2022 YOU & YOUR BENEFITS A PARTNERSHIP FOR GOOD HEALTH - MYFINISHMASTER
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Benefits decision guide
2022
You & your benefits
A partnership for good health
Welcome Providing great benefit choices to you and your family is
just one of the many ways we support the physical,
financial, and emotional well-being of the people who
make our company successful — you.
Your benefits
We recognize how important benefits are to you. That’s why Effective date of coverage
we’re committed to supporting your overall wellness with a For existing employees enrolling during Open Enrollment, the
comprehensive benefits program designed to meet your unique effective date of most plans is January 1st.
needs. Key features of your benefits include:
Choice among many popular benefit options.
Effective and affordable health care coverage.
Programs to help ensure financial security for you and your
family.
Take action
Use this guide to better understand your 2022 benefits, so you
can make the best choices for yourself and your family. Then
be sure to enroll by the enrollment deadline to ensure you
receive coverage.
Who can enroll?
Full-time employees (30+ hrs./wk.) – Eligible upon hire;
benefits may be chosen 30 days after hire date.
Part-time employees (20-29.99 hrs./wk.) – Eligible upon
hire; benefits may be chosen 30 days after hire date.
Eligible dependents – Includes employee’s spouse/
domestic partner and children to age 26, plus disabled
dependent children of any age who meet plan criteria.
1
Inside this guide Important reminders
If you want to keep your current benefits in 2022, you
will need to re-enroll in all benefits, including Flexible
Health .................................................. 3 Spending Accounts (FSAs) and a Health Savings Account
(HSA). If you’re currently participating in either of these
Medical .......................................................................... 3
accounts, your contributions won’t carry forward — you
Compare medical plans ................................................. 4
must re-enroll.
A Closer Look at HDHP ................................................. 5
New employees: Enroll 30 days after your date of hire.
Flexible Spending Accounts (FSAs)............................... 7
If you don’t enroll within this time period, you will not have
Dental and Vision benefits ............................................. 8 benefits coverage, except for plans and programs that are
Dental plans ................................................................... 8 fully paid by FinishMaster, such as Basic Life & AD&D.
Vision plans ................................................................... 8
Open Enrollment: Enroll before the enrollment
Focus on Wellness......................................................... 9 deadline. You must take action to enroll in benefits for
2022, your current elections will not roll over. This includes
Financial ............................................ 10
taking action to enroll in the Health Care Flexible
Life and Accident insurance ......................................... 10
Spending Account (FSA), Combination FSA, Dependent
Disability ...................................................................... 11 Care FSA and Health Savings Account (HSA). If you do
Disability insurance ...................................................... 11 not make any elections, you will only be enrolled in the
Voluntary Benefits ........................................................ 12 company provided Basic Life & Accidental Death and
Dismemberment coverage.
Accident insurance....................................................... 12
Critical Illness insurance .............................................. 12
Hospital Indemnity insurance ....................................... 12
Pet insurance ............................................................... 12
Identity Theft Protection ............................................... 12
Legal plan .................................................................... 13
Auto and Homeowner’s insurance ............................... 13
Enroll ................................................. 14
Contacts....................................................................... 14
The Health section of this guide provides an overview of your medical plan options. You can find detailed
information about each plan, including a breakdown of costs, in each plan’s Summary of Benefits and Coverage
(SBC). The SBCs summarize important information about your health coverage options in a standard format to
help you compare costs and features across plans.
Quality health coverage is one of the most valuable
benefits you enjoy as a FinishMaster employee. Our
Health benefits program offers plans to help keep you and your
family healthy and also provide important protection in
the event of illness or injury.
Medical Which plan is right for you?
You have a choice of medical plans with a range of coverage
levels and costs. This gives you the flexibility to choose what’s Consider which plan
features are most $1,850 $2,850
best for your needs and budget. important to you. Do you $900 PPO
HDHP HDHP
want to…?
2022 medical plan options Open and contribute to a
tax-free HSA, which has
$900 Deductible PPO no “use it or lose it” rule
No Yes Yes
and offers the opportunity
$1,850 Deductible HDHP with HSA to invest money for future
medical costs?
$2,850 Deductible HDHP with HSA Pay the lowest premium
cost, which may make it the
least expensive option if No No Yes
Key features you expect to have low
health care usage?
All of your medical plan options offer: Balance your out-of-pocket
and paycheck costs with a
Comprehensive, affordable coverage for a wide range of moderate deductible and
No Yes No
health care services. premium cost?
Pay the highest premium
Flexibility to see any provider you want, although you’ll save cost in order to keep your
money when you stay in-network. out-of-pocket costs as low Yes No No
as possible when you
Free in-network preventive care, with services such as need care?
annual physicals, recommended immunizations, well- woman
and well-child exams, flu shots, and routine cancer
screenings covered at 100%.
Prescription drug coverage included with each medical plan. 2022 deductions per pay period
Financial protection through annual out-of-pocket maximums $900 $1,850 $2,850
Coverage Level
that limit the amount you’ll pay each year. deductible deductible deductible
Non-Wellness
Choice of four coverage levels:
$88.78 $72.70 $47.61
Employee Only
o Employee Only
$237.25 $205.09 $154.91
Employee + Spouse
o Employee + Spouse
$207.59 $184.26 $140.35
Employee + Child(ren)
o Employee + Child(ren)
$311.31 $245.60 $171.59
Family
o Family
Wellness
$77.24 $61.16 $36.07
Employee Only
$225.71 $193.56 $143.37
Employee + Spouse
You and FinishMaster share the cost of your $196.05 $172.72 $128.81
Employee + Child(ren)
medical benefits — FinishMaster pays a generous
portion of the total cost and you pay the remainder. $299.77 $234.07 $160.05
Family
The amount you pay is deducted from your
paycheck. Your specific cost is determined by the
plan you choose and the coverage level you select.
3
Compare medical plans
The chart below provides a comparison of key coverage features and costs of FinishMaster’s 2022 medical plan options.
$900 deductible $1,850 deductible $2,850 deductible
In-network Out-of-network In-network Out-of-network In-network Out-of-network
Health savings and reimbursement accounts
HSA Eligible No Yes Yes
$500/year individual $500/year individual
HSA Employer Funding N/A
$1,000/year family $1,000/year family
Annual Deductible
Per person/per family $900/$1,800 $3,000/$6,000 $1,850/$3,700 $3,700/$7,400 $2,850/$5,700 $5,700/$11,400
Out-of-pocket maximum
Per person/per family $3,000/$6,000 $6,000/$12,000 $3,500/$6,500 $7,000/$13,000 $5,500/$11,000 $11,000/$22,000
Medical coverage
Doctor’s office visits $40 copay* 60% 80% 60% 70% 50%
Preventive care $0 copay* 60% 100%* 60% 100%* 50%
Specialist visits $80 copay* 60% 80% 60% 70% 50%
Outpatient surgery 80% 60% 80% 60% 70% 50%
Inpatient hospital (per
80% 60% 80% 60% 70% 50%
stay)
Emergency room 80% 80% 80% 80% 70% 70%
Labs and X-rays 80% 60% 80% 60% 70% 50%
Urgent Care 80% 60% 80% 60% 70% 50%
Retail prescription drugs (30-day supply)
Generic $10 copay* $10 copay* 80%** 80%** 70%** 70%**
70% ($25 min, 70% ($25 min,
Brand Formulary 80%** 80%** 70%** 70%**
$50 max) $50 max)
55% ($40 min, 55% ($40 min,
Non-formulary 80%** 80%** 70%** 70%**
$80 max) $80 max)
Subject to Subject to Subject to Subject to Subject to Subject to
Specialty Drugs
applicable copay applicable copay applicable copay applicable copay applicable copay applicable copay
Mail-order prescription drugs (90-day supply)
Generic $25 copay* Not covered 80%** Not covered 70%** Not covered
70% ($62.50
Brand Formulary Not covered 80%** Not covered 70%** Not covered
min, $125 max)
55% ($100 min,
Non-formulary Not covered 80%** Not covered 70%** Not covered
$200 max)
Subject to Subject to Subject to
Specialty Drugs Not covered Not covered Not covered
applicable copay applicable copay applicable copay
*Deductible does not apply
**Deductible waived for some medications
A Closer Look at HDHP
HEALTH
The high deductible health plan (HDHP) costs you less from 3. Free in-network preventive care
your paycheck, so you keep more of your money. This plan As with all FinishMaster health plans, preventive care is fully
rewards you for taking an active role as a health care consumer covered under the HDHP — you pay nothing toward your
and making smart decisions about your health care spending. deductible and no copays as long as you receive care from in-
As a result, you could pay less for your annual medical costs. network providers. Preventive care includes annual physicals,
well-child and well-woman exams, immunizations, flu shots,
HDHP advantages and cancer screenings.
1. Lower paycheck costs 4. Extensive provider network
Your per-paycheck costs are lower compared to FinishMaster’s The HDHP uses Anthem’s large network of doctors and other
other health plans, giving you the opportunity to contribute the health care providers.
cost savings to a tax-free Health Savings Account (HSA). You
pay for your initial medical costs until you meet your annual
deductible, and then you pay a percentage of any further costs
until you reach the annual out-of-pocket maximum.
1 You pay nothing for in-network
preventive care.
Free preventive
care
2. Tax-advantaged savings account
To help you pay your deductible and other out-of-pocket costs,
You pay your medical expenses up to the
the HDHP lets you open a Health Savings Account (HSA) and
make before-tax contributions directly from your paycheck.
FinishMaster will also contribute to your HSA to help cover your
2 annual deductible amount. Use your HSA
to plan ahead for these costs and save
money by paying with tax-free dollars.
Deductible
annual deductible:
All withdrawals from your HSA are tax-free, as long as you use
the money to pay for eligible health care expenses. In addition,
all the money in the account is yours and will never be forfeited.
3 After meeting your deductible, the plan starts to
pay coinsurance. You’ll only pay a percentage
of each bill.
Coinsurance
It rolls over from year to year, and you can take it with you if you
leave the company or retire. After age 65, you can withdraw
funds for any reason without a tax penalty — you pay ordinary
income tax only if the withdrawal isn’t for eligible health care
4
Out-of-pocket
You’re protected by an annual limit on
costs. The plan starts to pay 100% once
you've paid this amount during
the year
expenses. Maximum
Note: You won’t pay federal taxes on HSA contributions. However, you
may pay state taxes depending on your residence. Consult your tax
advisor to learn more.
Money-saving tip
If you enroll in the HDHP, put the money you save
through lower paycheck deductions into your tax-free
HSA so you’ll have money available when you need to
pay out-of-pocket costs.
Keep your money. Unlike an FSA, the money in your HSA
Health Savings Account (HSA) is always yours to keep and can be rolled over from year to
If you enroll in the HDHP, you are eligible to open an HSA. An year. You can take your unused balance with you when you
HSA is a tax-free savings account you can use to pay for eligible retire or leave FinishMaster.
health expenses anytime, even in retirement. Earn interest and invest for the future. Once your interest-
bearing HSA reaches a balance a minimum balance, you
How does an HSA work? can start an investment account, which offers a variety of no-
load mutual funds similar to 401(k) investments.
Build tax-free savings for health care. You can make
before-tax deductions from your paycheck into your HSA, Never pay taxes. Contributions are made on a before-tax
allowing you to save money by using tax-free dollars to pay basis, and your withdrawals will never be taxed when used
for eligible medical, prescription, dental, and vision expenses. for eligible expenses. Any interest or earnings on your HSA
The total amount that can be contributed to your HSA each balance build tax-free, too*
year is limited by the IRS. The following limits for 2022 * Money in an HSA grows tax-free and can be withdrawn tax-free if it is used
include any company contributions you receive from to pay for qualified health care expenses (for a list of eligible expenses, see
IRS Publication 502, available at www.irs.gov). If money is used for
FinishMaster. ineligible expenses, you will pay ordinary income tax on the amount
withdrawn plus a 20% penalty tax if you withdraw the money for ineligible
‒ Up to $3,650 for employee-only coverage. expenses before age 65. After age 65, withdrawals for ineligible expenses
are only subject to ordinary income tax. Please review your state regulations
as you may have to pay state taxes depending on your residency.
‒ Up to $7,300 if you cover dependents.
‒ Add $1,000 to these limits if you’re age 55 or older.
HSA eligibility
Receive company contributions. FinishMaster will make
Must be enrolled in a high deductible health plan, like
the following contributions to your account:
FinishMaster’s $1,850 Deductible plan or $2,850 deductible
‒ $500 for employee-only coverage. plan.
‒ $1,000 if you cover dependents. Cannot be covered by any other medical plan that is not a
HDHP. This includes a spouse’s medical coverage unless
Important: During Open Enrollment, you must actively select
it’s a HDHP.
an HSA contribution amount for 2022 in order to receive any
company contributions. Cannot be enrolled in a traditional health care FSA in 2022.
Use it like a bank account. Pay for eligible medical, Cannot be enrolled in Medicare, including Parts A or B,
prescription, dental, and vision expenses for yourself and your Medicaid or Tricare.
family by swiping your HSA debit card, or reimburse yourself
Cannot be claimed as a dependent on another person’s tax
for payments you’ve made (up to the available balance in your
return.
account). Keep in mind that you may only access money that
is actually in your HSA when making a purchase or Cannot be a veteran who has received treatment, other
withdrawal. There’s no need to turn in receipts (but keep than preventive care, through the Department of Veterans
them for your records). Affairs within the past three months.
Flexible Spending Accounts (FSAs)
HEALTH
Tax-advantaged FSAs are a great way to save money. The
money you contribute to these accounts comes out of your
HSA vs. Health Care FSA:
paycheck without being taxed, and you withdraw it tax-free when What’s the difference?
you pay for eligible health care and dependent care expenses.
Health Care
HSA
FinishMaster offers you the following FSAs: FSA
Health Care FSA Available if you enroll in a… HDHP PPO plan
Pay for eligible health care expenses, such as plan Eligible for company
Yes No
deductibles, copays, and coinsurance. contributions
Contribute up to $2,750* in 2022. Change your contribution
Yes No
amount anytime
Combination FSA Access your entire annual
contribution amount from the
Note: If you enroll in the HDHP and have an HSA, you are not No Yes
beginning of
eligible to open a Health Care FSA, but you can open a the plan year
Combination FSA. Access only funds that have
Yes No
been deposited
Use it to pay for dental and vision expenses.
“Use it or lose it” at year-end No Yes
Contribute up to $2,750* in 2022.
Money is always yours to Yes No
keep
Dependent Care FSA
Pay for eligible dependent care expenses, such as day care
for a child so you and/or your spouse can work, look for work, Managing your FSA(s)
or attend school full time. When you enroll in a Health Care FSA, you will receive a debit
card, which you can use to pay for eligible expenses.
Contribute up to $10,500* in 2022, or $5,250* if you are
Depending on the transaction, you may need to submit
married and filing separate tax returns.
receipts or other documentation to Discovery Benefits.
Estimate carefully What’s an eligible expense?
Keep in mind, FSAs are “use-it-or-lose-it” accounts. You will
Health Care FSA – Plan deductibles, copays, coinsurance,
forfeit any amount left in the account at the end of the plan year.
and other health care expenses. To learn more, see IRS
Publication 502 at www.irs.gov.
Dependent Care FSA – Child day care, babysitters, home
care for dependent elders, and related expenses. To learn
more, see IRS Publication 503 at www.irs.gov.
Another great way to save money through tax-free spending is FinishMaster’s commuter benefits program
through WEX. You can use before-tax dollars to pay for monthly parking or transit costs related to your
work commute. It’s easy and flexible. Before-tax deductions are allowed up to the IRS limit of $270* per
month for parking or transit.
For more information, call FinishMaster Commuter Benefits at 844-561-1337.
*Current IRS limits; the 2022 plan year limits may not have been available when this guide was printed.
Dental and Vision Benefits
HEALTH
Dental plans Vision plans
Healthy teeth and gums are important to your overall wellness. Having vision coverage allows you to save money on eligible
That’s why it’s important to have regular dental checkups and eye care expenses, such as periodic eye exams, eyeglasses,
maintain good oral hygiene. Learn about the dental plans contact lenses, and more for yourself and your covered
available to help you maintain your oral health. dependents.
Enhanced with
Standard Standard
Orthodontia
Annual deductible Exam (once per
$50/$150 $50/$150 $10 copay
(employee only/family) calendar year)
Contact Lens Fitting
Calendar-year maximum $2,000 $1,500 (once per calendar Not to exceed $60
Preventive/diagnostic year)
100%* 100%*
services Lenses (once per
$25 copay
calendar year)
Basic services 80% 80%
Frames (once per 2
Up to 130**
Major services 50% 50% calendar years)
Contact lenses (once
Up to 130**
Orthodontia 50% to $2,500** Not covered per year)*
*Contact lens coverage provided in lieu of frames and lenses
*Deductible does not apply ** 20% off any amount over the retail allowance
** Eligible children to age 19 and adults
Benefits shown are for in-network providers and are based Vision 2022 deductions (per pay period)
on negotiated fees. Out-of-network coverage is based on
reasonable and customary (R&C) charges. Plan Employee Employee Employee +
Family
only + Spouse Child(ren)
Dental 2022 deductions (per pay period)
Standard $2.28 $4.33 $4.56 $6.70
Employee
Employee Employee
Plan + Family
only + Spouse
Child(ren)
Enhanced $7.53 $15.04 $23.64 $34.82
Standard $6.56 $13.10 $15.72 $24.25
Remember, you can use your HSA or FSA
for qualified out-of-pocket dental and vision
expenses.
Focus on Wellness
HEALTH
Employee assistance program Take advantage of preventive
The FinishMaster Employee Assistance Program (EAP) is
available throughout the year to assist with your everyday
care benefits
needs, at no cost to you. It’s all part of our commitment to Good preventive care can help you stay healthy and detect any
supporting your total well-being. Get help with work-life issues; “silent” problems early, when they’re most likely to be treatable.
referrals for clinical, legal, and financial services; and more. To Most in-network preventive services are covered in full, so
begin taking advantage of this valuable benefit, visit there’s no excuse to skip them.
www.cignalap.com or call 1-800-538-3543.
Have a routine physical exam each year. You’ll build a
relationship with your doctor and can reduce your risk for
many serious conditions.
Get regular dental cleanings. Numerous studies show a
link between regular dental cleanings and disease
prevention — including lower risks of heart disease,
diabetes, and stroke.
See your eye doctor at least once every two years. If
you have certain health risks, such as diabetes or high
blood pressure, your doctor may recommend more frequent
eye exams.
Don’t have a personal doctor? Get care from your couch
You should. Here’s why. When you don’t feel well, or your child is sick, the
last thing you want to do is leave the comfort of
• Better health. Getting the right health screenings
your home to sit in a crowded waiting room full
each year can reduce your risk for many serious
of other sick people.
conditions. And remember, preventive care
doesn’t cost you anything. A virtual visit, included as a covered service under your
medical plan, lets you see and talk to a doctor from the
• A healthier wallet. A PCP can help you avoid comfort of your home or office without an appointment.
costly trips to the emergency room. Your doctor When you seek care through virtual visits, you’ll pay a flat
will also help you decide when you really need to
copay amount, which is the same as you would pay for an
see a specialist and can help coordinate care.
office visit. Consider a virtual visit when your doctor isn’t
• Peace of mind. Advice from someone you trust available, you become ill while traveling, or you’re
— it means a lot when you’re healthy, but it’s considering visiting a hospital emergency room for a non-
even more important when you’re sick. emergency health condition. To learn more and register for
care, go to www.livehealthonline.com.FinishMaster offers programs to help ensure financial
Financial security for you and your family. We also provide access
to voluntary benefits designed to help you save money on
valuable supplemental insurance coverage.
Life insurance rates
Rates per $1,000 of coverage (monthly)
Basic Life and AD&D insurance
Employee Age Employee & Spouse supplemental life
You automatically receive basic life and accidental death and
dismemberment (AD&D) insurance so that you can protect those Under age 24 $0.057
you love from the unexpected. There is no cost to you for this
25-29 $0.067
coverage. You can also choose supplemental coverage.
30-34 $0.080
35-39 $0.095
Employee paid 40-44 $0.150
Employee supplemental life – $10,000 increments up to
45-49 $0.247
five times your salary or $750,000.
50-54 $0.347
Spouse/domestic partner supplemental life – Elect $5,000
increments up to $150,000 (can’t exceed 50% of employee’s 55-59 $0.684
supplemental life amount).
60-64 $0.941
Child supplemental life – Elect $2,500 increments up to
65-69 $1.473
$10,000 for children up to age 26
70-74 $2.613
75+ $4.275
Note: Any life coverage enrolled in over the guaranteed issue
amount will require Evidence of Insurability (EOI). Life insurance
amounts over guaranteed issue may require approval from the AD&D insurance rates (all ages)
insurance carrier. After electing coverage, you will receive more Elect in $10,000 increments,
Employee supplemental AD&D up to the lesser of ten times
information. your salary or $1,000,000*
*If Family AD&D coverage is elected, dependent benefits are a portion of
employee benefits
Be sure you’ve selected a beneficiary for all Should you lose your life, sight, hearing,
your life and accident insurance policies. The speech, or use of your limb(s) in an accident,
beneficiary will receive the benefit paid by a AD&D provides additional benefits to help keep
policy in the event of the policyholder’s death. your family financially secure. AD&D benefits
It’s important to designate a beneficiary and are paid as a percentage of your coverage
keep that information up-to-date. Visit amount — from 50% to 100% — depending on
www.newyorklife.com to add or change a the type of loss.
beneficiary.Disability $
FINANCIAL
Disability insurance
The loss of income due to illness or disability can cause serious financial hardship for your family. FinishMaster’s disability insurance
programs work together to replace a portion of your income when you’re unable to work. The disability benefits you receive allow you to
continue paying your bills and meeting your financial obligations during this difficult time.
Summary of disability benefits
Short-Term Disability Optional Long-Term Disability
Who pays FinishMaster pays 50%; Employees pay 50% Employees pay 100%
Benefit provided Up to 60% of your weekly salary 60% of salary
Maximum benefit payable $1,000 per week $7,500
Until you’re no longer considered disabled or you reach
Maximum benefit duration 26 weeks
normal retirement age, whichever comes first
0 days for accident
Waiting period 180 days
7 day for sicknessVoluntary Benefits $
FINANCIAL
Pays upon diagnosis of a covered condition
Allstate Accident Examples of covered conditions include: cancer, heart
An accident can require a variety of treatments, testing, attack, stroke, major organ transplant, end stage renal
therapies and other care to assist in recovery. Even the best failure*
medical plans may leave you with extra costs to pay out of your
own pocket. Everyday expenses like your mortgage, car Allstate Hospital Indemnity
payment or childcare may be harder to cover due to lost or
Hospital stays are often unexpected, and just a few days can
reduced income.
strain even the healthiest of budgets. Hospitalization can cause
Accident Insurance can help you bounce back by providing cash serious financial setbacks due to out-of-pocket medical costs or
benefits if you experience a covered accident. These benefits loss of income. When you’re recovering, the last thing you need
help with expenses and protect your savings, letting you focus to worry about is how much it will cost to get better.
more on recovering.
Hospital Indemnity Insurance offers financial protection when
Highlights you’re hospitalized due to a covered illness or injury. Benefits
can help with the hospital bill or everyday expenses.
Receive cash benefits to help cover out-of-pocket
expenses associated with a covered accident Highlights
Pays in addition to existing medical insurance Collect a lump-sum benefit each day you’re in the
hospital
Pays benefits for each covered occurrence
No coinsurance, copays, waiting periods or deductibles
Examples of covered services include: emergency
room, hospitalization, doctor’s visits, physical therapy* Benefits are paid directly to you, in addition to other
insurance you may have
Additional benefits available for certain injuries, such as
dislocations, fractures, burns and lacerations* Benefits are provided for hospital admission and daily
hospital confinement*
Allstate Critical Illness * Not a guarantee of coverage. Benefits vary by state. Review plan documents to
Critical illnesses, such as heart attack, stroke, cancer or organ verify covered benefits
failure, are usually unexpected and may not be preventable.
Recovering from a serious illness often brings significant
Nationwide Pet Insurance
expenses other than medical costs, which can amount to You work hard to provide your family with everything they need.
thousands of dollars. So whether your family includes kids with two feet or kids with
Critical Illness Insurance can help with the treatment costs of four paws, you know what responsibility looks like.
covered critical illnesses and enhance your medical plan, giving Pets are unpredictable. While it’s hard to anticipate accidents
you the flexibility to pay bills related to treatment or to help with and illnesses, Nationwide® Pet Insurance makes it a little easier
everyday living expenses. to be prepared for them. From preventive care visits to
Highlights significant medical incidents, Nationwide® provides protection
for pets when you need it most.
Coverage is guaranteed issue, which means you may
qualify for coverage without having to answer any Nationwide® policies cover a multitude of medical problems and
health questions conditions related to accidents and illnesses, including cancer.
You are free to use any veterinarian worldwide—even specialists
Pays a lump-sum cash benefit directly to you to help and emergency care provide
cover out-of-pocket expenses associated with a
covered critical illness
Pays in addition to existing medical insurance benefitsVoluntary Benefits $
FINANCIAL
Identity Theft Protection Auto and Homeowner’s
Allstate is an industry-leading identity protection plan that Insurance
includes proactive identity and credit monitoring, offering you the
Most auto and home insurance experts suggest you review
most comprehensive solution to fight today’s identity fraud
your coverage annually to make sure you’re getting the best
issues. Benefits include:
coverage for your rates.
Identity and credit monitoring alerts to uncover fraud quickly
Purchasing auto and home could provide you with savings of
An annual credit report and a score each month, making it up to 15%. Farmers gives you access to a variety of personal
easier to monitor your credit insurance policies, including automobile, home*, landlord’s
rental dwelling, condo, mobile home, renters, recreational
Social media reputation monitoring to protect against
vehicle, boat and personal excess liability.
cyberbullying and reputational damage within social media
*Not offered in Massachusetts and Florida
sites
A digital wallet storage for securely storing documents and
credit cards with a lost wallet replacement service
Threshold monitoring to view and manage all of your financial
transactions from all your accounts in one place
$1,000,000 Identity Theft Insurance Policy
Legal Plan
Finding an affordable attorney to represent you when you are
buying or selling your home, preparing your will or having
trouble with creditors can be a challenge. Now there’s a
simple, convenient and affordable solution. As a plan member,
The MetLife® Legal Assistance Plan provides legal
representation for you and your family for legal matters
including:
Wills and Estate Planning
Family Law (Name Change, Adoption)
Consumer Protection (Auto Repair, Consumer Fraud)
Juvenile Court Matters (Includes Criminal Matters)
Debt-Related Matters (Bankruptcy, Tax Audits)
Home and Real Estate Matters (Purchase or Sale of a
Home, Security Deposits)
You will have access to more than 17,500 experienced
Network Attorneys nationwide. The plan is easy to use—no
copayments, deductibles or waiting periods. No one can
predict your future, but we can help you prepare for legal
needs that may lie ahead.Carefully consider your benefit options and your
anticipated needs. Then follow the instructions to enroll
Enroll yourself and any eligible dependents in health and
insurance benefits for 2022.
Changes during the year
How to enroll After your enrollment opportunity ends, you won’t be able to
You: have two options for enrolling in your benefits change your benefits coverage during the year unless you
experience a qualifying life event, such as marriage, divorce,
Online
birth, adoption, or a change in your or your spouse/domestic
Log in to WorkDay. partner’s employment status that affects your benefits
Enroll from any computer with internet access, 24 hours a day, eligibility.
seven days a week. Follow the prompts to set up your account Effective date of coverage
and select a secure password. For new employees, the effective date of coverage for most
plans is first of the month following date of hire.
For questions about benefits For existing employees enrolling during Open Enrollment, the
effective date of most plans is January 1st.
Call 1-866-486-8242
Members can reach out via touchcare.com, the TouchCare
mobile app, or assist@touchcare.com
Contacts
Benefit Plan Provider Phone number Website
Anthem Blue Cross Blue
Medical and Prescription 1-833-544-1039 www.anthem.com/yourhealth
Shield
Health Savings Account (HSA) WEX 1-866-451-3399 www.wexinc.com
Flexible Spending Accounts (FSAs) WEX 1-866-451-3399 www.wexinc.com
Commuter Benefits WEX 1-866-451-3399 www.wexinc.com
Dental Delta Dental 1-800-524-0149 www.deltadentalin.com
Vision EyeMed 1-866-800-5457 www.eyemed.com
Employee Assistance Program
Cigna 1-800-538-3543 www.cigna.com
(EAP)
Life and AD&D Insurance New York Life N/A www.newyorklife.com
Disability Insurance New York Life N/A www.newyorklife.com
Supplemental Medical (Accident,
Allstate Benefits 1-800-521-3535 www.allstatevoluntary.com
Critical Illness, Hospital Indemnity)
Pet Insurance Nationwide 1-855-525-1458 www.petbenefitsportal.com
Identity Theft Protection Allstate Identity Protection 1-800-789-2720 www.myaip.com
www.legalplans.com
Legal Plan MetLife Legal 1-800-821-6400
Access Code: GETLAW
Auto and Homeowner’s
Farmers GroupSelect 1-800-438-6381 https://myautohome.farmers.com/
InsuranceIMPORTANT NOTICE FROM FINISHMASTER ABOUT CREDITABLE PRESCRIPTION DRUG COVERAGE AND MEDICARE
The purpose of this notice is to advise you that the prescription drug coverage listed below under the FinishMaster medical plans is expected to pay out, on
average, at least as much as the standard Medicare prescription drug coverage will pay in 2022. This is known as “creditable coverage.”
Why this is important: if you or your covered dependent(s) are enrolled in any prescription drug coverage during 2022 listed in this notice and are or
become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty — as long
as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important
records.
If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t
apply to you. Please read the notice below carefully. It has information about prescription drug coverage with FinishMaster and prescription drug coverage
available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.
NOTICE OF CREDITABLE COVERAGE
You may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is
available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of
coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals
leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period.
If you are covered by one of the FinishMaster prescription drug plans listed below, you’ll be interested to know that the prescription drug coverage under
the plan is, on average, at least as good as standard Medicare prescription drug coverage for 2021. This is called creditable coverage. Coverage under one of
these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare
prescription drug plan.
• Anthem Blue Cross Blue Shield $900 Deductible Plan
• Anthem Blue Cross Blue Shield $1,850 Deductible Plan
• Anthem Blue Cross Blue Shield $2,850 Deductible Plan
• Kaiser Permanente $1,000 Deductible Plan
• Kaiser Permanente $2,000 Deductible Plan
If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue
your employer coverage. In this case, the FinishMaster plan will continue to pay primary or secondary as it had before you enrolled in a Medicare
prescription drug plan. If you waive or drop FinishMaster coverage, Medicare will be your only payer. You can re-enroll in the employer plan at annual
enrollment or if you have a special enrollment event for the FinishMaster plan, assuming you remain eligible.
You should know that if you waive or leave coverage with FinishMaster and you go 63 days or longer without creditable prescription drug coverage (once
your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month that you did not have
creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19% higher
than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may
have to wait until the following October to enroll in Part D.
You may receive this notice at other times in the future — such as before the next period you can enroll in Medicare prescription drug coverage, if this
FinishMaster coverage changes, or upon your request.
FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE
More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Medicare participants will get a
copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. Here’s how to get
more information about Medicare prescription drug plans:
• Visit www.medicare.gov for personalized help.
• Call your State Health Insurance Assistance Program (see a copy of the Medicare & You handbook for the telephone number).
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is
available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov or call 1-800-
772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enrollment period ends, you may need to
provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.
For more information about this notice or your prescription drug coverage, contact:
Stephanie Campbell/Sr. Benefits Specialist
115 West Washington St., Suite 700 South
Indianapolis, IN 46204
1-317-263-5232
campbells@finishmaster.comHIPAA SPECIAL ENROLLMENT NOTICE
NOTICE OF SPECIAL ENROLLMENT RIGHTS FOR HEALTH PLAN COVERAGE
If you have declined enrollment in FinishMaster’s health plan for you or your dependents (including your spouse) because of other health insurance
coverage, you or your dependents may be able to enroll in some coverages under these plans without waiting for the next Open Enrollment period,
provided you request enrollment within 30 days after your other coverage ends.
In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your
eligible dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.
FinishMaster will also allow a special enrollment opportunity if you or your eligible dependents either:
Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or
Become eligible for a state’s premium assistance program under Medicaid or CHIP.
For these enrollment opportunities, you will have 60 days – instead of 30– from the date of the Medicaid/CHIP eligibility change to request enrollment in
the FinishMaster group health plan. Note that this 60-day extension does not apply to enrollment opportunities other than due to the Medicaid/CHIP
eligibility change.
Note: If your dependent becomes eligible for special enrollment rights, you may add the dependent to your current coverage or change to another medical
plan.
To request a HIPAA special enrollment based on the events described above or obtain more information, contact Stephanie Campbell/Sr. Benefits Specialist
at 1-317-263-5232 or campbells@finishmaster.com.
WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA) NOTICE
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998
(WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending
physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.
If you would like more information on WHCRA benefits, call your medical carrier at the phone number listed on the back of your ID card.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT NOTICE
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with
childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However,
Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her
newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain
authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more
information on maternity benefits, call your medical carrier at the phone number listed on the back of your ID card.
MICHELLE’S LAW NOTICE
EXTENDED DEPENDENT MEDICAL COVERAGE DURING STUDENT MEDICAL LEAVES
The FinishMaster plan may extend medical coverage for dependent children if they lose eligibility for coverage because of a medically necessary leave of
absence from a post-secondary educational institution (including a college or university). Coverage may continue for up to a year, unless the child’s
eligibility would end earlier for another reason.
Extended coverage is available if a child’s leave of absence from school — or change in school enrollment status (for example, switching from full-time to
part-time status) — starts while the child has a serious illness or injury, is medically necessary, and otherwise causes eligibility for student coverage under
the plan to end. Written certification from the child’s physician stating that the child suffers from a serious illness or injury and the leave of absence is
medically necessary may be required.
If the coverage provided by the plan is changed during this one-year period, the plan will provide the changed coverage for the remainder of the leave of
absence.If your child will lose eligibility for coverage because of a medically necessary leave of absence from school and you want his or her coverage to be
extended, call Mercer Marketplace 365+ at 1-866-210-4699 as soon as the need for the leave is recognized by FinishMaster. In addition, contact your child’s
health plan to see if any state laws requiring extended coverage may apply to his or her benefits.
CHIP/MEDICAID NOTICE Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium
assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or
CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance
Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State
listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled
in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office
or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the
premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under
your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment”
opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in
your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of
states is current as of July 31, 2020. Contact your State for more information on eligibility.
ALABAMA – Medicaid COLORADO – Health First Colorado (Colorado’s Medicaid
Program) & Child Health Plan Plus (CHP+)
Website: http://myalhipp.com/ Health First Colorado Website:
Phone: 1-855-692-5447 https://www.healthfirstcolorado.com/
Health First Colorado Member Contact Center:
1-800-221-3943/ State Relay 711
CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus
CHP+ Customer Service: 1-800-359-1991/ State Relay 711
Health Insurance Buy-In Program
(HIBI): https://www.colorado.gov/pacific/hcpf/health-insurance-
buy-program
HIBI Customer Service: 1-855-692-6442
ALASKA – Medicaid FLORIDA – Medicaid
The AK Health Insurance Premium Payment Program Website:
Website: http://myakhipp.com/ https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/
Phone: 1-866-251-4861 hipp/index.html
Email: CustomerService@MyAKHIPP.com Phone: 1-877-357-3268
Medicaid Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – Medicaid GEORGIA – Medicaid
Website: http://myarhipp.com/ Website: https://medicaid.georgia.gov/health-insurance-premium-
Phone: 1-855-MyARHIPP (855-692-7447) payment-program-hipp
Phone: 678-564-1162 ext. 2131
CALIFORNIA – Medicaid INDIANA – Medicaid
Website: Healthy Indiana Plan for low-income adults 19-64
Health Insurance Premium Payment (HIPP) Program Website: http://www.in.gov/fssa/hip/
http://dhcs.ca.gov/hipp Phone: 1-877-438-4479
Phone: 916-445-8322 All other Medicaid
Email: hipp@dhcs.ca.gov Website: https://www.in.gov/medicaid/
Phone 1-800-457-4584
IOWA – Medicaid and CHIP (Hawki) MONTANA – Medicaid
Medicaid Website: Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
https://dhs.iowa.gov/ime/members Phone: 1-800-694-3084
Medicaid Phone: 1-800-338-8366
Hawki Website:
http://dhs.iowa.gov/Hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-
z/hipp
HIPP Phone: 1-888-346-9562KANSAS – Medicaid NEBRASKA – Medicaid
Website: https://www.kancare.ks.gov/ Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-800-792-4884 Phone: 1-855-632-7633
Lincoln: 402-473-7000
Omaha: 402-595-1178
KENTUCKY – Medicaid NEVADA – Medicaid
Kentucky Integrated Health Insurance Premium Payment Program Medicaid Website: http://dhcfp.nv.gov
(KI-HIPP) Website: Medicaid Phone: 1-800-992-0900
https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx
Phone: 1-855-459-6328
Email: KIHIPP.PROGRAM@ky.gov
KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx
Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov
LOUISIANA – Medicaid NEW HAMPSHIRE – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Website: https://www.dhhs.nh.gov/oii/hipp.htm
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 Phone: 603-271-5218
(LaHIPP) Toll free number for the HIPP program: 1-800-852-3345, ext. 5218
MAINE – Medicaid NEW JERSEY – Medicaid and CHIP
Enrollment Website: https://www.maine.gov/dhhs/ofi/applications- Medicaid Website:
forms http://www.state.nj.us/humanservices/
Phone: 1-800-442-6003 dmahs/clients/medicaid/
TTY: Maine relay 711 Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/default.aspx or
Private Health Insurance Premium Webpage: http://www.njfamilycare.org/index.html
https://www.maine.gov/dhhs/ofi/applications-forms CHIP Phone: 1-800-701-0710
Phone: 1-800-977-6740.
TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP NEW YORK – Medicaid
Website: https://www.mass.gov/info-details/masshealth-premium- Website: https://www.health.ny.gov/health_care/medicaid/
assistance-pa Phone: 1-800-541-2831
Phone: 1-800-862-4840
MINNESOTA – Medicaid NORTH CAROLINA – Medicaid
Website: Website: https://medicaid.ncdhhs.gov/
https://mn.gov/dhs/people-we-serve/children-and-families/health- Phone: 919-855-4100
care/health-care-programs/programs-and-services/other-insurance.jsp
Phone: 1-800-657-3739
MISSOURI – Medicaid NORTH DAKOTA – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 573-751-2005 Phone: 1-844-854-4825
OKLAHOMA – Medicaid and CHIP UTAH – Medicaid and CHIP
Website: http://www.insureoklahoma.org Medicaid Website: https://medicaid.utah.gov/
Phone: 1-888-365-3742 CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669
OREGON – Medicaid VERMONT– Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx or Website: http://www.greenmountaincare.org/
http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-250-8427
Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid VIRGINIA – Medicaid and CHIP
Website: Website: https://www.coverva.org/en/famis-select
https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP- https://www.coverva.org/en/hipp
Program.aspx Medicaid Phone: 1-800-432-5924
Phone: 1-800-692-7462 CHIP Phone: 1-800-432-5924
Email: HIPPcustomerservice@dmas.virginia.govRHODE ISLAND – Medicaid and CHIP WASHINGTON – Medicaid
Website: http://www.eohhs.ri.gov/ Website: https://www.hca.wa.gov/
Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line) Phone: 1-800-562-3022
SOUTH CAROLINA – Medicaid WEST VIRGINIA – Medicaid
Website: https://www.scdhhs.gov Website: http://mywvhipp.com/
Phone: 1-888-549-0820 Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
SOUTH DAKOTA - Medicaid WISCONSIN – Medicaid and CHIP
Website: http://dss.sd.gov Website:
Phone: 1-888-828-0059 https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Phone: 1-800-362-3002
TEXAS – Medicaid WYOMING – Medicaid
Website: http://gethipptexas.com/ Website: https://health.wyo.gov/healthcarefin/medicaid/programs-
Phone: 1-800-440-0493 and-eligibility/
Phone: 1-800-251-1269
To see if any other states have added a premium assistance program since July 31, 2021, or for more information on special enrollment rights, contact
either:
U.S. Department of Labor
www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such
collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or
sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not
required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any
other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not
display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are
encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200
Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.
OMB Control Number 1210-0137 (expires 1/31/2023)
PHYSICIAN DESIGNATION NOTICE
The Kaiser HMO Medium Plan generally requires the designation of a primary care provider. You have the right to designate any primary care provider who
participates in our network and who is available to accept you or your family members. Until you make this designation Kaiser HMO Medium Plan
designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact Kaiser at
1-800-464-4000 for English or 1-800-788-0616 Spanish or at www.kp.org/thrive.
For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from Kaiser HMO Medium Plan or from any other person (including a primary care provider) in order to obtain access
to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional,
however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved
treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact
Kaiser at 1-800-464-4000 for English or 1-800-788-0616 Spanish or at www.kp.org/thrive.
FINISHMASTER HIPAA PRIVACY NOTICE
Please carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this
information.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on the use and disclosure of individual health
information by FinishMaster health plans. This information, known as protected health information, includes almost all individually identifiable health
information held by a plan — whether received in writing, in an electronic medium or as an oral communication. This notice describes the privacy practices
of these plans: Anthem $900 Deductible Plan, $1,850 Deductible Plan and $2,850 Deductible Plan, Delta Dental Standard Dental Plan and Health Care
Flexible Spending Account. The plans covered by this notice may share health information with each other to carry out treatment, payment or health care
operations. These plans are collectively referred to as the Plan in this notice, unless specified otherwise.
THE PLAN’S DUTIES WITH RESPECT TO HEALTH INFORMATION ABOUT YOU
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy
practices with respect to your health information. If you participate in an insured plan option, you will receive a notice directly from the Insurer. It’sYou can also read
