Legal & Plan Documents <--Salaried-->
Summaries of Benefits and Coverage
The health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Benefits-eligible Team Members are offered a choice of medical coverage options. Choosing which option is right for you is an important decision. To help you make an informed choice, the Summaries of Benefits and Coverage (SBCs) summarize important information in a standard format. This helps you compare across options.
- 2023 Choice HRA Plan
- 2023 Value HRA Plan
- 2023 Choice HSA Plan
- 2023 Value HSA Plan
- 2022 Choice HRA Plan
- 2022 Value HRA Plan
- 2022 Choice HSA Plan
- 2022 Value HSA Plan
You can also request a paper copy, or request the SBCs in another language, free of charge, by calling Blue Cross and Blue Shield of Florida at 1-833-578-1132 (a toll-free number). You can also request a paper copy, or request SBCs prior to 2022 in another language, free of charge, by calling 1-800-985-3290 (a toll-free number).
On March 13, 2020, the President declared the outbreak of COVID-19 in the United States constituted a national emergency beginning March 1, 2020 and was extended on January 15, 2022 and remains in effect until the end of the public health emergency. The following document outlines temporary changes made to the Choice HRA and My Health Savings Plans during the declared public health emergency period.
COVID-19 Temporary Health Plan Changes
Summary Plan Descriptions
The Summary Plan Descriptions (SPDs) contain important information about each plan’s coverage, limitations, and exclusions. Bloomin’ Brands encourages you to become familiar with the SPDs. You can also request a paper copy of all plan documents, free of charge, by calling the BBI Resource Center at 1-800-555-5808 (Option 3). Summaries of Material Modifications (SMMs) represent updates to the SPDs.
Employee Benefit Plan:
- Bloomin’ Brands Wrap SPD
- Bloomin’ Brands ERISA Employee Benefit Plan Restatement – Pre 2022
- Bloomin’ Brands Cafeteria Program – 2022
- HIPAA Hybrid Entity Designation for the Employee Benefit Plan – effective January 2022
- Pre 2022 – Bloomin’ Brands Wrap SPD
- Pre 2022 – Bloomin’ Brands SPD
- 2018 Summary of Material Modifications
- Wellness Center Summary of Material Modifications – through 12.31.2022
Medical:
- Preferred Provider Plan of Benefits – Choice HSA Plan – as of June 2022
- Preferred Provider Plan of Benefits – Value HSA Plan – as of June 2022
- Preferred Provider Plan of Benefits – Choice HRA Plan – as of June 2022
- Preferred Provider Plan of Benefits – Value HRA Plan – as of June 2022
The following Summary Plan Descriptions only apply when you have been identified as living outside of a UnitedHealthcare network area (or the network is not of sufficient size to provide adequate access). This applies to a small group of Team Members.
EAP and Wellness:
Dental and Vision:
- 2022 Cigna Dental DHMO Patient Charge Schedule
- 2022 Cigna Dental DHMO Plan Certificate
- 2022 Cigna Dental DPPO In-Network Area Plan Certificate
- 2022 Cigna Dental DPPO Out-of-Area Plan Certificate
- 2022 VSP Vision Certificate of Coverage
Income Protection:
- Life Insurance Certificate of Coverage (VP and above)
- Life Insurance Certificate of Coverage (all other Salaried, Flex Managers, GEDMs, Sous Chefs, MITs, PDDs)
- Life Insurance ERISA Amendment
- AD&D Certificate of Coverage (VP and above)
- AD&D Certificate of Coverage (all other Salaried, Flex Managers, GEDMs, Sous Chefs, MITs, PDDs)
- New York Life Insurance Company Name Change Endorsement
- Business Travel Accident
Disability:
- Salaried Short-Term Disability Coverage Certificate
- Executive (VP and above) Long-Term Disability Coverage Certificate
- Salaried Long-Term Disability Coverage Certificate
- New York Life Insurance Company Name Change Endorsement
- Short-Term Disability ERISA Amendment
- Long-Term Disability ERISA Amendment
- New York Life Summary on How to File Your Disability Claim
New York Paid Family Leave:
- New York Paid Family Leave Plan Document
- New York Paid Family Leave Statement of Rights
- New York Life Insurance Company Name Change Endorsement
Financial and Legal:
Legal notices
Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from Bloomin’ Brands, your state may have a premium assistance program that can help you pay for coverage.
Special Enrollment Rights Notice
Special Enrollment allows you to enroll in the Bloomin’ Brands plan outside of the plan’s regular enrollment dates. Special Enrollments occur when you lose other group health coverage or experience a qualified life event, such as a marriage, birth, adoption, or placement for adoption.
Special Enrollment Rights Notice
Women’s Health and Cancer Rights Act of 1998
If you are enrolled in a medical plan, certain benefits are available for breast reconstruction in connection with a mastectomy.
Women’s Health and Cancer Rights Act Notice
Newborns’ and Mothers’ Health Protection Notice
If you are enrolled in medical coverage, this notice contains important information about hospital coverage following newborn delivery.
Newborns’ and Mothers’ Health Protection Notice
Medicare Part D Prescription Drug Notice
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage.
2023 Medicare Part D Creditable Coverage Notice
2022 Medicare Part D Creditable Coverage Notice
2021 Medicare Part D Creditable Coverage Notice
COBRA Rights Notice
This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it.
HIPAA Privacy Notice
The HIPAA Privacy Notice describes the plan’s practices for using and disclosing protected health information (PHI).
No Surprises Act
This notice describes your rights under the No Surprises Act, which provides protections against certain types of surprise medical bills.
Summary Annual Reports
The Summary Annual report (SAR) is a narrative summary of the plan’s financial status and summarizes the information on the plan’s annual report.
2021 Employee Benefit Plan Summary Annual Report
2020 Employee Benefit Plan Summary Annual Report
2019 Employee Benefit Plan Summary Annual Report
