BLUE CROSS BLUE SHIELD OF ARIZONA, INC.
Employee Assistance Program
Employee Assistance Program
The Company provides all employees and their families with access to an Employee
Assistance Program (EAP) through ComPsych®, the Guidance Resource Company®,
which includes:
ƒ Counseling and Referral Services, which can help you handle any issues you are
facing by providing sensitive, confidential support
ƒ LegalConnect, including telephonic legal information, referral, initial consultation at
no charge, and reduced rates
ƒ FinancialConnect, including telephonic information regarding personal finances
ƒ FamilySource child and elder care resources
ƒ GuidanceResources Online at www.guidanceresources.com, which has resources and
tools on topics such as health & wellness; law & regulations; family & relationships;
work & education; money & investments; consumer & leisure and home & auto.
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Eligibility
For purposes of the Employee Assistance Program (EAP), an employee is any individual
who is treated by the Company as its common law employee, who is on the regular
Company payroll, and whose compensation is reported by the Company on IRS Form W2.
Both full-time and part-time employees are eligible to participate on their date of hire.
Temporary employees, leased employees, independent contractors, and any persons not
classified as regular or term employees are not eligible.
As a Company employee, you and your eligible dependents can utilize the EAP, whether
or not you and/or your eligible dependents are enrolled in any other Company health care
benefits.
When Eligibility Ends
Your and your family members' access to EAP services ends on the earliest of the
following dates:
ƒ The last day of the month when you end your employment;
ƒ The last day of the month in which you retire;
ƒ The last day of any applicable COBRA period;
ƒ The day the Company discontinues the program
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How the Employee Assistance Program (EAP) Works
The EAP is automatically available to all eligible employees and their eligible family
members. You do not need to enroll or make any contributions. The Company pays the
full cost of the EAP.
The EAP is available through ComPsych, which is staffed by experienced professionals
who provide personal and confidential counseling services. These experts can help you
sort through issues and develop a solution you may not have considered on your own.
The services provided through the EAP are strictly confidential. ComPsych will not
release any information about you or your family members unless you give written
permission or unless the law requires it.
When You Need Help
You can reach ComPsych 24 hours a day, seven days a week. When you or a family
member needs help, simply:
ƒ Call ComPsych toll-free at 1-800-272-7255; TDD1-800-697-0353
ƒ Visit GuidanceResources Online at www.guidanceresources.com and enter the
Company’s company ID number, COM589
Assessment, Counseling and Referral Services
The EAP’s counseling services can provide you and your family members professional
counseling and referral services, an opportunity to confidentially discuss personal and
family problems for guidance and problem-solving help, and quality care by professional
counselors and therapists.
The EAP can help you and your eligible dependents by:
ƒ Identifying the problem
ƒ Recommending the appropriate counseling therapy and/or treatment
ƒ Providing referrals to community service providers and treatment programs
ƒ Giving confidential consultation
Contact with the EAP can be initiated in the following ways:
ƒ Manager or supervisor referral in order to help you improve job performance
ƒ Direct contact by employee
While the Company cannot require you to participate in the program, your supervisor,
manager, or Human Resources representative may recommend counseling. Your
compliance may be a condition of continued employment in cases of serious performance
or behavioral problems. However, participation in the EAP does not protect you from
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disciplinary action, up to and including termination of employment. Essentially, you are
responsible for the successful resolution of your problem through your willingness to
seek help and treatment.
Calling ComPsych
When you call ComPsych, a Guidance Resources counselor will listen to your concerns
and obtain a referral for you to talk to an expert counselor located in your area. During
the appointment, the counselor will discuss your situation and help you develop a plan of
action. You can visit a ComPsych counselor up to six times per presenting problem at no
cost to you. If it is determined your presenting problem cannot be resolved in six
sessions, or that you need additional services beyond six visits, you will be referred for
alternative or additional services after assessment. Your medical plan may cover any
additional or alternative services.
A ComPsych Guidance Resources counselor can help you deal with a variety of
concerns, including:
ƒ Depression
ƒ Grief and loss
ƒ Marital and family conflicts
ƒ Drug and alcohol abuse
ƒ Major life changes
ƒ Relationship issues
ƒ Anxiety and stress
ƒ Eating disorders
ƒ Physical or emotional abuse
FinancialConnect Financial Services
The FinancialConnect program offers you unlimited telephone access to certified public
accountants, certified financial planners, and other financial professionals who are trained
and experienced in handling personal financial issues and can offer consulting on issues
such as family budgeting, credit problems, tax questions, investment options, money
management and retirement programs.
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FamilySource Work-Life Programs
ComPsych’s FamilySource Guidance Specialists offer practical advice through
telephonic consultation, accurate and timely referral information, and educational
literature. Specialists are available to provide assistance on issues such as:
•
Finding and evaluating quality daycare
•
School selection for the relocating employee
•
Planning for your child’s college education
•
Understanding programs such as Medicare and Medicaid.
Callers receive detailed resource packages containing accurate referral information on
community resources, available openings in programs, and guidelines for evaluating:
•
daycare centers and after school programs
•
public and private schools and tuition assistance
•
geriatric assessment clinics
•
assisted living and other housing options for the elderly.
ComPsych will follow-up to make sure callers have received all the information
necessary to meet their specific needs.
LegalConnect Legal Services
The LegalConnect program provides you with unlimited telephone consultation with
attorneys who are trained and dedicated to providing legal information and assistance to
clients with such issues as divorce, bankruptcy, family law, real estate purchases and
wills.
If you need legal representation or extended assistance that cannot be provided by phone,
LegalConnect professionals can provide referrals to local attorneys. You or your family
member will receive a free 30-minute consultation and, thereafter, a 25% reduction in
fees for representation if you choose one of ComPsych’s network attorneys.
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Visiting GuidanceResources Online
GuidanceResources Online can help you obtain personal information for your life issues.
At GuidanceResources Online, you can:
ƒ Obtain information about personal, emotional, and life issues
ƒ Read HelpsheetsSM on your topic
ƒ Review frequently asked questions
ƒ Purchase expert-endorsed products and services to support your issue or lifestyle need
ƒ Get book recommendations
Remember, you’ll need to enter the Company’s company ID number to access the site:
COM 589
If You Need Additional Help
In cases where your situation calls for care beyond ComPsych’s counseling services, the
medical coverage you have through the corporation can help. The benefits available
depend on the medical option in which you have enrolled.
General Plan Information
Employer:
Blue Cross Blue Shield of Arizona, Inc.
2444 W. Las Palmaritas Drive
Phoenix, Arizona 85021-4883
(602) 864-4100
Employer I.D.: 86-0004538
Plan Administrator:
Blue Cross Blue Shield of Arizona, Inc.
2444 W. Las Palmaritas Drive
Phoenix, Arizona 85021-4883
(602) 864-4100
Plan’s Designated Agent for Legal Process:
Susan H. Navran, Esq.
Executive Vice President and General Counsel
2444 W. Las Palmaritas Drive
Phoenix, Arizona 85021
(602) 864-4179
Service of legal process may also be made upon the Plan Administrator.
Plan Year: January 1 through December 31
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ERISA Rights
As a participant in the EAP you are entitled to certain rights and protections under the
Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all
Participants shall be entitled to:
Receive Information About Your Plan and Benefits
•
Examine without charge, at the Administrator’s office all Plan documents, including
insurance contracts and a copy of latest annual report (Form 5500 Series) filed by the
Plan with the U.S. Department of labor and available at the Public Disclosure Room
of the Employee Benefits Security Administration.
•
Obtain upon written request to the Plan Administrator, copies of all Plan documents,
including insurance contracts and copies of the latest annual report (Form 5500
Series) and an updated summary plan description, and other Plan. The Administrator
may charge a reasonable fee for the copies.
•
Receive a summary of the Plan’s annual financial report. The Plan Administrator is
required by law to furnish each participant with a copy of this summary annual report.
Prudent Actions by Plan Fiduciaries
In addition to creating rights for Plan Participants, ERISA imposes duties upon the people
responsible for the operation of an employee benefit plan. The people who operate your
Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of
you and other Plan Participants. No one, including your Employer or any other person,
may fire you or otherwise discriminate against you in any way to prevent you from
obtaining a benefit or exercising your rights under ERISA.
Enforce Your Rights
If your claim for a benefit is denied or ignored, in whole or in part, you have a right to
know why this was done, to obtain copies of documents relating to the decision without
charge, and to appeal any denial, all within certain time schedules.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if
you request a copy of Plan documents or the latest annual report from the Plan and do not
receive them within thirty (30) days, you may file suit in a Federal court. In such a case,
the court may require the Administrator to provide the materials and pay you up to $110 a
day until you receive the materials, unless the materials were not sent because of reasons
beyond the control of the Administrator. If you have a claim for benefits that is denied or
ignored, in whole or in part, you may file suit in a state or Federal court. If it should
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happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against
for asserting your rights, you may seek assistance from the U.S. Department of Labor, or
you may file suit in a Federal court. The court will decide who should pay court costs and
legal fees. If you are successful, the court may order the person you have sued to pay
these costs and fees. If you lose, the court may order you to pay these costs and fees; for
example, if it finds your claim is frivolous.
Assistance with Your Questions
If you have any questions about the Plan, you should contact the Administrator. If you
have any questions about this statement or about your rights under ERISA, or if you need
assistance in obtaining documents from the Administrator, you should contact the nearest
office of the Employee Benefits Security Administration, U.S. Department of Labor,
listed in your telephone directory or the Division of Technical Assistance and Inquiries,
Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution
Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about
your rights and responsibilities under ERISA by calling the publication hotline of the
Employee Benefits Security Administration.
Claims Process
Any claim for benefits under the Plan must be made to ComPsych. If ComPsych denies
any claim for any reason other than failure to satisfy the eligibility requirements, you
must follow ComPsych’s claims review procedure.
Claims denied due to failure to satisfy the eligibility requirements must be made in
writing to the Administrator. If the Administrator denies a claim, the Administrator will
notify you of the denial within a reasonable period of time, but not later than 30 days
after receipt of the claim. This period may be extended one time by the Administrator for
up to 15 days, if the Administrator both (1) determines that an extension is necessary due
to matters beyond the control of the Plan and (2) notifies you, prior to the expiration of
the initial 30-day period, of the circumstances requiring the extension of time and the
date by which the Administrator expects to render a decision. If such an extension is
necessary due to your failure to submit the information necessary to decide the claim, the
notice of extension will specifically describe the required information, and you will be
given 45 days from receipt of the notice to provide the specified information. The notice
of a denial of a claim will be written in a manner calculated to be understood by a
claimant and will include:
(1) The specific reason or reasons for the denial;
(2) Reference to the specific plan provisions on which the denial is based;
(3) A description of any additional material or information necessary for you to
perfect the claim and an explanation of why such material or information is
necessary;
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(4) A description of the plan's review procedures and the time limits applicable to
such procedures, including a statement of your right to bring a civil action
under section 502(a) of ERISA following a claim denial on review.
Within 180 days after receipt of the above material, you shall have a reasonable
opportunity to appeal the claim denial to the Administrator for a full and fair review.
You or your duly authorized representative may:
(1) Request a review upon written notice to the Administrator;
(2) Submit written comments, documents, records, and other information relating
to the claim for benefits; and
(3) Receive, upon request and free of charge, reasonable access to, and copies of,
all documents, records, and other information relevant to the claimant's claim
for benefits.
The review will:
(1) Take into account all comments, documents, records, and other information
submitted relating to the claim, without regard to whether such information
was submitted or considered in the initial benefit determination.
(2) Not afford deference to the initial adverse eligibility determination and will be
conducted by an appropriate named fiduciary of the Plan who is neither the
individual who made the denial that is the subject of the appeal, nor the
subordinate of such individual.
A decision on the review will be made not later than 60 days after receipt of a request for
review, unless special circumstances require an extension of time for processing (such as
the need to hold a hearing), in which event a decision should be rendered as soon as
possible, but in no event later than 120 days after such receipt. A decision upholding the
denial of a claim will be written and will include:
(1) The specific reason or reasons for the denial;
(2) Reference to the specific plan provisions on which the denial is based;
(3) A statement that you are entitled to receive, upon request and free of charge,
reasonable access to, and copies of, all documents, records, and other
information relevant to your claim for benefits;
(4) A statement of your right to bring an action under section 502(a) of ERISA;
and
(5) The following statement: “You and your plan may have other voluntary
alternative dispute resolution options, such as mediation. One way to find out
what may be available is to contact your local U.S. Department of Labor
Office and your State insurance regulatory agency.”
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