2022 Benefits Guide
WeDear&IntroductionWelcomeStaffMember,arepleasedtowelcome 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 & Board Human Resource Team Wellness@roomandboard.com What’s in this guide I.Introduction & III.EligibilityII.FinancialWelcomeandLifeEvents IV.Medical Coverage V.Vision VII.FlexibleVI.DentalCoverageCoverageSpendingAccountsVIII.LifeandAD&DInsurance IX.Disability Benefits X.Other Benefits XI.Vacation, Personal and Holiday Pay, and Leaves of XIII.Provider/VendorXII.ContributionsAbsenceContact Info XIV.Legal Notices 2022 BENEFITS GUIDE
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, UKG and print them if UKGneeded. 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 UKG? • 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. Section II: Financial Your Room & Board Paycheck CONTACT THE WELLNESS TEAM FOR ASSISTANCE • If you usingquestionshavewhileUKG,please click here to send an email to the Wellness Team. • You can view our current schedulepayroll here. • Support your local throughorganizationsnon-profitour Give for Good program. HOW TO ENROLL • Visit: roomandboard.ultipro.com • Login: with your Room & Board email and password • Click on: Menu at the top left, then Life Events, then I am a new staff member 2022 BENEFITS GUIDE
Employee A: Age 39 Employee B: Age 29 Annual $47,000Income: Annual $47,000Income: Annual Investment: 8% Room & Board Match: 4% Rate of Return: 7% Rate of Return: 7% Annual Investment: 8% Room & Match:Board4% At the Age of Retirement Employee A will have $488,183 At the Age ofEmployeeRetirementBwillhave $1,062,433 THE VALUE OF TIME 2022 BENEFITS GUIDE
https://login.principal.com/login
Section II: Financial
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. 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. Automatic Enrollment 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%.
401(k) Match Room & Board provides a discretionary match based on company profitability. The match is 50% on the first 8% that you contribute to the plan. Matching amounts are placed into your account at the end of each plan year and follow a three-year vesting schedule. You become 25% vested after one year of employment, 50% vested after two years and would be fully vested after three years of employment with Room & Board. 401(k) Retirement Savings
Account Online 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 our team of financial advisors and have ongoing personal and private financial advise at no cost to you. Our advisors from National Financial Partners (NFP) can provide advice to you regarding 401(k) contributions and investemnts, along with rolloing over or consolidating other retirement accounts. Contact Information: Billy Gese, NFP bgese@nfp.com | 952-847-1357 Taylor Stevenson taylor.stevenson@nfp.com | 952-847-1357 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. 2022 BENEFITS GUIDE
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 $20,500 for 2022. You can change your 401(k) contributions at any time throughout the year. In 2022, 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. 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)
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.
YOU
• 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) 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 benefit elections remain in effect for the entire plan year; unless 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:
Section III:
• 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. Eligibility and Life Events HAVE 30 DAYS FROM YOUR DATE OF HIRE TO ENROLL IN ROOM & BOARD’S BENEFIT PLANS Mid-year changes to carefully.yourbasisonarebenefitsallowedalimited—planelections
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:
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2022 BENEFITS GUIDE
• statusEmployment – any event in which an
• 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.
Health Care Coverage Room & Board is pleased to offer you two high-quality health care benefit options to choose from: the High Deductible Plan paired with a Health Savings Account (HSA) and the Copay Plan. Both plans provide 100% coverage for preventive care. Keep in mind that choosing a network provider will most likely lower your cost for services. Section IV: Medical Coverage www.healthpartners.com/roomandboard 1-800-883-2177 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. CONTRIBUTIONS – BIWEEKLY COPAYPLAN YOUR PER DEDUCTIONPAYCHECK HIGH YOURHSADEDUCTIBLEPLANPERPAYCHECKDEDUCTION EMPLOYEE $95.00 $64.00 EMPLOYEE + SPOUSE/ PARTNER $233.00 $157.00 EMPLOYEE + CHILD(REN) $200.00 $135.00 FAMILY $355.00 $256.00 2022 BENEFITS GUIDE
to help save for current and future health care expenses. TIP: SEE PROVIDERSIN-NETWORK If you see in-network providers you will pay less than if you see out-ofnetwork providers. 2022 BENEFITS GUIDE
• Save money tax free • Pay for health care expenses tax free • Earn more money with company contributions Room
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Medical Plan Options
Option 2: High Deductible HSA Plan
Option 1: Copay Plan The Copay Plan offers a set dollar amount, or copay, for routine services like office visits and prescriptions. The Copay Plan offers a lower individual and family deductible. For coverage, the plan contains two components: an individual deductible and a family deductible. For families, once a family member meets their individual deductible the plan begins paying benefits for that person.
On the High Deductible plan all services excluding preventive care must first go toward satisfying the deductible before the plan starts to pay a portion of the claims. However this plan has lower monthly premiums and you have access to a Health Savings Account (HSA). High Deductible HSA Plan allows you to: & Board makes a contribution to an HSA level (see page 13). Half of this contribution be funded and half July. This HSA
The
in January
money is yours to spend on qualified health care expenses including vision and dental. You can also make tax-free contributions into your
The Copay Plan The Copay Plan is a traditional health plan with copays for routine services and a deductible for other covered services. preventiveIn-network care such as coveredimmunizationswellchildscreenings,check-ups,annualcancercareandareat100%. You pay a copay for o ce prescriptionsvisits,and 100% of other covered medical costs until you meet your deductible. Once you meet your deductible, you pay 20% for services up to your out-of-pocket maximum. If your accumulated out-ofpocket expenses reach the above maximums, the plan pays 100% for the remainder of the year. PREVENTIVE CARE DEDUCTIBLE$750lndividual$1500Family COINSURANCE MAXIMUMOUT-OF-POCKET$3000lndividual$6000Family HOW THE PLAN WORKS WHEN YOU SEE IN-NETWORK PROVIDERS 2022 BENEFITS GUIDE
COVERAGE LEVEL IN-NETWORK OUT-OF-NETWORK DEDUCTIBLE AND OUT-OF-POCKET MAXIMUM AMOUNT 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 This 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 No charge 50% coinsurance for eye exams 50% coinsurance for immunizations 50% coinsurance for other services Office Visits • Illness or injury • Mental/behavioral health, substance use disorder • Physical, Occupational and Speech therapy • Specialty visits $35 copay $35 copay $35 copay $75 copay Deductible then you pay 50% Online Care • Virtuwell • Doctor on Demand No charge Up to a $59 copay for Doctor on Demand Not covered Emergency Care • Urgent care • Emergency care at hospital ER • Ambulance $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 scan Deductible then you pay 20% Deductible then you pay 50% Copay Plan 2022 BENEFITS GUIDE
PRESCRIPTION DRUG SERVICES IN-NETWORK OUT-OF-NETWORK RETAIL (UP TO A 31-DAY SUPPLY) 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% MAIL ORDER (UP TO A 93-DAY SUPPLY) GENERIC $30 copay Not covered FORMULARY (BRAND) $150 copay Not covered NONFORMULARY (BRAND) $270 copay Not covered Copay CONTINUEDPlan Click here to view the Plan.forCoverageBenefitsSummaryfullofand(SBC)theCopay• 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 BENEFITS OF THE COPAY PLAN 2022 BENEFITS GUIDE
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 health care 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 $3,650 for individual coverage and $7,300 for family coverage.* *If you are age 55 or older you may contribute an additional $1,000 in 2022. Visit www.healthpartners.com/roomandboard to find out more about the advantages of a Health Savings Account. 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. $600$900$1200 HSApreventiveIn-network care such as coveredimmunizationswellchildscreenings,check-ups,annualcancercareandareat100%. You pay 100% of medical and prescription drug costs until you meet your deductible. Room & Board will contributionsmaketoyour HSA in an amount based on the tier of coverage you select. You can withdraw these funds tax-free and put them towards meeting your deductible or save them to help o set future expenses. Once you meet your deductible, you pay 20% for services and prescriptions* up to maximum.out-of-pocketyour If your accumulated out-ofpocket expenses reach the above maximums, the plan pays 100% for the remainder of the year. PREVENTIVEIN-NETWORK CARE $3600$1800DEDUCTIBLElndividualFamily COINSURANCE $6000$3000MAXIMUMOUT-OF-POCKETlndividualFamily USE YOUR HSA TO HELP PAY THESE EXPENSES HOW THE PLAN WORKS WHEN YOU SEE NETWORK PROVIDERS *For specialty drugs, you pay 20% up to $200 maximum of the cost prescriptionper per month. 2022 BENEFITS GUIDE
COVERAGE LEVEL IN-NETWORK OUT-OF-NETWORK DEDUCTIBLE AMOUNT EMPLOYEE (APPLIES TO SINGLE ONLY) $1,800 $3,600 FAMILY $3,600 $10,800 OUT-OF-POCKET MAXIMUM EMPLOYEE $3,000 $5,000 FAMILY $6,000 $15,000 2022 ROOM & BOARD HSA CONTRIBUTIONS (Pro-rated based on benefit eligibility date.) EMPLOYEE up to $600 ($50 per month) EMPLOYEE + SPOUSE/PARTNER up to $900 ($75 per month) EMPLOYEE + CHILD(REN) up to $900 ($75 per month) FAMILY up to $1,200 ($100 per month) IRS HSA LIMITS (These limits include both staff member and Room & Board contributions.) EMPLOYEE up to $3,650 EMPLOYEE + SPOUSE/PARTNER up to $7,300 EMPLOYEE + CHILD(REN) up to $7,300 FAMILY up to $7,300 High Deductible (HSA) Plan 2022 BENEFITS GUIDE
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% High Deductible (HSA) Plan CONTINUED 2022 BENEFITS GUIDE
PRESCRIPTION DRUG SERVICES IN-NETWORK OUT-OF-NETWORK RETAIL (UP TO A 31-DAY SUPPLY) 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% MAIL ORDER (UP TO A 93-DAY SUPPLY) 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 High Deductible (HSA) Plan CONTINUED Click here to view the forcoveragebenefitssummaryfullofand(SBC)theHSAPlan.• 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. BENEFITS OF THE HSA PLAN 2022 BENEFITS GUIDE
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.).
Plan Considerations
• 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.
“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 22 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 growbalancestax-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: 01/01/2022 2022 BENEFITS GUIDE
• You may also make contributions to your HSA up to the IRS maximums: $3,650/single and $7,300/family.
• If you are age 55+, you are eligible to make an additional $1,000
. •
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• 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.
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.
HealthPartners Resources
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• 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
. •
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
• 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 Wellbeats: Membership to on-demand workouts and challenges. Check it out at healthpartners.com/wellbeing 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 2022 Marketplace Coverage Options Notice. 2022 BENEFITS GUIDE
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. 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 with US Vision. Complete pair purchase required — member is still responsible for lenses, which are covered based on your vision benefits and may include an additional copay. Discounts are not insured benefits. Offer excludes Chanel, Cartier, Giorgio Armani, Gucci, Prada, Tiffany and Tom Ford frames. Section V: Vision Coverage Network = Insight Network www.eyemed.com 1-866-804-0982 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 Be stylish and savvy. Log into your member account at eyemed. com to get more special offers. COVERAGE LEVEL VISION CONTRIBUTIONS – BIWEEKLY EMPLOYEE $4.08 EMPLOYEE SPOUSE/PARTNER+ $7.76 EMPLOYEE CHILD(REN)+ $8.17 FAMILY $12.01 2022 BENEFITS GUIDE
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.
2022 BENEFITS GUIDE
SUMMARY OF BENEFITS IN-NETWORK OUT-OF-NETWORK EXAM SERVICES • Exam • Retinal Imaging $10 copay Up to $39 Up to $40 CONTACT LENS FIT AND FOLLOW-UP • Fit and Follow-up - Standard • Fit and Follow-up - Premium $40 10% off retail price Not covered Not covered FRAME • Any available frame at provider location $0 copay; 20% off balance over $150 allowance Up to $105 STANDARD PLASTIC LENSES • Single Vision • Bifocal • Trifocal • Lenticular • Progressive - Standard • Progressive - Premium Tier 1 - 4 $25 copay $25 copay $25 copay $25 copay $80 $110-$200copaycopay Up to $30 Up to $50 Up to $70 Up to $70 Up to $50 Up to $50 Vision Plan 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.
SUMMARY OF BENEFITS IN-NETWORK OUT-OF-NETWORK 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 $0 20%$12-$85copaycopay$75$0copay$0copay$0copayoffretailprice Up to $5 Up to $5 Not NotUpUpUpcoveredto$5to$5to$5covered CONTACT LENSES • Contacts - Conventional • Contacts - Disposable • Contacts - Medically Necessary $0 copay; 15% off balance over $150 allowance $0 copay; $100% of balance over $150 allowance $0 copay; Paid-In-Full Up to $105 Up to $105 Up to $210 OTHER • Hearing Care from Amplifon NetworkCare • Lasik or PRK from U.S. Laser Network 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 Not covered FREQUENCIES (Plan allows member to receive either contacts and frame, or frames and lens services) • Exam • Frame • Lenses • Contacts Once every plan year Once every plan year Once every plan year Once every plan year Vision CONTINUEDPlan 2022 BENEFITS GUIDE
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. Section VI: Dental Coverage www.deltadentalmn.org 1-800-448-3815 CONTRIBUTIONS – BIWEEKLY YOUR PER PAYCHECK DEDUCTION EMPLOYEE $7.85 EMPLOYEE + SPOUSE/ PARTNER $13.75 EMPLOYEE + CHILD(REN) $18.45 FAMILY $24.25 2022 BENEFITS GUIDE
SUMMARY OF BENEFITS DELTAPPODENTAL DELTAPREMIERDENTAL NON-PARTICIPATING EXAM SERVICES Deductible (calendar year) No deductible for diagnostic and preventive service or orthodontics $50$150individualfamily $50$150individualfamily $50$150individualfamily 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** Dental Plan 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. 2022 BENEFITS GUIDE
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. More information can be found on Worklife.
Your FSA Contribution
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expenses must
insurance • Uninsured
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 Examplesparticipate.ofeligible medical expenses, to the extent not covered by another plan, include: Co-payment and deductibles not covered by medical or dental expenses such as hearing aids, eyeglasses, lenses and certain eye surgeries complete listing of eligible expenses may be found IRS Publication 502, which is available at www.irs.gov Eligible be incurred (date is within the plan year of January 1, 2022 – December 31, 2022.
.
When you establish a 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.
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:
• Orthodontia • Diabetic supplies • Smoking cessation programs • Fertility services A
• 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. 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 $570 of your balance to the following calendar year. Medical Expenses
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Section VII: Flexible Spending Accounts (FSAs) https://www.wexinc.com/login/ 1-866-451-3399 2022 BENEFITS GUIDE
Medical Flexible Spending Account
• You elect the Copay Plan, or
Dental
• You elect the High Deductible HSA health insurance plan, or
• 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.
• Your spouse who is physically or mentally incapable of self-care
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.
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:
Eligible Dependents
• 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).
Eligible
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 for whom you have custody if you are divorced or legally separated
• Your dependent of any age, such as an elderly parent or other adult dependent, who meets all of the following criteria:
2022 BENEFITS GUIDE
Dependent Care FSA
• Your dependent under age 13 who lives with you for more than half the year and for whom you can claim an exemption
• Is physically or mentally incapable of caring for themself,
Limited Purpose Medical FSA
• Receives over half of their support from you,
• Lives with you for more than half the year, and
• 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. Expenses Include:
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 $570 of your balance to the following calendar year.
Commuter Expenses Staff members who incur work-related commuter expenses, including transportation or parking, may participate in this benefit. In 2022 you are able to deduct up to $280 per month pre-tax from your paycheck for transit expenses and $280 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 $280 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 a FSA. This example compares costs for single employee coverage. Your actual costs and tax savings will vary. 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 a FSA must be substantiated. When a claim cannot be automatically substantiated (e.g. a prescription co-payment) Wex will request documentation. It is imperative when asked for documentation that you provide it to Wex as soon as possible. If documentation is not provided, the IRS requires you to pay back the plan. 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 2022 BENEFITS GUIDE
coverage
coverage for staff members and
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Room(AD&D)DismembermentandInsurance&Boardpaysforbasicterm 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 for your spouse/ domestic partner in amounts of $5,000 up to a maximum of $500,000, dependent children in amounts of $5,000 and $10,000. AD&D $.02 $1,000 covered dependents. This not subject Evidence of Insurability.
Section VIII: Life and AD&D Insurance For questions about your Life and AD&D Insurance please contact your Wellness Team. 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 Voluntary Life Insurance Coverage Rates Rates are shown as your biweekly deduction. Your rate will increase as you move to the next age group. 2022 BENEFITS GUIDE
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. You may elect $200,000 without providing evidence of insurability during your initital enrollment period. 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 coverage for
coverage is
per
rates are
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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 Long-Termbenefit.
Short-Term Disability (STD) Salary Continuation
Section
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 physician’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. IX: Disability Benefits For questions about your Disability Insurance please contact your Wellness Team
529 College Savings Plan To make paying for college easier, Room & Board provides staff members the option to save for a child’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. Section X: Other Benefits 2022 BENEFITS GUIDE
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.
Discount Benefits Staff Member Discount
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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.
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
Cell Phone Service Discount
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 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 Wellbeinginformation. Academy To continue to grow in and outside of your role at Room & Board, we provide access to Wellbeing Academy. This Netflix-inspired series is taught by authors, celebrities and top wellbeing experts on an evergrowing catalog of courses. Thrive Account This account, run through our partner Thrive Pass, enables you to be reimbursed for a variety of wellness expenses. Full-time staff members will receive $25 per month and Part-time staff working 20-39 hours per week will receive $15 per month. Eligible expenses include, but are not limited to: Acupuncture, camping fees, golf green fees, gym memberships, mindfulness apps, online fitness subscriptions and online learning app.thrivepass.com. 2022 BENEFITS GUIDE
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. A licensed therapist 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. It’s Confidential Because this service is provided by Sand Creek, no one at work knows anything beyond what you choose to tell them.
• 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. ID: DownloadroomboardtheAppby www.mylifeexpert.com. To log in use Code: roomboard. 651-300-5755
• Therapeutic counseling: Help with stress that affects daily living, anger issues, prolonged grief, overuse of alcohol/drugs
visiting
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Company
Sand Creek is available to help you and your family anytime you are facing a situation that affects your emotional wellbeing. A licensed therapist will help assess your situation, identify options and get additional support. It’s Free Visit with your therapist for six one-hour in-person or telephonic sessions per issue at no charge.
• Personal growth: Improve parenting skills, change lifestyle habits, get out of a rut, transition a child to college, get married
Employee Assistance Program www.mylifeexpert.com
Here to Help Some reasons to call include:
• Day-to-day life: Difficulty managing stressors at home or work, a serious illness, relationship problems, grief, legal and financial woes
Section XI: Vacation, Personal and Holiday Pay, and Leaves of Absence
2022 BENEFITS GUIDE
StaffHolidaytime.Paymembersenjoypaid holidays immediately upon hire. Retail Holidays
BalanceVacationinourlives 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. After 10 years vacation increases to five weeks. 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.
• Click on Menu (top left) Myself > Benefits > Time Off
• Please be sure to check with your Leadership team before creating a WePersonalrequest.Timetrustoneanotherand 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
• From there you will see your vacation balance and the option to create a time off request.
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. To access your vacation balance, sign into UKG at roomandboard.ultipro.com:
Our showrooms are generally closed on Easter, Independence Day, Thanksgiving, Christmas Eve 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, Martin Luther King Jr. 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 Year’s Day, Martin Luther King Jr. Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas Eve 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. Paid Family Leave If you need to care for a family member due to an illness or injury we offer you up to four weeks of paid 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. Military Leave You will receive up to 4 weeks of paid time off per year when called to serve in the reserved armed forces. 2022 BENEFITS GUIDE
MEDICAL CONTRIBUTIONS – BIWEEKLY COVERAGE LEVEL COPAY PLAN HIGH DEDUCTIBLE HSA PLAN EMPLOYEE $95.00 $64.00 EMPLOYEE + SPOUSE/PARTNER $233.00 $157.00 EMPLOYEE + CHILD(REN) $200.00 $135.00 FAMILY $355.00 $256.00 Section XII: Contributions 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. COVERAGE LEVEL VISION CONTRIBUTIONS –BIWEEKLY EMPLOYEE $4.08 EMPLOYEE + SPOUSE/PARTNER $7.76 EMPLOYEE + CHILD(REN $8.17 FAMILY $12.01 COVERAGE LEVEL DENTAL CONTRIBUTIONS –BIWEEKLY EMPLOYEE $7.85 EMPLOYEE + SPOUSE/PARTNER $13.75 EMPLOYEE + CHILD(REN) $18.45 FAMILY $24.25 2022 BENEFITS GUIDE
BENEFIT PROVIDER CONTACT INFO 401(k) Principal www.principal.com 1-800-547-7754 DENTAL Delta Dental of MN www.deltadentalmn.org 1-800-448-3815 DISABILITY BENEFITS Voya wellness@roomandboard.com EMPLOYEE ASSISTANCE PROGRAM Sand Creek www.mylifeexpert.com 651-300-5755 FINANCIAL ADVISOR Billy Gese at NFP bgese@nfp.com 952-847-1357 FLEXIBLE SPENDING ACCOUNTS Wex www.wexinc.com 1-866-451-3399 HSA Optum Bank www.optumbank.com 1-866-234-8913 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 Section XIII: Provider/Vendor Contact Info The Wellness team is your Room & Board contact. They can be reached at wellness@roomandboard.com 2022 BENEFITS GUIDE
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 2022 BENEFITS GUIDE
2022 BENEFITS GUIDE
