Important Notices

The Employee Retirement Income Security Act (ERISA) requires plan administrators — the people who manage plans — to give plan participants in writing the most important facts they need to know about their retirement and health benefit plans including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Upon written request, others are available, free-of-charge or for minimal copying fees.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give participants a right to purchase individual coverage if no group health plan coverage is available, and have exhausted COBRA or other continuation coverage.

The Mental Health Parity Act (MHPA) provides for parity in the application of annual and lifetime dollar limits on mental health benefits with annual and lifetime dollar limits on medical/surgical benefits.

The Newborns and Mothers Health Protection Act (Newborns Act) requires group health plans that offer maternity hospital benefits for mothers and newborns to pay for at least a 48-hour hospital stay for the mother and newborn following childbirth (or, in the case of a cesarean section, a 96-hour hospital stay), unless the attending provider, in consultation with the mother, decides to discharge earlier.

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

•All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance;

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator at 919.359.6265.

Group health plans are required to offer special enrollment to otherwise eligible employees, spouses and any new dependents upon marriage, birth, adoption or placement for adoption, or when a loss of eligibility for other group health plan or health insurance coverage occurs and when employer contributions toward other coverage cease. Accordingly, an employee who is otherwise eligible, but not enrolled for coverage, can enroll (and can also enroll a spouse and any new dependents, if they are otherwise eligible under the plan) when any of these events occur, as long as notification is provided within 30 days of the date the change became effective.

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. Avalon Flooring considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our company privacy policies. This notice describes how we may use and disclose information about you in administering your benefits, and it explains your legal rights regarding the information.

In order to provide you with insurance coverage, we need personal information about you, and we obtain that information from many sources – particularly employment records, benefit enrollment forms, and through assisting you with personal issues such as claim and eligibility concerns. In administering your benefits, we may use and disclose personal information about you in various ways, including:

Benefit Plan Operations: During the course of running Avalon Flooring benefit plans, we may disclose personal information during activities such as the administration of reinsurance and stop loss, underwriting and rating,
detection and investigation of fraud, transfer of policies and contracts from and to other health plans, facilitation of a sale, transfer, merger, or consolidation of all or part of Avalon Flooring with another entity including due diligence related to such activity, and other general administrative activities like data and information systems management.

Business Associates: We may disclose your personal information to Business Associates who provide services to us and have signed an agreement with us assuring they will protect the information.

Industry Regulations: We may disclose your personal information to state insurance departments, boards of pharmacy, the U.S. Food and Drug Administration, the U.S. Department of Labor, and other government agencies that regulate us.

Law Enforcement: We may disclose your personal information to federal, state, and local law enforcement officials.

Legal Proceedings: We may disclose your personal information in response to a court order or other lawful process.

Public Welfare: We may disclose your personal information to address matters of public interest as required or permitted by law (e.g. child abuse and neglect, threats to public safety, and national security).

In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you.
Plan Administration: You may solicit our assistance in helping you obtain payment for a claim, work through a referral procedure, or one of many other issues that could arise. In these situations, we may disclose personal information about you to a provider, an insurer, a vendor, a relative, a friend, or any other person you identify. We will limit the disclosure to the authorized events and/or dates specified in your authorization and only provide the minimum necessary information required to address your concern.

If you have given us authorization, you may revoke it at any time, if we have not acted on it. If you are a minor, you also may have the right to block parental access to your health information in certain circumstances, if permitted by state law. If you have any questions regarding authorizations, please contact Avalon Flooring’s Privacy Officer.

You may make a written request to the Plan to do one or more of the following concerning PHI about you that the Plan maintains:

• To put additional restrictions on the Plan’s use and disclosure of PHI about you. The Plan does not have to agree to your request.
• To communicate with you in confidence about PHI about you by a different means or at a different location than the Plan is currently doing. The Plan does not have to agree to your request unless such confidential communications are necessary to avoid endangering you and your request continues to allow the Plan to collect premiums and pay claims. Your request must be in writing and must specify the alternative means or location to communicate with you in confidence.
• To see and obtain copies of PHI about you. In limited cases, the Plan does not have to agree to your request.
• To amend PHI about you. In some cases, the Plan does not have to agree to your request for amendment.
• To receive a list of disclosures of PHI about you that the Plan and its business associates made for certain purposes for the last six (6) years (but not disclosures before April 14, 2004).
• To send you a paper copy of this notice if you received this notice by email or on the Internet. In some cases, the Plan may charge you a nominal, cost-based fee to carry out your request.

If you want to exercise any of the rights described in this notice, please contact the location referenced below. The Plan will give you the necessary information and forms for you to complete and return to the location.

You also have the right to file a complaint if you think your privacy rights have been violated. To do so, please contact the location referenced below. You also may write to the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

The federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practice, and to follow the terms of the notice currently in effect.

We may change the terms of this notice and our privacy policies at any time. If we do, the new terms and polices will be effective for all of the information that we already have about you, as well as any information that we may receive or hold in the future.

Please note that we do not destroy personal information about you when you terminate your employment with us. It may be necessary to use and disclose this information for the purposes described above even after your employment terminates, although policies and procedures will remain in place to protect against inappropriate use or disclosure.

To request additional copies of this notice or ask questions, contact: HR Department
2030 Springdale Rd
Cherry Hill, NJ 08003
856-282-5942

Please read this notice carefully and keep a copy for your files. This notice has information about your current prescription drug coverage with Avalon Flooring 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. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Avalon Flooring has determined that the prescription drug coverage offered by Express-Scripts is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage.

Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

You can join a Medicare Part D drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. This may mean that you may have to wait to join a Medicare drug plan and that you may pay a higher premium (a penalty) if you join later. You may pay that higher premium (a penalty) as long as you have Medicare prescription drug coverage. However, if you lose creditable prescription drug coverage, through no fault of your own, you will be eligible for a sixty (60) day Special Enrollment Period (SEP) because you lost creditable coverage to join a Part D plan. In addition, if you lose or decide to leave employer coverage; you will be eligible to join a Part D plan at that time using an Employer Group Special Enrollment Period. 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. 

If you decide to join a Medicare drug plan, your Avalon Flooring coverage will not be affected. You can keep this coverage if you elect Part D; this plan will coordinate with Part D coverage for those individuals who elect Part D coverage.

Your current drug coverage through Avalon Flooring, Inc. is as follows:
Generic $10, Brand Formulary $50, Non-Formulary $100

**If you decide to join a Medicare Part D drug plan and drop your Avalon Flooring prescription drug coverage, be aware that you and your dependent(s) may not be able to get this coverage back.

**You should also know that if you drop or lose your coverage with Avalon Flooring 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 Part D drug plan later.

If you go 63 continuous days or longer without prescription drug coverage that’s at least as good as Medicare’s Part D prescription drug coverage, your monthly premium may go up by at least 1% of the base beneficiary premium per month for every month that you did not have coverage. For example, if you go 19 months without coverage, your premium may consistently be at least 19% higher than the 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 November to enroll.

For more information about this notice or your current prescription drug coverage…
**Contact the person listed below for further information. **NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare Part D drug plan, and if coverage through Avalon Flooring changes. Copies are available upon request.

**For more information about your options under Medicare prescription drug coverage…
**Refer to the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare Part D drug plans.

For more information about Medicare Part D prescription drug coverage:

• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help,
• 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 enroll in one of the Medicare Part D drug plans, you may be required to provide a copy of this notice when you enroll to demonstrate whether you have maintained creditable coverage and whether you are required to pay a higher premium (a penalty).

Name of Entity/Sender: Avalon Flooring
Address: 2030 Springdale Road, Suite 400
Cherry Hill, NJ 08003
Phone Number: HR - (856) 833-6337

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.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa or call 1-877-543-EBSA (7669).

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, 2022. Contact your State for more information on eligibility.