Open Enrollment Guide

Transcription

Navigating the Road Ahead:
A Guide to BorgWarner Hourly Benefit Options
You’re about to take a road trip through your benefit options. There’s a lot to see and
do! If you’re like most people, you’ll want to map your route before you go, talk to a
travel guide about the best sights to see along the road, and find out how to get the best
discounts. It’s time to Take the Wheel!
Road to Benefit Options
Welcome Center
3
Start Your Engines
4
•
•
•
•
How to Enroll
Enrollment Guidelines
If you Don’t Enroll on Time
Enrollment Tips
Roadside Assistance
5
1 Rules of the Road
6
•
•
•
•
Eligibility
Working Spouse Rule
Family Status Changes
Coordinating Benefits Between Plans
2 Medical and Prescription Drugs
9
3 Dental/Vision
20
4 Flexible Spending Accounts
22
5 Life Insurance and Disability Benefits
24
Additional BorgWarner Benefits and Programs
26
Other Required Information
33
Welcome Center
At BorgWarner, we believe that a healthy workforce is a more productive
workforce, and healthy employees are happier employees. Because health
care can be expensive, BorgWarner’s benefits offer you and your family:
• Access to programs and services that promote healthy lifestyles and
provide preventive care such as screenings, physicals, immunizations
and well-child care
• Assistance in paying health care expenses
• Protection against catastrophic health care costs
• On-site wellness program and access to tools and coaching
As a new employee, your HR Benefits Representative will review the benefits
with you during your new hire orientation. Fill out your enrollment form and
return it to the HR Benefits Representative within 31 days of the date you
become eligible to enroll.
Once you are enrolled, each year you have the opportunity to review and
change your benefits during BorgWarner’s Open Enrollment held annually
each fall. Information on the plans and an enrollment form will be sent to all
employees each year, even if you are not currently enrolled in benefits.
You can choose to enroll in one, some or all of the benefits offered. In
addition, you can choose different coverage levels for each. For example, you
can choose employee only coverage for Medical and family coverage for
Dental/Vision.
This guide provides a brief description of the benefits offered to
BorgWarner employees. For more details about your benefits,
see your HR Benefits Representative or visit
www.borgwarner.com/benefits/ithaca
for Summary Plan Descriptions.
Start Your Engines!
This guide is designed to help make the trip easier. Whether you’re taking your first trip or
you’ve been down this road before, it’s important that you carefully consider your needs,
choose well, and enroll on time.
How to Enroll:
1.
Read this guide to learn about your benefit options. Discuss options with your family.
2.
Fill in your enrollment form to make your elections and/or changes.
3.
Provide copies of required documents if you are enrolling eligible dependents.
4.
Be sure to SIGN YOUR FORM and make a copy for your records.
5.
Return the completed form(s) to your HR Benefits Representative located in Plant 2
before the deadline.
6.
If you enroll in a CIGNA health plan, you have the option to earn a $50 monthly discount
on your medical premiums by completing the CIGNA HRQ online by November 30, 2012.
Earn an additional $50 monthly discount by completing the Tobacco Cessation Pledge on
your enrollment form and required activities (if applicable) by February 29, 2013.
(Participation is voluntary - see page 17 for details).
Enrollment Deadlines:
New employees are eligible to enroll in the CIGNA Choice Health Fund medical plan, including prescription,
and/or CIGNA dental/vision coverage after completion of 4 months of employment. All new employees must
complete an enrollment form and provide dependent documentation, if applicable. All forms and
documentation must be received by the HR Benefits Representative within 31 days of the date you become
eligible for coverage.
For current employees, we post information each year regarding annual open enrollment meetings, plan
changes, and deadlines. This is your once-per-year opportunity to change plans or coverage levels if you
wish. Be sure to pay attention to the deadlines posted and enroll on time!
Once you enroll, you can only change your elections if you have a family status change (see page 8) or during
the annual open enrollment period.
If You Don’t Enroll on Time
During the Enrollment
Periods:
If you don’t enroll before the Open
Enrollment or New Hire deadline,
your enrollment will be based on
the coverage listed in the chart to
the right.
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Current Employees
New Employees
(after 4 months of employment)
Medical
Current coverage continues
CIGNA Choice Health Fund –
Employee only (Single) coverage
Dental/Vision
No coverage
Flexible Spending
Accounts (FSAs)
No participation
No participation
Disability
Basic coverage
Basic coverage
Basic Life
Insurance
Basic Life
Basic Life
Optional Life
No participation
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Roadside Assistance
There are many ways to get answers to your questions. You can use the list of
contacts below, either by phone or on the internet, or you can contact your local
HR Benefits Representative.
Plan Administrator
CIGNA
Benefit
Medical &
Prescription Drugs
Phone
Provider, claim and
health information:
1-800-237-2904
Tel-Drug Mail Order 1-800-TEL-DRUG
(1-800-835-3784)
Medical
Teamsters’
Optum Rx
Prescription
Drugs &
Mail Order
CIGNA
www.mycigna.com
Provider, claim and
health information:
1-888-839-5169
Dental &
Vision
1-800-788-4863
1-800-237-2904
(Dental only)
www.optumrx.com
www.mycigna.com
1-877-478-7557
(Vision only)
Flexible Spending
Accounts (FSAs)
1-800-237-2904
www.mycigna.com
Life Insurance &
Accident Insurance
1-888-622-6616
TTY:1-888-688-2860
www.metlife.com/mybenefits
T. Rowe Price
Retirement Savings
Program
1-800-922-9945
rps.troweprice.com
CIGNA
Disability / FMLA
1-800-237-2904
www.mycigna.com
Family Status
Changes
BorgWarner
Benefit Services
1-888-567-1002
For more general plan information
www.borgwarner.com/benefits/ithaca
CIGNA
MetLife
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www.mycigna.com
Teamsters’ Health
& Welfare Office:
1-518-437-9837
Teamsters’
BlueShield PPO
(formerly Prescription Solutions)
Web Site
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Rules of the Road
Eligibility
Your BorgWarner benefits are designed to provide coverage for:
•
You – as an actively employed, full-time employee of BorgWarner regularly scheduled to work at least 30 hours
a week once you have completed four (4) months of employment.
•
Your spouse – defined as your lawful spouse as evidenced by a marriage license, but eligibility varies by plan.
For more information, see details on the next page regarding the New York Marriage Equality Act. Co-habitants,
common-law marriages, legally separated individuals, life partners or divorced spouses are not eligible.
•
Your dependent children – including children to age 26*, regardless of whether the child is a
student. Coverage is also available to children 26 and older if legally deemed permanently and totally
disabled**. A child is defined as:
Biological child;
Legally adopted child or a child who has been placed with you for adoption;
Stepchild who lives with you. (Restrictions may apply. If you have a stepchild that lives with you, but your
stepchild is eligible to participate in another employer’s health plan, the BorgWarner Plan will only cover
the stepchild on a secondary basis.
Court-appointed child for whom you have full (not limited) legal guardianship; or
A child for whom you are required to provide health care support under a Qualified Medical Child Support
Order (QMCSO).
* If your child is married, his or her spouse and children are not eligible for coverage under the BorgWarner plans. Dependent
eligibility is different for life insurance. Details can be obtained from your Summary Plan Description found at
www.borgwarner.com/benefits/Ithaca, or contact MetLife directly.
** A Physicians Statement of Disability will be required for all disabled dependent children.
If you and your spouse work at BorgWarner, your dependent children can be covered under either one of
the parents’ Medical and Dental/Vision plans, but not both. In addition, you and your spouse cannot enroll
under two plans (both as a dependent and an employee, for example).
Proof of dependency (such as a marriage or birth certificate, legal guardian or adoption
papers, court order, tax documents) is required by BorgWarner. Documents must be
submitted when enrollment form is submitted. In all cases, BorgWarner will adhere to all court
orders in determining dependent status, such as in a divorce settlement.
If you have a child or spouse who may no longer qualify as a dependent, it is your responsibility to
contact your HR Benefits Representative within 31 days of the status change event. Failure to do so may result
in the loss of your dependent’s rights to COBRA health care continuation coverage and may have negative tax
consequences for you.
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New York Marriage Equality Act:
On June 24, 2011, New York State Governor Andrew Cuomo signed into law the Marriage Equality Act which
will allow same-sex couples to be married in New York State and to have, with certain exceptions, the same
legal protections as are available to opposite-sex couples married in New York State. The effective date of the
Legislation was July 24, 2011.
Spousal Coverage under BorgWarner Health and Dental/Vision Plans:
BorgWarner has reviewed the available information and guidance regarding the Marriage Equality Act
and how it relates to the BorgWarner benefits. According to the Summary Plan Description for the
BorgWarner Flexible Benefits Plan, a spouse is defined as:
“an individual of the opposite sex to whom you are legally married, as evidenced by a current and valid
marriage certificate (common-law marriages are not recognized). Co-habitants, domestic partners, life
partners, legally separated individuals and divorced spouses are not considered spouses under the
Plan. When deciding whether an individual qualifies as a spouse, the determination will be based upon
the laws of the State in which you maintain your legal residence, but solely to the extent that those
laws do not conflict with the Defense of Marriage Act (“DOMA”) of 1996.”
Since BorgWarner’s Benefit Plans are subject to the Internal Revenue Code (“Code”) and the
Employee Retirement Income Security Act (“ERISA”), the DOMA definition of a spouse will be used for
all eligibility purposes. Under DOMA, the term spouse for Code and ERISA purposes does NOT include
a same-sex spouse. Therefore, BorgWarner will NOT cover same-sex spouses under the company
health and dental/vision benefit plans.
BorgWarner will continue to monitor changes to DOMA and the NY Marriage Equality Act, and how
they affect the BorgWarner Benefit Plans.
Spousal Coverage under Teamster Medical Plan:
The Teamsters have decided to allow all legal spouses as defined by New York Marriage Equality Act
to be covered under their Medical Plan. The proper documentation (Marriage License) will be required
to add your spouse. If you would like to add your legal spouse, you must do so within 31 days of your
marriage or during the annual Open Enrollment period.
The Pre-Tax Premium treatment for a same-sex marriage will be handled differently due to the Internal
Revenue Code’s recognition of DOMA. The employee portion of the Premium can be deducted on a
pre-tax basis; however, the portion of the premium for the same sex-partner is a taxable benefit.
Met-Life Optional Spouse Life Plans:
Met-Life will recognize legal spouses per the New York Marriage Equality Act for all Optional Life Plans.
If you would like to add your spouse to one of the Met-Life Plans, please contact Met-Life directly at
888-622-6616 or online at www.Metlife.com/mybenefits.
Working Spouse Rule
If your spouse works more than 35 hours per week and is eligible for coverage under a group health,
prescription drug, organ or tissue transplant benefit offered by his or her employer and the employer pays 65%
or more of the plan’s cost, then your spouse must enroll in the employer’s basic health coverage in order to be
eligible for coverage as a dependent under the BorgWarner medical plan.
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Family Status Changes
Generally, according to government rules, you can only change your benefit elections during the annual open
enrollment period, unless you have a qualifying family status change, including:
•
•
•
•
•
Marriage or divorce
Birth or adoption
Job change for you, your spouse or dependent child
Eligibility for Medicare for you, your spouse or dependent child
Death of a spouse or dependent child
You have 31 days after the change to notify your HR Benefits Representative if you want to make new
elections. In addition, the change must be consistent with the qualifying event. See your Summary Plan
Description or your HR Benefits Representative for more information.
Important Reminder:
If you are making changes to your insurance coverage midyear due to a qualifying event such as those listed above,
you must fill out a new enrollment form and bring
supporting documentation of the status change to your HR
Benefits Representative. This information must be
submitted within 31 days after the change occurs.
Some examples of acceptable documents include birth
certificate, marriage license, divorce decree, COBRA
notice, or Certificate of Insurance from an employer or
insurance company.
For more information, talk to your HR Benefits
Representative located in the Human Resources
Department in Plant 2.
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Medical and Prescription Drugs
You have three medical plans to choose from, each with different coverage level options. All offer coverage for
in-network care, preventive care and prescription drugs. The main differences between the plans are the
payroll contributions, premium discounts offered, deductibles, coinsurance and whether they offer a Health
Reimbursement Account.
YOUR OPTIONS
BorgWarner Health Plans
Teamsters’ Health Plan
CIGNA/MVP
Choice Health Fund
CIGNA/MVP
POS
BlueShield
PPO
Single
Family
Employee
Employee + 1
Family
Employee
Employee + 1
Family
No
Coverage
Below is a quick comparison of the plans that you will choose from, highlighting some of the similarities and
differences. Keep reading for more details for each plan on the following pages in this section.
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BorgWarner Health Plans
CIGNA/MVP Choice Health Fund Plan
This medical option gives you the flexibility and choice to manage your own health care spending. It works
like most medical plans — with one very important difference. The Choice Health Fund features a
company-paid Health Reimbursement Account (HRA). As a new employee, this is the plan you will be
enrolled in once you have completed four (4) months of service. You may switch to one of the other plans
if you wish during the next annual open enrollment period – see your HR Benefits Administrator for more
information.
Each year, BorgWarner contributes half the cost of your deductible to your account that you use to pay for
your deductible and/or your prescription drug expenses*. You can stretch your fund by seeking the most
cost-effective care. This could mean choosing an in-network provider rather than an out-of-network
provider, or taking a generic medication instead of a brand name. The wiser your health care choices are,
the more likely you’ll save money.
If you don’t use all the money in your account this year, it automatically rolls over to help pay for your
expenses next year. It’s like a savings account for health care.
If you spend all the money in the account, you pay the remaining deductible before plan benefits begin.
You can also use a Health Care Flexible Spending Account to pay for these expenses tax-free (for details
see page 26). Perhaps the biggest advantage of the plan: Your monthly contribution for either single
or family coverage is $0 if you elect to participate in the voluntary Wellness Incentive Programs
outlined on page 17.
How the Choice Health Fund Works
BorgWarner contributes to your Health
Reimbursement Account (HRA) each year ($750
single or $1,500 family). Use the fund to pay for
your medical deductible or prescription drug
expenses*.
Once you use all of the money in the fund, you
pay the remaining member deductible gap ($750
single or $1,500 family).
After you meet your deductible, you and the
company pay coinsurance (80%/20% in-network).
Once you meet the out-of-pocket maximum
($3,000 single or $6,000 family in-network), the
plan pays for your eligible medical expenses for
the remainder of the year.
*
†
‡
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For medical and prescription drug expenses only.
Cannot be used for dental or vision.
Includes member deductible gap.
In-network preventive care covered at 100% with no deductible.
*HRA funds used to pay for prescription drug expense are not
apply to the medical deductible
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Build Your HRA and Lower Your Member Deductible Gap
Your HRA and Member Deductible Gap combine to make up the Plan Deductible. If you have money in your
HRA at the end of the year it is carried over for use in the next year. If you have a Flexible Spending Account
(FSA), that money is used before your HRA, so that your HRA can continue to grow. As your HRA grows, it
covers a larger portion of the Plan Deductible – reducing your Member Deductible Gap.
CIGNA/MVP Choice Health Fund Plan Prescription Coverage
CIGNA administers the prescription drug program for the Choice Health Fund Plan. There are
two ways to get your prescriptions filled: at a network pharmacy or through mail order. The
table below shows how much you pay for each prescription, depending on the type of
prescription drug you buy. The prescription drug program does not have a deductible, however,
the coinsurance and co-pays under the Prescription Drug Program do not count toward your
medical deductible or out-of-pocket maximum.
Co-pays are deducted from HRA but do not
count toward annual deductible. Use your
CIGNA medical card for your prescriptions.
Retail Pharmacy
30-day supply
Mail Order
90-day supply
$8
$16
$0
$0
Formulary
Lower-cost, yet highly effective brand-name
prescription drugs that generally have no generic
equivalent.
$8 + 30%
30% up to $150
per Rx
Non-formulary
Generally has equally effective and less costly
generic equivalents and/or one or more formulary
options
$8 + 50%
50%
Specialty Rx Formulary
Injectable drugs typically used to treat arthritis
and other conditions (does not include insulin)
30% up to $50 per Rx
for initial supply only
30% up to $150
per Rx
Specialty Rx Non-Formulary
50% up to $100 per
Rx
for initial supply only
50% up to $300
per Rx
Generic
Chemically equivalent, lower-cost version of a
brand-name drug.
Diabetes Generic Preventive Medications
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CIGNA/MVP PPO Plan
Under the CIGNA PPO Plan, you pay a set co-pay at the time you receive care (see the side-by-side plan
comparison on page 16 of this guide for breakout of co-pay details or the plan document for more specific
information). The co-pay for an office visit with your primary care physician is $20. If you go to a specialist for
treatment, the co-pay is $40.
There is a $200 deductible for in-network care for single coverage and a $400 deductible for in-network care
for family coverage. Once the deductible is met, the in-network services are generally covered at 90%.
The CIGNA PPO Plan requires a contribution to participate which is deducted from your paycheck. This
plan is available for your enrollment during the first open enrollment period following your four (4) month
probationary period. Your monthly contribution can be lowered if you elect to participate in the
voluntary Wellness Incentive Programs outlined on page 17.
CIGNA/MVP PPO Plan Prescription Coverage
CIGNA administers the prescription drug program for the CIGNA/MVP PPO Plan. There are
two ways to get your prescriptions filled: at a network pharmacy or through mail order. The
table below shows how much you pay for each prescription, depending on the type of
prescription drug you buy.
The prescription drug program does not have a deductible. That means your coverage begins
with your first prescription. However, the coinsurance and co-pays under the Prescription Drug
Program do not count toward your medical deductible or out-of-pocket maximum.
Retail Pharmacy
30-day supply
Mail Order
90-day supply
(for specialty drugs, mail
order is 30-day supply
$10
$16
$0
$0
Formulary
prescription drugs that generally have no
generic equivalent.
$30
30% up to $150
per Rx
Non-formulary
Generally has equally effective and less costly
generic equivalents and/or one or more
formulary options
$50
50%
Covered through
Mail Order
$100 for a 30 day supply
Specialty Rx Non-Formulary
Covered through
Mail Order
$100 for a 30 day supply
Use your CIGNA medical card for your
prescriptions.
Generic
brand-name drug.
Diabetes Generic Preventive Medications
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Additional information on all CIGNA/MVP Prescription Coverage:
If you are enrolled in either of the CIGNA/MVP health plans, you can get help enrolling in the mail order
program (CIGNA Tel-Drug) by visiting them on the web at www.mycigna.com or by calling 1-800-285-4812.
The mail order program is optional for CIGNA plan participants
Step Therapy and Prior Authorization (All CIGNA/MVP Plans)
Often, there are several medication choices available to treat a given medical condition. Though the safety and
clinical effectiveness of these choices can be equivalent, the cost can vary widely. This is most apparent with
generic medications that are FDA approved to be just as effective as brand name counterparts. Generics offer
significant opportunity to manage medication cost while maintaining quality health care.
Through Step Therapy, your pharmacist works with your doctor to find the most cost-effective and safest “step
one” drug first for treatment of your condition, then progresses to more costly “step two” brand-name drugs
only if necessary.
How Step Therapy Works
• There is a sequence of two “steps” in the choice of medication used to treat the following common
medical conditions:
» High Blood Pressure
» High Cholesterol (such as Lipitor)
» Stomach Acid conditions
• Step Therapy is also a requirement for:
» ACE (Angiotensin Converting Enzyme) Inhibitors / ARB (Angiotensin II Receptor Blockers)
drugs used for controlling high blood pressure, treating heart failure, and preventing kidney
failure in people with diabetes or high blood pressure
» Proton Pump Inhibitors (such as Nexium or Prevacid)
• If you are filling a prescription for one of these conditions for yourself or a dependent member 18 years
of age or older, your physician will prescribe a “first step” medication, generally a generic, before
“stepping” up to a higher cost-medication (brand-name drug), if medically necessary.
• If you try to fill a “step two” brand-name drug, the pharmacy’s system automatically checks to see if
you’ve used this before. If you have, the system pays the claim, however, if it is a new prescription the
pharmacist will be directed to call your doctor and suggest trying a more cost-effective “step one” drug,
such as a generic equivalent or brand formulary drug. In the meantime, you can still get a temporary
supply of the “step two” drug while you await your doctor’s approval.
Note: If you are currently taking a Step Therapy drug, you are considered “grandfathered”—meaning as
long as you continue on the Step Therapy drug, you will not be impacted if you exhaust your refills and
need a new prescription.
Prior Authorization
Our Prior Authorization system works with the Specialty Prescriptions and Step Therapy to ensure
your drug therapy is appropriate. Prior Authorization is needed for use of non-preferred brand
products without prior use of generic and preferred brand products. Also, if you take medications for
acne, weight management, hypertension or emphysema, your pharmacist will automatically call your
doctor for a diagnosis before filling your prescription.
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Teamsters’ Health Plan
BlueShield PPO Plan
The Teamsters’ coordinates their PPO Plan through BlueShield of Northeastern NY. Under the Teamsters’
BlueShield PPO Plan, you can visit any provider you wish, but you always pay less if you choose an in-network
provider, and there are no claim forms to file.
There is not deductible under this plan. For an office visit with an in-network provider, you pay a set co-pay of
$20 — the plan pays the rest of the bill. Other services, such as x-rays, lab tests, and hospitalization, are paid
under a co-insurance of 95% with no deductible. You are responsible for paying 5% for these services. See
the side-by-side plan comparison on page 16 of this guide for breakout of co-pay details or the plan document
for more specific information.
The Teamsters’ BlueShield PPO requires a contribution to participate which is deducted from your paycheck.
This plan is available for your enrollment during the first open enrollment period following your four (4) month
probationary period.
Questions regarding the plan can be directed to the Teamsters’ Health and Welfare Office (518)437-9837.
TEAMSTERS’ MEDICAL PLAN
OPTUM Rx PLAN
Retail Pharmacy
30 Day Supply*
Mail Order
90 Day Supply*
Generic
brand-name drug.
$10
$20*
Preferred Brand Formulary
prescription drugs that generally have no
generic equivalent.
$20
$40*
Preferred Brand Non-Formulary
Generally has equally effective and less cost
generic equivalents and/or one or more
formulary options.
$50
$100*
Injectable drugs
N/A
20%
A separate card is required – DO NOT use
BlueShield Medical card at pharmacy
* For all Teamsters’ PPO Participants, a mail order is mandatory for all long-term, on-going medications through Optum RX (formerly known as
Prescription Solutions)
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Additional information on BlueShield Prescription Coverage:
Retail Network Pharmacy
Use a retail pharmacy any time you need a prescription filled right away. Simply show your Optum Rx ID card
at a network pharmacy, and pay your portion of the cost. The pharmacist will file your claim for you. Most
national pharmacies are in the Optum Rx network, including Rite-Aid, Walgreen’s, and CVS.
Mail-order Service
If you use a maintenance drug – for high
blood pressure, for example – use the
convenient mail-order service. Order up to a 90-day
supply for one co-pay, and your drugs are delivered
directly to your home for free. You can order refills
over the phone or online. Purchasing your
maintenance medications through mail-order can
save you money, contact your prescription carrier to
determine your savings.
Mandatory Mail Order Service
The Teamster’s BlueShield Prescription Plan through
Optum Rx requires mandatory mail order service for
all maintenance prescriptions (such as cholesterol or
blood pressure medication).
For Teamsters’ BlueShield PPO plan participants, the mail service pharmacy is handled through Optum Rx
(formerly known as Prescription Solutions) by calling 1-800-788-4863. Customer Service representatives are
available 24 hours a day, 7 days a week to answer your questions.
You can always call the Teamsters’ Health and Welfare Office at 1-518-437-9837 with questions as well.
The mail order program is MANDATORY for Teamsters’ plan participants when filling prescriptions for
maintenance drugs such as cholesterol or blood pressure medication.
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Rewarding Healthy Behaviors – New Wellness Incentive Programs
(CIGNA Healthcare Medical Plans Only – does not apply to Teamsters’ Blue Shield Plan)
Monthly Premium Discounts:
To reward employees for taking positive steps toward a healthier lifestyle, BorgWarner will offer two incentives that
discount monthly medical premiums for employees enrolled in the CIGNA healthcare medical plans. Participation is
voluntary – the employee decides whether to complete both, one or neither of the discount incentives.
Each activity earns you a $50 monthly, for a combined discount of $100, off your monthly medical premium when you are
enrolled in either of the BorgWarner Health Plans. The discount applies only to the employee.
Discount #1: CIGNA Health Risk Questionnaire (HRQ):
Complete the CIGNA HRQ pledge section 1 of your enrollment form and return the form to Human
Resources by the due date
th
If you elect to take the HRQ, you must complete the CIGNA HRQ online by November 30 of each
year.
th
If you complete the CIGNA HRQ online by November 30 , your $50 monthly premium discount will
be applied to your payroll contribution beginning with your first paycheck in January of the following
year.
th
If you complete the CIGNA HRQ online AFTER November 30 , the premium discount will generally
be applied within 30 days of completion.
CIGNA will send a monthly notification report to BorgWarner to let them know who has completed
the HRQ. The individual HRQ results are NOT shared with BorgWarner.
Discount #2: Tobacco Cessation:
Complete the Tobacco Cessation section on your Open Enrollment Form by electing either NonTobacco User or Tobacco Cessation Pledge.
Non-tobacco users and tobacco users who elect the Tobacco Cessation Pledge will receive the
discount beginning with your first paycheck in January of the following year.
Tobacco users who elect the Tobacco Cessation Pledge must complete a BorgWarner approved
th
tobacco cessation program by February 28 of the following year. (See the nurse/health coach in
the Ithaca Wellness Clinic located in TC for more information about what qualifies.) The discount will
continue to be applied throughout the year as long as you complete the program on time.
st
Otherwise, your payroll deduction will return to the regular rate effective April 1 of the following
year.
th
If you complete the program AFTER February 28 , the premium discount will generally be applied
within 30 days of completion.
Contact the on-site Wellness Clinic today at 266-5018!
We offer an on-site program for employees that will qualify for the Tobacco Cessation
discount, as well as information on other local programs and on-going support.
We can also do a biometric screening to give you current cholesterol and blood pressure
data you can use to complete the HRQ, and we offer help completing the HRQ if you need it.
Talk to the RN/Health coach to find out more!
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Additional Wellness Incentives:
For taking certain healthy actions, BorgWarner will reward you and/or your spouse with Wellness Credits.
Participants in the CIGNA/MVP Choice Health Fund will receive a credit in their Health Reimbursement
Account (HRA) dollars.
Participants in the CIGNA/MVP PPO will receive a Taxable Gift Card for Wellness Credits.
Earned dollars will be credit to you six to eight weeks after they are earned. All of BorgWarner’s incentives
are voluntary – you decide whether to participate.
Annual Plan Incentives: Employee or Spouse can earn up to $200 credit
Participate in Disease Mgmt
$200
Spouse takes HRQ
$50
Spouse takes Tobacco Program
$50
Stress Mgmt Program
$50
Weight Mgmt Program
$50
It’s Easy to Participate!
Completing the annual premium discounts or participating in the wellness incentive programs is simple. Just log on to
www.mycigna.com and begin your journey to health! Click on “Manage My Health” on the blue bar at the top of the page,
then go to “My Health Assessment”.
All programs and information are completely confidential. BorgWarner does not receive individual results or information,
other than completion of program so that credit can be awarded as needed.
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Tools and Support - The CIGNA Integrated Personal Health Team:
CIGNA’s Integrated Personal Health Team model uses a “total health” approach to consolidate all CIGNA benefit plans
and wellness programs under one “total health umbrella”. Employees participating in one of the CIGNA health plans need
make only one call to one phone number to connect with a personal health advocate who will guide them to whatever type
of help they need, from advice on nutrition or help with managing stress, to resources for coping with all of the aspects of
a major illness.
One Phone Number: 1-800-237-2904
Whether you have a question about your health benefits, are checking the status of a medical claim, have a basic
health question, you simply call one phone number that is a dedicated line for use only by BorgWarner employees
and family members.
Access to an Integrated Personal Health Team
You now have access to a dedicated health team who work together behind the scenes to provide you with
seamless support. Your Personal Health Team consists of a wide variety of health specialists – nurses,
dieticians, clinicians and counselors – who stand ready to support you.
Your Own Personal Health Advocate
Your Personal Health Team is led by a health advocate. They are your first and primary point of contact
whenever you require health and wellness support from CIGNA. Your Health Advocate personally makes sure
your health and wellness needs are fully understood and that you are quickly and easily connected to the proper
support, programs, and resources. This means you no longer need to figure out on your own which CIGNA
wellness programs would be the best for you.
The Power of Preventive Care
An important part of being a good health care consumer is maintaining a healthy lifestyle and
obtaining regular preventive care visits. The CIGNA MVP medical plans focus on preventing health
care problems before they arise. Both the Choice Health Fund and the CIGNA PPO cover the full
cost of in-network preventive care – not deductible to meet or co-pays to pay!
Examples of Covered Preventive Care Services Include:
•
•
•
•
•
•
Well-baby care (up to age 3)
Well-child care exams (ages 3 to 21)
Routine immunizations per recommended immunization schedule
Colon Cancer Screening (age 50 and older or at any age with risk factors)
o Flexible Sigmoidoscopy every 5 years
o Colonscopy every 10 years
Screenings for Women
o OB/GYN exam once per year
o Breast Cancer Screening/Mammogram (ages 40 and older) once per year
o Cervical Cancer Screening (within 3 years of sexual activity or ages 21-64 every
three years)
Screening for Men
o Prostate Cancer Screening PSA (once per year for men ages 50 and older or at
any age with risk factors)
For a complete list of preventive services covered, please visit www.mycigna.com
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Dental/Vision
BorgWarner also offers a combined dental and vision plan for employees who have
completed four (4) months of employment. Here are your options:
YOUR OPTIONS
Dental/Vision
Coverage Level
No Coverage
Employee
Monthly Contribution
$12
Employee + 1
$25
Family
$25
Dental
Your dental benefits cover routine exams, fluoride treatments, X-rays, fillings, extractions,
crowns, bridges and braces. You can visit any dentist you choose. Preventive care is covered
at 100% with no deductible. Coverage for other services begins after you meet your annual
deductible. Then you pay a percentage of the cost, depending on the service. The plan pays
benefits up to the annual maximum. After that, you are responsible for all remaining charges
for the rest of the year.
Dental Plan Overview:
Annual Deductible
$50 per person
$200 per family
Annual Maximum
$2,000 per person
$8,000 per family
Preventive and Diagnostic:
Two routine exams, cleanings and bitewing X-rays per
year. One set of full-mouth X-rays every three years.
100% no deductible
Basic Restorative:
Fillings, root canals, denture adjustments and repairs,
surgery
80% after deductible
Major Restorative:
Replacement of existing dentures or bridgework once every
five years
Orthodontia
$1,500 lifetime maximum
TMJ:
Non-surgical treatment only
up to $1,000 lifetime maximum
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Before Expensive Dental Work Begins
If your dentist recommends a procedure that is expected to cost more than $200, you can find out how much
the plan will pay before the work is done. Just ask your dentist to complete a pre-treatment estimate which
describes the findings of the examination, recommended treatment and an estimate of costs. After the Dentist
completes the estimate, submit it to the Insurance Company. The Insurance Company will tell you how much
will be paid, if you decide to have the work done.
For more information, make sure you review the chart on the enrollment insert, or see your HR Benefits
Representative.
Vision
Your vision benefits provide coverage for one exam per calendar year, and either one pair of eyeglasses
(frames and lenses) or contacts once every 24 months. More information can be found on the enrollment
insert.
Like your medical benefits, coverage is higher when you visit an in-network provider. If you visit
an in-network provider, you pay a co-pay, and your claims are filed for you. If you visit an outof-network provider, your co-pays are higher, and you must file your own claims.
To locate a CIGNA Vision Network provider, visit www.mycigna.com. Log into the site, select the medical or
dental tab, and click on the Vision Benefits link. Or, call CIGNA Vision Member Services at 1-877-478-7557.
Vision Plan Overview:
Vision Care Network
Out-of-Network
Exam
Once per calendar year
$10 copay
$40 maximum
Single Lenses*
$10 copay
$40 copay
Bifocal Lenses*
$10 copay
$45 copay
Trifocal Lenses*
$10 copay
$50 copay
Lenticular Lenses*
$10 copay
Not covered
Frames*
$60 allowance
$30 allowance
Contacts*
$60 allowance
$60 allowance
*Covers one pair of eyeglasses (lenses and frames) OR contact lenses once every 24 months
Should you see an eye doctor or medical doctor?
Your vision benefits cover services performed by an ophthalmologist or optometrist to perform regular
checkups and correct your vision if needed. In some cases, an eye or vision problem – such as cataracts –
requires medical attention. In that case, your diagnosis and treatment would be covered under your medical
plan.
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Flexible Spending Accounts
Flexible Spending Accounts (FSAs) are a great way to save 25% or more on income taxes
while you budget for health care and dependent care expenses. Here are your FSA options.
Keep in mind, the two FSAs are separate, so you may enroll in one, both or none of them.
YOUR OPTIONS
Health Care FSA
Dependent Care FSA
Both FSAs
No FSAs
How FSAs Work
1.
2.
3.
You decide how much to contribute to an FSA each year. Your election does NOT carry over into
the next year.
Your contributions are deducted from your paychecks throughout the year before taxes are
withheld. This makes savings convenient. Plus it reduces your taxable income, saving you save
25% or more on income taxes, depending on your personal situation.
When you have an eligible expense, file a claim to get reimbursed from your FSA.
Choice Health Fund Participants:
If you participate in the Choice Health Fund and participate in the Flexible Spending Account, your FSA funds
will be used before your HRA funds. You will be able to use the Auto-Claims Forwarding process that allows
you to not pay up front for Medical or Prescription expenses as long as you have money in your FSA.
Auto-Claims Forwarding Process (CIGNA Medical and Dental Plans):
Health Care FSA claims are handled directly by CIGNA on your behalf. No claim forms to fill out or receipts to
keep track of! With this “auto-forward claims” feature, it’s all handled for you automatically.
Auto-claims forwarding is not currently available for vision claims, but vision expenses are reimbursed to you
by submitting a claim form to CIGNA.
Teamsters’ BlueShield PPO Participants:
If you are enrolled in the Teamsters’ BlueShield PPO and are going to participate in the Health Care FSA, you
should note that the way you submit a claim for reimbursement from the FSA will differ. Non-CIGNA members
will receive a debit card to use for FSA purchases. To complete the process, you will also be required to
complete a claim form to substantiate the purchase, and submit it to CIGNA within 30 days of the debit card
purchase.
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Page 22
The table below explains what each account is designed to cover, how much you can contribute and
how to file a claim.
New for
2013!
Health Care FSA
Dependent Care FSA
Purpose
For HEALTH CARE expenses that are not
covered by your medical, dental and vision
benefits for you and your dependents
For DAY CARE expenses for your
children or elderly dependents while you
work
How Much You
Can Contribute
$0 - $2,500 per year
$0 - $5,000 per year ($2,500 if you are
married and file separate tax returns)
Examples of
Eligible
Expenses
• Deductibles, copays, coinsurance
• Contacts, glasses, frames, laser eye
surgery
• Hearing exams
• Chiropractic care
• Orthodontia
• Prescription drugs
For details, see
www.irs.gov/publications/p502
Expenses that
CANNOT be
Paid with an
FSA
•
•
•
•
Health club memberships
Weight loss programs
Cosmetic surgery, teeth whitening
Many over-the-counter products unless
accompanied by a prescription
Reimbursement • Submit a claim form with your Explanation
Process
of Benefits or receipt.
• You’ll be reimbursed up to the full amount
you elected to contribute for the year, less
any paid claims.
• Eligible expenses for 2010 must be
incurred before March 15, 2010.
• If you enroll in the Choice Health Fund,
medical expenses will be paid through
your Health Reimbursement Account first.
Care in a home or day care center for your
children (up to age 13) or a disabled adult
you claim as a dependent on your taxes
After-school care program
Nursery school
Summer day camp
For details, see
www.irs.gov/publications/p503
School tuition
Nursing home expenses
Babysitting while you are not working
Overnight camp
Submit a claim form with your provider’s
Social Security number (or taxpayer ID)
and receipt.
You’ll be reimbursed up to the amount
currently in you account.
Eligible expenses for 2010 must be
incurred before December 31, 2010.
Budget Carefully
Because FSAs give you a tax break, the IRS has set certain rules for these accounts.
•
•
•
•
Page 23
Use it or lose it. Any money left in your account after the dates in the chart
above may be forfeited. You cannot rollover your balance into the next year.
Use the worksheets below to estimate your expenses.
No transfers between accounts. You cannot transfer funds from a Health Care FSA to a Dependent
Care FSA or vice versa.
Keep income tax deductions separate. Any expenses paid through an FSA cannot be taken as a
deduction on your personal income taxes such as the federal dependent care tax credit.
Once-a-year decision. You cannot change your election unless you have a qualified family status
change (see page 9).
2013 A
Life Insurance and Disability Benefits
Basic Life Insurance
Your Basic Life Insurance benefit offers financial protection for your survivors if you die while you’re
an active employee of the company. BorgWarner pays the full cost of this valuable benefit.
YOUR OPTIONS
Basic Life of 1x your base pay
as of January 1 each year
Business Travel Accident Insurance
BorgWarner pays the full cost of accident insurance that offers financial protection for your survivors if you die
or are injured while traveling on company business. The amount of your benefit may be reduced after age 70.
All Eligible Employees
All Hourly Union
employees of
Morse TEC Ithaca
Accidental Death
Total Disability
1% of
Accidental
Death benefit
up to 100
months
$100,000
Additional and Dependent Life Insurance
You can purchase additional life insurance for you, your spouse and your dependent children through MetLife.
Here are your options:
YOUR OPTIONS
You
Your Spouse
Your Dependent
Children
1 x annual base pay*
5x annual base pay*
6x annual base pay*
7x annual base pay*
8x annual base pay*
$ 5,000
$ 10,000
$ 25,000
$ 50,000
$150,000
$250,000
$ 5,000 each
$10,000 each
$15,000 each
$20,000 each
No coverage
* Up to $2,500,000
Your cost varies depending on your age, your spouse’s age and the amount of coverage selected.
Your optional life insurance policy is individually owned through MetLife. Therefore, no annual enrollment is
required; however, evidence of insurability may be required. If you are interested in participating in the plan, or
if you are a current participant and wish to make changes, contact MetLife directly at 1-888-622-6616
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Page 24
Voluntary Accident Insurance
Optional Voluntary Accident Insurance through MetLife covers accidental death, dismemberment and
permanent and total disability due to accidents at home or elsewhere, whether you are engaged in business or
pleasure. You can choose coverage for you and for your family as shown below.
YOUR OPTIONS
Union Hourly
No Coverage
$10,000 to $100,000 in
$5,000 increments
Because your policy is individually owned through MetLife, no annual enrollment is required. You pay the
cost through payroll deductions. Your cost varies depending on the coverage you select. Contact your Benefits
Representative for details.
Short-term and Long-term Disability
Disability benefits provide your family with a source of income if you are unable to work due to a
non-work-related illness or injury. Coverage for short-term disability begins on the first day of
employment. Long-term disability coverage begins after one year of employment.
YOUR OPTIONS
STD – basic coverage
LTD60 – basic coverage
LTD70 – optional coverage
•
Short-term Disability (STD) begins after you’ve been absent from work for seven days. It pays a portion of
your current earnings while you are disabled. Weekly amounts paid during approved short-term disability
leave of absences vary based on your service date with BorgWarner. See the current union agreement for
details. Short-term disability ends when you recover or after six months of disability, whichever is sooner.
•
Long-term Disability (LTD60) is basic coverage available to employees which begins after you’ve been
disabled for more than six months and meet the insurer’s definition of disabled. It pays 60% of your current
salary up to $5,000 per month until you reach normal retirement age. Long-term disability benefits will be
reduced by the amount of other income you may receive such as Social Security or workers’ compensation.
•
Long-term Disability (LTD70) is optional coverage available to employees. If elected, coverage begins
after you’ve been disabled for more than six months and meet the insurer’s definition of disabled. It pays
70% of your current salary (including a combination of wages and an average of 3 years of employee
incentive plan payouts as calculated on Jan 1 of each year for the previous year) up to $5,000 per month
until you reach normal retirement age. Long-term disability benefits will be reduced by the amount of other
income you may receive such as Social Security or workers’ compensation.
If you become disabled, you must file a disability form and be under the care of a physician. All disability claims and family
medical leave claims are administered by CIGNA. To begin the claims process, you contact CIGNA at 1-888-842-4462.
If you take a leave of absence, including family and medical leave or military leave, contact your local HR representative
about whether or not you can continue your medical coverage during your leave. Your HR representative can also explain
how your leave may impact your other benefits.
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2013 A
Don’t forget to elect your beneficiaries!
You need to make decisions now so that your loved ones are protected later. Once you decide on
the amount and type of insurance you need, you also need to designate beneficiaries for each policy.
To designate or change your beneficiary for any of your life insurance policies call
MetLife directly at 1-888-622-6616 or visit their website online at
www.metlife.com/mybenefits
You also need to designate your beneficiary for your T. Rowe
Price accounts. To do this, you can call T. Rowe Price
directly at 1-800-922-9945 or visit their website online at
rps.troweprice.com
Enroll!
Now that you’ve followed the steps in your guide and reviewed your opions, you’re almost
ready to complete and turn in your enrollment form.
Before you do, review it to make sure you’ve:
Printed clearly so that your form can be processed correctly
Reviewed and verified your personal and dependent information
Made elections or waived coverage under each section
Signed and dated the last page
Made a copy for your files
Provided all necessary documents for dependent(s) enrollment
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Information on the following pages on additional benefits made
available to BorgWarner employees is provided for your use.
No annual enrollment is necessary for these benefits.
As always, please call Benefit Services at 888-567-1002 or see
your HR Benefit Representative in Plant 2 if you have specific
questions or need more information regarding any employee
benefits.
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2013 A
BorgWarner Morse TEC
Wellness Clinic
800 Warren Road
Ithaca, New York 14850
Telephone:
607-266-5018
WHO ARE WE?
The Wellness Program at BorgWarner is designed to support our employee’s current health care needs, help
prevent future disease, and promote health and wellness. It is available to all active full-time BorgWarner
Employees.
In order to offer these services and still protect the privacy of our employees, BorgWarner has contracted with
the Guthrie Clinic in Ithaca to offer an on-site clinic located in Plant 2. On-site care includes the services of an
RN/Health Coach, a General Practice Physician, an Occupational Medicine Physician, and a Physical
Therapist.
Our on-site Wellness Clinic and Wellness Program offer a
variety of on-site services and support for all
BorgWarner active full-time employees!
Services Include:
Illness, Disease Prevention, Pain Management,
Wellness Physicals, Health Screening, Health Coaching
Testing & Diagnostic Services,
Nutrition and Weight Evaluation & Guidance,
Smoking Cessation,
Lunch & Learns, Annual Health Fair,
Employee Wellness Committee,
Employee Support Groups
and much more…
Call the Wellness Clinic today!
(607)266-5016/5018
WE HOPE YOU WILL CONSIDER VISITING US SOON ...
AND DON’T FORGET TO CHECK OUT OUR EASY ON-LINE SCHEDULING!
Appointments can be scheduled by calling the clinic at (607)266-5018. You can also
schedule an appointment at any of the BorgWarner Employee Kiosk locations or from
the HR Intranet Site (ICE).
“Wellness is a journey, not a destination ...
The sooner you begin your journey, the greater your odds of success.”
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Our Clinic Staff
is
Here for You!
Wellness Clinic Hours:
Mon: 7:00 am - 4:00 pm
Tues: 8:00 am - 5:00 pm
Wed: 7:00 am - 4:00 pm
Thurs: 7:00 am - 4:00 pm
Occupational Medicine Hours:
Friday by Appointment
The clinic closes at noon each day for lunch
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2013 A
BORGWARNER WELLNESS PROGRAM
GYM MEMBERSHIP REIMBURSEMENT
As an added wellness benefit, you are eligible to receive a 50% reimbursement (up to a maximum of $200) of
a health club membership or exercise program fee just for completing your annual preventive care exam, either
on-site with our Wellness Clinic or with your primary care provider.
This benefit applies to any fitness center of your choice. However, certain area fitness centers will offer you
additional discounts if you tell them that you are a member of the BorgWarner Employee Wellness Program.
For the most up to date information on discounts that may be available, you should contact the individual
health clubs directly.
The process is simple:
You join a fitness center of your choice and pay their fee. Make sure you get a paid receipt
from the center. Bring a copy of the paid receipt to your HR Benefits Representative that is
clearly marked with your name and employee number, along with proof that you have
completed your annual preventive care exam. We will then request reimbursement be paid to
you as part of the normal payroll process. You should see your reimbursement in your
paycheck in about two (2) weeks. Please note that this is considered a taxable benefit.
REIMBURSEMENT GUIDELINES TO REMEMBER:
To be eligible for this reimbursement, you must have had a wellness visit with one of our on-site clinic
providers OR had a routine preventive exam with your own primary care physician within the last twelve
(12) months. The Wellness Clinic can give you a voucher to submit with your gym membership receipt
as proof of eligibility. An EOB from your insurance company will be required as proof of primary care
physician services.
Employee is responsible to pay the gym membership in advance. BorgWarner will not pre-pay any
portion of the membership fee.
Reimbursements will only be made to the employee, not the fitness center.
Only one (1) reimbursement will be allowed per employee per calendar year. (This means for example
if you only turn in three months of receipts, you will only be reimbursed for three months in that
calendar year.)
Reimbursements will be made for receipts within the last twelve (12) months.
Your privacy is important to us. The Wellness Clinic maintains a secure electronic healthcare
record system that is not accessed by BorgWarner personnel. Rest assured, your medical history
is kept safe and confidential. No records are released without your prior written consent.
Visit the Wellness Clinic to obtain a copy of our privacy policy.
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Safety Shoes
Employees can purchase safety footwear from catalogs, department
stores or the shoe mobile. BorgWarner will reimburse up to a maximum
of $90.00 per year.
When purchased at the shoe mobile:
The shoe mobile vendor comes twice a month with postings several weeks ahead. Check bulletin boards for
exact dates and times. Some things to remember:
•
•
May pay for shoes at truck with cash or credit card
Employee identification badge required at time of purchase
Reimbursement amount is not subject to sales tax, only the amount due by the employee is taxable.
Example
The shoes being purchased are $130.00. The employee receives a shoe reimbursement of $90.00. The
employee is responsible to pay the remaining balance.
$130 - $90 = $40 + $3.20 (NYS sales tax) = $43.20 due by employee
When purchased at somewhere other than the mobile vendor:
The employee must fill out and submit a form with an original ANSI approved safety shoe receipt to the shoe
mobile operator. An employee can receive up to the maximum reimbursement level for each calendar year,
which will be January 1 – December 31. You are allowed $90 per pay period for safety shoes. If there is a
purchase price lower than the maximum allowable reimbursement level, the employee will only receive a
reimbursement for the purchase price.
Example
If shoes purchased by employee cost $35 then the employee will be reimbursed $35 and have $55 remaining
toward a reimbursement for the purchase of an additional pair of shoes. Once maximum reimbursement level
is exhausted, the shoe mobile operator will not accept more receipts.
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Safety Glasses
Non-prescription Safety Glasses
Each new employee will be issued a pair of safety glasses. It will be the responsibility of each employee for the
safekeeping of their safety glasses. A new pair will be given only to those who return a damaged pair.
Distribution of safety glasses will be done through General Stores.
Prescription Safety Glasses
If you need prescription safety glasses, BorgWarner offers a voucher program to help employees with the
additional costs of purchasing them.
In order to purchase safety glasses, you must have a current prescription. Please note that BorgWarner’s
program helps cover the cost of the safety glasses, but does not cover the cost of an eye exam.
Here’s how the voucher system works:
1. Stop by the HR Office in Plant 2 to obtain a voucher for safety glasses.
2. Contact one of the safety glasses program vendors for an appointment. At this appointment, one of
their representatives will go over all of the safety glasses options and costs with you. Information on
available vendor locations can be obtained from the HR Office or from the Safety Manager in each
plant.
3. BorgWarner will be billed up to the maximum amount for your safety glasses. Anything above and
beyond the maximum amount will be the responsibility of the employee to pay at the time of service.
Replacement Prescription Safety Glasses
BorgWarner will only replace glasses if:
1. A 24 month period had elapsed since the last purchase of safety glasses. OR
2. A significant change in the lens prescription has occurred or if the safety glasses have been damaged
or destroyed as a result of a work related incident. OR
3. Your glasses have been damaged due to a work related incident. The company will not cover the
replacement cost if damaged or destroyed though employee carelessness.
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Retirement Savings Plan (RSP)
BorgWarner understands the importance of planning ahead and encourages all team members to save for the
future. To that end, the Company offers a comprehensive Retirement Savings Plan (RSP) that combines
personal contributions with company-matching contributions, depending on your length of service, to help you
build a nest egg for your future.
Employees are eligible to begin making contributions to the RSP and begin accumulating retirement savings.
upon completion of sixty (60) days of service. The Company will get involved and supplement employee
contributions after completion of six (6) months of service
Your RSP Account may consist of any, or all, of the following accounts:
Company Retirement Account (CRA)
Savings Account (SA)
Retiree Health Account (RHA)
Company Retirement Account (CRA)
After six (6) months of employment, BorgWarner will automatically contribute an amount of the CRA based on
a percentage of your compensation and years of service, whether or not you elect to contribute to the other
accounts. The CRA is reserved for retirement savings and is not available for loan or withdrawal. The
contribution schedule is based on years of service. See the current union agreement for details.
Savings Account (SA)
After sixty (60) days of employment, you may begin contributing from 1% to 28% of your annual compensation
to the SA on a before-tax or after-tax basis. After six (6) months of employment, BorgWarner will match the
first 3% of the before-tax contributions you make to this account. Contact T Rowe Price (by phone or on-line) to
enroll in or opt out of the SA. If you do not contact them, you will automatically be enrolled to contribute 3% to
the SA on a before-tax basis after one hundred twenty (120) days of employment. You may obtain a loan and
make withdrawals of your own funds (matching funds are not eligible) from your SA according to the provisions
of the plan. Contact T Rowe Price for more details.
Retiree Health Account (RHA)
The RHA portion of the RSP is a valuable way to help you save today for medical costs you may incur after
you leave BorgWarner. After 60 days of employment, you may contribute from 1% to 3% of your pay on a
before-tax basis. After six (6) months of employment, BorgWarner will match RHA contributions dollar for dollar
up to $500 annually. The RHA match is in addition to the company match you receive for your Savings
Account Before-Tax contributions. Contact T Rowe Price (by phone or on-line) to enroll in the RHA or to make
changes after you are enrolled.
Vesting
You are always vested in, and have a non-forfeitable right to, the value of your contributions to your RSP
Account. You become vested in the contributions made by the Company after three (3) years of continuous
service with BorgWarner.
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OTHER REQUIRED INFORMATION
Your Right to Continuation Coverage and How It Works
In certain circumstances, a federal law called the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
requires the Company to offer you, and your covered spouse and dependent children the opportunity to temporarily
extend coverage under the Plan when coverage otherwise would end. If you are an eligible employee of the Company,
you have the right to choose continuation coverage if you lose coverage because of a reduction in your work hours or the
termination of your employment (for any reason other than gross misconduct).
If you are the spouse of an employee covered by the Plan, you have the right to choose COBRA continuation coverage
for yourself if you lose group health coverage under the plan because of any of the following:
•
The death of your spouse;
•
The termination of your spouse’s employment (for any reason other than gross misconduct), or a reduction in your
spouse’s work hours;
•
A federal bankruptcy proceeding being commenced by or against the Company after you retire;
•
Divorce or legal separation from your spouse; or
•
Your spouse becomes entitled to Medicare benefits.
In the case of a dependent child of an employee covered under the Plan, he or she has the right to choose COBRA
continuation coverage if coverage under the plan is lost because of any of the following:
•
The death of the employee;
•
The termination of the employee’s employment (for any reason other than gross misconduct), or a reduction in the
employee’s work hours;
•
Divorce or legal separation of the employee;
•
A federal bankruptcy proceeding being commenced by or against the Company after you retire;
•
His or her ceasing to qualify as a dependent under the Plan; or
•
The employee’s entitlement to Medicare benefits.
Under the law, the employee, covered spouse and dependent children have the responsibility to inform the plan
administrator of a divorce, legal separation, or a dependent child losing dependent status under the Plan within 60 days of
the applicable “qualifying event”, as described above, or from the date coverage would be lost due to the qualifying event,
whichever is later.
The Company has the responsibility to inform the plan administrator within 30 days of the qualifying event if the qualifying
event is the employee’s death, termination of employment, a reduction in work hours, entitlement to Medicare, or the
Company’s bankruptcy. The plan administrator then has 14 days to inform you of your continuation rights.
You have 60 days from the date coverage would end or the date you are informed of your right to COBRA continuation
coverage, whichever is later, to tell the Company that you want COBRA continuation coverage. By the 45th day following
your election, you are required to make your first premium payment to the Company for such coverage. For all
subsequent premium payments, you will have a 30-day grace period from the due date in which to make your payment.
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If you are a covered employee, you may have a second opportunity to elect COBRA if:
1. You lost coverage because of a termination of employment (other than for gross misconduct) or a reduction in
hours; and
2. You are included in a group of employees for whom a petition is filed with the U.S. Secretary of Labor after
November 3, 2002 for Trade Adjustment Assistance under the Trade Act of 1974 because of your termination of
employment or reduction in hours; and
3. The U.S. Secretary certifies that you are eligible for Trade Adjustment Assistance.
If international trade adversely affects your employment with the Company and you lose coverage under the Plan as a
result, you may become eligible for a second COBRA election period.
1. If you become eligible for trade adjustment assistance (TAA) under the Trade Act of 1974 because of your
termination of employment or reduction in hours which resulted in your loss of coverage under the Plan, and you
did not elect COBRA coverage during your initial COBRA election period, you will have a second 60-day COBRA
election period to elect COBRA coverage for yourself and other qualified beneficiaries in your family.
2. Your second COBRA election period begins on the first day of the month in which you are determined to be eligible
for TAA. However, your COBRA election must be made not later than 6 months after the date you lost coverage
under the Plan. If you elect COBRA during the second election period, your COBRA coverage will begin on the
first day of the second election period. Contact the Plan Administrator or your local Human Re sources
Representative for additional information about TAA-related second COBRA election periods.
If you elect COBRA continuation coverage during a special second COBRA election period, the maximum duration of your
COBRA coverage will still be measured from the date you originally lost coverage.
You must notify the plan administrator if you become eligible for a special second COBRA election period. If you do not
timely choose or pay for COBRA continuation coverage, your coverage under the Plan will end.
If you choose COBRA continuation coverage, the Company is required to give you coverage which, as of the time
coverage is being provided, is the same as that provided under the Plan to similarly situated employees, spouses, or
dependent children. If this coverage has been or is later discontinued or changed, your coverage will also be discontinued
or changed. However, you must be allowed to elect coverage under any other plan maintained by the Company, which is
available to similarly situated employees, spouses, or dependent children.
The law requires that you have the opportunity to maintain this COBRA continuation coverage for up to 18 months, if you
lost coverage because of a termination of employment or a reduction in work hours. If coverage was lost due to any other
reason listed above, the required continuation period is up to 36 months. If the qualifying event was the Company’s
bankruptcy after you returned to work, you (or your surviving spouse) may choose COBRA continuation coverage for your
lifetime.
Effective January 1, 1997, a child that is born to or placed for adoption with a covered employee during a period of
COBRA coverage will also be eligible to become a qualified beneficiary. In accordance with the terms of the employer’s
group health plan(s) and the requirements of federal law, these qualified beneficiaries can be added to COBRA coverage
upon proper notification to the Plan Administrator of the birth or adoption.
If you experience a second qualifying event (other than a federal bankruptcy proceeding), while COBRA continuation
coverage is in effect, the coverage period for a covered spouse or dependent child generally is extended up to a total of
up to 36 months after the termination of employment or reduction in hours. However, if the second qualifying event is the
employee’s entitlement to Medicare, the coverage period can be extended for a covered spouse and dependent children
for up to 36 months from the date the employee became entitled to Medicare, regardless of the length of the COBRA
continuation coverage before that time.
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2013 A
If the qualifying event was a federal bankruptcy proceeding, and the second qualifying event is the employee’s death,
coverage continues for your surviving spouse and covered dependents for up to 36 months from the date of the
employee’s death.
Special rules apply if an employee, covered spouse, or dependent child is determined to be disabled by the Social
Security Administration at any time during the first 60 days of COBRA coverage due to a termination of employment or a
reduction in work hours. In that case, the disabled individual is entitled to purchase up to an additional 11 months of
coverage for a total period of coverage of 29 months. The disabled individual can be a covered employee or any other
qualified beneficiary. However, you must advise the Company before the end of the 18 month continuation period and
within 60 days from the date you are determined to be disabled (as described above) in order to be eligible for this
extended coverage. In addition, if the Social Security Administration determines that you (or your covered spouse or
dependent children) are no longer disabled, you are legally required to inform the Company within 30 days of the date you
are notified of that determination, and the right to COBRA continuation coverage terminates either at the beginning of the
month starting 30 days after that determination or on the date 18 months after you initially lost coverage, whichever is
later.
Your COBRA continuation coverage period will be cut short if:
•
The Company stops providing plan benefits to any employees, spouses and dependents (including successor
plans);
•
The premium required for your COBRA continuation coverage is not paid on a timely basis;
•
You first become covered (as an employee or otherwise) after the date of your COBRA election under another
employer’s group plan which does not include a pre-existing condition limitation or exclusion with respect to any
pre-existing condition you may now have; or
•
You first become entitled to Medicare after the date of your COBRA election.
Under the law, you may be required to pay the cost of COBRA continuation coverage, up to 102% of the full cost of
coverage. If you qualify for extended benefits due to disability, and elect the additional 11 months of coverage, you may
be required to pay up to 150% of the full cost of coverage for the additional period.
Your COBRA coverage is provided subject to your eligibility. The plan administrator reserves the right to terminate your
COBRA coverage retroactively if you are determined to be ineligible. Because you, your spouse and dependents may
have COBRA rights in the future, please keep the plan administrator informed if your marital status or address changes. If
you have any questions about your rights under COBRA, please contact the plan administrator.
2013 A
Page 36
Notice of Privacy Practices of the Group Health Plan
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction This notice applies to you if you are covered as an employee, former employee or dependent under the group health plan
maintained by BorgWarner Inc. and its subsidiaries (collectively referred to in this notice as the “Company”). The group health plan
includes various health plans and options that provide medical, dental, vision, prescription drug, and health flexible spending account
benefits. The group health plan is described in detail in the BorgWarner Flexible Benefits Plan in which BorgWarner Inc. and its
subsidiaries participate. The plans and options that make up the group health plans are collectively referred to in this notice as the
“Plan” and are a single covered entity for purposes of the HIPAA privacy rules.
Effective April 14, 2003, the Plan became subject to new federal privacy regulations under the Health Insurance Portability and
Accountability Act (“HIPAA”). These regulations, which may be found at 45 Code of Federal Regulations, Parts 160 and 164, are
referred to in this notice as the “HIPAA privacy rules.” The HIPAA privacy rules regulate “covered entities,” including many doctors,
hospitals, and health plans (such as the Company’s Plan). The HIPAA privacy rules do not directly regulate employers or non-health
benefit plans such as workers compensation, disability, life insurance, dependent care, financial planning, business travel, or other nonhealth benefits plans. However, employers can indirectly be subject to certain requirements of the HIPAA privacy rules, as described
below, and it is the policy of the Company to protect the privacy of your health information in accordance with the HIPAA privacy rules.
The state in which you live may also impose restrictions on the use of disclosure of your health information that are more stringent than
the HIPAA privacy rules. While these state laws generally do not apply to employer-sponsored group health plans, they often apply to
doctors, hospitals, health insurance companies, and HMOs. The Health Privacy Project of the Institute for Health Care Research and
Policy maintains information on state health privacy laws at its website, www.healthprivacy.org, which you may find helpful in protecting
the privacy of your health information and in gaining access to your health records.
Protected Health Information The HIPAA privacy rules regulate the use and disclosure by the Plan of “protected health information”
(commonly referred to as “PHI”). PHI is any “individually identifiable health information” maintained or transmitted by the Plan (in any
form or medium). Individually identifiable health information is health information that identifies you or creates a reasonable basis to
believe that it could be used to identify you, including information relating to your health condition or receipt of health care. Health
information that is merely in summary form and that does not identify you as its subject is not PHI and may be used or disclosed by the
Plan without restriction under the HIPAA privacy rules. For example, the Company may use aggregated data regarding claims paid for
all Plan participants to help project benefit costs for the next year. With respect to PHI, however, the HIPAA privacy rules prevent the
Plan from using your PHI or disclosing it to the Company or anyone else except as permitted by the HIPAA privacy rules, as authorized
by you, or as required by law.
Uses and Disclosure of Protected Health Information for Treatment, Payment, and Health Care Operations The HIPAA privacy
rules permit the Plan to use or disclose your PHI without your authorization for purposes of treatment, payment, or health care
operations. This is necessary in order to provide you with quality health care. The Plan’s business associates may also use or disclose
your PHI for treatment, payment, or health care operations on the Plan’s behalf. Business associates include the Plan’s third party
administrators, as well as brokers, service providers, lawyers, accountants, consultants, and other appropriate persons who help to
ensure that the Plan is run properly and that you receive any benefits to which you are entitled. PHI may also be shared among the
Company’s various group health plans that make up the Plan for purposes of treatment, payment, or health care operations. The terms
“treatment,” “payment,” and “health care operations” are explained below:
• “Treatment” means generally the provision, coordination, or management of health care and related services by one or more
health care providers. For example, the Plan may disclose your PHI to your doctor (and staff), the Plan’s third party
administrators (and staffs), and other appropriate persons to help provide you with proper medical treatment.
• “Payment” means any action undertaken by the Plan to obtain premiums, to determine responsibility for providing coverage, or to
obtain or provide reimbursement for the health care services you receive. This includes, but is not limited to, eligibility and
coverage determinations, billing, claims management and processing, plan reimbursement, reviews for medical necessity,
utilization review, and pre-authorization for treatment. For example, the Plan may disclose to your doctor (and staff), the Plan’s
third party administrators (and staffs), and other appropriate persons information concerning a particular medical procedure that
you have had performed to determine whether the procedure is covered by the Plan.
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2013 A
• “Health care operations” means all the activities involved in the administration of the Plan. This includes, but is not limited to,
quality assessment and improvement, evaluating providers, underwriting and other activities relating to obtaining or amending
insurance contracts, disease management, cost management, and other general administrative activities. For example, the Plan
may use PHI about you to refer you to a disease management program, to evaluate the quality of care you are receiving from
your providers, or to project benefit costs and determine premiums.
Other Uses and Disclosures Permitted Without Authorization The Plan may disclose the Plan’s enrollment and disenrollment
information to the Company without your authorization. This information merely indicates whether you are enrolled in the Plan and
shows your specific Plan benefit options. The Company requires such information for payroll withholding and other purposes. The Plan
may also disclose your PHI to the Company or its business associates without your authorization so that the Company may obtain bids
for services or make decisions about modifying or terminating the Plan. Information provided to the Company for these purposes will be
in summary form. This means that the information will be limited to claims history, claims expenses, or types of claims experienced,
with your name and certain types of other identifying information removed. The Plan may use or disclose your PHI at any time without
your authorization as required by the HIPAA privacy rules or other applicable law.
Disclosure of Your PHI to Company Personnel without Authorization In connection with the disclosures described in the previous
two sections of this notice, the Plan may disclose your PHI to Company personnel who are involved in the administration of the Plan.
These disclosures will be made in connection with the Company’s role as the sponsor of the Plan, and will be made to enable Company
personnel to carry out their duties in administering the Plan. In many circumstances, it will be appropriate for such personnel to share
your PHI with the Plan’s business associates outside of the Company. The Company has amended the Plan documents to protect your
PHI as required by the HIPAA privacy rules, and any disclosures or uses of PHI by the Company will be governed by the written
provisions of the Plan documents. In addition, the Company has instituted policies and procedures to help ensure that your PHI is made
available only to those individuals who need it to perform important Plan functions. Human Resources personnel have received training
in the proper handling of PHI and have been informed of the sensitivity of this information. It is the policy of the Company that PHI
received from the Plan is not to be used for employment-related purposes or other purposes not related to the Company’s sponsorship
or administration of the Plan.
Uses and Disclosures Requiring That You Receive an Opportunity to Agree or Object Certain circumstances might arise where
the Plan needs to disclose your PHI to family members or other appropriate persons in order to ensure that you are receiving
appropriate care or to notify certain persons of your medical condition or your location. To the extent that such disclosures are related to
matters other than the Plan’s treatment or payment functions or involve more than the minimum necessary amount of PHI, the Plan will
make such disclosures only if you have agreed (or have not objected) to the disclosure. Specifically, the Plan may disclose your PHI to
your family member, relative, close personal friend, or another person designated by you, but only to the extent the information is
directly relevant to that person’s involvement with your care or payment for care. The Plan may also disclose your PHI to notify or assist
in notifying your family member, personal representative, or other person responsible for your care of details regarding your location or
your general condition. Unless the disclosure is specifically related to the Plan’s current treatment or payment functions (i.e., claims
administration), you will be given an opportunity to agree or object to the disclosure, and the disclosure will be made only if you either
affirmatively agree or your do not object to the disclosure. If you are unavailable or you are incapacitated, the Plan may disclose your
PHI to such individuals without providing you with an opportunity to agree or object if the Plan determines that to do so is in your best
interests under the circumstances.
Uses and Disclosures Requiring Your Written Authorization Where use or disclosure is not otherwise permitted under the HIPAA
privacy rules, the Plan is required to obtain your written authorization before using or disclosing your PHI. If you choose to sign an
authorization to disclose information, you can later revoke that authorization to stop future uses and disclosures, except to the extent
the Plan has acted in reliance upon your authorization. In some cases, the Plan (including Company personnel and business
associates acting on behalf of the Plan) will ask you to sign a written authorization regarding the use and disclosure of your PHI even
when one is not clearly required under the HIPAA privacy rules. This is to protect your privacy rights and to ensure that representatives
of the Company, the Plan, and its business associates are fully authorized to communicate with each other regarding your situation in
order to provide you with the best possible health care benefits.
Incidental Uses and Disclosures The HIPAA privacy rules permit incidental uses and disclosures that occur as a by-product of a
permissible or required use or disclosure. An incidental use or disclosure is a secondary use or disclosure that cannot reasonably be
prevented, is limited in nature, and that occurs as a result of another use or disclosure that is permitted by the HIPAA privacy rules. The
Plan has instituted reasonable safeguards to protect against uses and disclosures not permitted by the HIPAA privacy rules and to limit
incidental uses or disclosures. However, those safeguards cannot totally guarantee the privacy of your PHI. In implementing
safeguards, the Plan considers the nature of the PHI held, the potential risks to privacy, the potential effects on patient care, and the
2013 A
Page 38
financial and administrative burden of particular safeguards. The Plan is not required to obtain your authorization or notify you if an
incidental disclosure occurs.
Reservation of the Plan’s and Company’s Rights Generally, it is the Plan’s policy to avoid the use and disclosure of your PHI
whenever possible. Therefore, the Plan will not normally use or disclose your PHI, except when necessary for treatment, payment, or
health care operations or to comply with the HIPAA privacy rules or other applicable law. However, the Plan reserves the right to use or
disclose your PHI in any manner permitted by the HIPAA privacy rules. The Company is also committed to the protection of your PHI
and generally seeks to avoid the use and disclosure of your PHI whenever possible. However, the Company reserves the right to use or
disclose your PHI received from the Plan in any manner permitted by the HIPAA privacy rules. Please remember that health information
maintained by the Company (i.e., health-related employment records or the records of a benefit plan of the Company that is not part of
the Plan, such as a short- or long-term disability plan) is not subject to the HIPAA privacy rules and may be used or disclosed in
accordance with the Company’s standard policies (subject to applicable law).
Your Rights You have the right to review and receive copies of your PHI maintained by the Plan in a designated record set or used by
the Plan to make decisions about your coverage or benefits. The term “designated record set” means the enrollment, payment, claims
adjudication, and case or medical management records maintained by the Plan. You will be charged a reasonable copying fee if you
request copies of this information. Your request should be made in writing on the appropriate form, which you may obtain by contacting
your local Human Resources department at the address or phone number listed below. The Plan will respond to the request within 30
days of your request (60 days if the information is maintained offsite), subject to a possible 30-day extension. If your request is denied,
you will receive a written explanation of the reasons for the denial. Please remember that the Plan is only responsible for providing you
with information contained in its records. Hospital records and other records not maintained by the Plan must be procured directly from
the individual or institution that maintains those records.
You have the right to receive a list of instances where the Plan or Company disclosed your PHI to third parties for reasons other than
treatment, payment, or health care operations, except in cases where you have authorized the disclosure, the disclosure was merely
incidental to a disclosure that is otherwise permitted under this privacy policy, or the disclosure was required for law enforcement or
national security purposes. The list provided to you will include only those disclosures (if any) made on or after April 14, 2003. You may
request one such accounting at no charge every 12 months. For any additional requests, you will be charged a reasonable copying fee.
Your request should be made in writing on the appropriate form, which you may obtain by contacting your local Human Resources
department at the address or phone number listed below.
If you believe that information in your record is incorrect or if important information is missing, you have the right to request that the Plan
correct existing information or add missing information. Your request should be made in writing on the appropriate form, which you may
obtain by contacting your local Human Resources department at the address or phone number listed on the next page. The Plan has
60 days to respond to your request, subject to a possible 30-day extension. If your request is denied, you will receive a written
explanation of the reasons for the denial.
You have the right to request restrictions on the Plans use or disclosure of your PHI for treatment, payment, and health care operations.
You may also request restrictions on disclosures to your family members or other individuals who are involved in your care or payment
for your care. The Plan will consider your request but is not required to agree to such restrictions. Any restriction agreed to by the Plan
will not apply if the use or disclosure is necessary to provide you with emergency treatment. Further, the Plan generally will not agree to
restrictions on disclosures related to the Plan’s treatment, payment, and health care operations. Your request should be made in writing
on the appropriate form, which you may obtain by contacting your local Human Resources department at the address or phone number
listed below.
The Plan will respond to your request in writing. The Plan will also accommodate reasonable requests for you to receive
communications of your PHI at alternate locations or by alternate methods, if the normal method of communication could endanger you.
You may exercise your rights through a personal representative, provided that such individual produces evidence of his or her authority
to act on your behalf. The Plan will only accept the following as evidence of such authority: (1) a power of attorney for health care
purposes notarized by a notary public; (2) a court order appointing the individual as your conservator or guardian; or (3) proof that such
individual is your parent (if you are a minor). Your personal representative will be treated as you would with respect to access to your
PHI and your other rights under the HIPAA privacy rules. However, the Plan retains the discretion to deny your personal representative
access to your PHI if the Plan finds evidence that such denial is necessary to protect you from abuse or neglect.
Page 39
2013 A
The Plan’s Legal Duties The HIPAA privacy rules require the Plan to maintain the privacy of your PHI, to provide this notice about its
information practices, and to follow the practices described in this notice. The Plan may change its privacy policies at any time, and
changes may apply to all PHI held by the Plan at the time of the change. When the Plan makes a significant change in policy, a revised
Notice of Privacy Practices will be distributed to all current Plan participants within 60 days of the effective date of the change. This
notice and the privacy policies of the Plan and the Company do not create any legal rights, contractual or otherwise, under state or
federal law, but simply give you notice of the Plan’s obligations, and your rights, under the HIPAA privacy rules.
Questions and Complaints If you have questions regarding your privacy rights described in this Notice, if you are concerned that the
Plan has violated your rights under the HIPAA privacy rules, or if you disagree with a decision made about access to or amendment of
your health records, please contact your local Human Resources department at the address or phone number listed below.
Alternatively, you may contact the Assistant Privacy Officer at the address or phone number listed below. You are permitted to send
written complaints to the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200
Independence Avenue SW, Washington, DC 20201. Neither the Plan nor the Company will retaliate against you in any way for
exercising your right to file a complaint.
You may request a paper copy of this notice at any time by contacting your local Human Resources Department at the address listed
below.
BorgWarner Inc.
3850 Hamlin Road
Auburn Hills, MI 48326
Privacy Officer
Jan McAdams
Vice President of Human Resources
BorgWarner Inc.
3850 Hamlin Road
Auburn Hills, MI 48326
This updated Notice is effective June 13, 2005, and provides new contact information. No other material modifications have been made
to this Notice since its initial Effective Date of April 14, 2003.
This enrollment guide and the materials that accompany it provide highlights of BorgWarner’s Hourly Employee
Flexible Benefit Plan. They are not intended to include all program details. If there is a discrepancy between this
brochure and the Summary Plan Descriptions or official plan documents for the program, the Summary Plan
Descriptions and plan documents will govern. Nothing in this brochure or the other enclosed materials implies
that participation in the plans is a guarantee of continued employment with the company. The company has the
right to change or end these plans at any time and to require added contributions.
2013 A
Page 40
Don’t
Forget!
Page 41
Use this page to take notes when you attend your
Employee Benefit Information Meeting:
2013 A

Open Enrollment Guide

Transcription

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