Room & Board 2023 Open Enrollment Guide

Enrollment

Introduction

Welcome to our Benefits Open Enrollment

Welcome to our Benefits Open Enrollment

Our goal is to provide meaningful benefits that support your wellbeing and the wellbeing of your loved ones. In return, you are expected to take accountability for understanding and appropriately utilizing your benefits. We encourage you to take the time to learn about all of the benefits, review your current elections and make choices that are right for you and your family for 2023.

During Open Enrollment, staff members can enroll in the following benefits:

• Medical • Dental

• Vision • Voluntary Life

• Voluntary Accidental Death & Dismemberment (AD&D)

• Flexible Spending Accounts (FSAs)

How to Enroll or Waive Benefits Coverage for 2023

Be sure to read this guide in its entirety, as well as the other Open Enrollment resources on Worklife. Make your decisions and complete your enrollment or waive coverage in UKG.

Keep in mind that the benefit elections you made for 2022 do not automatically carry over. Be sure to make active elections for 2023 benefits during Open Enrollment in order to avoid a lapse in coverage. You will not be able to make changes during the year unless you experience a qualified life event.

2023 Highlights

• We are pleased to share that staff members will not see an increase to their biweekly health insurance premiums.

• There are no changes to our health insurance or dental plan designs.

• Staff members will see an increase to their dental premiums. Please see the dental section for more information.

• Health Savings Account (HSA) contribution limits have increased from $3,650 to $3,850 for individual coverage and from $7,300 to $7,750 for family coverage.

Copay Plan

DEDUCTIBLE AND OUT-OF-POCKET MAXIMUM AMOUNT

EMPLOYEE (PER MEMBER)

FAMILY

IN-NETWORK

COVERAGE LEVEL

OUT-OF-NETWORK

Routine Preventive Care

• Preventive care

• Screening

• Immunization

Office Visits

• Illness or injury

• Mental/behavioral health, substance use disorder

• Physical, occupational and speech therapy

• Specialty visits

Online Care

• Virtuwell

• Doctor on Demand

Emergency Care

• Urgent care

• Emergency care at hospital ER

• Ambulance

Inpatient Hospital Care

Outpatient Care

• Scheduled outpatient procedures

• Outpatient MRI and CT scans

$750 deductible amount $3,000 out-of-pocket maximum

$1,500 deductible amount $6,000 out-of-pocket maximum

No charge

$35 copay $35 copay $35 copay $75 copay

No charge Up to a $59 copay for Doctor on Demand

$1,150 deductible amount $4,500 out-of-pocket maximum

$2,300 deductible amount $9,000 out-of-pocket maximum

50% coinsurance for eye exams 50% coinsurance for immunizations 50% coinsurance for other services

Deductible then you pay 50%

Not covered

$100 copay for urgent care $200 copay for ER 20% coinsurance for medical transportation

Deductible then you pay 20%

$100 copay for urgent care $200 copay for ER 20% coinsurance for medical transportation

Deductible then you pay 50%

Deductible then you pay 20% Deductible then you pay 50%

Copay Plan

PRESCRIPTION DRUG SERVICES

IN-NETWORK

RETAIL (UP TO A 31-DAY SUPPLY)

GENERIC

FORMULARY (BRAND)

NONFORMULARY (BRAND)

SPECIALTY

MAIL ORDER (UP TO A 93-DAY SUPPLY)

OUT-OF-NETWORK

copay You pay 50%

copay You pay 50%

copay You pay 50%

copay You pay 50%

GENERIC $30 copay Not covered

FORMULARY (BRAND) $150 copay Not covered

NONFORMULARY (BRAND) $270 copay Not covered

BENEFITS OF THE COPAY PLAN

• It has a lower deductible

• You pay a flat $35 for each office visit ($75 for specialty care)

• Labs and x-rays are 100% covered

• Prescriptions have a flat copayment

Click here to view the full Summary of Benefits and Coverage (SBC) for the Copay Plan.

DEDUCTIBLE AMOUNT

(HSA)

MAXIMUM

HSA CONTRIBUTIONS

MEMBER HSA CONTRIBUTIONS

COVERAGE LEVEL

High Deductible (HSA) Plan

IN-NETWORK

COVERAGE LEVEL

OUT-OF-NETWORK

The information below shows the amount you are responsible for paying by type of care after the deductible is met.

Routine Preventive Care

• Preventive care

• Screening

• Immunization

Office Visits

• Illness or injury

• Mental/behavioral health, substance use disorder

• Physical, occupational and speech therapy

Online Care

• Virtuwell

• Doctor on Demand

Emergency Care

• Urgent care

• Emergency care at hospital ER

• Ambulance

No charge

Deductible then you pay 20%

40% coinsurance for eye exams

40% coinsurance for immunizations No charge for well-child visits 40% coinsurance for other services

Deductible then you pay 40%

Deductible then you pay 20%

Not covered

Deductible then you pay 20% Deductible then you pay 20%

Inpatient Hospital Care Deductible then you pay 20% Deductible then you pay 40%

Outpatient Care

• Scheduled outpatient procedures

• Outpatient MRI and CT scans

Deductible then you pay 20% Deductible then you pay 40%

High Deductible (HSA) Plan

CONTINUED

RETAIL (UP TO A 31-DAY SUPPLY)

Generic

Formulary (Brand)

Nonformulary (Brand)

Specialty

MAIL ORDER (UP TO A 93-DAY SUPPLY)

Generic

Formulary (Brand)

Nonformulary (Brand)

Specialty

PRESCRIPTION DRUG SERVICES

IN-NETWORK

Deductible then you pay 20%

Deductible then you pay 20%

Deductible then you pay 20%

Deductible then you pay 20%

OUT-OF-NETWORK

Deductible then you pay 40%

Deductible then you pay 40%

Deductible then you pay 40%

Deductible then you pay 40%

Deductible then you pay 20%

Deductible then you pay 20%

Deductible then you pay 20%

Deductible then you pay 20%

BENEFITS OF THE HSA PLAN

• It has lower monthly premiums

• Room & Board contributes to your health savings account (HSA)

• Tax advantages – your HSA contributions are tax-deductible, you can spend your money tax-free, and any growth is tax-free too.

• It’s your money and your unused HSA money rolls over every year.

Click here to view the full summary of benefits and coverage (SBC) for the HSA Plan.

Not covered

Not covered

Not covered

Not covered

How the Plans Work

PREVENTIVE CARE

In-network preventive care, such as annual check-ups, cancer screenings, well-child care and immunizations, are covered at 100%.

How the Copay Plan Works: IN-NETWORK PROVIDERS

DEDUCTIBLE

$750 lndividual $1500 Family

You pay a copay for o ce visits, prescriptions and 100% of other covered medical costs until you meet your deductible.

COINSURANCE OUT-OF-POCKET MAXIMUM

Once you meet your deductible, you pay 20% for services up to your out-of-pocket maximum.

$3000 lndividual $6000 Family

If your accumulated out-ofpocket expenses reach the above maximums, the plan pays 100% for the remainder of the year.

How the High Deductible HSA Plan Works: IN-NETWORK PROVIDERS

USE YOUR HSA TO HELP PAY THESE EXPENSES

IN-NETWORK PREVENTIVE CARE

In-network preventive care, such as annual check-ups, cancer screenings, well-child care and immunizations, are covered at 100%.

DEDUCTIBLE $1800 lndividual $3600 Family

You pay 100% of medical and prescription drug costs until you meet your deductible. Room & Board will make a contribution to your HSA based on the tier of coverage you select. (Single= $600, Single+1 =$900, Family= $1,200). You can withdraw these funds tax-free and put them towards meeting your deductible or save them to help o set future expenses.

COINSURANCE

Once you meet your deductible, you pay 20% for services and prescriptions* up to your out-of-pocket maximum.

OUT-OF-POCKET MAXIMUM

$3000 lndividual $6000 Family

If your accumulated out-ofpocket expenses reach the above maximums, the plan pays 100% for the remainder of the year.

*For specialty drugs, you pay 20% up to $200 maximum of the cost per prescription per month.

Plan Considerations

It’s important to consider your options when selecting your medical plan. Deciding on a plan is a personal decision for you and your family. When choosing the plan that’s right for you, it’s important to think about your total costs:

Fixed costs (annual premium contributions) + variable costs (out-of-pocket expenses) = total costs

Here are a few things to think about when choosing a medical plan:

• Consider your per paycheck premium contribution. Since your maximum out-ofpocket exposure is the same on both plans, your premium contribution is an important consideration.

• How do you and your family use your health care? Consider the number of office visits you make in an average year, the number and cost of prescription drugs you use, and the number of foreseeable hospital visits you anticipate in the upcoming plan year (pregnancy, chronic conditions, etc.).

• Enrolling in our High Deductible Plan gives you access to a health savings account (HSA). HSA dollars can be used for qualified health care expenses, including vision and dental for yourself and any tax dependents. Your HSA dollars will rollover year-toyear, giving you the ability to save for future health care expenses. To learn more about HSAs, go to www.optumbank.com.

• You may also make contributions to your HSA up to the IRS maximums: $3,850/single and $7,750/family.

• If you are age 55+, you are eligible to make an additional $1,000 “catch-up” contribution. Be sure to factor in your Room & Board contribution with these limits. There are some tax advantages to contributing to an HSA; see right.

• If you enroll in our Copay Plan, you have the ability to open a Medical Flexible Spending Account that allows you to set aside pre-tax money from your paycheck to pay for eligible medical, vision and dental expenses. (See page 15 for more information.)

HSA TAX ADVANTAGES

• Staff member contributions are tax-free, reducing your taxable income.

• Distributions of HSA funds are tax-free when used to cover qualified health care expenses.

• HSA balances grow tax-free.

CHECK OUT HEALTHPARTNERS PLAN FOR ME

• This online tool helps you compare your plan options and potential costs – all based on your unique situation. Go to healthpartners.com/planforme.

• Group Number: 2353

• Site Number: All

• Effective Date: 01/01/2023

Vision Coverage

The vision plan through EyeMed allows you and your covered family members to receive an eye exam at an EyeMed in-network provider for just a $10 copay. You also receive a $150 allowance toward your choice of a complete pair of eyeglasses or contact lenses. There are also other great discount benefits as an EyeMed member when you go to an “Insight” in-network provider.

With EyeMed, you have access to independent providers, LensCrafters, Pearle Vision and Target Optical as well as online retailers contactsdirect.com, glasses.com, lenscrafters.com and rayban.com.

LEVEL

VISION CONTRIBUTIONS

BIWEEKLY

PLASTIC LENSES

of the

or supporting structures;

or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; 4) Services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; 5) Plano (non-prescription) lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or materials provided by any other group benefit plan providing vision care; 9) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; 10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/Premium Progressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium Progressive as a Standard. Benefit allowance provides no remaining balance for future use within the same benefit year. Fees charged for a non-insured benefit must be paid in full to the Provider. Such fees or materials are not covered.

IN-NETWORK

SUMMARY OF BENEFITS

OUT-OF-NETWORK

LENS OPTIONS

CONTACT LENSES

copay; 15% off balance over $150 allowance $0 copay; $100% of balance over $150 allowance $0 copay; Paid-In-Full

to $105 Up to $105 Up to

OTHER

Dental

Routine dental care can not only improve your oral health but your overall health as well. Delta Dental of Minnesota offers two networks — Delta Dental PPO and Delta Dental Premier — that work together to provide the greatest access to providers and help control your costs. Choosing a dentist in the Delta Dental PPO network may save you even more money.

Four out of five dentists nationally are Delta Dental Network dentists. You can choose to see a dentist outside of the network, but your expenses may be higher, and you may be responsible for submitting your own claim. To find a participating dentist, simply visit www.deltadentalmn.org and use the interactive ‘’Find a Dentist” tool or call Customer Service toll-free at 800-448-3815.

Dental

SUMMARY OF BENEFITS

PREMIER

Flexible Spending Accounts (FSAs)

FSAs are voluntary accounts that allow you to use pre-tax funds to pay for certain expenses. You can set up three separate accounts — one for qualified health care expenses, one for qualified dependent care expenses and one for work-related parking/ transit expenses.

Medical Flexible Spending Account

The Medical FSA provides a way to pay for your family’s eligible medical, vision and dental expenses with pre-tax money that is deducted from your paycheck.

Contributions

You may make pre-tax contributions of up to $2,650 per year to your Medical FSA. If you have money left over at the end of the calendar year, you will be able to rollover up to $610 of your balance to the following calendar year.

Eligible Medical Expenses

Eligible expenses can be found here through WEX: https://www.wexinc.com/insights/ benefits-toolkit/eligible-expenses/

Limited Purpose Medical FSA Contributions

You may make pre-tax contributions of up to $2,650 per year to your Limited Purpose

Medical FSA. If you have money left over at the end of the calendar year, you will be able to rollover up to $610 of your balance to the following calendar year.

Eligible Expenses Include:

• Dental expenses

• Vision expenses

• Out-of-pocket medical expenses after you reach the federally-qualified High Deductible HSA Plan annual deductible ($1,400 for single coverage, $2,800 for family coverage).

Dependent Care FSA Contributions

You may contribute up to $5,000 per year, per family household, on a pre-tax basis to the Dependent Care FSA. This annual maximum applies to all contributions made by you and your spouse to a Dependent Care account.

Eligible Dependents

You can be reimbursed for dependent care expenses if they are necessary to allow you or your spouse to work. The services must be provided by a qualified dependent care provider to care for your child, disabled spouse, elderly parent or other dependent who is physically or mentally incapable of self-care.

Commuter Expenses

Staff members who incur work-related commuter expenses, including transportation or parking, may participate in this benefit. In 2023 you are able to deduct up to $300 per month pre-tax from your paycheck for transit expenses and $300 per month for parking expenses.

How Does the Commuter Benefit Work?

• You decide how much of your paycheck you want to deposit into your transit or parking account each pay period.

• Your deduction will be loaded onto a debit card for you to pay for transit or parking expenses. You can also submit requests for reimbursements.

• Transactions or reimbursement requests cannot exceed the $300 IRS monthly maximums.

• Any amount remaining at the end of the calendar year will roll forward to the next calendar year.

Use it to Pay for Things Like:

• Bus passes, commuter van, light rail, train and subway fares

• Parking ramps

FSA Example

The following illustrates the tax benefits of an FSA. This example compares costs for single-employee coverage. Your actual costs and tax savings will vary.

WITH FSA WITHOUT FSA

Taxable income $40,000 $40,000

Your FSA contribution -$2,500 $0

Net taxable income $37,500 $40,000

Less taxes -$4,310 -$4,740

Expenses paid after taxes $0 -$2,500

Remaining income $33,190 $32,760

Your savings $430 $0

Substantiation of Claims for all FSAs

We find great value in using our flex debit card to pay for claims at the time of service. The card gives you instant access to the funds in your account. The IRS regulations mandate that all claims incurred in an FSA must be substantiated. When a claim cannot be automatically substantiated (e.g., a prescription co-payment), WEX Benefits will request documentation. It is imperative when asked for documentation that you provide it to WEX Benefits as soon as possible. If documentation is not provided, the IRS requires you to pay back the plan.

Voluntary Life and AD&D Insurance

Voluntary Life Insurance

Room & Board pays for basic term life insurance in the amount of 2 ½ times the annual salary for all staff members who work 20 hours or more per week. Depending on your situation, you may find that you need additional coverage. You can elect Voluntary Life Insurance through VOYA for you, your spouse or domestic partner, and your dependent children, up to the benefit maximums listed below.

How it Works

You can elect coverage for yourself up to five times your annual salary in increments of $10,000 to a maximum of $500,000. You can cover your spouse, domestic partner and/ or child(ren) only if you elect coverage for yourself. For your spouse/domestic partner, you can elect up to 100% of your coverage in increments of $5,000 up to $500,000.

If you are currently enrolled in coverage, you will be able to increase your election by $20,000 during Open Enrollment without Evidence of Insurability. If this is your first time enrolling, you can elect up to $20,000 of coverage for yourself at Open Enrollment and $10,000 for your spouse/partner.

Child coverage is available in amounts of $5,000 or $10,000. You can cover unmarried children up to age 26.

Voluntary Accidental Death and Dismemberment (AD&D) Insurance

Room & Board pays for basic term AD&D insurance in the amount of 2½ times the annual salary for all staff members who work 20 hours or more per week. You may also elect additional AD&D insurance for yourself and eligible dependents. If elected, this benefit is paid in addition to the life benefit if you or a covered dependent dies in a covered accident. If you survive a serious accident, it can pay you a benefit for certain severe injuries such as loss of vision, hearing and limbs.

How it Works

You can choose a benefit amount up to five times your annual salary in increments of $10,000 to a maximum of $500,000. You can purchase coverage for your spouse/ domestic partner in amounts of $5,000 up to a maximum of $500,000, and coverage for dependent children in amounts of $5,000 and $10,000. AD&D rates are $.02 per $1,000 coverage for staff members and covered dependents. This coverage is not subject to Evidence of Insurability.

Voluntary Life Insurance Coverage Rates

Rates are shown as your biweekly deduction. Your rate will increase as you move to the next age group.

AGE BAND RATE PER $10,000 BENEFIT < 24 $0.231 25-29 $0.277 30-34 $0.369 35-39 $0.415 40-44 $0.554 45-49 $0.923 50-54 $1.569 55-59 $2.538 60-64 $3.415 65-69 $5.862 70-74 $9.60 75+ $16.246

Contact Information

BENEFIT

CARRIER OR ADMINISTRATOR GROUP #

PHONE NUMBER WEBSITE

952-883-5000 or 1-800-883-2177

MEDICAL HealthPartners 2353

Monday – Friday 7 a.m. - 7 p.m. CST Española: 1-866-398-9119

FLEXIBLE SPENDING ACCOUNT (FSA) Wex N/A

HEALTH SAVINGS ACCOUNT (HSA) Optum N/A

www.healthpartners.com/ roomandboard

DENTAL Delta Dental of MN 1133

1-866-451-3399 Monday-Friday 6 a.m. - 9 p.m. CST www.wexinc.com

1-866-234-8913

Monday–Friday 7 a.m. - 7 p.m. CST www.optumbank.com

1-800-448-3815 Monday–Friday 7 a.m. - 7 p.m. CST www.deltadentalmn.org

VISION EyeMed T07745 1-866-804-0982 www.eyemed.com

Room & Board Wellness Team Email: wellness@roomandboard.com

Laura Lorentz, Benefits & Payroll Associate 612-629-2172

Skye Seesz, Wellness Manager 612-629-2164

Resources

Room & Board Benefit Enrollment and Payroll Site Worklife Open Enrollment Resources HealthPartners Resources Legal Notices