Author: Lothian, Maria

Benefits Overview

Your benefits are an important part of your overall compensation. This overview was designed to answer some of the basic questions you may have about your benefits.
February 1, 20XX-January 31, 20XX

Eligibility
You are eligible for benefits if you work 30 or more hours per week. For new hires, benefits are effective on the date of hire. You may also enroll your eligible family members under certain plans you choose for yourself. Eligible family members include:
Your legally married spouse
Your registered domestic partner (RDP) and/or their children, where applicable by state law
Your children who are your natural children, stepchildren, adopted children or children for whom you have legal custody (age restrictions may apply). Disabled children age 26 or older who meet certain criteria may continue on your health coverage.

Choose Carefully!
Due to IRS regulations, you cannot change your elections until the next annual Open Enrollment period, unless you have a qualified life event during the year. Following are examples of the most common qualified life event:
Marriage or divorce
Birth or adoption of a child
Child reaching the maximum age limit
Death of a spouse, RDP or child
You lose coverage under your spouse’s/RDP’s plan
You gain access to state coverage under Medicaid or CHIP

Making Changes
To make changes to your benefit elections, you must contact Human Resources within 30 days of the qualified life event (including newborns). Be prepared to show documentation of the event such as a marriage license, birth certificate or a divorce decree. If changes are not submitted on time, you must wait until the next Open Enrollment period to make your election changes.
Cost of Benefits
Your contributions toward the cost of benefits are automatically deducted from your paycheck before taxes. The amount will depend upon the plan you select and if you choose to cover eligible family members. Please refer to the separate rate sheet for your contributions.

Medical
We are proud to offer you a choice of medical plans. Following is a high-level overview of the coverage available.

Key Medical Benefits	(Carrier) / Plan name 1	(Carrier) / Plan name 2		(Carrier) / Plan name 3
	In-Network Only	In-Network	Out-of-Network1	In-Network	Out-of-Network1
Deductible (per calendar year)
Individual / Family
Out-of-Pocket Maximum (per calendar year)
Individual / Family
Company Contribution to Your Health Savings Account (HSA) per calendar year: prorated for new/hires/newly eligible
Individual / Family
Covered Services
Office Visits (physician / specialist)
Virtual Visits
Routine Preventive Care
Emergency Room
Urgent Care Facility
Inpatient Hospital Stay
Prescription Drugs (Tier 1 / Tier 2 / Tier3)
Retail Pharmacy (30-day supply)
Mail Order (90-day supply)

To be eligible for the HSA, you cannot be covered through Medicare Part A or Part B or TRICARE programs.
Coinsurance percentages and copay amounts shown in the above charts represent the percentages that the member is responsible for paying.
* Benefits with an asterisk ( * ) require that the deductible be met before the Plan begins to pay.
If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount.
If you enroll one or more family members, you must meet the full FAMILY deductible before the plan starts to pay expenses for any one individual.
If you enroll one or more family members, you must meet the full FAMILY out-of-pocket maximum before the plan starts to pay eligible covered services at 100% for any one individual.

Dental
We are proud to offer you a choice of dental plans. Following is a high-level overview of the coverage available.

Key Dental Benefits	HMO Plan	PPO Plan
	In-Network Only	In-Network	Out-of-Network1
Deductible (per calendar year)
Individual
Family
Benefit Maximum (per calendar year; preventive, basic and major services combined)
Per Individual
Covered Services
Preventive Services
Basic Services
Major Services
Orthodontia (Adults & Children)

If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount.

Vision Plan
We are proud to offer you a vision plan through
Vision Service Provider (VSP). If you use a network provider, exams are subject to a $10 copay, materials require a $10 copay and frames are covered up to $500. Exams and lenses are covered once every 12 months and frames are covered once every 12 months.

Life and AD&D
Basic Life and Accidental Death and Dismemberment (AD&D coverage is provided through Anthem at NO COST. You also have the opportunity to purchase additional Supplemental coverage at affordable group rates through Anthem.
Basic Coverage: 2 times your base salary plus commissions, up to a $500,000 maximum.
Supplemental Coverage: Employee Coverage up to $500,000, spouse/RDP Coverage up to $250,000 (not to exceed 50% of your additional life coverage) and child(ren) Coverage up to $10,000.

Disability
Disability Insurance provides benefits that replace part of your lost income when you become unable to work due to a covered injury or illness.
Voluntary Short-Term Disability (STD): Provided through Anthem at an affordable group rate. Benefit amount is equal to 60% of your weekly earnings up to $600. Benefits begin after 7th day of disability.
Voluntary Long-Term Disability (LTD): Provided through Anthem at an affordable group rate. Benefit amount is equal to 60% of your weekly earnings up to $10,000. Benefits begin after 90th day of disability.

Contacts
Medical: [Carrier] - [Phone] - [Website]
Dental: [Carrier] - [Phone] - [Website]
Vision: [Carrier] - [Phone] - [Website]
Life and AD&D: [Carrier] - [Phone] - [Website]
Disability: [Carrier] - [Phone] - [Website]
Call Center: [Carrier] - [Phone] - [Website]
HR: [Phone] - [E-mail]

DISCLAIMER: The material in this benefits brochure is for informational purposes only and is neither an offer of coverage or medical or legal advice. It contains only a partial description of plan or program benefits and does not constitute a contract. Please refer to the Summary Plan Description (SPD) for complete plan details. In case of a conflict between your plan documents and this information, the plan documents will always govern. Annual Notices: ERISA and various other state and federal laws require that employers provide disclosure and annual notices to their plan participants. The Company will distribute all required notices annually.