2023 Benefits at Separation

You will have the option of continuing several of the benefits you were enrolled in prior to your separation.

If you separate from the Company please be sure that your current address is on file. You will receive important benefits information at your home address upon separation.

Please review the Summary Plan Description found on-line for each plan. If you have additional questions after reviewing this information, please contact the Benefits Service Center at 1-866-481-4922.

*NOTE - Some of your benefits require you to contact the carrier directly, within a specified amount of time, to continue coverage.

Your benefits generally end on your last day of work or your 91st day of continuous disability. For example, if your employment ends on June 5th or your 91st day of disability is June 5th, your benefits end at midnight on June 5th.

For a summary of the information on this page, see document, "Benefits at Separation".

Separation Checklist

+ Make sure your mailing address and phone numbers are current
+ Review the "Benefits at Separation-Details" Information below
+ Contact the Benefits Service Center at 866-481-4922 if you have any questions

Benefits at Separation Details

Cigna Health Plans

If your employment with the Company ends prior to age 60 or with less than ten (10) years of service, you will be eligible to continue health coverage under COBRA, and coverage will be limited to a maximum of 18 months or when you or your covered dependents reach age 65 or become eligible for any other group medical coverage, including Medicare (other than for end-stage renal failure).

You and your eligible dependents may elect “continuation coverage” for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). (There are extensions available past 18 months for some qualified beneficiaries). The company does not contribute toward the cost of COBRA coverage. If you elect COBRA and pay the required premiums, coverage is retroactive to the day your benefits originally ended, so there is no loss of coverage.

If you retire from the Company after age 60 with at least ten (10) years of continuous service with Mohawk, then you, and your eligible dependents, may continue your medical coverage until you or your covered dependents become age 65, or become eligible for any other group medical coverage, including Medicare, (other than for end-stage renal failure). Dependents that reach age 65 before the employee reaches age 65 will no longer be eligible for COBRA benefits. Your benefits will be the same as those provided to active covered employees, and the premiums for this will be equal to the COBRA premiums under the Plan. This amount can change annually and you are responsible for payment of these premiums directly to Tax Saver.

COBRA administration for the Cigna Health Plans and the My Medical Neighborhood Health Plan is handled by TaxSaver. Within one to two weeks after the end of your group coverage, you will be sent paperwork to your address on file. This paperwork will explain how you may continue your health coverage. If you want to continue coverage, please note that this application must be submitted within 60 days of receipt. If you have any questions about your COBRA benefits, you may contact Tax Saver at 888-602-6272.

Dental & Vision Plans
Coverage under the Company’s Dental and Vision Plans may be continued under the same qualifications and provisions as stated above for the Health Plan. Notice to make this election will also be sent to your address on file within 45 days after your group coverage ends. If you want to continue coverage, please note that this application must be submitted within 60 days of receipt.

COBRA Vendor for Medical, Dental, & Vision Plans
TaxSaver
P.O. Box 609002
Dallas, TX 75360

COBRA Customer Service - 9:30 am – 6:45 pm ET – 888-602-6272 / Fax: 214-528-8122
www.taxsaverplan.com

For premium payments:
TaxSaver
P.O. Box 2309
Omaha, NE 68103-2039

COBRA rates

Health Savings Account
Contributions cease with your last check. Your HSA dollars are portable and yours to keep and you may continue using the funds for qualified health care expenses. Account will transition to a free-agent account and you will receive a new card. Bank fees will apply. For questions about your health savings account, contact:

Cigna Health Plan—HSA Bank: 1-855-566-4295

Flexible Spending Accounts
Claims may be filed for expenses that were incurred before your employment ended, unless you elect to continue after-tax contributions under COBRA. You have 90 days to file a paper claim on these expenses. Claim forms are located under the Forms section of this website. Your debit card will be disabled as of your last day of employment. If you make after-tax contributions under COBRA, you may file claims for expenses incurred after your separation date. You have until March 31, 2022 to file your claims for expenses incurred between January 1, 2022 and December 31, 2022. If you have any questions, you may contact TaxSaver Plan at 800-328-4337.

Life and AD&D Insurance

You may continue life coverage under the conversion or portability provisions of the group plan. Mohawk will send employee/member information to MetLife in order to mail required forms to you. Completed forms must be returned within 91 days from your last day of employment. Questions regarding premium rates should be directed to MetLife at 1-877-275-6387.

Whole Life Insurance
You will receive a letter from Unum within 4 to 6 weeks after your last day of employment. You have the option of continuing your policy at the same rate by paying your premium directly to Unum. Unum can be reached at 1-800-635-5597.

Short-Term and Long-Term Disability Insurance
Short-term and long-term disability insurance terminates upon separation of employment and may not be continued.

Retirement 401k
You will receive a distribution packet in the mail at your home address from Fidelity within 2 weeks from your last day of employment. You have the options of receiving a cash distribution, doing a rollover into an IRA account or leaving your money in your account. You can set-up an IRA at your local bank or set-up one with Fidelity. This must be done prior to requesting a distribution. If your balance is less than $5,000, you have to take some form of distribution. You cannot leave your money in the account. If you elect a cash distribution and you are under age 59 ½, there will be an early withdrawal penalty of 10% imposed when you file your taxes at the end of the year. You will receive a 1099 form from Fidelity showing the cash distribution you received and you will have to claim this as income on your tax return. If you are over age 59 ½, the early withdrawal penalty will not apply. Any cash distribution will be taxed at an approximate rate of 20%. You can take a portion of your account as a cash distribution and the rest as a rollover. The packet you receive will have all the forms that you need to sign along with the tax information. If you do not receive this form, or have questions about this process, you may contact Fidelity at 1-800-835-5087. You may also access the Fidelity website at www.401k.com.
Resource Guide

Critical Illness

You may elect to continue your coverage providing you had six months continuous coverage. Call MetLife at 1-866-626-3705within 31 days of your last day of employment to request continuation of coverage. MetLife will mail a portability packet to you within 15 days. Return the completed packet along with any payment information requested. You have three options for direct bill: annual paper notice, quarterly paper notice, or monthly bank draft. If you have questions, call the MetLife customer service center at 1-866-626-3705.

Auto and Home Insurance
You have the option of continuing your policy directly with MetLife at the same low group rates. You must contact MetLife at 1-888-438-6388 within 31 days from your last day of employment to begin paying your premiums from home.

Long Term Care
Should you wish to continue your Long Term Care coverage if you separate from the Company, you may complete and submit the Portability Form to Unum within 31 days of separation for review and processing.

529 College Bound Savings Program
For information on continuing contributions to your College Savings Account after your employment ends, please call Alliance Capital at 888-324-5057.

Travel Assistance Program
Your eligibility to utilize the Travel Assistance program ends upon separation from the Company and may not be continued.

Commuter Benefits
Claims may be filed for expenses that were incurred before your employment ended. You have until March 31st the following year to file a paper claim on these expenses. Claim forms are located on the Commuter Benefits page under the Forms section of this website. Your debit card will be disabled as of your last day of employment. If you have any questions, you may contact TaxSaver Plan at 1-888-602-6272 or the Benefits Service Center at 1-866-481-4922.

* Please note that this information provides a general summary. For specific details you must refer to each Summary Plan Description, and in the event of question or discrepancy, the terms of the Plan will prevail.