Benefits guide US employee - 2020 Plan Year - Explain My Benefits

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Benefits guide US employee - 2020 Plan Year - Explain My Benefits
US employee
benefits guide
         2020 Plan Year
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
CONTENTS                                             2020 UPDATES
Benefit Eligibility                             2    Eligibility changes
Enrollment and Coverage Deadlines               3    Effective January 1, 2020, domestic partners
Medical/Prescription Plan Comparison            4    (same and opposite sex) will be covered under
                                                     medical, dental, vision, supplemental life,
Preventive Care Services                        5
                                                     accident, hospital indemnity, critical illness,
Prescription Drug Coverage                      6    identify theft, the Employee Assistance Program
Flexible Spending Accounts (FSAs)               7    (EAP) and Health Advocate.
HRA/HSA Information                            8-9   All new dependents enrolled in a KEMET plan
Dental Coverage                                10    will require proof of eligibility.
                                                     See page 2 for more information.
Vision Coverage                                11
Accident Insurance                             12
Hospital Indemnity Insurance                   12
                                                     Medical insurance changes
                                                     Beginning January 1, 2020, medical
Critical Illness Insurance                     13    contributions will be based on the following
Life and Accidental Death & Dismemberment      14    salary ranges: Less than $70,000, $70,000 -
Disability Pay and Insurance                   15    $149,999, and $150,000+.
Identity Theft                                 16    See pages 2-5 for more information.
Health Advocate                                17
401(k) Savings Plan                            18    Prescription vendor
                                                     Beginning January 1, 2020, OptumRx will be
Additional Benefits                            19
                                                     the new prescription vendor for Blue Cross Blue
Business Travel Accident Insurance
                                                     Shield of South Carolina.
Tuition Reimbursement
Work/Life Balance                                    See page 6 for more information.
Employee Assistance Program (EAP)              20
Service Provider Contact Information           21    HRA administrator
                                                     Beginning January 1, 2020, Accrue Health
Enrolling Online                               22
                                                     will be the new HRA administrator through
Explain My Benefits (EMB) Enrollment Support   23    Blue Cross Blue Shield of South Carolina.
                                                     See page 8 for more information.

                                                     HSA contribution limits
                                                     For 2020, the IRS has capped combined
          The information contained within           HSA contribution limits at $3,550 (individual)
            this guide reflects in-network           and $7,100 (family).
               providers and services.               See page 9 for more information.
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Your Benefit Program
We are pleased to present KEMET’s 2020 benefits package, designed with your family’s health and well-
being in mind. The contents of this booklet summarize your 2020 benefit options. Membership in our benefit
program provides the flexibility to select one, or many benefit options to accommodate the coverage you and
your family need.
We encourage you to visit the KEMET Benefits Portal to review specific details of each plan. The benefit
decisions you make during this enrollment period will be in effect through December 31, 2020. Only
a qualified change in family status will allow you to make certain benefit changes before the next open
enrollment period. Examples of a qualified change are the birth or adoption of a child, marriage, divorce,
or change in employment status (for dependent that affects eligibility). You must contact your benefits
administrator to make the change within 30 days of the event or your changes will not take effect until the
following open enrollment period.
It is important that you review this information
carefully as you and your family make your
benefit selections. Additionally, official plan
documents can be found on the KEMET                     Did you....
Benefits Portal. Should you have benefit-                   update your personal information?
related questions, enrollment specialists are
                                                            identify your beneficiaries?
available to help at (888) 734-6937, option 1.
                                                           elect or waive:
Once you've read through the information
in this booklet, and reviewed your benefit                      medical coverage for you and your family?
options, use this checklist to ensure you've got                dental benefits ?
everything covered.                                             vision benefits?
Please make your benefit selections online                     life insurance for your spouse/domestic partner?
through the KEMET Benefits Portal prior to
                                                               life insurance for your child(ren)?
the enrollment deadline.
                                                               supplemental accident insurance?
                                                               supplemental hospital indemnity insurance?
                                                               supplemental critical illness insurance?
                                                          enroll in/identify your FSA/HSA contributions?

                                                                                                                  1
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Benefit eligibility
    Employee eligibility
    You are eligible to elect benefits if you are regularly scheduled to work 20 or more hours a week.

    Dependent eligibility
    If you enroll, you can add your:
    • Spouse
    • Domestic Partner (same or opposite sex)
         To establish that your relationship constitutes an eligible domestic partnership you and your
         domestic partner must:
        •   be at least 18 years old
        •   not be legally married, under federal law, to each other or anyone else or part of another domestic
            partnership during the previous 12 months
        •   currently be in an exclusive, committed relationship with each other that has existed for at least 12 months
            and is intended to be permanent
        •   currently reside together, and have resided together for at least the previous 12 months, and intend to do
            so permanently
        •   have agreed to share responsibility for each other’s common welfare and basic financial obligations
        •   not be related by blood to a degree of closeness that would prohibit marriage
    • Children
        •   Biological children
        •   Legally adopted children or children placed with you for adoption
        •   Stepchildren (your children or your legal spouse’s or domestic partner’s children)
        •   Children who reside with you and for whom you are appointed by the court as their legal guardian
        •   Children covered under a medical support court order
        •   Children of any age if they are certified as disabled before age 27. Please discuss with BCBS for additional
            information.

    Verifying eligibility
    During Open Enrollment, if you enroll a spouse, domestic partner and/or children who are not
    currently covered on a KEMET plan, you will be required to provide documentation to verify proof of
    eligibility for your dependents. If you are a new hire and enrolling dependents you will be required to
    provide proof of dependent eligibility before your dependent coverage is effective.
    Required documents Include:
    • Spouse Marriage Certificate or prior year tax return (first page)
    • Domestic Partner (same or opposite sex) Affidavit of Domestic Partnership
    • Children Birth Certificate, Proof of Legal Guardianship, QMCSO or prior year tax return (first page)
    Required documentation must be submitted to your HR Representative before the effective date of
    coverage. If proof of eligibility is not provided prior to the effective date, you will have to wait until the
    next available Open Enrollment period to add dependents.

2
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Enrollment deadlines
   The deadlines to enroll are:

   • 30 days from your hire or
       eligibility date
   • 30 days from the date of a
       Qualified Life Event (QLE), such
       as marriage, birth, divorce, or
       gain / loss of other coverage or
       of a dependent’s eligibility

              IMPORTANT: If you miss the 30-day deadline to make a benefit election change
              following a Qualified Life Event, you cannot make a change to your benefits until the
              earlier of another QLE or the next Open Enrollment period.

              As a new hire or if newly eligible, you will automatically be enrolled in the 401(k)
              after 30 days. You may adjust your contribution and investment strategy at any time.

When Coverage Ends
Coverage for you and your dependents will end on the date you are no longer employed by KEMET.
Coverage will end on the date of certain Qualified Life Events, such as divorce, or when a domestic
partnership ends.

Coverage for your dependent children will end as follows:
• At the end of the month of their 27th birthday for medical, dental and vision
• At the end of the month of their 19th birthday for supplemental life insurance, or if a full-time
  student, at the end of the month of their 25th birthday
• At the end of the month of their 26th birthday for Allstate voluntary benefits

                                                                                                      3
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Medical plans
                KEMET offers two Consumer-Directed Health Plan (CDHP) options for 2020:
                        a CDHP accompanied by a Health Reimbursement Account (HRA); and
                        a CDHP accompanied by a Health Savings Account (HSA).
                Both plans are administered through Blue Cross Blue Shield. KEMET will provide funds for your use
                toward meeting the deductible based on the coverage level you choose for your medical plan.

                                                                            HRA                                                HSA
    plan feature                               Less than $70,000      $70,000 to $149,999 $150,000 and above
    KEMET FUNDING (indiv./family)
    pro-rated quarterly, based on hire date.    $750 / $1,500            $750 / $1,500             $750 / $1,500            $750 / $1,500

    ANNUAL DEDUCTIBLE (indiv./family)
    In-Network                                  $1,500 / $3,000         $1,750 / $3,500           $2,000 / $4,000          $1,500 / $3,000
    Out-of-Network                              $3,000 / $6,000         $3,500 / $7,000           $4,000 / $8,000          $2,500 / $5,000

    COINSURANCE
    In-Network                                                                20%                                                20%
    Out-of-Network                                                            50%                                                40%

    MAX MEDICAL OUT-OF-POCKET
    (indiv./family)
    In-Network                                 $2,000 / $4,000          $3,750 / $5,850          $5,500 / $11,000          $3,000 / $6,000
    Out-of-Network                             $6,000 / $12,000        $11,250 / $17,550         $12,000 / $18,000         $5,000 / $10,000

    WELLNESS OFFICE VISITS                                            100% KEMET-paid*                                    100% KEMET-paid*
                                                                        (no cost to you)                                    (no cost to you)
    REGULAR OFFICE VISITS
    In-Network                                                    20% after deductible is met                         20% after deductible is met
    Out-of-Network                                                50% after deductible is met                         40% after deductible is met
    DIAGNOSTIC X-RAY/LAB TEST
    In-Network                                                         100% KEMET-paid                                20% after deductible is met
    Out-of-Network                                                 50% after deductible is met                        40% after deductible is met
    VISION SERVICES                                          $150 per member reimbursement                                   Not covered

    PRESCRIPTIONS                                           NOT SUBJECT to medical deductible                        SUBJECT to medical deductible
    Preventive Medicines                                          100% KEMET-paid*                                        100% KEMET-paid*
    Retail (30-day supply)
    In-Network                                 20% coinsurance         20% coinsurance           20% coinsurance      20% after deductible is met
    Out-of-Network                             50% coinsurance         50% coinsurance           50% coinsurance      40% after deductible is met
    Mail Order (90-day supply)
                                                                                                                           20% coinsurance
    In-Network                                 20% coinsurance         20% coinsurance           20% coinsurance        after deductible is met
    Out-of-Network not covered
    Maximum Prescription                                                                                                Included in Maximum
    Out-of-Pocket (indiv./family)               $500 / $1,000            $500 / $1,000             $500 / $1,000        Medical Out-of-Pocket
    *Amounts over Usual, Customary and Reasonable (UCR) charges for out-of-network providers are not covered.
    Visit the KEMET Benefits Portal to review plan documents for specific details.

4
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Preventive care
KEMET’s commitment to a healthier company begins with YOU!
Both medical plan options are accompanied by a wellness program
and online tools to better manage your health.

     KEMET’s 100% paid preventive care service program provides you and your covered
     dependents access to many routine preventive health screenings, annual exams, childhood
     immunizations, and more. Deductible, co-pay, and coinsurance do not apply (if you use an
     out-of-network provider, you will be financially responsible for any amount over UCR charges).
     Visit the KEMET Benefits Portal to review plan documents for specific details, and take
     advantage of free routine preventive health screenings, annual exams, and childhood
     immunizations for you and your covered dependents.

Manage your care
                                                                                             Log in today at
My Health Toolkit® puts all the tools you need to manage your                    southcarolinablues.com.
benefits right at your fingertips. It’s your single secure source for
information about your specific insurance plan.

Online, or through the mobile app, My Health Toolkit® provides easy access to
find a doctor, view your ID card, see what’s covered by your health plan, check the
status of a claim, see how close you are to meeting your deductible, and more!

        monthly rates
                                         employee      employee + spouse/ employee +
                                           only         domestic partner   child(ren)               family

        HRA
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Prescription drug coverage
                                   KEMET provides a comprehensive prescription drug benefit based on
                                   the medical plan you choose.

    If you elect the HRA plan, prescription costs are not subject to the health plan calendar year
    deductible. The plan pays 80%* of eligible retail or mail order prescription charges (your coinsurance
    amount is 20%), up to a $500 (ind.) / $1,000 (family) maximum, at which point the plan will pay 100%.

    If you elect the HSA plan, prescriptions are applied toward meeting your health plan calendar
    year deductible. Once your deductible has been met, the plan pays 80%* of eligible retail or mail order
    prescription charges (your coinsurance amount is 20%) until you have reached the Maximum Medical
    Out-of-Pocket ($3,000 ind./$6,000 family). The plan then pays 100%.
                                                                       *Information provided based on in-network costs.

    Maintenance medicines: KEMET plans allow for two 30-day fills of maintenance medications at any
    pharmacy in the network. Then, your plan will cover maintenance medicines only if you have 90-day
    supplies filled through mail service, or at a CVS/pharmacy. If you choose to refill 30-day supplies of
    maintenance medications after two times, your plan will not pay for them.

    Visit the KEMET Benefits Portal to review plan documents for specific details.

                      OptumRx will be the new pharmacy administrator effective January 1, 2020.
                      There will be little to no effect on most members for this change. There will be a
                      few updates to your health plan’s prescription drug coverage for 2020:

      ID Cards:                   Mail-Service Pharmacy: Enrolled         Specialty Pharmacy: Beginning
      New BCBS member             members who use mail service            January 1, 2020, BriovaRx will be the
      identification cards        receive up to a 90-day supply of        new preferred specialty pharmacy.
      will be issued for 2020.    medications they take regularly.        BriovaRx is a division of OptumRx.
      Please be sure to           Beginning January 1, 2020, this         If you currently use a specialty drug
      show your new ID            service will be provided by             purchased through CVS Specialty
      card to your doctors        OptumRx Home Delivery. Most             Pharmacy, the prescription will
      and pharmacy.               current mail-service prescriptions      automatically transfer to the new
                                  will automatically transfer to          specialty pharmacy.
                                  OptumRx Home Delivery.

6
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
Flexible spending
A Flexible Spending Account (FSA) is an annual account that you fund with pre-tax dollars
through payroll deduction, to cover certain IRS eligible out of pocket expenses.

KEMET offers two types of FSA’s:

  Health Care FSA                                                                                      Swipe your Discovery Benefits
                                                                                                    debit card and health care expenses
  The health care FSA allows you to set aside up to $2,700 (subject to IRS                             will automatically be approved
                                                                                                             at the point of sale.
  limit changes) annually to use for qualified medical, prescription, dental,
                                                                                                    Find out which expenses are eligible
  and vision expenses not paid for you by your benefit plans. Funds are                                at DiscoveryBenefits.com.
  available once enrolled.                                                                          Manage your accounts online or via
                                                                                                    the convenience of the mobile app.
  Dependent Care FSA
  The dependent care FSA allows you to save up to $5,000 annually ($2,500 for married
  individuals filing taxes separately) for qualified expenses relating to the care of eligible
  dependents (day care) up to age 13, or any dependent who is mentally or physically
  incapacitated. Funds are available as they are deducted from your paycheck.

                                If you elect the HSA medical plan option, you will not be able to elect a health
                                care FSA, but the dependent care FSA is still available to you. If you elect the HSA
                                plan for 2020 and have funds in your FSA after December 31, 2019 your HSA funds
                                will not be accessible until April 1, 2020. After that, your HSA funds will only be
                                available for expenses incurred after March 31, 2020.
  IMPORTANT: The IRS requires you to save all your receipts in this program in the event you are audited. If you used
  your Benefit Card, you may be asked to provide a receipt. Visit the KEMET Benefits Portal to review specific details.

                                                                                                                                           7
Benefits guide US employee - 2020 Plan Year - Explain My Benefits
How the HRA works
    The next pages illustrate how the HRA and HSA plans work. The HRA plan covers both preventive
    care and diagnostic lab and x-ray at no cost to you. Be sure to review the plan documents when
    deciding the best fit for your needs.

                     When you elect the HRA option, KEMET
                                                                   Blue Cross Blue Shield introduces
                     provides funds based on the coverage
                     level you choose for your medical plan:       AccrueHealth to manage HRA funds.
                     $750 annually for employee-only coverage;
                     $1,500 annually for all other levels. Funds   If you enroll in the KEMET HRA plan, you will receive
                     are prorated based on your date of hire.      an AccrueHealth Benefit Access Visa® Debit
                                                                   Card that you may use to pay your providers for eligible
                                                                   health care expenses either at the time of service, or at
                                                                   a later time after BCBS processes your medical claim.

                                                                   You will be able to access your HRA fund information
                                                                   through a single sign-on from My Health Toolkit®
                                    CDHP plan benefits             to the AccrueHealth member portal. You will also have
                                                                   access to your HRA on a mobile application. More
                                                                   details available on My Health Toolkit®.
                                                                   If you do not want to use a debit card to pay for your
                                                                   medical expenses, you have the option to pay for your
                                                                   qualified medical expenses any other way you wish (out

                                     DEDUCTIBLE
                                                                   of pocket, a different debit or credit card, etc.), and then
                                                                   request a reimbursement from AccrueHeatlh using the
                                         (see page 4)              member portal or the mobile app.

                                           KEMET
                                        contribution

                                                                    KEMET’s funds are used to begin fulfilling
                                                                    your deductible.
                                                                    • If you use all of your HRA funds, you are
                                                                       then responsible for meeting the rest of
                                                                       the plan’s deductible.
     • Unused HRA funds roll over
        from year to year, providing you
        remain in the HRA medical plan.
     • HRA funds may not be used for
       prescription drugs, dental, or
       vision expenses.                                                   Once the deductible has
                                                                          been met, the HRA plan
     • Your HRA rollover funds                                            pays traditional benefits
        will be capped at $5,000.                                            (80% in-network/
                                                                           50% out-of-network).

8
How the HSA works
                                        When you elect the HSA plan, KEMET provides up
                                        to $750 (employee-only coverage) or $1,500 (for all
                                        other levels) to help kick start your HSA. You may also
                                        contribute to your HSA through payroll deduction (pre-
                                        tax!). These funds can be used for qualifying health
                                        care (medical, prescription, dental, vision) expenses.

                                              ?      How much should you contribute?
                                                     Use the HSA Calculator at www.
                                                     DiscoveryBenefits.com/HSAcalculator to
                                                     determine how much you should set aside in
                                                     your HSA to cover your expenses until you meet
                                                     your medical plan deductible. Depending on your
 You may choose to invest your HSA
                                                     average household medical, dental, and vision
 funds through a variety of self-
                                                     expenses, you may need to stash a little of your
 directed investment options, and,
                                                     own money into your account.
 after age 65, your HSA funds can be
 withdrawn for retirement purposes.                   In 2020, the maximum annual combined (KEMET
 Unused funds roll over year to year,                 + your) HSA contribution is $3,550 (individual)
 and your HSA funds are portable,                     and $7,100 (family).
 which means should you leave the                     Participants age 55 or older can contribute up to an
 medical plan or leave the company,                   additional $1,000/year in catch-up contributions.
 you can take any remaining funds
 with you.

• You don’t pay payroll taxes on your HSA contributions.
• HSA funds used for qualified health expenses are tax-free.
• Interest earned is also tax-free.                                                   The HSA gives you a
Your annual HSA contribution will be divided equally between pay                      triple tax advantage
periods and then deposited into your account each pay period. KEMET’s                  and let’s you decide
contribution to your HSA will be deposited at the beginning of the year.                when and how to
If you are a new hire, KEMET’s contribution will be pro-rated based on                    use the funds.
the calendar quarter you are hired and deposited after you enroll in the
HSA plan. The money is yours to keep and rolls over from year to year.

                                                                                                              9
Dental
     KEMET’s Dental program, administered by Blue Cross Blue Shield provides you with the freedom
     to choose any dentist you wish – but you’ll get the most savings from a network provider
     because it allows you receive the most significant discounts. Network dentists are contracted
     to honor special negotiated fees.

     The plan pays at set benefit levels for services based on UCR charges. Any
     amount charged by a dentist in excess of the UCR charges will be your
     financial responsibility.
                                                                                      Network dentists are
                                                                                       contracted to honor
                                                                                     special negotiated fees.
                                                                  Network
                                                                  Dentist
       Annual Deductible (per person)                               $25
       – applies to all but preventive & diagnostic care
       Calendar Year Plan Maximum                                  $3,000
       Preventive & Diagnostic Care                                 100%
       General & Basic Care (incl. periodontic/endodontic)          80%
       Major (no waiting period)                                    50%
       Orthodontia (child and adult)                                100%
       Orthodontia Lifetime Maximum                                $1,500

       See the plan documents for complete details and covered items.

                                                employee                               $10

     monthly rates
                                                employee + spouse/domestic partner     $20
                                                employee + child(ren)                  $22
                                                family                                 $32

          Log into MyHealth Toolkit to find a network
          provider, check your benefit coverage, review
          your dental claim history, print an extra ID card,
          or view an Explanation of Benefits (EOB).

10
Vision
KEMET offers vision insurance through EyeMed because they, like us, are committed to making
it easy for you to understand your benefits and stay healthy.

As with the medical and dental plans, network doctors provide the most affordable benefit.
                                                 In-Network                             Out-of-Network
       Eye Exam                                   $25 co-pay                      Up to $30 reimbursement

       Eyeglass Frames                     $140 allowance, then
                                                                                  Up to $70 reimbursement
                                         20% off remaining balance
       Eyeglasses
         Single vision                            $25 co-pay                          $25 reimbursement
         Bifocal                                  $25 co-pay                          $40 reimbursement
         Trifocal                                 $25 co-pay                          $60 reimbursement
       Contact Lenses
         Conventional                      $140 allowance, then                   Up to $112 reimbursement
                                         15% off remaining balance
         Disposable                           $140 allowance                      Up to $112 reimbursement
         Medically Necessary                   Covered 100%                       Up to $210 reimbursement
                                           15% off retail price or                             N/A
       Laser Vision Correction            5% off promotional price
       Frequency         Examination | Lenses or Contact Lenses: Once every 12 months
                         Frames: Once every 24 months

       See the plan documents for complete details and covered items.

                                                        employee                                          $4.72

          monthly rates
                                                        employee + spouse/domestic partner                $8.98
                                                        employee + child(ren)                             $9.45
                                                        family                                           $13.89

                                    The KEMET HRA health plan includes a vision benefit
                                   that can be used on items such as vision exams, single
                                     vision, bifocal or trifocal lenses, contact lenses, and
                                  eyeglass frames. The plan pays up to $150 per member,
                                  per calendar year. Due to IRS regulations, the HSA plan
                                               does not include vision coverage.

                                                                                                                  11
Allstate benefits
     Cash-paid benefits like Accident and Critical Illness insurance through Allstate help to make the
     unexpected a little easier – reimbursing you for deductibles, co-pays and other out-of-pocket
     expenses that are not otherwise covered by your medical plan.

     All Allstate plans are “guaranteed issue,” meaning there are no medical questions to answer at
     enrollment. Should you decide to leave KEMET, benefits are portable. Coverage for dependent children
     is through the end of the month in which the child reaches age 26.

     Accident Insurance
              Accident insurance is an excellent benefit for those with active lifestyles or who have
              children involved in sports or other extracurricular activities. The Allstate accident
              plan pays a cash benefit that corresponds with hospital and intensive care confinement
              related to an accident and covers more than 20 benefits, including emergency room visits,
              hospitalization, fractures, and dislocations. It is designed to pay benefits direct to you, the
              policyholder, based on treatment received, and off-the-job injuries sustained as a result of a
              covered accident. There is no limit on the number of accidents.

                                                                                        PLAN 1       PLAN 2

                 monthly                   employee
                                           employee + spouse/domestic partner
                                                                                        $10.12
                                                                                        $17.48
                                                                                                     $17.73
                                                                                                     $30.62
                 rates                     employee + child(ren)                        $22.31       $39.74
                                           family                                       $29.35       $51.14

     Hospital Indemnity Insurance
              Life is unpredictable. Without any warning, an illness or injury can lead to a hospital
              confinement, medical procedures and/or visits, which may mean costly out-of-pocket
              expenses. With Allstate Hospital Indemnity benefits, you can feel assured that you
              have the protection you need if faced with a hospitalization. The plan covers first-day
              hospitalization, hospitalization accompanied by pregnancy, daily hospitalization
              (up to 10 days), and even comes with a hospital intensive care benefit.

                                                                                       PLAN 1         PLAN 2

                 monthly                  employee
                                          employee + spouse/domestic partner
                                                                                       $34.45
                                                                                       $92.43
                                                                                                      $46.02
                                                                                                     $123.24
                 rates                    employee + child(ren)                        $59.67         $79.56
                                          family                                       $99.97        $133.25

12                                               See the plan documents for complete details and covered services.
Allstate benefits
Critical Illness Insurance
    When a major illness is diagnosed, there can be several expenses that are not covered
    by medical insurance, such as deductibles and coinsurance. Allstate Critical Illness
    insurance pays a lump sum cash benefit to help cover any out of pocket expenses when a
    covered critical illness is diagnosed.
    Critical Illness insurance covers things like cancer, heart attack, coronary artery bypass
    surgery, stroke, major organ transplant, and end state renal failure, and includes a $50
    Wellness benefit (1 per person/year reimburses for things like pap smear, mammogram,
    colonoscopy, lipid test, PSA, chest X‐Ray, etc.).
    You may elect a $10k or $20k plan benefit. Covered dependents receive 50% of your basic-
    benefit amount. Benefits are paid regardless of any other medical or disability plan coverage.

                                                                    age       non-    tobacco                                 age      non-    tobacco
                                                                            tobacco                                                  tobacco
                                   employee + employee/child(ren)

          monthly
                                                                                                employee/spouse-dp + family
                                                                    18-24    $2.65   $2.97                                    18-24 $4.58     $5.07
                                                                    25-29    $3.31   $3.67                                    25-29 $5.57     $6.11
          rates*                                                    30-34
                                                                    35-39
                                                                             $4.40
                                                                             $6.31
                                                                                     $5.43
                                                                                     $8.27
                                                                                                                              30-34 $7.23     $8.78
                                                                                                                              35-39 $10.09 $13.03
                                                                    40-44    $8.64 $11.67                                     40-44 $13.58 $18.12
                                                                    45-49   $11.97 $17.44                                     45-49 $18.58 $26.78
          $10,000 benefit
                                                                    50-54   $16.42 $25.32                                     50-54 $25.26 $38.60
                                                                    55-59   $21.68 $34.41                                     55-59 $33.16 $52.23
                                                                    60-64   $30.83 $49.55                                     60-64 $46.87 $74.96
                                                                    65-69   $43.10 $70.08                                     65-69 $65.29 $105.76
                                                                    70-74   $58.92 $95.04                                     70-74 $89.00 $143.19
                                                                    75-79   $75.55 $117.28                                    75-79 $113.93 $176.54

                                                                    age       non-    tobacco                                 age      non-    tobacco
                                                                            tobacco                                                  tobacco
                                   employee + employee/child(ren)

                                                                                                employee/spouse-dp + family

                                                                    18-24 $4.04     $4.69                                     18-24 $6.66     $7.64
                                                                    25-29 $5.36     $6.07                                     25-29 $8.67     $9.74
                                                                    30-34 $7.58     $9.63                                     30-34 $11.96 $15.06
                                                                    35-39 $11.38 $15.30                                       35-39 $17.69 $23.56
                                                                    40-44 $16.03 $22.07                                       40-44 $24.67 $33.74
                                                                    45-49 $22.70 $33.63                                       45-49 $34.67 $51.07
          $20,000 benefit
                                                                    50-54 $31.61 $49.38                                       50-54 $48.01 $74.68
                                                                    55-59 $42.13 $67.56                                       55-59 $63.81 $101.97
                                                                    60-64 $60.43 $97.87                                       60-64 $91.23 $147.41
                                                                    65-69 $84.96 $138.93                                      65-69 $128.06 $209.01
                                                                    70-74 $116.60 $188.83                                     70-74 $175.52 $283.86
                                                                    75-79 $149.83 $233.30                                     75-79 $225.36 $350.57

     * Rates are based on the employee’s age as of January 1st of each year.
                                                                                                                                                         13
Life insurance
     Basic Life Insurance
      Basic Life Insurance helps provide financial protection to your loved ones in the event of your
      death. KEMET provides, at no cost to you, Basic Life Insurance coverage through
      Aetna equal to two times your salary.
                Basic Life Insurance for Sales Professionals
                In determining life insurance, the definition of “salary” for commission-based
                sales professionals is calculated using base salary plus target commissions.
      Life insurance terminates if you separate from KEMET. However, this coverage may be converted to an
      Aetna individual policy within 31 days after coverage ends.

     Accidental Death and Dismemberment (AD&D)
      Accidental Death and Dismemberment (AD&D) coverage provides a benefit if you die, lose a limb,
      sight, or are paralyzed as a result of an accident. In addition to company-paid Basic Life Insurance,
      KEMET provides you with basic AD&D protection in the amount equal to your Basic Life
      coverage amount in the event of an accidental death or serious injury.

     Supplemental Life Insurance
      All benefit-eligible employees have the option of purchasing additional (supplemental) life insurance for
      themselves and their eligible dependent children (defined on next page).
      For You
      If you are interested in purchasing supplemental life insurance, you may choose from one to two times
      your salary. The employee rate for this additional coverage is based on your age and annual base salary.

      For Your Spouse-Domestic Partner / Dependent Child(ren)
      Life Insurance for your dependents provides you with the opportunity to protect your spouse/domestic
      partner (amounts of $5,000, $10,000, or $35,000) and eligible dependent children (amounts of $1,000,
      $2,000, or $10,000). Dependent coverage amount cannot exceed 100% of employees combined
      coverage amounts. Rates vary, depending on age and the amount of coverage selected.

      Supplemental coverage is portable. This allows you to continue life insurance coverage should you leave
      KEMET. Visit the KEMET Benefits Portal to review plan documents for specific details.

14
age
Identity theft protection
     Whether it’s your health, your financial security, or your privacy, KEMET is committed to
     protecting your WHOLE family.

     Because professional protection and assistance have become important tools in fighting the identity
     theft epidemic, KEMET offers a proactive identity theft protection system that detects fraud in various
     credit and non-credit related services.

     InfoArmor offers two levels of coverage:                Privacy Armor       Privacy Armor
                                                                                      Plus
       Identity and credit monitoring
       Dark web monitoring
       Financial transaction monitoring
       Social media reputation monitoring
       Accounts secured with two-factor authentication
       24/7 Privacy Advocate remediation
       $1 million identity theft insurance policy
       Tri-bureau credit alerts
       Unlimited credit reports from TransUnion
       401(k) and HSA stolen fund reimbursement
       Tax fraud refund advances

     Enrolling in InfoArmor’s plan provides assurance that your private matters are being monitored
     24 hours a day, 7 days a week. Their proactive approach works to help stop identity theft before it
     happens, and they are committed 100% to helping protect your information as if it were their own.
     This coverage is portable and can be converted to an individual policy at the same rate, should you
     leave the company.

                                                             Privacy Armor        Privacy Armor
         monthly                                                                       Plus

         rates                                  employee
                                                family
                                                                  $7.95
                                                                 $13.95
                                                                                       $9.95
                                                                                      $17.95

16
Benefit support
                     With so many options to choose from, you may find yourself looking for help
                     understanding plan details to make the right benefit choices for your family.

During enrollment and throughout the year, Health
Advocate specialists can assist you with things like:                          HEALTH ADVOCATE
coverage and eligibility; enrolling online; additional
resources for having a baby; screenings and routine                      Help with Medical Care
exams; medical claims that weren't paid correctly;                       • Learn more about your diagnosis
replacing a lost ID card, etc.                                             and treatment
                                                                         • Get answers to your questions
It’s simple. If you have a health care or insurance issue you
                                                                           about medical conditions
need help with, just call Health Advocate. Health Advocate is            • Find out the latest research and
available at no cost to employees, spouse/domestic partners,               most advanced approaches to care
dependents, parents and parents-in-law. Health Advocate                  • Connect with the right in-network
                  staff is specially trained to handle each case           doctors and specialists to obtain
                  with the utmost confidentiality.                         second opinions
                                                                         Help with Administrative Issues
                                                                         • Get answers to benefits, eligibility
                     Benefit specialists can be reached                    and coverage questions
                  Monday through Friday, 8 a.m. to 9 p.m. ET:            • Navigate through copays,
                                                                           coinsurance, and cost-sharing
                    (866) 695-8622                                       • Get assistance transferring medical
                                                                           records
                    answers@HealthAdvocate.com
                                                                         • Untangle medical bills and resolve
                                                                           claims and billing issues
                    www.HealthAdvocate.com/members
                                                                         Help On the Go
                                                                         • Access your Health Advocate
                                                                           benefits via the app

                                   O  Y  EE BENE                         • View personalized advice based on
                                                                           your health needs and goals
                                  L
                                PHealth                                  • Check the status of your Health
                                                          FIT
                       EM

                                        Advocate provides                  Advocate cases, upload documents
                                   confidential support for
                                                             S

                                  medical/HSA, prescription              • View your case history to access
                                drugs, dental, vision, critical            the information you need
                               illness, and accident benefits.
                                                             TE

                              Plus, benefit specialists can also
                      HE

                               provide instant support with

                              LT H
                                                       CA

                                      enrolling online!
                                                                   This service is available free of charge to all

                                            ADVO
                         A

                                                                   KEMET employees, their spouse/domestic
                                                                   partners, dependent children, parents and
                                                                      parents-in-law ...as often as needed.
                                                                                                                     17
401(k) savings plan
     KEMET’s 401(k) Employee Savings Plan, administered by T. Rowe Price, enables you to save
     money for retirement on a tax deferred basis, which means contributions to the plan are made
     before income taxes are taken out of your paycheck. By making pre-tax contributions, you
     lower your current taxable income. A Roth Plan is available
     if you prefer to make post-tax contributions.

                                 6%
                                                                              Automatic Increase
                                                       AU TO MATIC
                                                      EN RO LL ME NT          KEMET believes being able to
                                                                              retire comfortably is important.
                                                                              Therefore, each year, your 401(k)
                             As a new hire, you are automatically
                             enrolled in KEMET’s 401(k) Plan at 6%
                                                                              contribution will increase by 1%,
                             of your annual base salary.                      up to a maximum of 10%.
                                                                              If you want to grow your savings
                             Your money is invested in a pre-assembled
                             T. Rowe Price Retirement fund with a target      faster, you can choose a higher
                             date closest to the year you will turn 65.       rate. And, if you find you need
                                                                              to cut back, you can cancel or
     Your Contribution                                                        change the service at any time.
     Your 401(k) contribution amount should be guided by                      Your 401(k) contribution limit
     your retirement savings goal. You are 100% vested in                     in 2020 is $19,500. If you are
     your own contributions and the company’s contributions                   age 50 or over, your “catch-up”
     once funds are deposited into your account, which                        contribution limit will be an
     means you have the right to receive the funds in your                    additional $6,500 in 2020.
     account when you retire or leave the company.

          KEMET’s Contribution
          Don’t miss out on free money!
          For each payroll period in which you make 401(k) contributions, KEMET will
          make a matching contribution to your account based on your contributions
          for that payroll period. The KEMET matching contribution will equal 100%
          of the first 6% of your base compensation that you contribute, up to all the
          statutory limits. KEMET matching contributions are taxable upon withdrawal.

            Open Enrollment is a good time to review your 401(k) account.
            It is important to review your beneficiary designations, contribution amount, and asset
            allocation at least once a year, particularly as things change in your personal life. Access
            your account at any time online at rps.troweprice.com, or contact a customer service
            representative at (800) 922-9945 to make changes to your contribution (from 0% up to
            75%), or choose a mix of equities and bonds that better suit your risk tolerance.
18
Additional benefits
KEMET is committed to building a team that thrives both within and outside the workplace.
Our comprehensive array of benefits includes the following additional benefits to help make
that possible:

Business Travel Accident Insurance
   Providing protection for you when you are traveling on company business is important. That’s
   why KEMET provides you with business travel accident insurance coverage equal to five times
   your annual base pay, up to a maximum of $1M per incident.

Tuition Reimbursement
   Qualified employees may be reimbursed for qualified education fees, up to $10,000 per year.
   See your HR Representative for more details.

Work/Life Balance
   KEMET promotes work/life balance by providing all eligible employees with ten (10) paid holidays
   per year, and a vacation schedule that accrues based on seniority. In addition, KEMET provides
   paid leave for bereavement, jury duty, and military training or reserve duty.

                                                                                                      19
Employee assistance program
     Whether you want help dealing with a situation that’s troubling you, or are looking for
     information and referrals, our Employee Assistance Program (EAP) can help. EAP is available to
     you and your immediate family members.

     Available 24 hours a day, 365 days a year, this program is designed to help you resolve personal
     problems, and provides confidential counseling from independent professionals via face-to-face or
     24-hour phone service. To learn more, call the confidential toll-free number at (800) 395-1616.

        Financial Counseling             Anger management                 Workplace concerns
        Adult Care                       Relationship issues              Legal Services
        Childcare                        Family concerns                  Parenting/Adoption
        Personal Counseling              Stress management                Assistance

        Grief and loss                   Spiritual concerns               College Assistance

        Trauma issues                    Alcohol/substance abuse

                 Dedicated, confidential
                 professionals are available            Don’t delay if
                 24 hours a day, 7 days                 you need help.
                 a week to serve you.

                 Call Toll-free (800) 395-1616
                 or visit them online at
                 www.ibhcorp.com.

20
Get connected!
For your convenience, we’ve listed KEMET’s service providers and their contact information.
This information, and specific plan documents are available on the KEMET Benefits Portal.

Medical, Prescription, Dental, HRA Plan Vision            Health Advocate
BlueCross BlueShield of South Carolina                    BlueCross BlueShield of South Carolina
    (800) 922-1185        www. southcarolinablues.com        (866) 695-8622      www. members.healthadvocate.com

HRA Administration (beginning 1/1/2020)                   Vision Plan
AccrueHealth
                                                          EyeMed
    (844) 643-3099      www.member.accrue-health.com
                 support@accrue-health.com                   (866) 939-3633      www.eyemedvisioncare.com

Accident, Hospital Indemnity, Critical Illness            HSA/FSA Administration
                                                          Discovery Benefits
Allstate                                                                        www.DiscoveryBenefits.com
                                                             (866) 451-3399
    (866) 701-7439             www.allstatebenefits.com             customerservice@discoverybenefits.com

Identity Theft                                            Life, Disability, Accidental Death
                                                          & Dismemberment
InfoArmor                                                 Aetna
    (800) 789-2720             www.MyPrivacyArmor.com        (800) 872-3862         www.aetna.com

Employee Assistance Program                               401(k)/Retirement
Integrated Behavioral Health                              T. Rowe Price
    (800) 395-1616             www.ibhcorp.com               (800) 922-9945          rps.troweprice.com

                                                                                                                   21
Enrolling online
     Employees must enroll online through the KEMET Benefits Portal.

                                                                                                      Access the
                                                                                                  KEMET Benefits Portal
                                                                                                          via

        1.      Login to UltiPro at https://e42.ultipro.com/default.aspx
                Use your KEMET logon credentials (username and password)

                                                                                                          MYSELF

        2.      Go to Menu >> Myself>>Benefits>>Links

                                                                                                                   Benefits
                                                                                                                    Benefits Summary
                                                                                                                    Beneficiaries/Dependents
                                                                                                                    Links

        3.      Select KEMET Benefits Portal
                                     Benefits Summary Manage My Benefits Beneficiaries/Dependents Links

                                     KEMET Benefits Portal
                                     Medical, Dental, RX, Life, Accient, Vision, Identity Theft
                                     T. Rowe Price
                                     401(k)

        4.      Scroll to the KEMET section and select “Log Into Your Benefit System”

        5.      Review and select your desired benefits for 2020

22
Your benefits. Your health. Your choice.

   Before you make your selections, it is important to understand exactly what is
   covered, and what you will need to pay before and after you meet your deductible.

   Again this year, the benefit professionals at Explain My Benefits (EMB)
   are available to all KEMET employees to help make the enrollment
   process a positive experience. You may call (888) 734-6937, option 1, to
   speak with an EMB benefit specialist about any enrollment questions.

   You can also login to the KEMET Benefits Portal now, and at any time
   throughout the year to review your coverage details, and update your
   personal information.

                                                                                       23
Notes

24
Notes

        25
Legal Notices
Notice of Special Enrollment Rights for Health Plan Coverage: As you know, if you have declined enrollment in KEMET Electronics
Corporation health plan for you or your dependents (including your spouse/domestic partner) because of other health insurance
coverage, you or your dependents may be able to enroll in some coverages under this plan without waiting for the next open
enrollment period, provided that 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.
KEMET 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 KEMET Electronics Corporation group health plan. Note that this new 60-day extension doesn’t apply
to enrollment opportunities other than due to the Medicaid/CHIP eligibility change.
Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your current coverage or
change to another health plan.

Women’s Health and Cancer Rights Act 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 plan administrator at (864) 963-6300.
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 plan administrator at (864) 963-6300.

Michelle’s Law Notice – Extended dependent medical coverage during student medical leaves
The KEMET Electronics Corporation 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, notify the plan administrator as soon as the need for the leave is recognized to KEMET Electronics
Corporation. In addition, contact your child’s health plan to see if any state laws requiring extended coverage may apply to his or
her benefits.
KEMET Electronics Corporation 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 KEMET Electronics Corporation 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. 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’s important to note
   that these rules apply to the Plan, not KEMET Electronics Corporation as an employer — that’s the way the HIPAA rules work.
   Different policies may apply to other KEMET Electronics Corporation programs or to data unrelated to the Plan.

   How the Plan may use or disclose your health information
   The privacy rules generally allow the use and disclosure of your health information without your permission (known as an
   authorization) for purposes of health care treatment, payment activities, and health care operations. Here are some examples
   of what that might entail:
   • Treatment includes providing, coordinating, or managing health care by one or more health care providers or doctors.
   Treatment can also include coordination or management of care between a provider and a third party, and consultation and
   referrals between providers. For example, the Plan may share your health information with physicians who are treating you.
   • Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations, and
   provide reimbursement for health care. This can include determining eligibility, reviewing services for medical necessity or
   appropriateness, engaging in utilization management activities, claims management, and billing; as well as performing “behind
   the scenes” plan functions, such as risk adjustment, collection, or reinsurance. For example, the Plan may share information
   about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.
   • Health care operations include activities by this Plan (and, in limited circumstances, by other plans or providers), such
   as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal
   grievance resolution. Health care operations also include evaluating vendors; engaging in credentialing, training, and
   accreditation activities; performing underwriting or premium rating; arranging for medical review and audit activities; and
   conducting business planning and development. For example, the Plan may use information about your claims to audit the third
   parties that approve payment for Plan benefits.
   The amount of health information used, disclosed or requested will be limited and, when needed, restricted to the minimum
   necessary to accomplish the intended purposes, as defined under the HIPAA rules. If the Plan uses or discloses PHI for
   underwriting purposes, the Plan will not use or disclose PHI that is your genetic information for such purposes.

   Provider-Choice Rights Notice :The KEMET Electronics Corporation generally allows 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. For children, you may designate a pediatrician as the primary care provider. You do not need prior
   authorization from KEMET Electronics Corporation 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 the Blue Cross Blue Shield of South
   Carolina. For other questions please contact plan administrator at (864) 963-6300.

This document and the contents of this package present only highlights of the benefits offered by KEMET. If any inconsistency
exists between the informal wording of this material and the official plan documents, the plan documents will be the final
authority. KEMET reserves the right to modify, change, amend or terminate any of its benefit plans at any time. No supervisor,
manager, or any other representative of the company has any authority to enter into any verbal or written agreement contrary
to the foregoing or contrary to the terms of official plan documents.
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, 2016. Contact your State for more information on eligibility.

ALABAMA – Medicaid Website: http://myalhipp.com         MASSACHUSETTS – Medicaid and CHIP Website:            OREGON – Medicaid Web:
Phone: 855.692.5447                                     http://www.mass.gov/eohhs/gov/departments/            http://healthcare.oregon.gov/Pages/index.aspx
                                                        masshealth/                                           http://www.oregonhealthcare.gov/index-es.html
ALASKA – Medicaid The AK Health Insurance               Phone: 1-800-862-4840                                 Phone: 1-800-699-9075
Premium Payment Program Website: http://
myakhipp.com/; Phone: 1-866-251-4861                    MINNESOTA – Medicaid Website:                         PENNSYLVANIA – Medicaid Website:
Email: CustomerService@MyAKHIPP.comMedicaid             http://mn.gov/dhs/people-we-serve/seniors/health-     http://www.dhs.pa.gov/provider/medicalassistance/
Eligibility: http://dhss.alaska.gov/dpa/Pages/          care/health-care-programs/programs-and-services/      healthinsurancepremiumpaymenthippprogram/
medicaid/default.aspx                                   other-insurance.jsp                                   index.htm; Phone: 1-800-692-7462
                                                        Phone: 1-800-657-3739
ARKANSAS – Medicaid Website: http://myarhipp.                                                                 RHODE ISLAND – Medicaid Website: http://www.
com/; Phone: 1-855-MyARHIPP (855-692-7447)              MISSOURI – Medicaid Website:                          eohhs.ri.gov/; Phone: 855-697-4347
                                                        www.dss.mo.gov/mhd/participants/pages/hipp.htm
COLORADO – Health First Colorado (Colorado’s            Phone: 573.751.2005                                   SOUTH CAROLINA – Medicaid Website: www.scdhhs.
Medicaid Program) & Child Health Plan Plus (CHP+)                                                             gov; Phone: 888.549.0820
Health First Colorado Website:                          MONTANA – Medicaid Website:
https://www.healthfirstcolorado.com/                    http://dphhs.mt.gov/MontanaHealthcarePrograms/        SOUTH DAKOTA – Medicaid Website: http://dss.
Health First Colorado Member Contact Center:            HIPP; Phone: 800.694.3084                             sd.gov; Phone: 888.828.0059
1-800-221-3943/ State Relay 711CHP+: Colorado.gov/                                                            TEXAS – Medicaid Website: www.gethipptexas.com/
HCPF/Child-Health-Plan-Plus                             NEBRASKA – Medicaid Website:
                                                        http://www.ACCESSNebraska.ne.gov                      Phone: 800.440.0493
CHP+ Customer Service: 1-800-359-1991/
State Relay 711                                         Phone: (855) 632-7633                                 UTAH – Medicaid and CHIP Medicaid Website:
                                                        Lincoln: (402) 473-7000 Omaha: (402) 595-1178         https://medicaid.utah.gov/
FLORIDA – Medicaid Website: www.                                                                              CHIP Website: http://health.utah.gov/chip
flmedicaidtplrecovery.com/hipp/                         NEVADA - Medicaid Website: http://dhcfp.nv.gov
                                                        Medicaid Phone: 1-800-992-0900                        Phone: 1-877-543-7669
Phone: 877.357.3268
                                                        NEW HAMPSHIRE – Medicaid Website:                     VERMONT – Medicaid Website: www.
GEORGIA – Medicaid Website: http://dch.georgia.                                                               greenmountaincare.org/Phone: 800.250.8427
gov/medicaid, Click on Health Insurance Premium         http://www.dhhs.nh.gov/ombp/nhhpp/
Payment (HIPP) Phone: 404-656-4507                      Phone: 603.271.5218                                   VIRGINIA – Medicaid Website:
                                                        Hotline: 888.901.4999                                 http://www.coverva.org/programs_premium_
INDIANA – Medicaid Healthy Indiana Plan for low-                                                              assistance.cfm; Phone: 1-800-432-5924
income adults 19-64 Website: http://www.in.gov/         NEW JERSEY – Medicaid Website:http://www.state.
                                                        nj.us/humanservices/dmahs/clients/medicaid/           CHIP Website: http://www.coverva.org/programs_
fssa/hip/; Phone: 1-877-438-4479                                                                              premium_assistance.cfm; Phone: 1-855-242-8282
All other Medicaid Website: http://www.                 Medicaid Phone: 609-631-2392
indianamedicaid.com; Phone 1-800-403-0864               CHIP Website: http://www.njfamilycare.org/index.      WASHINGTON – Medicai Website: http://www.
                                                        html                                                  hca.wa.gov/free-or-low-cost-health-care/program-
IOWA – Medicaid Website: http://dhs.iowa.gov/           CHIP Phone: 1-800-701-0710                            administration/premium-payment-program; Phone:
hawk-i; Phone: 888.346.9562                                                                                   1-800-562-3022 ext. 15473
                                                        NEW YORK – MedicaidWebsite:
KANSAS – Medicaid Website: www.kdheks.gov/hcf/          www.nyhealth.gov/health_care/medicaid/                WEST VIRGINIA – Medicaid Website: http://
Phone: 785.296.3512                                     Phone: 800.541.2831                                   mywvhipp.com/
KENTUCKY – Medicaid Website: http://chfs.ky.gov/        NORTH CAROLINA – Medicaid Website:                    1-855-MyWVHIPP (1-855-699-8447)
dms/default.htm                                         https://dma.ncdhhs.gov/                               WISCONSIN – Medicaid and CHIP Website: https://
Phone: 800.635.2570                                     Phone: 919-855-4100                                   www.dhs.wisconsin.gov/publications/p1/p10095.pdf
LOUISIANA – Medicaid Website: http://dhh.louisiana.     NORTH DAKOTA – MedicaidWebsite:                       Phone: 800.362.3002
gov/index.cfm/subhome/1/n/331                           www.nd.gov/dhs/services/medicalserv/medicaid/         WYOMING – Medicaid Website: https://
Phone: 888.695.2447                                     Phone: 844.854.4825                                   wyequalitycare.acs-inc.com/; Phone: 307.777.7531
MAINE – Medicaid Website: www.maine.gov/dhhs/           OKLAHOMA – Medicaid and CHIP
ofi/public-assistance/index.html                        Website: www.insureoklahoma.org
Phone: 800.442.6003, TTY: Maine relay 711               Phone: 888.365.3742

                                                                                                              P.O. Box 5928, Greenville, SC 29606
                                                                                                              (864) 963-6300
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