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HIGHLIGHTS

2023

EMPLOYEE BENEFIT

Jasper Seating Benefit Guide | 23

WELCOME to your

Jasper Seating Company recognizes the importance of being able to provide our employees and their families with quality benefits as part of their overall compensation package. Therefore, Jasper Seating Company has developed a comprehensive benefits package that drives quality and value while satisfying the diverse needs of our workforce. This summary highlights your benefit options offered by Jasper Seating for 2023.

BENEFITS

ELIGIBILITY Employees working thirty (30) hours a week or more are eligible for all benefits outlined in this summary. Eligible employees may elect to cover a spouse, and dependents up to age 26 regardless of full-time student status. If you choose to cover a working spouse who has medical benefits available through their employer, Jasper’s benefits will pay secondarily. Benefits will be effective FIRST OF THE MONTH FOLLOWING 60 DAYS FROM DATE OF HIRE. MEDICAL Jasper Seating Company medical plans offer great flexibility in managing care for you and your family. As part of your benefits package, Jasper Seating gives employees the option of choosing from three different medical plans. These plans are administered by Kentucky Health Administrators (KHA). NETWORK Patoka Valley Health Care Cooperative will remain the primary network. United Health Care is the wrap network for inside & outside of Indiana. Call 866-664-3261 or log on to www.kyhealthadmin.com to access claims payments, ID cards and to inquire about eligibility. Once enrolled you may visit the Patoka Valley Health Care Cooperative’s website at www.pvcooperative.com for participating providers. For United Health Care please visit this website https://www.uhc.com/find-a-doctor to find a provider

BENEFIT / SERVICE

PLAN 1

PLAN 2

HSA Plan

In Network

Non Network

In Network

Non Network

In Network

Non Network

Annual Deductible Individual / Family"

$850 / $1,700

$1,350 / $2,700

$2,850 / $4,700

Out of Pocket Maximum (Medical)

$3,000 / $6,000

$4,000 / $8,000

$6,600 / $13,200 $6,600 / $13,200

Overall Maximum (Medical & Rx)

$6,600 / $13,200 $6,600 / $13,200 $6,600 / $13,200 $6,600 / $13,200 $6,600 / $13,200 $6,600 / $13,200

Employee Coinsurance

20%

50%

20%

50%

20%

50%

100% Covered

50%

100% Covered

50%

100% Covered

50%

Office Visit

20%

50%

20%

50%

20%

50%

Inpatient Hospital

20%

50%

20%

50%

20%

50%

Outpatient Hospital

20%

50%

20%

50%

20%

50%

Emergency Room

20%

Preventive Care

Urgent Care

20%

50%

20%

50%

20%

50%

Lifetime Maximum

Unlimited

Prescription Drug Deductible

$100

$125

Included with Medical

Generic Drugs

30%

50%

35%

50%

40%

Brand Drugs Specialty Drugs

50%

30%

50%

35%

50%

40%

50%

Tier 1 – 30% Tier 2 – 50% Tier 3 – 75%

Tier 1 – 35% Tier 2 – 50% Tier 3 – 75%

Tier 1 – 40% Tier 2 – 50% Tier 3 – 75%

WEEKLY DEDUCTION NICOTINE FREE CREDIT $2/WEEK

Employee

$51

$36

$27

Employee + Spouse

$102

$72

$54

Employee + Children

$79

$57

$38

Family

$118

$87

$58

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SURGERY BENEFIT Edison gives you a choice in your medical care - allowing you to receive a qualified second opinion, surgery, and treatment plan from America’s Top Medical Centers. Edison Healthcare manages a private network of internationally acclaimed SmartCare Centers. With Edison, eligible members and a caregiver can take advantage of travel, meals, hotels, rental cars, and all medical care at little to no cost. If you are on a PPO plan, there is no cost to you. If you are on the HSA Plan, you will meet a lower deductible before it’s covered 100%. Edison HSA Deductible: Single: $1,400 | Family: $2,800 MEDICAL CASH OPT OUT In order to receive the $10 Cash Opt Out, you are required to waive medical benefits and provide Proof of Coverage under another medical plan. If you and your spouse are both employed at Jasper Seating, you can either enroll as a single or a dependent, but not both. By enrolling in coverage as a single or a dependent, you will not be eligible for the Cash Opt Out. The same applies to dependents who work at Jasper Seating and are covered on a parent’s plan who also work for Jasper Seating. If you are enrolled in Medicare, you will not be eligible for the Cash Opt Out. TELADOC A telemedicine company using telephone and videoconferencing technology to provide on-demand remote medical care via mobile devices, the internet, video and phone. 24/7 access to a national network of U.S. board certified doctors for non-emergency conditions (ear infection, rash, pink eye, fever, flu, strep as examples) who can diagnose, treat and prescribe medication if medically necessary. Behavioral health (counseling) is an included service. Medical calls are provided for a $45 copay. Behavioral health varies based on the provider. Contact 1-800-TELADOC or Teladoc.com or download the app! HEALTH SAVINGS ACCOUNT (HSA) An optional Health Savings Account (available with the HSA Plan option only) allows you to set aside some of your income on a pre-tax basis to pay for eligible expenses that may not be covered as part of your benefit plan. Contributions to the HSA will carry-over year after year preventing loss of any unused funds. • Administered by Old National, the HSA helps you pay for eligible expenses, medical, dental, vision and prescription, not covered by the HSA Plan medical or other benefit plans. The 2023 annual contribution is $3,850 for individual and $7,750 for family. For those 55 or older, there is an additional $1,000 contribution allowed. • A debit card will be issued, at no cost, to use when paying for covered expenses. DENTAL Staying healthy includes obtaining quality dental care for you and your family. Jasper Seating’s dental plan is provided through Kentucky Health Administrators (KHA). BENEFIT

SERVICE Annual Deductible

$0 Individual / $0 Family

Annual Maximum

$1,000 Individual / $2,000 Family

Preventive Care

100%

Basic Treatment (after deductible)

50%

Major Treatment (after deductible)

50%

Orthodontia Services (child and adult coverage)

$1,000 Lifetime Maximum

VISION Jasper Seating Company is pleased to offer a vision program through Kentucky Health Administrators (KHA). SERVICE

BENEFIT

FREQUENCY

Exam

$40 Allowance

12 Months

Lens

Single - $40 Allowance Bifocal - $50 Allowance Trifocal - $60 Allowance

12 Months

Frames

$50 Allowance

12 Months

Contacts

$75 Allowance

12 Months

Prescription Safety Glasses

$75 Allowance

12 Months

WEEKLY DEDUCTION - INCLUDES BOTH DENTAL AND VISION TOGETHER Employee

$3.50

Family

$7.00 Jasper Seating Benefit Guide | 23

FLEXIBLE SPENDING ACCOUNTS (FSA) A Flexible Spending Account allows you to set aside some of your income on a pre-tax basis to pay for certain health expenses that may not be covered as part of your benefit plans. An FSA gives you the opportunity to pay less for planned expenditures, ultimately helping you save money for other things you may want or need. • Administered by Benefit Marketing Solutions LLC (BMS) the Health Care Account helps you to pay for medical, dental, vision and prescription expenses not covered by your benefit plans. This includes any deductibles, copayments and such items as orthodontia, glasses and contact lenses. The annual contribution is $3,016. Weekly per pay minimum $10. Weekly per pay maximum is $58. A debit card will be issued at no cost to use when paying for covered expenses. If additional cards are needed, contact BMS at 502244-1161. SHORT TERM DISABILITY INSURANCE Jasper Seating provides employees with short-term disability coverage as it is medically necessary and documented by your physician. This benefit is provided at no cost to you. LONG TERM DISABILITY INSURANCE Employees often do not consider the financial hardship that can occur as a result of becoming disabled. Jasper Seating understands that financial stability is an important part of an employee’s benefit package. Long-term disability coverage provides up to up 60% of your pre-disability income, effective after 180 days of disability due to accident or illness. Coverage is provided through Sun Life. BASIC LIFE / AD&D* Life insurance is an important part of your financial well-being especially if others depend on you for support. Jasper Seating provides basic life and AD&D coverage at no cost to you through Sun Life. The basic life benefit amount is $10,000. AD&D insurance provides benefits to you or your beneficiary if, due to an accident, you suffer loss of life or limb. *Benefit and age reductions will apply. VOLUNTARY LIFE INSURANCE / AD&D** In addition to basic life insurance, Jasper Seating offers employees the opportunity to purchase additional voluntary life insurance and AD&D through Sun Life. Employees may purchase $10,000 - $200,000 in $10,000 increments not to exceed 5 times annual salary. Guarantee Issue $200,000. Employees may also purchase voluntary dependent life insurance for their spouse or children. Benefits for spouse can be purchased in increments of $5,000. Benefits for children may be purchased in the amount of $5,000 or $10,000. Guarantee Issue for spouse $40,000. Guarantee Issue for children $10,000. You must select voluntary life coverage on yourself in order to cover your spouse and/or children. **If an employee is married to another employee, they cannot elect coverage on each other and only one can cover the children. Likewise, a dependent employed by Jasper Seating cannot be covered as a dependent and carry individual coverage at the same time. ACCIDENT INSURANCE You are given the opportunity to purchase accident insurance on yourself, spouse and/or children. When you enroll yourself and/ or your dependents in this benefit, you pay the full cost through weekly payroll deductions. Accident insurance will pay you money based on the injury and the treatment you receive, whether it is a simple sprain or something more serious like an injury from a car accident. Your plan can pay you a benefit for emergency room treatment, stitches, injury-related surgery as well as many other accident related experiences. CRITICAL ILLNESS INSURANCE You are given the opportunity to purchase critical illness insurance on yourself, spouse and/or children. When you enroll yourself and/or your dependents in this benefit, you pay the full cost through weekly payroll deductions. What is a critical illness? Heart attack, stroke and cancer are examples of a critical illness. Critical illness insurance can help by paying a lump sum payment directly to you at the first diagnosis of a covered condition. It offers valuable peace of mind from the rising costs of specialist healthcare which are not covered by ordinary health insurance. 401(k) RETIREMENT SAVINGS ACCOUNT Offers both Pre-Tax and Roth options. Eligibility Service Requirement – two months at time of enrollment. Enrollment Periods – January 1, April 1, July 1, October 1. Matching Jasper Seating contribution – 50% on first 4% of employee contribution. Questions? Contact Fidelity at 800-835-5097. ADDITIONAL BENEFITS • Gym Reimbursement – up to $20/month, paid quarterly. Proof of payment must be provided as well as attendance of 8 days/ month. • Paid Time Off Policies listed in Employee Handbook – including vacation, holidays and bereavement.. Contact Human Resources with questions on the Additional Benefits

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