2016 EMPLOYEE BENEFITS GUIDE HOURLY EMPLOYEES Featuring:
2016 EMPLOYEEBENEFITS GUIDE
HOURLY EMPLOYEES
Featuring:
2 Hourly Employee Benefits Guide 2016
2016 Annual EnrollmentAn Annual Enrollment Newsletter for Denny’s Salaried Employees
November 2011
2012 Annual Enrollment News
Enrollment Period – Monday, Nov. 14, 2011 – Wednesday, Nov. 30, 2011
Don’t forget to enroll for 2012 to continue or change your benefits. Benefits will NOT
automatically roll over. The 2012 enrollment period is November 14, 2011 through
November 30, 2011. If you have any questions about your benefits or the 2012 Annual
Enrollment process, please call the Denny’s Employee Benefits Department at
1-800-859-2244 Monday to Friday from 8:00 AM to 5:00 PM ET.
Dear Denny’s Team Member,
It is that time of year again to review your benefit needs – and the healthy choices you
should make for you and your family’s long-term health. Denny’s will continue to provide
comprehensive benefits – and I encourage you to take an active role in your health and well-
being. There are several important things you should know as you prepare to enroll for 2012.
As you know, healthcare costs continue to rise and companies are struggling to find ways to
keep their medical costs down. Denny’s costs for benefits are also rising at an increase of
9.6% for 2012. I know you’ve had your share of premium increases in the past, with employee
medical premiums increasing between 6% and 12% each year over the past five years. For
2012, we’ve calculated that the average employee increase in premiums will be 11%.
However, I am extremely excited to tell you that your actual increase for medical benefits
for 2012 will be ZERO! Yes, you read this correctly, we are NOT increasing your medical
premiums for 2012. Denny’s will be paying for the entire cost of the medical plan increases.
This is nearly a $1 million increase to the Company, but I believe it is an important investment
in our employees. I recognize the challenging economic times that we’ve all been through, but
more importantly, I want you to know how strongly I feel about each of you and the health
of you and your families.
But you must also do your part to control rising costs. One way that each of you can help
is to become more aware of your own health by taking the Simple Steps Health Assessment.
In addition, Denny’s, in conjunction with Aetna, will be implementing a Healthy Lifestyle
Coaching Program for 2012. I encourage you to take advantage of this great opportunity to
learn more about your health and how to achieve a healthier lifestyle. The payoff in the long
run will equate to healthier employees, which equals less medical claims, which leads to lower
premium increases each year.
Important information containing the details of this program, and the details of all of your
benefits, can be found in this newsletter.
There are no other significant changes to your benefit offerings for 2012. However, we have
made a slight enhancement to the dental coverage. If you elect to enroll in the Aetna Dental
$25 deductible plan, your annual benefit will increase from $1,000 annually to $1,500 annually.
This will create a small increase of up to $9.27 bi-weekly based on your coverage level.
I am looking forward to a great year for Denny’s in 2012 and I want you to be a happy, healthy,
and productive part of that success!
2016 Benefits Enrollment
At Denny’s, we are committed to providing quality benefits for our employees at an
affordable cost. The well-being of our employees is very important to me. As you make
your benefit selections, we encourage you to review your current benefits package and
consider whether it still meets the health and financial needs of you and your family.
The financial challenges facing the healthcare industry continue to lead to changes in
our benefit costs. Denny’s has done its best to keep the impact as minimal as possible to
you, and we continue to shoulder the majority of the cost of benefits.
We are excited to announce that medical premiums did not increase for 2016. We are
also pleased to offer life insurance for all hourly employees who have worked with the
company for one year. Hourly employees who have worked at least six months with the
company are now eligible for Dental and Vision benefits regardless of the number of
hours worked.
We will again offer several health care plans from which to choose - including a
traditional preferred provider plan and consumer-focused, high-deductible plans. In
addition, you will also have the option of adding benefits such as dental and vision
coverage, flexible spending (FSA) or health savings accounts (HSA), plus voluntary life,
accident and critical illness policies.
Signing up for benefits is easy - you can enroll online through our enrollment website,
or, if you have questions or need additional assistance, you can simply call a toll-free
number and speak with a specially trained counselor who can help you select the
offerings that best fit your needs.
I encourage you to review this guide carefully for details on the benefits available to
you, including the benefit changes summarized on the next page. Thank you for the
talents you bring to our company, and I look forward to a healthy and successful 2016!
Sincerely,
John Miller
President and CEO of Denny’s, Inc.
3This guide is a quick reference to help answer most of your questions.
Annual Enrollment Begins Soon!
Denny’s Annual Enrollment period is being held October 26, 2015 through November 11, 2015. This is your once-a-year opportunity to elect, change or waive benefits coverage. The elections you make during this Annual Enrollment will be effective January 1 through December 31, 2016.
You can make enrollment elections online by going to www.benefitsgo.com/Dennys15. In addition to the enrollment website, benefits counselors will be avilable to answer questions and conduct one-on-one enrollment sessions over the phone.
To ensure a smooth enrollment process, please complete the enclosed Benefits Contribution Worksheet before completing your enrollment.
How to enroll:There are two ways to elect, change or waive benefits coverage for 2016:
• Online at www.benefitsgo.com/Dennys15
• Click on “Enroll”
• On the next screen, enter the following information:
Username: Your birth date (MMDDYYYY) + Last four digits of your Social Security Number
Password: Your birth date (MMDDYYYY)
• By telephone. Speak directly to a benefits counselor by calling the Denny’s BenefitsEnrollment Center at 1-855-874-0439. See the suggested enrollment schedule below. If youmiss your recommended window, please call in as soon as possible before November 11.
Spanish-speaking counselors will be available.
Denny’s Benefits Enrollment Center CalendarHours of Operation: Monday – Friday, 10 a.m. to 7 p.m. (ET)
Phone Number: 1-855-874-0439
If your last name begins with: Your call-in dates are:
A to H 10/26, 10/27, 10/28
I to Q 10/29, 10/30, 11/02
R to U 11/03, 11/04, 11/05
V to Z 11/06, 11/09, 11/10, 11/11
Upon completion of your benefit elections, carefully review your online confirmation statement to be sure all the information is correct.
You Must Enroll Online or Call the Enrollment Center and Actively Enroll. If you do not enroll, you will not have coverage through the Denny’s plan in
2016. If you recently enrolled as a new hire/newly eligible employee, you will still need to re-enroll for 2016.
YOU MUST RE-ENROLL. (YOUR CURRENT BENEFITS WILL NOT ROLL OVER)
4 Hourly Employee Benefits Guide 2016
Contents
CO
NT
EN
TS
2016 BENEFIT HIGHLIGHTS
Enrollment and Eligibility ............................................................................................................................... 5
Medical Plan Descriptions ...............................................................................................................................6
Medical Plan Terms to Know ........................................................................................................................ 7
Medical Plan Comparison ...............................................................................................................................8
Prescription Drug Benefit ...............................................................................................................................9
Hawaii Medical Plan .......................................................................................................................................... 10
Hawaii Prescription Drug Benefit ............................................................................................................... 11
Dental ........................................................................................................................................................................12
Vision .........................................................................................................................................................................13
Health Savings Account .................................................................................................................................14
Flexible Spending Account...........................................................................................................................15
Life Insurance Options .....................................................................................................................................16
Travel Insurance ............................................................................................................................................17-18
401(k) Plan Highlights ......................................................................................................................................19
Medicare Notice ................................................................................................................................................20
Important Notices .............................................................................................................................................21
Rally Program ..................................................................................................................................................... 24
Voluntary Worksite Benefits .......................................................................................................................25
• The annual maximum family contribution for the Health Savings Account (HSA) has increased to $6,750.
• The annual maximum for the Flexible Spending Account (FSA) has increased to $2,550.
• The deductibles for the High Deductible Plans have decreased.
• The maximum out-of-pocket for the PPO family plan has decreased.
• We are now part of the BCBS Vaccine Network, which is included in the Pharmacy benefit. The VaccineNetwork has almost 62,000 pharmacies nationwide. It covers flu shots, including high-dose Fluzone, Intra-nasal flu vaccine (FluMist), Intradermal flu vaccine, adults over 65, and pediatric pneumonia vaccine. Thereis no co-payment for members who receive the flu or pneumonia vaccines from an in-network pharmacy.
5This guide is a quick reference to help answer most of your questions.
Enrollment and Eligibility
Annual EnrollmentThe 2016 annual enrollment period is Oct. 26 - Nov. 11, 2015. BENEFITS WILL NOT AUTOMATICALLY ROLL OVER. You must enroll or you will not have coverage for the 2016 Plan Year.
Annual enrollment is the period each year to make changes to your benefits. You can change plans as well as add or drop dependent coverage provided your dependent(s) meet all eligibility requirements. Any changes made during annual enrollment must remain until the following annual enrollment period, unless you experience a qualifying life event.
New HiresYou are eligible for full benefits if you have at least one year of service and are averaging a minimum of 30 hours per week during a rolling 52-week period. You are eligible for dental and vision benefits if you have six months of service, regardless of hours. If you average more than 20 hours per week, you may enroll in voluntary benefits.
IRS Section 125 guidelines allow you to pay certain benefit premiums before any taxes are deducted from your pay; therefore you pay fewer taxes.
Eligible DependentsYou also have the option to enroll your eligible dependents in some of these plans. Eligible dependents may include:
• Spouse - Your legally married spouse as recognized under any state law.
• Domestic Partner - Your spousal equivalent in whichyou may be required to provide a copy of a domestic partnership affidavit or other documentationproving domestic partnership eligibility.
•Your dependent children up to age 26* or whenapplicable, your unmarried children of any age whoare incapable of self-support due to a mental orphysical disability and who are totally dependent onyou.
When Can I Make Changes?During each annual enrollment period, you have the opportunity to review your benefit elections and make changes for the coming plan year. For most benefits you may only make changes to your elections during the year if you have a change in a qualifying life event. Life events include: marriage, divorce; gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, marriage, or reaching the dependent child age limit; changes in your spouse’s employment affecting benefit eligibility; changes in your spouse’s benefit coverage with another employer that affects benefit eligibility; changes in employee work status.
The change to your benefit elections must be consistent with the life event. You have 31 days from the date of the life event to submit an enrollment change form and documentation of the event to the Employee Benefits Department. Your election will become effective the day of the life event once paperwork is received. Otherwise, you must wait until the next annual enrollment period to make a change to your elections.
If you have any questions about your benefits or the 2016 Annual Enrollment process, please call the Employee Benefits Department at 1-800-859-2244.
*Certain limitations apply.
Employees that have completed 12 months of employment and have worked an average of 30 hours per week (within the past year) are eligible for the
following benefits:
Employees that have completed 6 Months of employment are eligible
for the following benefits:
Employees that have completed 6 Months of employment and have worked an average of 20 hours per week (within the past six months) are eligible for the
following benefits:
*All Coverage Effective 1st Of Month Following…(eligibility date)Medical x
Dental x x x
Vision x x x
Basic Life x
Supplemental Life x
Dependent Life x
FSA x x x
HSA x
Voluntary Plans (through Aflac & TransAmerica)
x NOT ELIGIBLE FOR VOLUNTARY BENEFITS
x
6 Hourly Employee Benefits Guide 2016
Medical Plan Descriptions
Preferred Provider Organization (PPO)PPOs offer coverage within a network of doctors and hospitals, but you do not have to choose a primary care physician. You can see a specialist when medically necessary - usually without a referral. You may seek care outside the network, but you will pay a higher cost.
With the PPO plan, you must pay a portion of costs through co-pays and co-insurance. If you stay within the Blue Cross Blue Shield network of providers, your co-pays for doctors’ visits are $25 for primary care and $40 for specialists. For other services, you must pay the cost of services in-full until you reach the deductible, then the plan covers 80% of costs until you reach the maximum out-of-pocket limit. The deductibles and out-of-pocket limits differ for in-network and out-of-network care. The PPO carries the highest premium cost to you, but it limits your total out-of-pocket expenses.
You may set aside pre-tax dollars to pay for certain out-of-pocket healthcare expenses through a flexible spending account (FSA). To find out how you can use an FSA to save money with your PPO plan, see page 15.
High Deductible Health Plans (HDHP)Our high-deductible plans, as the names suggest, carry a higher deductible than the PPO. Essentially, HDHPs are another type of medical plan where you pay a set amount of out-of-pocket costs before the health insurance begins to pay. In exchange, your premiums in the HDHP plans are lower than in the PPO plan. The deductibles and out-of-pocket limits differ for in-network and out-of-network care. In the HDHP I plan, you pay the full cost of doctors’ visits and medical services until you reach the deductible. After that, the plan covers 80% of costs until you reach the maximum out-of-pocket limit ($6,250 for an individual, $12,500 for family).
The HDHP II plan is similar, and it covers 60% of costs once the deductible is met. The maximum out-of-pocket limit is the same as with the HDHP I plan.
There are no co-pays in the HDHP Plans.
The HDHP options save you money up front through lower premiums than the PPO. To see how you can save even more money, flip to page 14 for information about a Health Savings Account.
Denny’s has designed its medical plan options to give you the opportunity to reduce your total cost of health-care. Benefit-eligible employees can choose between:
• A Preferred Provider Organization (PPO)• Two High Deductible Health Plans (HDHP)
All three plans are similar in that they provide access to the Blue Cross Blue Shield network of medical providers, which represents the best doctors and medical facilities in your region. They differ in how much you pay in premiums and how much you pay out-of-pocket for services. You pay the lowest cost for services when you stay in the network.
Giving You Options to Reduce Your Total Cost of Healthcare
HOW THE PLANS STACK UP
Highest Premium
Lowest Out-of-Pocket
Expense
Lowest Premium
Highest Out-of-Pocket
Expense
Higher Premium
Higher Out-of-Pocket
Expense
PPO PLAN HDHP 1 PLAN HDHP 2 PLAN
If you anticipate you will use a lot of medical services, this plan will limit your out-of-pocket exposure, but the up-front cost is high.
This plan has a lower premium in exchange for higher out-of-pocket costs.
If you anticipate minimal use of medical services, this plan will save you the most money.
You pay 20% once deductible is met
You pay 20% once deductible is met You pay 40% once
deductible is met
7This guide is a quick reference to help answer most of your questions.
What’s my Total Cost of Healthcare?Your Total Cost of Healthcare is how much you pay in premiums (the contribution taken out of your earnings each pay period) and how much you pay out-of-pocket when you see a doctor or other provider.
The truth is, many people pay more than they need to for healthcare. A healthy person can take advantage of lower premiums to lower his/her total healthcare cost and even save money for medical expenses down the road in future years.
Here are some definitions that may help as you familiarize yourself with each of the plan offerings:
Co-payA fixed amount you pay each time you use medical services until you reach your out-of-pocket maximum. Example: You may pay the co-pay for doctor’s visits or if you get a prescription filled.
DeductibleThe amount you pay for medical services before your health insurance plan begins to pay. Not everything you pay for (including your premium and co-pays) counts toward your deductible.
Co-insuranceThe percentage you pay after you meet your deductible. Example: After your deductible is met, you might pay 20% of a bill and your plan pays 80%. But once you meet the annual out-of-pocket maximum, your plan pays 100% of your costs for covered services.
PremiumThe amount deducted biweekly from your paycheck for the coverages you elected.
Out-of-Pocket ExpensesThe maximum amount you will have to pay. This is your deductible and co-insurance maximum. Once this amount is met, covered expenses are paid at 100% of the allowed charges for the rest of the year.
Terms to Know
Your Share of the Premium(the money deducted from
your paycheck)
Your Out-of-Pocket Costs(co-insurance, co-pays, deductibles, etc.)
YOUR TOTAL COST OF HEALTHCARE
+
Preventive care includes such services as annual physical exams, mammograms, pap smears, prostate screenings, and colonoscopies.
Based on federal Healthcare Reform Guidelines, preventive care is covered at 100% under all plans. For more information, visit www.healthcare.gov.
8 Hourly Employee Benefits Guide 2016
Medical Plan Comparison
Contact: BCBS at www.southcarolinablues.com 1-800-760-9290 (M-F 8am-6pm ET)PPO HDHP I HDHP IIIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible $1,000 individual/$3,000 family
$2,000 individual/$6,000 family
$2,000 individual/$4,000 family
$4,000 individual/$12,000 family
$4,000 individual/$8,000 family
$8,000individual/$16,000 family
Out-of-Pocket Maximum
$4,000 individual/$9,000 family
$8,000 individual/ $16,000 family
$6,250 individual/$12,500 family
$8,500 individual/$25,500 family
$6,250 individual/12,500 family
$12,500 individual/$25,000 family
Co-insurance 80% 60% 80% 50% 60% 40%
Primary Care Physician/ Specialist
$25 co-pay/ $40 copay
60% afterDeductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Preventive Services 100% Not Covered 100% Not Covered 100% Not Covered
Sustained Health Services
$25 co-pay$300 max. N/A 100%
$300 max. N/A 100%$300 max. N/A
Inpatient Facility Charges
$250 co-pay, then 80% after
Deductible
$500 co-pay, then 60% after
Deductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Skilled Nursing Facilities Charges
80% afterDeductible
60% afterDeductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Outpatient Facility Charges
80% afterDeductible
60% afterDeductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Independent Lab and X-rays 100% 60% after
Deductible80% after
Deductible50% after
Deductible60% after Deductible
40% afterDeductible
Chiropractic Benefits
80% afterDeductible$500 max.
60% afterDeductible$500 max.
80% afterDeductible$500 max
50% afterDeductible$500 max.
60% afterDeductible$500 max.
40% afterDeductible$500 max.
Ambulance 80% afterDeductible
80% afternetwork
Deductible
80% afterDeductible
80% afterDeductible
60% afterDeductible
60% after Deductible
Urgent Care (not outpatient hospital)
$25 or $40 co-pay based on place of
service
60% after Deductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% after Deductible
Emergency Room Facility
$100 co-pay, then 80% after
Deductible
$100 co-pay, then 60% after
Deductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Emergency Room Professional
80% afterDeductible
60% afterDeductible
80% afterDeductible
50% after Deductible
60% afterDeductible
40% afterDeductible
PPO HDHP I HDHP IIIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible $1,000 individual/ $3,000 family
$2,000 individual/ $6,000 family
$2,000 individual/ $4,000 family
$4,000 individual/ $12,000 family
$4,000 individual/ $8,000 family
$8,000 individual/ $16,000 family
Out-of-Pocket Maximum
$4,000 individual/ $9,000 family
$8,000 individual/ $16,000 family
$6,250 individual/ $12,500 family
$8,500 individual/ $25,500 family
$6,250 individual/ 12,500 family
$12,500 individual/ $25,000 family
Co-insurance 80% 60% 80% 50% 60% 40%
Primary Care Physician/ Specialist
$25 co-pay/ $40 copay
60% after Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
Preventive Services 100% Not Covered 100% Not Covered 100% Not Covered
Sustained Health Services
$25 co-pay$300 max. N/A 100%
$300 max. N/A 100%$300 max. N/A
Inpatient Facility Charges
$250 co-pay, then 80% after
Deductible
$500 co-pay, then 60% after
Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
Skilled Nursing Facilities Charges
80% after Deductible
60% after Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
Outpatient Facility Charges
80% after Deductible
60% after Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
Independent Lab and X-rays 100% 60% after
Deductible80% after
Deductible50% after
Deductible60% after Deductible
40% afterDeductible
Chiropractic Benefits
80% after Deductible$500 max.
60% after Deductible$500 max.
80% after Deductible$500 max
50% after Deductible$500 max.
60% after Deductible$500 max.
40% after Deductible$500 max.
Ambulance 80% after Deductible
80% after network
Deductible
80% after Deductible
80% after Deductible
60% after Deductible
60% after Deductible
Urgent Care (not outpatient hospital)
$25 or $40 co-pay based on place of
service
60% after Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
Emergency Room Facility
$100 co-pay, then 80% after
Deductible
$100 co-pay, then 60% after
Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
Emergency Room Professional
80% after Deductible
60% after Deductible
80% after Deductible
50% after Deductible
60% after Deductible
40% after Deductible
9This guide is a quick reference to help answer most of your questions.
Prescription Drug Benefit
Your Share of the PremiumYour share of the premium is deducted from your earnings. You share this cost with Denny’s, which pays a majority of the medical insurance premium.
Preferred PPO HDHP I HDHP II
In-Network Out-of- Network In-Network Out-of-
Network In-Network Out-of- Network
RETAIL
Generic $1531-day supply N/A
80% after deductible
50% after deductible
60% after deductible
40% after deductible
Preferred Brand $4031-day supply N/A
80% after deductible
50% after deductible
60% after deductible
40% after deductible
Non-Preferred Brand $7031-day supply N/A
80% after deductible
50% after deductible
60% after deductible
40% after deductible
MAIL ORDER (90-day supply)
Generic $25 N/A80% after deductible
50% after deductible
60% after deductible
40% after deductible
Preferred Brand $90 N/A80% after deductible
50% after deductible
60% after deductible
40% after deductible
Non-Preferred Brand $175 N/A80% after deductible
50% after deductible
60% after deductible
40% after deductible
Specialty DrugMember Provider #: 1-800-237-2767.
$12531-day supply N/A
80% after deductible
31-day supply
50% after deductible
31-day supply
60% after deductible
31-day supply
40% after deductible
31-day supply
PPO HDHP I HDHP IIIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible $1,000 individual/$3,000 family
$2,000 individual/$6,000 family
$2,000 individual/$4,000 family
$4,000 individual/$12,000 family
$4,000 individual/$8,000 family
$8,000individual/$16,000 family
Out-of-Pocket Maximum
$4,000 individual/$9,000 family
$8,000 individual/ $16,000 family
$6,250 individual/$12,500 family
$8,500 individual/$25,500 family
$6,250 individual/12,500 family
$12,500 individual/$25,000 family
Co-insurance 80% 60% 80% 50% 60% 40%
Primary Care Physician/ Specialist
$25 co-pay/ $40 copay
60% afterDeductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Preventive Services 100% Not Covered 100% Not Covered 100% Not Covered
Sustained Health Services
$25 co-pay$300 max. N/A 100%
$300 max. N/A 100%$300 max. N/A
Inpatient Facility Charges
$250 co-pay, then 80% after
Deductible
$500 co-pay, then 60% after
Deductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Skilled Nursing Facilities Charges
80% afterDeductible
60% afterDeductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Outpatient Facility Charges
80% afterDeductible
60% afterDeductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Independent Lab and X-rays 100% 60% after
Deductible80% after
Deductible50% after
Deductible60% after Deductible
40% afterDeductible
Chiropractic Benefits
80% afterDeductible$500 max.
60% afterDeductible$500 max.
80% afterDeductible$500 max
50% afterDeductible$500 max.
60% afterDeductible$500 max.
40% afterDeductible$500 max.
Ambulance 80% afterDeductible
80% afternetwork
Deductible
80% afterDeductible
80% afterDeductible
60% afterDeductible
60% after Deductible
Urgent Care (not outpatient hospital)
$25 or $40 co-pay based on place of
service
60% after Deductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% after Deductible
Emergency Room Facility
$100 co-pay, then 80% after
Deductible
$100 co-pay, then 60% after
Deductible
80% afterDeductible
50% afterDeductible
60% afterDeductible
40% afterDeductible
Emergency Room Professional
80% afterDeductible
60% afterDeductible
80% afterDeductible
50% after Deductible
60% afterDeductible
40% afterDeductible
Bi-Weekly Medical Premium Rates
Medical Plan PPO HDHP 1 HDHP 2
EmployeeContribution
EmployeeContribution
EmployeeContribution
Employee $80.46 $59.54 $41.98
Employee & Spouse $169.62 $138.00 $116.77
Employee & Child(ren) $153.63 $113.08 $98.77
Employee & Family $266.55 $166.15 $146.31
Contact: BCBS at www.southcarolinablues.com 1-800-760-9290 (M-F 8am-6pm ET)
10 Hourly Employee Benefits Guide 2016
Medical (Hawaii Residents Only)
KAISER HAWAII
BENEFIT MEMBER PAYS
Deductible None
Annual Supplemental Charges Maximum per Calendar Year $2,500/$7,500
Outpatient Services
Office visits $20 per visit
Routine obstetrical (maternity) care No charge
Inpatient Services
Hospital room and board, doctors' medical and surgical services, and anesthesia services
10% of applicable charges including observation & maternity stay
Laboratory, Imaging, and Testing Services
Inpatient lab, imaging, and testing See Inpatient Services Co-pay
Outpatient lab, imaging, and testing$10 per day OR
10% of applicable charges for: specialty lab tests, specialty imaging, specialty testing & radiation therapy
Mental Health Services
Outpatient office visits $20 per visit
Hospital inpatient care 10% of applicable charges
Day treatment or partial hospitalization services $20 per visit
Non-hospital residential services 10% of applicable charges
Chemical Dependency Services
Outpatient office visits $20 per visit
Hospital inpatient care 10% of applicable charges
Day treatment or partial hospitalization services $20 per visit
Non-hospital residential services 10% of applicable charges
Emergency Services (for initial treatment only)
Within the Hawaii service area $100 per visit
Outside the Hawaii service area $100 per visit
Ambulance Services 20% of applicable charges
Diabetes Equipment and Internal Prosthetics, Devices, and Aids
Diabetes equipment 50% of applicable charges
Internal prosthetics, devices, and aids No charge
External Prosthesis/Durable Medical Equipment (with additional hearing aid allowance; see rider for details) 20% of applicable charges
Contact: Kaiser at www.kp.org 1-800-966-5955 (M-F 8am-5pm and Sat 8am-12pm)
11This guide is a quick reference to help answer most of your questions.
Medical (Hawaii Residents Only)
This Plan is a Health Maintenance Organization (HMO)This HMO provides access to the Kaiser Permanente network of physicians and other medical providers.
With an HMO, all care is coordinated through your primary care physician (PCP) – typically referred to as your family doctor. You pay a co-pay for all primary care and specialist visits. Other services require either a co-pay or small percentage of applicable charges.
You need a referral from your PCP to visit a specialist, receive tests and access any other type of service (except for emergency situations).
The HMO does not cover care outside the network, except for emergencies.
The plan will pay for emergency care if you are visiting outside the network’s region (for instance, if you’re on vacation).
Your Share of the Premium
Your share of the premium is deducted from your earnings. You share this cost with Denny’s, which pays a majority of the medical insurance premium.
Prescription Drug Coverage
Contact: Kaiser at www.kp.org 1-800-966-5955 (M-F 8am-5pm and Sat 8am-12pm)
Kaiser HMO
In-Network
RETAIL
Generic $5
Preferred Brand $10
Non-Preferred Brand $45
MAIL ORDER (90-DAY SUPPLY)
Generic $10
Preferred Brand $20
Non-Preferred Brand $90
Bi-Weekly Medical Premium Rates
Employee Contribution
Employee Only 1.5% of biweekly salary
Employee & Spouse $115.26
Employee & Child(ren) $109.50
Employee & Family $207.39
12 Hourly Employee Benefits Guide 2016
Dental
Delta Dental PPO Providers offer deep discounts from standard charges without charging amounts in excess of deductibles and plan maximums.
Delta Dental Premier Providers offer lesser discounts than PPOs but have the assurance of not charging amounts in excess of co-insurance, deductibles, and plan maximums.
Non-Network Providers are not contracted with Delta Dental. The benefit payment for services will be based on the amount charged by the majority of dentists. If the dentist’s fee is higher, you will be responsible for the balance.
Delta Dental$25 Deductible Plan $50 Deductible Plan
Delta Dental PPO & Premier
Non-Participating
Providers
Part-Time Employees
Delta Dental PPO & Premier
Non-Participating
Providers
Part-Time Employees
Contract Year Deductible $25 individual $25 individual $25 individual $50 individual $50 individual $50 individual
Annual Maximum $1,500 $1,500 $1,500 $750 $750 $750
Preventive Services 100% 100%100% Benefits
available immediately
100% 100%100% Benefits
available immediately
Basic Services 80% 80%
80% Benefits available after 6 months on the
plan
80% 80%
80% Benefits available after 6 months on the
plan
Major Services 50% 50%
50% Benefits available after 12 months on the
plan
N/A N/A N/A
Orthodontia **Part-time employees must be enrolled for 12 months before becoming eligible for the Orthodontia Benefit
50% up to $2,000 lifetime maximum, no
deductible
50% up to $2,000 lifetime maximum, no
deductible
50% up to $2,000 lifetime maximum, no deductible**
N/A N/A N/A
Preventive Services Exams, bitewing x-rays, full mouth x-rays (once every three years), cleanings, topical fluoride (dependent children under 19 years of age), space maintainers (under the age of 19 – once per benefit period), sealants for dependent children under age 19 (once every five years), and emergency palliative treatment
Basic ServicesFillings, non-surgical periodontics, surgical periodontics, endodontics, simple extractions, surgical extractions, general anesthesia, and oral surgery
Major ServicesBridge and dentures (once every five years), crowns, and inlays and onlays (once every five years)
Contact: Delta Dental at www.deltadentalsc.com 1-800-335-8266 (M-F 8am-6pm ET)
While our dental plan design remains the same for 2016, our provider network has expanded, helping you save on out-of-pocket dental costs. Both plan options pay a percentage of covered charges. The share you pay is determined by the plan you choose. The plan will not pay charges above reasonable and customary (R&C). The plan continues paying a percentage of your covered services until you reach the calendar year maximum for benefits for the plan year, January 1, 2016 through December 31, 2016.
About Delta Dental Networks
Bi-Weekly Rates (per pay period)$25
Deductible Plan
$50 Deductible
Plan
Employee Only $18.22 $10.09
Employee & Spouse $37.25 $20.65
Employee & Child(ren) $40.54 $20.49
Employee & Family $63.90 $32.93
13This guide is a quick reference to help answer most of your questions.
Vision
Contact: VSP at www.VSP.com 1-800-877-7195 (M-F 8am- 11pm ET, Sat 9am-8pm ET)
VSP CHOICE PLAN
Provider NetworkVSP Network 27,000 providers 46,000 access points
Frequency Exam every 12 months Lenses every 12 months Frame every 24 months
Co-pay $10 Exam and $10 Materials
WellVision Exam Comprehensive WellVision Exam covered in full
Contact Lens Exam (fitting and evaluation) Standard fit & Premium fit: Covered in full after co-pay. Member receives 15% off of contact lens exam services; Member’s co-pay will never exceed $60.
Lenses
Lens Options
Frames
Glass or plastic, single vision, lined bifocal, lined trifocal, or lenticular prescription lenses are covered in full (less any applicable co-pay).
Guaranteed pricing on all lens options, saving our members an average of 20-25%.
Dependent children are eligible for covered in full polycarbonate prescription lenses.
Frames are covered in full (less any applicable co-pay) up to the retail allowance of $150.
20% off any amount above the allowance.
Frame allowance backed by a wholesale guarantee, meaning VSP fully covers more frames compared to retail allowance plans.
Contact Lenses 15% off contact lens services, not materials.
Instead of eyeglasses, elective contact lens material are covered up to $150 toward any prescription contact lenses.
Necessary contact lenses are covered in full (less any applicable co-pay) for specific conditions for which contact lenses provide better visual correction.
Diabetic Eyecare ProgramProvides additional coverage through medical diagnosis and procedure codes specifically targeted toward Type 1 and 2 diabetics - Co-pay $20.
Eye Health Management Program
Includes member materials, care from VSP providers, and data that supports your wellness initiatives.
Laser VisionCare Program
Discounts only available from VSP contracted facilities
Discounts averaging 15-20% off or 5% off a promotional offer for laser surgery including PRK, LASIK, and Custom LASIK (Using wavefront technology with the microketatome surgical device only).
Value-added Benefits 20% off unlimited additional pairs of prescription glasses and/or non-prescription sunglasses.
OPEN ACCESS REIMBURSEMENT SCHEDULE
Eye Exam $45
Single Vision Lined Bifocal Lined Trifocal
Lenticular Progressive
Frames
$30 $50 $65 $100
$50
$70
Elective ContactNecessary Contact
$105
$210
Bi-Weekly Vision Rates
Employee $3.55
Employee & Spouse $5.14
Employee & Child(ren) $6.19
Employee & Family $9.90
14 Hourly Employee Benefits Guide 2016
Health Savings Account (HSA)
Denny’s has teamed up with HSA Bank to create an affordable health coverage option that helps you save on healthcare expenses while protecting your health and finances. It combines a high-deductible health plan from your insurance provider with a tax-advantage health savings account (HSA). Together, they offer you health, savings, and tax advantages that a traditional plan cannot duplicate.
Your HSA can be used to pay for eligible medical expenses such as:
• deductibles / co-insurance• prescriptions• dental and vision care• premiums for COBRA
Some of the Advantages Include:• Funds roll over year after year. There’s no “use it or
lose it” philosophy.
• Your HSA is portable – the funds follow you if youleave your employer or change health insurance.
• The account has the potential to build more savingsthrough investing. You may choose a variety of HSAself-directed investment options.
• After age 65, funds can be withdrawn for any purpose without penalty.
• The maximum contribution for 2016 =Single $3,350; Family $6,750.
• If over age 55, you can do a catch-up contributionnot to exceed $1,000.
Contact: HSA Bank at www.hsabank.com 1-800-357-6246 (M-F 7am-9pm CT)
MEDICAL EXPENSES HDHP WITH HSA PLAN TRADITIONAL PLAN $4,000 Annual Deductible $1,500 Annual Deductible
8 Doctor Visits $568 $200
4 Preventive Care Visits $0 $0
2 Urgent Care Visits $254 $150
1 Outpatient Surgery (Ear Tube Placement) $903 $903
Total Medical Expenses $1,725 $1,253
COST COMPARISONEmployee’s Annual Premium $3,076 $4,072
Total Medical Expenses $1,725 $1,253
Federal Tax Savings -$259 $0
Social Security and Medicare (FICA) Tax Savings -$132 $0
State Tax Savings -$69 $0
Out-of-Pocket Expenses $4,341 $5,325
SAVINGS WITH AN HDHP/HSA PLAN $984
Compare and See the HSA Advantage!Annually, this typical family of four will face these medical expenses:
You can use the savings to fund your HSA account
15This guide is a quick reference to help answer most of your questions.
WORD TO THE WISE...USE IT OR LOSE IT.Remember to calculate your expenses conservatively when making FSA elections. IRS regulations require that you forfeit any money left in your account after the claims submission deadline.
Flexible Spending Account (FSA)
REMEMBER... • Keep all of your receipts.• You might be required to submit receipts to verify expense eligibility.• The card is only valid at eligible merchants.• The card can be used up to the amount available in your account up to a daily maximum limit of $2,000.• Transactions over the available amount will be denied.• You have 24/7 access to account information at www.myrsc.com.
Contact: Benefit Coordinators at www.myrsc.com or 1-800-951-1012
Flexible spending accounts (FSAs) enable you to put aside money for important expenses and help you reduce your income taxes at the same time. Denny’s offers two types of flexible spending accounts — a healthcare flexible spending account and a dependent care flexible spending account.* These accounts allow you to set aside pre-tax dollars to pay for certain out-of-pocket healthcare or dependent care expenses.
1. Each year, during the annual enrollment period, or as a new employee, you decide how much to set aside for healthcareand/or dependent care expenses.
2. Your contributions are deducted from your paycheck on a before-tax basis in equal installments throughout the calendaryear.
3. You will receive a MasterCard debit card that you will use to pay for eligible expenses.
4. Your mySourceCard operates through programmed merchant codes that include doctors, hospitals, dentists/orthodontists,vision providers, pharmacies, and more.
5. Simply present your mySourceCard when paying for eligible expenses, and the funds will be paid directly from yourreimbursement account. The available credit on your card will be the available balance in your account up to a dailymaximum amount of $5,000.
6. The mySourceCard works just like any other debit card; but, there are five major differences:
• Limited to specific merchants deemed eligible by your plan
• Limited to expenses deemed eligible by your plan
• Card cannot be used at the ATM
• Card will not allow “cash back” with a purchase
• There is no PIN
*Please note that these accounts are separate — you may choose to participate in one, both, or neither. You cannot use money from thehealthcare FSA to cover expenses eligible under the dependent care FSA or vice versa.
Plan Annual Maximum Contribution Examples of Covered Expenses
Healthcare Flexible Spending Account $2,550 Co-pays, deductibles, orthodontia, prescription medications, etc.
Dependent Care Flexible Spending Account$5,000 ($2,500 if married and filing separate tax returns)
Daycare, nursery school, elder care expenses, etc.
16 Hourly Employee Benefits Guide 2016
Life Insurance Options
Contact: Prudential at www.prudential.com/mybenefits 1-800-524-0542
Basic Life InsuranceDenny’s provides Basic Life Insurance coverage equal to $5,000.
Supplemental Life InsuranceDenny’s also offers supplemental life insurance for yourself and your dependents.
SUPPLEMENTAL COVERAGE FOR: COVERAGE AMOUNTS AVAILABLE
You Additional $5,000, $10,000 or $15,000
Spouse and Dependent Children $5,000 or $10,000
Voluntary Accidental Death and Dismemberment (AD&D)
FAMILY MEMBER BENEFIT EQUAL TO A % OF YOUR COVERAGE AMOUNT
Spouse 60% of your coverage
Spouse and children 50% of your coverage for spouse plus 15% for each child
Children only 20% of your coverage for each child
Voluntary Accidental Death and Dismemberment (AD&D) coverage pays benefits upon death or a specified physical loss caused by an accident, such as the loss of hands, feet, sight, speech or hearing. This plan provides coverage for accidents occurring on or off the job, in or away from the home, or while traveling.
You can choose coverage for yourself only, in one of the following amounts: $10,000; $20,000; $30,000; $40,000; $50,000.
You can also choose coverage for you and your family. When you choose family coverage, your spouse and eligible dependent children are automatically covered and receive a percentage of your coverage amount.
The benefit you, or your family members, receive is based on the amount of coverage you choose and your family make-up at the time of the accident, as illustrated below.
17This guide is a quick reference to help answer most of your questions.
Travel Insurance
Contact: On Call International in the US at 1-800-565-9320/Worldwide 1-312-935-3654
You now have access to the AXA Travel Assistance Program, an essential service provided by AXA Assistance USA, Inc. This service offers you and your dependents medical and travel assistance services, 24 hours a day, 365 days a year. Participants have access to assistance services when faced with an emergency while traveling internationally, or domestically when more than 100 miles away from home; you and your dependents are eligible to access these services for up to 120 consecutive days for any given trip.* With one single phone call to (800) 565-9320 within the U.S. and +1 (312) 935-3654 outside the U.S. (collect), you and your dependents (whether traveling together or separately) will haveimmediate access to a broad range of travel assistance services.
Through this program, you will be connected to a global network of:• Over 600,000 service providers• Air and ground ambulance services• Trained multilingual personnel who can assist you quickly and professionally in a travel emergency
MEDICAL SERVICES
Medical and Dental ReferralsWith a worldwide network of providers at our fingertips, this service is able to offer you referrals to primary care physicians, dentists, clinics and hospitals.
Coordinate Hospital AdmissionThis service will assist with pre-certification for admission and elective outpatient surgical intervention. In the event that a hospital does not recognize your medical insurance, we will assist in guaranteeing hospital admission for you or your dependents by validating your health coverage and/or assisting with arrangements to advance funds.
Critical Care MonitoringDuring your hospitalization, our medical professionals will remain in regular communication with the treating facility to monitor your care.
Emergency Medical EvacuationWhenever adequate medical facilities are not available locally, our medical professionals will recommend and arrange the appropriate method of transportation, equipment and personnel to evacuate you to the nearest facility capable of providing proper care.
Medical RepatriationIf you need medical assistance to return home, our medical professionals will determine the appropriate transportation method and assist with all necessary travel arrangements based upon your medical condition.
Transportation to Join PatientIf you are traveling alone and expected to be hospitalized for more than seven days, this service will provide round-trip common carrier transportation to the place of hospitalization for a designated family member or companion.
Return of Dependent ChildrenIf a minor child is left unattended as a result of an accident or illness, this service will provide assistance with arranging transportation, with attendants if required, to return home.
Return of Mortal RemainsThis service will arrange the transportation, and offer reasonable assistance in legal formalities, for the return of mortal remains.
Vehicle Return ServicesIn the event that you need to be medically repatriated or evacuated to your home, this service will coordinate and manage all arrangements needed for the return of your unattended vehicle.
Escort ServicesIn the event that you need to be medically repatriated or evacuated, this service will arrange for a family member or companion who is traveling with you, to escort you to your destination.
Transportation of Travel CompanionIf you need to be evacuated or repatriated, this service will coordinate all arrangements for a family member or companion to join you. If our medical professionals cannot adequately assess the need for medical transport or evacuation, we will dispatch a physician to your location to make an assessment.
Dispatch of Prescription MedicationIf you forget or lose a prescribed medication, this service will assist with replacement medication. If the medication is not available locally, we will coordinate the dispatch of prescription medication, when possible and legally permissible, or provide you with an appointment with a physician in order to re-establish the prescription. This service is also available for medical devices, eye glasses and contact lenses.
18 Hourly Employee Benefits Guide 2016
Travel Insurance
* Applicable laws or policy terms may limit available coverage and benefits.Travel assistance services are independently offered and administered byAXA Assistance USA, Inc. (AXA). Insurance benefits for the program are
underwritten by a third party licensed insurance company.
Contact: On Call International in the US at 1-800-565-9320/Worldwide 1-312-935-3654
TRAVEL SERVICES Lost Document and Lost Article AssistanceThis service will assist with arrangements to replace or forward copies of lost or stolen documents, including passports, driver’s licenses and credit cards, as well as assist with procedures to file loss reports and to recover lost or stolen articles such as luggage.
Pet Housing and ReturnThis service can assist with pet-friendly hotel accommodations, boarding facilities and travel home for pets.
Emergency Cash and Bail AssistanceIf your wallet is stolen, this service can help arrange an emergency cash advance. This service can also provide assistance in obtaining bail bonds, where available.
Legal ReferralsThis service will provide referrals to an interpreter or legal personnel to you as necessary.
Arrangement for Political EvacuationThis service can arrange for the repatriation on political grounds for all covered travelers located in countries when their home country government calls for evacuation.
Urgent Message RelayThis service will relay emergency messages on the member’s behalf.
Online General Travel InformationBefore you travel, this service can provide information about visa, passport, immunization requirements and local customs. You can also obtain 24-hour pre-departure information on weather, currency or holidays. This service can be provided 24/7 over the phone by our Assistance Coordinators and also through an online tool.
HOW TO ACCESS SERVICESNext time you or your family members are traveling and need assistance, remember to use the phone number on the back of your Travel Assistance ID card. Be sure to carry the card with you at all times. One simple phone call to the Response Center puts you in touch with trained staff that will ensure your call is handled in an appropriate and timely fashion.
EXCLUSIONSTravel Assistance Services will not be provided or available for any loss or injury that is caused by, or results from:
• Suicide, attempted suicide or any intentionally self-inflictedinjury while sane or insane (in Missouri, sane only).
• Act of declared or undeclared war (political evacuation notsubject to this exclusion.)
• Participating in, or practicing for, professional sports.
• Piloting or learning to pilot or acting as a member of the crew
of any aircraft.
• The commission of or attempt to commit a felony by theInsured Person or the Insured Person’s being engaged in anillegal occupation as a contributory cause.
• Normal childbirth, normal pregnancy (except Complications ofPregnancy) or voluntary induced abortion.
• Mental or nervous condition, unless hospitalized.
• Participating in maneuvers or training exercises of an armedservice, except while participating in weekend or summertraining for the reserve forces of the United States, includingthe National Guard.
NOTEThe maximum benefit per person for costs associated with medical evacuations, repatriations or the return of mortal remains is $150,000 USD per occurrence. All additional costs associated with these or other medical and travel services will be the responsibility of the member.
Contact your primary health insurance carrier for considerationof coverage for medical expenses.
Additional travel assistance services will be provided by AXA Assistance USA, Inc. at no extra cost. AXA Assistance USA, Inc. is not responsible for third party costs associated with these services. Please remember that the Response Center needs to be contacted to activate these services.
Treatment must be authorized and arranged by AXA’s designated personnel to be eligible for services under this program. All services must be provided by or coordinated through AXA Assistance USA, Inc. No claims for reimbursement will be accepted.
For your convenience, please cut out the card below and always carry it with you while traveling.
19This guide is a quick reference to help answer most of your questions.
401(k) Plan Highlights
When can I enroll?You must be 21 years of age and have 6 months of service with the employer. Plan entry dates are the first day of any payroll period.The following employees are not eligible to join this plan:
• Employees covered by a collective bargaining agreement• Non-resident aliens• Leased employees• Employees whose basic compensation is not paid by Denny’s.
How much can I contribute to my 401(k) account?
You may contribute to your account with pre-tax and/or Roth contributions. Together, both contribution types are subject to the annual dollar limit on deferrals. You may contribute from 1% to 25% up to the IRS limit of $18,000 for 2016.
If you are age 50 or over by the end of the calendar year, you may qualify to make additional pre-tax or “catch-up” deferrals of up to $6,000 in 2016.
When can I change or stop my contributions?
You may change or stop your plan contributions anytime.
Does Denny’s make any contributions?
Effective 2016, Denny’s will make a safe harbor matching contribution for participants equal to 100% (on a dollar-for-dollar basis) of the first 3% of the pretax or Roth 401(k) contributions that you defer from your eligible compensation plus 50% (50¢ for each $1) of the next 2% deferred from your eligible compensation for the plan year. You can receive matching contributions in accordance with the following table:
Prior to 2016 certain employees previously were excluded from receiving a matching contribution under the plan in order for the plan to meet certain IRS compliance requirements. Effective 2016, the plan will provide safe harbor matching contributions. All employees who are eligible to make deferrals to the plan also are eligible for the safe harbor matching contributions.
Vesting. What does this mean to my 401(k) account?
“Vested” means you have ownership rights to a certain percentage of the amounts in your plan accounts. You are always 100% vested in your pretax 401(k) and Roth 401(k) contributions accounts, and you are always 100% vested in your safe harbor matching contributions account. The employer does not currently make any other types of contributions to the plan. If any other contributions are made, they generally will be 100% after your third complete year of service.
Can I roll over money into my 401(k) account?
You may roll over money into your account from the following sources:• 403(b) plans• 457 plans• Other qualified plans
See your Summary Plan Description or Plan Administrator for rollover details.
How do I enroll and/or obtain information about my account?
You may enroll in the plan or access your account via the Internet at wellsfargo.com or the Wells Fargo Retirement Service Center at 1-800-728-3123 (toll-free nationwide). For Spanish press option 2. Once you enroll in the plan, you will receive quarterly account statements.
May I borrow money from my account?
You may borrow up to $50,000 or 50% of your vested balance, whichever is less. The minimum loan amount is $1,000. You may be charged a loan set-up fee of $50. You may have one loan outstanding at a time. Residential loans are not allowed. For more information on plan loans, including other loan requirements and the current interest rate, call the Wells Fargo Retirement Service Center at 1-800-728- 3123 (toll-free nationwide). For Spanish press option 2.
To request more information or an enrollment kit, contact the Wells Fargo Retirement Service Center at 1-800-728-3123. Retirement Service Center representatives are available Monday through Friday from 6
a.m. to 10 p.m. Central Time.
PARTICIPANT DEFERRAL
COMPANY MATCH
1% 1%
2% 2%
3% 3%
4% 3.5%
5% or more 4%
20 Hourly Employee Benefits Guide 2016
Medicare NoticeApplies to drug plans through your medical insurance carrier
IMPORTANT NOTICE FROM DENNY’S INC. ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Denny’s Inc. medical plan and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coveragebecame available in 2006 to everyonewith Medicare. You can get thiscoverage if you join a MedicarePrescription Drug Plan or join aMedicare Advantage Plan (like an HMOor PPO) that offers prescription drugcoverage. All Medicare drug plansprovide at least a standard level ofcoverage set by Medicare. Some plansmay also offer more coverage for ahigher monthly premium.
2. Denny’s Inc. has determined that theprescription drug coverage offeredby our Health Plan is, on average forall plan participants, expected to payout as much as standard Medicareprescription drug coverage pays andis therefore considered CreditableCoverage. Because your existingcoverage is Creditable Coverage, youcan keep this coverage and not pay ahigher premium (a penalty) if you laterdecide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Denny’s Inc. coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current Denny’s, Inc. coverage, be aware that you and your dependents will be able to get this coverage back if you re-enroll in the employer plan at annual enrollment or if you have a special enrollment event for the Denny’s, Inc. group insurance plan.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Denny’s, Inc. and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
Summary of Options for Medicare Eligible Employees (and/ or Dependents)
Medical and prescription drug coverage are offered as a package under the Denny’s Inc. plan (you cannot elect medical coverage without prescription drug coverage).
1. Continue medical and prescription drug coverage under the Denny’s Inc. Planand do not elect Medicare D coverage.Impact – your claims continue to bepaid by the Denny’s Inc. plan.
2. Continue medical and prescriptiondrug coverage under the Denny’s Inc.plan and elect Medicare D coverage.Impact - As an active employee (ordependent of an active employee)the Denny’s Inc. plan continues to payprimary on your claims (pays beforeMedicare D).
3. Drop the Denny’s Inc. plan coverageand elect Medicare Part D coverage.Impact – Medicare is your primarycoverage. You will not be able to rejointhe Denny’s Inc. plan until the nextopen enrollment period unless youexperience a qualified life event.
For More Information About This Notice Or Your Current Prescription Drug Coverage Contact…
Denny’s Employee Benefits Department 203 East Main Street Spartanburg, SC 29319 1-800-859-2244
NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Denny’s Inc. prescription plan changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans.
For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health InsuranceAssistance Program (see the insideback cover of your copy of the“Medicare & You” handbook for theirtelephone number) for personalizedhelp.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Creditable Coverage October 2015
21This guide is a quick reference to help answer most of your questions.
DENNY’S INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTSLoss of Other Coverage- If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. You will be required to submit a signed statement that this other coverage is the reason for waiving enrollment originally. To be eligible for this special enrollment opportunity you must request enrollment within 30 days after your other coverage ends or after the employer stops contributing towards the other coverage.
New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption- 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/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.
Medicaid Coverage- Denny’s group health plan will allow an employee or dependent who is eligible, but not enrolled for coverage, to enroll for coverage if either of the following events occur:
1. TERMINATION OF MEDICAID OR CHIP COVERAGE- If theemployee or dependent is covered under a Medicaid plan or undera State child health plan (SCHIP) and coverage of the employeeor dependent under such a plan is terminated as a result of loss ofeligibility.
2. ELIGIBILITY FOR PREMIUM ASSISTANCE UNDER MEDICAID ORCHIP- If the employee or dependent becomes eligible for premiumassistance under Medicaid or SCHIP, including under any waiveror demonstration project conducted under or in relation to sucha plan. This is usually a program where the state assists employedindividuals with premium payment assistance for their employer’sgroup health plan rather than direct enrollment in a state Medicaidprogram.
To be eligible for this special enrollment opportunity you must request coverage under the group health plan within 60 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP or the date you or your dependent’s Medicaid or state-sponsored CHIP coverage ends.
To request special enrollment or obtain more information, please contact the Employee Benefits Department at 1-800-859-2244.
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, 2015. Contact your State for more information on eligibility
ALABAMA – Medicaid Website: www.myalhipp.com Phone: 1-855-692-5447
ALASKA – Medicaid Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529ARIZONA – CHIP Website: http://www.azahcccs.gov/applicants/default.aspx Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437
FLORIDA – Medicaid Website: https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268
COLORADO – Medicaid Medicaid Website: http://www.colorado.gov/hcpf Medicaid Customer Contact Center: 1-800-221-3943
GEORGIA – Medicaid Website: http://dch.georgia.gov/ - Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 404-656-4507
IOWA – Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562
INDIANA – Medicaid Website: http://www.in.gov/fssa Phone: 1-800-889-9949
KANSAS – Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884
KENTUCKY – Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570
LOUISIANA – Medicaid Website:http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447
MAINE – Medicaid Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741
Important Notices
22 Hourly Employee Benefits Guide 2016
MASSACHUSETTS – Medicaid and CHIP Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120
MINNESOTA – Medicaid Website: http://www.dhs.state.mn.us/id_006254 Click on Health Care, then Medical Assistance Phone: 1-800-657-3739
MISSOURI – Medicaid Website:http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
MONTANA- Medicaid Website: http://medicaid.mt.gov/member Phone: 1-800-694-3084
NEBRASKA – Medicaid Website: www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633
NEVADA – Medicaid Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218
NEW JERSEY – Medicaid and CHIP 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
NEW YORK – Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831
NORTH CAROLINA – Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100
NORTH DAKOTA – Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-800-755-2604
OKLAHOMA – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
OREGON – Medicaid Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid Website: http://www.dhs.state.pa.us/hipp Phone: 1-800-692-7462
RHODE ISLAND – Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300
SOUTH CAROLINA – Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820
SOUTH DAKOTA- Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059
TEXAS – Medicaid Website: http://gethipptexas.com/ Phone: 1-800-440-0493
UTAH – Medicaid and CHIP Website: Medicaid: http://health.utah.gov/medicaid CHIP: http://health.utah.gov/chip Phone: 1-866-435-7414
VERMONT– Medicaid Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
VIRGINIA – Medicaid and CHIP 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
WASHINGTON – Medicaid Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx Phone: 1-800-562-3022 ext. 15473
WEST VIRGINIA – Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx Phone: 1-877-598-5820, HMS Third Party Liability
WISCONSIN – Medicaid and CHIP Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002
WYOMING – Medicaid Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531
To see if any other states have added a premium assistance program since July 31, 2015, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration http://www.dol.gov/ebsa/ 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services https://www.cms.gov/ 1-877-267-2323, Menu Option 4, Ext. 61565
HIPAA PRIVACY NOTICEProtecting Your Health Information Privacy Rights
The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. Please contact your medical plan carrier to request a copy of the Notice.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT (NMHPA)Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and insurers may not, under Federal law, require that a provider obtain authorization from the plan or the insurer for prescribing a length of stay not more than 48 hours (or 96 hours).
Important Notices
23This guide is a quick reference to help answer most of your questions.
NOTICE REGARDING THE WOMEN’S HEALTH AND CANCER RIGHTS ACT
On October 21, 1998, Congress passed a bill called the Women’s Health and Cancer Rights Act. This new law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services.
These services include:•Reconstruction of the breast upon which the mastectomy has been performed,•Surgery/reconstruction of the other breast to produce a symmetrical appearance,•Prostheses, and•Treatment of physical complications during all stages of mastectomy, including lymphedemas.
In addition, the plan may not:• Interfere with a woman’s rights under the plan to avoid these requirements, or• Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the
requirements of the law.
However, the plan may apply deductibles and co-pays consistent with other coverage provided by the plan.
If you have any questions about the current plan coverage, please contact the Employee Benefits Department at 1-800-859-2244.
REPORT ELIGIBILITY CHANGES IN A TIMELY MANNER
It is your responsibility to notify the Benefits Department when a dependent becomes eligible or ceases to be eligible for coverage under our benefit plans. All eligibility changes should be reported within 30 days of the event. Failure to report changes in a timely manner can impact your ability to add newly eligible dependents or discontinue pre-tax premium contributions on ineligible dependents.
In addition, failure to report a loss of eligibility due to legal separation or divorce or a dependent that has otherwise ceased to be eligible, such as a child reaching the maximum dependent child age limit, can impact your dependent’s rights for group health plan coverage under the federal law known as COBRA. If you fail to report the loss of eligibility within 60 days of the event, your dependents may be left with no continuation coverage under our plan. Please see your COBRA notice or your group health plan summary plan description for additional information.
The information contained in this summary should in no way be construed as a promise or guarantee of employment or benefits. The company reserves the right to modify, amend, suspend, or terminate any plan at any time for any reason. If there is a conflict between the information in this brochure and the actual plan documents or policies, the documents or policies will always govern. Complete details about the benefits can be obtained by reviewing current plan descriptions, contracts, certificates, policies and plan documents available from Human Resources.
Important Notices
24 Hourly Employee Benefits Guide 2016
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A service for members of
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This guide is a quick reference to help answer most of your questions.
Voluntary Worksite Benefits
25 25This guide is a quick reference to help answer most of your questions.
AFLAC AND TRANSAMERICA VOLUNTARY BENEFITSThe following benefits are offered to you by Aflac and TransAmerica. Choosing to elect coverage is completely voluntary. You will decide which benefits, if any, are suitable to your situation. Denny’s, Inc. does not sponsor or endorse these benefits, contribute to the cost of coverage or profit as a result of offering these benefits to you. Our sole functions as they relate to these voluntary benefits are limited to permitting Aflac and TransAmerica to publicize the benefits to you, collecting premiums through after-tax payroll deductions and remitting those premiums to Aflac and TransAmerica. Denny’s, Inc. is not responsible for ensuring the accuracy or completeness of the information provided to you by Aflac and TransAmerica. If you have questions or concerns about any of these benefits or how a claim is handled, youwill need to contact Aflac and TransAmerica directly.
Denny’s is still offering three new voluntary benefits, including policies for accidents and critical illness through Aflac and a whole life insurance policy through TransAmerica. Because they are voluntary, you pay the full cost of the premiums through convenient payroll deductions. These benefits are individually owned and portable, which means you can take your policy with you if you retire or leave the company, with certain stipulations
Group Accident InsuranceContact: Aflac at www.aflacgroupinsurance.com or 1-800-433-3036Voluntary accident insurance provides benefits for covered injuries and specified accident-related expenses for an individual or family. Since health insurance only covers certain expenses (and plan limits can apply), this plan is designed to help cover the out-of-pocket expenses that result from a covered accident.
• This is a voluntary benefit. You pay the full cost of the premium.
• The benefit amount is determined by the type of injury and its severity.
• All benefits are paid directly to you, unless you choose otherwise.
Plan Features:• Benefits are paid for accidents that occur on or off the job, so you have 24-hour coverage.
• You can also elect to cover your spouse and children.
• There are no health questions or physical exams required.
• Benefits are payable regardless of any other insurance programs.
• Coverage is guaranteed-issue, provided the applicant is eligible for coverage.
• The plan features benefits for both in-patient and out-patient treatment of covered accidents.
• Benefits are available for spouses and/or dependent children.
• There’s no limit on the number of claims an insured can file.
• Premiums are paid by convenient payroll deduction.
• Coverage is effective on the first of the month following the enrollment form approval date, provided payrolldeductions begin during that month.
Group Critical Illness InsuranceContact: Aflac at www.aflacgroupinsurance.com or 1-800-433-3036The out-of-pocket costs of a serious illness can be severe, even if you have medical insurance.
Critical illness insurance pays a lump sum benefit directly to you (unless otherwise assigned) if you are diagnosed with a covered condition. You use this money however you choose: help cover expenses your family incurs to be by your side, help replace lost earnings from being out of work, or to help cover deductibles and co-insurance.
You choose a benefit amount when you enroll. You can choose a benefit amount between $5,000 and $30,000 in increments of $5,000. Your premium will be determined by the benefit amount you choose, your age and tobacco status.
Covered Illnesses Include:• Heart Attack • End Stage Renal (Kidney) Failure
• Stroke • Coronary Artery Bypass Surgery *
• Major Organ Transplant • Cancer and Carcinoma in Situ *
Voluntary Worksite Benefits
Critical Illness Insurance Plan Features:• Lump-sum benefits paid directly to the insured (unless otherwise assigned) following the diagnosis of each
covered critical illness.
• Payroll deduction – premiums are paid through convenient payroll deduction.
• Guaranteed-Issue coverage is available
• Spouse coverage is available.
• Each dependent child is covered at 50% of the primary insured amount at no additional charge.
• Annual health screening benefits are included.
• The plan is portable with certain stipulations.
• Level premium rates are based upon the applicant’s age at the time of application. Rates cannot be individuallyincreased on a particular insured due to a change in age, health or individual claim.
• Immediate effective date – coverage will be effective the date the employee signs the application.
The benefits counselor will provide plan details and rates during your enrollment session. Rates will vary depending on your age, tobacco use, and the amount of coverage you elect.
*Carcinoma in Situ and Coronary Artery Bypass Surgery benefits are paid at 25% of the chosen benefit amount. Payment of the Carcinoma in Situ benefit will reduce the benefit for cancer 25%. Payment of the Coronary Artery Bypass Surgery benefit will reduce the benefit for a heart attack by 25%.
This is a brief product overview only. The plan has limitations and exclusions that effective benefits payable. Please refer to the plan for complete limitations and exclusions.
Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands.
Continental American Insurance Company • 2801 Devine Street • Columbia, South Carolina 29205 AGC1500236 IV (9/15)
Whole Life InsuranceContact: Transamerica at www.transamericaemployeebenefits.com or 1-888-763-7474Whole life insurance is designed to provide a death benefit to your beneficiaries if you pass away, but it can also build cash value that you can use while you are still alive. At an affordable premium, you can have the added financial protection you and your family may need during times of uncertainty.
• You have the ability to purchase whole life insurance for yourself, your spouse, your children and/or grandchildren.
• Whole life insurance is voluntary, which means you purchase the amount of coverage that best fits your needs.
• No physical exams are required to apply for coverage (although health questions may be asked).
• Benefits are in addition to any other life insurance benefits you may receive.
• You pay for the coverage through convenient payroll deductions.
• Level premiums never change.
• Guaranteed interest rate at 4%.
The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations that may affect any benefits payable.
You can receive detailed information on the plan and costs during your enrollment session. Your enrollment counselor can help you calculate the cost of the benefit, which will vary depending upon your age, the amount of coverage you elect, the amount of dependent coverage you choose, and other such factors.
27This guide is a quick reference to help answer most of your questions.
Voluntary Worksite Benefits
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