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2019-2020 Benefits Guide


Benefits are as easy as 1-2-3! 1. Get to Know Your Benefits! Review this guide to see what benefits are available to you.

2. Ask Questions! Send an email to our benefit consultants at SL Goodell Insurance Services (connect@slgoodell.com)

3. Take Action! Make your elections in Employee Navigator. This is intended only as a general description of the plan's benefits and quoted rates. It is not a contract. For additional information about benefits or exclusions and limitations please refer to the plan's disclosure or summary plan description. In the event of any discrepancy, wording in the policy will prevail.


Benefits Health Medical CalChoice - Providing seven HMO plan options and one PPO plan option.

Dental

Income Protection Basic Life/AD&D Mutual of Omaha - $25K Benefit

Long-Term Disability Mutual of Omaha - 60% of monthly earnings

Delta Dental Classic PPO

Vision

401(K)

VSP 12/12/12 Signature Plan

With a safe harbor company match

Perks Vacation 10 paid holidays & generous PTO Vacation time after 60 days of employment

Pet Insurance Pet Benefit Solutions - Voluntary pet insurance, membership discounts, prescription discounts


Medical, Dental, and Vision Effective Dates Effective: Oct 1, 2019 to Sept 30, 2020

New Hire Effective Date

Medical - First of the month following the 30th day after date of hire. Ancillary - First of the month following the 60th day after date of hire.

Qualifying Life Event Effective Date

Subject to the nature of the qualifying event, either first of the month following or coinciding with date of life event.-Employees may elect to participate in the Company's medical, dental and/or vision plan(s) or decline coverage by consenting to an electronic waiver of insurance coverage and providing proof of health coverage, if applicable.

Elections or changes made during Open Enrollment

All benefits-eligible employees are entitled to an annual open enrollment period to make election changes, effective October 1st each year.


Rates: Your Monthly Contribution Effective Oct 1, 2019

Medical

Employee Only:

Employee + Dependents:

Anthem Blue Cross Silver Select PPO B

$108.33

Any additional dependent

Kaiser Permanente Bronze HMO C (HSA)

$54.16

Silver HMO C

$54.16

premiums will

Bronze HMO B (HSA)

$54.16

Silver HMO B

$54.16

UnitedHealthCare -

Premiums vary based upon

Silver Signature Value HMO A

$108.33

Bronze Alliance HMO B (HSA)

$54.16

Silver Focus HMO D

$54.16

Delta Dental Classic PPO Employee Only

$0

Dependents

$0

be paid for by the employee.

Sharp Performance -

Dental

dependent age and number of dependents.

Vision VSP Signature 12/12/12 Employee Only

$0

Dependents

$0


Plan Details Medical Plan Basics

Anthem Blue Cross Silver Select PPO B

Kaiser Permanente Bronze HMO C (HSA)

Kaiser Permanente Silver HMO C

Sharp Performance Bronze HMO B (HSA)

Deductible: Individual

$1,700

$6,000

$2,000

$5,650

Deductible: Family

$3,400

$12,000

$4,000

$11,300

Max out of pocket: Individual

$7,900

$6,650

$7,500

$6,650

Max out of pocket: Family

$15,800

$13,300

$15,100

$13,300

Infertility

See EOC

Not covered

Not covered

Not covered

Primary Care Physician

$45 copay (deductible waived)

40% after deductible

$45 copay (deductible waived)

40% after deductible

Specialist Physician

$90 copay (deductible waived)

40% after deductible

$80 copay (deductible waived)

40% after deductible

Laboratory Services

35% after deductible

40% after deductible

$40 copay (deductible waived)

40% after deductible

Referal Required for Specialist

No

Yes

Yes

Yes

Chiropractic Care

50% (deductible waived; 20

Not covered

Not covered

Not covered

Copays & Coinsurance

visits/yr max)

Urgent Care Facility

$90 copay (deductible waived)

40% after deductible

$45 copay (deductible waived)

40% after deductible

Hospitalization: Inpatient

$750 copay per admit

40% after deductible

20% after deductible

40% after deductible

Pharmacy

$20/$50/$90 (after RX ded)

40% after deductible

$5/$55 (after RX ded)

40% after deductible


Plan Details Medical Plan Basics

Sharp Performance Silver HMO B

UnitedHealthCare Silver Signature Value HMO A

UnitedHealthCare UnitedHealthCare Bronze Alliance HMO B (HSA) Silver Focus HMO D

Deductible: Individual

$2,100

$2,250

$6,500

$2,250

Deductible: Family

$4,200

$4,500

$13,000

$4,500

Max out of pocket: Individual

$7,900

$7,900

$6,500

$7,900

Max out of pocket: Family

$15,800

$15,800

$13,000

$15,800

Infertility

Not covered

See EOC

See EOC

Not covered

Primary Care Physician

$40 copay (deductible waived)

$50 copay (deductible waived)

$0 after deductible

$50 copay (deductible waived)

Specialist Physician

$70 copay (deductible waived)

$75 copay (deductible waived)

$0 after deductible

$75 copay (deductible waived)

Laboratory Services

$15 copay (deductible waived)

$40 copay (deductible waived)

$0 after deductible

$40 copay (deductible waived)

Referal Required for Specialist

Yes

Yes

Yes

Yes

Chiropractic Care

Not covered

$15 copay (20 visits/yr max;

$0 after deductible (20

$15 copay (20 visits/yr max;

limitations apply)

visits/yr max)

limitations apply)

Copays & Coinsurance

Urgent Care Facility

$70 copay (deductible waived)

$50 copay (deductible waived)

$0 after deductible

$50 copay (deductible waived)

Hospitalization: Inpatient

40% after deductible

40% after deductible

$0 after deductible

40% after deductible

Pharmacy

$20/$50/$100 (after RX ded)

$20/$50/$100 (after RX ded)

$0 after deductible

$20/$50/$100 (after RX ded)


Plan Details Dental With your Delta Dental Classic PPO Plan, employees select from any dentist in the PPO network to experience the most savings. Employees who cannot find a PPO dentist may also visit dentists outside the PPO network at higher rate of charge. Out of network benefits are limited to the PPO fee schedule.

PPO Delta Dental Providers

In Network

Non-PPO/Out-of-Network

Individual Deductible per calendar year

$50

$50

Family Deductible per calendar year

N/A

N/A

Deductible waived for

Preventive

Preventive

Annual Maximum Benefit

$1000 per person per calendar year

Preventive Care

100%

100%

Basic Care

80%

80%

Major Care

50%

50%

Orthodontia

50% after deductible (children only) Maximum Benefit: $1,000


Plan Details Vision The Plan Basics

VSP Signature 12/12/12

Exams Copay

$20

Materials Copay

$20

Services Frequencies Exams

Once every 12 months

Lenses (for glasses or contact lenses)Â

Once every 12 months

Frames

Once every 12 months

Network discounts (cosmetic extras, glasses and

Limitless within 12 months of exam

contact lens professional services)


Plan Details Life and AD&D Mutual of Omaha

Employee Benefit

Your employer provides a $25,000 amount of Basic Term Life coverage for all full time employees.

Accidental Death and Dismemberment

Your Basic Life coverage includes Enhanced Accidental Death and Dismemberment coverage of $25,000.

Premiums

Paid by the company in full


Plan Details Long Term Disability Mutual of Omaha Coverage amount

60% of salary to maximum $6,000/month

Maximum payment period: Maximum length of time you can receive disability benefits.

Social Security Normal Retirement Age Benefit length varies past age 61.

Accident or Illness benefits begin: The length of time you must be disabled before benefits begin.

Day 91

Information Regarding Long Term Disability Disability (Long-Term): For the first two years of disability, you will receive benefit payments while you are unable to work in your own occupation. After two years, you will continue to receive benefits if you cannot work in any occupation based on training, experience and education. Earnings definition: Your covered salary includes average bonuses and commissions.


Plan Details Pet Benefit Solutions Clark Land Resources has implemented a new pet benefit. Pet Benefit Solutions offers a 3-tier approach to providing your pet with the best possible care. Enrollment is voluntary and paid for 100% by the employee. You may choose to enroll in any or all of the following: Pets Best Pet Health Insurance, Pet Assure Veterinary Discount Plan, or PetPlus Prescription Discount Plan.

90% reimbursement on accidents and

25% savings at participating veterinarians

Members save up to 50% on:

illnesses.

on all in-house medical services including:

Prescription Medications

Low Deductibles; No Annual Limit

Office Visits, X-rays, Vaccinations

Flea & Tick Products, Heartworm

Online or App Claims Submission

Dental Work, Spay & Neuter

Preventatives

Coverage on Accidents, Illnesses, Surgeries,

Emergency Visits, Surgeries,

Vitamins & Supplements

Exam Fees, Cancer, and Moe.

Hospitalization

Food (Rx & Non-Rx), Treats & Supplies

24/7 Pet Help Line by WhiskerDocs

24/7 Lost Pet Recovery Service

24/7 Pet Help Line by WhiskerDocs


Additional Resources and Contact Information Name

Services

Contact

Web

CalChoice

Medical

1-800-393-6130

https://www.calchoice.com/

Delta Dental of CA

Dental

1-800-765-6003

https://www.deltadental.com/

VSP

Vision

1-800-877-7195

https://www.vsp.com/

Mutual of Omaha

Life Insurance, Long-Term Disability

1-800-877-5176

https://www.mutualofomaha.com/

Pet Benefit Solutions

Pet Insurance, Pet Discounts, Pet Prescription

1-888-913-7387

https://www.petbenefits.com/

Discounts


https://www.employeenavigator.com/benefits/Account/Login

For questions, contact SL Goodell Insurance Services: connect@slgoodell.com 1-877-490-3535

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