If you are an active, full time employee working at least 30 hours per week and are classified as benefits eligible.
You must enroll online (see pages 6-7 in the Yellow Book for instructions) by November 15, 2024. You are effective for benefits on the first day of the month following two (2) full calendar months of employment. If you enroll, you may cover eligible dependents by proving dependent eligibility. Dependent Eligibility forms on the Enrollment site https://jmsmith.bcenroll.net > Posted Forms. If you enroll your spouse a Working Spouse Affidavit will be sent to you for completion.
Eligibility continues as long as you are a regular full time employee scheduled to work at least 30 hours per week.
J M Smith Corporation includes routine vision exams as a preventive service under the medical plan. Benefits for routine vision exams are paid at 100%.
Lasik or Laser Eye surgery is covered under the J M Smith Corporation’s medical plan. It is subject to your plan deductible then 50% up to $1,000 per year when utilizing participating providers only. A $2,000 lifetime maximum applies.
You may continue coverage for you and your legal dependents at your own expense. Certain conditions apply. You will be provided with the proper forms, information, and costs upon leaving your employment with J M Smith Corporation.
HIPAA
Health Insurance Portability and Accountability Act (HIPAA) of 1996 Notice
This information is being provided to you pursuant to the Health Insurance Portability and Accountability Act (HIPAA) of 1996. It contains some special information regarding your rights to enroll for coverage under the medical plan in the future. This information is very important if you are currently declining coverage under the medical plan for yourself or for any of your dependents. We are required to provide you with this notice in order to comply with HIPAA.
If you have decided to decline coverage for yourself or for any of your dependents (including your spouse), you may be able to enroll yourself and/or your dependents in this plan later, under some circumstances, without waiting for an open enrollment period.
You can enroll yourself and your dependents in this plan without waiting for an open enrollment period if:
Any request must be consistent with the change in family status. For example, the birth or adoption of a child would permit enrollment in or change to family coverage.
If you decide not to enroll in this plan now and then want to enroll later, you must qualify for special enrollment as described above.
If you do not qualify for special enrollment, you will have to wait until an open enrollment period.
For more information, please contact your human resources administrator.
Women’s Health and Cancer Rights Act (WHCRA) Notice
Re: Health Plan Coverage for Reconstructive Breast Surgery under The Women’s Health and Cancer Rights Act of 1998
Since 1998, Congress has required that all health plans cover reconstructive surgery following a mastectomy.
When a covered individual receives benefits for a mastectomy and decides to have breast reconstruction based on consultation between the
attending physician and the patient, the health plan must cover:
Our plan complies with the Federal mandate. This coverage will be subject to all other Plan provisions.
Pam WatsonYou may obtain the following forms simply by clicking on the description.
There in this form.
