EMPLOYEE BENEFITS GUIDE
Welcome to your
EMPLOYEE BENEFITS! ABC Corp appreciates your commitment to our success. We’re equally committed to providing you with competitive, affordable health and wellness benefits to help you take care of yourself and your family.
Please read this guide carefully. It has a summary of your plan options and helpful tips for getting the most value from your benefits plans. We understand that you may have questions about annual enrollment, and we’ll do our best to help you understand your options and guide you through the process.
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ELIGIBILITY & ENROLLMENT
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MEDICAL BENEFITS
X
TELEHEALTH
X
WELLNESS PROGRAM
X
HEALTH SAVINGS ACCOUNT (HSA)
X
401(K) RETIREMENT PLAN
X
FLEXIBLE SPENDING ACCOUNTS
X
DENTAL PLAN
X
VISION PLAN
X
EMPLOYEE ASSISTANCE PROGRAM
X
LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE
X
SHORT- AND LONG-TERM DISABILITY PLANS
X
CRITICAL ILLNESS AND ACCIDENT INSURANCE
X
ADDITIONAL BENEFITS
X
CONTACTS
X
ABC CORP | EMPLOYEE BENEFITS GUIDE
ELIGIBILITY & ENROLLMENT If you want medical, dental or vision coverage in 2020 for yourself or your family, you must enroll in one of the plan options during the annual enrollment period. If you need to add or remove coverage for yourself or your dependents, you must wait until the next open enrollment period, unless you have a qualifying life event as defined by the IRS. Here are some examples of qualifying life events:
Birth, legal adoption or placement for adoption.
Marriage, divorce or legal separation.
Dependent child reaches age 26.
Spouse gains or loses employment or eligibility with their current employer.
Death of your spouse or dependent child.
Spouse or dependent becomes eligible or ineligible for Medicare/Medicaid or the state children’s health insurance program.
Change in residence that changes coverage eligibility.
Court-ordered change.
The IRS requires that you make changes to your coverage within 31 days of your qualifying life event. You’ll need to provide proof of the event, such as a marriage certificate, divorce decree, birth certificate or loss-of-coverage letter. Please remember to add your Social Security number and the Social Security numbers of your dependents during enrollment.
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MEDICAL BENEFITS ABC Company is committed to helping you and your dependents maintain your health and wellness by providing you with access to the highest level of care. We offer you a choice of two medical plan options for 2020:
Enhanced high-deductible health plan (enhanced HDHP).
Basic high-deductible health plan (basic HDHP).
If you choose, you can open a health savings account (HSA) with either of these plans. To learn more about HSAs, please see page xx.
Here are some terms you’ll see in this guide: COINSURANCE: Your share of the costs of a healthcare service, usually figured as a percentage of the amount charged for services. You start paying coinsurance after you’ve paid your plan’s deductible. Your plan pays a certain percentage of the total bill, and you pay the remaining percentage. COPAY: A fixed amount you pay for a specific medical service (typically an office visit) at the time you receive the service. The copay can vary depending on the type of service. Copays cannot be included as part of your annual deductible, but they do count toward your out-of-pocket maximum. DEDUCTIBLE: The amount you pay for healthcare services before your health insurance begins to pay. For example, if your plan’s deductible is $3,000, you’ll pay 100 percent of eligible healthcare expenses until the bills total $3,000 for the year. After that, you share the cost with your plan by paying coinsurance. IN-NETWORK: A group of doctors, clinics, hospitals and other healthcare providers that have an agreement with your medical plan provider. You’ll pay less when you use in-network providers. OUT-OF-NETWORK: Care received from a doctor, hospital or other provider that is not part of the medical plan agreement. You’ll pay more when you use out-of-network providers. OUT-OF-POCKET MAXIMUM: This is the most you must pay for covered services in a plan year. After you spend this amount on deductibles, copayments and coinsurance, your health plan pays 100 percent of the costs of covered benefits. However, you must pay for certain out-of-network charges above reasonable and customary amounts. REASONABLE AND CUSTOMARY: The amount of money a health plan determines is the normal or acceptable range of charges for a specific health-related service or medical procedure. If your healthcare provider submits higher charges than what the health plan considers normal or acceptable, you may have to pay the difference.
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ABC CORP | EMPLOYEE BENEFITS GUIDE
MEDICAL & PRESCRIPTION DRUG PLAN SUMMARY ENHANCED HDHP MEDICAL
BASIC HDHP
In-network
Out-of-network
In-network
Out-of-network
Employee only
$
$
$
$
Family
$
$
$
$
%
%
%
%
Employee only
$
$
$
$
Family
$
$
$
$
Preventive care
%
%
%
%
Office visit (PCP and specialist)
%
%
%
%
Emergency room
%
%
%
%
Urgent care
%
%
%
%
Inpatient care
%
%
%
%
Outpatient care
%
%
%
%
Deductible
Coinsurance (what the plan pays after the deductible is reached) Out-of-pocket maximum (includes deductible)
PRESCRIPTION DRUGS
Employee Pays
Employee Pays
Retail (30-day supply) Tier 1 — generics
$
$
$
$
Tier 2 — preferred
$
$
$
$
Tier 3 — nonpreferred
$
$
$
$
Tier 1 — generics
$
$
$
$
Tier 2 — preferred
$
$
$
$
Tier 3 — nonpreferred
$
$
$
$
Mail order (90-day supply)
Prescription drugs — 100 percent coverage for preventive generics before the deductible applies. Preventive brand and non-preferred brand (second- and third-tier) drugs are covered at the plan’s coinsurance maximum amounts as outlined in the chart. A deductible does not apply.
MEDICAL & PRESCRIPTION BIWEEKLY EMPLOYEE PAYROLL CONTRIBUTIONS ENHANCED HDHP
BASIC HDHP
Employee
$
$
Employee + Spouse
$
$
Employee + Child(ren)
$
$
Family
$
$
Employees can elect the medical and prescription drug plan without enrolling in te dental or vision plan.
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SHORT- AND LONG-TERM DISABILITY PLANS ABC Company offers two company-paid disability plans by <disability carrier> to provide financial assistance in case you become disabled or unable to work.
SHORT-TERM DISABILITY (STD) PLAN STD benefits are designed to replace a portion of your income for a non-work-related short-term injury or illness. STD benefits are paid at 60 percent of your eligible weekly base pay, up to $3,000 weekly, during the first 12 weeks of injury or illness. Short-term disability eligibility — Full-time employees
100% paid by the employer
Weekly benefit amount Weekly benefit maximum Benefits begin Benefits duration Pre-existing condition limitation Waiting period
LONG-TERM DISABILITY (LTD) PLAN The ABC Company LTD plan is available to eligible full-time employees the first of the month following the date of hire. This benefit offers financial protection to you when you need it most—if you become disabled and can no longer work. The plan will also help you return to work, if appropriate. If you become totally disabled, you will receive 60 percent of your base salary, up to $15,000 monthly, after you have satisfied the 90-day waiting period for benefits. Your benefit amount may be offset by other benefits you are receiving, such as Social Security or workers’ compensation. Your monthly benefits are subject to federal income tax and may be subject to state and local taxes. Long-term disability eligibility — Full-time employees Monthly benefit amount Monthly benefit maximum Benefits begin Benefits duration Pre-existing condition limitation Waiting period
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100% paid by the employer
Coordination of disability benefits Your benefit may be reduced if you receive disability benefits from retirement, Social Security, workers’ compensation, state disability insurance, no-fault benefits and return-to-work earnings. Refer to your certificate of coverage for more details.
ABC CORP | EMPLOYEE BENEFITS GUIDE
EMPLOYEE ASSISTANCE PROGRAM (EAP) We all know that life can be challenging at times. Issues like illness, debt and family problems can leave us feeling worried or anxious and not able to be at our best. The EAP, sponsored by <EAP carrier>, provides confidential support and resources for you and your dependents at no charge. You can seek expert guidance for any kind of issue, from everyday matters to more serious problems affecting your well-being. Here’s what the program offers:
EAP: Five face-to-face visits with experienced clinicians (per occurrence), without any per-session cost to you. Legal resources: Unlimited phone access to <EAP carrier> legal professionals, an initial consultation at no charge with a local attorney and discounts on additional services. Financial resources: One face-to-face visit, up to one hour, with a financial planner. Unlimited phone access to financial professionals for information regarding personal finance and related issues.
Work/life resources: Information and referrals on child care, elder care, adoption, relocation and other personal convenience matters.
The EAP provides counseling on all aspects of life, including:
Health risk assessments: Online access to a health risk assessment survey and a variety of health management tools and information.
Online will preparation: Access to <provider>, which offers the ease and simplicity of online will preparation. You can complete a will and download it to your computer.
Difficulties in relationships
Emotional/psychological issues Stress and anxiety issues with work or family
Alcohol and drug abuse
Personal and life improvement
Legal or financial issues
Depression
Child care and elder care issues Grief issues 7
CONTACTS MEDICAL
RETIREMENT
<medical carrier>
<401k provider>
Member services: XXX.XXX.XXXX Website: <medical website>
Customer service: XXX.XXX.XXXX Website: <401k website>
PRESCRIPTION
FLEXIBLE SPENDING ACCOUNTS
LIFE/AD&D
<flex spending provider>
<life provider>
Customer service: XXX.XXX.XXXX Website: <flex spending website>
Customer service: XXX.XXX.XXXX Website: <life website>
DENTAL
TRAVEL
<dental provider>
<travel provider>
Customer service: XXX.XXX.XXXX Website: <dental website>
Customer service: XXX.XXX.XXXX Website: <travel website>
<HSA provider>
VISION
Customer service: XXX.XXX.XXXX Website: <hsa website>
<vision provider>
SHORT- & LONG-TERM DISABILITY
Mail-order pharmacy: XXX.XXX.XXXX Website: <pharmacy website>
WELLNESS PROGRAM
EMPLOYEE ASSISTANCE PROGRAM <EAP carrier> Customer service: XXX.XXX.XXXX Website: <eap website>
<wellness provider> Hotline: XXX.XXX.XXXX Website: <wellness website>
HEALTH SAVINGS ACCOUNT
Customer service: XXX.XXX.XXXX Website: <vision website>
<std provider> Customer service: XXX.XXX.XXXX Website: <std website>
The descriptions of the benefits are not guarantees of current or future employment or benefits. If there is any conflict between this guide and the official plan documents, the official documents will govern.