Chestnut Hill Benevolent Association (BA) — Summary Plan Description

Christian Science Nursing Care Plan (Rev. 11.29.18)

Eligibility: Employees who are classified as Status 1, 2, or 3, and their dependent children*

  • *Dependent children: are an employee’s biological and adopted children who have not yet attained age 26.

Coverage Levels: Employees and their dependent children* will be covered according to Maximum Annual Coverage Level Amount per calendar year noted below as defined by the Employee’s Status level.
Plan Costs: Currently the BA covers the full cost of BA services for BA employees and their dependent children up to the Maximum Annual Coverage Level Amount per calendar year for the Employee’s Status level.
Covered Services: Only Christian Science Nursing Services provided by the BA are covered by this plan. Healthcare services provided by any other organization than the BA are not covered by this plan.
Effective January 1, 2015 and beyond, the CSNC Plan (the “Plan”) will cover an employee’s dependent children with the same amount of coverage the employee has based on the employee’s full or part-time status level as noted below:
Employee Status level /Maximum Annual Coverage Level Amount per calendar year of BA services
Status 1 (full-time regular employees) $5,000
Status 2 (regular employees 30+ hours/week) $4,000
Status 3 (regular employees 20+ hours/week) $3,000
The Plan provides the following Christian Science nursing services to employees:

  • Christian Science nursing care at the facility
  • Visiting Christian Science nursing care
  • Out-patient Christian Science nursing care services at the facility

Each Christian Science nursing case and provision for care is subject to space or case-load availability, and applicants must meet current BA requirements for acceptance. This Plan covers employees and their dependent children as defined above (but not spouses). Covered individuals may receive Christian Science nursing care, and necessary supplies, up to the dollar amounts noted above without charge when authorized and approved by BA management. The cost of BA Services that exceed the Maximum Annual Coverage Level Amount per calendar year, any nursing supplies purchased separately and other incidental expenses such as practitioner fees, special equipment, phone, hair care, etc. are the responsibility of the covered individual or, if a dependent child, his or her parents. Any exception needs to be approved by the Chief Executive Officer (CEO).
Enrollment of Employee and Dependent Children
BA employees are automatically enrolled in the Plan and covered at the appropriate level of coverage effective immediately upon being classified as a Status 1, 2, or 3 employee – no form is required for the employee’s enrollment.
Dependent children will be enrolled once the employee has completed the Dependent Children Enrollment Form, which can be obtained from the BA’s Human Resource Office. Employees should contact the BA Human Resources Department to complete the form to enroll dependent children in the Plan within 30 days of:

  1. the effective date a BA employee is classified as Status 1, 2, or 3,
  2. the birth or adoption of a dependent child, or
  3. if these time-frames are missed, the eligible BA employee and any dependent children can be enrolled at Open Enrollment for the following year.

Maximum Annual Coverage Level Amount per calendar year Changes as Employee Status Level Changes
The effective coverage amount will automatically change to the ranges noted above for the employee and covered dependent children as of the effective date of the employee’s change to a different Employee Status Level between Status 1, 2, or 3.
Termination of Coverage
Coverage in the Plan will terminate on the earlier of:

  1. the last day of the month of the employee’s termination of employment,
  2. for a dependent child, the last day of the month in which the dependent child reaches age 26,
  3. the last day of the month a BA employee changes to a status other than Status 1, 2, or 3,
  4. the date on which the Plan is amended to exclude the class of employee currently eligible to participate, or
  5. the date on which the Plan is terminated.

Employees and their dependent children will be offered the option of continuing coverage for an extended period under the COBRA guidelines in effect at the time. Employees and their dependent children will be notified of their options with regard to this coverage.
Note: The administrator of this group health plan believes this plan is a self-funded “grandfathered health plan” under the ACA. As permitted by the ACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means this plan may not include certain consumer protections of the ACA that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on certain benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the BA’s Human Resources Office: 617-975-2523.