Room & Board

2020 Enrollment Guide

What’s in this guide I. Introduction & Welcome II. Financial III. Eligibility and Life Events IV. Medical Coverage V. Vision Coverage VI. Dental Coverage VII. Flexible Spending Accounts VIII. Life and AD&D Insurance IX. Disability Benefits X. Other Benefits XI. Vacation, Personal and Holiday Pay, and Leaves of Absence XII. Contributions XIII. Provider/Vendor Contact Info XIV. Legal Notices 2020 ENROLLMENT GUIDE

Introduction & Welcome Dear Staff Member, We are pleased to welcome you to Room & Board!

We care about you and those that you love. That’s why our wellness offerings are not simply a strategy to keep you and your family physically well to manage our health care costs. Our initiatives are designed to be holistic and it all begins with meaningful work. We work hard to create a place of work that will engage and reward you. We recognize how fundamental enjoying your work can be to your sense of wellbeing.

In addition, we recognize that living a full life includes emotional wellbeing, having a sense of control over personal financial matters and community giving. Room & Board supports organizations in our communities whose values and philosophies are like ours. We encourage you to be a part of the community where you live and work, whether through financial support or by volunteering your time.

We look forward to getting to know you and working together. Please let us know if you have any questions.

Warm regards, Room & Boards Human Resources Team Wellness@roomandboard.com

Section II: Financial

Your Room & Board Paycheck We respectfully request that you take advantage of our direct deposit benefit. Your first paycheck will be a paper paycheck, and will not be directly deposited into your bank account. You will receive your first paycheck at your work location on payday.

Once your paychecks are being directly deposited, you will be able to view your paychecks through our Human Resources Information System, UltiPro, and print them if needed.

UltiPro

To access click here.

Please note that when you are accessing this tool, you are accessing confidential payroll information. You should be aware of your surroundings when accessing this site. For this purpose, the system can only be accessed when you are personally logged in. Login by using your network username and password for single sign-on.

When finished viewing or updating your information, be sure to Logout.

What Can I do in UltiPro?

• View pay history – as well as print on demand.

• Make changes to or view personal information – such as mailing address, phone number, email address and emergency contacts.

• Make changes to or view your payroll and tax information – such as earnings history, direct deposits and tax withholdings.

Model Your Pay

You can access a “Model My Pay” tool that calculates your net pay using different scenarios. This is a financial planning tool and does not affect any of your current earnings information — it allows you to view your earnings based on changes to federal tax, state tax or deduction information.

2020 ENROLLMENT GUIDE

CONTACT THE WELLNESS TEAM FOR ASSISTANCE • If you have questions while using UltiPro, please click here to send an email to the Wellness Team.

• You can view our current payroll schedule here.

• Access the Community Giving Payroll Deduction Election and Change Form, and list of charitable partners, here.

Section II: Financial 401(k) Retirement Savings

THE VALUE OF TIME Employee A: Age 39

Employee B: Age 29

To live comfortably in retirement, experts say we need to save 15 percent of our annual income each year. Remember, time is money — the money you save earlier in your lifetime has the benefit of being invested and increasing in value over time. This is a powerful tool.

Annual Income: $47,000

Annual Income: $47,000

Automatic Enrollment

Annual Investment: 8%

https://login.principal.com/login

Room & Board’s 401(k) plan allows you to elect deductions from their paychecks for retirement savings purposes. New staff members are immediately eligible to participate in the plan.

We feel so strongly about participating in a savings plan for retirement that you will be automatically enrolled in our plan at a rate of 6% of your pay beginning with the first pay date after the end of the 45 day period that begins on your hire date. The 6% will be deducted from paychecks contributed to the retirement plan on your behalf unless you elect a different salary deferral percentage or opt out of the plan. The plan also includes an automatic salary deferral increase provision. Salary deferral contributions for automatically-enrolled participants will automatically increase by 2% every January 1st up to 10%.

Room & Board Match: 4%

Rate of Return: 7%

At the Age of Retirement Employee A will have

$488,183

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Annual Investment: 8% Room & Board Match: 4%

Rate of Return: 7%

At the Age of Retirement Employee B will have

$1,062,433

Staff members can set up deferral percentages two different ways: Traditional (Pre-Tax) 401(k)

Deductions from your pay are taken prior to paying income taxes on the dollars, lowering your current taxable income.

When you retire and start drawing funds from your 401(k) account, you pay income taxes on those dollars.

Roth (Post-Tax) 401(k)

Deductions from your pay are taken after you have already paid income taxes on the dollars. When you retire and start drawing funds from your 401(k) account, you don’t pay income taxes on those withdrawals.

Contribution Limits

You may choose a different deduction amount or to not participate, and can withhold up to 80 percent of your income, up to the maximum of $19,500 for 2020.

You can change your 401(k) contributions at any time throughout the year. In 2020, if you are 50 years of age or older, up to an additional $6,500 can be deferred.

Investing Your Dollars

You have the option of choosing your own mix of investment options from our investment fund lineup. Investment portfolios and more information can be found here.

2020 ENROLLMENT GUIDE

You can also choose one of our five RetireView models. RetireView allows you to choose a risk tolerance and then puts you in an age band based on the number of years to retirement. The models become more conservatively invested as you get closer to retirement. New hires that do not make an investment election will be defaulted into the Moderate Aggressive RetireView model.

Accessing Your 401(k) Account Online

FINANCIAL RESOURCES • To access your account with Principal click here.

• To view directions on how to create your online account click here.

• To access the Qualified Default Investment Alternative and Automatic Contribution Arrangement (QDIA) Notice, and other required notices related to your 401(k), please click here.

You will be able to enroll or waive automatic enrollment online during your first week with Room & Board. You will be automatically enrolled beginning with the first pay date after the end of the 45 day period that begins on your hire date unless you make a change on Principal’s website or via its phone system.

Once you establish your account, you can: • Update your 401(k) beneficiaries • Change your contribution amount and/ or investment options • View your statements

Financial Advisor Benefit

You have the opportunity to meet with a certified financial advisor Billy Gese, a financial advisor with NFP, and have ongoing personal and private financial advice at no cost to you. Billy can provide advice to you regarding 401(k) contributions and investments, along with rolling over or consolidating other retirement accounts.

Contact Information: Billy Gese, NFP bgese@nfp.com | 1-952-847-1357

Section III: Eligibility and Life Events The benefits outlined in the following pages are offered to all staff members who fulfill a weekly schedule of 20 or more hours. You are eligible for benefit coverage the first of the month coinciding with or following date of hire. Unless otherwise noted, premiums listed are deducted from paychecks pre-tax when available.

Eligible dependents include: • Legal spouse • Domestic partner if eligibility requirements are met • Children ages birth up to 26 years old (regardless of whether or not they are a full-time student) Please note that domestic partner premiums must be deducted pre- and post-tax. The staff member must pay income taxes on the portion of the premium that Room & Board pays for your domestic partner’s coverage.

Changing Your Benefits During the Year Your benefit elections remain in effect for the entire plan year; unless you have an IRS qualified life event (proof will be required). All changes as a result of a qualified life event must be made within 30 days of the event. Eligible qualified life events include the following: • Legal marital status – any event that changes your legal marital status, including marriage, death of spouse, divorce, legal separation or annulment.

• Number of dependents – any event that changes the number of your dependents, including birth, adoption, placement for adoption, divorce or death of a dependent, or assuming primary support of the child of an unmarried dependent child.

2020 ENROLLMENT GUIDE

• Employment status – any event in which an eligible dependent gains or loses access to employersponsored coverage.

YOU HAVE 30 DAYS FROM YOUR DATE OF HIRE TO ENROLL IN ROOM & BOARD’S BENEFIT PLANS Mid-year changes to benefits are allowed on a limited basis — plan your elections carefully.

• Dependent status – any event, due to age or similar circumstances that causes your dependent to satisfy or cease to satisfy eligibility requirements under the plan which you receive coverage.

• Medicare or Medicaid eligible status – you or your spouse become Medicare or Medicaid eligible If you have a qualifying life event mid-year, please contact a member of the Wellness Team to determine your ability to make mid-year changes.

Section IV: Medical Coverage www.healthpartners.com/roomandboard 1-800-883-2177

Health Care Coverage

Room & Board is pleased to offer you two high-quality health care benefit options to choose from: the Moderate Deductible Plan paired with a Health Reimbursement Account (HRA) and the High Deductible Plan paired with a Health Savings Account (HSA).

Both plans provide 100% coverage for preventive care. Both plans also pay the same percentage for each medical service covered once the deductible is reached. Keep in mind that choosing a network provider will most likely lower your cost for services.

CONTRIBUTIONS – BIWEEKLY MODERATE DEDUCTIBLE HRA PLAN YOUR PER PAYCHECK DEDUCTION

HIGH DEDUCTIBLE HSA PLAN YOUR PER PAYCHECK DEDUCTION

SINGLE

$85.00

$57.00

SINGLE + 1

$197.75

$135.50

FAMILY

$310.75

$226.00

Network Coverage

HealthPartners provides your health care coverage and processes your claims.

You get access to 1 million doctors and 6,000 hospitals in the United States.

HealthPartners offers members nationwide access to providers through an alliance with Cigna Healthcare. HealthPartners administers the health plan coverage and processes the claims. Find more information about our network coverage in the HealthPartners-CIGNA network FAQs posted on Worklife.

2020 ENROLLMENT GUIDE

Medical Plan Options Option 1: Moderate Deductible HRA Plan

The Moderate Deductible Plan offers a lower individual deductible. For family coverage, the plan contains two components: an individual deductible and a family deductible. This allows individual family members to meet an individual deductible and then access co-insurance coverage prior to the entire family deductible being met.

Combined family expenses will not be more than the family deductible. All services excluding preventive care and prescriptions must first go toward satisfying the deductible before the plan starts to pay a portion of the claims. Most prescriptions are subject to co-payments. Room & Board contributes money into a HRA to help reimburse deductible expenses. The full HRA contribution is funded on the first day of the plan year and is available for your use after satisfying the first $650 of your deductible. HRA contributions are based upon coverage level (see page 7 for more information). Any funds left in the HRA at the end of the run-out period are forfeited and do not rollover to the next plan year. You are not able to contribute to a HRA. This plan will cost you more from each paycheck but you could have lower costs for your prescriptions.

Option 2: High Deductible HSA Plan

The High Deductible Plan offers a slightly higher deductible than the Moderate Deductible Plan. If you enroll in family coverage your family will need to meet the family deductible before the plan will begin to cost share. All services excluding preventive care must first go toward satisfying the deductible before the plan starts to pay a portion of the claims. Room & Board makes a contribution to a HSA based on your coverage level (see page 7). Half of this contribution will be funded in January and half in July. This money is yours to spend on qualified health care expenses including vision and dental. You can also make tax-free contributions into your HSA to help save for current and future health care expenses. The per paycheck cost for this plan is lower than the Moderate Deductible Plan. You will have a slightly higher deductible but can choose how you spend your HSA dollars.

2020 ENROLLMENT GUIDE

The Moderate Deductible Health Reimbursement Account (HRA) Plan What is a Health Reimbursement Account?

Think of it as a business expense account for your healthcare expenses. Room & Board deposits taxfree dollars into your account and you can use these funds to pay eligible health expenses once you satisfy your required portion of your deductible.

COVERAGE TYPE

YOU PAY

HRA REIMBURSEMENT

REMAINING DEDUCTIBLE AMOUNT YOU PAY

Single

First $650

Next $600

None

Single + 1

First $650*

Next $900

Up to $950

Family

First $650*

Next $1,200

Up to $1,750

*The first $650 you pay covers combined family expenses. For example, if you selected Single +1 coverage, and you had $500 in expenses and your dependent had $150 in expenses, you have met your requirement of paying the first $650 of your deductible. The next $900 in medical expenses incurred would be reimbursable.

HOW THE PLAN WORKS WHEN YOU SEE NETWORK PROVIDERS USE YOUR HRA TO HELP PAY THESE EXPENSES IN-NETWORK PREVENTIVE CARE In-network preventive care such as annual check-ups, cancer screenings, wellchild care and immunizations are covered at 100%.

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DEDUCTIBLE

$1250 lndividual $3600 Family

You pay 100% of medical costs (excluding prescriptions) until you meet your deductible. Room & Board will make contributions to your HRA in an amount based on the tier of coverage you select. Once you satisfy your required portion of the deductible, you will be reimbursed by the tax free company HRA contributions to satisfy the next portion of your deductible. The table above outlines your portion of the deductible.

COINSURANCE Once you meet your deductible, you pay 20% for services 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.

Moderate Deductible HRA Plan

COVERAGE LEVEL IN-NETWORK

OUT-OF-NETWORK

Single (per member)

$1,250

$2,400

Family

$3,600

$7,200

Single

$3,000

$5,000

Family

$6,000

$15,000

DEDUCTIBLE AMOUNT

OUT-OF-POCKET MAXIMUM

2020 ROOM & BOARD HRA CONTRIBUTIONS Single

$600

Single + 1

$900

Family

$1,200

STAFF MEMBER HRA CONTRIBUTION Single

None – but FSA available

Single + 1

None – but FSA available

Family

None – but FSA available

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Moderate Deductible HRA 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 • Preventive care • Screening • Immunization

No charge

Office Visits • Illness or injury • Mental/behavioral health, substance use disorder • Physical, Occupational and Speech therapy

• 40% coinsurance for eye exams • 40% coinsurance for immunizations • 40% coinsurance for other services

Deductible then you pay 20%

Deductible then you pay 40%

No charge for first three visits (Virtuwell only); then you pay 20% after deductible

Not covered

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

Deductible then you pay 20%

Deductible then you pay 20% Urgent care: 40%

Inpatient Hospital Care

Deductible then you pay 20%

Deductible then you pay 40%

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

Deductible then you pay 20%

Deductible then you pay 40%

Online Care • Virtuwell • Doctor on Demand

BENEFITS OF THE MODERATE DEDUCTIBLE HRA PLAN • If you are just covering yourself, the deductible is low ($1,250) and you are responsible for paying only the first $650 • You pay only copays for generic and formulary brand prescription drugs.

2020 ENROLLMENT GUIDE

• You maintain eligibility to contribute to a Flexible Spending Account to pay covered expenses (that you are responsible for) with pre-tax contributions.

Moderate Deductible HRA Plan CONTINUED

PRESCRIPTION DRUG SERVICES IN-NETWORK

OUT-OF-NETWORK

Generic

$10 copay

You pay 40%

Formulary (Brand)

$50 copay

You pay 40%

You pay 20% with a minimum of $50 copay to max $100 copay

You pay 40%

You pay 20% to $200 max

You pay 40%

Generic

$20 copay

Not covered

Formulary (Brand)

$100 copay

Not covered

You pay 20% with a minimum of $50 copay to max $100 copay

Not covered

You pay 20% to $200 max

Not covered

RETAIL (UP TO A 31-DAY SUPPLY)

Nonformulary (Brand) Specialty MAIL ORDER (UP TO A 93-DAY SUPPLY)

Nonformulary (Brand) Specialty

Using Your HRA is Easy!

• In January, Room & Board will put money into your HRA. If you are hired mid-year, you will receive a pro-rated HRA contribution.

• You see your doctor.

• Your doctor submits the reimbursement form to HealthPartners.

• HealthPartners processes the claim and sends an Explanation of Benefits (EOB) to you and your doctor. Your doctor will send you a bill.

• If you reach your deductible, you will get a payment from your HRA to help pay the bill. If you have not reached your deductible you will be responsible for the bill.

• Any unused money in your HRA will not roll over into the next year.

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Login to your HealthPartners account to track your HRA balance and payments Click here to view the full Summary of Benefits and Coverage (SBC) for the Moderate Deductible HRA Plan.

The High Deductible Health Savings Account (HSA) Plan What is a Health Savings Account?

Think of it as a 401(k) savings account for your healthcare expenses. Both you and the company deposit tax-free dollars into your account and you can use these funds to pay eligible health care expenses now, or accumulate balances for future expenses. The money rolls over from year to year and is yours to keep, even if you leave the company.

You can make tax-free contributions to your HSA as well. Total contributions including yours and the company’s cannot exceed $3,550 for individual coverage and $7,100 for family coverage.* *If you are age 55 or older you may contribute an additional $1,000 in 2020.

THREE WAYS A HEALTH SAVINGS ACCOUNT REDUCES YOUR TAXES • You can make tax-free contributions • Your account grows tax-free.

• You can withdraw tax-free dollars from your HSA to pay eligible health care expenses.

Visit www.healthpartners.com/roomandboard to find out more about the advantages of a Health Savings Account.

HOW THE PLAN WORKS WHEN YOU SEE 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, wellchild care and immunizations are covered at 100%.

2020 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 contributions to your HSA in an amount 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.

High Deductible (HSA) Plan

COVERAGE LEVEL IN-NETWORK

OUT-OF-NETWORK

Single (applies to single only)

$1,800

$3,600

Family

$3,600

$10,800

Single

$3,000

$5,000

Family

$6,000

$15,000

DEDUCTIBLE AMOUNT

OUT-OF-POCKET MAXIMUM

2020 ROOM & BOARD HSA CONTRIBUTIONS Single

up to $600

Single + 1

up to $900

Family

up to $1,200

STAFF MEMBER HSA CONTRIBUTION Single

up to $2,950

Single + 1

up to $6,200

Family

up to $5,900

2020 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 • Preventive care • Screening • Immunization

No charge

• • • •

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

Office Visits • Illness or injury • Mental/behavioral health, substance use disorder • Physical, Occupational and Speech therapy

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 scan

Deductible then you pay 20%

Deductible then you pay 40%

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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)

Your HSA is managed by Optum Bank Discover the benefits of a HSA and how it works by visiting the Optum Bank website.

Click here to view the full Summary of Benefits and Coverage for the High Deductible HSA Plan

2020 ENROLLMENT GUIDE

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-ofpocket 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-of-pocket 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.).

• If you are using prescription medications and you are currently a HealthPartners member you can use the Rx shopping tool by logging into your myHealthPartners account.

• You may also make contributions to your HSA up to the IRS maximums: $3,550/single and $7,100/family. If you are age 55+, you are eligible to make an additional $1,000 “catchup” contribution. Be sure to factor in your Room & Board contribution with these limits.

• If you enroll in our Moderate Deductible 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 9 for more information.)

THERE ARE SOME TAX ADVANTAGES TO CONTRIBUTING TO A HSA: • Your contributions are tax-free, reducing your taxable income.

• Consider the accounts associated with each plan. Room & Board will make the same contribution to both the HSA and HRA accounts depending on your coverage level.

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

• HRA dollars can only be used after a certain portion of the deductible is met and the dollars do not rollover every year.

• HSA balances grow tax free.

• 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-to-year, giving you the ability to save for future health care expenses. To learn more about HSAs, go to www.optumbank.com.

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HealthPartners Resources HealthPartners is a true partner in helping you manage your health and making decisions that are right for you. Resources and support are at your fingertips at www.healthpartners.com/roomandboard.

Plan For Me HealthPartners® Plan for Me helps you compare your plan options so you can pick the right plan for you. Go to www.healthpartners.com/planforme and enter the below information to get started.

• Group Number: 2353 • Site Number: All • Effective Date: 01/01/2020 HealthPartners’ resources include personal support to help you manage your care including: pharmacy navigators, behavioral health navigators, a baby line, as well as nurse navigators who can help manage your care. You can reach these resources through Member Services at 1-800-883-2177.

• Nurseline/Careline Services: Experienced registered nurses are ready to help members by assessing medical conditions and discussing treatment options. This service is available 24 hours a day, 7 days a week at 1-800-551-0859.

• Virtuwell: HealthPartners’ answer to online health care, Virtuwell will treat more than 40 conditions all with your computer. Check it out at www.virtuwell.com.

• Doctor on Demand: Allows you to interact through live video doctor visits including assessment, diagnosis and prescriptions when necessary. They treat many physical conditions from head to toe as well as mental health concerns and issues. Check it out at www.doctorondemand.com.

• Frequent Fitness: Health discounts including a $20 monthly discount on participating gym/fitness memberships.

• Additional Resources: Additional health and wellbeing education tools and resources on topics such as tobacco cessation, pregnancy, cancer, stress/ anxiety and more.

Please click here for the 2020 Marketplace Coverage Options Notice.

2020 ENROLLMENT GUIDE

Section V: Vision Coverage Network = Insight Network www.eyemed.com 1-866-804-0982 With your vision plan from EyeMed you can choose from a mix of thousands of providers — independent eye doctors, your favorite retail stores and everything in between. Find your ideal fit at eyemed.com or in the EyeMed Members App. Get special offers with an account on eyemed.com. Enter your email, choose a password and sign up for emailed savings. Log in 24/7 to view your benefit details or health and wellness information.

Use Your Freedom Pass Today Go to freedompass.eyemed.com and enter EMFP20 to get your in-store offer code.

Show this coupon to the store associate.

Use code 755288.

Shop These Top Brands And More

Get the Frame You Want for $0 Out-Of-Pocket

As an EyeMed member, you can enjoy a Freedom Pass, a special offer that goes above and beyond your frame allowance. Choose your favorite frame at LensCrafters®, Target Optical® or Sears® Optical and pay nothing — regardless of the retail price.* Here’s how it works: Say you love those brand-name frames that cost $180. If you have a frame allowance of $130, Freedom Pass covers the remaining $50. Plus, you can still use your vision benefits to help pay for your lenses and complete your look. *Valid for frames only and must be used in conjunction with your EyeMed frame benefit of $130 or more. Valid for select EyeMed plans and may be used once per frame benefit year. Valid in-store at LensCrafters, Target Optical and Sears Optical. Not valid at Sears Optical stores affiliated COVERAGE LEVEL VISION CONTRIBUTIONS – BIWEEKLY with US Vision. Complete pair purchase required — member is still responsible for lenses, SINGLE $3.79 which are covered based on your vision benefits and may include SINGLE + $7.59 an additional copay. Discounts CHILD(REN) are not insured benefits. Offer excludes Chanel, Cartier, Giorgio SINGLE + SPOUSE Armani, Gucci, Prada, Tiffany and OR DOMESTIC $7.21 Tom Ford frames.

PARTNER FAMILY

2020 ENROLLMENT GUIDE

$11.16

Be stylish and savvy. Log into your member account at eyemed.com to get more special offers.

Vision Plan

SUMMARY OF BENEFITS IN-NETWORK

OUT-OF-NETWORK

$10 copay

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 copay $120 copay $135 copay $200 copay

Up to $30 Up to $50 Up to $70 Up to $70 Up to $50 Up to $50 Up to $50 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 Progressive - Premium Tier 2 Progressive - Premium Tier 3 Progressive - Premium Tier 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.

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Vision Plan CONTINUED

SUMMARY OF BENEFITS IN-NETWORK

OUT-OF-NETWORK

$45 copay $57 copay $68 copay $85 copay $75 $0 copay $0 copay $0 copay 20% off retail price

Up to $5 Up to $5 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; plus balance over $150 allowance $0 copay; Paid-In-Full

Up to $5 Up to $5 Up to $5

Discounts on hearing exam and aids; call 1-844-526-5432 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 Anti Reflective Coating - Premium Tier 2 Anti Reflective Coating - Premium Tier 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

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

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

Not covered

Section VI: Dental Coverage www.deltadentalmn.org 1-800-448-3815 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

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CONTRIBUTIONS – BIWEEKLY YOUR PER PAYCHECK DEDUCTION SINGLE

$7.25

SINGLE + 1

$13.80

FAMILY

$23.15

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.

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Section VII: Flexible Spending Accounts (FSAs) www.discoverybenefits.com 1-866-451-3399 FSAs are voluntary accounts that allow you to use pre-tax funds to pay for certain expenses as determined by IRS regulations. You can set up three separate accounts — one for qualified health care expenses, one for qualified dependent care expenses and one for parking/transit expenses. The monies in one account cannot be used to satisfy expenses in the other account. You can participate in one or more of these accounts or none at all, depending on your needs.

Discovery Benefits administers the FSA for Room & Board. More information can be found on Worklife.

Your FSA Contribution When you establish an FSA, you choose the annual amount you wish to contribute, up to certain plan limits. This amount is deducted from your paycheck in equal installments before Federal and Social Security taxes are withheld. If you experience a qualified life event, you are eligible to change your FSA election during the year.

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.

You are eligible to sign up for the Traditional Medical FSA if: • You elect the Moderate Deductible HRA health insurance plan, or • If you waive coverage under Room & Board’s health insurance plans and you or your spouse do not have a Health Savings Account.

Legally married spouses and children from birth up to age 26 are eligible dependents for the Medical FSA.

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Contributions

You may make pre-tax contributions of up to $2,650 per year to your Medical FSA. We include the rollover feature in our Medical FSA. If you have money left over at the end of the calendar year, you will be able to rollover up to $500 of your balance to the following calendar year.

Eligible Medical Expenses

If you set up a Medical FSA, you can be reimbursed for eligible expenses that you or your dependents incur during the plan year you participate.

Examples of eligible medical expenses, to the extent not covered by another plan, include: • Co-payment and deductibles not covered by medical or dental insurance • Uninsured expenses such as hearing aids, eyeglasses, contact lenses and certain eye surgeries • Orthodontia • Diabetic supplies • Smoking cessation programs • Fertility services A complete listing of eligible expenses may be found in IRS Publication 502, which is available at www.irs.gov. Eligible expenses must be incurred (date service is rendered) within the plan year of January 1, 2020 – December 31, 2020.

Limited Purpose Medical FSA

Dependent Care FSA

Contributions

Contributions

You may make pre-tax contributions of up to $2,650 per year to your Limited Purpose Medical FSA. We include the rollover feature in our 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 $500 of your balance to the following calendar year.

A Limited Purpose Medical FSA can be a good idea if you plan on incurring eligible dental or vision expenses early in the plan year, you want to save your HSA contributions for future expenses or your medical expenses are high enough that you want to take advantage of setting aside additional pre-tax dollars for dental and vision expenses.

You are eligible to sign up for the Limited Purpose Medical FSA if: • You elect the High Deductible HSA health insurance plan, or • If you waive coverage under Room & Board’s health insurance plans or are covered elsewhere under a qualified High Deductible Health Plan (HDHP) and are contributing to a HSA.

Eligible Expenses Include: • Dental expenses • Vision expenses • Out-of -pocket medical expenses after you reach the federallyqualified HDHP annual deductible ($1,400 for single coverage, $2,800 for family coverage).

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. Therefore, if you are married and filing separately for federal income tax purposes, you may elect to contribute up to $2,500 per year.

Eligible Dependents

You can be reimbursed for dependent care expenses if they are necessary to allow you or your spouse to work. These services may be provided inside or outside your home by babysitters, companions or eligible day care centers. Services may not, however, be provided by someone you claim as a dependent on your tax return. Your dependent care expenses must be for: • Your dependent under age 13 who lives with you for more than half the year and for whom you can claim an exemption • Your dependent under age 13 for whom you have custody if you are divorced for legally separated • Your spouse who is physically or mentally incapable of self-care • Your dependent of any age, such as an elderly parent or other adult dependent, who meets all of the following criteria: • Is physically or mentally incapable of caring for himself or herself, • Receives over half of his or her support from you, • Lives with you for more than half the year, and • Is your sibling, step-sibling or any of their descendants; a parent or step-parent or any of their ancestors; an aunt, uncle, niece or nephew; children or parents-in-law; or an unrelated individual who shares your residence as a member of the household.

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Commuter Expenses Staff members who incur work-related commuter expenses, including transportation or parking, may participate in this benefit. In 2020 you are able to deduct up to $265 per month pre-tax from your paycheck for transit expenses and $265 per month for parking expenses.

How Does the Commuter Benefit Work?

• You decide how much of your paycheck you want to deposit into your FSA 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 $265 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

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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 FSA’s

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) Discovery Benefits will request documentation. It is imperative when asked for documentation that you provide it to Discovery Benefits as soon as possible. If documentation is not provided the IRS requires you to pay back the plan.

Section VIII: Life and AD&D Insurance For questions about your Life and AD&D Insurance please contact your Wellness Team.

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.

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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

Section IX: Disability Benefits For questions about your Disability Insurance please contact your Wellness Team.

Short-Term Disability (STD) Salary Continuation This benefit provides you with income protection if you become ill/injured or otherwise unable to work as defined by your physician. Benefit eligibility begins on the first day of the month following the date of employment. Salary continuation pays you on the first day of disability and continues for up to 26 weeks. (The accident or illness must be 7 or more days in duration in order for salary continuation to apply.) Our salary continuation policy provides 100% of your salary for the first 12 weeks of disability and 60% of your base pay for the remaining 14 weeks. This is a taxable benefit. There is no premium cost to you for this benefit.

Long-Term Disability This benefit provides you continuing income protection during a disability. This benefit supplements your income following the expiration of the short-term salary continuation benefit. The long-term protection may continue indefinitely, depending upon a physicianâ&#x20AC;&#x2122;s definition of your ability to work. Our long-term plan pays 60% of your base pay and this payment is non-taxable. This benefit is paid for by Room & Board and begins on the first day of the month following the date of employment.

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Section X: Other Benefits 529 College Savings Plan To make paying for college easier, Room & Board provides staff members the option to save for a childâ&#x20AC;&#x2122;s education through direct deposit from your paycheck into a 529 account. With the advice of Financial Advisor Billy Gese and his partners at NFP, we chose a New York Vanguard 529 Fund as our preferred savings vehicle. We selected it because of its fee structure, investment options and possible tax advantages depending on where you live (you do not need to be a New York resident to participate).

As with any investment decision, you should check with your tax provider and/or a financial advisor to determine if this is the best savings option for your situation. Keep in mind that Billy Gese is also available to answer any questions. For more information click here.

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Estate Planning Room & Board provides estate planning assistance to help you understand the nature and importance of estate planning, and to defray the cost of document preparation. This includes wills, healthcare directives or living wills, and powers of attorney. Having these documents in place prior to death or incapacity helps ensure that assets transfer as you would intend without family discrepancies and/or the potential of probate or unnecessary tax consequences.

To support your desire to complete these documents, Room & Board will pay 25 percent of professional estate planning document creation up to $250. You are free to use any service or estate planning attorney you choose. You will be responsible for any changes that need to be made to these documents in later years.

For additional resources, including help identifying a qualified estate attorney, click here.

Discount Benefits Staff Member Discount

Many staff members share a great excitement for our products. To encourage this enthusiasm, Room & Board offers you a 35 percent discount off the purchase price of both accessories and furniture, and a 50 percent discount on mattresses and bedding. In addition, we offer an annual 50 percent discount on any one order up to a total retail price of $2,000. After one year of employment, you can take advantage of our payroll deduction financing option to spread some or all of the cost over a 12-month period.

We also provide free delivery to any staff member residence.

Cell Phone Service Discount

You are eligible for a monthly service charge discount through AT&T and Verizon on qualified voice and data plans. See Worklife for more information.

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HealthPartners Fitness Center Discount If you are enrolled in our health insurance the frequent fitness program provides eligible members a reimbursement of up to $20 for working out 12 or more times per month at a participating club. Two adult members per health plan contract may participate per health plan contract for a combined savings of up to $40.

Travel Benefits

For personal travel, Room & Board has a Travel Associate on staff to help coordinate travel needs, at no charge to staff members. This includes everything from air tickets, hotels and car rentals to full vacation packages or cruises. When you are ready to schedule, contact Travel Associate Rachel Lowe at 1-612-280-0666.

Staff Member Store Interested in your own Room & Board t-shirt, sweatshirt or water bottle?

Room & Board-branded apparel and accessories are available through our online Staff Member Store. Not to be confused with our uniforms, these personal items are accessible via a link on Worklife. Each market has samples to try on for size. Talk to your manager for more information.

Online Learning To continue to grow in and outside of your role at Room & Board, we provide access to an online learning platform called Being. This Netflixinspired series is taught by authors, celebrities and top wellbeing experts on an ever-growing catalog of courses.

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Employee Assistance Program www.sandcreekeap.com 1-615-300-5755 A designated licensed therapist from Sand Creek is available to help you and your family anytime you are facing a situation that affects your emotional wellbeing. Wendi will help assess your situation, identify options and get additional support.

It’s Free

Visit with your therapist for four one-hour in-person or telephonic sessions per issue at no charge.

You also receive 30 minutes of free legal advice and a 25% discount if you retain that attorney, as well as four free 30-minute sessions with a certified financial planner.

If more counseling or treatment is needed, your counselor will help you figure out your options.

It’s Convenient

Help is as close as your phone. Wendi will listen to what’s on your mind and either begin a counseling session or start the intake process to set up face-to-face sessions with a licensed counselor near your work or home. Telephonic counseling services are also available.

It’s Voluntary

A manager or co-worker might suggest you reach out if you’ve talked about a complex problem or they notice something is troubling you, but the decision to contact Sand Creek is always yours.

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It’s Confidential

Because this service is provided by Sand Creek, no one at work knows anything beyond what you choose to tell them.

Here to Help

Some reasons to call include: • Personal growth: Improve parenting skills, change lifestyle habits, get out of a rut, transition a child to college, get married • Day-to-day life: Difficulty managing stressors at home or work, a serious illness, relationship problems, grief, legal and financial woes • Therapeutic counseling: Help with stress that affects daily living, anger issues, prolonged grief, overuse of alcohol/drugs • Crisis: Support for suicidal thoughts, PTSD, addiction, panic and anxiety attacks Sand Creek is Available to You Right Now. Calls are answered 24/7/365.

Contact Information: Wendi, Licensed Therapist 1-615-300-5755 www.sandcreekeap.com Login ID: roomandboard To download the Sand Crek EAP App to your device, visit the App Store (Apple) or Google Play (Android).

Section XI: Vacation, Personal and Holiday Pay, and Leaves of Absence Vacation Balance in our lives is essential. Therefore, we provide a vacation schedule that allows you time away from work to focus on the things in life that are most important. You accrue vacation bi-weekly, at a rate equivalent to three weeks a year for each of their first five years of employment. After five years of employment, the vacation accrual schedule increases to four weeks of vacation each year. A week of vacation is equivalent to the hours you are scheduled each week. Therefore, a 40-hour staff member earns 40 hours of weekly vacation; a 32-hour staff member earns 32 hours as a week of vacation.

Vacation time is available to use as soon as it has been accrued.

However, we ask that you speak with your manager at least four weeks in advance of the requested time off to ensure that your needs are in balance with the needs of our customers and your peers. If you experience an unexpected event that requires time off beyond the amount available in your vacation balance you may be eligible for vacation contributions from other staff members.

It’s important that you take your vacation time. Therefore, we reserve the right to limit vacation balances that can be carried over to the following year to a maximum accrual of four weeks of your typical schedule, except where prohibited by law. For example, a four-day Design Associate could carry over 128 hours while a five-day Design Associate could carry over 160.

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To access your vacation balance, sign into UltiPro at roomandboard.ultipro.com: • Click on Menu (top left) Myself > Benefits > Time Off • From there you will see your vacation balance and the option to create a time off request.

• Please be sure to check with your Leadership team before creating a request.

Personal Time We trust one another and work hard to keep our commitments to the business. You are afforded the flexibility to balance your personal obligations with equal priority to the needs of the business. We do not have a formal personal or sick pay policy. Our preference is to pay you for missed time and not reduce your pay or request the use of vacation time.

Holiday Pay Staff members enjoy paid holidays immediately upon hire.

Retail Holidays Our showrooms are generally closed on Easter, Independence Day, Thanksgiving and Christmas Day. Staff members who have a scheduled day off on these holidays will receive another paid day off within the holiday month. To meet the needs of our customers, our stores are open on New Year’s Day, Memorial Day and Labor Day. For these holidays, staff members will receive a paid day off within the holiday month.

Delivery Centers, Distribution Centers and Central Office Holidays Staff members receive the following days as paid holidays: New Yearâ&#x20AC;&#x2122;s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving and Christmas Day. To understand more about your holiday schedule, please talk to your Leadership team.

Paid Parental Leave To support you during an exciting yet challenging time, we offer caregivers four weeks of paid leave. Birth mothers receive an additional six to eight weeks of disability leave.

Bereavement Leave Loss of a loved one is difficult. To allow time to grieve, we recognize paid time off in the event of a death of a loved one. The determination of appropriate time off is left to the discretion of your manager. This leave is available immediately upon hire.

Personal Leave If, for compelling reasons, you should desire time off from your position, an unpaid personal leave of absence may be granted for up to 12 weeks. Managers will evaluate requests and may grant a leave based upon the nature of the request, your performance and role, and/or the particular needs of the location/ department.

Military Leave You will receive up to 4 weeks of paid time off per year when called to serve in the reserved armed forces.

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Section XII: Contributions MEDICAL CONTRIBUTIONS – BIWEEKLY COVERAGE LEVEL

MODERATE DEDUCTIBLE HRA PLAN

HIGH DEDUCTIBLE HSA PLAN

SINGLE

$85.00

$57.00

SINGLE + 1

$197.75

$135.50

FAMILY

$310.75

$226.00

COVERAGE LEVEL

VISION CONTRIBUTIONS – BIWEEKLY

SINGLE

$3.79

SINGLE + CHILD(REN)

$7.59

SINGLE + SPOUSE OR DOMESTIC PARTNER

$7.21

FAMILY

$11.16

COVERAGE LEVEL

DENTAL CONTRIBUTIONS – BIWEEKLY

SINGLE

$7.25

SINGLE + 1

$13.80

FAMILY

$23.15

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VOLUNTARY LIFE AND AD&D COVERAGE RATES – BIWEEKLY AGE BAND

RATE PER $10,000 BENEFIT

AGE BAND

RATE PER $10,000 BENEFIT

< 24

$0.231

50-54

$1.569

25-29

$0.277

55-59

$2.538

30-34

$0.369

60-64

$3.415

35-39

$0.415

65-69

$5.862

40-44

$0.554

70-74

$9.60

45-49

$0.923

75+

$16.246

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

Section XIII: Provider/Vendor Contact Info BENEFIT

PROVIDER

CONTACT INFO

401(k)

Principal

www.principal.com

DENTAL

Delta Dental of MN

www.deltadentalmn.org 1-800-448-3815

DISABILITY BENEFITS

Voya

wellness@roomandboard.com

EMPLOYEE ASSISTANCE PROGRAM

Sand Creek

www.sandcreekeap.com 1-615-300-5755

FINANCIAL ADVISOR

Billy Gese at NFP

bgese@nfp.com 952-847-1357

FLEXIBLE SPENDING ACCOUNTS

Discovery Benefits

www.discoverybenefits.com 1-866-451-3399

HSA

Optum Bank

www.optumbank.com

LIFE AND AD&D INSURANCE

Voya

wellness@roomandboard.com

MEDICAL

HealthPartners

www.healthpartners.com/roomandboard 1-800-883-2177

VISION

EyeMed

www.eyemed.com 1-866-804-0982

The Wellness Team is your Room & Board contact.

They can be reached at wellness@roomandboard.com

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Section XIV: Legal Notices HIPAA Notice of Privacy Practices HIPAA Special Enrollment Rights Important Notice From Room & Board About Your Prescription Drug Coverage and Medicare Newborns’ and Mothers’ Health Protection Act Notice Premium Assistance Under Medicaid and The Children’s Health Insurance Program (CHIP) Women’s Health and Cancer Rights Act Notice

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