Rapattoni Corporation Due Friday May 12, 2023 Open Enrollment Reminders Enrollment Form Reminders Highlights for 2023 2023 Open Enrollment Benefits you select during open enrollment will be effective June 1st, 2023 through May 31st, 2024 This is your annual opportunity to make plan changes, such as: • Change your plan elections • Change your covered dependents • Change your life insurance beneficiary designations • No change to employee contributions! o Rapattoni Corporation is absorbing all premium increases for the new plan year, your monthly medical and dental costs will not change! • Anthem PPO Medical plan enhancements o Lower annual out-of-pocket maximum(s) o Lower Urgent Care copay o Lower Prescription Drug copay schedule • No changes to Kaiser HMO Medical plan • No changes to Dental, Vision, and Life/AD&D plans or monthly costs If you are currently enrolled in any Rapattoni Corporation plans you will be automatically re-enrolled unless changes are made during Open Enrollment. You only need to submit a form if you are making changes during Open Enrollment. Enrollment and change forms are due to Amanda Barrios ([email protected]) by Friday, May 12th. Mid-year changes are allowed if you have a qualifying Life Event, such as: • Marriage, divorce or domestic partnership • Birth or adoption • Spouse loses coverage • Court-ordered dependent coverage
Medical: Choose between Anthem PPO and Kaiser HMO Anthem PPO (Platinum PPO 15/250/10%) Kaiser HMO (Platinum 90 HMO 0/10) • Must select a Primary Care Physician (PCP) • Need referrals from PCP to see specialists • Must use network providers, typically only available within CA • Includes Pediatric Dental and Adult Optical Eyewear coverage Benefits Anthem PPO (In-Network Benefits) Kaiser HMO Annual Deductible (Individual/Family) $250 / $750 $0 Annual Out-of-Pocket Maximum (Individual/Family) $3,800 / $7,600* $3,000 / $6,000 Preventive Care Services No charge (Deductible Waived) No charge Primary Care Office Visit $15 per visit (Deductible Waived) $10 Specialist Visit $30 per visit (Deductible Waived) $20 Lab and X-Ray $10 per visit (Deductible Waived) $40 Hospitalization 10% coinsurance $500 per admission Chiropractic Care 50% coinsurance (up to 20 visits/year) $15 per visit (up to 20 visits per year, combined with acupuncture) Acupuncture $15 per visit (Deductible Waived) $15 per visit (up to 20 visits per year, combined with chiropractic) Retail Prescription Copay (30-Day Supply) Level 1 Pharmacies** Generic: $5 Brand Formulary: $30* Non-Formulary: $50* Specialty: 30% up to $250 Generic: $5 Brand: $15 Specialty: 10% up to $250 *Benefit enhancement effective June 1, 2023 **Level 1 refers to Anthem Rx preferred in-network retail pharmacies, Level 2 (non-preferred pharmacy) coverage is also available Please note, this is only a brief summary of benefits. Refer to the actual policies or certificates for complete details. Where applicable, “Annual” and “Year” are based on calendar year. • Freedom to choose any provider, even if they are out-of-network or out-of-state • No need for referrals to see specialists • Includes Pediatric Dental coverage
Dental: MetLife PPO Vision: MetLife Voluntary Vision Anthem Life/AD&D Insurance MetLife PPO Dental MetLife Voluntary Vision Benefits In-Network Out-of-Network Annual Deductible* (Individual/Family) $50 / $150 $50 / $150 Annual Maximum $1,500 $1,250 Preventive (exams, cleanings, fluoride, x-rays) 100% Basic Restorative (fillings, root canals, periodontics) 90% 80% Major Restorative (dentures, crowns) 60% 50% Plan Design In-Network Eye Exam $10 copay, once every 12 months Standard Corrective Lenses $0 copay, once every 12 months Frames and Contact Lenses $0 copay, $150 ($85 Costco) allowance once every 12 months Please note, this is only a summary of benefits. Refer to the actual policies or certificates for complete details. Where applicable, “Annual” and “Year” are based on calendar year. Please note, this is only a summary of benefits. Refer to the actual policies or certificates for complete details. • Flexibility of in and out-of-network dentists • One of the nation’s largest dental PPO networks • Employee-paid, available to employees and dependents • Uses the VSP network of providers • Out-of-network coverage/reimbursement available Rapattoni Corporation provides all employees with up to $50,000 in company-paid Basic Life/AD&D Insurance. Coverage is guaranteed, but reduces with age. Includes a limited Employee Assistance Program (EAP) benefit for all employees and members of their household. Optional (Employee-paid) Group Term Life Insurance is also available with approved Statement of Health, in either $50,000, $100,000, or $150,000 amounts. See intranet for rates and additional information.
Additional Rapattoni Benefits As a reminder, you have access to a range of benefits through Rapattoni Corporation including: • 401k • Paid Holidays • Bereavement Pay • Discounts • And More! Open Enrollment Summary With Open Enrollment coming up, we encourage you to review your plan elections, beneficiary designations, plan changes for the new year, and make any necessary updates. As a reminder, any changes you make during Rapattoni Corporation’s Open Enrollment will be effective June 1st, 2023 through May 31st, 2024, unless you experience a qualifying life event. Be sure to complete and submit your forms by Friday, May 12th if you are interested in making changes. Should you have any questions please contact Amanda Barrios in HR at [email protected]. Rapattoni Corporation 112 S. Lakeview Canyon Rd., STE 260 Westlake Village, CA 91362 • 1-800-722-7338