Room & Board Open Enrollment 2024

2024 Open Enrollment Guide

Introduction

2024 Open Enrollment Dates November 1, 2023 – November 15, 2023

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 2024.

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)

2024 Highlights

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

ENROLL HERE: https://roomandboard.ultipro.com Navigate to Menu > Myself > Open Enrollment

• Health insurance premiums will increase. Staff members will see a 9% average increase to their biweekly premiums.

• Dental and vision premiums will not be increasing.

• Flexible Spending Account (FSA) contribution limits have increased from $2,650 to $3,050 • Health Savings Account (HSA) contribution limits have increased from $3,850 to $4,150 for individual coverage and from $7,750 to $8,300 for family coverage.

How to Enroll or Waive Benefits Coverage for 2024

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 2023 do not automatically carry over. Be sure to make active elections for 2024 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.

Need help or have questions about our benefits?

Contact wellness@roomandboard.com.

2024 OPEN ENROLLMENT GUIDE

CONTRIBUTIONS – BIWEEKLY COPAY PLAN YOUR PER PAYCHECK DEDUCTION

HIGH DEDUCTIBLE HSA PLAN YOUR PER PAYCHECK DEDUCTION

EMPLOYEE

$103.50

$69.00

EMPLOYEE + SPOUSE/PARTNER

$256.00

$173.00

EMPLOYEE + CHILD(REN)

$218.00

$147.00

FAMILY

$387.00

$279.00

Copay Plan

COVERAGE LEVEL IN-NETWORK

OUT-OF-NETWORK

EMPLOYEE (PER MEMBER)

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

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

FAMILY

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

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

DEDUCTIBLE AND OUT-OF-POCKET MAXIMUM AMOUNT

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

Routine Preventive Care

• Preventive care • Screening • Immunization

Office Visits

• Illness or injury • Mental/behavioral health, substance use disorder • Specialty visits

Online Care

• Virtual (available in select states) • Doctor on Demand

Emergency Care

• Urgent care • Emergency care at hospital ER • Ambulance

No charge

$35 copay $35 copay $75 copay No charge Subject to applicable Office Visit copay ($35 or $75)

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

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

Inpatient Hospital Care

Deductible then you pay 20%

Deductible then you pay 50%

Outpatient Care • Scheduled outpatient procedures • Outpatient MRI and CT scans

Deductible then you pay 20%

Deductible then you pay 50%

2024 OPEN ENROLLMENT GUIDE

Copay Plan CONTINUED

PRESCRIPTION DRUG SERVICES IN-NETWORK

OUT-OF-NETWORK

GENERIC

$10 copay

You pay 50%

FORMULARY (BRAND)

$50 copay

You pay 50%

NONFORMULARY (BRAND)

$90 copay

You pay 50%

SPECIALTY

$200 copay

You pay 50%

GENERIC

$30 copay

Not covered

FORMULARY (BRAND)

$150 copay

Not covered

NONFORMULARY (BRAND)

$270 copay

Not covered

RETAIL (UP TO A 31-DAY SUPPLY)

MAIL ORDER (UP TO A 93-DAY SUPPLY)

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

2024 OPEN ENROLLMENT GUIDE

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

High Deductible (HSA) Plan

COVERAGE LEVEL IN-NETWORK

OUT-OF-NETWORK

EMPLOYEE (APPLIES TO SINGLE ONLY)

$1,800

$3,600

FAMILY

$3,600

$10,800

EMPLOYEE

$3,000

$5,000

FAMILY

$6,000

$15,000

DEDUCTIBLE AMOUNT

OUT-OF-POCKET MAXIMUM

2024 ROOM & BOARD HSA CONTRIBUTIONS EMPLOYEE

up to $600

EMPLOYEE + SPOUSE/PARTNER

up to $900

EMPLOYEE + CHILD(REN)

up to $900

FAMILY

up to $1,200

STAFF MEMBER HSA CONTRIBUTIONS EMPLOYEE

up to $3,550

EMPLOYEE + SPOUSE/PARTNER

up to $7,400

EMPLOYEE + CHILD(REN)

up to $7,400

FAMILY

up to $7,100

2024 OPEN ENROLLMENT GUIDE

High Deductible (HSA) Plan CONTINUED

COVERAGE LEVEL IN-NETWORK

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 No charge

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

Deductible then you pay 20%

Deductible then you pay 40%

Online Care • Virtuwell • Doctor on Demand

Deductible then you pay 20%

Not covered

Emergency Care • Urgent care • Emergency care at hospital ER • Ambulance

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%

• Preventive care • Screening • Immunization

Office Visits

• Illness or injury • Mental/behavioral health, substance use disorder • Physical, occupational and speech therapy

2024 OPEN ENROLLMENT GUIDE

High Deductible (HSA) Plan CONTINUED

PRESCRIPTION DRUG SERVICES IN-NETWORK

OUT-OF-NETWORK

Generic

Deductible then you pay 20%

Deductible then you pay 40%

Formulary (Brand)

Deductible then you pay 20%

Deductible then you pay 40%

Nonformulary (Brand)

Deductible then you pay 20%

Deductible then you pay 40%

Specialty

Deductible then you pay 20%

Deductible then you pay 40%

Generic

Deductible then you pay 20%

Not covered

Formulary (Brand)

Deductible then you pay 20%

Not covered

Nonformulary (Brand)

Deductible then you pay 20%

Not covered

Specialty

Deductible then you pay 20%

Not covered

RETAIL (UP TO A 31-DAY SUPPLY)

MAIL ORDER (UP TO A 93-DAY SUPPLY)

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.

2024 OPEN ENROLLMENT GUIDE

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

Health Savings Account (HSA) A health savings account (HSA) is a personal healthcare bank account created exclusively for those staff members on a high deductible plan. Room & Board contributes bi-annually to your health savings account. This is our way of investing in your health and providing you with valuable financial support. We also want to encourage you to contribute to your HSA through pre-tax payroll contributions.

You own your HSA which is administered through Optum Bank. You determine how much you will contribute to your account, when to use your money to pay for qualified medical expenses, and when to reimburse yourself. Remember, this is a bank account; you must have money in the account before you can spend it.

HSAs offer you the following advantages: • Tax savings: HSAs provide triple tax savings. Contributions are tax free; the account grows tax free, and spending is tax free (as long as it is on qualified medical costs).

• Reduced out-of-pocket costs: You can use the money in your HSA to pay for eligible medical expenses and prescriptions. The HSA funds you use can help you satisfy your plan’s annual deductible.

2024 OPEN ENROLLMENT GUIDE

• A long-term investment that stays with you: Unused account dollars are yours to keep even if you retire or leave the company.

Additionally, you can invest your HSA funds, so your available healthcare dollars can grow over time.

• The opportunity for long-term savings: Save unused HSA funds from year to year- you can use this money to reduce future outof-pocket health expenses. You can even save HSA dollars to use after you retire.

Once your account is opened Optum Bank will send you a debit card that you can use to pay your healthcare expenses.

Important HSA eligibility: The IRS does not allow you to open and fund an HSA if you have other healthcare coverage or are enrolled in Medicare. If you enroll in Medicare after you turn 65 the coverage is retroactive up to 6 months. You will want to stop contributing to your HSA 6 months prior to enrolling in Medicare if you are over 65.

Contact wellness@roomandboard.com if you have questions about your eligibility for an HSA.

How the Plans Work

How the Copay Plan Works: IN-NETWORK PROVIDERS PREVENTIVE CARE

DEDUCTIBLE

COINSURANCE

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

$750 lndividual $1500 Family

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

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

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%.

2024 OPEN ENROLLMENT GUIDE

DEDUCTIBLE

$1800 lndividual $3600 Family

$600 $900

HSA

$1200

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 offset future expenses.

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

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

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.

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.

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.

• 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: $4,150/single and $8,300/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 16 for more information.)

2024 OPEN ENROLLMENT GUIDE

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: 01/01/2024

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.

COVERAGE LEVEL

2024 OPEN ENROLLMENT GUIDE

VISION CONTRIBUTIONS – BIWEEKLY

SINGLE

$4.08

SINGLE + CHILD(REN)

$7.76

EMPLOYEE + SPOUSE/PARTNER

$8.17

FAMILY

$12.01

Vision Plan

SUMMARY OF BENEFITS IN-NETWORK

OUT-OF-NETWORK

$10 copay Up to $39

Up to $40

$40 10% off retail price

Not covered Not covered

$0 copay; 20% off balance over $150 allowance

Up to $105

$25 copay $25 copay $25 copay $25 copay $80 copay $110-$200 copay

Up to $30 Up to $50 Up to $70 Up to $70 Up to $50 Up to $50

EXAM SERVICES • Exam • Retinal Imaging

CONTACT LENS FIT AND FOLLOW-UP • Fit and Follow-up - Standard • Fit and Follow-up - Premium

FRAME • Any available frame at provider location

STANDARD PLASTIC LENSES • • • • • •

Single Vision Bifocal Trifocal Lenticular Progressive - Standard Progressive - Premium Tier 1 - 4

Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed’s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Benefits are not provided from services or materials arising from: 1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye, eyes or supporting structures; 3) Any eye 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.

2024 OPEN ENROLLMENT GUIDE

Vision Plan CONTINUED

SUMMARY OF BENEFITS IN-NETWORK

OUT-OF-NETWORK

$0 copay $12-$85 copay $75 $0 copay $0 copay $0 copay 20% off retail price

Up to $5 Up to $5 Not covered Up to $5 Up to $5 Up to $5 Not covered

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

Up to $105

Discounts on hearing exam and aids; call 1-877-203-0675 15% off retail or 5% off promo price; call 1-800-988-4221

Not covered

LENS OPTIONS • • • • • • •

Anti Reflective Coating - Standard Anti Reflective Coating - Premium Tier 1-3 Photochromic - Non-Glass Scratch Coating - Standard Plastic Tint - Solid or Gradient UV Treatment All Other Lens Options

CONTACT LENSES • Contacts - Conventional • Contacts - Disposable • Contacts - Medically Necessary

Up to $105 Up to $210

OTHER • Hearing Care from Amplifon NetworkCare • Lasik or PRK from U.S. Laser Network

FREQUENCIES (Plan allows member to receive either contacts and frame, or frames and lens services) • • • •

Exam Frame Lenses Contacts

2024 OPEN ENROLLMENT GUIDE

Once every plan year Once every plan year Once every plan year Once every plan year

Not covered

Dental Coverage 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.

2024 OPEN ENROLLMENT GUIDE

CONTRIBUTIONS – BIWEEKLY YOUR PER PAYCHECK DEDUCTION EMPLOYEE

$8.75

EMPLOYEE + SPOUSE/PARTNER

$16.25

EMPLOYEE + CHILD(REN)

$21.15

FAMILY

$28.75

Dental Plan

SUMMARY OF BENEFITS DELTA DENTAL PPO

DELTA DENTAL PREMIER

NON-PARTICIPATING

$50 individual $150 family

$50 individual $150 family

$50 individual $150 family

Calendar Year Plan Maximum Per person

$1,500

$1,000

$1,000

Lifetime Ortho Maximum Per covered person

$2,000

$2,000

$2,000

Diagnostic & Preventive Services (deductible does not apply)

100%

100%

100% of maximum allowable fee**

Basic Services

90%

80%

80% of maximum allowable fee**

Endodontics

90%

80%

80% of maximum allowable fee**

Periodontics

90%

80%

80% of maximum allowable fee**

Oral Surgery • Surgical/Nonsurgical extractions

90%

80%

80% of maximum allowable fee**

Major Restorative

60%

50%

50% of maximum allowable fee**

Prosthetic Repairs and Adjustments

60%

50%

50% of maximum allowable fee**

Prosthetics

60%

50%

50% of maximum allowable fee**

Orthodontics (dependent children only, age 8-18)

60%

50%

50% of maximum allowable fee**

EXAM SERVICES Deductible (calendar year)

No deductible for diagnostic and preventive service or orthodontics

This is a summary of benefits only and does not guarantee coverage. For a complete list of covered services and limitations/exclusions, please refer to the Dental Benefit Plan Summary. **Dentists who have signed a participating network agreement with Delta Dental have agreed to accept the maximum allowable amount as payment-in-full. Non-participating dentists have not signed an agreement and are not obligated to limit the amount they charge; the member is responsible for paying any difference to the non-participating dentists.

2024 OPEN ENROLLMENT GUIDE

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 $3,050 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/

2024 OPEN ENROLLMENT GUIDE

Limited Purpose Medical FSA

Contributions You may make pre-tax contributions of up to $3,050 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 2024 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

2024 OPEN ENROLLMENT GUIDE

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

$0

- $2,500

$33,190

$32,760

$430

$0

Expenses paid after taxes Remaining income Your savings

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 (not to exceed a total election of $200,000), $10,000 for your spouse (not to exceed $50,000) 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 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.

2024 OPEN ENROLLMENT GUIDE

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

MEDICAL

CARRIER OR ADMINISTRATOR

HealthPartners

GROUP #

2353

PHONE NUMBER

WEBSITE

952-883-5000 or 1-800-883-2177 Monday – Friday 7 a.m. - 7 p.m. CST

www.healthpartners.com/ roomandboard

Española: 1-866-398-9119 FLEXIBLE SPENDING ACCOUNT (FSA)

Wex

N/A

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

www.wexinc.com

HEALTH SAVINGS ACCOUNT (HSA)

Optum

N/A

1-866-234-8913 Monday–Friday 7 a.m. - 7 p.m. CST

www.optumbank.com

DENTAL

Delta Dental of MN

1133

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

2024 OPEN ENROLLMENT GUIDE

Resources

Worklife Open Enrollment Resources Legal Notices