Ahmed Basha

COMPANY LOG O 2020 BENEFITS GUIDE 2020 Enrollment Guide Client Name appreciates your commitment to our success. We’re equally committed to providing you with competitive, affordable health and wellness benefits to help you take care of yourself and your family. Please read this guide carefully. It has a summary of your plan options and helpful tips for getting the most value from your benefits plans. We understand that you may have questions about annual enrollment, and we’ll do our best to help you understand your options and guide you through the process. This guide is not your only resource, of course. Any time you have questions about benefits or the enrollment process, you can contact your human resources representative. Although this guide contains an overview of benefits, for complete information about the plans available to you, please see the summary plan description (SPD) at . Title: Tel: Mobile: Email ID: “Ehent eria acculpariam ent vellenda nis as ipsam aut vellaborro quam volupis etur sin cus eiciend ipicab iliquid quo excerit dolorat eseditiur? Cupta quam ulloreium aliquate landes delitatur, omnis sintet officae voluptat.” N OTE FRO M ACCO U N T TE A M S : This page will contain a “welcome letter” from the client (C-suite, HR director, etc.) to the employee. These can either be written by the client, or you can use a sample letter. Arum arum id quis ab ipsus, te niet quam dolorum as simoditatia quiantet pre suntin cuptiur molut res reri antiur am, iditas dolupta tesequia ipidelisci a velit volenis vel ipsantus volorpor sim eariore mquodit faccullat. Endandebit omnimus, explit as elis et que labore et et, odia volore posanda eriatempore perum, verum vitem am alibus sintionsero esti alit audae et lanitatur simpos aut voluptatiis et eosam harum que volupta tibearis ex ea doluptu riscienit veliti doluptat. Endandebit omnimus, explit as elis et que labore et et, odia volore posanda eriatempore perum, verum vitem am alibus sintionsero esti alit audae et lanitatur simpos aut voluptatiis et eosam harum que volupta tibearis ex ea doluptu riscienit veliti doluptat. Endandebit omnimus, explit as elis et que labore et et, odia volore posanda eriatempore perum, verum vitem. Ga. Et lit etur a quodiae millantium es ipsus, ulligent labo. Ugit, que rersperios alique dunt odia disit acimintem iduciam, sequaspe si nus quae nihilla voluptatquas inullorum quiatur? HE R E ’ S W H ERE TO FIND ... Who is Eligible?2 Dental9 Making Changes2 Vision9 How to Enroll2 Life and Disability Insurance10 Enrollment Deadlines2 Additional BENEFITS11 Employee Payroll Contributions3 Pet Insurance12 Medical4 Employee BENEFITS14 How to be a Smart Consumer5 Children BENEFITS16 Health Savings Account (HSA)6 Glossary of Terms18 Flexible Spending Account (FSA)7 Contacts19 Supplemental Health Benefits8 Notes20 Arum lignate mporemporem evelique recto eniatempos abor moluptibus derupta sperum remposam ad qui alisque volupta qui te nonsequi blabore rataqui ommolut quas aut etur, voluptam, core quatur repratia est fugiam et pero qui beate di ducillabor simodignim il ipsus, conseque nonem et eium nihit explab inus excerio stibus reius sequid mo inverna turiandit aut ut et venecul liquisci aut voloritas aut volo ommolupit volor repernam consed que dolor alit, sequo tem veligenducia volorem enihillit essum ut vel iliquidenis molorum que nam assumquaero volupta tecaessi ut exped enim iur, saectatem Regards, Client Name 1 2020 Enrollment Guide W H O I S EL IGIBL E? M AKING C HANG ES Benefits are available to all full-time employees working a minimum of 30 hours per week and their dependents. For those enrolling during Open Enrollment, your benefits will become effective on . For new hires, your benefits will become effective on . You may only make changes to your elections during open enrollment each year or during the year if you experience a qualifying event. Qualifying events include, but are not limited to: z Birth, legal adoption, or placement for adoption. Eligible dependents include: z Marital status. z Dependent child reaches age 26. z Spouse gains or loses employment or eligibility with current employer. z Your legal spouse Your children from birth to age 26 (including your natural/legally adopted/stepchildren, and/or your unmarried dependent children of any age who are mentally or physically disabled and who are dependent on you for support) < PAYROLL FRE QUE N CY> E M P LOYE E PAYROLL CON TRI B UTI ON S Medical/Rx Employee $- $- $- Employee + spouse $- $- $- Death of a covered dependent. Employee + child(ren) $- $- $- z Spouse or dependent becomes eligible or ineligible for Medicare/Medicaid or SCHIP. Family $- $- $- z Change in residence that changes eligibility for coverage. z Court-ordered change. Changes to your coverage due to a qualifying life event must be made within <30> days of that life event. Proof of the qualifying life event is required (marriage certificate, divorce decree, birth certificate, or loss of coverage letter). Note: Any change you make to your coverage must be consistent with the change in status. Dental Employee $- Employee + spouse $- Employee + child(ren) $- Family $- Vision H OW TO ENRO LL To sign up for benefits, visit before the end of your enrollment period. Employee $- Employee + spouse $- Employee + child(ren) $- Family $- Note: Additional rate information can be found in your enrollment portal. E NR OL LMENT DE ADLINES 2 Type of Employee/Dependent Enrollment Opportunity Coverage Effective Date Current Employee Annually during the enrollment period Start of Plan Year New Hire Must enroll within days of hire Employees who experience a Qualified Life Event Changes must be made within <3X> days of life event 3 2020 Enrollment Guide M EDICAL Mobile App Pharmacy Your medical provided by . You will always have stronger benefits when visiting in-network providers. z Find an in-network pharmacy or use the drug cost estimator tool by visiting . z Discount sites like GoodRx and WellRx can help you instantly save (please note: prescriptions acquired under these plans do not go through your insurance). % z Ask if a generic/mail order is available. $/$ z Generic contraceptives and diaphragms are covered and available at no cost. z See if your drug has a Patient Assistance Program. In-Network Calendar Year Deductible (Single/Family) Coinsurance Annual Out of Pocket Maximum Single/Family $/$ Physician Office Visits Primary Care Physician $ Specialist $ Telemedicine $ Telemedicine Prescription Drugs Retail $/$/$ Mail Order $/$/$ Outpatient Care Outpatient Surgery $ Urgent Care $ Hospital Inpatient $ Emergency Room $ Please note: The above chart shows your medical plan benefits for in-network coverage only. Your plan offers out-ofnetwork benefits; however, benefits are reduced when care is provided out-of-network. The chart above is a brief summary of your medical benefits and does not include all the details about benefit plan features and rules. For details and the terms of your medical and pharmacy plan benefits, refer to your Certificate of Insurance. If there are any inconsistencies between this document and the official Plan document and certificates of insurance, the Plan documents or certificates of insurance will prevail. 4 The app lets you easily access your health care information and gives you tools to help estimate costs, manage claims and find providers — anytime and anywhere. It’s built to be your go-to health care resource when you’re on the go. provides access to telemedicine through . 24/7 Nurse Line z Choose appropriate medical care. z Find a doctor or hospital. z Understand treatment options. z Achieve a healthier lifestyle. z Answer medical questions. The program lets you get the care you need — including most prescriptions — for a wide range of minor acute conditions. Now you have access to these board-certified doctors via secure video chat or phone, without leaving your home or office. When, where and how it works best for you. Cost Estimator Different doctors and hospitals may charge different amounts for the same service. can help you compare costs based on your own benefits. H OW TO B E A S M A RT CON S UM E R 5 2020 Enrollment Guide H E ALTH SAVINGS ACCO U N T (H SA) FLE XI B LE S P E N D I N G ACCOUN T (FSA ) You are eligible if: You are enrolled in the HDHP Available to What is a Flexible Spending Account? participants in the . A Health Savings Account (HSA) is a taxadvantaged savings account that can be used for your qualified health care expenses. You own your HSA and can contribute to the account with pre-tax payroll deductions based on your needs. You are not covered by a spouse’s plan You can choose to participate in one or both accounts, and it’s not necessary to “sign up” specific family members for these accounts. You are not enrolled in Medicare, TRICARE or TRICARE for Life Health Care FSA You have not received VA benefits in the past 3 months As an added benefit, will contribute <$XX> to your account . You can manage your HSA at . You’ll set up your payroll contributions during your enrollment period and can make changes at any time throughout the year (although it may take between 1–2 payroll periods for any changes to be processed). When electing an FSA, you will set an annual contribution amount. FSA’s do not rollover year to year, so you will have until to use the funds. . The goal is to choose an amount that will cover medical or dependent care expenses, but that is not so high that the money will be forfeited at the end of the year. No one else can claim you as a dependent Did you know an HSA provides triple tax benefits? The money you contribute is pre-tax, and the interest that accumulates in the account is taxfree. In addition, money withdrawn from an HSA isn’t taxed, provided you use it for qualified health care expenses. Like a savings account, you will only be able to withdraw funds that are in the account. How Do I Access / Make Contributions to My HSA? A flexible spending account (FSA) is an account that can reimburse you for qualified health care or dependent care expenses. You can fund qualified expenses with pre-tax dollars deducted from your paychecks. How Much Can Be Deposited into an HSA in 2020? z Up to $3,550 for individual z Up to $7,100 for family <55* *Not enrolled in Medicare Dependent Care FSA A health care FSA reimburses employees for eligible medical expenses, up to the amount contributed for the plan year. Eligible health care expenses include many of the out-ofpocket expenses you pay to maintain your health and well-being. Visit irs.gov for a full list of eligible expenses. You may use pretax dollars from your Dependent Care FSA to pay expenses for the care of a dependent child, spouse or elderly parent inside your home (from a qualified provider), and expenses outside your home, such as baby-sitters, nursery schools, or day care centers. You may contribute up to $2,750 annually (funds will be available as of the election effective date). You may contribute anywhere up to $5,000 annually (or $2,500 if you are married and file a separate tax return). You can only be reimbursed up to the amount that you have contributed. OTHER HSA ADVANTAGES You can use the account to pay for qualified health care expenses. The maximum contribution increases by $1,000 55+* *Not enrolled in Medicare Unspent dollars roll over each year and are yours to keep if you retire or leave the company. You can invest your HSA funds, so your available health care dollars can grow over time. 6 7 2020 Enrollment Guide S UP PL E ME NTAL H EALTH BENEFITS Our medical plans provide great coverage for you and your family’s health care needs. Still, everyone’s needs are slightly different. That’s where supplemental health options come in! These benefits are designed to protect your family’s finances in case of an unforeseen injury or illness. These benefits are offered to you through . Please visit for additional details. Accident Insurance Accident plans pay cash benefits directly to you to help pick up some of the costs remaining after your health insurance plan kicks in following a covered accident. Critical Illness Insurance Critical illness insurance helps protect your income and personal assets when out-of-pocket expenses increase as a result of a specified illness. This plan covered conditions like: heart attack, stroke, end stage renal failure, invasive cancer, and more. D E N TA L Although you can choose any dental provider, when you use an in-network dentist, you will generally pay less. If you choose an out-of-network provider, you may be billed the difference between what pays, and what your outof-network provider charges for the services. To locate an in-network provider, please visit . Annual Deductible (Individual / Family) $ Annual Plan Maximum $ Diagnostic and Preventive Services (Deductible Waived) $ Basic Services $ Major Services $ Orthodontia $ V I S I ON In-Network Out-of-Network Examination (Every Months) Material Our vision care benefits include coverage for eye exams, lenses and frames, contact lenses, and discounts for laser surgery. The vision plan is built around the providers, who have higher benefits at a lower cost to you. When you need services, consider using an innetwork provider for the most bang for your buck! When you use an out-of-network provider, you will be reimbursed for services according to the grid below. To locate an in-network provider, visit . Lenses (Every Months) $ $ Single $ $ Bifocal $ $ Trifocal $ $ Frames (Every Months) New Frames $ $ Contact Lenses (Every Months) Elective $ $ Medically Necessary $ $ Hospital Indemnity Insurance An unexpected or even planned stay in the hospital can be expensive as you meet your deductible and out-of-pocket obligations under the medical plan. The Hospital Indemnity plan is designed to provide financial protection by paying you a direct benefit to meet out-of-pocket expenses and extra bills that can occur. Lump sum benefits are paid directly to you based on the type of facility and number of days of confinement. 8 9 2020 Enrollment Guide L IFE AND DISABILITY INSURANC E A D D I TI ON A L B E N E FI TS Benefit Description Contact Information Who pays? Employer Paid Comprehensive pet insurance coverage is available. Discounted rates available Every online transaction leaves a trace behind, taking on a life of its own, which can put your credit and identity at risk. can help monitor your credit and protect your identity. Discounted rates available With a legal plan, you can rest assured that whether you’re facing a legal issue that’s big, small or somewhere in between, you’ll have access to legal advice and services when you need them. Discounted rates available We are pleased to offer an Employee Assistance Program to assist you and your family through difficult times. Life Insurance We provide Basic Life and AD&D insurance at no cost to you! z Insurance Coverage Benefit z Basic Life and AD&D $ Employee Assistance Program If you would like additional coverage, Voluntary Life and AD&D insurance is available to you, your spouse and your dependent children. You must enroll in coverage for yourself in order to cover your spouse or children. If you don’t enroll in Voluntary Life when it’s first available to you, or elect an amount over the Guaranteed Issue, you may be required to complete an Evidence of Insurability (EOI) form. Insurance Coverage z Benefit Voluntary Employee Life $ Voluntary Spouse Life $ Voluntary Child Life $ z Unlimited access to Master’s-level counselors by phone 24/7. Up to face-to-face visit with a counselor at no cost. Unlimited access to helpful tools and resources online. Referrals available. Pet Insurance Disability The company provides ShortTerm and/or Long-Term Disability. These plans give you income protection in the event you are ill or injured in a non-work related injury, and can’t come to work. If you don’t enroll in Disability coverage when it’s first available to you, you may be required to complete and Evidence of Insurability (EOI) form. Short-Term Disability Benefits Long-Term Disability Benefits Elimination Period days Elimination Period days Weekly Benefit of weekly earnings Monthly Benefit of monthly salary Maximum Weekly Benefit <$X> Maximum Monthly Benefit <$X> Maximum Benefit Period weeks Maximum Benefit Period weeks Identify Theft Protection Legal Plan 10 11 2020 Enrollment Guide Restio cullandipsa event molore, quuntur? Od quo est, accumqu istiur acepelit etus doloreruptat voluptiis mi, con perio voluptur, cone ipienimagnis pel iumendit pe si sum con repra prati aut adi occulpa risquidero te quam, occuptate et qui tem et fuga. Evelit, es et lat ex et ant. P ET I N S U R ANCE Sub Heading Officiis ipsam, totat quundel luptur, se porror rest, comnimendae net voluptio ma sitatur repudi siminte parum aut elia dissum raturitatusa prorro im sinto illo et volo eturitio. Nam et quiaeptatur mi, coribeaquam aspel il iducian digniet quist, quate reici untio berum quo illaborenis volupta simus sam comni deleniscidia nonecae explabo. Lor am sus everiti debit eliquis quostes dolorumque poris es id ut reptate dolo quas aut untetur? BENEFITS Ex eossitatur si ipsanditis dio debis idelenditia natectiis Ex eossitatur si ipsanditis dio debis idelenditia natectiis Ex eossitatur si ipsanditis dio debis idelenditia natectiis Ex eossitatur si ipsanditis dio debis idelenditia natectiis Ex eossitatur si ipsanditis dio debis idelenditia dolorporume natectiis volor rehent quam rera nusdae pra niat porerci aspienim audam doluptatquo comnihicatia ne pa sum nulparuptur simagnatem exerum eicipsa ndeliqu asinulpa sequas in pernatur alic tet officius nulpa doluptatur sam, sae la que sunt plaut labore officiis maxime dis qui deruptur re, quam quia volupta temquas arit in conecus, conseruptur anditassint volent, que nonsequIbusdaesera volupta nes verrum fugit plissit fugia versper natem. Name cuptat. Ehentem aditi a volut qui volorit rectem volorem quid quunt qui utectist, quundit ped etur? Sub Heading Vit aut dolupta perum vid et liquund itaquatiae nus consequ atemolorro blabore ptatquate serchil illabo. Ut aut eni niatquam nos debis ea porum quatur, sitatur si res nihicipitat dit fuga. Ut eos dit andaeste plaut labo. Ut plam rem sedit duntium 12 faccabo. Itati od modit, ommolup tatiam, quatur aspicabore nitate molor repel invelis voluptiis dolum que et aut is doluptatiis ilis quissim ustions edisquis esti ium, nobisse quasper uptatur aut ea plibus, vendist emporerupta pa sitaspe llenet aut vent eatem aut ditaeri ssimaximpor aut quatemquat. Sub Heading Em ellorec tustibus sum sequo tem qui cum, sit, idebis intus consed quiaeri oruptiis alitio. Ut eos repudae nos expe in ne volorum enihil ipsamenet et dolorpo rruptatem ipis ea sin rectectur aut in porecte posam anisinisi cullaudis qui dunt. Rior atureni minctur sin peri ilibus a net quaecto bla solupienihil idi idem sunt oditiorunt que etur, sitior magnam aut am vento endaecto qui inveles cienient veliquo il illabo. Il mint aut ulluptatur sunti unt ea vitio di alibus exero magnimi nveles delestium dolorendis eaquae conem reperundi. Sub Heading Tota a inctas sapiciet aspere nam videst fuga. Nem es elent atia nonseque molupicil int auta debit millabo. Itat. Hendandeliam que doluptatur alitiur aut atiorit inctaspidi quo qui reptatetur? Harchicipsam essitatium ipidit litam acepedi citionsed et doluptatur ab idi que es volupta volenis maio. Quatecum repudae dus. Tae numquo ius moleces quament, optatus, volutam labore commolum nullautatia qui rempor aspitae. Tem fugia volupta adigniet harion nati accus, officim poribuscima quunt volupti od eos sitibus exerspictus, et quam, utatio. Nequaecepta accabor iandus id min pliquid que volorrovit aut magnist, is dempossit que simuscipsum intibus citaerum nimus, escit poriosa peditat emporerumqui doluptios dolupta temolorum eveniam, vendem quae se eum que porias aria voluptatur? Udio omnis. Is solupis eiustrum am facipsa epedis ducius etur rehent qui a sequi officillupti quiatia ventia volorro temo exerum endi re re nature verspis ad et alit aliquis inusam, conse labor molorrum nobis solesen dendaerum voloreiuntur aceatur sam rehentota porrovitias explignim everiorum est iment et audam asimaximus most voluptat aut lanimusantio evenis sequam restor mod unt abo. Nem veliquiae adis aliquissunt doluptas unt fugiam apis de pra volendunt adiam sitatiae prepudit volest odiciatusci odis magnatia dipit aut rem eicim simus ressin con con cor adictem quis eium et, vitas aliqui comnim re, sum nonse intur? Pis ra acium haribea eos raerciat idero dolupidus nos as repeles elit eaquis alibus nam aut ulliciet quatus doluptas earum solorum quam aut ad minum comniene odigenist dolesectium natestiat. Sub Heading Labor aceatus atus, quos min perendandae. Dam que plaut est, aut reicimaior magnihil min praes eos unt ad quam, officilic te volecae voluptas serit, sitiam nossincto quam est velit enimusa nditate nostemquam, omnim aborum ni non conet, que plaborpor andae voloritasse porio coreriti ario quia doluptae as am expedis ati cus pre ommod quunt. Obissequis adi comnis re ament assimus ciandam eum fuga. Arcipsam et estrum res ut adipiciis aut ut quidis magnatis nonsequam natur mo quibusc itatias molenima cupta voluptati te de conse quo bearchilia niminci dis cus culpa et, te mo idusa voluptiis ant fugiam, ea quis maio. Et quisquo quae modipit atibus dollaut et essunt as di ommolorem. Nam quodia dit resequam eliquibus et alignatus 13 2020 Enrollment Guide E M PLOYE E BE NEF ITS Medical Plan Legal Plan Critical Illness Insurance Employee Assistance Program Dependent Care FSA Health Care FSA Accident Insurance Hospital Indemnity Insurance 14 Pet Insurance Identify Theft Protection 15 2020 Enrollment Guide CH I L D R E N BENE FITS Dental Critical Illness Your children from birth to age 26 Health Care FSA Including your natural/ legally adopted/ stepchildren, and/or your unmarried dependent children of any age who are mentally or physically disabled and who are dependent on you for support. Vision Medical/Rx “Ehent eria acculpariam ent vellenda nis as ipsam aut vellaborro quam volupis etur sin cus eiciend ipicab iliquid quo excerit dolorat eseditiur? Cupta quam ulloreium aliquate landes delitatur, omnis sintet officae voluptat.” To sign up for benefits, visit enrollmentsite.com before the end of your enrollment period. Dependent Care FSA 16 17 2020 Enrollment Guide GLOSSARY OF TERMS COPAYMENT: A copayment (copay) is the fixed dollar amount you pay for certain in-network services on a PPO type plan. In some cases, you may be responsible for coinsurance after a copay is made. COINSURANCE: Your share of the costs of a health care service, usually figured as a percentage of the amount charged for services. You start paying coinsurance after you’ve met the deductible. Your plan pays a certain percentage of the total bill, and you pay the remaining percentage. DEDUCTIBLE: A deductible is the amount of money you must meet before your plan begins paying for services covered by coinsurance. Some services, such as office visits that require copays do not apply to the deductible. For example, if your plan’s deductible is $1,000, you’ll pay 100 percent of eligible health care expenses until you have met the $1,000 deductible. After that, you share the cost with your plan by paying coinsurance. Formulary: A list of prescription drugs covered by the plan. Also called a drug list. IN-NETWORK: A group of doctors, clinics, hospitals and other health care providers that have an agreement with your medical plan provider. You pay a negotiated rate for services when you use in-network providers. OUT-OF-NETWORK: Care received from a doctor, hospital or other provider that is not part of the plan agreement. You’ll pay more when you use out-of-network providers since they don’t have a negotiated rate with your plan provider. You may also be billed the difference between what the out-of-network provider charges for services and what the plan provider pays for those services. OUT-OF-POCKET MAXIMUM: This is the most you must pay for covered services in a plan year. After you spend this amount on deductibles and coinsurance, your health plan pays 100 percent of the costs of covered benefits. However, you must pay for certain out-of-network charges above reasonable and customary amounts. HIGH DEDUCTIBLE HEALTH PLAN (HDHP): This is a type of medical plan that requires the member to reach a deductible prior to having services covered by coinsurance. All expenses paid by the member count toward the deductible and out of pocket maximum. CON TACTS MEDICAL PLAN MEDICAL AND DEPENDENT CARE FSA Member services: XXX.XXX.XXXX Nurseline: XXX.XXX.XXXX Technical support: XXX.XXX.XXXX General website: Enrolled in medical: Customer service: XXX.XXX.XXXX Website: PRESCRIPTION SERVICES Customer service: XXX.XXX.XXXX Website: Mail-order pharmacy: XXX.XXX.XXXX Website: SHORT- AND LONG-TERM DISABILITY DENTAL Customer service: XXX.XXX.XXXX Website: Customer service: XXX.XXX.XXXX Website: VISION Customer service: XXX.XXX.XXXX Website: HSA Customer service: XXX.XXX.XXXX Website: RETIREMENT <401k provider> Customer service: XXX.XXX.XXXX Website: 18 LIFE AND AD&D HUMAN RESOURCES Phone: XXX.XXX.XXXX Email:- Support Line Member Services: General Website: Annual notices are available here: 19