HR MCCS HQ PERSONAL & FAMILY READINESS DIVISION
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Pre-Tax Health Premium Plan Summary Plan Description (SPD)
Introduction
The money you earn is important to you and your family. To help you keep more of your earnings, the Personal and Family Readiness Division offers you a pre-tax premium conversion plan. The Plan is called the Pre-Tax Health Premium Plan, and helps you because you don't pay federal income taxes on the money you spend for medical and dental premiums. With the Pre-Tax Health Premium Plan, you can pay your medical and dental premiums to the Personal and Family Readiness Division's group health plan on a pre-tax basis. This means that your premiums are deducted from your pay before federal income taxes are calculated. Paying your premiums with pre-tax dollars can help you reduce the high cost of medical and dental care. The Plan was set up under Section 125 of the Internal Revenue Code of 1986, and has been in place since 1 January 1991.This SPD describes the key provisions of this Plan and the benefits you will receive. The Plan described in this summary is governed by a plan document. Should there be a discrepancy between this summary and the provisions of the plan document, the provisions of the plan document will govern. In addition, you should not rely on any oral descriptions of the Plan, since the written descriptions in the plan document will always govern. If you have any questions, contact your local Marine Corps Community Service (MCCS) NAF personnel office, Building 1401.
Participating in the Pre-Tax Health Premium Plan -
Effective 1 January 2001, you decide whether or not to participate in the Plan. Enrollment is automatic once you are eligible, but you may opt out as described below if you do not wish to participate.
Who is eligible -
You are eligible to participate in the Plan if you are:
· a regular full time or regular part time nonappropriated fund civilian employee of Marine Corps Community Services or miscellaneous activities;
· regularly scheduled to work 20 or more hours a week;
· work in the
· are enrolled in the Personal and Family Readiness Division medical and dental plan.
If you wish to opt out of the Pre-Tax Health Premium Plan -
As a current health and dental plan participant, you may request to "opt out" of the Plan only during applicable selection period dates. All "opt out" elections made during the selection period will be effective 1 January following the selection period.
If you are new or have a category change (i.e. flexible to regular) and want to "opt out," you may do so during your 31-day eligibility period. Otherwise, you will have to wait until the next selection period.
All MCCS NAF Personnel Offices will announce dates for annual selection periods so that you will have an opportunity to make a decision regarding your participation in the Plan. Watch for them. Be sure to read all correspondence on MCCS benefits when received.
Changing your enrollment -
Under normal circumstances, you can change your enrollment during your 31 day eligibility period or during a designated open enrollment period. Otherwise, you may change the amount of your deduction or cancel during a plan year only if you have a change in family status or other "qualifying event". An allowable family status change includes (these are IRS imposed restrictions):
· Marriage, divorce, legal separation, or annulment;
· The birth, adoption, or placement for adoption of a child;
· The death of your spouse or child;
· Change in your employment status, or that of your spouse, including termination or commencement of employment; change from an ineligible category (flexible) to an eligible category (regular/full time or regular/part time); or commencement of or return from an unpaid leave of absence;
· Dependent status - through ceasing to qualify due to age or student status;
· Change in your worksite or residence or that of your spouse or child;
· Eligibility for COBRA for your spouse or child;
· Acceptance by the Plan of a qualified medical child support order; or
· Entitlement to Medicare or Medicaid by you, your spouse, or your child.
Financial hardship is not considered a qualifying event for cancellation or changes to coverage.
If any of these events occur and you elect to change your coverage, please notify your local NAF personnel office within 31 days. This 31-day eligibility period applies to any change in coverage (due to addition of a dependent, etc.) You must supply written documentation (for example, a birth certificate for a new child) for any qualifying event.
How the Plan Works -
When you elect to participate in the Pre-Tax Health Premium Plan, your taxable gross income will be reduced by the amount of your medical and dental bi-weekly premiums. This means that your bi-weekly premiums are paid with pre-tax dollars.
The pre-tax advantage -
The Plan offers you a tax advantage because you are already paying for your medical and dental benefits, but with money that has first been subject to income and Social Security taxes. Under this Plan, these same expenses will be paid for with a portion of your pay before federal income tax and Social Security tax are withheld. Tax treatment under state and local laws may vary.
The Plan's pre-tax premium option will reduce your income taxes and, in some cases, your Social Security taxes. This means that you will pay less tax and have more money to spend and save. To calculate your specific tax savings, please consult with your tax advisor.
The impact on Social Security -
By paying your medical and dental premiums through the Plan, your Social Security earnings will reflect the reduction. The negative impact on your actual Social Security benefit is minimal. Typically, the advantage of your tax savings while employed is much greater than the impact on your Social Security entitlement.
Other Important Information -
If you terminate employment your pre-tax deductions will automatically stop with your last paycheck and your participation in the Plan will end. If you take a leave of absence, and are enrolled, you will need to make arrangements with payroll to keep the premiums paid up to date.
Changes in the law -
Plan participants are allowed certain tax advantages through current tax laws. These laws and, therefore, the terms of the Plan, are subject to change. You will be notified if a change in the law requires changes to the Plan.
Retirees -
Only active employees, enrolled in Personal and Readiness Division-administered medical and dental coverage, are entitled to participate in the Plan. The Pre-Tax Health Premium Plan does not apply to terminated or retired employees who elect continued or converted health insurance.
Dependent’s Aid
Due to legal review by the Staff Judge Advocate, the Dependent’s Aid Association has been dissolved. The funds that are currently in the account will be distributed to recipients until exhausted. Any questions about this program can be directed to Jea’nette King, Secretary / Treasurer, at 451-5904.
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Health and Dental Insurance
EMPLOYEE HEALTH BENEFITS
Health Insurance-
As a NAF instrumentality of the Federal Government, the Marine Corps NAF community offers health insurance through the Department of Defense (DoD) Uniform Health Plan (UHP). Aetna US Healthcare (AUSHC) is currently the third party administrator for the DoD UHP.
Under the DoD UHP our area is now primarily covered under the Open Choice PPO Plan.
For additional information, or specific plan coverage, please contact Colleen Reid at your local personnel office.
Open Choice – Preferred Provider Option (PPO)
This plan is known as the PPO plan. Employees go to doctors within the PPO Network and pay co-payments. There is an annual deductible of $200 per person ($600 max per family). If services are rendered outside the PPO Network, a deductible of $600 per person ($1,800 max per family) will apply. The deductible does not apply to office visits or preventive care services when staying within the Network.
Dental Coverage -
NAF Employees enrolled in a UHP Medical plan may enroll in the UHP Dental plan. Plan offers two cleanings, exams per year, subject to reasonable and customary costs. There is a $100 deductible per person ($300 max per family).
Stand Alone Dental (SAD) –
NAF Employees not enrolled in a UHP Medical plan and want ONLY Dental coverage may enroll in our SAD plan. Plan offers two cleanings, exams per year, subject to reasonable and customary costs. There is a $100 deductible per person ($300 max per family). Jaw joint disorder such as TMJ is NOT covered under this plan.
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