Plateau 2022 Benefits Guide

BENEFITS GUIDE May 1, 2022 – April 30, 2023

TA B L E O F

CONTENTS Eligibility & Enrollment

3

Employee Navigator

4-5

Medical Plans

6-8

How to Access Healthgram

9-11

Health Savings Account

12

Dental

13

Vision

14

Contributions

15

Basic & Supplemental Life

16

Supplemental Life Rates

17

Voluntary Disability

18

Accident & Critical Illness

19

Contacts

20

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E L I G I B I L I T Y & E N RO L L M E N T Who is Eligible to Join the Benefit Plan?

Qualifying Event Changes

You and your dependents are eligible to join the health and our company welfare benefit plans if you are a full-time employee regularly scheduled to work 30 hours per week.

You must be enrolled in the plan to add dependent coverage.

You are allowed to make changes to your current benefit elections during the plan year if you experience an IRSapproved qualifying change in life status. The change to your benefit elections must be consistent with and on account of the change in life status.

Who is an Eligible Dependent?

IRS-approved qualifying life status changes include:

•

Your spouse to whom you are legally married

•

Marriage, divorce or legal separation

•

Your dependent child under the maximum age specified in the Carriers’ plan documents including: • Natural child • Adopted child • Stepchild • Child for whom you have been appointed as the legal guardian

•

Birth or adoption of a child or placement of a child for adoption

•

Death of a dependent

•

Change in employment status, including loss or gain of employment, for your spouse or a dependent

•

Change in work schedule, including switching between fulltime and part-time status, by you, your spouse or a dependent

•

Change in residence or work site for you, your spouse, or a dependent that results in a change of eligibility

The Dependent Maximum Age Limits is up to age 26. The dependent does not need to be a full-time student; does not need to be an eligible dependent on parent’s tax return; is not required to live with you; and may be unmarried or married.

•

If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage

•

If you or your dependents become eligible for a state’s premium assistance subsidy under Medicaid or CHIP

Once the dependent reaches age 26, coverage will terminate on the last day of the birth month.

If you have a life status change, you must notify the company within 60 days for changes in life status due to a Medicare or CHIP event and within 31 days of the other events.

*Your child’s spouse and a child for whom you are not the legal guardian are not eligible.

A totally disabled child who is physically or mentally disabled prior to age 26 may remain on the if the child is primarily dependent on the enrolled member for support and maintenance.

If you do not notify the company during that time, you and/or your dependents must wait until the next annual open enrollment period to make a change in your benefit elections.

When Do Benefits Become Effective?

Your benefits become effective on the first day of the month following your 60 days as a full-time employee with Plateau.

Annual Open Enrollment?

Each year during the annual Open Enrollment Period, you are given the opportunity to make changes to your current benefit elections. To find out when the annual Open Enrollment Period occurs, contact Human Resources.

!

Please note, loss of coverage due to nonpayment or voluntary termination of other coverage outside a spouse’s or parent’s open enrollment is not an IRS-approved qualifying life event and you do not qualify for a special enrollment period.

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E M P L O Y E E N AV I G AT O R E N R O L L M E N T G U I D E Step 1: Log In Go to www.employeenavigator.com and click Login •

Returning users: Log in with the username and password you selected. Click Reset a forgotten password.

•

First time users: Register as a new user. Create an account, and create your own username and password.

The name Plateau’s Payroll uses is the name you must use to register your new account.

The company Identifier is: PLATEAUEX The last 4 digits of your social security number Your date of birth

• • • •

Step 2: Welcome!

After you login, click Let’s Begin to complete your enrollment and additional required tasks if applicable.

Step 3: Start Enrollments After clicking Start Enrollment, you’ll need to complete some personal & dependent information before moving to your benefit elections.

TIP Have dependent details handy. To enroll a dependent in coverage you will need their date of birth and Social Security number.

Step 4: Benefit Elections To enroll dependents in a benefit, click the checkbox next to the dependent’s name under Who am I enrolling?

Below your dependents you can view your available plans and the cost per pay. To elect a benefit, click Select Plan underneath the plan cost.

Click Save & Continue at the bottom of each screen to save your elections.

If you do not want a benefit, click Don’t want this benefit? at the bottom of the screen and select a reason from the drop-down menu.

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E M P L O Y E E N AV I G AT O R E N R O L L M E N T G U I D E

Step 5: Forms If you have elected benefits that require a beneficiary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in those details.

Step 6: Review & Confirm Elections Review the benefits you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment.

You can either print a summary of your elections for your records or login at any point during the year to view your summary online.

TIP If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.

Step 7: You’re Finished You are finished. You can go back to your homepage to view your elections and you can make changes until the enrollment window closes.

You can login to review your benefits 24/7!

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BUY UP MEDICAL PLAN OPTION 1 – $2,500 DEDUCTIBLE COPAY PLAN BUY UP Medical Plan 1 - $2500 Deductible Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

Deductible

$2,500 Individual | $7,500 Family

$5,000 Individual | $20,000 Family

Coinsurance

20% after deductible

40% after deductible

$6,600 Individual | $13,200 Family

$19,800 Individual | $39,600 Family

Primary Care Physician Office Visit

$25 copay

Deductible, then 40%

Specialist Office Visit

$50 copay

Deductible, then 40%

Plan pays 100%

Deductible, then 40%

Deductible, then 20% at Free-standing facility or Hospital

Deductible, then 40%

Hospital Inpatient Care

Deductible, then 20%

Deductible, then 40%

Outpatient Surgery

Deductible, then 20%

Deductible, then 40%

$150 copay per visit, then 20% after deductible

Paid as In-network

$60 copay

Deductible, then 40%

(what you owe after you have paid the deductible)

Annual Out-of-Pocket Maximum

Preventive Care Services Complex Imaging Services (CT Scans, PET Scans & MRI’s)

Emergency Room Urgent Care Prescription Drugs Tier 1 — Generic Drugs Tier 2 — Preferred Brand-Name Tier 3 — Non-Preferred Brand-Name Tier 4 - Specialty Drugs

Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply Retail: $15 copay Mail Order: $30 copay Retail: $35 copay Mail Order: $60 copay Retail: $60 copay Mail Order: $90 copay Retail: 20% to max of $300 per drug Mail Order: Not available

Not covered Not covered Not covered Not covered

HOW TO FIND A PHYSICIAN To locate participating providers, follow these easy steps: 1.

2.

3.

4.

5.

Log onto www.healthgram.com Click on Members Under Resource Links select Find a Doctor Select Website next to the Cigna PPO Network Icon This will redirect you to the Cigna website to search for In-Network providers by location. If you are searching as a guest make sure you select the PPO.

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MEDICAL PLAN OPTION 2 – $2,800 HIGH DEDUCTIBLE HEALTH PLAN (HDHP) Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

Deductible

$2,800 Individual | $5,600 Family

$5,600 Individual | $11,200 Family

Coinsurance

20% after deductible

40% after deductible

$5,600 Individual | $11,200 Family

$16,800 Individual | $33,600 Family

Primary Care Physician Office Visit

Deductible, then 20%

Deductible, then 40%

Specialist Office Visit

Deductible, then 20%

Deductible, then 40%

Plan pays 100%

Deductible, then 40%

Complex Imaging Services (CT Scans, PET Scans & MRI’s)

Deductible, then 20%

Deductible, then 40%

Hospital Inpatient Care

Deductible, then 20%

Deductible, then 40%

Outpatient Surgery

Deductible, then 20%

Deductible, then 40%

Emergency Room

Deductible, then 20%

Paid as In-network

Urgent Care

Deductible, then 20%

Deductible, then 50%

Annual Out-of-Pocket Maximum

Preventive Care Services

Prescription Drugs

Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply

Tier 1 — Generic Drugs

Deductible, then 20%

Not covered

Tier 2 — Preferred Brand-Name

Deductible, then 20%

Not covered

Tier 3 — Non-Preferred Brand-Name

Deductible, then 20%

Not covered

Tier 4 - Specialty Drugs

Deductible, then 20%

Not covered

HOW TO FIND A PHYSICIAN To locate participating providers, follow these easy steps: 1.

2.

3.

4.

5.

Log onto www.healthgram.com Click on Members Under Resource Links select Find a Doctor Select Website next to the Cigna PPO Network Icon This will redirect you to the Cigna website to search for In-Network providers by location. If you are searching as a guest make sure you select the PPO.

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CORE MEDICAL PLAN OPTION 3 – $6,500 DEDUCTIBLE COPAY PLAN Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

Deductible

$6,350 Individual | $12,700 Family

$12,700 Individual | $25,400 Family

Coinsurance

30%

50% after deductible

$7,900 Individual | $15,800 Family

$23,700 Individual | $47,400 Family

Primary Care Physician Office Visit

$30 copay

Deductible, then 50%

Specialist Office Visit

$60 copay

Deductible, then 50%

Plan pays 100%

Deductible, then 50%

Deductible, then 30%

Deductible, then 50%

$500 copay per admission, then 30%, no deductible

Deductible, then 50%

Deductible, then 30%

Deductible, then 50%

$350 copay per visit, then 30% after deductible

Paid as In-network

$75 copay

Deductible, then 50%

(what you owe after you have paid the deductible)

Annual Out-of-Pocket Maximum

Preventive Care Services Complex Imaging Services (CT Scans, PET Scans & MRI’s) Hospital Inpatient Care Outpatient Surgery Emergency Room Urgent Care

Prescription Drugs

Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply

Tier 1 — Generic Drugs

Retail: $15 copay Mail Order: $40 copay

Not covered

Tier 2 — Preferred Brand-Name

100% Coinsurance, no deductible

Not covered

Tier 3 — Non-Preferred Brand-Name

100% Coinsurance, no deductible

Not covered

Tier 4 - Specialty Drugs

100% Coinsurance, no deductible

Not covered

HOW TO FIND A PHYSICIAN To locate participating providers, follow these easy steps: 1.

2.

3.

4.

5.

Log onto www.healthgram.com Click on Members Under Resource Links select Find a Doctor Select Website next to the Cigna PPO Network Icon This will redirect you to the Cigna website to search for In-Network providers by location. If you are searching as a guest make sure you select the PPO.

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H O W T O AC C E S S H E A LT H G R A M You can search for health care providers at: • The Healthgram member portal at www.Healthgram.com • The Cigna PPO webpage at www.cigna.com/hcpdirectory • You can contact Healthgram Connect at 1-888-904-9081

The medical coverage offered to Plateau Excavation employees and their families is administered by Healthgram.

You have three plans to choose from for the 2022 plan year (pages 6-8 of this guide).

All three plans use the extensive Cigna PPO Network. Each plan offers a national network and the freedom of seeking care from both contracted (In Network) and non-contracted (Out of Network) physicians or facilities. The best way to maximize your medical benefits is to seek care from an In Network physician or facility.

Healthgram Connect With the Healthgram Connect advocacy service, you have access to a team of experts available to help employees navigate the healthcare system, maximize their benefits and avoid the burden of unnecessary healthcare costs.

These healthcare advisors work to: • • • • • • • • • •

Resolve employee questions Proactively identify emerging and current health issues Educate on employee benefits and options for a treatment or service Provide advice regarding prior authorization requirements for tentatively scheduled services Act as a liaison between providers Determine deductibles or other out-of-pocket/coinsurance requirements Research claim receipts and/or payment status information Continuously find ways to save both employee and employer money Help with replacement of a lost or stolen ID card Assist with any other issues concerning healthcare insurance

Members: • • •

Always take your Health Insurance ID Card with you to appointments and show it to the provider’s office upon arrival.

To view a digital copy of your ID card, log into your Member Portal at members.healthgram.com and click on the “ID Card” link on your dashboard.

If you need to manually submit a claim to Healthgram for reimbursement, log in to your Member Portal and download the Claim Form within the “Documents” section.

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H E A LT H S AV I N G S AC C O U N T ( H S A ) Available only if you enrolled in the $2,800 HDHP

What is a Health Savings Account?

What Type of Expenses Can Be Paid From an HSA?

A Health Savings Account (HSA) is an account permitted under the federal tax law that allows you to save money for healthcare expenses on a tax-favored basis. It is an individual account that belongs to you and is not part of (Company Name)’s medical plan. The account is portable, which means it is not tied to your employment at (Company Name). Your HSA stays with you if you retire or leave the company. Because the HSA has special tax status under the law, it is governed by numerous mandatory tax rules and regulations.

You can receive tax-free distributions from your HSA to pay for or to be reimbursed for qualified medical expenses that are incurred after you establish your HSA. These include: ▪ ▪

▪

Who is Eligible for an HSA?

Any medical expenses that apply toward your deductible, Any healthcare expenses that are qualified expenses for tax purposes under Section 213 of the Internal Revenue Code. Some of these expenses are described in IRS Publication 502, Once your reach age 65, Medicare premiums or other health insurance, other than a Medicare supplemental policy.

Generally, to be eligible to set up and contribute to an HSA, you: ▪ ▪ ▪ ▪

You may find information about these rules on the IRS website (www.irs.gov), including IRS Publication 969 and 502. You may also want to consult a tax-advisor.

How Much Can I Contribute to An HSA? As noted by federal law, the annual contribution limits are: ▪ ▪

How Do I Enroll in an HSA?

Must be covered by a Consumer Directed Health Plan (CDHP) – the $2,800 HDHP plan (page 7 of this guide) Cannot be claimed as a dependent on anyone else’s tax return Are not enrolled in Medicare (due to age or disability) or Tricare Cannot be enrolled in a general purpose FSA, nor can your spouse

You can go to any banking institution of your choice and apply for an HSA account. This account works similarly to how a bank would manage your personal savings or checking account.

When you open your HSA, you receive a debit card and/or checkbook to be used on many out-of-pocket qualified expenses like doctor visits, vision and dental care, and prescriptions.

HSA Bank – how to open your Health Savings Account ▪ ▪ ▪ ▪ ▪

Log on to www.hsabank.com and click “OPEN AN HSA” Follow the instructions to set up your individual HSA. Let HR know how much to fund your account.

Funds in your account roll over every year The money is yours, so the account stays with you if you leave your employer

The amount is $3,650 for individual coverage and $7,300 for family coverage.

Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000.

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D E N TA L Select A Dental Plan That Meets Your Needs Plateau is pleased to offer MetLife dental this year. This dental plan provides In-Network and Out-of-Network benefits. Benefits provide access to coverage for dental care ranging from routine cleanings to major services and repairs. Through MetLife you have access to thousands of unique providers. Out-of-network benefits are available, however, using In-Network dentists will provide the best rates for services. Below is a summary of the benefits offered.

Service Waiting Period for Late Enrollees?

Employees who enroll themselves and/or their dependents 31 or more days after the initial eligibility period will be subject to a 12-month waiting period before the plan elected will pay for Basic or Major services. The waiting periods may be decreased or eliminated based on the number of months the member had dental insurance immediately before their effective date.

To find a dentist, log on to www.metlife.com. Your dental network is “PDP/PDP PLUS”.

MetLife Dental Plan Highlights

In-Network (Plan Pays)

Out-of-Network (Plan Pays)

Your Deductible

$50 individual / $150 Family

$50 individual / $150 Family

Calendar Year Maximum Applies to preventive, basic, and major services

$1,000 combined In-network and Out-of-Network

$1,000 combined In-network and Out-of-Network

Preventive & Diagnostic Services – Type A Exams: 2 times in 1 calendar year Cleanings: 2 times in 1 calendar year Fluoride: 1 time in 12 months for child under age of 19 Sealants: 1 per molar in 36 months for child under the age of 16 Full Mouth X-Rays: Once in 60 months Bitewing W-Rays: 1 time in 12 months for child under the age of 19; 1 time in 12 months for adults

100% (Deductible waived)

100% (Deductible waived)

Basic Services – Type B Space Maintainers: 1 per lifetime for child under the age of 17 Amalgam Filings: 1 replacement per surface in 24 months Labs & Other Tests Emergency Palliative Treatment Resin Composite Fillings (includes coverage for composite fillings on molars) Oral Surgery: Simple Extractions

80% After deductible

80% After deductible

Major Services – Type C Consultations: 2 in 12 months Root Canal: 1 per tooth per lifetime Periodontal Maintenance: 2 perio Treatments in 1 calendar year, includes 2 cleanings Periodontal Surgery: 1 per quadrant in any 36 month period Scaling & Root Planning: 1 per quadrant in any 36 month period Dentures: 1 in 84 months Denture Adjustments: 1 in 6 months Inlays/Onlays/Crowns: 1 replacement per tooth in 84 months Implant Services: 1 per tooth position in 84 months Implant Supported Prosthetic: 1 per tooth in 84 months Implant Repairs: 1 per tooth in 12 months Tissue Conditioning: 1 in 24 months General Anesthesia Pulpotomy Periodontal Surgery – soft & connective tissue grafts Other Oral Surgery TMJ

50% Coinsurance

50% Coinsurance

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VISION Plateau will continue to offer Vision insurance through Humana. Humana offers easy access to thousands of conveniently located vision care providers. Unlike other programs that may restrict provider options, Humana offers a nationwide network of convenient, accessible options for eye care including optometrists, ophthalmologists, opticians and many leading optical retailers, such as Lens Crafters, and Pearl Vision.

• • •

Evening and weekend hours at many locations Choice of thousands of fashionable, designer frames No appointment necessary (but is strongly suggested), and service in “about an hour” in most locations

HUMANA VISION Services

In Network

Out Of Network

Routine Exam with Dilation

$10 Copay

Up to $30

Standard Contact Lens fit and follow-up

Up to $55

Not Covered

Premium* Contact Lens fit and follow-up

10% off retail

Not Covered

$130 frame allowance 20% off balance over allowance

Up to $65

Single

$15 Copay

Up to $25

Bifocal

$15 Copay

Up to $40

Trifocal

$15 Copay

Up to $60

UV Coating

$15

Not Covered

Tint (Solid and Gradient)

$15

Not Covered

Standard Scratch Resistant Coating

$15

Not Covered

Standard Polycarbonate

$40

Not Covered

Standard Anti-Reflective Coating

$45

Not Covered

Standard Progressive (Add-on to Bifocal)

$15

Up to $40

$130 allowance 15% off balance over allowance

Up to $104

Up to $130

Up to $104

$0

Up to $200

Eye Exam:

Frames: Any available frame at provider location

Standard Plastic Lenses:

Lens Options:

Contact Lenses: (Material Only) Conventional Disposable Medically Necessary

Frequency: Examination Frames

12 months** 24 months

Eyeglass Lenses

12 months**

Contact Lenses

12 months**

CONTRIBUTIONS Plateau Excavation contributes to the cost of medical coverage for all eligible employees. For an additional premium employees can add dependent coverage. Please refer to the chart below for your weekly payroll deductions.

Weekly Payroll Deductions Weekly Employee Contributions

Employee Only

Employee & Spouse

Employee & Child(ren)

Family

BUY UP Medical Option 1 $2,500 Deductible Copay Plan

$86.00

$199.00

$188.00

$247.00

HDHP Medical Option 2 $2,800 HDHP

$55.00

$149.00

$138.00

$197.00

CORE PLAN Medical Option 3 $6,500 Deductible Copay Plan

$32.00

$135.00

$129.00

$200.00

Dental

$5.49

$12.52

$10.54

$17.79

Vision

$1.83

$3.67

$3.48

$5.47

Voluntary Life Life / AD&D

Premiums based on benefit amounts selected and your age.

Long Term Disability

Premiums based on your monthly salary and your age.

Short Term Disability

Premiums based on 66 2/3% of your weekly salary.

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E M P L OY E R PA I D L I F E A N D A D & D Plateau Excavation provides all Full-Time employees a $20,000 basic life and Accidental Death & Dismemberment (AD&D) benefit.

Life insurance pays your named beneficiary in the event of your death. AD&D insurance will provide a benefit to your beneficiary if your death is the result of an accident. AD&D insurance will provide a benefit to you if you suffer certain accidental injuries, such as the loss of limb (arm/leg), loss of eyesight or permanent paralysis. This coverage is now provided through Unum and is paid for by Plateau Excavation.

Life benefit amounts will reduce to 65% of the original amount at age 65, to 50% at age 70, to 35% at age 75, to 20% at age 80.

Benefits terminate at retirement.

S U P P L E M E N TA L L I F E A N D A D & D Employees may elect additional life insurance up to 5x annual earnings, up to a maximum of $500,000. Spouses may elect increments of $5,000 up to a maximum of $500,000, subject to guaranteed issue schedule. The spouse's Voluntary Life benefit cannot exceed 100% of the employee's Voluntary Life amount. Dependent Child(ren) coverage is available in increments of $2,000, up to a maximum benefit of $10,000.

Voluntary Life is provided through Unum.

Guaranteed Issue Schedule • • •

Employee: $150,000 Spouse: $25,000 Child: All coverage is guarantee issue

Voluntary Life benefit amounts will reduce to 65% of the original amount at age 65, to 50% at age 70, to 35% at age 75, to 20% at age 80. Benefits terminate at retirement. The spouse's Voluntary Life benefit amount will reduce in accordance with the employee’s age.

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S U P P L I M E N TA L L I F E C O S T O F C OV E R A G E Life and AD&D are sold together for Employee and Spouse Coverage. The amount of AD&D coverage must be equal to the amount of Voluntary Life benefits the employees select for themselves and their covered spouses. AD&D coverage is not available for a child.

• Employee coverage must be elected in $5,000 increments, minimum amount $10,000, the maximum amount per employee is $500,000 subject to Guarantee Issue schedule.

• Spouse coverage must be elected in $5,000 increments, not to exceed 100% of the employee amount, subject to Guarantee Issue schedule.

• Dependent Child(ren) coverage is available in increments of $2,000, up to a maximum benefit of $10,000.

Monthly Life Rates Per $1,000 Of Benefit

Employee

Spouse

Age < 25

$0.082

$0.082

25-29

$0.095

$0.095

30-34

$0.100

$0.100

35-39

$0.152

$0.152

40-44

$0.199

$0.199

45-49

$0.329

$0.329

50-54

$0.511

$0.511

55-59

$0.819

$0.819

60-64

$1.261

$1.261

65-69

$2.236

$2.236

70+

$4.00

$4.00

$0.060

$0.060

Monthly AD&D Rates Per $1,000 Of Benefit Employee, Spouse, Child Monthly Child Cost Per $1,000 Of Benefit All Children, one unit

$0.366

Example$

Monthly Premium

Life Coverage Employee, Age 41

$100,000 selected benefit (100 x .199 = $19.90)

$19.80

Spouse, Age 35

$25,000 selected benefit (25 x .199 = $4.98)

$4.98

Two Children

$5,000 selected benefit (5 x .366 = $1.83)

$1.83

Cost of Life Coverage

$26.71

AD&D Coverage Employee, Age 41

$100,000 selected (100 x .06 = $6.00)

$6.00

Spouse, Age 35

$25,000 selected benefit (25 x .06 = $1.50)

$1.50

Two Children

$5,000 selected benefit (5 x .06 = $0.30)

$0.30

Cost of AD&D Coverage

$7.80

Total Monthly Cost Employee, Age 41

$100,000 Life and AD&D benefits

$25.80

Spouse, Age 35

$25,000 Life & AD&D benefits

$6.48

Two Children

$5,000 Life benefit

$2.13 Total Monthly Cost

$34.41

Weekly Cost

$7.94

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VO L U N TA RY D I S A B I L I T Y I N S U R A N C E Disability coverage provides the financial security of knowing that you will continue to receive income if you are unable to work due to illness or injury.

Short-Term Disability Even a few weeks away from work can make it difficult to manage household expenses. Voluntary Short-Term Disability is available to you through Unum. This coverage will pay up to 60% of your weekly salary up to a maximum of $1,000 for non work-related accidents or sickness, so you can focus on getting better, and worry less about keeping up with your bills. Benefits begin after the 14th day of disability for accident and sickness. Benefits are payable up to a maximum of 11 weeks.

Long-Term Disability Serious illnesses or accidents can come out of nowhere. They can interrupt your life and your ability to work for months ─ even years. Voluntary Long-Term Disability coverage is available to you through Unum. This benefit pays 60% of your monthly earnings in the event of a disability after 90 days for accident and illness up to a maximum weekly benefit of $5,000. The Long-Term Disability benefit pays up to the Social Security Normal Retirement Age (SSNRA).

The policy does not provide benefits for a disability caused by a pre-existing condition. A pre-existing condition is any condition for which you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines prior to your effective date of coverage. Please refer to the plan certificate for the pre-existing guidelines.

Age

Rate per $10 of Weekly Benefit

Age

Rate per $100 of Monthly Covered Payroll

Age < 25

$0.42

Age < 25

$0.27

25-29

$0.45

25-29

$0.31

30-34

$0.45

30-34

$0.46

35-39

$0.50

35-39

$0.66

40-44

$0.60

40-44

$0.87

45-49

$0.67

45-49

$1.25

50-54

$0.79

50-54

$1.73

55-59

$1.01

55-59

$2.35

60-65

$1.22

60-65

$2.51

65+

$1.36

65-69

$3.17

70+

$3.46

O T H E R S TA N DA R D F E AT U R E S Full Maternity Benefits

Social Security Assistance

Vocational Rehabilitation

Continuity of Coverage

Workplace Modification Benefit

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VO L U N TA RY AC C I D E N T I N S U R A N C E Accident insurance can pay you money for covered accidental injuries and their treatment.

Accident insurance is an extra layer of protection when you suffer an unexpected, qualifying accident. It provides you money to cover any extra, out-of-pocket expenses associated with your injury.

Accident insurance pays you a lump sum in cash after you suffer an accident like a severe burn, broken bone or emergency room visit. Our accident insurance policies also offer a special benefit that pays extra for children injured while playing an organized sport like soccer, baseball, lacrosse, or football.

BENEFIT

COVERAGE AMOUNT

Concussions

$150

Dislocations

Schedule up to $6,000

Emergency Room Treatment

$150

Eye Injury

$300

Fractures

Schedule up to $7,500

Hospital Admission

$1,000

Laceration

Schedule up to $600

VO L U N TA RY C R I T I C A L I L L N E S S I N S U R A N C E A critical illness has a dramatic and immediate impact on employees and their families. The costs associated with such illnesses create hardships for many, especially with the trend toward higher out-of-pocket healthcare costs.

Unum’s Critical Illness plan pays a tax-free, lump sum cash benefit to insured employees upon the first occurrence, and even reoccurrence, of a covered illness. These benefit dollars may be used to help replace lost income, travel, childcare, medical deductible, and other uncovered expenses.

COVERED CONDITIONS Heart Attack

Blindness

Major Organ Failure

End-Stage Kidney Failure

Benign Brain Tumor

Coronary Artery Bypass Surgery

Coma

Stroke

Cancer

Carcinoma in situ

Permanent Paralysis

Occupational HIV

Plateau Excavation Benefit Guide | 20

KEY CONTACTS & RESOURCES Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard:

Erica Labarreare Account Executive

Your Employee Support Contact

678-424-6557 Elab@sspins.com NEED HELP WITH A CLAIM? BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING: Kristie Mercer – Claims Support Specialist 770-635-2293 kmercer@sspins.com Darlene Moorman – Client Support Specialist 770-635-0439 dmoorman@sspins.com

Annual Notices are available here: https://issuu.com/pjmarcomm/docs/flipbook_info

Benefit

Company

Phone

Website

Medical Coverage

Healthgram

800-550-6214

www.Healthgram.com

Pharmacy Coverage

Elixir

800-771-4648

www.elixirsolutions.com

Dental

MetLife

800-275-4638

www.metlife.com/mybenefits

Vision

Humana

800-448-6262

www.humana.com

Life/AD&D

Unum

866-679-3054

www.unum.com

Long-Term Disability

Unum

866-679-3054

www.unum.com

Short-Term Disability

Unum

866-679-3054

www.unum.com

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