Capital BlueCross

Medical/Rx
Vision
Wellness
2014 Benefits Guide
Dental
Health
Reimbursement
Account
Flexible Spending
Accounts
Disability
Insurance
Life
AD&D
Welcome to the KidsPeace
Corporation!
As a Benefit-Eligible Associate you
are eligible to participate in our
comprehensive benefits program.
Voluntary
Life
EAP
Hyatt Legal Plan
Enrollment
Considerations
October 2013
To All KidsPeace Corporation Benefit-Eligible Associates:
Your role is critical in fulfilling the mission of our organization!
The enclosed benefit booklet will help inform you of the benefits available to you as a
Benefit-Eligible Associate at KidsPeace Corporation.
If you have any questions regarding the information contained in this booklet please
feel free to contact me at (610)-799-8785 or Kathy Truby at (610) 799-7727. You
may also contact Val Lewis at our health insurance broker, BSI Corporate Benefits.
Val can be reached at (484)-821-1300 ext. 207 or vlewis@bsicorporate.com.
The information in this enrollment guide is presented for illustrative purposes only.
Upon enrollment, you will receive a complete Summary Plan Document (SPD) for
each benefit which provides specific and detailed information of your benefits.
While every effort was taken to accurately report your benefits within this booklet
discrepancies are always possible. In the event of a discrepancy, the actual SPD will
prevail.
We are looking forward to a long-term relationship with you and wish you success in
your career with the KidsPeace Corporation.
Sincerely,
Johanna Ulicny
Manager, Employee Benefits
KidsPeace Corporation
 Contact Information/Table of Contents 
Refer to this list when you need to contact one of your benefit vendors. For general
information contact the Human Resource Department.
MEDICAL INSURANCE: Capital Blue Cross
Customer Service
(800) 962-2242
Website:
www.capbluecross.com/kidspeace
PGS 4-14
Prescription Coverage: Capital BlueCross-CVS Caremark
Customer Service
(800) 552-8159
Website:
www.caremark.com
PGS 15-20
VISION INSURANCE:
Customer Service
Website:
Capital Blue Cross
(800) 962-2242
www.capbluecross.com/kidspeace
PGS 21-25
WELLNESS: Capital Blue Cross
Customer Service
(800)327-2255
Website:
www.capbluecross.com/kidspeace
PGS 26-36
DENTAL INSURANCE:
Customer Service
Website:
PGS 37-39
United Concordia
(800) 332-0366
www.ucci.com
FLEXIBLE SAVINGS & HEALTH REIMBURSEMENT ARRANGEMENTS:
Customer Service
(800) 444-1922
Website:
www.basiconline.com
DISABILITY INSURANCE:
Customer Service
Website:
BASIC
PGS 40-46
Mutual of Omaha
(800) 877-5176
www.mutualofomaha.com
PGS 47-50
BASIC LIFE & AD&D INSURANCE: Mutual of Omaha
Customer Service
(800) 755-8805
Website:
www.mutualofomaha.com
PG 51
VOLUNTARY LIFE:
Customer Service
Website:
Mutual of Omaha
(800) 755-8805
www.mutualofomaha.com
EMPLOYEE ASSISTANCE PROGRAM: BalanceWorks
Customer Service
(800)327-2255
Website:
www.mybalanceworks.com
LEGAL PLANNING:
Customer Service
Website:
Hyatt
(800) 821-6400
www.legalplans.com
ONLINE ENROLLMENT GUIDE
Website:
https://lawpa.c0vf.netaspx.com/lawson/portal/index.htm
ENROLLMENT CONSIDERATIONS
PGS 52-54
PGS 55-56
PG 57
PGS 58-59
PG 60
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 Medical Insurance 
Capital BlueCross
For a list of participating providers,
go to www.capbluecross.com/kidspeace
Group# 00502614
Who is eligible?
KidsPeace Corporation offers Benefit-Eligible Associates medical/Rx coverage on
the first day of the month following 60 days of employment.
How much does this cost me?
For employee contributions, please refer to the bi-weekly payroll contribution sheet
available from your review.
Under
$55,000
HRA
PPO1
PPO2
Over
$55,000
HRA
PPO1
PPO2
EE
$29.16
$36.70
$66.18
EE
$37.50
$43.58
$78.43
EE+SP
$58.30
$73.39
$132.35
EE+SP
$74.96
$87.15
$156.86
EE+CH
$52.49
$66.05
$119.12
EE+CH
$67.49
$78.44
$141.17
EE+CHREN
$64.16
$80.73
$145.59
EE+CHREN
$82.49
$95.87
$172.55
FAMILY
$75.82
$95.41
$172.06
FAMILY
$97.49
$113.30
$203.92
KidsPeace Corporation offers Benefit-Eligible Associates and their dependents a choice
between 2 PPO (Preferred Provider Organization) medical insurance plans and a Health
Reimbursement Arrangement Plan. You are not required to select a Primary Care
Physician. You will be able to see a specialist without a referral, and may also choose
to see providers outside the Blues network but you will be subject to additional out-ofpocket expenses. In order to receive Preferred Benefits, you must use an in-network
participating provider.
A listing of participating providers is available at
www.capbluecross.com/kidspeace.
You may opt out of medical coverage under the KidsPeace Corporation insurance plan
if you have coverage from another source (spouse’s employer or parent
coverage).
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Benefit Options for 2014
PPO 1
PPO 2
HRA
Deductible
$550 Individual
$1,100 Family
$325 Individual
$650 Family
$2,500 Individual
$5,000 Family
HRA Fund
N/A
N/A
$1,000/$2,000
Coinsurance
30% In-Network
20% In-Network
0% In-Network
Out of Pocket
Max
$2,750/$5,500
(Includes Copays,
Ded. and
Coinsurance)
$1,825/$3,650
(Includes Copays,
Ded. and
Coinsurance)
$2,500/$5,000
(Includes
Deductible)
First 3
Office/SP Visits
$0
N/A
N/A
Office Visit
$20
$15
100% after Ded.
Specialist
$40
$30
100% after Ded.
ER
$125 waived if
admitted
$125 waived if
admitted
100% after Ded.
Urgent Care
$50
$50
100% after Ded.
In-Network Highlights
_______
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Pharmacy Insurance 
Capital BlueCross/CVS Caremark
For a list of participating providers,
go to www.capbluecross.com/kidspeace
Group# 00502614
Who is eligible?
KidsPeace Corporation offers Benefit-Eligible Associates medical/Rx coverage on
the first day of the month following 60 days of employment.
How much does this cost me?
For employee contributions, please refer to the medical bi-weekly payroll
contribution sheet available for your review. The Pharmacy benefit is included with
the cost of the Medical Plans.
KidsPeace Corporation offers Benefit-Eligible Associates and their dependents one Rx
Plan and the benefit summary is included in the booklet. The Rx Plan is switching to
Capital BlueCross. They use CVS Caremark national network. CVS Caremark has one
of the largest networks in the country with over 67,000 pharmacies nationwide.
Note: You don’t have to use a CVS Pharmacy.
Here
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are some other things to consider about the Rx Plan:
Capital BlueCross/CVS Caremark is the new administrator.
What you pay depends upon where your drug falls on the Rx Formulary.
The Capital BlueCross Rx Formulary is different from Highmark.
Visit www.capbluecross.com/kidspeace to check your medication’s tier status on
their on-line formulary.
Certain medications have quantity limitations; please reference your Guide to
Prescription Drug Benefits booklet.
Specialty medications are handled by CuraScipts.
Ask your doctor for a generic medication before being prescribed a Brand named
medication.
Mandatory Mail applies after two fills at a retail pharmacy.
New scripts are needed from your physician for mail order.
Please reference the Rx Benefit Highlight & Guide to Prescription Drugs Benefits
The KidsPeace Rx Plan has Prior Authorization or Step Therapy. This program is
designed to ensure KidsPeace members are taking advantage of generic medication
when available. There is more information about the Step Therapy Process in the
booklet but here are a few highlights:
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Certain medications are subject to enhanced prior authorization (or step
therapy) due to health care concerns and/or safety reasons.
In order to have these medications covered under your prescription drug
benefit, you may be required to first try a formulary alternative or complete the
authorization process.
To obtain authorization, your physician or pharmacist should call or fax a
request with supporting clinical information to CVS Caremark at 1-800-2945979 (fax: 1-888-836-0730).
You may initiate an authorization by calling CVS Caremark at 1-800-585-5794,
or by visiting the web site at www.capbluecross.com.
To ensure no lapse in current medications; Capital BlueCross will delay the
implementation of the Enhanced Prior Authorization (Step Therapy) process for
90 days (1/1/2014 – 3/31/2014).
Any members already pre-approved and currently taking a prescription that
requires enhanced Prior Authorization will be able to fill that medication during
the 90 day period, no questions asked.
If there is a lapse in treatment, it could require you to start the Step Therapy
process from the beginning.
Any new medication prescribed to a member after 4/1/2014 will apply the
Enhanced Prior Authorization (Step Therapy) process.
Also included in the booklet is the Caremark Mail Order Form. If you are currently on
mail order, we encourage you to take this form to your doctor so your mail order
prescription can be transferred to Caremark without any lapse. CVS Caremark will
also allow members to fill a 90 day supply at a CVS Retail store at the cost of
the mail order copayment.
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 Vision Insurance 
Capital BlueCross
For a list of participating providers,
Go to www.capbluecross.com/kidspeace
Group# 00502614
Who is eligible?
KidsPeace Corporation offers Benefit-Eligible Associates vision coverage on the first
day of the month following 60 days of employment.
How much does this cost me?
For employee contributions, please refer to the bi-weekly payroll contribution sheet
available from your review.
Under
$55,000
Vision
Over
$55,000
Vision
EE
$2.00
EE
$2.00
EE+SP
$4.00
EE+SP
$4.00
EE+CH
$4.00
EE+CH
$4.00
EE+CHREN
$4.00
EE+CHREN
$4.00
FAMILY
$6.00
FAMILY
$6.00
KidsPeace Corporation offers Benefit-Eligible Associates and their dependents vision
coverage through Capital BlueCross. The Vision Plan is on the following page and the
benefits are the same as last year, only the insurance carrier is changing. Capital
BlueCross uses National Vision Administrators (NVA) network. NVA has one of the
largest vision networks in the country and you can find a participating provider at
www.capbluecross.com/kidspeace.
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KidsPeace
Wellness Rewards
Complete the following (5) activities between
1/1/14 and 12/31/14 and earn $250*
1. Must get annual physical from primary care physician (annual physical is
2.
3.
4.
5.
covered in full by medical plan)
Must get annual CBC and Chem Profile bloodwork (basic annual
bloodwork is covered in full by the medical plan including sugar and
cholesterol)
Must complete the confidential On-line Health Risk Assessment (on
Capital Blue Cross Website)
Complete one online Digital Health Coaching Program
Must get annual Flu Shot in 2014.
**Please reference Schedule of Preventive Services on page 13 of this
Benefit Booklet that lists specifics of routine exams and screenings that
are covered in full.
th
Paid by January 30 , 2015.
*Must be enrolled in one of the KidsPeace Medical Plans
and must be employed by KidsPeace Corporation at time
the bonus is paid.
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 Dental Insurance 
United Concordia Companies
For a list of participating providers,
Go to www.ucci.com
Group# 0262423
Who is eligible?
KidsPeace Corporation offers Benefit-Eligible Associates dental coverage on the first
day of the month following 60 days of employment.
How much does this cost me?
For employee contributions, please refer to the bi-weekly payroll contribution sheet
available from your review.
Under
$55,000
Dental
Over
$55,000
Dental
EE
$2.25
EE
$2.81
EE+SP
$4.39
EE+SP
$5.48
EE+CH
$4.39
EE+CH
$5.48
EE+CHREN
$6.75
EE+CHREN
$8.43
FAMILY
$6.75
FAMILY
$8.43
KidsPeace Corporation offers Benefit-Eligible Associates and their dependents dental
coverage through United Concordia Companies, Inc. (UCCI). The Dental Plan is on the
following page and the benefits are the same as last year. UCCI is one of the largest
Dental carriers in the country and you can find a participating provider at
www.ucci.com.
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 Dental Insurance 
United Concordia
Group#0262423
CONCORDIA FLEX
Dental Benefits Summary for KidsPeace
Network: Advantage Plus
Representative listing of covered services – certificate of coverage provides a detailed description of benefits.
Benefit Category
2
1
Plan Pays
Class I – Diagnostic/Preventive Services
Exams
Cleanings & Fluoride Treatments
X-rays
100%
Sealants
Space Maintainers
Palliative Treatment (Emergency)
Class II – Basic Services
Basic Restorative (Fillings, etc.)
Simple Extractions
Endodontics
Repairs of Crowns, Inlays, Onlays
80%
Complex Oral Surgery
Nonsurgical & Surgical Periodontics
General Anesthesia
Class III – Major Services
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Inlays, Onlays, Crowns
60%
Prosthetics (Bridges, Dentures)
Orthodontics to any age
Diagnostic, Active, Retention Treatment
50%
Program Maximums/Deductibles
Annual Program Maximum (per covered person)
$1,500
Lifetime Orthodontic Maximum (per covered person)
$1,500
Lifetime Periodontic Maximum (per covered person)
$2,500
Annual Program Deductible (per person/per family)
$50 per member (excludes Class I and
II services); $50 per member for
Orthodontics
Non-network Reimbursement
90th Percentile
1.
The listed network percentages represent the portion of United Concordia’s maximum
allowable charges (MACs) for which the plan will be responsible. Network providers agree to
accept United Concordia’s MAC for covered services as payment in full and also agree to file
claims for you. If you or your family members receive services from a non-network provider,
United Concordia will apply the percentages shown to the [non-network reimbursement] for
covered services and you will be responsible for the difference, up to the provider’s charge.
United Concordia’s standard exclusions and limitations apply.
2. Unmarried dependent children covered to age [19]. Unmarried dependent students/disabled
children covered to age [23].
CONTACT UNITED CONCORDIA
Phone
Mail
Web
1-800-332-0366
Customer service representatives are available from 8 a.m. to 8 p.m. ET.
United Concordia, PO Box 69420, Harrisburg, PA 17103-9420
www.unitedconcordia.com
Once enrolled, register to use My Dental Benefits for 24/7, secure access to benefit
information including eligibility, claim status, procedure history, ID card requests and
more!
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Medical Care FSA (Flexible Spending Account)
Through the use of the Health Care Spending Account, you can use pre-tax dollars to
pay for uninsured medical, prescription, dental and vision expenses. A partial listing of
eligible expenses is below. (For a full listing visit basiconline.com).
The account operates much like a bank account. Deposits are made into your
account through pre-tax payroll deductions. You may deposit annually a maximum of
$2,500 for Health Care and a minimum of $250.
Visit www.basiconline.com/employees to use BASIC’s tax savings calculator to
estimate the size of your tax saving, annually or per pay check, when you choose to
participate. Your FSA plan year is from January 1, 2014 -December 31, 2014. All
expenses must be incurred during this timeframe to be eligible for reimbursement.
Also, the Health FSA will have the full annual election available to you on day
one of the plan year.
Withdrawals from the account are made using a Reimbursement Form or your Debit
Card (Benny Card). The Reimbursement Form, along with a copy of your receipt and/or
bill, and a description of the expense should be submitted to BASIC. Expenses can be
submitted via mail, fax, or uploaded to the BASIC website. A Direct Deposit will be
issued to you for eligible expenses. You are also able to swipe the Debit Card at the
Point of Sale to access FSA funds immediately. You may receive a request to provide
documentation for the swipe. Please retain all receipts. Requested receipts may be
faxed, mailed, or uploaded to the BASIC website. * Please note that beginning the 2014
plan year access to your account must be made via the debit card or manual
reimbursement through direct deposit.
BASIC will provide you two Benny (Debit Cards) upon enrollment into the FSA plan. The
cards will be mailed to your home. You will also receive a separate letter to you home
address confirming your election as well as providing information on how to log into
your personal account. The letter will contain your unique User Name and Password.
The online site will provide access to balances, payment information, and allow you to
upload documentation to BASIC.
BASIC will be available to answer all questions at: 800-372-3539
Flex Over the Counter Drugs (changed in 2012)
Participants may not use a Flex Debit Card to purchase over the counter drugs. You must
purchase them with your own money and submit a medical necessity form or prescription for
reimbursement. If participants do not have a medical necessity form or prescription, they
expense will be denied.
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Acupuncture
Arch supports
Alcoholism or
Drug Treatment costs
Ambulance
Artificial Limbs
Birth Control Pills
Car Controls (equipment
for handicapped)
Chiropractors
Clinic Costs
Contact Lenses
(including insurance)
Eligible Expenses (Partial Listing)
Cosmetic Surgery
(medically necessary)
Crutches
Deductibles and
Co-payments
Dental and Vision
Diagnostic Tests
Doctor’s Fees
Eyeglasses
(lenses, frames, and exams)
Guide Dog
Health Care
Equipment
Hearing Aids
Hypnosis
of disease)
(for treatment
Immunizations
Lab Fees
Lasik Eye Surgery
Learning Disability
Lifetime Care
Nursing Home Costs
Optometrist
Orthopedic Shoes
Pap Smears
Physical Exams
Physical Therapy
Prescription Drugs
Smoking Cessation
Aids (prescription only)
Sterilization
Surgery (General)
Syringes
Television (closed
captioned)
Well Baby Care
Wheelchairs
X-Rays
Vaccines
Drugs
Ineligible Expenses (Partial Listing)
Any illegal treatment
Babysitting fees to enable you to visit a
doctor
Cosmetic Surgery
Dental bleaching/teeth whitening
Ear piercing
Health club memberships
Lens replacement insurance(warranties)
Life insurance or disability insurance
Marriage counseling
Massage therapy (unless prescribed)
Propecia or Rogaine
Sonicare toothbrushes
Vitamins & nutritional supplements
Weight loss treatment programs
Please visit the BASIC website for a full listing.
www.basiconline.com
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HEALTH CARE FSA EXPENSE WORKSHEET
This worksheet will help you determine how much to contribute to your Health Care FSA in the upcoming plan year. This
is not a complete list, but it does contain some of the more common medical expenses that are eligible.
To estimate your future expenses, it helps to review similar expenses you've had over the past year and consider any upcoming
eligible health expenses that you expect to incur during the coverage period. It's important to carefully estimate your expenses
before you decide how much you want to contribute to the FSA. Be conservative — balances left after the claim filing deadline
will be forfeited.
Medical Expenses
Annual Checkups
Chiropractic Services
Copays/Coinsurance
Contraceptives/Birth Control
Deductibles
Fertility Treatments
Flu Shots
Hearing Devices
Hearing Device Batteries
Immunizations/Shots
Insulin/Diabetic Supplies
Lab Tests
Mammograms
Medical Equipment
Over-the-Counter Medicine
Dental Expenses
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
_________
__________
__________
(Medical Necessity Form Required)
Physical Therapy
Physical Exams
Prescription Drugs
Psychiatric Care
Surgery
Weight Loss Programs
__________
__________
__________
__________
__________
__________
Cleanings
Crowns
Deductibles
Dentures
Fillings
Fluoride Treatments
Orthodontia
Retainers
Root Canals
__________
__________
__________
__________
__________
__________
__________
__________
__________
Vision
(Vision warranties/service agreements and clip-on sunglasses
are NOT eligible)
Copays
__________
Contact Lenses
__________
Contact Lenses Solution__________
Exams
__________
Frames
__________
Laser Eye Surgery
__________
Lenses
__________
Prescription Sunglasses__________
(Medical Necessity Form Required)
Well-baby Care
__________
(A) Total of the Amounts You Listed Above: __________________
(Note that you cannot exceed your employer’s plan year maximum.)
(B) Number of Paychecks per Plan Year: _______
(Typically, 52 for weekly, 26 for bi-weekly, 12 for monthly, 24 for semi-monthly payroll.)
(C) Divide Line (A) by Line (B) = __________
(This is how much you would contribute per paycheck to your Health Care FSA.)
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Dependent Care FSA (Flexible Spending Account)
Through the use of a Dependent Care Flex Account, you can reduce your tax burden by
using pre-tax dollars to pay for eligible child or dependent care expenses. Federal law
also allows you to claim a direct credit against federal income taxes for eligible child or
dependent care expenses. You may use this account or take a federal tax credit - but
not both.
This plan operates much like a bank account. Deposits are made into your account
through pre-tax payroll deductions. Withdrawals from the account are made using a
reimbursement form, which is available through your Human Resources Department.
The reimbursement form, along with a copy of your receipt and/or bill and a
description of the expense should be submitted to Basic.
Dependent care expenses are expenses incurred by you to enable you to work. If you
are married, the expenses must be to enable you and your spouse to work, or your
spouse to attend school on a full time basis. The expenses must be for the care of
your dependent that is under age thirteen (13) and for whom a personal-exemption
deduction is allowed for federal income tax purposes; or for the care of your dependent
or spouse who is physically or mentally incapable of self-care, or for household services
in connection with the care of such a person.
If you are single or married filing a joint return, the maximum amount is
$5,000 per plan year. If you are married and you file a separate tax return,
the maximum amount is $2,500 per plan year.
Unlike the Health FSA the funds are only available in the Dependent Care account as
they are deducted from payroll. You will only be able to access the Dependent Care
funds up to the contributed amount from your paycheck. As like the Health FSA any
unused funds will be forfeited following the plan year.
*Due to non-discrimination testing, which is mandatory, the total of all pre-tax benefits received for
highly compensated and key employees may be reduced to pass required testing.
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Q & A on Dependent Care FSA (Flexible Spending Account)
Q. My child is cared for by a neighbor in her home. Can I set aside money in
the dependent care account to cover these expenses?
A. Yes. As long as the child-care services are necessary to enable you and your
spouse to work, the child is under 13 years of age and you can provide your
neighbor’s name, address and social security number.
Q. If my spouse and I both participate in the dependent care account plans,
how does the $5,000 limit apply?
A. The $5,000 limit does not apply to each account separately, but rather applies to
limit the total tax-free dependent care reimbursements that you can receive from all
employer plans in the year. Accordingly, the maximum tax-free reimbursement you
and your spouse can receive is $5,000 if you file a joint return. If instead, you file
separate returns, each of you will be entitled to receive $2,500 of reimbursement tax
free.
Q. Can the reimbursement account be used to cover the cost of a baby-sitter
for social purposes?
A. No. You may only use the account to reimburse you for expenses for dependent
care while you and your spouse (if married) are at work.
Q. I’m a little confused about the term “care that enables you and your
spouse to work.” Here is my situation: My 3 year old son attends nursery
school 5 days a week. My spouse works full time and I work 3 days a week,
but I am looking for a full time job. Does that 2 day discrepancy mean I
can’t fully participate in the dependent care program?
A. No, you are still eligible to participate; that’s because the word “work” includes
any time you are paid to work, whether full or part time as well as any time during
which you are actively looking for work.
Q. Is the dollar limit under the dependent care account affected by the
number of children that I have?
A. No. Unlike the dependent care tax credit, the dependent care account exclusion is
not affected by the number of children you have. The dollar limit under the
dependent care account, however, is determined by whether you file a separate or
joint return. The dollar limit is $5,000 if a joint return is filed and $2,500 if separate
returns are filed.
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KidsPeace
Health Reimbursement Arrangement-(HRA)
Your employer has funded an HRA plan to offset the costs you incur with your deductible
expenses.
Here is how it works…
Note: This plan is available to those individuals that participate in the HRA plan. The HRA
plan year will be from January1 to December 31. Services/expenses will need to be incurred
within the plan year in which you are requesting reimbursement. Any unused funds will be
rolled over to the new plan year.
Reimbursement of Deductible expenses, excluding RX.
HRA Pays
$1,000
$2,000
Single Deductible
Family Deductible
Coordination with FSA:
If you choose to participate in the FSA plan you must exhaust the Medical FSA
portion prior to utilizing the HRA dollars. This insures any payroll deductions are
not forfeited, and allows unused HRA dollars to roll to the following plan year. If
you do not wish deductible expenses to be paid through the FSA and prefer other
expenses such as, RX, Dental, and Vision to be paid, submit these expenses to
exhaust the FSA first. Then file all deductible expenses through the HRA.
Also, note that should you participate in the FSA plan while on the HRA plan all
expenses swiped on the FSA card will require documentation. Expenses will
continue to be paid at the point of sale, but notification will be provided to
substantiate the expense with BASIC.
How to Submit a Claim (If you didn’t use a Benny Card):
1. Requests for reimbursement will need to be submitted on an HRA reimbursement form.
2. For expenses applied to your health plan deductible you will need to submit the claim
form to BASIC along with the explanation of benefits (EOB) from your health plan.
Deductible reimbursement requests cannot be processed without an EOB.
3. Reimbursements will be made directly to you. It will then be your responsibility to pay
the respective provider if payment was not made at the time of service.
4. You have a 90-day run out period to submit claims at the end of each plan year.
5. Submit claims by fax, upload or U.S. mail.
Fax 800-731-1922 or 269-488-6255
Upload claims to: https://claims.basiconline.com
Mail to BASIC, 9246 Portage Industrial Dr., Portage, MI 49024
Claims status/questions: 888-472-0777 or 269-488-6785
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 Life and Disability Insurance 
Mutual of Omaha
Who is eligible?
KidsPeace Corporation offers Benefit-Eligible Associates Life and Disability
Coverage on the first day of the month following 60 days of employment.
How much does this cost me?
All Benefit-Eligible Associates receive KidsPeace paid Life, AD&D, Short-Term and
Long-Term Disability at no cost. The benefits are attached in later pages but here
are few highlights:
Life/AD&D: 1 times salary
STD: 66 2/3% of your before-tax weekly earnings, Maximum Benefit Period 22
weeks, Maximum Weekly benefit $1,500
LTD: 55% of your before-tax monthly earnings, Maximum benefit 5 years for nonManagement and normal Social Security Retirement for management, Maximum
Monthly benefit $10,000.
Voluntary Life Insurance (PLEASE READ):
KidsPeace Corporation Benefit-Eligible Associates the opportunity to purchase voluntary
life insurance. This coverage is also offered through Mutual of Omaha. If you are
interested, this year’s open enrollment is the time to enroll. Studies show 4 out of 5
individuals don’t have enough life insurance in the event of a death. KidsPeace is able
to offer voluntary life insurance at an affordable cost compared to purchasing the life
insurance on your own. Mutual of Omaha is also offering $150,000 of guaranteed
issued life insurance. This means you can purchase up to $150,000 without going
through a medical review. If you would like to purchase an amount over $150,000 up
to the maximum $500,000 you may be subject to a medical review.
The rate sheet is attached and the enrolling or declining the voluntary life insurance will
be part of your online open enrollment. You will see the rates are very affordable.
Example: It would cost a 40 year old requesting $100,000 in life insurance $8.07 per
paycheck.
Voluntary Dependent Life insurance is also available and more information is included in
the following pages.
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Employee Assistance Program
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THE HYATT PREMIER LEGAL PLAN
Hyatt Legal Plans is a subsidiary of MetLife
Only $15.00 per month by Payroll Deduction
(Covers employee, spouse and dependents)
WHAT’S COVERED?
• Unlimited telephone advice and office consultations on virtually any personal
legal matter* with a plan attorney of your choice.
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Preparation of wills, codicils, living wills and living trusts
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Preparation of power of attorney, deeds, demand letters, promissory notes and
mortgages
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Review of personal legal documents
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Representation for:
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Purchase, Sale or Refinancing of your Primary Residence
Debt Collection Defense, Identity Theft
Civil Litigation Defense
Tenant Negotiations and Eviction Defense
Name Change
Uncontested Adoptions and Guardianships
Immigration Assistance
Traffic Ticket Only – No DUI
FEATURES
• Over 9,000 attorneys nationwide
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Fees for covered services, provided by Plan Attorney, are fully covered
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Plan Attorneys will schedule evening and Saturday appointments
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If a Plan Attorney is used, no claim forms are needed
•
Out-of-Network option available
Call Hyatt Legal Plans’ Client Service Center at (800)821-6400 for more
information on the Hyatt Premier Legal Plan. Client Service Representatives
are available Monday-Thursday (8am-7pm) Friday (8am-6pm). All times are
Eastern Time. Hyatt will be happy to answer your questions; provide a
complete plan description; and provide a list of local plan attorneys. Visit us
on the web at Legalplans.com and enter password 571129.
*Plan excludes business and employment-related matters.
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Enrollment Process
Once again, all benefit enrollments will be completed
electronically through our KEIO associate self-service
system. You can access KEIO account at
https://lawpa.c0vf.netaspx.com/lawson/portal/index.htm .
If you have never signed into KEIO, have forgotten your
password, and/or the KEIO system is unavailable, please
contact IT for assistance. IT can be reached by e-mail using
the following address: KEIO@kidspeace.org or
IThelp@kidspeace.org.
If you have a life event, you must contact your local Human
Resources Department within 31 days of the life event, and
prior to attempting to enroll in benefits through KEIO. Life
events include, but are not limited to, births, adoption,
deaths, marriages, divorces, or loss of insurance by a
dependent.
Open Enrollment is November 4th – November 17th. The
LAST DAY to complete your online enrollment is Sunday,
November 17th, 2013.
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Below are some helpful hints to make your enrollment process a success:
ENROLLMENT ELECTION OPTIONS:
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SINGLE – Electing benefits for yourself ONLY
FAMILY [EMP+SPOUSE+CHILD(REN)] – Electing benefits for your family which includes yourself, spouse and
child/children
EMP+SPOUSE – Electing benefits for yourself and a spouse (husband/wife) – No children
EMP+CHILD – Electing benefits for yourself and ONLY 1 child
EMP+CHILDREN – Electing benefits for yourself and more than 1 child (2 or more children)
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SAVING YOUR BENEFIT ELECTIONS:
To SAVE your benefit elections, you MUST click the “Keep These Benefits” option at the end of the enrollment
process.
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PRINTING YOUR EMPLOYEE BENEFITS:
• It is VERY important to answer “YES” when prompted to print your elections at the end of this
process. It is advisable that you retain this copy of your records.
• PLEASE DO NOT use PRINTSCREEN to obtain this printed.
• If you need to verify to which printer your printout will be sent, click on “QUIT” below then click on “FILE” at
the top of the Screen, then click “PRINT” to see the printer name. Cancel out the print screen when done.
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 Enrollment Considerations 
Eligibility Requirements
Benefit-Eligible associates working at KidsPeace Corporation are eligible for coverage on the
first of the month following 60 days of employment.
Dependent Coverage
Medical/Rx - An eligible dependent is a dependent of the employee such as employee’s spouse
or the child of the employee by birth, legal adoption, or legal guardianship. Please refer to each
insurance carrier’s summary plan description to determine when coverage ends for your
dependents. Dependent children are covered until age 26.
Dental/Vision - An eligible dependent is a dependent of the employee such as employee’s
spouse or the child of the employee by birth, legal adoption, or legal guardianship. Please refer
to each insurance carrier’s summary plan description to determine when coverage ends for your
dependents. Dependent children are covered until age 19 and full-time students to age 23.
Effective Date
Coverage will become effective the 1st of the month coinciding with 60 days of employment.
Termination Date
Coverage will terminate as of midnight on the last day of the month in which termination or layoff from the employer occurs.
Open Enrollment
The Plan offers an annual open enrollment period each year. Plan changes during open
enrollment will be effective January 1st. Unless you have a qualifying event under special
enrollment rights, you are not permitted to make any changes to your elections until the next
open enrollment period.
The information in this benefits guide has been prepared by KidsPeace Corporation, for illustrative purposes
and to conform to the requirements for summary plan descriptions as mandated under the Employee
Retirement Income Security Act of 1974 (ERISA). While every effort was taken to accurately report your
benefits, discrepancies, or errors are always possible. In case of discrepancy between this benefits guide and
the actual plan documents, the actual plan documents will prevail. The company will not be bound by the
terms and material contained in this book except as required by ERISA. While the company expects that the
employee benefit plans described in this handbook will continue, the company reserves the right to amend or
terminate those plans at any time, except as required by ERISA. Neither the benefit plans nor the summary
plan descriptions contained in this benefits guide are intended to create any rights on the part of employees.
Specifically, no rights are created with respect to continued employment. It is understood that all employees
to whom the materials in this benefits guide apply, are employed at the will of the individual and the company
or other affiliated companies employing them, and in accord with all statutory provisions. All information is
confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have
questions about this benefit guide, please contact Human Resources at (610) 799-8785.
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