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2011 Open Enrollment October 11 – November 12, 2010

Welcome to UNIFI’s 2011 benefits open enrollment! We are pleased to offer you the Benefits Advantage Flexible Benefits Program once again as an integral part of UNIFI’s Total Rewards Program. The benefits described here are just some of the features that bring value to your working at a UNIFI company. Open Enrollment Informational Sessions The available informational sessions for this year’s open enrollment are listed below; meetings should last about 45 minutes with time at the end for questions. If you aren’t able to attend a session in person, you can listen in on any of the sessions scheduled in Lincoln by dialing 877-504-6661, access code 4024677160. Bethesda (all times are EDT) Calvert Wednesday, October 13th – 10th Floor Conference Room 8am Thursday, October 14th – 10th Floor Conference Room 2pm Acacia Tuesday, October 12th – Hurson Nason 10am AFSB Wednesday, October 13th – Employee Lounge 2:30pm Cincinnati (all times are EDT) Home Office Wednesday, October 13th – Rossi A 10:00am & 2pm Thursday, October 14th – Rossi A 10:30am & 2:30pm Tuesday, October 19th – Rossi A 10am & 2pm Summit Tuesday, October 12th – Main Conference Room 1pm & 2pm Lincoln (all times are CDT) Home Office Monday, October 11th – New Third 9am & 1pm Thursday, October 14th – New Third 1:30pm & 3pm Wednesday, October 20th – New Third 9am & 11am Fallbrook Wednesday, October 13th – Cafeteria Private Dining 11am, 1pm & 2:30pm Thursday, October 21st – Cafeteria Private Dining 11am & 12:30pm

Table of Contents Changes to Plans for 2011............................................................................................1 Core Benefits ................................................................................................................2 Short-Term Disability Plan Long-Term Disability Plan Group Term Life Insurance Business Travel Accident Insurance Employee Assistance Plan Your Pre-Tax Elections Health Plan Options ..............................................................................................4 Dental Plan ...........................................................................................................8 Vision Plan ..........................................................................................................11 Flexible Spending Accounts................................................................................13 Supplemental Life Insurance...............................................................................15 Your Post-Tax Elections Spouse Term Life Insurance ...............................................................................15 Dependent Term Life Insurance..........................................................................15 Accidental Death & Dismemberment (AD&D) .....................................................15 Open Enrollment Process and Instructions ..............................................................16

Health Care Reform Whether it is from the earlier open enrollment communication or the local and national news, many of you have heard of the recent changes to health care due to the Patient Protection and Affordable Care Act (PPACA – also known as “Health Care Reform”). Due to the PPACA, UNIFI will be making certain changes to the health care plans. However, UNIFI is already in compliance with many of the requirements including: No pre-existing condition limitations Preventive services covered at 100% No annual limits on essential benefits Break times and private locations for nursing mothers Employees can choose the primary care doctor or pediatrician they want from a plan’s provider network. • Employees can see an OB-GYN without needing a referral. • • • • •

New for 2011 • Expanded coverage up to age 26 for children of covered associates

• • • • • • •

• •

regardless of status (e.g. full-time student) for medical, dental, vision, dependent life and AD&D plans. The $3.5 million lifetime maximum under the medical plans has been eliminated. Domestic partner benefits have been expanded to include dental and vision plans. Coverage for Applied Behavioral Analysis (ABA) therapy for treatment of autism has been added under the medical plan. Mental health provider visits will now be considered under the primary care visit copay. No prior approval is needed before employees seek emergency care at a hospital outside a plan’s network United Healthcare’s Cancer Support Program has been added to the medical plan. A new prescription drug discount program through Walmart has been added to the dental and vision plans. (See the Dental and Vision sections of this booklet for details.) The UNIFI Adoption Assistance program has been expanded. (See the Core Benefits section for details.) Over-the-Counter drugs will no longer be eligible for reimbursement through FSAs or HSAs as a result of the PPACA. (For more information, see the Flexible Spending Accounts or Health Savings Accounts sections.) -1-

Core Benefits Our Benefits Advantage plan is built on a solid foundation of core benefits. Core benefits are provided to our associates who are regularly scheduled to work at least 20 hours per week. These benefits are fully company paid. There is no cost to you. A description of each major core benefit is included below: Short-Term Disability Plan The Short-Term Disability Plan provides benefits when eligible associates are unable to work due to illness or injury after satisfaction of a 7-day elimination period. Approved claims pay an income replacement benefit of 66 2/3% of salary or eligible earnings for a maximum of 25 weeks. Long-Term Disability Plan The Long-Term Disability Plan provides benefits when eligible associates are unable to work due to illness or injury after satisfaction of a 180-day elimination period. Approved claims pay an income replacement benefit of 60% of salary or eligible earnings. Group Basic Life Insurance UNIFI provides group basic life insurance in an amount equal to your salary or eligible earnings with a minimum of $50,000 and a maximum of $100,000. A basic accidental Death and Dismemberment benefit is also provided equal to 100% of your basic life insurance with lesser amounts for certain losses.


Business Travel Accident Insurance Eligible associates are covered by business travel accident insurance. The policy provides up to $300,000 of accidental death and dismemberment benefits if you are injured or die in an accident while traveling on Company business. Employee Assistance Program The Employee Assistance Program (EAP) provides free, confidential, and professional services to help you find solutions before, during and after any problem - large or small adversely affects your well being, health or job performance. Our EAP also provides a wealth of information through the internet on topics such as parenting, nutrition, eldercare, and personal finance. Adoption Assistance Program Adopting a child can be a major change in an associate’s life, so UNIFI has implemented an Adoption Assistance Program that provides eligible associates with reimbursement of up to $5,000 for Qualified Adoption Expenses. Also, Adoption Leave provides associates with up to ten working days leave with full pay in connection with the adoption process. See the UNIFI Intranet policies page for more information.


Health Plan Options Many companies don’t offer you a choice in health plans. They offer only one and you either elect it or you don’t. At UNIFI, we understand that the same option doesn’t necessarily work well for everyone so we still offer you choices. There are three health plan options for you to choose from. All three are administered by United HealthCare. • • •

Premium Plan Standard Plan High Deductible Health Plan (which allows you to participate in a Health Savings Account)

These plans provide valuable features such as: - In-Network Preventive Services paid at 100% • Annual physical • Well-child visits • Well-woman/Well-man visits • Vaccinations • Mammogram • Diagnostic screenings (e.g. cholesterol, cancer) - Colonoscopy covered at co-insurance level with no deductible - Access to the nation’s leading health care network On the next page is a brief comparison of each plan. More complete descriptions of the plans can be found in the Summary Plan Descriptions located on the HR Intranet page. Health and Wellness In addition to the preventive services noted above, UNIFI also offers the following health and wellness programs, depending on location, for your participation. • • • • • • • •

Annual Health Risk Assessments Fitness Subsidy Program Weight Watchers Reimbursements Flu Shot Clinics UNIFIed Strides Walking Program Quit Power Smoking Cessation Program Healthy Pregnancy Program Healthy Behaviors Program

More information on these programs can be found on the HR Intranet page. -4-

Health Plan Comparison Premium Plan $ 500 Ded

Premium Plan $ 500 Ded

Standard Plan $1,000 Ded

Standard Plan $1,000 Ded









$ 500 $ 1,500

$ 1,000 $ 3,000

$ 1,000 $ 3,000

$ 2,000 $ 6,000

$ 2,500 $ 5,000

$ 5,000 $10,000








Out-of-Pocket Maximum Individual Family

$ 2,500 $ 7,500

$ 5,000 $15,000

$ 4,000 $12,000

$ 8,000 $24,000

$ 2,500 $ 5,000

$10,000 $20,000

Lifetime Max







Office Visit Copays Primary Specialist

$ 20 $ 40


$ 30 $ 50




100% No Maximum

100% No Maximum

100% No Maximum

100% No Maximum

100% No Maximum

100% No Maximum

Retail $ 10 $ 30 $ 50

Mail Order $ 10 $ 30 $ 50

Retail $ 15 $ 35 $ 55

Mail Order $ 15 $ 35 $ 55

Benefits Summary

Deductible Individual Family

Preventative Prescription Tier 1 Tier 2 Tier 3 Mail Order

Retail Mail Order Ded/Coinsur Ded/Coinsur Ded/Coinsur Ded/Coinsur Ded/Coinsur Ded/Coinsur

2 ½ x Retail 2 ½ x Retail 2 ½ x Retail 2 ½ x Retail Ded/Coinsur Ded/Coinsur

* The HDHP is the “qualified” High Deductible Health Plan (HDHP). Coverage under this medical option allows for a contribution to a Health Savings Account (HSA). If enrolling more than one person in the HDHP, the family deductible must be met before benefits are paid. **After Deductible

Semimonthly Health Plan Costs

EE EE + Spouse/Domestic Partner EE + Child(ren) Family

Premium Plan $ 500 Deductible $73.27

Standard Plan $1,000 Deductible $28.49





$139.20 $251.35

$54.12 $105.40

$24.98 $55.23



High Deductible Health Plan (HDHP) and Health Savings Account (HSA) Information The High Deductible Health Plan (HDHP) helps protect you from large healthcare expenses once the deductible has been met. This plan does not offer any “first dollar coverage”, which means the plan does not pay for any medical expenses until the annual deductible has been met. Those expenses are paid either out-of-pocket or with funds from a Health Savings Account (HSA) which then go toward meeting your annual deductible. A HDHP is a type of health qualifying plan that allows you to have a HSA. A HSA is a financial account that you can use to accumulate tax-free funds to pay for qualified health care expenses as defined by the Internal Revenue Service. The account acts like a regular checking account with a debit card and earns interest. All money in the account is owned by you and is fully vested as soon as it is deposited. Funds can accumulate over time and the account is portable. As long as you use the funds for qualified health care expenses, you will pay no taxes. If you use the money for other expenses, you will pay tax and a penalty. The IRS has established HSA contribution limits* for 2011 as follows: • $3,050 for individual coverage • $6,150 for family coverage *Individuals age 55 and over are able to make additional catch up contributions not exceeding $1,000. HSAs offer the following advantages: • Tax Savings. You contribute pre-tax dollars to the HSA. UNIFI will also make contributions to your HSA on a per pay period basis. Any monies used for eligible expenses can be withdrawn tax-free. • Reduce your out-of-pocket costs. You can use the money in your HSA to pay for eligible medical expenses and prescriptions. The HSA funds you use can help you meet your plan’s annual deductible. It can also be used for eligible dental and visions expenses. • Invest the funds and take them with you. Unused account dollars are yours to keep even if you retire or leave the company. Additionally, your HSA funds earn interest, so your available healthcare dollars can grow over time. • The benefits of preventive care, without the cost. Receive 100% coverage for certain recommended preventive care, with no deduction from your HSA or out-ofpocket costs for you when you see an in-network provider. • The opportunity for long-term savings. Save unused HSA funds from year to year – money you can use to reduce future out-of-pocket health expenses. You can even save HSA dollars to use after you retire. UNIFI will contribute funds to your HSA; $500 annually for employee only coverage, $1,000 for employee plus spouse, children or family coverage. These contributions will be deposited on a per pay period basis ($20.83 and /$41.67, respectively) and do count toward the annual contribution limits. -6-

Following are some key HSA points: • All company contributions will be made to an account at Acacia Federal Savings Bank (AFSB), the UNIFI HSA provider. • If you elect to make voluntary contributions to the HSA through payroll deduction, those contributions will be made to AFSB on a per pay period basis. You may change your contribution the beginning of any pay period. • You can voluntarily deposit funds (non-payroll deducted) directly to your AFSB account at any time. • It is your responsibility to ensure you do not exceed the annual contribution limits. (For 2011 they are: $3,050 for single, $6,150 for family, with an additional catch up contribution of $1,000 available for associates 55 and older.) • It is your responsibility to ensure your HSA funds are used only for qualified expenses. PLEASE NOTE: For 2011 over-the-counter (OTC) medications will no longer be reimbursable under the healthcare FSA unless a doctor prescribes them. However, things such as first aid supplies, insulin and diabetic supplies, and eye care and contact lenses supplies are still eligible for coverage. For more information, or a more complete list of eligible items, please see the HR Intranet or the BCI Online Benefits Website. • You may choose to establish an HSA at another financial institution though pre-tax payroll deduction will not be available and any company contribution would continue to be made to AFSB. • If you have an existing HSA, you may roll that over to AFSB. The HSA at AFSB will be an interest bearing account with no minimum balance requirement or annual administration fee. The company will pay the $20 set-up fee. Account holders can access funds in a variety of ways including a free VISA Check Card issued by AFSB. For more information on the AFSB HSA, please contact them directly at ext. 78301 (703-506-8301) or at


Dental Plan The UNIFI Dental Plan offers benefits for preventive and diagnostic care, minor and major restorative services, and orthodontics. There is also an incentive program called “Dental Rewards” that encourages you to seek routine dental care by raising the annual maximum benefit available to you, should you meet the guidelines as outlined in the plan. The inclusion of “LASIK Advantage” and “SoundCare” give this Plan something for almost everyone. Type I & II Procedures Services Preventive, Diagnostic, & Minor Restorative: Oral Exam Fillings or restorations Cleaning Simple extractions Fluoride treatment Oral surgery X-rays General anesthesia Space maintainers Endodontics (root canals) Diagnostic services Periodontics (gum disease)

Your Coinsurance PPO In-Network*

Your Coinsurance Out of Network

Year 1: 30% Year 2: 20% Year 3: 10% Year 4+: Covered in full

Year 1: 40% Year 2: 30% Year 3: 20% Year 4+: 10%

No deductible applies

No deductible applies

*To find a PPO provider, go to the Ameritas Group website at and select “Find a Provider.” When selecting a network, choose “PPO-Nationwide.” Note: If you are a late entrant, meaning you did not enroll in dental coverage when you were first eligible, your coverage will start at level 1 providing only for exams, cleanings and fluoride applications (for children only) for the first 12 months. The late entrant guidelines also apply to the LASIK Advantage and SoundCare programs, as your year one benefit will not begin until you have been on the plan for 12 consecutive months.

Type III Procedures Services Major Restorative: Onlays Crowns and build-ups Removable dentures* Fixed bridges* Full or partial denture relines/adjustments* Implants *Subject to Policy Provisions

Deductible & Your Coinsurance Annual deductible $50/individual $100/family maximum 50% after deductible

Calendar Year Maximum Benefit Type I, II and III Procedures combined (not including orthodontia)



Dental Rewards The annual dental maximum can be increased under a feature called Dental Rewards! Here’s how it works . . . if you file at least one dental claim during the calendar year and your benefits paid are less than $750 for the year, you will qualify for a reward of a $400 increase in your annual maximum the following calendar year. This continues until you reach a Dental Reward total of $1,200. The reward amount is available to use in future years in addition to your $2,000 calendar year maximum. The total Dental Reward amount earned is reduced by any amount used in any year. Note: Orthodontic procedures are excluded from Dental Rewards as they have their own maximum benefit. Here’s an example: Annual dental max for Preventive, Basic, and Major Procedures combined ........$2000 Annual threshold (in other words, claims for the year do not exceed this amount) $750 Annual reward toward next benefit year.................................................................$400 Next year’s annual maximum benefit plus the reward..........................................$2400 Orthodontia Services

Your Coinsurance

No age limit


Lifetime Benefit Maximum


LASIK Advantage and SoundCare An important advantage of participating in our Dental Plan is having access to two significant programs that can assist you in covering benefits that may not be covered under other benefit plans. LASIK Advantage and SoundCare cover vision and hearing procedures that aren’t otherwise covered under the medical or vision plans.

LASIK Advantage LASIK Advantage provides benefits for LASIK and related procedures. As a participant in the dental plan you earn a lifetime LASIK benefit per eye over time. The benefit amount increases over a four year period, with the highest benefit provided in year four. Benefits are earned for each eye. The LASIK Advantage benefit is available to participants age 18 and older. The benefit offers choice! Any specialist can be chosen as there is no network tied to this coverage. Lifetime Benefit Earned per Eye: Year One $100

Year Two $250

Year Three $500 -9-

Year Four $750

SoundCare The dental plan also includes a hearing benefit called SoundCare. Benefits are available for: Annual Hearing Exam ................... 100% coverage (no deductible applies) up to a maximum annual benefit of $75 Hearing Aid Maintenance.............. 100% coverage (no deductible applies) up to a maximum annual benefit of $40 Hearing Aids ................................. 50% coverage (no deductible applies) Year One: Up to $500 per ear Year Two: Up to $750 per ear Year Three: Up to $1000 per ear Once you use the hearing aid coverage at any level, you become re-eligible for the hearing aid benefit at the highest benefit level after five years as long as there is no break in your coverage. While you’re free to use any licensed hearing professional, Ear Professionals International Corporation (EPIC) will offer you the services of its nationwide alliance of screened, qualified experts in hearing evaluation and treatment. EPIC also offers trained hearing counselors who can answer your questions, help you schedule appointments and deliver negotiated best pricing for treatment protocols including hearing aids.

Semimonthly Dental Plan Costs DENTAL PRICE TAGS EE


EE + Spouse/Domestic Partner


EE + Child(ren)




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Vision Plan Associates participating in this eye care plan may choose from any eye care provider. However, by obtaining services from any Vision Service Plan (VSP) provider, associates can benefit from significant cost savings! VSP offers a nationwide network of eye care professionals who accept discounted fees as full payment for services under prearranged guidelines. In addition, associates using VSP providers receive special discounts on additional pairs of prescription glasses and services associated with contact lenses. Through the VSP eye care benefit, associates also have access to discounts for laser eye surgery. VSP Benefits Annual Deductible Exams Materials

Services Annual Exam Frames Single Lenses Bifocal Lenses Trifocal Lenses Lenticular Lenses Contact Lenses Necessary (***) Contact Lenses Elective (***)

Benefits with VSP Provider

Maximum Covered Expense with Non-VSP Provider (****)

$0 $25.00

$0 $25.00

Benefits with VSP Provider

Maximum Covered Expense with Non-VSP Provider (****)

100% Covered $120.00 (**) 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered $105.00 per pair (***)

$47.00 $45.00 $48.00 per pair $69.00 per pair $85.00 per pair $125.00 per pair $210.00 per pair $105.00 per pair

**VSP provides a $120 allowance toward a new frame. If patient chooses a frame valued at more than the plan’s allowance, the patient will receive a 20% discount on the amount over the frame allowance. ***Patients have the choice of frames and lenses OR contact lenses in a 12 month period ****Patient pays remainder To find a VSP provider, visit the Ameritas Group website at and select “Find a Provider” or contact VSP at 800-877-7195.

Frequency Allowance The same frequency allowance applies whether using a VSP or non-VSP provider. Exam .................................................. Every 12 Months Lenses................................................ Every 12 Months Frames ............................................... Every 12 months

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Semimonthly Vision Plan Costs VISION PRICE TAGS $5.75 $11.03 $9.27 $14.55

EE EE + Spouse/Domestic Partner EE + Child(ren) Family

NEW FOR 2011 for both the Dental and Vision Plans Ameritas Group is partnering with retail industry giant Walmart Stores, Inc. to offer discounts on prescription medications through any Walmart or Sam's Club pharmacy nationwide. This optional no-additional-cost Rx discount is available to all of our dental, eye care and hearing care policyholders. Because it's not insurance, the Rx discount adds value without increasing premium costs. All UNIFI associates who participate in our dental and/or eye care plans are eligible. To find out how to get the Rx discount and where to call for more information, click here.

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Flexible Spending Accounts (FSAs) Flexible Spending Accounts (FSAs) help you manage your out-of-pocket expenses by allowing you to set aside money from your pay on a pre-tax basis to help pay for eligible healthcare (medical, dental and vision) and dependent care expenses. Since taxes are not taken out, the money you are reimbursed through the FSA goes further than after-tax dollars when paying for out-of-pocket expenses. Because of the tax benefits associated with FSAs, there are also some restrictions: • You must use the money placed in the account for any given year to pay for eligible expenses you have during that same year. • If you have money left in your account that is not used for eligible expenses during the year that money is forfeited. In other words, “use it or lose it.” • You cannot transfer money back and forth between the healthcare and the dependent care accounts. • You may not change, start or stop your healthcare FSA contributions once the plan year begins, however certain status changes may allow changes in your dependent care FSA. There are three kinds of flexible spending accounts. Each one is described below: Dependent Care FSA The Dependent Care FSA allows you to contribute up to $5,000 annually to cover certain expenses for the care of dependents which allow either you or your spouse to work or attend school full time. A dependent is defined as a child under age 13 claimed as a tax dependent, or other individual living with you (e.g. child over 12, spouse, parent, sibling) who is physically or mentally unable to care for him/herself. UNIFI offers a subsidy of up to $1,000 for the dependent care FSA depending on your annual salary. For example: If You Earn…

You Contribute…*

$25,000 or less






$45,001-$55,000 $55,001 or more

$4,750 $5,000

UNIFI Matches… 20% of your contribution 15% of your contribution 10% of your contribution 5% of your contribution 0%

Up to…* $1,000


$ 750


$ 500


$ 250 $ 0

$5,000 $5,000

*Divide these amounts in half if you and your spouse file separate tax returns. - 13 -

For a Total of…*

Healthcare FSA You can contribute to a Healthcare FSA even if you don’t participate in the UNIFI health plan. You may contribute up to $5,000 annually to cover eligible healthcare-related expenses. A debit card is also available for this account to make it easy for you to pay for these expenses; substantiation of those payments may still be required. Some examples of eligible expenses are provided below. These expenses are eligible only if they were not paid for by insurance. (For a complete list of eligible expenses review IRS Publication 502.) • • • • •

Office Visit Copays Deductibles or co-insurance Prescription Drug Copays Dental Expenses Vision Expenses

PLEASE NOTE: For 2011 over-the-counter (OTC) medications will no longer be reimbursable under the healthcare FSA unless a doctor prescribes them. However, things such as first aid supplies, insulin and diabetic supplies, and eye care and contact lenses supplies are still eligible for coverage. To be reimbursed for OTC medications, you will need to supply not only the receipt, but the prescription (or a copy) to BCI for payment. For more information, or a more complete list of eligible items, please see the HR Intranet or the BCI Online Benefits Website. Limited Purpose Healthcare FSA For participants in the High Deductible Health Plan, most healthcare expenses are reimbursable only through their Health Savings Account (HSA). However, the Limited Purpose FSA allows you to set aside pre-tax money to use for eligible dental and vision expenses. Claims submitted to the Limited Purpose FSA that are not dental or vision related will be denied. FSA Claims Process FSA claims will be processed by Brokerage Concepts, Inc. (BCI). BCI supports UNIFI’s benefit enrollment and FSA administration. Your FSA contributions can be accessed one of two ways. 1. You can elect to receive a “Benefits Card,” a debit MasterCard that can be used at retailers participating in the Inventory Information Approval System (most pharmacies and drug stores participate however that is not a guarantee that your specific pharmacy will). Using the benefits card will allow you instant access to the money in your FSA without submitting a paper claim. However, using the benefits card does not mean that you will not have to substantiate your claim. Under certain circumstances you may receive a request to verify the eligibility of a purchase made by using your card. 2. You can choose to submit paper claims for reimbursement. You may choose to set up a direct deposit to your bank account or to have a check mailed to you. Claims for reimbursement from your FSA may be submitted to BCI through March following the end of the plan year as long as the expenses were incurred during the plan year for which the FSA was elected. - 14 -

Group Life Insurance Life insurance helps you ensure the financial security of your loved ones. How much life insurance you need and what types are right for you depend on your personal needs and circumstances. UNIFI’s Group Life Plan offers several different types and levels of coverage to choose from. When considering additional group life insurance options, remember that UNIFI already provides group basic life insurance in an amount equal to your salary or eligible earnings with a minimum of $50,000 and a maximum of $100,000. Supplemental Life Coverage In addition to the Core group life insurance coverage, associates have the option of purchasing up to $650,000 (in $10,000 increments) of additional coverage. Evidence of Insurability (EOI) will be required if your election is greater than your current coverage level. Premiums for Supplemental Life Coverage are payroll deducted on a pre-tax basis offering you additional tax savings when you elect this coverage. The premiums for all other Group Life options are collected after taxes are deducted from your pay. Spousal Life Coverage You may purchase life insurance separately for your spouse with a minimum of $10,000 and a maximum of $250,000 of coverage in $5,000 increments. The amount of spousal life insurance coverage purchased may not exceed 100% of your Core and Supplemental coverages combined. Evidence of insurability will be required if the election is greater than the current coverage level. Child Life Coverage You may purchase life insurance for your children in increments of $2,500 with a maximum of $10,000. Evidence of insurability is not required for child life coverage. Coverage elected includes all children at one rate.

Accidental Death & Dismemberment (AD&D) A separate voluntary AD&D plan is also provided which allows you to supplement the basic coverage provided by the group life plan. AD&D provides a benefit if you die or are injured as a result of an accident. You may purchase $10,000 to $500,000 in coverage in increments of $5,000-$10,000 depending on the level of coverage. Coverage amounts exceeding $250,000 may not exceed 10 times your annual eligible earnings. If you elect dependent/family coverage, the coverage level for your dependents is based on the coverage level you elect for yourself. - 15 -

Open Enrollment Process and Instructions Once again all enrollments will be done online utilizing the Online Benefits Site. All associates eligible for benefits must complete the enrollment process even if you are not currently enrolled in benefits or if you do not wish to make changes to your current coverage. The enrollment process should be completed as soon as possible beginning Monday, October 11th, but no later than Friday, November 12th. The following is a guide to the enrollment process. If you do not remember your username or password once you have accessed the site, you should follow steps 4 and 5 below to retrieve it prior to beginning your enrollment. 1. Go to the Online Benefits Site, You may access the site from any computer 24 hours a day, 7 days a week. The link can also be found on the HR Intranet page under “Benefits.” 2. Enter your username and password. This is a username and password that you created when you first logged on to the system. It is not automatically set as your LAN ID and password. 3. The username and password you enter must exactly match the information Benefit Concepts, Inc. (BCI), our third-party administrator, has on file for you. 4. If you cannot remember either your username or password, follow the "Forgot your username?" and "Forgot your password?" links to retrieve this information. 5. Answer the hint question that you selected during your initial setup. 6. Note: If you are unable to recall the answer and are still unsuccessful logging into the site, contact BCI at 1-800-898-1309 or by email at 7. Upon a successful log in, we encourage you to review all of the information that is available on the site. 8. Click on the "2011 Open Enrollment" link to begin the enrollment process. 9. Review the enrollment instructions as well as the "Online Enrollment Tips" link. 10. Current coverage will be indicated as you complete the process. 11. Check all personal data for accuracy (i.e. address, date of birth and dependent information, etc.) 12. Make your benefit elections 13. If you do not wish to elect Accidental Death and Dismemberment, or if you do not wish to participate in either the health care or the dependent care flexible spending accounts, you must enter a zero (“0”) in the box. 14. Review your elections; the system will notify you if you have made any errors. If you are satisfied with your elections, click continue. 15. Your enrollment is complete only when you see the red Confirmation Number at the bottom of the page. Please print your confirmation statement for your records. - 16 -

If you need to make changes you can log back into the site and go back to either your last saved transaction or your last saved confirmation; changes to your elections can be made through the end of the day on Friday, November 12th. Open enrollment is just a week away! Hopefully this e-brochure has given you the information you need to make the decisions that will be most beneficial for you and your family.

If you experience difficulty with the enrollment process, contact BCI at 800-898-1309 or If at any time you have questions regarding the benefits program, please contact one of the following: • • •

Melissa Zahourek Ext. 87162 Jami Gray Ext. 52286 Dana Hill Ext. 71268

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Notice to all health plan participants. Women’s Health and Cancer Rights Act The Women's Health and Cancer Rights Act of 1008 was enacted on October 21, 1998. Group health plans providing benefits for mastectomy must also provide, in connection with mastectomy for which the participant or beneficiary is receiving benefits, coverage for: • Reconstruction of the breast on which the mastectomy has been performed; • Surgery and reconstruction of the other breast to produce symmetrical appearance; and • Prostheses and physical complications of mastectomy, including lymphedemas. Coverage must be provided in a manner determined in consultation between the attending physician and the patient. These benefits will be provided subject to the same annual deductibles and coinsurance provisions applicable to other medical and surgical benefits provided under the plan. Extension of dependent coverage to age 26 Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the UNIFI Companies Health Benefit Plan. Individuals may request enrollment for such children for 30 days from the date of this notice or the end of open enrollment, whichever is later. Enrollment will be effective January 1, 2011. For more information, contact your local benefits representative. Lifetime limits The lifetime limit on the dollar value of benefits under the UNIFI Companies Health Benefit Plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice or the end of open enrollment, whichever is later, to request enrollment. For more information, contact your local benefits representative. Notice about the Early Retiree Reinsurance Program You are a plan participant, or are being offered the opportunity to enroll as a plan participant, in an employmentbased health plan that is certified for participation in the Early Retiree Reinsurance Program. The Early Retiree Reinsurance Program is a Federal program that was established under the Affordable Care Act. Under the Early Retiree Reinsurance Program, the Federal government reimburses a plan sponsor of an employment-based health plan for some of the costs of health care benefits paid on behalf of, or by, early retirees and certain family members of early retirees participating in the employment-based plan. By law, the program expires on January 1, 2014. Under the Early Retiree Reinsurance Program, your plan sponsor may choose to use any reimbursements it receives from this program to reduce or offset increases in plan participants’ premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs. If the plan sponsor chooses to use the Early Retiree Reinsurance Program reimbursements in this way, you, as a plan participant, may experience changes that may be advantageous to you, in your health plan coverage terms and conditions, for so long as the reimbursements under this program are available and this plan sponsor chooses to use the reimbursements for this purpose. A plan sponsor may also use the Early Retiree Reinsurance Program reimbursements to reduce or offset increases in its own costs for maintaining your health benefits coverage, which may increase the likelihood that it will continue to offer health benefits coverage to its retirees and employees and their families. If you have received this notice by email, you are responsible for providing a copy of this notice to your family members who are participants in this plan.

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Open enrollment brochure  

Open enrollment brochure

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