Employee Benefits Information

ANNOUNCEMENTS
30 Day Veggie Challenge	10/31/18	Tracking form to keep up with vegetables consumed during this 30 day challenge.
Open Enrollment 11/5/18 - 11/16/18	10/22/18	Hog Slat’s annual open enrollment runs from Nov 5 – Nov 16^th. During this time you can make changes to any of your Hog Slat employee health benefits. An enrollment packet has been mailed to everyone’s homes with directions for making changes. If you have not received your booklet by 10/25/18, call payroll and confirm your mailing address. A copy of the Employee Benefits Enrollment Guide can be found under the Health Benefits forms section below.
Out of State Prior Approval Review Acknowledgement Form (English/Español) Formulario de Reconocimiento de Revisión Previa para Empleados de Fuera del Estado	9/18/18	Effective immediately, all current and future non NC based employees who enroll in the Hog Slat Health Plan (BCBSNC) must sign and submit a copy of this form. This form explains that the responsibility for obtaining prior review, approval, and/or certification for certain medical services is the responsibility of the employee and/or their covered dependent. Failure to obtain this approval will result in denial of claim payment. Efectivo inmediatamente, todos los empleados actuales y futuros que no tengan a Carolina del Norte (NC) como base y que se inscriban en el Plan de salud Hog Slat (BCBSNC) deben firmar y enviar una copia de este formulario. Este formulario explica que la responsabilidad de obtener una revisión, aprobación o certificación previa para ciertos servicios médicos es responsabilidad del empleado y / o su dependiente cubierto. Si no se obtiene esta aprobación, se negará el pago de la petición.
BCBSNC & Pre-Approval for Radiology	3/30/18	Explains the need to obtain pre-certification/approval prior to obtaining radiology services.
WELLNESS PROGRAM
Annual Employee Wellness Memo		Description of the 2018 – 2019 wellness program requirements and rewards.
Wellness Program Video		Hog Slat Wellness Program Video 2018-2019
Wellness Program Guide (English)		Detailed description of wellness program eligibility, policies, and procedures.
Wellness Program Guide (Español)		Descripción detallada de la elegibilidad, las políticas y los procedimientos del programa de bienestar.
Proof of Annual Physical Form		Form for physician to complete during annual physical for wellness program
Frequent Fitness Form (Home Workouts)		Tracking form for working out at home
Fitness Reimbursement Form (Gym Workouts)		Form to be included with an attendance print out from your gym workouts
Fitness Reimbursement Form - No Print Out (Gym Workouts)		Tracking form to be used if gym does not offer attendance print out. Signature from gym attendant required.
Weight Watchers Reimbursement Form		Tracking form for Weight Watcher Points reporting
On-Site Health Clinic Information (English/Spanish)		Flyer containing address, hours, and appointment information for the Clinton, NC Hog Slat Health clinic. Folleto que contiene la dirección, las horas y la información de citas de Clinton, NC Hog Slat Health clinic.
On-Site Health Clinic Dispensary Information (English/Spanish)		Flyer containing the names of the medications offered at the Clinton, NC Hog Slat Health clinic Folleto con los nombres de los medicamentos ofrecidos en Clinton, NC Hog Slat Health clinic
HEALTH BENEFITS
Employee Benefits Enrollment Guide (English)		Guide providing a full description of the Hog Slat medical benefit offerings. Sent out during open enrollment and provided to all new hires.
Employee Benefits Enrollment Guide (Español)		Guía que proporciona una descripción completa de las ofertas de beneficios médicos de Hog Slat. Enviado durante la inscripción abierta y proporcionado a todos los nuevos empleados.
BCBSNC Member Guide		The official Blue Cross and Blue Shield member guide for the Hog Slat Health Plan. Contains information on eligibility, covered services, excluded services, and appeals.
Summary Plan Description		Overview of the basic rules and laws governing the Hog Slat health and wellness benefits.
Summary Plan Description (Español)		Descripción de las reglas y leyes básicas que rigen los beneficios de salud y bienestar de Hog Slat.
Understanding Your Health Insurance		Coming soon...
Ameritas Vision Benefits Summary		Description of the Ameritas Vision plan benefits
Ameritas Dental Benefits Summary		Description of the Ameritas Dental plan benefits
Guardian Long-Term Disability Description & Rates		Description of the Guardian Long Term Disability benefits and rates
Guardian Term Life Description & Rates		Description of the Guardian Term Life Insurance benefits and rates
2018 Hog Slat - Colonial Benefit Booklet		Overview of the Colonial Ancillary products: Supplemental Short Term Disability, Critical Care with Cancer, and Accident Care
Health Insruance Enrollment Form (BCBSNC)		Use this form to enroll in the insurance if you are not already enrolled
Health Insurance Change Form (BCBSNC)		Use this forms to make changes to your current enrollment: add / drop self and/or dependents, change address, etc.
Out of State Prior Approval Review Acknowledgement Form (English/Español) Formulario de Reconocimiento de Revisión Previa para Empleados de Fuera del Estado		All current and future non-NC based employees who enroll in the Hog Slat Health Plan (BCBSNC) must sign and submit a copy of this form. This form explains that the responsibility for obtaining prior review, approval, and/or certification for certain medical services is the responsibility of the employee and/or their covered dependent. Failure to obtain this approval will result in denial of claim payment. Efectivo inmediatamente, todos los empleados actuales y futuros que no tengan a Carolina del Norte (NC) como base y que se inscriban en el Plan de salud Hog Slat (BCBSNC) deben firmar y enviar una copia de este formulario. Este formulario explica que la responsabilidad de obtener una revisión, aprobación o certificación previa para ciertos servicios médicos es responsabilidad del empleado y / o su dependiente cubierto. Si no se obtiene esta aprobación, se negará el pago de la petición.
Tobacco Use Affidavit		When enrolling in the health insurance, complete this to declare your tobacco use status. Dependents do not need to fill out this form.
Dental Insurance Enrollment Form (Ameritas)		Use this form to enroll in the dental insurance if you are not already enrolled
Dental Insurance Change Form (Ameritas)		Use this forms to make changes to your current dental enrollment: add / drop self and/or dependents, change address, etc.
Vision Insurance Enrollment Form (Ameritas)		Use this form to enroll in the vision insurance if you are not already enrolled
Vision Insurance Change Form (Ameritas)		Use this forms to make changes to your current vision enrollment: add/drop self and/or dependents, change address, etc.