BenefitEmployeeSummary Effective For Plan Year: January 1, 2022 – December 31, 2022
Welcome to Starkweather & Shepley’s Employee Benefit Summary TABLE OF CONTENTS BenefitsEligibilityBenefitOverviewPlansOffered Page 2 Medical Benefits Page 3 & 4 Medial Scenarios Page 3 Health Reimbursement Arrangement (HRA) Page 3 Health Savings Account (HSA) Page 3 Flexible Spending Account (FSA) / DCAP Page 3 Dental & Vision Benefits Page 5 Life / AD&D Page 6 Voluntary Insurance Page 6 Employee Assistance Plan (EAP) Page 6 Contact Information Page 8 Employee Contributions Page 8 BENEFITS OVERVIEW Starkweather & Shepley is proud to offer a comprehensive benefits package to eligible employees. The complete benefits package is briefly summarized in this booklet. Upon receipt, you will receive plan documents, which give you more detailed information about each of these programs. Benefit Plans Offered • Medical • Dental • Vision • FSA / DCAP • Life / AD&D • Long Term Disability • Short Term Disability • Voluntary Benefits • 401(K) Retirement Plan • Employee Assistance Program (EAP) Definitions of Eligible Employee Status: • Full Time = 37.5 hour per week • Part Time = 20+ hours per week Benefit Plans Offered Full time and Part time employees and your dependents are eligible for benefits on the first of the month following date of hire. Eligible dependents are your approved: spouse, child(ren) under age 26, disabled dependents of any age, add dependent coverage. Elections made now will remain in effect until the next open enrollment period unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact HR within 30 days. 2022 Plan Year: January 1, 2022 – December 31, 2022 This document is an outline of coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environments. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area. 2
Administered by London Health Administrators
If you enroll in Healthmate Coast to Coast, you will be able to enroll in the FSA through London Health allows you to pay for qualified expenses, such as healthcare and dependent care with pre tax dollars. The 2022 contribution maximum is $2,750 for healthcare expenses and $5,000 for dependent care.
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If you enroll in Blue Solutions for HSA Plan you will also be enrolled in the HSA administered by London Health Administrators. You should not pay anything at the time of service except at the pharmacy. Wait until the claims are processed. BCBSRI will coordinate with London Health and send out Explanation of Benefits for eligible expenses. You will be sent a statement from your health care provider if you owe a deductible to the health care provider. If so you can use your HSA card for payment.
HEALTH SAVINGS ACCOUNT (HSA)
Administered by London Health Administrators
MEDICAL COVERAGE
Medical Coverage
FLEXIBLE SPENDING ACCOUNT (FSA) / DEPENDENT CARE ASSISTANCE PROGRAM (DCAP)
Comprehensive and preventative healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way especially in healthcare. Routine exams and regular preventative care provide an inexpensive review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost.
Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through S&S. S&S offers you an excellent medical package, that encompasses a Health Savings Account (HSA) and Health Reimbursement Arrangement (HRA) through London Health Administrators.
Administered by Blue Cross Blue Shield of RI (BCBSRI)
HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
If you enroll in Blue Solutions for HSA Plan or HMC2C Coinsurance 356, you will also be enrolled in the HRA administered by London Health Administrators. Present your BCBSRI HSA/HRA card at each healthcare visit and indicate to the health care provider that London Health is your secondary insurance provider. You should not pay anything at the time of service. Wait until the claims are processed. BCBSRI will coordinate with London Health and pay the provider directly for eligible expenses once your in network deductible is met. You will be sent a statement from your health care provider if you owe a copay and/or portion of the deductible to the health care provider. The HRA reimburses annual deductible under our medical plan.
Administered by London Health Administrators
Medical Coverage MEDICAL COVERAGE Administered by Blue Cross Blue Shield of RI (BCBSRI) 4 Blue Solutions for HSA Plan HMC2C Coinsurance 356 (only open to associates 65+) Annual Deductible $6,350 / $12,700 $6,850 / $13,700 Out of Pocket Maximum $6,350 / $12,700 $6,850 / $13,700 Primary Care Provider Requied / Network No / National No / National IN NETWORK SERVICES: HOSPITAL SERVICES: Inpatient Semi private Room, Related Services & Supplies $0 After Deductible $0 After Deductible Outpatient Procedures & Surgery $0 After Deductible $0 After Deductible Emergency Room Services $0 After Deductible $200 Co payment OFFICE VISITS: Urgent Care Treatment Centers $0 After Deductible $50 Co payment Preventative Care (Well Visits, Labs & X Rays) $0 Co payment $0 Co payment Primary Care Physician $0 After Deductible $30 Co payment Specialty Physician $0 After Deductible $50 Co payment INDEPENDENT LAB, X-RAY, CLINICS Lab and X Ray Services (Diagnostic) $0 After Deductible $0 Co payment Machine Tests (MRI, MRA'S, CT Scans & Nuclear) $0 After Deductible $0 After Deductible PHARMACY SERVICES: Prescription Drugs (30 Day Supply) Tier 1 $0 After Deductible $10 Prescription Drugs (30 Day Supply) Tier 2 $0 After Deductible $35 Prescription Drugs (30 Day Supply) Tier 3 $0 After Deductible $60 Prescription Drugs (30 Day Supply) Tier 4 $0 After Deductible $100 Mail Order (90 Day Supply) $0 After Deductible $25 / $87.50 / $180 / N/A OUT OF NETWORK SERVICES: Annual Deductible $12,700 / $25,400 $13,700 / $27,400 Copayment After Deductible 40% 20% Out of Pocket Limit $19,050 / $38,100 $20,550 / $41,100
BENCHMARKING INFORMATION Assurex Global survey response Contributions Benchmark – 75% Employer / 25% Employee Starkweather & Shepley 85% Employer / 15% Employee Premium (employee only) Benchmark Starkweather$618&Shepley $548 5 HDHP Coverage Comparison Benchmark (Assurex Global) Starkweather & Shepley Deductible $2,500 / $4,500 $1,400 / $2,800 Coinsurance 20% N/A Out of Pocket Maximum $5,000 / $10,000 $1,400 / $2,800 Scenario 1 Scenario 2 Scenario 3 Bronchitis Twisted Knee on Kid’s Toy Gallbladder Surgery $ 240.00 Primary Care visit $ 87.00 Rx Bill $ 4,500 in ER Charges $ 50,000 on going claim Total Out of Pocket Total Out of Pocket Total Out of Pocket $ 120.00 Allowed by BCBS for OV $87.00 at Pharmacy $ 1,400 / $ 2,800 $ 1,400 / $ 2,800 WORST CASE SCENARIOS
Delta Dental Premier / National Coverage Annual Deductible N/A Annual Benefit Maximum $1,500 per member Preventative Dental Services (Cleanings, Exams, X rays) 100% Basic Dental Services Fillings, Root Canals, Oral Surgery, Extractions, Crowns over natural teeth 100% Periodontics 80% Major Dental Services Prosthodontics bridges, dentures, implants 50% Orthodontics N/A Dependent Coverage 26 DENTAL BENEFITS Administered by Delta Dental of RI Good oral care enhances overall physical health, appearance and mental well being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the S&S dental benefit plan. 6 VSP Signature Wellvision Exam $10 Copay (Every calendar year) Prescription Glasses $25 Copay Frames $150 allowance (Every calendar year) Lenses Included in Prescription Glasses Contacts (instead of glasses) Up to $60 Copay $150 allowance (Every calendar year) VISION BENEFITS Administered by VSP Keep your eyes in good health with the S&S vison benefit plan.
GROUP LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURNANCE (AD&D) Administered by UNUM S&S provides a basic life insurance and AD&D benefit of $50,000. Coverage is fully paid by Starkweather & Shepley. The basic life and AD&D can and should have a named beneficiary in the event the benefit is paid out. GROUP VOLUNTARY BENEFITS Administered by Various S&S offers the following insurance plans available through payroll deductions: Accident Insurance Supplemental Life and AD&D Critical Illness Insurance Flexible Spending Medical Pet Insurance Flexible Spending Dependent Care (DCAP) MetLife Legal Identity Theft ** ! New for 2022! EMPLOYEE ASSISTANCE PROGRAM (EAP) Administered by Coastline EAP Personal issues, planning for life events or simply managing daily life can affect your work, health and family. Coastline provides support, resources and information for personal and work life issues. The Employee Assistance Program (EAP) is company sponsored, confidential and provided at no cost to you or your family members. Your EAP offers assistance in the following areas: • Confidential Counseling (no copay first 3 sessions) • Financial Information and Resources • Legal Support and Resources • Work Life Solutions • Childcare/Eldercare • Family Problems • Addictions Coastline EAP 800 445 1195 | 401 732 9444 www.coastlineeap.com 7
8 Benefit Plan Bi-Weekly BLUE SOLUTIONS FOR HSA PLAN Wellness Non Wellness Individual $37.96 $101.22 Family $87.81 $234.15 HMC2C COINSURANCE 356 65+ Wellness Non-Wellness Individual $45.82 $122.18 Family $106.19 $283.18 Benefit Plan Bi Weekly DENTAL PLAN Individual $16.82 Family $49.76 VISION PLAN Individual $6.09 Emp+1 $8.82 Family $15.82 2022 BENEFIT RATES
CONTACT INFORMATION BENEFIT ADMINISTRATOR PHONE WEBSITE/EMAIL Medical Blue Cross Blue Shield of Rhode Island (BCBSRI) 800.230.9050401.274.4848 www.bcbsri.com Health Reimbursement Arrangement (HRA) London Health Administrators 401.435.4700 www.londonhealthusa.com Dental Delta Dental of RI 800.843.3582 www.deltadentalri.com Group Life and AD&D UNUM 1 800 875 2626 www.unum.om Group BenefitsVoluntary Refer to Flock www.helloflock.com 401(K) Retirement Plan T. Rowe Price 1 800 922 9945 rps.troweprice.com Employee Assistance Program (EAP) Coastline 800.445.1195 www.coastlineeap.com Starkweather & Shepley Florence DuPerry HR Consulting Practice Leader 401.435.3600 fduperry@starshep.com Lindsay Azevedo Talent Acquisition Specialist lazevedo@starshep.com Alicia Vazquez HR Business Partner avazquez@starshep.com Amanda Couture Payroll and Benefits Admin acouture@starshep.com 9 Any questions, please reach out to HR@starshep.com