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OPEN ENROLLMENT FOR 2022 BENEFITSNOVEMBER 1 - 15 | MYBENEFITS.PACCAR.COM
YOUR MEDICAL PLAN OPTIONS ARE CHANGING!
OPEN ENROLLMENT DEADLINENovember 15, 2021 I Before 10:00pm Pacific Time
Plan Changes ...................................................................................................................................................................................... 3
What You Need To Do ........................................................................................................................................................................ 4
The Basics of PACCAR Benefits ......................................................................................................................................................... 5
New High Deductible Health Plan (HDHP) and Health Savings Account (HSA) ......................................................................... 6
Comparing HSAs and FSAs ............................................................................................................................................................... 7
Plan Comparison Chart (Medical) ..................................................................................................................................................... 8
Plan Comparison Chart (Prescription Drugs) .................................................................................................................................. 9
Plan Comparison Chart (Dental & Vision) ........................................................................................................................................ 10
2022 Plan Rates .................................................................................................................................................................................. 11
Consider a Tax Advantaged Account ............................................................................................................................................... 12
Special Features of the PACCAR Premera Medical Plan ................................................................................................................ 13
Diabetes Programs ............................................................................................................................................................................. 14
PACCAR Employee Assistance Program (EAP) by Magellan ......................................................................................................... 15
Helpful Websites & Phone Numbers ................................................................................................................................................ 17
Notices ................................................................................................................................................................................................. 18
2 U.S. Salaried Employees
WHAT’S IN THIS BOOKLET
3 U.S. Salaried Employees
BUSINESS TRAVEL ACCIDENT
Aggregate Benefit Limit: If more than one insured person is injured in the same accident, the maximum amount payable for all such losses combined will not exceed $15,000,000 per accident.
FLEXIBLE SPENDING ACCOUNTS
FSA Debit Card RenewalIf you enrolled in a Healthcare FSA for 2022 and your FSA debit card was originally issued in 2019, you will receive a new one in the mail from HealthEquity by the end of 2021, regardless of whether you activated the old card or not.
The FSA debit card is active for three years from the issue date. The expiration date is displayed on the debit card. If you need additional cards for your dependents, log into your HealthEquity account through mybenefits.paccar.com, or call the HealthEquity Customer Service at 1-877-924-3967.
This Plan Changes section constitutes a Summary of Material Modification (SMM) of the U.S. Salaried health and welfare plans effective January 1, 2022. If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.
PLAN CHANGESNEW MEDICAL OPTION
PACCAR has added a High Deductible Health Plan and an optional Health Savings Account (HDHP/HSA). Read all about it on page 6.
ADDITIONAL PREMERA PLAN CHANGES
Medical Option A The individual deductible for Option A will change to $450. The family deductible will be $1,350.
Medical Option DThis option will be eliminated effective 1/1/2022. You can enroll in another option during open enrollment. If you are currently enrolled in Option D and do not select a new plan for 2022, you will be enrolled in Option A for 2022.
Specialty Drug Savings ProgramThe SaveOnSP program has been added. If you are eligible to participate, you will receive a letter from SaveOnSP or a referral from Accredo for more information about the program and how to enroll. See page 9 for more information.
Colorectal Cancer Screening Age LimitThe USPSTF recommends screening for Colorectal Cancer in adults at the age of 45 years old (rather than 50). Effective 1/1/2022, Premera will update the age limit for Colorectal Cancer Screening. The change is in response to recommendations from the U.S. Preventive Services Task Force (USPSTF).
New ID CardsPremera will issue new ID cards to enrolled employees and their family members.
1. Go to mybenefits.paccar.com. Use Chrome, Microsoft Edge or Safari for best results.
2. Click on the “Forgot User ID or Password?” link. See screenshot on the right.
3. Follow the prompts.
Step-by-step password reset instructions are available under the “Reset Password” tile of mybenefits.paccar.com.
Need help? Contact your local HR.
4
KEY POINTS
U.S. Salaried Employees
WHAT YOU NEED TO DO
PACCAR Open Enrollment is your chance to enroll or make changes to your medical, dental/vision, flexible spending accounts, health savings account, life and AD&D benefits for 2022.
OPEN ENROLLMENT CHECKLIST REMEMBER! OPEN ENROLLMENT IS YOUR CHANCE TO:
READY TO ENROLL?Where: Online at mybenefits.paccar.comWhen: November 1 through 15, 2021Deadline: Before 10:00pm Pacific Time on November 15Effective Date of Changes: January 1, 2022
Questions: Contact your local HR Department
ADD OR REMOVE DEPENDENTS
CHANGE LIFE AND/OR AD&D ELECTIONS
CHANGE YOUR MEDICAL OPTION
ENROLL IN AN FSA OR HSA ACCOUNT
� Read this Booklet � Learn About the New Medical Option & HSA � Log into mybenefits.paccar.com � Make Your Benefit Elections
3 Change and/or Elect Benefits 3 Update Your Life and AD&D Beneficiaries 3 Update Your Personal Information Including
Your Email, Address and Phone Number
Log Qualifying Status Changes Print Confirmation
Update Benefits
OPEN ENROLLMENTDEADLINE
November 15, 2021 Before 10:00pm
Pacific Time
Update Address, Email, Phone
5 U.S. Salaried Employees
ELIGIBLE DEPENDENTS HEALTH PLANS
� Your lawful spouse, unless legally separated. Lawful means a legal union of two persons that was validly formed in any jurisdiction.
� Your biological or adopted children until age 26.
� Your children who are physically or mentally incapable of supporting themselves. Child must be incapacitated prior to age 26, unmarried and dependent on you for major support. Proof of disability required.
� You and your spouse’s stepchildren, foster children or children to age 26 for whom you or your spouse has obtained legal guardianship.
IF YOU MISS OPEN ENROLLMENT
� You will need to wait until the next annual Open Enrollment to make any changes to your medical, dental/vision, FSA or life and AD&D elections.
� If you have a qualifying life event (e.g. marriage, birth, divorce) during the year, you may be able to make benefit changes consistent with your life event.
� It is recommended that you submit your changes within 30 days of your life event on mybenefits.paccar.com. Supporting documentation and approval may be required by Corporate Benefits (see COVID-19 related deadline changes on page 19).
THE BASICS OF PACCAR’S BENEFITSCOMPLETE ENROLLMENT ONLINE
mybenefits.paccar.com
All benefit election changes must be made online at mybenefits.paccar.com. This website provides plan details, coverage levels, premiums and more.
If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.
6 U.S. Salaried Employees
NEW HIGH DEDUCTIBLE HEALTH PLAN (HDHP) AND HEALTH SAVINGS ACCOUNT (HSA)
Annual Deductible1 $1,400/Individual $4,200/Family
Coinsurance2 20%
Preventive Care Covered in Full No Deductible
More details on the HDHP covered benefits page 8.
A Health Savings Account (HSA) is a savings account that lets you set aside money on a pre-tax basis to pay for eligible medical expenses. HSAs offer the triple tax advantage:
� Pre-tax savings � Tax-free investment earnings � No tax when used to pay for eligible medical expenses.
You own your HSA. You don’t have to use your savings within the calendar year. Balances rollover from one year to the next. Your savings go with you if you leave PACCAR.
HIGH DEDUCTIBLE HEALTH PLAN (HDHP OPTION)
HEALTH SAVINGS ACCOUNT(HSA)
In 2022 PACCAR is introducing a new Medical Option called a High Deductible Health Plan (HDHP). Enrollment in the HDHP Option makes you eligible for PACCAR’s new Health Savings Account (HSA).
Medical Option C and the new HDHP Option look similar but there is a difference in how the deductibles will be applied to your claims.
You must be enrolled in the PACCAR HDHP Option to participate in PACCAR’s HSA.
How PACCAR Medical Options’ Deductibles Work
Type of Care Medical Options A, B and C HDHP Option
Preventive Care No Deductible Applied No Deductible Applied
Prescription Drugs No Deductible, Copays Apply Family* Deductible Must be Met, Then Copays Apply
Teladoc No Deductible, Copay Applies Family* Deductible Must be Met, Then Copay Applies
If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.
7 U.S. Salaried Employees
COMPARING HSAs AND FSAsHealth Savings Account Healthcare FSA
Account Owner Employee PACCAR
Contribution Limits $3,650 (Individual Plan) $7,300 (Family Plan) $2,750
Health Plan Eligibility Must be Enrolled in the HDHP Option Not Available if Enrolled in HDHP Option
Fund Availability As They are Contributed On First Day of Plan Year
Tax Savings• Contributions are Tax Free• Withdrawals for Qualified Medical Expenses are Tax-Free• Investment Earnings on the Account Balance are Tax-Free
Contributions are Tax-Free
Rollover HSA Funds Rollover Year-to-Year and Never Expire Unused Balance Forfeited Annually
Investment Capability Yes No
Portability Yes – HSA Stays with the Employee No Portability
Can Cover COBRA Costs Yes No
Can Cover Retirement Medical Costs Yes No
Administrator Fidelity HealthEquity
HEALTH SAVINGS ACCOUNT (HSA)
The HSA is an individual savings account that is available to people enrolled in the HDHP Option. Eligible contributions are tax-deductible, and you can use your HSA money tax-free to pay for qualified medical expenses for you, your spouse, and your qualified dependents. You choose how to invest your HSA money for potential growth. Investment returns are not taxed.
HSA CONTRIBUTIONS
Annual Minimum: $120Annual Maximum: $3,650/Individual
$7,300/Family
HSA contributions can be changed once a month at mybenefits.paccar.com. Changes will take effect the first of the following month.
If you’re age 55 or older at the beginning of the tax-year, you may be eligible to make an additional $1,000 catch-up contribution.
ELIGIBILITY
You’re eligible to open and contribute to a PACCAR HSA if:
1. You’re enrolled in the HDHP Option
2. You’re not covered by an ineligible health plan
3. You’re not enrolled in Medicare
4. You cannot be claimed as a dependent on someone else’s tax return
8
KEY POINTS
U.S. Salaried Employees
PLAN COMPARISON CHART
This Plan Comparison section constitutes a Summary of Material Modification (SMM) of the U.S. Salaried health and welfare plans effective January 1, 2022. If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.
PLAN FEATURESPACCAR MEDICAL PLAN
Option A Option B Option C HDHP Option
In-Network In-Network In-Network In-Network
Eligible Dependents Lawful spouse; children to age 26
Preventive Care (Not subject to annual deductible1)
Covered in full
Emergency Room $150 copay per visit; remaining expense subject to annual deductible1 then 20% coinsurance2. Copay waived if admitted.
Deductible, $150 copay per visit then 20%
coinsurance
Outpatient Lab and X-ray 20%2
Annual Deductible1 $450 Individual$1,350 Family
$700 Individual$2,100 Family
$1,400 Individual$4,200 Family
$1,400 Individual$4,200 Family Aggregate5
Your Coinsurance2 20%2
Chiropractic Care 20%2 (limited to 30 visits per calendar year)
Maternity Care 20%2
Physician Visits 20%2
Urgent Care 20%2
Annual Out-of-Pocket Limit3
$3,000 Individual$6,000 Family
$4,500 Individual$9,000 Family
$6,500 Individual
$13,000 Family
$6,500 Individual
$13,000 Family
Teladoc $10 copay After deductible, $10 copay
GLOSSARY
1 Annual Deductible – amount you pay before the plan begins paying for covered services. Preventive care and prescription drugs not subject to annual deductible.
2 Coinsurance – after meeting the annual deductible, the amount you pay, as a % of the allowable charge4.
3Annual Out-of-Pocket Limit – the most you pay per calendar year for covered medical services, including prescription drugs. Deductible, coinsurance andcopays count toward out-of-pocket limit.
4Allowable Charge – fee agreed upon by BCBS Association and the provider as the maximum charge. For out-of-network services, your provider may bill you for any amount above the allowable charge. Providers who receive COVID related relief funds cannot balance bill patients.
5Aggregate Deductible - the entire family deductible must be paid before the Plan pays for services for any family member
9
KEY POINTS
U.S. Salaried Employees
PLAN COMPARISON CHART
All PACCAR Medical Options include
coverage for prescription drugs through Express Scripts, a pharmacy benefit manager. This coverage is not available separately.
IMPORTANT NOTESON PACCAR MEDICAL PLANS
The plan comparison chart is only a sample of the services covered. All information is based on in-network charges. For information on other, specific services covered by the PACCAR Health Plan call 1-888-PACCAR-5 or refer to the Employee Benefits Handbook on mybenefits.paccar.com.
For out-of-network provider services, you pay 40%2 of the allowable charge4 plus any amount over the allowable charge4 for most covered services.
An in-network provider has an agreement with the PACCAR Health Plan Administrator and agrees to accept the allowable charge4 as payment in full.
An out-of-network provider is not bound to negotiated rates. If the provider charges you more, you will be responsible for paying the balance over the allowable charge4.
PLAN COMPARISON CHART
PLAN FEATURES
Copay/Coinsurance Not Subject to Deductible
Subject to Annual Deductible, then
Copay/Coinsurance
Option A Option B Option C HDHP OptionIn-Network In-Network In-Network In-Network
Generic
Preferred Brand Name
Non-Preferred Brand Name
Retailcopay / coinsurance
Mail Ordercopay / coinsurance
(Up to 30-day supply) (Up to 90-day supply)
$10 $20
30%$30 minimum$75 maximum
30%$75 minimum
$180 maximum
50%$50 minimum
$125 maximum
50%2
$125 minimum$300 maximum
NEWAvailable through PACCAR Medical Plans
Visit pillpack.com or call 866-332-1668 to get started.
Order or refill mail-order prescriptions by logging into your Premera account at premera.com. You may also call Premera Customer Service at 1-888-PACCAR-5 for refills.
Start the Mail Order Program today to save time and money.
If you are currently taking or will be taking certain specialty medications, you may be able to participate. If you are eligible to participate, you will receive a letter from SaveOnSP or a referral from Accredo for more information about the program and how to enroll.
Not included in the HDHP Option.
• Pre-sorted dosages• Packaged by date & time• Free Delivery
Express Scripts Mail Order Program
SaveOnSP PillPack Provides:
10
KEY POINTS
U.S. Salaried Employees
PLAN COMPARISON CHARTPACCAR DENTAL PLAN
Adult (members age 19 and over)
Pediatric(members under age 19)
Annual Deductible1 $50 per individual limited to $150 per family
$50 per individual limited to $150 per family
Individual Benefit Maximum
Benefits for preventive, basic and major care are
limited to $1,500 per calendar year
Benefits for preventive, basic and major care are unlimited
Preventive Care(Not subject to annual deductible1)
100% of allowable charges4 100% of allowable charges4
Basic Care 20%2 20%2
Major Care 40%2 40%2
Orthodontia(Not subject to annual deductible1)
50%2; limited to $2,000 individual lifetime maximum
Medically necessary: 50%2; no benefit limit per calendar
year
Cosmetic: 50%2; $2,000 individual lifetime maximum
PACCAR VISION PLANVision Exam 100% allowable charges4
Vision HardwareCovered at 100% of allowable charges4 for any
combination of lenses, frames or contact lenses; limited to $250 per calendar year for adults and children
PACCAR Dental & Vision Plans are provided through Premera Blue Cross.
To locate an in-network provider log in at premera.com and select Find a Doctor from the menu or call Customer Service at 888-PACCAR-5 Monday through Friday, 6 a.m. to 6 p.m. (Pacific Time).
1, 2, 4 See page 8 for glossary definitions.
11
KEY POINTS
U.S. Salaried Employees
2022 PLAN RATES
Semi-Monthly Medical Employee Contributions*
PACCAR MEDICAL PLAN COSTSOption A Option B Option C HDHP Option
Below Salary Grade 35
Employee $99.00 $78.50 $44.50 $36.00
Employee +1 $197.50 $139.00 $85.50 $69.00
Family $297.00 $204.50 $129.50 $104.50
Semi-Monthly Dental/Vision Employee Contributions
PACCAR DENTAL/VISION PLAN COSTS
All Employee Grades
Employee $7.21
Employee +1 $14.11
Family $20.99
* Employees grades 35-44 pay an additional $20/$30/$40 (employee/employee +1/family) per month; Employees grades 45 and above pay an additional $40/$60/$80 (employee/employee +1/family) per month; Tobacco users pay an additional $30 per month.
Get the best healthcare for you and your family
REFERRALS TO QUALITY, IN-NETWORK PROVIDERS
EXPERT SECOND OPINIONS
NEED A PRIMARY CARE DOCTOR? GRAND ROUNDS HEALTH AND
PREMERA CAN HELP
Use a Grand Rounds advisor to find a high-quality in-network doctor that can meet your personal needs. To get started, call 855-PACCAR-9 or visit grandrounds.com/paccar.
Use the find a doctor tool on premera.com or call Premera customer service at 888-PACCAR-5.
12 U.S. Salaried Employees
HEALTHCARE FSA DEPENDENT CARE (DAYCARE) FSA HEALTH SAVINGS ACCOUNT (HSA)
Description of Account
This plan lets you set aside pre-tax dollars through payroll deductions, spread over 24 pay periods, for eligible healthcare expenses for you and your eligible dependents.
This plan lets you set aside pre-tax dollars through payroll deductions, spread over 24 pay periods, for eligible dependent care expenses such as daycare to allow you and your spouse to work or attend school full time.
An individual savings account that is available to people enrolled in a the HDHP Option. Eligible contributions are tax-deductible, and you can use your HSA money tax-free to pay for qualified medical expenses for you and your qualified dependents. You choose how to invest your HSA money for potential growth. Investment returns are not taxed.
Annual Contributions
• Annual Minimum: $120• Annual Maximum: $2,750• No waiting- access full annual amount
regardless of year-to-date payroll contributions.
• Annual Minimum: $120• Annual Maximum: $5,000 (highly-
compensated employees may have a lower maximum)
• Can only access available balance in your FSA account.
• Annual Minimum: $120• Annual Maximum: $3,650/Individual
$7,300/Family• Can only access available balance in
your HSA account.
Eligible Expenses
Go to www.HealthEquity.com for a detailed list of eligible expenses.
Go to www.HealthEquity.com for a detailed list of eligible expenses.
Go to www.fidelity.com/go/hsa/how-to-spend for a list of eligible expenses.
Important Account Limitations
• Use it or lose it!• Employees enrolled in the HDHP are not
eligible to enroll in the Healthcare FSA.
• Use it or lose it!• Only available for children under 13
Go to www.HealthEquity.com for details on eligible dependents.
• Must be enrolled in HDHP• Cannot be enrolled in Healthcare FSA• Cannot be enrolled in Medicare• Cannot be claimed as a dependent on
someone else's tax return.
DeadlinesHealthcare expenses must be incurred by March 15, 2023 and claims submitted by April 30, 2023.
Dependent Care expenses must be incurred by December 31, 2022 and claims submitted by March 31, 2023.
No deadline as long as you incurred your qualified medical expense after you established your HSA.
Debit CardsAutomatically sent after enrollment. Activation of the card disables automatic reimbursement.
Not Applicable. Automatically sent after enrollment. Cards arrive within 7-10 days.
Reminder: Healthcare FSA Debit Card: As soon as you activate your debit card, the automatic reimbursement option, available to PACCAR Plans through Premera Blue Cross, will be turned off for you. If you want to switch back to automatic reimbursement, you can turn it back on by logging into your HealthEquity account through mybenefits.paccar.com.
REMEMBER! WITH A TAX ADVANTAGED ACCOUNT: You have to enroll every year during the annual Open Enrollment.
CONSIDER A TAX ADVANTAGED ACCOUNT
Teladoc provides a variety of telemedicine services, including general medical and mental health from the comfort of home. You can even get a prescription sent to your local pharmacy, if medically necessary.
Get StartedDownload the free Teladoc app or call 1-855-332-4059.
Find the best doctors in your network
Grand Rounds Health can help you:• Find a top-rated doctor who’s
in-network, nearby and accepting new patients
• Get an expert second opinion• Answer your difficult medical
questions.
Get StartedDownload the free Grand Rounds Health app, visit grandrounds.com/PACCAR, or call 1-855-PACCAR-9 between 8am - 9pm ET.
Consult with a nurse by phone to discuss symptoms and where to go for care.
Get StartedThe phone number is at the back of your Premera Blue Cross ID Card.
Your call is free and confidential at1-888-PACCAR-5.
TELADOC GRAND ROUNDS 24-HOUR NURSELINE
13 U.S. Salaried Employees
SPECIAL FEATURES OF THE PACCAR PREMERA MEDICAL PLAN
14
KEY POINTS
U.S. Salaried Employees
Omada is a lifestyle change program to help you lose
weight, gain energy and reduce the risk of type 2 diabetes and
heart disease.
omadahealth.com/paccar
Livongo provides diabetes management tools including
a connected device, test strips and lancets, all delivered
to your home.
join.livongo.com/paccar
Virta is a clinically-proven treatment to control type
2 diabetes by reducing blood sugar and A1c levels,
eliminating the need for medication.
virtahealth.com
14
PACCAR supports you in the prevention and management of prediabetes and diabetes with these programs.
All at no additional cost to you and your dependents enrolled in a PACCAR Medical Plan administered by Premera Blue Cross.
PREVENT MANAGE CONTROL
DIABETES PROGRAMS PART OF YOUR PACCAR PREMERA MEDICAL PLAN
DISCOUNTS OFFERED THROUGH MAGELLAN/LIFE MART
Access real savings on real life needs• Car buying and services • Child and elder care • Financial and legal products • Furniture, appliances, electronics and more
Access the Magellan Healthcare Discounts: 1. Go to MagellanAscend.com. 2. Click on “Find My Company/Log In.” 3. Find your division in the drop-down menu, or select
“PACCAR Inc” if you cannot find your division then click on “Go.”
4. On the Magellan homepage under “Explore” click on the Discount Center
Questions? Call Magellan Healthcare at 1-800-523-5668
15 U.S. Salaried Employees
1-800-523-5668MagellanAscend.com
The Employee Assistance Program (EAP) is available to you and your household members even if you’re not enrolled in a PACCAR health plan. Get started today. Call your EAP at 1-800-523-5668 or visit MagellanAscend.com
EMPLOYEE ASSISTANCE PROGRAM (EAP)
KEY FEATURES• Up to 5 free counseling
sessions• Confidential services
provided by a third party• Available 24/7/365
COUNSELING • Get help with anxiety, grief,
depression, relationships and more
• Counselors are available in-person, by text, live chat, phone or video
LIFESTYLE COACHING• Your coach helps you
develop action-based solutions and remain accountable
• Coaches are available by phone or video
SELF-CARE PROGRAMS• Emotional wellness
coaching apps help you reduce stress, build resilience and improve sleep
• Programs are personalized
PACCAR EMPLOYEE ASSISTANCE PROGRAM
16 U.S. Salaried Employees
PACCAR EMPLOYEE ASSISTANCE PROGRAM
Free Employee Assistance Program Apps
myStrength
Available to All Employees and Families via Magellan
myStrength is a digital self-care program that has 30-plus topics and thousands of activities to help you live your best life.
Get Started:• Go to magellanascend.com• Click the blue
“Find My Company/Log In”• Enter “PACCAR Inc” or select your
division from the drop-down list• In the “Explore” section, click on the
“Self-Care Programs” icon• Click on “Get Started”
BetterHelp is confidential virtualtherapy and offers an alternative form of traditional, in-person counseling.
Sessions are available via:• Text messaging• Live phone chat• Live video chat• Live chat session
To get started, go tobetterhelp/magellan and click on“Get Started” or call 800-523-5668.
PACCAR MEDICAL PLAN (PREMERA) � In-Network Directory: premera.com, then select “Find a Doctor” or call Grand Rounds 855-PACCAR-9
� 888-PACCAR-5 (888-722-2275) for: • Premera Customer Service (M-F 5am-8pm Pacific Time)
• Medical/Dental/Vision/Prescription Plan Information (including PillPack)
• 24-Hour Nurseline• Teladoc• Omada • Livongo• Virta Health• PACCAR Designated Centers of Excellence
GRAND ROUNDS HEALTH 855-PACCAR-9 GRANDROUNDS.COM/PACCAR
FLEXIBLE SPENDING ACCOUNT (FSA) � HealthEquity.com (formerly WageWorks) � HealthEquity Customer Service: 877-924-3967
HEALTH SAVINGS ACCOUNT (HSA) � 401k.com � Fidelity Customer Service: 800-835-5098
DEPENDENT CARE REFERRAL SERVICES � MagellanAscend.com � Magellan 24 Hour Support: 800-523-5668
TOBACCO CESSATIONQuit For Life Program � Quitnow.net � Customer Service: 866-QUIT-4-LIFE (866-784-8454)
EXPERIAN FREE CREDIT MONITORING � Premera.com (log into your account) � Customer Service: 888-PACCAR-5 (888-722-2275)
PACCAR LIFE AND AD&D � MetLife Customer Service: 800-638-6420 � Travel Assistance Services• webcorp.axa-assistance.com
• Username: axa• Password: travelassist
• AXA Customer Service:• US: 800-454-3679• International: 312-935-3783 (collect)
EMPLOYEE DISCOUNTS � Magellan - MagellanAscend.com � PACCAR - mybenefits.paccar.com
EMPLOYEE ASSISTANCE PROGRAM (EAP) � MagellanAscend.com � Magellan Customer Service: 800-523-5668
INTERNATIONAL SOS � Internationalsos.comPACCAR Member #: 11BYCA529386
� Customer Service (from US): 215-942-8226
Detailed plan information is provided in the Employee Handbook available on mybenefits.paccar.com17 U.S. Salaried Employees
HELPFUL WEBSITES AND PHONE NUMBERS
18 U.S. Salaried Employees
NOTICESIf you would like to request a special enrollment or obtain more information, go to mybenefits.paccar.com and select Update Benefits. You may also contact Human Resources or the Corporate Benefits Department.
Notice of Privacy PracticesThe HIPAA (Health Insurance Portability and Accountability Act of 1996) privacy regulations protect your rights regarding the use and disclosure of Protected Health Information. The PACCAR Plan Notice of Privacy Practices describes how your plan may use or disclose your health information and your rights with regard to this information.
To obtain a copy of this notice, go to mybenefits.paccar.com, contact your Human Resources representative or the PACCAR Privacy Officer, Corporate Benefits Department, PACCAR Inc, 777 106th Ave NE, Bellevue, WA 98004, (425) 468-7440.
Patient Protection DisclosureIf a medical benefit option offered under the PACCAR Health Plans requires or allows the designation of a primary care provider, you have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. If the medical plan option designates a primary care provider automatically, the Plan will designate one for you until you make a designation. For information on how to select a primary care provider, and how to obtain a list of the participating primary care providers, please refer to the applicable certificate of coverage or Summary Plan Description (SPD). For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from the Plan Administrator or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a healthcare professional in the benefit networks who specializes in obstetrics or gynecology. The healthcare 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. You can locate healthcare professionals who specialize in obstetrics or gynecology by contacting the Plan Administrator.
Post-Mastectomy BenefitsThe PACCAR Medical Plans provide coverage for the following post-mastectomy services in a manner determined in consultation with the attending physician and the patient:
� Reconstruction of the breast on which the mastectomy had been performed;
� Surgery and reconstruction of the other breast to produce a symmetrical appearance;
� Prostheses; and � Physical complications of all stages of mastectomy,
including lymphedemas.
These benefits are provided to any covered individual who receives mastectomy-related services subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this Plan.
For more information, call Premera Customer Service at 888-PACCAR-5 (888-722-2275).
Special Enrollment Rights6 (Qualifying Life Event) If you are declining enrollment for yourself or your dependents (including your spouse) because you have other health insurance coverage, you may be able to enroll yourself and your dependents at a later date.
� If you or your dependents lose eligibility for other group health coverage (or if the employer stops contributing toward your or your dependents’ other coverage), you may be able to enroll yourself and your dependents if you request enrollment online within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
� 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 dependents, provided that you request enrollment online within 30 days5 after the marriage, birth, adoption or placement for adoption.
� If you or your dependents lose coverage under Medicaid or the Children’s Health Insurance Program (CHIP) because of ineligibility or become eligible for state premium assistance (under Medicaid or CHIP) for a PACCAR Medical Plan, you may be able to enroll yourself and your dependents if you request enrollment online within 60 days from the date of the qualifying Medicaid or CHIP event.
Newborns’ and Mothers’ Health Protection Act (NMHPA)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 issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Genetic Information Nondiscrimination Act (GINA)Among other safeguards, GINA prohibits an employer from discriminating against employees on the basis of genetic information and limits a Plan’s ability to acquire or monitor genetic information except as expressly provided in the Act. As with other compliance duties, the Plan and Employer will satisfy all applicable laws and regulations related to GINA requirements.
Pregnancy Discrimination ActThe Pregnancy Discrimination Act (PDA) forbids discrimination based on pregnancy when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, such as leave and health insurance, and any other term or condition of employment.
CARES Act The Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The Act allows over-the-counter (OTC) drugs and medicines without a prescription, along with feminine hygiene products purchased on or after January 1, 2020, to be eligible for healthcare flexible spending account (FSA) & Health Savings Account (HSA) reimbursement.
CARES Act Hub The HealthEquity CARES Act Hub will be updated as new information is available, we encourage you to visit this website today and bookmark it for future reference, healthequity.com/cares.
6 The deadlines summarized in this section have been extended during the COVID-19 National Emergency, see page 19.
19 U.S. Salaried Employees
USERRACoverage During Military LeaveUnder a federal law called the Uniformed Services Employment and Reemployment Rights Act (USERRA), if you are absent from work because of service in the uniformed services, you can continue health coverage for yourself and your dependents.
How Coverage WorksDuring a military leave that is expected to be 30 days or less5, your current employee coverage will continue without interruption, assuming you pay the normal share of premiums for the coverage. Regarding benefits during your period of paid military service leave (up to one year), see the section below titled “Benefits While on Military Service Leave.” If your military leave is expected to be longer than one year, you are entitled to continue health, dental, and vision benefits for you and your dependents under both USERRA and COBRA.
USERRA expands on your COBRA continuation coverage rights in the following ways:• You can continue coverage for yourself and for any dependent who is covered when your service in the uniformed services
begins.• Coverage extends for the length of active service or 24 months, whichever is less. Note that COBRA coverage may extend
beyond 24 months in some cases, depending on the type of qualifying event.• Coverage costs for disabled dependents cannot exceed 102% of the COBRA premium while you are entitled to USERRA
continuation coverage.• Your USERRA coverage is not required to end if you or a covered dependent becomes covered under another health plan.
Paying for CoverageIf you or your covered dependents choose coverage under USERRA, you or the dependents must pay monthly premiums for the coverage.
Benefits While on Military Service LeaveWhile on paid military service leave, you may maintain the health, dental, and vision benefits in which you were enrolled before your military service leave by paying your normal share of premiums for coverage. Short and long-term disability coverage will continue during a paid military service leave for up to 26 weeks.
After your paid military service leave ends, you will not be eligible to participate in the employer’s health, dental, and vision benefits. However, you may elect continuation coverage under USERRA (which, in general, is coverage similar to COBRA continuation coverage) for up to 24 months.
You also may be eligible to continue life insurance and other benefits at your own expense, if permitted by the plan terms and applicable law. All benefits are subject to the terms and conditions of the plans, which may include coverage limits (for example, a war exclusion).
COVID-19 COMPLIANCE UPDATES COVID-19 Related Benefit Changes Federal Regulations & Guidance to Implement Recent Congressional Acts deductibles, copays and coinsurance are waived for COVID-19 diagnostic testing covered with cost-sharing waived for insured plans and ERISA group plans. Antibody testing is considered “COVID-19 diagnostic testing” in certain situations.
Deadline Extensions Due to the COVID-19 National Emergency, the Internal Revenue Service (IRS) and the Department of Labor (DOL) have temporarily extended certain benefit deadlines. The temporary deadline for any of the items below is determined by ignoring the “Outbreak Period”. The Outbreak Period started on March 1, 2020 and runs through at least 60 days after the COVID-19 National Emergency ends. The official end of the Outbreak Period has yet to be announced.
Extended deadlines have been provided for the following items: • Qualifying life events notification and enrollment changes
(e.g. marriage, birth, divorce). • COBRA election period and COBRA premium payment
period. • The date you must inform PACCAR of a divorce, legal
separation, disability or dependents losing eligibility for COBRA purposes.
• The filing of benefit claims and appeals deadlines (e.g. this means you have longer to submit 2019 and 2020 FSA claims for reimbursement).
In addition, deadlines related to COBRA eligibility, election period and premium payment have been extended.
NOTICES
20 U.S. Salaried Employees
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).
CHIP NOTICESIf 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, 2021. Contact your State for more information on eligibility.
Alabama - Medicaid
Website: http://myalhipp.com/Phone: 1-855-692-5447
Alaska - Medicaid
The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.comMedicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Arkansas - Medicaid
Website: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)
COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)
Health First Colorado Website: https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center:1-800-221-3943/ State Relay 711CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plusCHP+ Customer Service: 1-800-359-1991/ State Relay 711
Florida - Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/Phone: 1-877-357-3268
Georgia - Medicaid
Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162 ext 2131
Indiana- Medicaid
Healthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: http://www.indianamedicaid.comPhone 1-800-403-0864
Iowa - Medicaid
Website: http://dhs.iowa.gov/HawkiPhone: 1-800-257-8563
Kansas - Medicaid
Website: http://www.kdheks.gov/hcf/Phone: 1-785-296-1500
Kentucky - Medicaid
Website: https://chfs.ky.govPhone: 1-800-635-2570
Louisiana - Medicaid
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-342-6207
Massachusetts - Medicaid and CHIP
Website: http://www.mass.gov/eohhs/gov/departments/masshealth/Phone: 1-800-841-2900
Minnesota - Medicaid
Website: https://mn.gov/dhs/partners-and-providers/news-initiatives-reports-workgroups/minnesota-health-care-programs/spa.jspPhone: 1-800-657-3739
21 U.S. Salaried Employees
CHIP NOTICESMissouri - Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 1-855-373-4636
Nebraska - Medicaid
Website: http://www.ACCESSNebraska.ne.govPhone: (855) 632-7633Lincoln: (402) 473-7000Omaha: (402) 595-1178
Nevada - Medicaid
Medicaid Website: https://dhcfp.nv.govMedicaid Phone: 1-800-992-0900
New Hampshire - Medicaid
Website: https://www.dhhs.nh.gov/oii/hipp.htmPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext 5218
New Jersey - Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710
New York - Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831
North Carolina- Medicaid
Website: https://medicaid.ncdhhs.gov/Phone: 919-855-4100
Oklahoma - Medicaid
Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742
Oregon - Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075
Pennsylvania - Medicaid
Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htmPhone: 1-800-692-7462
South Carolina - Medicaid
Website: https://www.scdhhs.govPhone: 1-888-549-0820
Texas - Medicaid
Website: http://gethipptexas.com/Phone: 1-800-440-0493
Utah - Medicaid and CHIP
Medicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669
Virginia - Medicaid and CHIP
Medicaid Website: https://coverva.org/Medicaid Phone: 1-855-242-8282CHIP Website: https://www.insurekidsnow.gov/coverage/va/index.htmlCHIP Phone: 1-877-543-7669
Washington - Medicaid
Website: https://www.hca.wa.gov/Phone: 1-800-562-3022 ext. 15473
West Virginia - Medicaid
Website: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
Wisconsin - Medicaid
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002
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