Benefit Guide - SAMPLE

BENEFIT GUIDE 2023

WELCOME… In keeping with a commitment to our most valuable resource—our people—we are pleased to offer a benefits program designed to protect your health and well-being. We believe we are providing a program that offers not only quality and value, but one that satisfies the diverse needs of our workforce.

ELIGIBILITY Eligible Employee If you are an employee working 30 or more hours per week, you are eligible to enroll yourself in the benefits described in this guide.

Eligible Dependent The following family members are eligible for medical, dental, and vision coverage: legally married spouse, legal children; natural or adoptive.

ENROLLMENT New Employees You become eligible for benefits the first of the month following 30 days after hire. You must enroll yourself and your dependents no later than your effective date.

Open Enrollment Employees who did not enroll at their initial eligibility period or who previously waived coverage for themselves and/or their dependents can take advantage of the Open Enrollment period.

Our plan year runs January 1 through December 31. You have the once-a-year opportunity to enroll in or make changes to your benefits during open enrollment.

Changes During the Year Benefit changes only occur once a year, during Open Enrollment, unless you experience a “qualifying life event” such as: marriage, divorce, legal separation, birth or adoption, commencement or termination of adoption proceedings, change in dependent status, death of a qualified dependent, change in residence due to an employment transfer for you or your spouse, or change in spouse’s benefits or employment status.

All paperwork must be completed and submitted back to HR no later than 30 days from the qualified event date.

Enrollment Portal www.employeenavigator.com Your company identifier is:

ABC Company Register and use your personal login and password to access benefit information, enroll or make changes.

MEDICAL PLAN OPTIONS

Option 1

PPO Medical Plan

This is a traditional PPO medical plan with copays for certain services. If enrolled in the PPO medical plan, you may seek services from both In-Network and Out-ofNetwork providers. If you seek services from In- Network providers your cost will be less than if you see Out-of-Network providers.

Option 2 HMO HDHP Medical Plan

This is an HMO High Deductible Health Plan (HDHP). If enrolled in the HMO HDHP medical plan, you are eligible to participate in a Health Savings Account (HSA). An HSA is an investment tool that helps you save for healthcare expenses, including deductibles and coinsurance. If enrolled in the HMO HDHP medical plan, you may seek services from In-Network providers only. If you seek services from Out-ofNetwork providers, insurance will not pay towards any cost for services rendered.

PREVENTIVE CARE SERVICES Preventive care services are those that are linked to routine wellness exams and screenings. Nonpreventive services are those that are considered diagnostic or treatment for an illness, injury, or other medical condition.

If you go in for a Preventive Screening and a condition is found, it is no longer Preventive and will be billed as Diagnostic (and not covered at 100%).

Preventive care is covered at 100% in-network. The US Preventive Services Task Force maintains a list of preventive services that all Health Care Reform compliant plans should cover at 100% for in-network providers. The following is a list of common services that are included: • Routine physical exam • Well baby exams • Immunizations • Bone density tests • Cholesterol screenings • Mammograms • Pap smears/pelvic exams

• Colonoscopies • Prostate test • Lab procedures • Screenings for HIV, HPV, and domestic violence • Breastfeeding supplies • Contraceptive drugs, devices, and sterilization • Smoking cessation

MAKING THE MOST OF YOUR MEDICAL PLAN Know where to go – Save the ER for emergencies!

Going to the emergency room (ER) or calling 9-1-1 is always the way to go when it’s an emergency. We’ve got you covered for those situations. You are responsible for ER costs when it’s not an emergency. If you need care but it’s not an emergency, try these other options. You can avoid a long wait and the higher costs that come with a non-emergency ER visit.

Call your doctor.

Visit a retail health clinic.

Head to urgent care.

Your doctor knows your story.

Treatment that’s nearby.

Quick after-hours care.

Your primary care provider usually has easy access to your records, knows the bigger picture of your health, and may offer same-day appointments to meet your needs.

Consider this when you have a rash, minor burns, cough, sore throat, minor allergic reactions, bumps, cuts, and scrapes, or when you need shots. Hours of operation vary.

An Urgent Care Center may be the right choice when you have back and joint pain, cough/cold, sinus or ear pain, sprains and strains, or even need x-rays. Flexible hours, including nights and weekends.

Use Virtual Care.

Emergency Room.

Anywhere, anytime online virtual visit.

Only for true life-threatening situations.

Speak with a medical practitioner who can diagnosis, treat & prescribe right over the phone 24/7. Great for colds, flus, infections, pink eye, poison ivy & more.

There are situations when the ER is the only option. However, it will be the most expensive and take the most time if it is not a life-threatening or severe situation. Use the options listed above to save money and time.

MEDICAL PLAN BENEFITS OPTION 1

OPTION 2

PPO Medical Plan

HMO HDHP Medical Plan

Network

Anthem Blue Cross

Anthem Blue Cross

Calendar Year Deductible

Individual: $5,000 Family: $10,000

Individual: $X,XXX Family: $X,XXX

100%

XXX%

Individual: $7,350 Family: $14,700

Individual: $5,000 Family: $10,000

Office Visit Copay Primary Care Specialist Care

$30 copay $60 copay

$30 copay $60 copay

Virtual Visit Copay

$30 copay

$30 copay

100% covered

100% covered

Inpatient Hospital

0% after deductible

0% after deductible

Outpatient Services

0% after deductible

0% after deductible

Emergency Room

0% after deductible

0% after deductible

$75 copay

$75 copay

Coinsurance Out of Pocket Maximum

Preventive Visit Copay

Urgent Care Prescription Drug Copay Retail Pharmacy Mail Order

$10/$40/$70/25%

$10/$40/$70/25%

$25/$120/$210/25%

$25/$120/$210/25%

Out of Network Benefits

Reduced Levels of Benefits

Reduced Levels of Benefits

YOUR Rx CHOICE TIERED NETWORK Level 1 includes nearly 20,000 pharmacies where you can get your prescriptions filled for the copay or percentage of the drug costs you normally pay as part of your prescription drug plan. Level 1 includes popular chains such as: • CVS • Target • Walmart • Kroger • Safeway

Level 2 offers you more pharmacy choices, but you’ll also pay a little more — an extra amount on top of your share of the drug cost, depending on your benefit — no matter which drug you fill.

Pharmacies available on Level 2 include: • Walgreens • Rite Aid • Sam’s Club • Meijer • Costco

DENTAL PLAN BENEFITS OPTION 1

PPO Dental Plan Network

PPO and Premier

Calendar Year Deductible

$50 individual / $150 family

Annual Maximum

$1,000 per person

Preventive Services

100% covered, no deductible

Oral exam, cleanings, x-rays, fluoride for children

Basic Services

20% after deductible

Extractions, minor oral surgery, fillings

Major Services

50% after deductible

Endodontics, periodontics, implants, oral surgery

Orthodontic Services

$1,000 lifetime maximum

VISION PLAN BENEFITS

Benefit Frequency

In-Network

Out-of-Network Reimbursement

Vision Exam

12 months

$10 copay

Up to $40 allowance

Frames

24 months

Frame Lenses

12 months

Contacts

12 months

Lasik & PRK

N/A

$130 retail allowance 20% off balance

Up to $91 allowance

Single – $10 copay

Single – up to $20 allowance

Bifocal – $50 copay

Bifocal – up to $100 allowance

Trifocal – $80 copay

Trifocal – up to $160 allowance

$130 retail allowance 15% off balance Provider Discount up to 20%

Up to $130 allowance

Not available

LIFE AND AD&D INSURANCE PLAN Life Insurance is payable to the designated beneficiary upon the death of the insured.

Accidental Death & Dismemberment (AD&D) Insurance provides specified benefits for a covered accidental bodily injury that directly causes dismemberment (i.e., the loss of a hand, foot or eye). If death occurs from an accident, both the Life and AD&D benefit would be payable.

Employer Sponsored Basic Life Insurance Life Benefit

$20,000

AD&D Benefit

$20,000

Benefit Reduction

Benefits are reduced by 35% at age 65, by an additional 15% at age 70

Conversion

If you terminate your employment, you may convert your coverage to an individual Whole Life Policy offered by the insurance carrier

VOLUNTARY LIFE INSURANCE PLAN This plan provides the opportunity to purchase additional coverage on yourself. If you enroll, you may also purchase coverage on your spouse and/or children. If you do not elect at initial enrollment, you will need to complete an application which includes medical questions. You may be declined or offered a lower amount than requested. If you elect less than the maximum benefit, you may be eligible at open enrollment to increase your amount.

Voluntary Life Insurance Life Benefit

$50,000 guarantee issue, if under age 70. $10,000 guarantee issue, if age 70 and above. $10,000 increments up to $300,000.

Benefit Reduction

Benefits are reduced by 35% at age 65, by an additional 15% at age 70

Conversion

If you terminate your employment, you may convert your coverage to an individual Whole Life Policy offered by the insurance carrier

Spouse Coverage

$5,000 increments up to $100,000. Cannot exceed 100% of employees benefit. $20,000 guarantee issue if under age 70. $10,000 guarantee issue if age 70 and above.

Children Coverage

$5,000 or $10,000 – eligible children 14 days or older (if under 14 days of age receive $1,000)

DISABILITY PLAN BENEFITS If you become disabled and cannot work, no benefit becomes more important to your financial security than disability income protection. As an eligible employee you are eligible for both Short-Term Disability (STD) and Long-Term Disability (LTD) Insurance. The premiums are post-tax; therefore, if you ever receive a disability benefit payment, it will be a tax-free benefit. STD has a pre-existing condition limitation of 3/6.

LTD will require you to complete an application which includes medical questions if you do not elect the benefit when initially offered at new hire.

Voluntary Short-Term Disability Weekly Benefit

60% of your weekly salary to a maximum weekly benefit of $1,000

Benefits Begin

8th day absent due to accident 8th day absent due to illness

Benefit Duration

Up to 12 weeks

Voluntary Long-Term Disability Monthly Benefit

60% of your monthly salary to a maximum monthly benefit of $5,000

Benefits Begin

90 days after you have been absent from work due to a covered accident or illness

Benefit Duration

Age 65

HEALTH SAVINGS ACCOUNT (HSA) If you are enrolled in a high-deductible health plan, you are eligible to participate in a Health Savings Account (HSA). An HSA is an investment tool that helps you save for healthcare expenses, including deductibles, coinsurance, prescriptions, physician visits and more. For a list of HSA compatible expenses, please visit IRS.gov.

Contributions to your HSA are pre-tax, and any interest earned on the account is tax-free. You may opt to direct some funds from your paycheck directly to your HSA, making saving easy! These bank accounts are in your name and are separate from your employer. Balances rollover year after year. There is not a useit-or-lose provision with an HSA. In addition to being contributed tax-free, interest earnings and withdrawals for qualified medical expenses are also tax-free. Triple tax savings!

Annual Maximum Contribution 2023

What Expenses Are Allowed?

Advantages Of An HSA

Things To Consider

Employee Only

Employee + Dependent(s)

Up to $3,850

Up to $7,750

•

Medical (including copays, coinsurance), dental (fillings, ortho), and vision expenses (glasses, contacts, LASIK)

•

Prescription medications (including prescribed over-the-counter drugs)

•

COBRA and Long-Term Care premiums

•

Acupuncture and chiropractor expenses

•

Labs and x-rays

•

HSA funds used for eligible expenses are tax-free

•

Contributions are tax-deductible and earnings grow tax-free

•

HSA funds roll over from year to year

•

HSA accounts are portable and yours to keep, regardless of your employer or insurance carrier

•

Deposits may be invested in mutual funds

•

Plans eligible for HSAs come with a higher annual deductible

•

HSA-eligible plans work differently than traditional plans. Take the time to fully understand how your plan works

•

You will need to save receipts for eligible expenses for tax filing purposes

•

If you are over 55 years of age, you can make catch-up contributions

•

You are not eligible for an HSA if you are insured by more than one health plan, including Medicare

EMPLOYEE ASSISTANCE PROGRAM (EAP) Life is not always easy. Sometimes a personal or professional issue can get in the way of maintaining a healthy, productive life. Your Employee Assistance Program (EAP) can be the answer for you and your family.

We’re here to help employees and their eligible dependents with personal or job-related concerns, including: • Emotional well-being • Family and relationships • Legal and financial • Healthy lifestyles • Work and life transitions

Program Portal www.anthem.com

EAP Benefits • Access to EAP professionals 24 hours a day, seven days a week • Provides information and referral resources • Service for employees and eligible dependents • Robust network of licensed mental health professionals • Face-to-face sessions with a counselor may be available What to Expect You can trust your EAP professional to assess your needs and handle your concerns in a confidential, respectful manner. Our goal is to collaborate with you and find solutions that are responsive to your needs. Your EAP benefits are provided through your employer. There is no cost to you for utilizing EAP services. If additional services are needed, your EAP will help locate appropriate resources in your area.

Get the most out of your benefits When it comes to managing your health plan and making more informed decisions, simpler is better.

You have a personalized website that helps you access and manage your health plan. Use it to: • Find and estimate costs for the network care you need.

• See what’s covered and get information about preventive care.

• View claim details and account balances.

• Sign up for paperless delivery of your required plan communications Going Mobile Use your mobile device to search for doctors, hospitals and more with our free app, Sydney Health, from the App Store or Google Play. Just search for Anthem Blue Cross and Blue Shield or Sydney Health, and download the app. You can even get turn-by-turn directions to find a doctor’s office. Access your health plan ID card.

THE LEGALSHIELD MEMBERSHIP • • • • • • • • • • • • •

Dedicated Law Firm Direct access, no call center Legal Advice/Consultation On unlimited personal issues Letters/Calls made on your behalf Contracts/Documents Reviewed Up to 15 pages Residential Loan Document Assistance For the purchase of your primary residence Will Preparation - Living Will, Health Care Power of Attorney, Financial Power of Attorney Speeding Ticket Assistance Upload your speeding ticket from the mobile app directly to la IRS Audit Assistance (Begins with the tax return due April 15th of the year you Trial Defense (If named defendant/respondent in a covered civil action suit) Uncontested Divorce, Separation, Adoption and/or Name Change Representation (Available 90 days after enrollment) 25% Preferred Member Discount (Bankruptcy, criminal charges, DUI, personal injury, etc.)

24/7 Emergency Access For covered situations

THE IDSHIELD MEMBERSHIP • Credit Monitoring Continuous credit monitoring through TransUnion • Online Privacy Management IDShield provides consultation and guidance on ways participants can protect their privacy and personally identifiable information across the internet and on their smart devices.

• NEW! Reputation Management & Score Scans social media accounts for existing content that could be damaging to participants’ online reputations. Ranks your online reputation risk by giving you a score based off the content found on your social media accounts.

• Financial Account Monitoring Accounts monitored include checking, savings, employer 401k accounts, loans, and more.

• $1 Million Protection Policy Coverage for lost wages, legal defense fees, stolen funds, and more.

• Unlimited Service Guarantee Ensures that we won’t give up until your identity is restored!

• Identity Restoration Performed by Licensed Private Investigators to restore your identity to its pre-theft status.

• 24/7 Emergency Access In the event of an identity theft emergency.

HELPFUL CONTACTS The Strategic Benefits team is here to help you make the most of your employee benefits package. Please refer to this list when you need to contact one of your benefit vendors. For general information, contact your Human Resources Department or our Strategic Benefits team.

First & Last Name

First & Last Name

(XXX) XXX-XXXX first.last@sbcinci.com

(XXX) XXX-XXXX first.last@sbcinci.com

•

• • • •

Plan Management

Enrollments/Terminations Claims Employee Contact Employee Navigator Support

Additional Resources…

Contact...

Call...

Email/Visit...

Medical

Anthem

(XXX) XXX-XXXX

xxxx@xxxx.com

Dental

Delta Dental

(XXX) XXX-XXXX

xxxx@xxxx.com

Vision

EyeMed

(XXX) XXX-XXXX

xxxx@xxxx.com

Life/AD&D

Principal

(XXX) XXX-XXXX

xxxx@xxxx.com

STD/LTD

Principal

(XXX) XXX-XXXX

xxxx@xxxx.com

KEY TERMS TO REMEMBER Plan Year Refers to the timeframe of January 1 through December 31.

Calendar Year Refers to the timeframe of January 1 through December 31.

Annual Deductible Your annual deductible is the amount you must pay each period before the plan starts paying a portion of medical expenses. Some services may require copays and do not apply to the deductible.

Copays and Coinsurance These expenses are your share of cost paid for covered services. Copays are a fixed dollar amount and are due at the time you receive care. Coinsurance is the percentage of covered expenses shared by you and the plan. In some cases, coinsurance is paid after the deductible has been met.

Out-of-Pocket Maximum This is the total amount you can pay out of pocket each plan year before the plan pays 100% of expenses for the rest of the plan year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the deductible.

NOTES

424 Wards Corner Road, Suite 120 Loveland, OH 45140 Main Phone: 513-366-3700 Fax: 513-351-1173

This booklet is a summary of your benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment nor is it a contract to provide these benefits.

Intellectual property of Strategic Benefits. Do not reproduce without the express permission of Strategic Benefits.