SCANA Corporation 2016 Benefits · 2016-09-06 · Your Benefits. Your Choice. 1 Aim for your best health Every year, SCANA evaluates how to manage the ever-increasing cost of health

SCANA Corporation

2016 BenefitsEffective January 1, 2016

This guide serves as the Summary of Material Modifications describing the changes made to the SCANA Corporation Health and Welfare Plan and the Flexible Benefits Plan. This guide should be kept with a copy of the applicable summary plan description that was provided to you and which can be found on The Edge. The details of these plans are contained in the official plan documents, including some insurance contracts. The plans are subject to and governed by applicable federal laws and regulations, principally those administered by the Internal Revenue Service and the Department of Labor. SCANA reserves the right at will to change or terminate any of the benefits offered by the Plan, or the Plan itself, as allowed by applicable law. For details on benefits, you are encouraged to view the benefits summaries on the open enrollment website found on The Edge.

It’s a big decision. Who will you turn to when you have a nagging health problem, a sick

child or symptoms that might be serious — or might not? The online Doctor and Hospital

Finder makes the decision a little easier.

You can search by city or ZIP code for providers near your home or work. Or narrow your search to find providers in certain specialties, such as pediatricians or allergists.

If you already have a doctor’s name, you can see whether he or she is in your network. You can even do an advanced search for providers who match your gender or language preferences.

Other tools, such as quality reports and patient reviews, provide extra insight about the doctors and facilities you’re considering. It’s worth taking a little time to check them out — and make sure you end up with exactly the kind of health services you want and need.

Find the right doctor, choose the right care

To use the Doctor and Hospital Finder, log in to your My Health Toolkit account. Select the Resources tab, then click Find a Doctor or Hospital.

Find other in-network providers• To locate a dentist near you, log in to your My Health Toolkit

account. Select the Resources tab, click Find a Doctor or Hospital, then click the Dental Directory link.

• To locate an in-network pharmacy, log in to your My Health Toolkit account. Select the Benefits tab, then click Find a Pharmacy.

Your Benefits. Your Choice. 1

Aim for your best health

Every year, SCANA evaluates how to manage the ever-increasing cost of health

care while offering quality benefits at an affordable price. We make necessary

adjustments in order to remain compliant with health care reform laws, manage

the continuing increase in health care claims, and offer coverage that is

comparable to our market and industry peers.

As you consider your 2016 benefit options, I encourage you to conduct your

own personal evaluation to find any opportunities to better manage your health

care costs. Here are some suggestions:

• Take advantage of an HSA. A health savings account is a great way to save for inevitable out-of-pocket

costs, while enjoying some tax advantages.

• Use BlueCross in-network providers as much as possible. You’ll enjoy discounted rates and avoid balance

billing by a provider.

• Ask for generic prescriptions. And check SCANA Pharmacy’s free preventive generic list to see if it in-

cludes your maintenance medication for a chronic illness.

• Get preventive screenings and have wellness visits, which are 100% covered.

• If treatment, hospitalization or tests are required, do the research to compare costs and quality of care –

just like you would do for any other major expense.

• Use SCANA’s health coaching services if you need help developing healthier lifestyle habits.

• Contact Ernst & Young financial planners – free of charge – for advice on adequate levels of income

replacement coverage or to look at cash flow and how to make an HSA work for you.

Take a close look at the benefits presented in this book and make sure you understand them so that you get

the most from your investment. If you have any questions, be sure to call on the resources provided.

When it comes to managing health care, we all have a role to play to ensure we make good decisions that

support our best health.

Stay well,

Kevin Marsh

SCANA Chairman & Chief Executive Officer


How to Enroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

What you need to know now . . . . . . . . . . . . . . . . . . . . 5Overview of SCANA Choice plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Prescription Drug Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Vision Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Dental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

HSA and FSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Discount Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Life, Accident and Disability Insurance . . . . . . . . . . . . . . . . . . . . . . . . 22

Employee Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Required Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Summary of Benefits and Coverage . . . . . . . . . . . . . . . . . . . . . . . . . 36

Dependent Change Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Life Insurance Beneficiary Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Caremark Mail Service Order Form . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Enrollment Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Contents

Your Benefits. Your Choice.4

Use this guide to review your benefit options and determine the coverage you want to elect.

Then log on to PeopleSoft to enroll using your checklist from page 53.

How to enroll online for your 2015 benefits1. Access The Edge from a work computer or home (only if you have an Entrust token). If you need to reset your network

password, call the IST Help Desk at 803-217-7655 and select option 1.

a. From a work computer, click on The Edge and select either the 2016 Benefits Open Enrollment promotion image at the top of the page or the PeopleSoft Hub link.

b. From a home computer, go to https://remote.scana.com and log in with your user ID, password and Entrust token. On the Juniper home page, select The Edge and then follow the directions above for accessing online enrollment.

2. Log in to PeopleSoft using your user ID and your network password.

a. If you selected the 2016 Benefits Open Enrollment promotion image, you will be redirected to the online enrollment page.

b. If you selected the PeopleSoft Hub link, click on the Benefits Enrollment link under Announcements.

3. Make your benefit elections.

4. If you don’t have an existing health savings account (HSA), complete the HSA authorization form to begin the process of opening your account.

5. Establish pretax payroll deductions for HSA or FSA. (You can have a dependent care FSA and HSA, but you cannot have a health care FSA and HSA.)

6. Review your dependent/beneficiary information for accuracy. If you need to make a change, contact the benefits team (803-217-4444) and provide the required documentation. (See pages 47-49 for forms.)

7. If you plan to cover your spouse, certify that he/she does not have access to employer group medical coverage elsewhere.

8. Review your selections.

9. Press “Submit” to complete your transaction.

10. Print your summary of benefit elections. (Note: Printing from home is not available.)

11. You can make changes to your elections until 11:59 p.m. Friday, October 23, 2015.

12. All employees will receive benefit confirmation statements via interoffice mail following the close of open enrollment.


What you need to know nowThere are many resources available to help you make decisions about your 2016 benefits. Refer to the resources on the inside back cover of this book.

Overview of benefits changes, effective January 1, 2016

• Vision will become a separate election from medical, and you can cover your spouse and/or dependents (to age 23), even if they aren’t eligible for coverage under SCANA’s medical plan. See pages xx-xx.

• There will be a slight increase in medical plan premiums, ranging from $.22 - $1.37 per pay period, depending on level of coverage. See page 7 for details.

• Spouses with access to other employer-sponsored group coverage will not be eligible for coverage under SCANA’s medical plan. A spousal coverage affidavit must be submitted if you plan to cover your spouse in 2016.

• The Standard will be SCANA’s new life insurance benefit administrator. Optional life insurance rates will decrease by 5 percent. Employees who currently have supplemental life insurance coverage have a one-time opportunity during 2016 open enrollment to increase their level of coverage by 1x without providing Evidence of Insurability.

• The optional premiums for supplemental short- and long-term disability will convert to a salary-based rate of $.30 per $100 for all employees, regardless of tenure. See pages 20-21 for details.

• In 2017, the Long-Term Disability Share medical plan will transition to the marketplace, without a SCANA subsidy. SCANA will pay Allsup to assist LTD participants in finding marketplace options and applying for premium subsidies.

If you have questions about any of these changes, contact SCANA’s benefits team at 803-217-4444.


The SCANA Choice plan is a consumer-driven health plan featuring affordable premiums.

In this plan, your medical and prescription costs combine to satisfy the deductible and

out-of-pocket maximum.

As a participant in the SCANA Choice plan, you may be eligible to open a health savings account through HSA Bank to contribute pretax dollars through payroll deduction*. SCANA also contributes seed money: $400 for individual coverage and $800 for any level of family coverage into your HSA account. The account is yours to use for paying medical expenses as they occur or to save for future needs, like medical expenses in retirement. You may even use the account to pay qualified medical expenses for your spouse who may be covered under another plan, as long as your spouse doesn’t have a health care flexible spending account (FSA).

Prescription coverage is included when you elect medical coverage through SCANA, and preventive services are provided at 100 percent coverage when an in-network provider is used.

* Individuals enrolled in TRICARE or Medicare, or who have received VA medical benefits in the previous 90 days, are ineligible to make HSA contributions.

2016 SCANA Choice Plan In Network Out of NetworkPreventive Care 100% Coverage Deductible and coinsurance apply

Deductible $1,500 Individual $3,000 Family

$3,000 Individual $6,000 Family

HSA Seed Money $400 individual/$800 family

Medical care – Inpatient, Outpatient 20% after deductible 40% after deductible

Emergency/Urgent Care/Ambulance 20% – after deductible

Annual Out-of-Pocket MaximumDeductible & Coinsurance

$3,000 Individual $6,000 Family Includes Rx

$6,000 Individual $12,000 Family Includes Rx

Overview of SCANA Choice plan

New BlueCross ID cards will be issued by early 2016 for all participants who elect vision coverage or change their election for medical or dental coverage. You may use existing cards until the new ones arrive, but discard them once you receive the new cards in order to have accurate information.


• In-network providers are required to precertify all hospital admissions, outpatient surgical procedures and some radiological imaging. In-network providers incur a penalty for non-emergency services that are not precertified.

• If you use an out-of-network provider, precertification is your responsibility, and you are responsible for paying the penalty if you fail to precertify. See Summary of Benefits and Coverage for more details.

• You may request additional BlueCross ID cards online at www.SouthCarolinaBlues.com or by calling Member Services toll free at 877-705-5428.

• If your spouse has medical coverage through Medicare, TRICARE, VA, a trade or professional association, or an individually purchased plan, you may cover him/her on SCANA’s plan.

Things to note

Understanding Choice Plan Deductibles and Out-of-Pocket Maximums• Preventive care is covered 100%, regardless of deductible.

• The deductible ($1,500/individual; $3,000/family) must be met before SCANA pays any portion of non-preventive care claims.

• One member of the family can meet the entire family deductible.

• Prescription benefits are not paid by SCANA until the Choice plan deductible is met, with the exception of certain preventive generic drugs through the SCANA Pharmacy.

• Both medical and prescription claims count toward the deductible and toward out-of-pocket maximums.

• Vision and dental expenses do not contribute to the deductible.

2016 Choice Medical Plan Premiums

Plan Employee Only Employee/Spouse Employee/Dependents Employee/Family

SCANA ChoicePer Pay $9.45 $35.46 $31.91 $59.10

Annual $245.70 $921.96 $829.66 $1,536.60

If you are adding a dependent, see form on page 47.


2016 Prescription Benefits

SCANA PharmacyIn Network

Retail or Mail OrderPer Rx

Out-of-Pocket MaximumEmployee pays amounts below after deductible is met.

Preventive Generic Medications1 (not subject to deductible) Free 30%

$100/31-day $250/90-dayNon-preventive Generic Medications

and Preferred Brand Medication 25% 30%

Non-Preferred Brand 50% None

Specialty Medications 31-day supply only

Caremark2 Pharmacy ONLY 50% $250/31-day

90-day Prescriptions: Only available at the SCANA Pharmacy or Caremark Mail Order Pharmacy.

Out-of-Network Benefits: Available with 50% coinsurance for generic and preferred brand only.

1 Specific generic medications included can change from time to time without notice. 2 Caremark is an independent company providing specialty pharmacy services and prescription drug benefits on behalf of BlueCross.

Prescription benefits are automatic in the SCANA Choice plan. You pay negotiated

prescription costs in full until your deductible is met (except certain preventive generics

through SCANA Pharmacy), and these costs count toward your deductible.

DRUG CARD PRESCRIPTION DRUG COVERAGE

With more than 64,000 network pharmacies to choose from, it’s easy to find one that’s near you. At network pharmacies, the pharmacist will use a computer to check your eligibility for benefits and to determine the amount you will pay for prescriptions. If you don’t present your ID card or don’t use a network pharmacy, you’ll have to file a claim and you may not be reimbursed for the full amount you paid. Please see the benefits summary listed in this booklet to determine the amounts you pay for your prescriptions.

SPECIALTY DRUGS

Specialty drugs treat conditions such as cancer, hepatitis, multiple sclerosis or rheumatoid arthritis, just to name a few. The exclusive provider for specialty drugs is Caremark. Visit The Edge for a list of specialty drugs. You may contact Caremark at 888-963-7290.

MAIL-SERVICE PROGRAM

Caremark Mail Order Pharmacy is convenient and can save you money if you take prescription drugs on a regular basis. You’ll receive up to a 90-day supply of your prescription drugs at one time with free standard shipping. Getting started is easy! Use the form in the back of this booklet.

GENERIC DRUGS SAVE YOU MORE

Choosing generics is an excellent way to save money! With generic drugs, you get the same quality as brand-name drugs at a lower cost. Ask your doctor if generics are right for you.

OVER-THE-COUNTER

Except for liquid Zantac and nicotine replacement, medications available over-the-counter, regardless of strength or formulation, are not covered by the prescription benefit.

Convenience and savings


DENTAL PLAN HIGHLIGHTS AND RATES

When you go to the dentist, present your BlueCross ID card to make sure the dentist applies your benefits correctly.

With BlueCross dental benefits, you receive benefits whether or not you and your eligible

dependents visit an in-network dentist. When you visit an in-network dentist, you’ll enjoy

lower out-of-pocket expenses as our providers have agreed to lower their fees. And you

won’t be balance-billed for charges above the allowable amounts.

Dental coverage for you and your family

Benefits Comprehensive PlanCalendar Year Maximum (Class I, II and III expenses) $1,500 per person

Annual DeductibleIndividual/Family $50 per person/$150 per family

Reimbursement Levels Based on Reasonable and Customary Allowances

Class I - Preventive & Diagnostic Care• Oral Exams (Two per year)• Routine Cleanings (Two per year)• Full Mouth X-rays or Panoramic X-ray (One every three years) • Bitewing X-rays (Two per year)• Fluoride Application (Two per year)• Sealants (Limited to posterior tooth for a person age 6-18/One treatment per tooth every three years) • Space Maintainers (Limited to non-orthodontic treatment)• Emergency Care to relieve pain

No charge

Class II - Basic Restorative Care Fillings, Root Canal Therapy, Osseous Surgery, Dental Consultation, Periodontal Scaling and Root Planing Denture Adjustments and Repairs, Extractions, Oral Surgery (Surgical removal of impacted wisdom teeth is covered under the Medical Plan)

You pay 20% after deductible

Class III - Major Restorative CareCrowns, Dentures, Bridges, Dental Implants (up to plan maximum)


Class IV – Orthodontia (Limited to dependent children under the age of 19) $1,500 lifetime limit (payments made monthly)


Pretreatment review is suggested when dental work in excess of $300 is proposed. Have your provider send an undated claim form along with the proposed treatment plan to BlueCross for a pretreatment estimate to be sent to you and your dentist detailing what services your plan will cover and how much it will pay.

2016 Dental Plan Premiums

Plan Employee Only Employee/Spouse Employee/Dependents Employee/Family

Comprehensive Per Pay $3.59 $7.64 $6.82 $10.76


To find locations near you, visit www.EyeMedVisionCare.com or call Member Services toll free at 866-723-0513. Identify yourself as a member by presenting the BlueCross ID card provided to you. You pay the provider directly for purchases that exceed the covered allowed amounts.The provider files the claim on your behalf.

Vision benefits through EyeMed Vision Care are a separate election from the SCANA Choice medical plan.

Employee Only

Employee/Spouse

Employee/Dependents

Employee/Family

Per Pay Period $0.91 $1.74 $1.83 $2.69

Annual Cost $23.76 $45.14 $47.52 $69.88

OUT-OF-NETWORK REIMBURSEMENTS

If you visit an out-of-network provider, you are responsible for paying the provider in full at the time of service. You will need to submit a claim form for reimbursement. To get a claim form, call Member Services at 866-723-0513 or visit our website.

EXAMS, CONTACTS AND GLASSES

You are eligible for a comprehensive eye exam and standard lenses or contacts once every 12 months (from last visit/purchase) from a participating provider.

You have a $135 allowance to purchase frames once every 24 months (from last purchase). If your frames or contacts cost more than the $135 allowance, you are responsible for paying the remaining balance.

With your vision benefit through EyeMed, you have access to a national network of providers,

including LensCrafters, Target Optical, most Pearle Vision and Sears Optical locations, and

many independent doctors of optometry. EyeMed Vision Care is an independent company

that offers vision benefit programs on behalf of BlueCross. With thousands of locations to

choose from, you are certain to find a provider close to your home or office that offers

appointment times convenient for you.

Benefits are valid once per benefit period. Once you have used your in-network benefits, unlimited pairs of eyeglasses and contacts are available at discounted prices through a participating provider. See provider for details. Benefits and/or discounts cannot be used in conjunction with other discounts, coupons or promotions. This information is intended as a summary of benefits only. It does not describe all the terms, provisions and limitations of your plan. Participating providers are independent contractors solely responsible for vision examinations and products. Locations are subject to change. Please call 866-723-0513 to verify participation.

See the savings


Vision Care Services Member Cost Out-of-Network ReimbursementExam with Dilation as Necessary Covered in full $60

Exam Options

Standard Contact Lens Fit and Follow-Up Up to $55N/A

Premium Contact Lens Fit and Follow-Up 10% off retail price

Frames

Any available frame at provider location $135 allowance, 20% off balance over $135 $82

Standard Plastic Lenses

Single Vision/Bifocal /Trifocal /Lenticular Covered in full $78/$97/$107/$150

Standard Progressive Lens Covered in full $149

Premium Progressive Lens 80% of charge less $120 allowance $149

Lens Options

UV Treatment/Tint (Solid and Gradient) /Standard Plastic Scratch Coating $15

N/A

Standard Polycarbonate - Adults $40

Standard Polycarbonate - Children under 19 $0

Standard Anti-Reflective Coating $45

Polarized/Other Add-Ons 20% off retail price

Contact Lenses (Contact lens allowance includes materials only)

Conventional $135 allowance, 15% off balance over $135 $125

Disposable $135 allowance, plus balance over $135 $125

Medically Necessary Covered in full $210

Laser Vision Correction

Lasik or PRK from U.S. Laser Network 15% off retail price or 5% off promotional price

N/A

Additional Pairs Benefit Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the funded benefit has been used.

N/A

Frequency

Examination/Lenses or Contact Lenses Once every 12 months

Frame Once every 24 months

Either standard lenses or contact lenses are covered every calendar year; not both.

Plan Exclusions:1) Orthoptic or vision training, subnormal vision aids and any associated supplemental

testing; Aniseikonic lenses 2) Medical and/or surgical treatment of the eye, eyes or supporting structures3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder

as a condition of employment; Safety eyewear4) Services provided as a result of any Workers’ Compensation law, or similar legislation,

or required by any governmental agency or program whether federal, state or subdivisions thereof

5) Plano (non-prescription) lenses and/or contact lenses

6) Non-prescription sunglasses7) Two pair of glasses in lieu of bifocals8) Services or materials provided by any other group benefit plan providing vision care9) Services rendered after the date an Insured Person ceases to be covered under the Policy,

except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order

10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available

Vision benefits


HEALTH SAVINGS ACCOUNT (HSA)

• To contribute to an HSA you must be enrolled in the Choice plan. You cannot be enrolled in Medicare, Medicaid, TRICARE or have received VA medical benefits in the past three months.

• You must have an account with HSA Bank to receive your seed money and take advantage of payroll deduction for your contribution.

• You cannot have both an HSA and a health care FSA.

• If you enroll in Medicare after turning age 65, you can no longer contribute to an HSA, and the annual contribution limit is prorated.

• The maximum amount you can contribute to an HSA is prorated by the number of months you are enrolled in the Choice plan for the year.

• SCANA will contribute $400 for individual and $800 for family coverage to new and re-enrolling HSAs. The money will be available in all accounts opened at HSA Bank as of January 4, 2016.

• You cannot use your HSA funds for over-the-counter medications and supplies, unless you have a prescription.

• For tax-free reimbursement of medical expenses for dependents, the dependent must otherwise qualify as a tax dependent of the account holder. Consult your tax adviser for more details.

• The penalty for nonqualified HSA withdrawals is 20 percent.

HEALTH CARE FSA

• Available to employees who waive SCANA coverage or who are not eligible to contribute to HSA.

• Health care FSA balances up to $500 carry over at the end of the calendar year.

• Most over-the-counter medications and supplies are not covered by FSA funds, unless you have a prescription.

See next page for a chart summarizing HSAs and health care FSAs.

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (FSA)

• All employees may elect to enroll and contribute to a dependent care FSA, regardless of whether you participate in SCANA’s medical plan.

• Funds can be used for eligible day care, after-school and elder care expenses and programs.

• Receipts must be submitted for reimbursement.

• Minimum contribution amount per year is $50 and the maximum amount is $5,000.

SCANA offers three types of optional accounts for you to make pretax contributions to help

with health care or dependent care expenses. The IRS determines the maximum amount

of money that can be contributed each year and maintains the list of qualified expenses.

Always keep your receipts so you can verify, if audited, that your purchases were allowed.

If you want to establish an optional account, you must log in to PeopleSoft and enroll

during this open enrollment period. The three account types are:

HSA and FSA

For HSAs • Seed money will be prorated based on

when the HSA is opened: Q1 = $400/$800; Q2 = $300/$600; Q3 = $200/$400; Q4 = $100/$200.

• Seed money cannot exceed $800 per family (includes spouses who both work at SCANA).

For Health Care FSAs • Annual maximum contribution is $2,500.


HSA Health Care FSA

Description Actual bank account owned by employee that allows saving and paying for qualified medical, dental and vision expenses tax-free

Spending account that allows employee to pay for qualified medical, dental and vision expenses tax-free

Medical plan eligibility Choice Plan • Choice Plan, but ineligible to contribute to HSA • Waive coverage

Interest earning Yes No

SCANA contribution Seed money ($400/$800)* None

Annual maximum contribution $3,350 single; $6,750 family** $1,000 catch-up if eligible (age 55+)

$2,500 ($50 minimum)

Access funds Debit card, checks or Internet banking Debit card or submit receipts

Account balance carryover Balance rolls from year to year Balances up to $500 carry over at year end

Portability Account is owned and retained by employee upon termination

Employee generally forfeits balance upon termination

Availability of funds Funds must be in account to use Annual designated amount available for use January 1

Contributions Payroll deduction amount set during open enrollment period and changes can be made throughout year via PeopleSoft Self Service; other after-tax contributions can be made via check/money order

Annual amount determined during open enroll-ment and can only be changed after qualifying event (marriage, birth, death, etc.)

Administered by HSA Bank (see page 16) WageWorks (see page 19)

* Amount prorated based on date account is opened. ** Amount prorated based on the number of months you are enrolled in the Choice plan for the year.

For more information, refer to the FSA and HSA information on The Edge, visit the IRS website for rules and regulations, or consult your tax adviser.

Understanding the differences between HSAs and FSAs


What is an HSA?Health savings accounts (HSAs) work in combination with an HSA-compatible health plan. The HSA allows you to contribute funds on a pretax or tax-deductible basis, which you may use to pay for eligible medical expenses.

What are the advantages of an HSA?• Funds Roll Over Annually

There is no “use it or lose it” rule. If you don’t use your funds, you can save them for future, eligible medical expenses.

• Tax Advantages An HSA provides you triple tax savings: pretax funds can be used to contribute to your account; tax-free earnings through investment; and tax-free withdrawals for qualified medical expenses.

• You Own the Account Even if your HSA-compatible coverage ends, you can still use your HSA funds tax-free for eligible medical expenses.

• Additional Retirement Savings After age 65, you can withdraw funds (subject to applicable taxes) for purposes other than medical expenses, without penalty.

• Long-term Investment Opportunities You can invest your HSA dollars through HSA Bank’s investment partners, who offer stocks, bonds and mutual funds. For more information, visit www.hsabank.com/investments. Note: Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. All HSAs with HSA Bank are FDIC insured.

• You’re in Charge You choose when to use your HSA or pay out of pocket.

Eligible medical expensesAn eligible medical expense is an expense that pays for health care services, equipment or medications as described in IRS Publication 502*. In general, your HSA can be used for:

• Expenses applied to your health plan deductible

• Dental care services

• Vision care services

• Prescription drugs and medicines

• Certain medical equipment

* A list of Qualified Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf.

Learn moreVisit HSA Bank’s website at: http://hsabank.com/hsabank/education/cdh-demos.

What can a Health Savings Account (HSA) do for you?

Want to better understand how an HSA fits into your financial plan? Contact the Ernst & Young financial planner line at no cost to you: 866-724-1946.

HSA Bank is an independent company that administers some health savings accounts on behalf of BlueCross. Please consult your tax adviser regarding your personal

situation and whether this is the right program for you.

HSA BANK CLIENT ASSISTANCE CENTER

800-357-6246, Monday – Friday, 7 a.m. – 9 p.m., CT; and Saturday, 9 a.m. – 1 p.m., CT [email protected] www.hsabank.com 605 N. 8th Street, Suite 320, Sheboygan, WI 53081


Save on everyday expenses .If you waive SCANA coverage or are ineligible to contribute to an HSA, you can open a health care FSA during open enrollment. You have money ready for eligible expenses not covered by your insurance.

Use the WageWorks Health Care Card .Use your WageWorks Health Care Card instead of cash or credit at health care providers and pharmacies for eligible services, goods and prescriptions. You will only be able to use your card for over-the-counter (OTC) drugs at the pharmacy counter if a valid prescription is presented at the time of purchase. You still will be able to use your card for non-drug OTC items and devices, such as bandages and contact lens solution, as long as you shop at merchants that have an industry standard (IIAS) inventory system that can verify the eligibility of items at checkout. An updated list of IIAS merchants is maintained at www.sigis.com. Always remember to save receipts when using the card. The IRS requires you keep them for your tax records, and you will also need them if we request documentation for verification.

Using your FSA is easy .When you elect a health care FSA, your account is funded with the full amount you’ve chosen at the beginning of the year. As soon as that happens, it’s ready to use for eligible expenses. Throughout the year, you “pay your account back” with pre-tax contributions from your paycheck.

You can also choose a WageWorks Dependent Care FSA to help with the cost of care for eligible children or aging parents while you are at work. A dependent care FSA works a lot like a health care FSA, but your account is funded several times a year, so funds are available as contributions are taken from your paycheck.

Sign up during open enrollment. See how much you could save at www.FSAWorks4Me.com

Open a WageWorks® FSA and watch your savings grow

Health care FSA balances up to $500 carry over at the end of the calendar year.

WageWorks is an independent company that provides FSA administration on behalf of the employer group, SCANA. Please consult your tax adviser regarding your personal situation and

whether this is the right program for you.

QUESTIONS?

Helpful tips, guides, video tutorials and FAQs are available online at www.wageworks.com. WageWorks Customer Service professionals also are standing by to help you. Just call 877-WageWorks (877-924-3967), Monday – Friday, 8 a.m. – 8 p.m. EST.

It’s an emergency! Or … is it?

Emergency roomDefinitely head for the hospital with potentially life-threatening conditions such as:

• Heavy bleeding

• Loss of consciousness

• Major injuries, such as broken bones

• Severe pain or severe allergic reaction

• Suspected heart attack

• Head trauma

Urgent careThese clinics are less costly than an ER and could be a convenient choice for minor emergencies. Most offer shorter waits, walk-in services, and sometimes perks such as online check-in. Urgent care could be good for:

• Cold, cough, sore throat

• Flu, respiratory infections

• Minor fractures and sprains

• Eye, ear or skin infections

• Minor cuts and animal bites

It’s important to get to an emergency

room in a life-or-death situation. But it’s

also smart to know when the ER is really

your best option.

An ER visit could involve hours of

waiting and hundreds of dollars. You’ll

see a doctor who doesn’t know you —

and if you show up for something minor

like a cold or a sprain, you could delay

treatment for others who have true

emergencies.

Your primary care physician should be

your first call for routine medical care.

If your doctor’s office is closed, here are

some guidelines to help you protect your

health while saving time and money.


Your regular health plan benefits generally will not cover these services. You are responsible for any costs of these services your benefit plan does not cover … but they may help you take charge of your health and save money.

Check out the discounts on items such as:• Hearing screenings

• Hearing aids

• Cosmetic surgery

• Cosmetic dentistry

• Hair restoration

• Eye care

• Eyewear

• Lasik services

• Weight loss programs

• Allergy relief products

• Companion Global Healthcare

• Companion Global Dental

Are there alternative health services you find helpful — or want to try?You also can find discounts on:

• Acupuncture

• Massage therapy

• Chiropractic services

• Fitness centers

• Diet and supplement advisers

For details on discounts:1. Go to www.SouthCarolinaBlues.com.

2. Select Member Perks, then choose a category.

Besides the health benefits outlined in this booklet, you have access to discounts on a

variety of products and services to enhance your quality of life. Think of them as special

perks just for being Blue.

Discounts for you — just for being Blue


SCANA offers you options for life, accident and disability insurance. If the basic coverage doesn’t meet your needs, you can elect supplemental coverage using payroll deduction to cover the costs. To name or change beneficiaries for life insurance, see form on page 49.

Insurance type Coverage options Cost NotesLife Basic = 2x base pay, up to $1.25M

(hired prior to 1/1/13) 1x base pay, up to $1.25M

(hired on or after 1/1/13)

Supplemental available up to 6x base pay pending Evidence of Insurability

Basic coverage at no cost to employee

Supplemental rates on next page; employee pays full cost with after-tax dollars

At age 65 or older, coverage amount is limited to 65% of your coverage at that time.

Premium adjusts accordingly.

Current enrollees can increase coverage by 1x up to $______ without Evidence of Insurability.

Accidental Death & Dismemberment

Basic = 2x base pay, up to $500K (prior to 1/1/13) 1x base pay, up to $500K

(on or after 1/1/13)

Supplemental available up to 2x base pay


Supplemental rates on next page; employee pays full cost with after-tax dollars

Supplemental coverage increases if your salary increases throughout the year; premium adjusts accordingly.

Spouse $10K - $100K Based on employee age and amount of coverage selected (see supplemental life insurance rates)

Employee pays full cost with after-tax dollars

Evidence of Insurability is required if you want to increase your coverage during open enrollment or due to a qualified family status change.

Dependent $10K per child until age 23 $0.55 per pay period, regardless of number of dependents covered

Employee pays full cost with after-tax dollars

For SCANA married couples, only one parent may cover their dependents.

Short-term disability

Basic = 66 2/3% base pay replacement

Supplemental available for 100% base pay replacement for up to 6 weeks


Supplemental rates based on salary; employee pays full cost with pretax dollars

Employee may use PTO (2.7 hours = 1 day) to supplement or transition bank (per 8 hours), if applicable

A five-day (40-hour) elimination period applies to all approved cases.

Benefits begin on sixth day of absence (or 41st hour) and continue up to 1,040 hours in rolling 12-month period.

Long-term disability

Basic = 50% base pay replacement

Supplemental available for 66 2/3% base pay replacement


Supplemental rates based on salary; employee pays full cost with pretax dollars

Recertification required for continuation of benefits.

Benefits begin after 26 weeks of occupational or non-occupational injury or illness with approved application for benefits.

Life, accident and disability insurance

Beginning January 1, 2016, The Standard will manage and administer SCANA’s life insurance benefits.

For help determining your coverage needs, contact the Ernst & Young financial planner line at 866-724-1946.


Supplemental life insurance cost (same for spouse), per $1,000 of coverage

Age Per Pay Period Rate≤ 34 $0.0212

35-39 $0.0295

40-44 $0.0415

45-49 $0.0628

50-54 $0.0960

55-59 $0.1795

60-64 $0.2585

65-69 $0.4791

70-74 $0.8580

75+ $0.8580

AD&D supplemental cost per pay period, per $1,000 of coverage

Employee-only supplemental coverage option

Rate

1x base pay$ .012

2x base pay

Supplemental short-term (100 percent of base pay coverage) and long-term (66 2/3 percent of base pay coverage) disabilityDisability rate is based on salary: $.30 per $100 of salary

EXAMPLE:

Salary = $50,000 $50,000/$100 = $500 $0.30 x $500 = $150 $150/26 pay periods = $5.77 rate per pay period

Rates adjust, as necessary, during the pay period following a change in age or salary.


Life is not a spectator sport — but sometimes it feels like you’re tackling some really tough

problems. We provide an Employee Assistance Program (EAP) that can help, whether or not

your challenges are job-related.

Help getting over life’s hurdles

SCANA employees and any household members are eligible for the EAP benefit. Each person receives three sessions per contract year free of charge. For more information, call 800-790-5770 or visit www.CompanionBenefitAlternatives.com.

Companion Benefit Alternatives, Inc. (CBA) administers the Employee Assistance Program. Because CBA is a separate company, it is responsible for all services related to this program. If you haven’t sought help from the EAP, you might be surprised at all the situations in which it can be helpful. They range from counseling for a family crisis to referrals for pet professionals.

CounselingWe will pay for up to three confidential sessions for you and each of your covered family members. When you are challenged by personal or emotional issues, licensed counselors are available to help you evaluate the issue and develop a plan for dealing with it. Some examples:

• Marital, relationship or family conflicts

• Crisis intervention

• Mental health or substance abuse issues

• Handling stress, grief, loss or trauma

• Concerns about workplace issues or work-life balance

Life managementThe EAP can provide help with practical problems — how to draw up a living will, for instance. These services include:

• Help finding elder care or child care

• Financial advice for retirement, reorganizing the budget or dealing with a crisis

• Legal consultation from licensed attorneys

• Resources for finding the right school or college

• Adoption assistance

• A pet care program

Everyday choices for a happy, healthy life.

Wellness is more than

just seeing a doctor

when you are sick.

It means making day-

to-day decisions that

can put you on the

path to a long, healthy

life. There are some

risk factors you can’t

change — your age,

for example, or health

problems that run in

the family. So it makes

sense to focus on risk

factors you can change.

MoveAim for 30–60 minutes of physical activity each day. Exercise doesn’t have to take place in a gym — get creative and find activities that you enjoy. Go for a walk, ride your bike, swim, jog, jump rope or even dance!

EatFill half of your plate fruits and veggies. Swap out sugary sodas with water. Choose whole grains, such as wheat, oatmeal and brown rice, instead of refined grains like white bread and white rice. Reach for lean proteins and calcium-rich foods.

CareTake care of your body. Make sure you get enough sleep at night. Don’t smoke — if you do, find the help you need to quit. Schedule your annual physical. If you notice symptoms of a health issue, don’t procrastinate — see your doctor.

FeelGet mentally fit by finding ways to de-stress. Block off some “me time” in your busy schedule. Stay connected to your friends and family. Volunteer for something you’re passionate about. Read a new book or start a journal. Practice being grateful for one thing each day.


NOTE: Please read this notice carefully and keep it with your important papers. If you enroll in one of the plans approved by Medicare that offers prescription drug coverage, you may need to give a copy of this notice when you join. This notice shows you have been enrolled in a creditable health plan and are not required to pay a higher premium.

INTENDED AUDIENCE

This notice is intended for anyone eligible for Medicare (employee or dependent) who is eligible for prescription drug coverage through the SCANA Choice Plan.

ABOUT THIS NOTICE

This notice has information about your current SCANA prescription drug coverage and Medicare Part D, the prescription drug coverage available through Medicare. Important highlights of this notice are:

• Your next opportunity to enroll in Medicare D is October 15- December 7, 2015. This annual enrollment is available to those eligible for Medicare.

• SCANA has determined that your current prescription drug benefit is, on average for all plan participants, expected to pay out at least as much as the standard Medicare prescription drug coverage. Therefore, the SCANA prescription drug plan is creditable coverage.

• Creditable coverage means you may enroll for Medicare D during the 2016 enrollment period outlined above and not pay higher premiums.

If you or one of your dependents is eligible for Medicare, you or they have the option of continuing your existing health plan with prescription drug coverage from the Company or enrolling in the Medicare prescription drug coverage.

IMPORTANT: If you decide to enroll in Medicare prescription drug coverage, you are not eligible to continue the SCANA medical and prescription drug plans. Your coverage will be terminated. Also, even though your current prescription drug coverage with the Company is creditable, if you drop it and have a break in creditable coverage of 63 days or more before enrolling in the Medicare prescription drug coverage, you could be subject to paying higher premiums for coverage.

LIMITED INCOME ASSISTANCE

For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this additional help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or call them at 800-772-1213 (TTY 800-325-0778).

FOR MORE INFORMATION ABOUT THIS NOTICE

Contact the SCANA Benefits Care Line at 803-217-4444 if you require further information about this notice. You may receive this notice at other times in the future, such as before the next enrollment period for Medicare prescription drug coverage, or if this coverage changes. You also may request a copy of this notice.

WOMEN’S HEALTH AND CANCER RIGHTS ACT NOTICE

The Women’s Health and Cancer Rights Act of 1998 provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between breasts, prostheses, and complications resulting from a mastectomy (including lymphedemas). You may contact the Benefits Care Line at 803-217-4444 for more information.

SPECIAL ENROLLMENT NOTICE

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in the SCANA health plans if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 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. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

If either of the following two events occur, you will have 60 days from the date of the event to request enrollment in your employer’s plan:

• Your dependents lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because they are no longer eligible.

• Your dependents become eligible for a state’s premium assistance program.

To request special enrollment or obtain more information, contact the Benefits Care Line at 803-217-4444.

Important notice from SCANA about your health plan and Medicare


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, 2014. Contact your State for more information on eligibility –

ALABAMA – Medicaid COLORADO – Medicaid

Website: http://www.medicaid.alabama.gov

Phone: 1-855-692-5447

Medicaid Website: http://www.colorado.gov/

Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943

ALASKA – Medicaid

Website: http://health.hss.state.ak.us/dpa/programs/medicaid/

Phone (Outside of Anchorage): 1-888-318-8890

Phone (Anchorage): 907-269-6529

ARIZONA – CHIP FLORIDA – Medicaid

Website: http://www.azahcccs.gov/applicants

Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437

Website: https://www.flmedicaidtplrecovery.com/

Phone: 1-877-357-3268

GEORGIA – Medicaid

Website: http://dch.georgia.gov/ - Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP)

Phone: 1-800-869-1150 IDAHO – Medicaid MONTANA – Medicaid

Medicaid Website: http://healthandwelfare.idaho.gov/Medical/Medicaid/Premiu

Website: http://medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml


2

mAssistance/tabid/1510/Default.aspx

Medicaid Phone: 1-800-926-2588

Phone: 1-800-694-3084

INDIANA – Medicaid NEBRASKA – Medicaid

Website: http://www.in.gov/fssa

Phone: 1-800-889-9949

Website: www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633

IOWA – Medicaid NEVADA – Medicaid

Website: www.dhs.state.ia.us/hipp/

Phone: 1-888-346-9562

Medicaid Website: http://dwss.nv.gov/

Medicaid Phone: 1-800-992-0900 KANSAS – Medicaid

Website: http://www.kdheks.gov/hcf/

Phone: 1-800-792-4884

KENTUCKY – Medicaid NEW HAMPSHIRE – Medicaid

Website: http://chfs.ky.gov/dms/default.htm

Phone: 1-800-635-2570

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

Phone: 603-271-5218

LOUISIANA – Medicaid NEW JERSEY – Medicaid and CHIP

Website: http://www.lahipp.dhh.louisiana.gov

Phone: 1-888-695-2447

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/

Medicaid Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710

MAINE – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741

MASSACHUSETTS – Medicaid and CHIP NEW YORK – Medicaid

Website: http://www.mass.gov/MassHealth

Phone: 1-800-462-1120

Website: http://www.nyhealth.gov/health_care/medicaid/

Phone: 1-800-541-2831

MINNESOTA – Medicaid NORTH CAROLINA – Medicaid

Website: http://www.dhs.state.mn.us/

Click on Health Care, then Medical Assistance

Phone: 1-800-657-3629

Website: http://www.ncdhhs.gov/dma

Phone: 919-855-4100

MISSOURI – Medicaid NORTH DAKOTA – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-800-755-2604

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, 2014. Contact your State for more information on eligibility –

ALABAMA – Medicaid COLORADO – Medicaid

Website: http://www.medicaid.alabama.gov

Phone: 1-855-692-5447

Medicaid Website: http://www.colorado.gov/

Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943

ALASKA – Medicaid

Website: http://health.hss.state.ak.us/dpa/programs/medicaid/

Phone (Outside of Anchorage): 1-888-318-8890

Phone (Anchorage): 907-269-6529

ARIZONA – CHIP FLORIDA – Medicaid

Website: http://www.azahcccs.gov/applicants

Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437

Website: https://www.flmedicaidtplrecovery.com/

Phone: 1-877-357-3268

GEORGIA – Medicaid

Website: http://dch.georgia.gov/ - Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP)

Phone: 1-800-869-1150 IDAHO – Medicaid MONTANA – Medicaid

Medicaid Website: http://healthandwelfare.idaho.gov/Medical/Medicaid/Premiu

Website: http://medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml

3

OKLAHOMA – Medicaid and CHIP UTAH – Medicaid and CHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

Website: http://health.utah.gov/upp

Phone: 1-866-435-7414

OREGON – Medicaid VERMONT– Medicaid

Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075

Website: http://www.greenmountaincare.org/

Phone: 1-800-250-8427

PENNSYLVANIA – Medicaid VIRGINIA – Medicaid and CHIP

Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm

Medicaid Phone: 1-800-432-5924

CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm

CHIP Phone: 1-855-242-8282

RHODE ISLAND – Medicaid WASHINGTON – Medicaid

Website: www.ohhs.ri.gov

Phone: 401-462-5300

Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx

Phone: 1-800-562-3022 ext. 15473

SOUTH CAROLINA – Medicaid WEST VIRGINIA – Medicaid

Website: http://www.scdhhs.gov

Phone: 1-888-549-0820

Website: www.dhhr.wv.gov/bms/

Phone: 1-877-598-5820, HMS Third Party Liability

SOUTH DAKOTA - Medicaid WISCONSIN – Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://www.badgercareplus.org/pubs/p-10095.htm

Phone: 1-800-362-3002

TEXAS – Medicaid WYOMING – Medicaid

Website: https://www.gethipptexas.com/

Phone: 1-800-440-0493

Website: http://health.wyo.gov/healthcarefin/equalitycare

Phone: 307-777-7531

To see if any other states have added a premium assistance program since July 31, 2014, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 OMB Control Number 1210-0137 (expires 10/31/2016)



This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I. INTRODUCTION

This Notice describes Our* legal obligations and your legal rights regarding Your Protected Health Information held by Us under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Among other things, this Notice describes how Your Protected Health Information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.

The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information is individually identifiable health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, that relates to:

1. your past, present or future physical or mental health or condition;

2. the provisions of health care to you; or

3. the past, present or future payment for the provision of health care to you.

The Plan provides health benefits to the eligible employees of SCANA Corporation (the “Plan Sponsor”) and their eligible dependents. The SCANA Pharmacy provides covered prescription drugs and services to Plan participants.

II. OUR PRIVACY OBLIGATIONS

We are required by federal and applicable state law to protect the privacy of individually identifiable health information about you that We create or receive (“Your Protected Health Information”), to provide you with this Notice of Our legal duties and privacy practices, to provide notice to affected individuals following a breach of unsecured protected health information, and follow the terms of this Notice that are currently in effect. When We use or disclose Your Protected Health Information, we are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure).

III. USES AND DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION

We may use and disclose to others Your Protected Health Information without your written Authorization for the following purposes. For each category, we will explain what we mean and

present some examples. Not every use or disclosure in a category will be listed. However, the ways We are permitted to use and disclose information will fall within one of the categories. The amount of health information used or disclosed will be limited to information that excludes most direct identifiers, such as name, address, and Social Security number, unless more information is needed. If additional information is needed, it will be limited to the “minimum necessary” to accomplish the purpose of the use or disclosure.

A. Treatment. We may disclose medical information about you to facilitate medical treatment services. For example, the Plan may disclose Your Protected Health Information to your health care provider for its provision, coordination, or management of your health care and related services. SCANA Pharmacy may use or disclose Your Protected Health Information as necessary to maintain a patient profile on you, which may include information about you, your medical condition, medications, and any allergies you may have. SCANA Pharmacy may also use and disclose Your Protected Health Information in dispensing prescription medicines and related products and services, including counseling you and your caregivers about proper use of your medications.

B. Payment. We may use and disclose Your Protected Health Information for payment purposes. For example, the Plan may use or disclose Your Protected Health Information to obtain payment for your coverage and to determine and fulfill the Plan’s responsibility to provide health benefits, to make coverage determinations, administer claims and coordinate benefits with other coverage you may have. The Plan also may disclose Your Protected Health Information to another health plan or a health care provider for its payment activities — for example, for the other health plan to determine your eligibility or coverage, or for the health care provider to obtain payment for health care services provided to you. SCANA Pharmacy may use Your Protected Health Information to obtain payment for covered prescription drugs provided to you, or to assist another provider in obtaining payment for covered services it provides to you.

C. Health Care Operations. We may use and disclose Your Protected Health Information for Our health care operations. For example, We may use and disclose Your Protected Health Information to do business planning, arrange for medical review and conduct quality assessment and improvement activities. We also may disclose Your Protected Health Information to another health plan or a health care provider that has or had a relationship with you for it to conduct quality assessment and improvement activities; accreditation, certification, licensing, or credentialing activities; or for the purpose of health care fraud

SCANA Corporation, Group Health PlansNotice of Privacy Practices


and abuse detection or compliance — for example, for the other health plan to perform case management or evaluate health care provider performance, or for the health care provider to evaluate the outcomes of treatments or conduct training programs to improve health care skills.

D. To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on Our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use and/or disclose Your Protected Health Information, but only after they agree in writing with us to implement appropriate safeguards regarding Your Protected Health Information. For example, We may disclose Your Protected Health Information to a Business Associate to administer claims or to provide support services, such as utilization management, pharmacy benefit management or subrogation, but only after the Business Associate enters into a Business Associate Agreement with Us. Business Associates are required to comply with HIPAA requirements to safeguard Your Protected Health Information.

E. To Comply with the Law. We may use and disclose Your Protected Health Information to the extent required to comply with applicable law.

F. Disclosures to the Health Plan Sponsor. We may disclose Your Protected Health Information to certain employees or other Individuals under the control of the Plan Sponsor as necessary for them to carry out the Plan Sponsor’s responsibilities to administer Plan payment and health care operations activities.

G. Health-Related Communications. We may contact you to give you information about health-related benefits and services that may be of interest to you. We may also contact you to provide appointment or refill reminders or information about treatment alternatives or other health-related benefits and services that may be useful to you.

H. Public Health Activities. As required by law, We may disclose Your Protected Health Information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting births and deaths; notifying people of recalls of products they may be using; reporting child abuse or neglect (only if you agree or when required by law); reporting domestic violence (only if you agree or when required by law); reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

I. Health Oversight Activities. We may disclose Your Protected Health Information to a government agency that is legally responsible for oversight of the health care system or for ensuring compliance with the rules of government benefit programs such as Medicare or Medicaid, or other regulatory programs for which health information is necessary for determining compliance.

J. Judicial and Administrative Proceedings. We may disclose Your Protected Health Information in the course of a judicial or administrative proceeding in response to a subpoena, discovery request or legal order or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested information.

K. Law Enforcement Officials. We may disclose Your Protected Health Information to the police or other law enforcement officials as required by law or in compliance with a court order or other process authorized by law.

L. Health or Safety. We may disclose Your Protected Health Information to prevent or lessen a serious and imminent threat to the health or safety of an Individual or the public.

M. Organ and Tissue Donation. If you are an organ donor, We may release Your Protected Health Information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

N. Specialized Government Functions. We may disclose Your Protected Health Information to units of the government with special functions, such as the U.S. military or the U.S. Department of State.

O. Workers’ Compensation. We may disclose Your Protected Health Information as necessary to comply with workers’ compensation laws.

P. Research. We may disclose Your Protected Health Information to researchers when:

1. the individual identifiers have been removed; or,

2. when an institutional review board or privacy board has (a) reviewed the research proposal; and (b) established protocols to ensure the privacy of the requested information, and approves the research.

IV. REQUIRED DISCLOSURES

The following is a description of disclosures of Your Protected Health Information We are required to make.

A. Government Audits. We are required to disclose Your Protected Health Information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining Our compliance with HIPAA requirements.

B. Disclosures to You. When you request, We are required to disclose to you the portion of Your Protected Health Information that contains medical records, billing records, and any other records used to make decisions regarding your health care or health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of Your Protected Health Information.


V. OTHER DISCLOSURES

A. Personal Representatives. We will disclose Your Protected Health Information to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA Privacy Rule, We do not have to disclose information to a personal representative if We have reasonable belief that:

1. you have been, or may be, subject to domestic violence, abuse or neglect by such person;

2. treating such person as your personal representative could endanger you; or,

3. in the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.

B. Authorizations. Other uses or disclosures of Your Protected Health Information not described above will only be made with your written authorization. You may revoke your written authorization at any time, so long as the revocation is in writing. Once We receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.

We will obtain a written authorization for any use or disclosure of psychotherapy notes, except:

1. to carry out the following treatment, payment, or health care operations: use by the originator of the psychotherapy notes for treatment; use or disclosure by the covered entity for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; or use or disclosure by the covered entity to defend itself in a legal action or other proceeding brought by the individual; and

2. a use or disclosure that is: required by the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining the Plan’s compliance with the HIPAA privacy rule; permitted by law; for health oversight with respect to the oversight of the originator of the psychotherapy notes; to a coroner or medical examiner for the purpose of identifying a decedent; or to avert a serious threat to health or safety.

Please note that We do not use Your Protected Health Information for marketing or fundraising efforts. We do not sell Your Protected Health Information. We do not use or disclose Your Protected Health Information that is genetic information for underwriting purposes as prohibited by the Genetic Information Nondiscrimination Act (GINA) of 2008.

VI. YOUR INDIVIDUAL RIGHTS

A. Right to Inspect and Copy Your Protected Health Information. You may request access to Our records that contain Your Protected Health Information in order to inspect and request copies of the records. If Your Protected Health Information is maintained or used in an “electronic health record”, you may obtain a copy of the information in an electronic format and direct the copied information to be transmitted to another individual or organization. Under limited circumstances, We may deny you access to a portion of your records. If you desire access to your records, please obtain a record request form from the Privacy Office and submit the completed form to the Privacy Office. If you request copies, We reserve the right to charge you copying and mailing costs.

We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request to the Privacy Office at the address below.

B. Right to Request Amendment of Your Records. You have the right to request that We amend Your Protected Health Information that you believe is incorrect or incomplete. To make such a request, please obtain an amendment request form from the Privacy Office and submit the completed form, including the reason for the amendment, to the Privacy Office. We may deny your request for amendment if it is not in writing or does not include a reason to support the request. In addition, We may deny your request if you ask Us to amend information that:

1. is not part of the medical information kept by or for Us;

2. was not created by Us, unless the person or entity that created the information is no longer available to make the amendment;

3. is not part of the information that you would be permitted to inspect and copy; or,

4. is already accurate and complete.

If We deny your request, you have the right to file a statement of disagreement with Us and any future disclosures of the disputed information will include your statement.

C. Right to Receive An Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of Your Protected Health Information. The accounting will not include:

1. disclosures for purposes of treatment, payment or health care operations (except to the extent required by law, if the Plan maintains Your Protected Health Information as an electronic health record);

2. disclosures made to you;


3. disclosures made pursuant to your authorization;

4. disclosures made to friends or family in your presence or because of an emergency;

5. disclosures for national security purposes; and,

6. disclosures incidental to otherwise permissible disclosures.

To request this list of accounting of disclosures, you must submit your request in writing to the Privacy Office. Your request must state a time period of not longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

D. Right to Request Additional Restrictions. You may request restrictions on Our use and disclosure of Your Protected Health Information. For example, you could ask that We not use or disclose information about a surgery you had or a prescription drug you take. While We will consider requests for additional restrictions carefully, We are not required to agree to a requested restriction unless your request is to restrict Our disclosure of Your Protected Health Information to a health plan when such information would be used for health care operations or payment, the disclosure is not otherwise required by law, and Your Protected Health Information relates solely to a health care item or service paid for entirely out of pocket by you (or a person other than the Plan on your behalf). If you wish to request additional restrictions, please obtain a request form from the Privacy Office and submit the completed form to the Privacy Office. You will be given a written response.

E. Right to Receive Confidential Communications. We will accommodate any reasonable request for you to receive Your Protected Health Information by alternative means of communication or at alternative locations. Your request must specify how or where you wish to be contacted. Please note that in certain situations, such as eligibility and enrollment information, the Plan (but not the SCANA Pharmacy) is obliged to communicate directly with the employee rather than a dependent unless the request clearly states that disclosure of that information to the employee could endanger you.

F. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you agreed to receive such notice electronically. You may obtain a copy of this Notice at the “Health, Wealth, and Career” Web page on the SCANA Intranet site or you may contact the Privacy Office at the address below.

G. Right to Receive Notification. You are entitled to receive notice from Us if the confidentiality of any of Your Protected Health Information maintained in an unsecured form is compromised.

H. For Further Information; Complaints. If you desire further information about your privacy rights, are concerned that the Plan or SCANA Pharmacy has violated your privacy rights or disagree with a decision that We made about access to Your Protected Health Information, you may contact the Plan’s Privacy Office. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services. Upon request, the Privacy Office will provide you with the correct address for the Secretary. The Plan will not retaliate against you if you file a complaint with it or the Secretary.

VII. EFFECTIVE DATE AND DURATION OF THIS NOTICE

A. Effective Date. This Notice is effective on September 9, 2013.

B. Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If We change this Notice, We may make the new notice terms effective for all of Your Protected Health Information that We maintain, including any information created or received prior to issuing the new notice. If We change this Notice, We will send the new notice to you if you are then covered by the Plan. You also may obtain any new notice by contacting the Privacy Office.

C. Limitation on Application of Notice. This Notice does not apply to information that does not identify an Individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an Individual. In addition, the Plan may use or disclose “summary health information” to the Plan Sponsor for its purposes of obtaining premium bids (although the Plan will not use or disclose genetic information for this purpose) or modifying, amending or terminating the Plan. Summary health information is information that summarizes claims history, claims expenses or types of claims experienced by Individuals for whom the Plan Sponsor provides benefits under the Plan and from which the Individual identifying information, except for five-digit zip codes, has been deleted. The Plan and Plan Sponsor also may use or disclose eligibility and enrollment information without your Authorization.

VIII. PRIVACY OFFICE

SCANA Corporation 220 Operations Way Cayce, SC 29033-3701

* For purposes of this Notice of Privacy Practices, “Our,” “We,” “Us,” or “Plan” refers to the following companies of the SCANA Corporation Organized Health Care Arrangement: the medical benefits, prescription drug benefits, vision benefits, dental benefits, medical benefits portion of the Employee Assistance Plan, and SCANA Pharmacy benefits of the SCANA Corporation Health and Welfare Plan; the SCANA Corporation Health Care Flexible Spending Account Plan.

Telephone: 1-800-335-6974 Email: [email protected]


New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health

Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic

information about the new Marketplace and employmentbased health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The

Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible

for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance

coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or

offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on

your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible

for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be

eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does

not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your

employer that would cover you (and not any other members of your family) is more than 9.5% of your household

income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the

Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your

employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer

contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for

Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-

tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or

contact .

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the

Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health

insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered

by the plan is no less than 60 percent of such costs.

Form Approved OMB No. 1210-0149 (expires 1-31-2017)

Judy Verona 803-217-7033

New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health

Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic

information about the new Marketplace and employmentbased health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The

Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible

for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance

coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or

offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on

your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible

for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be

eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does

not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your

employer that would cover you (and not any other members of your family) is more than 9.5% of your household

income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the

Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your

employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer

contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for

Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-

tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or

contact .

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the

Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health

insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered

by the plan is no less than 60 percent of such costs.

Form Approved OMB No. 1210-0149 (expires 1-31-2017)

Judy Verona 803-217-7033David Simmons at 803-217-8099


PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an

application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered

to correspond to the Marketplace application.

3. Employer name 4. Employer Identification Number (EIN)

5. Employer address 6. Employer phone number

7. City 8. State 9. ZIP code

10. Who can we contact about employee health coverage at this job?

11. Phone number (if different from above) 12. Email address

Here is some basic information about health coverage offered by this employer:

• As your employer, we offer a health plan to:

All employees.

Some employees. Eligible employees are:

• With respect to dependents:

We do offer coverage. Eligible dependents are:

We do not offer coverage.

If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to

be affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium

discount through the Marketplace. The Marketplace will use your household income, along with other factors,

to determine whether you may be eligible for a premium discount. If, for example, your wages vary from

week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly

employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the

employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your

monthly premiums.

Your eligible Dependents include the following. For your non-spouse who meets one or more of the criteria below, dependent status applies regardless of whether coverage is available through another employer and regardless of student or marital status:

1. Your lawful spouse pursuant to a marriage that is legally recognized under the laws of the issuing state, territory or country. Divorced spouses are not eligible for coverage under the plan even if the employee is ordered by the court to provide health coverage.

2. Your child who is your biological son or daughter under the age of 26, your stepson or stepdaughter under age 26 (under age 23 for dental coverage).

3. Your child who is 26 years of age or older, is primarily supported by you, and is incapable of self-sustaining employment because of a mental or physical disability. You should provide proof of the child’s condition and dependence to the SCANA Benefits Team within 31 days after the child’s 26th birthday. During the next two years, the Plan may, from time to time, ask for proof of continuation of the condition and dependence. After that, the Plan may require proof no more than once a year.

4. An individual for whom you have legal guardianship, who lives with you and depends on you for support and who is under age 26 (under age 23 for dental coverage).

5. An individual who is part of a Qualified Medical Child Support Order.

6. An individual, under age 26 (for medical coverage) and under age 23 for dental coverage, who has been placed with you for foster care by an authorized placement agency or court.

7. Any child under the age of 26 whom you adopt, including a child who is placed with you for adoption, will be eligible for Dependent insurance upon the date of placement with you. A child will be considered placed for adoption when you become legally obligated to support that child, totally or partially, prior to that child’s adoption being finalized. If a child placed for adoption is not adopted, all health coverage ceases when the placement ends, and will not be continued.

SCANA Corporation and its Subsidiaries 57-0784499

220 Operation Way, MC-C131 803-217-9000

Cayce SC 29033

VP of Human Resources c/o Manager of Benefits

803-217-8099 [email protected]

3











All employees.














monthly premiums.

Full-time (i.e. regularly scheduled to work 32 or more hours per week)

3











All employees.














monthly premiums.

3


In accordance with the Affordable Care Act, health plans must issue Summary of Benefits and

Coverage (SBC). SBCs are standardized documents that follow a template prescribed by the

law. The purpose of the SBC is to help consumers understand and compare health plans.

SBCs will have coverage examples using a format like the Nutrition Facts labels found on

packaged foods.


PLEASE PRINT IN INK OR TYPE

Employee Name ________________________________________________ Social Security Number __________________________

Address/Mail Code _________________________________________________ Your Employee ID # __________________________

Employees wanting to add or change dependent information associated with their benefits coverage must forward the required documentation to the Benefits Department at MC C131 for updates to be made. If you add a dependent or spouse to your insurance coverage, this documentation is required first:

• Adding a spouse – a copy of a marriage license, Social Security card and proof of joint ownership (federal/state tax return, mortgage statement, bank statement, lease agreement, credit card statement, property tax, etc.)

• Adding a dependent – a copy of long form birth certificate and Social Security card

Dependent InformationName Birthdate SSN Relation Medical Y/N Dental Y/N Life Ins. Y/N

Signature:____________________________________________________________________ Date: _____________________________

SUBMIT FORM AND REQUIRED DOCUMENTATION TO 220 Operation Way MC C131 Cayce, SC 29033

Additions/changes will not be made without receipt of this information.

NOTE: To knowingly enroll an ineligible dependent in SCANA’s benefits is a violation of SCANA’s Code of Conduct.

SCANA Corporation Dependent Change FormSee page 35 for definitions of eligible dependents.


PLEASE PRINT IN INK OR TYPE

Employee Name ________________________________________________ Social Security Number __________________________

Address/Mail Code _________________________________________________ Your Employee ID # __________________________

I reserve the right to change this designation at any time. I revoke any and all previous beneficiary designations prior to the effective date shown below.

TYPES OF BENEFICIARY

1 = Regular or Sole Beneficiary

2 = Co-Beneficiary – Share as Specified

3 = Contingent Beneficiary – To receive in the event of the death of the primary beneficiary.

If more than one contingent beneficiary is designated, payment will be made in equal shares or all to the last survivor.

Designate the distribution of the proceeds as a percentage of the total amount.

Beneficiary Name/AddressThe information below is required for benefit assignment.

Type of Beneficiary (1, 2, 3)

Whole Percentages Only

Name _______________________________________

Address _____________________________________

___________________________________________

Date of Birth __________________________

Relationship __________________________

SS# ________________________________

Name _______________________________________

Address _____________________________________

___________________________________________

Date of Birth __________________________

Relationship __________________________

SS# ________________________________

Name _______________________________________

Address _____________________________________

___________________________________________

Date of Birth __________________________

Relationship __________________________

SS# ________________________________

Signature ______________________________________________________ Effective Date ___________________________________

RETURN TO 220 Operation Way MC C131 Cayce, SC 29033

SCANA Corporation Life Insurance Beneficiary Form

Mail this form to:

Enter ID # below if not shown or if different from above

Number of New prescriptions:

Number of Refill prescriptions:

Please use blue or black ink, capital letters, and fill in both sides of this form.

Shipping Address. To ship to an address different from the one printed above, please make changes here.

New Prescriptions - Mail your new prescriptions with this form.

Refills - Order by Web, phone, or write in Rx number(s) below.

We may package all of these prescriptions together unless you tell us not to.

Refills. To order mail service refills, enter your prescription number(s) here.

A

B

Use this addressfor this order only.

Apt./Suite #

City State ZIP Code

Street Name

-- --Daytime Phone #: Evening Phone #:

Last Name First Name MI Suffix (JR, SR)

1) 2) 3) 4)

5) 6) 7) 8)

Prescription Plan Sponsor or Company Name

BC 27131

©2010 Caremark. All rights reserved. P13-N

Mail ServiceOrder Form

FOR FASTEST SERVICE, order refills at www.caremark.com or call the number on your prescription benefit ID Card.

CAREMARK PO BOX 94467PALATINE, IL 60094-4467

Generic Medicines: Choosing generics is an excellent way to save money. With generics, you get the same quality as brand-name medicines, at a lower cost. To help you save money, Caremark will substitute generic medicines for brand-name medicines whenever possible. If you have been prescribed a brand-name medicine with a generic equivalent and you DO NOT want us to substitute the generic medicine, please provide specific instructions, including the names of your brand-name medicines, in the Comments/Special Instructions section of this form. Your health plan has chosen Caremark, an independent company, to administer its Mail Service Prescription program. For more information, visit your health plan’s Web site as listed on your member ID card, or call Caremark at 1-888-963-7290.

On behalf of BlueCross, Caremark assists in the administration of the prescription drug program. Caremark is an independent company that provides pharmacy benefits management.

.

Tell us about the people getting prescriptions. If there are more than two people, please complete another form.

1st person with a refill or new prescription. This person needs: Easy open caps Spanish forms and labels

Tell us about new allergies or health information for this person. Only tell us about new information.Allergies:

Health Information:

Special Instructions:

Electronic Check. Pay from your bank account. First time users register online or call Customer Care.

Bill Me Later®. Works like a credit card. First time users register online or call Customer Care.

Credit or Debit Card. (VISA®, MasterCard®, Discover®, or American Express®)Fill in this oval to use your card on file.Fill in this oval to use a new card or to update your card expiration date.

Check or Money Order. Amount: $Regular delivery is free and will take 7 to 10days from the day you send this form.

• Faster delivery charges may change.• Faster delivery is for shipping time, not processing time.• Faster delivery can only be sent to a street address, not a PO box.

C

D

How would you like to pay for this order? Fill in the oval to choose a payment.E

2nd person with a refill or new prescription. This person needs: Easy open caps Spanish forms and labels

ErythromycinCephalosporin CodeineAspirinNoneSulfa Other:

Peanuts

Arthritis Asthma Diabetes Acid Reflux GlaucomaHigh Blood PressureOther:

High Cholesterol Migraine Osteoporosis Prostate Issues

Penicillin

Heart ProblemThyroid

Gender: M F Date of Birth:Date new prescription written:

Doctor’s Last Name Doctor’s First Name Doctor’s Phone #

Tell us about new allergies or health information for this person. Only tell us about new information.Allergies:

Health Information:

ErythromycinCephalosporin CodeineAspirinNoneSulfa Other:

Peanuts

Arthritis Asthma Diabetes Acid Reflux GlaucomaHigh Blood PressureOther:

High Cholesterol Migraine Osteoporosis Prostate Issues

Penicillin

Heart ProblemThyroid

Gender: M F Date of Birth:Your E-Mail:

Your E-Mail:

Date new prescription written:

Doctor’s Last Name Doctor’s First Name Doctor’s Phone #

Fill in this oval if you DO NOT want to use this payment method for future orders.

2nd Business Day ($17)Next Business Day ($23)

If you want faster delivery, choose:

Credit Card Holder Signature/Date

Exp.Date

Suffix(JR,SR)

Suffix(JR,SR)

Business days are only

Monday-Friday

CMK 49-27131-0810

• Make check or money order out to Caremark.• Write your prescription benefit ID number on your check or money order.• If your check is returned, we will charge you up to $40.

Payment for Balance Due and Future Orders: If you chose Electronic Check, Bill Me Later®, or a Credit or Debit Card, we will also use it to pay for any balance that you owe and for future orders.


Enrollment Checklist for:Employee Name: ____________________________________________ Employee ID: ______________________

Use the list below to circle your 2016 benefit elections.

For a summary of your current benefits coverage, log in to the PeopleSoft Hub and choose “View Current Benefit Elections” under My Health.

Benefit 2016 OptionsMedical SCANA Choice Plan

Waive

Spousal coverage m Yes, I am electing to cover my spouse under SCANA’s medical plan and certify that my spouse does not have access to other employer-sponsored group coverage.

Dental ComprehensiveWaive

Vision Waive

Supplemental Life (up to 6x base pay) Evidence of Insurability may be required

1x 2x 3x 4x 5x 6x

Supplemental AD&D (up to 2x base pay) 1x 2x

Spouse life Evidence of Insurability required

$10,000 $20,000 $50,000 $100,000

Dependent life (same rate regardless of number of dependents)

Elect Waive

Short-term disability Buy up to 100% base pay replacement for up to 6 weeks

Do not buy up

Long-term disability Buy up to 66 2/3% base pay replacement Do not buy up

Health savings account (HSA) eligibility

m Yes, I am eligible for a health savings account because I am: • Not covered by any other health plan, including my spouse’s health insurance • Not receiving benefits from my own or my spouse’s Health Care FSA • Not enrolled (or have already disenrolled) from any part of Medicare or TRICARE • Have not received Veteran’s medical benefits in the past 90 days • Not claimed as a dependent on another person’s tax return

HSA contribution Annual contribution = $____________ Waive contribution

Dependent care flexible spending account (FSA) contribution

Annual contribution = $____________ Waive contribution

Health care flexible spending account (FSA) contributionAvailable only if you waive medical coverage or are not eligible to contribute to an HSA

Annual contribution = $____________ Waive contribution

Go paperless m Yes, I currently receive paper copies of benefits communications (i.e., summary plan descriptions and documents required to be furnished under Section 104(b)(4) of ERISA). I agree to go paperless, with the understanding that I can request a paper copy of a communication at any time by calling 803-217-4444.

Employee only

Employee/ Spouse

Employee/ Dependents

Employee/ Family

Employee only

Employee/ Spouse


Employee/ Family

Employee only

Employee/ Spouse


Employee/ Family

Clip and keep this wallet card.#

When you need medical advice call

877-705-5428 Reliable health care answers

A service brought to you by

24-hour Customer Service

Contact Information

Topic Resource Phone WebsiteBenefits Employee Resource Center 803-217-4444 Health, Wealth & Career

on The Edge

24-hour customer service BlueCross BlueShield of South Carolina Customer Service

877-705-5428 SouthCarolinaBlues.com My Health Toolkit

Prescription costs, drug lists SCANA Pharmacy 803-217-9173 866-769-9039

Health, Wealth & Career on The Edge

Mail-order prescriptions and specialty drugs

Caremark 888-963-7290 SouthCarolinaBlues.com

Health savings account HSA Bank 800-357-6246 hsabank.com

Flexible spending account WageWorks 877-924-3967 FSAworks4me.com wageworks.com

Employee Assistance Program Companion Benefit Alternatives 800-790-5770 cba.personaladvantage.com CompanionBenefitAlternatives.com

Disability and FMLA MetLife 877-638-8262 Health, Wealth & Career on The Edge

Financial planning for spending/savings accounts and benefits coverage

Ernst & Young 866-724-1946 SCANA.eyfpc.com

Two BlueCross representatives are on site at SCANA during normal business hours to help you with your benefits needs.

Visit

www.EyeMedVisionCare.comOr call 866-723-0513.*

* When calling, please provide your full name and date of birth. EyeMed Vision Care is an independent company that offers vision benefits on behalf of your health plan.

Clip and keep this wallet card.#

Questions about your vision benefits?

A service brought to you by

SCANA-17612-9-2015BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

We are excited to have you as part of the BlueCross

family. Our goal is to help you get the most out of your

benefit plan. Getting more information or answers to

your questions is easy. Simply visit us online at

www.SouthCarolinaBlues.com

Documents

SCANA Corporation 2016 Benefits · 2016-09-06 · Your Benefits. Your Choice. 1 Aim for your best health Every year, SCANA evaluates how to manage the ever-increasing cost of health