New Employee Benefits Enrollment - Dow Corning

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MISCELLANEOUS BENEFIT INFORMATION HIPPA Notice of Privacy Practices and Cover Letter The Dow Corning Health Care Plan is required under the Health Insurance Portability and Accountability Act (HIPPA) privacy regulation to put safeguards in place to protect the privacy of information, including providing our participants with a Notice of Privacy Practices. Business Travel Accident Insurance This insurance covers you while on company business. This coverage is provided by Dow Corning at no cost to you. You will have access to this form on your second day of hire via the Horizon’s portal. You must complete, sign, date, and return this form regardless of whether you anticipate traveling on your job. 5
DENTAL Coverage is effective on your first day of work. See Benefit Enrollment Information page for details on how to enroll for benefit coverage. After two months from your start date, if you fail to enroll in a dental plan, you will automatically be enrolled the Delta Dental Plan for Employee Only. Plan Highlights Dow Corning offers dental coverage through Delta Dental, the nation’s largest dental benefits system. The Delta Dental plan provides three levels of coverage, according to the dentist you select and the coverage level in which your dentist participates. The three levels of coverage are: � DeltaPreferred Option (DPO) – This provides the highest level of coverage. Delta Dental will pay the dentist directly (there are no claim forms to submit), based on the dentist’s submitted fee or the DPO fee schedule, whichever is less. If the Delta Dental plan amount is lower than the submitted fee, the dentist cannot charge you for the difference. You are only responsible for your co-insurance. � DeltaPremier (DP) – Compared to the DeltaPreferred Option, your coverage levels will be lower for some services, which means that your co-insurance will be higher. Delta Dental pays your participating dentist directly (there are no claim forms to submit), based on the dentist’s submitted fee or the non-DP fee schedule, whichever is less. If the Delta Dental plan amount is lower than the submitted fee, the dentist cannot charge you for the difference. You are only responsible for your co-insurance � Non-participating – You will be responsible for paying the dentist whatever he or she charges, at the time of your appointment. Your dentist may file the claim form for you. Delta Dental will send the plan-allowed reimbursement to you, based on the fee schedule for non-participating dentists. A non-participating dentist can bill you for the difference between the Delta Dental fee schedule and the dentist’s fee. You should know… � You can visit www.deltadentalmi.com to locate participating dentists in you area. Use this website no matter which state you reside in. 6
Page 1 and 2: Dow Corning Corporation - Multibase
Page 3 and 4: INTRODUCTION Dear Fellow Employee:
Page 5: BENEFIT ENROLLMENT INFORMATION Dow
Page 9 and 10: MEDICAL Coverage is effective on yo
Page 11 and 12: Cost and Coverage Comparison Chart
Page 13 and 14: VISION Coverage is effective on you
Page 15 and 16: DEPENDENT LIFE Coverage is effectiv
Page 17 and 18: BASIC & OPTIONAL LIFE Coverage is e
Page 19 and 20: ACCIDENTAL DEATH & DISMEMBERMENT (A
Page 21 and 22: HEALTH SAVINGS ACCOUNT (HSA) The fe
Page 23 and 24: FLEXIBLE SPENDING ACCOUNTS (FSA) Do
Page 25 and 26: LONG TERM DISABILITY (LTD) Coverage
Page 27 and 28: BUSINESS TRAVEL ACCIDENT LIFE Busin
Page 29: BENEFIT ENROLLMENT WORKSHEET After

New Employee Benefits Enrollment - Dow Corning

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