2023 Employee Benefits Guide
Welcome to the 2023 Digger Specialties, Inc. Employee Benefits Guide. This guide offers you and your family members a look into your comprehensive benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage options for you and your family. We have included brief descriptions of our benefit offerings and the cost. If you have any questions, please contact the Human Resources Department at 574.546.5999; ext. 1350. Welcome to your Benefits
Contents Enrollment 4 Medical Plan 7 Edison Health 8 KISx Card 9 TrueRx 10 SHARx 12 Dental Insurance 13 Vision Insurance 15 Disability Insurance (STD & LTD) 16 Life Insurance 20 Critical Illness 23 Accident Insurance 25
Open Enrollment
This benefit guide provides an overview of the benefits that Digger Specialties offers.
Each year, Digger Specialties conducts a benefits open enrollment, which allows employees to make changes to their benefit plan elections. Benefits elected during open enrollment are effective from January 1st through December 31st
All benefits eligible employees will be required to complete their benefits using Employee Navigator in order to be enrolled in benefits for the 2023 plan year.
Who is eligible?
To be eligible for benefits, you must be a full-time employee of Digger Specialties. Your spouse and dependents are also eligible for coverage under applicable benefit plans.
When does coverage become effective?
New employees will become eligible for benefits effective on the first day of the month following 60 days of employment, provided you have completed the enrollment process and all required information and documents.
Enrollment Changes
As long as you remain eligible, your benefit elections will be in place until December 31st , 2023. However, you may make mid-year changes if you have a qualifying event. Examples of qualifying events that allow you to change your benefits elections during the year are:
• Marriage or divorce
• Birth, adoption or change in the custody of a child
• Death of your spouse or dependent child
• A change in the employment status of a spouse, impacting your benefit eligibility
• A change in your dependent’s status (due to age or eligibility for medical coverage through his/her own employer)
• A significant reduction in the average number of hours worked
If you have a qualifying event, you must change your benefit elections within 30 days of the event. If you do not make a change within 30 days, you must wait until the next open enrollment period. Please contact human resources for more information.
4
Enrollment
5
Enrollment
6
Enrollment
Medical Plan
Health Plan In-Network Benefits Summary
This brief benefit summary includes your in and out of-network benefits. Edison Health Solutions will be paying your claims using the Anthem Blue Access PPO network. This s a well-recognized network that includes most local physicians and hospitals. As always, please check with your health care provider to verify participation before receiving services.
$2,000 PPO Plan In-Network Out-of-Network Deductible: Individual/Family $2,000 / $5,000 $4,000 / $10,000 Coinsurance (You Pay) 20% 50% Out of Pocket Max: Individual/Family $4,000 / $10,000 $8,000 / $20,000 Preventive Care 100% - No Deductible 50% - After Deductible Primary Care Provider $35 Copay 50% - After Deductible Specialist $70 Copay 50% - After Deductible Urgent Care $70 Copay 50% - After Deductible Emergency Room $300 Copay + 20% Coinsurance $300 Copay + 20% Coinsurance Prescription Drugs Retail (30-day supply/Retail 90) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 $4 / $12 Copay $15 / $45 Copay $45 / $135 Copay $90 / $270 Copay Covered by SHARx (see page 12) Deductible & Coinsurance Mail Order (90-day supply) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 $8 Copay $30 Copay $112.50 Copay $270 Copay Covered by SHARx (see page 12) Not Covered 7
Medical Plan
Edison Health
Our health plan has partnered with the Edison Healthcare to provide preferred access to some of the nation’s leading Smart Care Medical Centers. These centers feature integrated care teams who meet specific criteria for ethics, quality, safety and effectiveness, and who have an established track record for successfully treating patients with complex conditions. There are no out of pocket costs for you to utilize this program
Countless people put their personal health and quality of life at risk every day by assuming all doctors and hospitals provide the same level of care. Unfortunately, that’s just not the case. When you or a loved one face a complex surgery or a life-threatening illness, choosing the right health care provider is even more important. The good news – you now have help making that choice.
It is important that you take care of yourself and your family – the right way. Edison Healthcare is an added benefit to you and your family when facing one or more of the following:
Spine Surgery
Orthopedic Surgery
Heart Surgery
Valve Replacement Surgery
Why Edison Healthcare?
Hepatitis-C Treatment
Transplant Surgery
Stem-Cell Therapy
Cancer Diagnosis
This smart care program is a cost-saving solution designed for individuals that have been advised to have one of the procedures listed above. Members are provided with access to the Edison Heathcare Smart Centers, ensuring that the original diagnosis is correct, and the current treatment is appropriate, both of which are highly cost-effective.
This program incorporates concierge care that coordinates all aspects of service to:
• Identify spine, heart and valve, cancer, orthopedic, and transplant surgery candidates
• Discuss program benefits and advantages
• Arrange care with medical destinations/facilitate travel and lodging
• Evaluate via a multi-disciplined team
• Confirm or correct diagnosis
• Provide quality surgery or alternative treatment
• Assist with follow-up care and monitor results
If you have an upcoming surgery, please contact your care coordinator to see if you qualify for Edison Healthcare.
8
Medical Plan
KISx Card
The KISx Card, or Keep It Simple Surgery, is a surgical and imaging program that Digger Specialties has made available to you for the most common surgical and imaging procedures. Some of the most common procedures through the KISx Card include:
• Orthopedic
• General Surgery
• Colonoscopies
• MRIs
• CT Scans
• PET Scans
If you utilize the program, you may receive your procedure at no cost!
How Does it Work?
If your doctor recommends a surgery or imaging procedure listed above, call KISx to see if they can assist with your elective procedure by choosing a KISx Card provider, your total cost will be $0 out of pocket to you.
Step 1: Call a KISx Card Nurse at 717.766.8844 to find out more about your procedure and how the program works. They will assist you in finding the right facility close to home.
Step 2: Your KISx Card Nurse will help you schedule your procedure. Upon scheduling, they will provide you with a voucher to take to your initial consultation.
Step 3: Save! You will not pay anything out of pocket for choosing a KISx Card provider. Every aspect of your procedure is covered through the KISx Card.
9
Prescription Drug
TrueRx 1 1
Prescription Assistance Program
SHARx
What is SHARx?
SHARx is a pharmacy advocacy solution offered by Digger Specialties. This program was created to extend advocacy program benefits to employees like you. Their role is to help facilitate the advocacy onboarding process for each eligible member of the Digger’s health plan and to provide access for all high-cost medications.
Who is eligible?
This program is available to members enrolled in the health plan. If you are currently on a high-cost medication ($350+ per month), you will be required to use the SHARx program.
What are the costs?
There are no costs to you. Digger Specialties pays for 100% of the cost of this service for all members covered on the company medical plan. Prescriptions obtained thru SHARx will be free to you and your family.
What to expect
It is important to note that this is not an overnight solution and usually takes from two to four weeks on average to implement your cost savings, depending on outside circumstances of doctor cooperation, ease of communication, and understanding.
Please understand that this service is not insurance. SHARx is not an insurance company, and they are not offering insurance. They are a prescription drug advocacy firm helping people like you lower the cost of their prescription and medications.
How to sign up?
If you have been identified as having a high-cost medication, you will receive a welcome email from SHARx. After receiving the email, please follow the instructions in the email:
• Click on the custom link in the email to create an account on the SHARx platform
• Validate your identity and set up a user account for the website
• After logging in, you can verify the prescription information on file for you and your dependents
• Complete a “Request for Advocacy” and the SHARx team will begin the process
If you do not receive a welcome email or are prescribed a high-cost medication in the future, please email sharx@sharxplan.com or call 314-451-3555
12
Dental Insurance
Cigna Dental
You have the option to select one of two comprehensive dental insurance plan, administered by Cigna Dental. You do not need to be enrolled in the health insurance plan to enroll in dental insurance.
Cigna Dental Oral Health Integration Program provides enhanced dental coverage for members with diabetes, heart disease, and pregnant women.
This is a partial listing of benefits and services only. All covered services are subject to the conditions, limitations, exclusions, terms and provisions of the Dental Certificate.
Type of Service Core Plan Buy-Up Plan Calendar Year Deductible Single Family $100 $300 $100 $300 Annual Dental Maximum per Person $500 $1,000 Preventive Services Oral Exams & Cleanings, Bitewing X-rays & Fluoride Treatments, Sealants (children up to age 14) 100% - no deductible 100% - no deductible Basic Services Fillings, Simple Extractions, X-rays, Periodontics 80% - after deductible 80% - after deductible Major Services Major Restorative Services, Crowns, Bridges, Dentures 50% - after deductible 50% - after deductible Pre-Determination of Benefits $200 or more of expected treatment $200 or more of expected treatment Dependent Child Age Limit To age 26 To age 26
13
Dental Insurance
Cigna Dental PPO
You may utilize the dental provider of your choice, and the benefit level (100%, 80% or 50%, depending on the type service) is the same regardless of the provider being considered in or out of network. However, by using a provider participating in the Cigna Dental PPO, you may have lower out-of-pocket costs due to pre-negotiated rates and maximum allowable costs in the provider contract.
If you utilize a dental provider that does not participate in the Cigna Dental PPO, you are responsible for any amount charged by the provider which exceeds the reasonable and customary (R&C) allowable fee. The R&C fee is the amount the insurance company considers the reasonable charge based on the type of service and the geographical area where you receive treatment.
Note: Even if you use a participating dentist, you are always responsible for your deductible and coinsurance amount.
You may visit www.cigna.com to find participating providers in your area or by calling (800)244-6224:.
1. Click on “Find a Doctor, Dentist or Facility”
2. Select “Employer or School” link
3. Enter your zip code
4. Select “Doctor by Type” link
5. Select, “General Dentist, Pediatric Dentist, or Orthodontist”
6. Continue as a “Guest” until January 1st, then you can setup a username and password
7. Select “Cigna DPPO Advantage” Plan
14
Vision Insurance
Vision Service Plan (VSP)
You have the option to enroll in a vision insurance plan through VSP. You may visit www.vsp.com or call (800) 877-7195 to find participating providers in your area using the VSP Choice network. No ID Card is necessary for your provider to file claims with VSP.
Benefits When Using a Participating VSP Choice Provider
• Focuses on your eyes and overall wellness
Well Vision Exam
• One every calendar year $10
• $130 allowance for a wide selection of frames
• 20% off amount over your allowance
Frames
• $150 allowance for featured brand frames
• $70 Costco allowance
• Every other calendar year
• Single vision, lined bifocal, and lined trifocal lenses
$25 (combined with lenses)
Lenses
• Polycarbonate lenses
• Every calendar year
• Standard progressive lenses
$25 (combined with frames)
Lens Enhancements
Contacts (in lieu of glasses)
• Premium progressive lenses
• Custom progressive lenses
• Average 35 – 40% off other lens enhancements $10-$175
• $130 allowance for contacts; copay does not apply
• Contact lens exam (fitting and evaluation)
• Every calendar year
Dependent children are covered to the end of the month in which they turn age 26. You will receive scheduled reimbursements if you utilize an out-of-network provider.
Up to $60
Copay
15
Disability Insurance
We are offering you the opportunity to purchase disability coverage on either a short-term or long-term basis. Coverage will be offered through Mutual of Omaha.
Annual enrollment period: If you did not elect short-term disability coverage when you were initially eligible, you may do so up to the guaranteed issue amount without completing the Evidence of Insurability (EOI).
Voluntary Short-Term Disability (STD) – Plan Features
Short-Term disability insurance provides you with weekly income if you become disabled due to injury or illness, including maternity.
• STD benefits begin on the 14th day of a disability due to an injury or a sickness.
• Your weekly benefit is equal to 60% of your salary to a maximum of $1,000. The benefit is reduced by other income you may receive, including Social Security.
• You are eligible to receive STD benefits for up to 11 weeks, provided you remain disabled.
• There is a pre-existing condition limitation for any treatment received 3 months prior to your effective date and will not be covered until you have been insured under the disability plan for 6 months.
Short-Term Disability Weekly Contributions
Voluntary Long-Term Disability (LTD) – Plan Features
Long-Term Disability insurance helps protect you and your family’s income in the event of a long-term illness or disability. If you did not enroll when you were initially eligible, you may do so by providing evidence of Insurability (EOI) online at https://www3.mutualofomaha.com/eoi/#/home
• LTD benefits begin on the 91st day of a disability due to an injury or illness.
• Your monthly benefit is equal to 60% of your salary to a maximum of $5,000.
• The monthly benefit is reduced by Social Security or other income you receive.
• LTD benefits continue to Social Security Normal Retirement Age with a Reducing Benefit Duration , provided you remain disabled.
• Benefits are generally tax-free.
• Pre-existing condition limitation: If you become disabled due to a pre-existing condition during the first 12 months that you are covered, the benefit will not be paid until you have been covered under the disability plan for 12 months.
Increases to your current STD or LTD benefits resulting from salary increases will not require EOI
Weekly Rate per $10 $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 0.125 1.25 2.49 3.74 4.98 6.23 7.48 8.72 9.97 11.22 12.46
This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency.
Disability Insurance
Long-Term Disability Weekly Contributions
This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency.
Age Weekly Rate per $100 of Covered Payroll Covered Monthly Payroll Benefit Amount $500 $300 $667 $400 $833 $500 $1,000 $600 $1,167 $700 $1,333 $800 $1,500 $900 $1,667 $1,000 <20 0.042 0.21 0.28 0.35 0.42 0.48 0.55 0.62 0.69 20-24 0.044 0.22 0.29 0.37 0.44 0.51 0.58 0.66 0.73 25-29 0.062 0.31 0.42 0.52 0.62 0.73 0.83 0.93 1.04 30-34 0.092 0.46 0.62 0.77 0.92 1.08 1.23 1.38 1.54 35-39 0.12 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00 40-44 0.15 0.75 1.00 1.25 1.50 1.75 2.00 2.25 2.50 45-49 0.205 1.03 1.37 1.71 2.05 2.40 2.74 3.08 3.42 50-54 0.307 1.53 2.05 2.56 3.07 3.58 4.09 4.60 5.12 55-59 0.369 1.85 2.46 3.08 3.69 4.31 4.92 5.54 6.15 60-64 0.402 2.01 2.68 3.35 4.02 4.68 5.35 6.02 6.69 65-69 0.422 2.11 2.82 3.52 4.22 4.93 5.63 6.33 7.04 70-99 0.443 2.22 2.95 3.69 4.43 5.17 5.91 6.65 7.38
Age Weekly Rate per $100 of Covered Payroll Covered Monthly Payroll Benefit Amount $1,833 $1,100 $2,000 $1,200 $2,167 $1,300 $2,333 $1,400 $2,500 $1,500 $2,667 $1,600 $2,833 $1,700 $3,000 $1,800 <20 0.042 0.76 0.83 0.90 0.97 1.04 1.11 1.18 1.25 20-24 0.044 0.80 0.88 0.95 1.02 1.10 1.17 1.24 1.32 25-29 0.062 1.14 1.25 1.35 1.45 1.56 1.66 1.77 1.87 30-34 0.092 1.69 1.85 2.00 2.15 2.31 2.46 2.62 2.77 35-39 0.12 2.20 2.40 2.60 2.80 3.00 3.20 3.40 3.60 40-44 0.15 2.75 3.00 3.25 3.50 3.75 4.00 4.25 4.50 45-49 0.205 3.77 4.11 4.45 4.79 5.13 5.48 5.82 6.16 50-54 0.307 5.63 6.14 6.65 7.16 7.67 8.18 8.70 9.21 55-59 0.369 6.77 7.38 8.00 8.62 9.23 9.85 10.46 11.08 60-64 0.402 7.36 8.03 8.70 9.37 10.04 10.71 11.38 12.05 65-69 0.422 7.74 8.45 9.15 9.85 10.56 11.26 11.97 12.67 70-99 0.443 8.12 8.86 9.60 10.34 11.08 11.82 12.55 13.29
Disability Insurance
Long-Term Disability Weekly Contributions
This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency.
Age Weekly Rate per $100 of Covered Payroll Covered Monthly Payroll Benefit Amount $3,167 $1,900 $3,333 $2,000 $3,500 $2,100 $3,667 $2,200 $3,833 $2,300 $4,000 $2,400 $4,167 $2,500 $4,333 $2,600 <20 0.042 1.32 1.38 1.45 1.52 1.59 1.66 1.73 1.80 20-24 0.044 1.39 1.46 1.53 1.61 1.68 1.75 1.83 1.90 25-29 0.062 1.97 2.08 2.18 2.28 2.39 2.49 2.60 2.70 30-34 0.092 2.92 3.08 3.23 3.38 3.54 3.69 3.85 4.00 35-39 0.12 3.80 4.00 4.20 4.40 4.60 4.80 5.00 5.20 40-44 0.15 4.75 5.00 5.25 5.50 5.75 6.00 6.25 6.50 45-49 0.205 6.50 6.85 7.19 7.53 7.87 8.22 8.56 8.90 50-54 0.307 9.72 10.23 10.74 11.25 11.77 12.28 12.79 13.30 55-59 0.369 11.69 12.31 12.92 13.54 14.15 14.77 15.38 16.00 60-64 0.402 12.72 13.38 14.05 14.72 15.39 16.06 16.73 17.40 65-69 0.422 13.37 14.08 14.78 15.48 16.19 16.89 17.60 18.30 70-99 0.443 14.03 14.77 15.51 16.25 16.98 17.72 18.46 19.20
Age Weekly Rate per $100 of Covered Payroll Covered Monthly Payroll Benefit Amount $4,500 $2,700 $4,667 $2,800 $4,833 $2,900 $5,000 $3,000 $5,167 $3,100 $5,333 $3,200 $5,500 $3,300 $5,667 $3,400 <20 0.042 1.87 1.94 2.01 2.08 2.15 2.22 2.28 2.35 20-24 0.044 1.97 2.05 2.12 2.19 2.27 2.34 2.41 2.48 25-29 0.062 2.80 2.91 3.01 3.12 3.22 3.32 3.43 3.53 30-34 0.092 4.15 4.31 4.46 4.62 4.77 4.92 5.08 5.23 35-39 0.12 5.40 5.60 5.80 6.00 6.20 6.40 6.60 6.80 40-44 0.15 6.75 7.00 7.25 7.50 7.75 8.00 8.25 8.50 45-49 0.205 9.24 9.58 9.93 10.27 10.61 10.95 11.30 11.64 50-54 0.307 13.81 14.32 14.83 15.35 15.86 16.37 16.88 17.39 55-59 0.369 16.62 17.23 17.85 18.46 19.08 19.69 20.31 20.92 60-64 0.402 18.07 18.74 19.41 20.08 20.75 21.42 22.08 22.75 65-69 0.422 19.00 19.71 20.41 21.12 21.82 22.52 23.23 23.93 70-99 0.443 19.94 20.68 21.42 22.15 22.89 23.63 24.37 25.11
Disability Insurance
Long-Term Disability Weekly Contributions
This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency.
Age Weekly Rate per $100 of Covered Payroll Covered Monthly Payroll Benefit Amount $5,833 $3,500 $6,000 $3,600 $6,167 $3,700 $6,333 $3,800 $6,500 $3,900 $6,667 $4,000 $6,833 $4,100 $7,000 $4,200 <20 0.042 2.42 2.49 2.56 2.63 2.70 2.77 2.84 2.91 20-24 0.044 2.56 2.63 2.70 2.78 2.85 2.92 3.00 3.07 25-29 0.062 3.63 3.74 3.84 3.95 4.05 4.15 4.26 4.36 30-34 0.092 5.38 5.54 5.69 5.85 6.00 6.15 6.31 6.46 35-39 0.12 7.00 7.20 7.40 7.60 7.80 8.00 8.20 8.40 40-44 0.15 8.75 9.00 9.25 9.50 9.75 10.00 10.25 10.50 45-49 0.205 11.98 12.32 12.67 13.01 13.35 13.69 14.03 14.38 50-54 0.307 17.90 18.42 18.93 19.44 19.95 20.46 20.97 21.48 55-59 0.369 21.54 22.15 22.77 23.38 24.00 24.62 25.23 25.85 60-64 0.402 23.42 24.09 24.76 25.43 26.10 26.77 27.44 28.11 65-69 0.422 24.63 25.34 26.04 26.75 27.45 28.15 28.86 29.56 70-99 0.443 25.85 26.58 27.32 28.06 28.80 29.54 30.28 31.02
Age Weekly Rate per $100 of Covered Payroll Covered Monthly Payroll Benefit Amount $7,167 $4,300 $7,333 $4,400 $7,500 $4,500 $7,667 $4,600 $7,833 $4,700 $8,000 $4,800 $8,167 $4,900 $8,333 $5,000 <20 0.042 2.98 3.05 3.12 3.18 3.25 3.32 3.39 3.46 20-24 0.044 3.14 3.22 3.29 3.36 3.43 3.51 3.58 3.65 25-29 0.062 4.47 4.57 4.67 4.78 4.88 4.98 5.09 5.19 30-34 0.092 6.62 6.77 6.92 7.08 7.23 7.38 7.54 7.69 35-39 0.12 8.60 8.80 9.00 9.20 9.40 9.60 9.80 10.00 40-44 0.15 10.75 11.00 11.25 11.50 11.75 12.00 12.25 12.50 45-49 0.205 14.72 15.06 15.40 15.75 16.09 16.43 16.77 17.12 50-54 0.307 22.00 22.51 23.02 23.53 24.04 24.55 25.07 25.58 55-59 0.369 26.46 27.08 27.69 28.31 28.92 29.54 30.15 30.77 60-64 0.402 28.78 29.45 30.12 30.78 31.45 32.12 32.79 33.46 65-69 0.422 30.27 30.97 31.67 32.38 33.08 33.78 34.49 35.19 70-99 0.443 31.75 32.49 33.23 33.97 34.71 35.45 36.18 36.92
Life Insurance
Basic Life and AD&D Insurance
Digger Specialties provides you with a $15,000 Basic Life and AD&D benefit through Mutual of Omaha. Digger provides this benefit to you at no cost.
Voluntary Term Life Insurance
Term Life insurance is an important part of your benefits. It’s not easy to think about, but an unexpected death in the family could burden the surviving family members with large expenses on less income. Purchasing additional term life insurance could assist your loved ones with mortgage payments, funeral expenses, medical expenses, childcare expenses, etc.
Guaranteed issue amounts are available to you one time as a new hire at your initial benefits eligibility
If you are not a new hire electing benefits for the first time, you must complete a health questionnaire, and coverage is not guaranteed.
If you need to complete the EOI please do so online at https://www3.mutualofomaha.com/eoi/#/home (this way will be faster) or you can download the document to complete.
*Term Life: Benefit paid to designated beneficiary upon death of insured. Coverage is for a certain term and has no cash value.
Choice of $10,000 increments. Not to exceed 5 times your annual salary.
Choice of $5,000 increments. Employee must elect coverage for spouse to be eligible. Not to exceed 100% of employee elected amount.
$2,000 Increments
Employee must elect coverage for child(ren) to be eligible.
Issue*
*Available amounts shown are offered to any eligible applicant (employee and dependent(s) without regard to health status if you enroll during the initial new employee waiting period. No medical questions are asked on the application unless the amount applied for exceeds the amounts shown.)
$100,000 of coverage is available on a guaranteed acceptance basis within your new employee waiting period. $50,000 if age 60 or older.
$50,000 of coverage is available on a guaranteed acceptance basis within your new employee waiting period.
No health questions required for eligible children.
Continued next page >
20 Term Life Benefit* Employee Spouse Dependent Child
Minimum Amount $10,000 $5,000 $2,000 Maximum Amount $500,000 $100,000 $10,000 Guarantee
Life Insurance
Amount *AD&D (Accidental Death & Dismemberment): Double indemnity for accidental death or a percentage of the benefit payable per covered non-work-related accidental injury.
The benefit amount is equal to the life amount elected by you. Cost included in the schedule.
Employee must elect coverage for spouse to be eligible.
Employee must elect coverage for dependent to be eligible.
Benefits will reduce: • 35%
age 65 • 50% of the original amount at age 70
Additional Benefits
Accelerated Death Benefit Cash advance against the death benefit available if insured has a terminal illness.
Portability
Conversion
Eligibility
You may continue your term insurance coverage when employment ends by paying the required premiums.
You may apply to convert your term life insurance to a whole life policy at termination of employment.
All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage on the policy effective date. A delayed effective date will apply if the employee is not actively at work.
Open Enrollment
Annual Open Enrollment
If you are currently enrolled, you can increase your coverage by $10,000 without evidence of insurability. If your current coverage amount is $100k or you do not have coverage currently, EOI is required.
Cannot be in a period of limited activity* on the day coverage takes effect. *Period during which a dependent is confined to a health care facility and/or unable to perform what would be considered regular.
Evidence of insurability is required for spouses but not dependent children.
Beneficiary: Open enrollment is a great time to update your beneficiary if you have had a life event this past year: marriage, divorce. Please contact Human Resources to request the change form.
AD&D Benefit* Employee Spouse Dependent Child
Benefit Reduction Employee Spouse Dependent Child
• 35% at employee’s age 65 • Spouse coverage terminates at age 70 N/A
at
Employee
Spouse & Dependents
Life Insurance
Employee Weekly (52 Weeks) Premium Supplemental Life and AD&D Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Refer to Program Specifications for your maximum benefit amounts. Benefits
This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency.
and premium amounts reflect age reductions.
Age Weekly Rate per $1,000 $10K $20K $30K $40K $50K $60K $70K $80K $90K $100K <25 0.03 .30 .60 .90 1.20 1.50 1.80 2.10 2.40 2.70 3.00 25-29 0.03 .30 .60 .90 1.20 1.50 1.80 2.10 2.40 2.70 3.00 30-34 0.032 .32 .65 .97 1.29 1.62 1.94 2.26 2.58 2.91 3.23 35-39 0.042 .42 .83 1.25 1.66 2.08 2.49 2.91 3.32 3.74 4.15 40-44 0.058 .58 1.15 1.73 2.31 2.88 3.46 4.04 4.62 5.19 5.77 45-49 0.09 .90 1.80 2.70 3.60 4.50 5.40 6.30 7.20 8.10 9.00 50-54 0.132 1.32 2.63 3.95 5.26 6.58 7.89 9.21 10.52 11.84 13.15 55-59 0.215 2.15 4.29 6.44 8.58 10.73 12.88 15.02 17.17 19.32 21.46 60-64 0.323 3.23 6.46 9.69 12.92 16.15 19.38 22.62 25.85 29.08 32.31 $6.5k $13k $19.5k $26k $32.5k $39k $45.5k $52k $58.5k $65k 65-69 0.494 3.21 6.42 9.63 12.84 16.05 19.26 22.47 25.68 28.89 32.10 $5k $10k $15k $20k $25k $30k $35K $40K $45K $50K 70-74 0.798 3.99 7.98 11.98 15.97 19.96 23.95 27.95 31.94 35.93 39.92 75+ 1.375 6.88 13.75 20.63 27.51 34.38 41.26 48.14 55.02 61.89 68.77
Dependents Weekly Premiums $2K $4K $6K $8K $10K <25 .07 .14 .21 .28 .35
23
NEW for 2023!
Critical Illness
Critical Illness
24
25 Accident Insurance NEW for 2023!
Accident Insurance
26
Accident Insurance
27
Contributions 28 Dental – Core Plan Medical Vision Employee Weekly (52 Weeks) Premium. 2023 Weekly Vision Payroll Deductions Vision Plan Employee Only $1.85 Employee + Spouse $3.12 Employee + Children $3.18 Employee + Family $5.13 2023 Weekly Dental Payroll Deductions Employed <3 years Employed 3+ Years Employee Only $1.65 $.50 Employee + Spouse $4.96 $3.80 Employee + Children $5.10 $3.94 Employee + Family $9.26 $8.10 2023 Weekly Medical Payroll Deductions Employed <3 Years Employed 3+ Years Employee Only $35.61 $10.68 Employee + Spouse $114.58 $90.20 Employee + Children $103.89 $81.79 Employee + Family $164.83 $129.79 Dental – Buy-Up Plan 2023 Weekly Dental Payroll Deductions Employed <3 years Employed 3+ Years Employee Only $2.90 $1.74 Employee + Spouse $7.45 $6.30 Employee + Children $7.65 $6.49 Employee + Family $13.39 $12.24
Carrier Website Customer Service Precertification Edison Health Solutions - Medical https://gateway.edisonehs.com/ 888.47EDISON 800.816.1206 Benefits Contact Information 29 Carrier Website Customer Service Mail Order/Specialty True Rx – Prescription Benefit Manager www.truerx.com 866.921.4047 Mail Order: www.ppsrx.com SHARx – Prescription Advocacy www.sharxplan.com 314.451.3555 Carrier Policy Website Customer Service Cigna– Dental #3340562 www.cigna.com 800.244.6224 Carrier Policy Website Customer Service VSP– Vision #30080329 www.vsp.com 800.877.7195 Carrier Policy Website Customer Service Mutual of Omaha – Life & Disability #B923 www.mutualofomaha.com 800.369.3809 Carrier Policy Website Customer Service UNUM – Critical Illness Accident #920911 – Critical Illness #920910 – Accident www.unum.com 800.635.5597
Annual Notices
Important group health plan notices are available on Employee Navigator. These notices contain important information about your benefits. Please visit http://gibson.employeenavigator.com.
Notices include:
Notice of Special Enrollment Rights
Notice of Patient Protection
Women’s Health and Cancer Rights Act
Newborns and Mothers’ Health Protection Act Notice
Michelle’s Law
Medicaid & CHIP Notice
Medicare Part D – Creditable Coverage Notice
Surprise Medical Bills
A paper copy is available free of charge upon request. Contact HR for additional information.
30
Notes
