatwork.com
DISABILITY
The Hartford
800-523-2233
www.thehartfordatwork.com
RETIREMENT
MassMutual
800-854-0647
www.massmutual.com/corp
group numbers,
doctors’ names
and more!
Lockton
BenefitLink
Username: Popeyes Management
Password: Chicken
EMPLOYEE ASSISTANCE
PROGRAM
ComPsych
877-809-3204
www.guidanceresources.com
UNUM VOLUNTARY
PRODUCTS
UNUM
800-275-8686
www.plane.biz/Register.aspx
POPEYES BENEFIT
DEPARTMENT
844-219-6070
benefits@popeyes.com
LOCKTON BENEFIITLINK
MOBILE APP
36
Medcom
800-523-7542
www.mywealthcareonline.com/medcom/
Username: Popeyes Management
Password: Chicken