Benefits Booklet 2023 AvMed

Associate Benefits Booklet





Effective January 1, 2023













This booklet is not an official summary plan description or policy and is not intended to provide full details, just highlights.
Every effort has been made to ensure the accuracy of benefit specifics and policy information as described in this
booklet. However, if statements in this booklet differ from the actual benefit plan documents or policy, then the terms
and conditions of the benefit plan documents, or policy will govern.

Table of Contents




SERVICE DIRECTORY 3


WHO IS ELIGIBLE FOR BENEFITS 4


REQUIRED DOCUMENTATION 5


LENGTH OF TIME ELECTIONS ARE BINDING 5


PREMIUMS & EMPLOYER HSA CONTRIBUTIONS 6

COBRA MONTHLY PREMIUMS 7


PRE-TAX BENEFITS & IMPUTED INCOME 7


CHANGE IN STATUS & SPECIAL ENROLLMENT 8


WHERE TO FIND ADDITIONAL INFORMATION 8

MEDICAL PLANS & COMPARISON CHARTS 9-12


HEALTH SAVINGS ACCOUNTS 13


FSA FLEXIBLE SPENDING ACCOUNTS 14-15


DENTAL PLAN 16-17


VISION PLAN 18

LIFE INSURACE – ASSOCIATE, SPOUSE, CHILD 19-21


DISABILITY – LONG TERM AND SHORT TERM 22-23


SUPPLEMENTAL PLANS 24


EMPLOYEE ASSISTANCE PROGRAM 25

401K RETIREMENT SAVINGS PLANS 26


ADDITIONAL BENEFITS 27



2

Service Directory




AvMed 800-882-8633
Member Engagement www.AvMed.org

Standard Insurance
Company 800-547-9515
Dental www.standard.com

EyeMed Vision Plan
Vision www.eyemedvisioncare.com 866-939-3633

HealthEquity
HSA www.myhealthequity.com 866-346-5800
FSA

Lincoln Financial www.LFG.com 800-234-3500
401k
LifeWorks 800-433-7916
Employee Assistance www.login.lifeworks.com TTY:
Program 800-772-0997

Lifetime Benefit Solutions www.lifetimebenefitsolutions.com 800-828-0078
COBRA
Metlife 800-756-0124
GVUL www.metlife.com/mybenefits

Standard Insurance
Company www.standard.com 800-628-8600
Disability 800-368-2859
Life Insurance

Allstate: Accident www.allstatebenefits.com


https://customers.transamericaempl
Transamerica: Cancer 800-251-7254
oyeebenefits.com
Standard: Hospital www.standard.com 866-851-5505


Preferred Legal
Identity Works by www.preferredlegal.com 888-577-3476
Preferred Legal









3

Who Is Eligible For Coverage



In accordance with the ACA, part time associates with more than 30 hours of service/week, or
at least 130 hours of service/ month are entitled to employer-sponsored medical benefits.
Associates who qualify will be notified via email.

Full Time
Child(ren)
Associates Current Domestic Up to age 26 Who
Scheduled to work Spouse Partner except Pays?
at least 36 hours a as noted
week
You &
Medical ✓ ✓ ✓ ✓ AvMed

You &
Dental ✓ ✓ ✓ AvMed


Vision ✓ ✓ ✓ You



Basic Life Insurance ✓ AvMed


Long Term Disability ✓ AvMed


Spouse Life ✓
Insurance You


Child Life Insurance ✓ You

Supplemental Life ✓
Insurance You


Short Term Disability ✓ You

Accident/Hospital/ ✓ ✓ ✓ You
Cancer Plan

Legal/ID Theft Plan ✓ ✓ ✓ ✓ You
Up to age 18

Extended Eligibility for Medical coverage only
Dependents who reach the age limit of 26 may be eligible for extended coverage
through the end of the year in which they turn 30. See affidavit for eligibility requirements
on UKG at Myself > My Company > Company Benefits Info. Medical premiums for
dependents age 26 to 30 will be post-tax.
Domestic Partner Tax Implication: When adding a domestic partner, the associate is
taxed on the full value of the company paid portion of their coverage.

4

Required Documentation




The following documentation is required to verify the relationship of a spouse,
domestic partner, or child. Coverage will not be effective until documentation is
received.


Spouse Official State Marriage certificate

Certification of Domestic Partnership issued by
Domestic Partner
the County
Child(ren) Official State Birth certificate(s)

Official State Birth certificate(s) + Marriage
Step-child(ren)
Certificate
Official State Birth certificate(s) + DP
Child(ren) of Domestic Partner
Certification
Child(ren) adopted Legal adoption documentation

Child(ren) under Legal Legal Guardianship documentation from
Guardianship Courts

Child(ren) under Foster Care Foster Care documentation from Courts




Length of Time Elections are



Binding



Benefits elected at initial enrollment or during open enrollment are binding until the end of
the plan year for which they are made (December 31 ) or until the associate:
st
• Is no longer eligible for the benefits, or
• Experiences a change in status or special enrollment event that permits a mid-year
change.

Elections may be changed within 31 days after a change in status or special enrollment
event (described on the following page), provided the elections are on account of and
consistent with the change. Associates eligible to make a permitted change must complete
the Qualifying Status Change Life Event in UKG within 31 days after the effective date of the
change in status (or within 60 days for certain special enrollment events, as described on the
following page). Review Summary Plan Descriptions (SPD) and/or policies posted in UKG for
effective date of coverage for eligible changes made within the specified timeframe.





5

Biweekly Premiums - AvMed



In accordance with the ACA, part time associates with more than 30 hours of service/week, or
at least 130 hours of service/ month are entitled to employer-sponsored medical benefits.
Associates who qualify will be notified via email.

Self + Self +
Pre-tax Self Only Family
Spouse Children
Copay HMO 1 ✓ $73.60 $288.53 $156.64 $282.71

Copay HMO 2 ✓ $61.86 $258.15 $127.77 $249.63

Copay CHOICE ✓ $77.49 $348.66 $232.58 $432.63

HDHP HMO 1 ✓ $23.74 $199.56 $94.81 $193.80

HDHP HMO 2 ✓ $0.00 $167.60 $62.40 $144.50

Dental Plan 1 ✓ $5.44 $24.88 $29.68 $47.08

Dental Plan 2 ✓ $1.08 $15.48 $19.80 $31.94


Vision Plan ✓ $3.88 $7.59 $6.30 $10.23

Hospital Plan $6.00 $10.20 $8.65 $15.25

Accident Plan $9.56 $18.12 $16.54 $25.10

Cancer Plan A $17.30 $31.60 $19.81 $31.60

Cancer Plan B $10.48 $19.14 $12.05 $19.14

Legal $4.60

ID Theft Plan $8.77

Legal + ID Theft
Bundle $11.98




Biweekly Employer HSA Contribution


Self Only Self + Spouse Self + Child(ren) Family


HDHP1 $46.15 $73.08 $73.08 $73.08

HDHP2 $53.85 $80.77 $80.77 $80.77




6

COBRA Monthly Premiums




Self Only Self + Spouse Self + Children Family

Copay HMO 1 $669.10 $1338.20 $1271.30 $2141.12
Copay HMO 2 $611.36 $1222.71 $1161.58 $1956.35

HDHP HMO 1 $539.27 $1078.55 $1024.62 $1725.68
HDHP HMO 2 $527.47 $1054.95 $1002.20 $1687.92

Copay CHOICE $684.19 $1368.39 $1299.96 $2189.42
Dental Plan 1 $37.25 $80.21 $90.82 $129.30

Dental Plan 2 $27.62 $59.45 $68.99 $95.84
Vision Plan $8.57 $16.77 $13.92 $22.61

COBRA rates do not include a company contribution to an HSA if enrolled in a
HDHP, nor any monthly fees to maintain the HSA account.


Pre-Tax Benefits


When you enroll in any of the benefits as defined as pre-tax in the biweekly
premium chart on the previous page, your share of the premium for you and
your covered dependents will be deducted from your pay before federal
income and social security taxes are calculated and deducted. Due to their
pre-tax status, the IRS has imposed strict guidelines on additions or deletions to
pre-tax benefits. Please review the section entitled “Length of Time Elections are
Binding” for further information and explanation of when changes can be
made to current benefit elections.

Pre-tax premiums will be paid on a perspective basis. Any retroactive premiums
payable due to a status change or special enrollment event will be deducted
post-tax.


Imputed Income



The IRS requires you to be taxed on the value of any group term life insurance over
$50,000. This includes the value of any employer-provided group term life insurance
as well as the value of any supplemental group term life insurance you pay for with
payroll deducted pre-tax premiums. The taxable value of this life insurance
coverage is called “imputed income.” Even though you don’t receive cash, you
are taxed as if you received cash in an amount equal to the value of this coverage.
Your pay statement reflects the value of the employer provided group term
coverage as both a taxable earning and a benefit deduction. This allows for tax
reporting and appears on your pay statement as Group Term Life (GTL).


7

Change in Status & Special



Enrollment



The following are considered a change in status by the IRS:

A change in the associate’s legal marital status, for example marriage, divorce, spouse’s
death.

A change in the number of dependents such as birth, death, or adoption.
Changes in employment status of the associate or of the associate’s spouse or
dependents, including the beginning/ending of employment, a change due to a strike, a
change from full-time to part-time or vice versa, the beginning/end of an unpaid leave of
absence, or a change in work site. Also, if employment status affects eligibility under the
plan.

A dependent becoming eligible or ceasing to be eligible for coverage due to age,
student status, obtaining other group coverage, or any similar circumstance.

A change in the residence of the associate, or the associate’s spouse or dependent.
The Medical/dental coverage changes must satisfy a consistency rule meaning that the
change must be on account of and correspond with a change in status that affects eligibility
for coverage under the medical/dental plan, such as a change that results in an
increase/decrease in the number of family members/dependents who may benefit from
coverage. Documentation of the change in status will be required.
If you or your eligible dependent(s) are covered under Medicaid or a State Children’s Health
Insurance Program (CHIP) and that coverage ends, you may be able to enroll yourself and
any affected dependent(s) in medical coverage. You must request special enrollment within
60 days after the Medicaid or CHIP coverage ends. If you or your eligible dependent
become eligible under Medicaid or CHIP for financial assistance to pay for health coverage,
you may disenroll from your employer’s coverage and enroll yourself and dependent(s) in
Medicaid or CHIP. You must disenroll from your employer’s coverage and enroll in Medicaid
or CHIP within 60 days after the date a government agency determines that you are eligible
for that financial assistance.

For full details see the Summary Plan Description of the Group Health & Welfare Plan located
on UKG at Menu > Myself > My Company > Company Benefits Info.

Where to find additional


information



All benefit information including summary plan descriptions, policies, videos, Q&As, and
guides can be found on UKG: Myself > My Company > Company Benefits Info.
Consult your Associate Handbook for further information and details regarding
company procedures for “Additional Benefits” starting on page 29.



8

Medical Benefits




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last Yes; see Change in
31 day of full-time
st
AvMed day of full-time Status/Special Yes
employment
employment Enrollment
You have the option of five medical plans. There are three copayment plans: two HMO
plans with in-network benefits only and one CHOICE plan offering both in-network and
out-of-network benefits. There are also two high deductible health plans (HDHP), both are
HMOs which offer in-network benefits only.

Key Terms
The amount you pay for covered services before your
Deductible insurance starts to share in the cost.
A fixed amount you pay for covered healthcare services or
Copayment (Copay) prescription drugs.

The percentage of costs you pay for a covered healthcare
Coinsurance service.
The most you pay per plan year for healthcare expenses
Out-of-pocket maximum including prescription drugs.



How do the copay plans work? How do the HDHPs work?
Throughout the plan year, you’ll only From the beginning of the plan year,
be charged a copayment for most-in you’ll pay the full contracted rate
network services including office visits, for any in-network covered services
1
immediate medical care, and including prescriptions until you
prescriptions. Copays do not count meet your annual deductible.
towards the annual deductible.


For a few in-network hospital and Upon meeting the individual annual
outpatient services, and for all out-of- deductible, or when 2 or more
network services on the CHOICE plan, members combine to meet the
2 you must meet the annual deductible family annual deductible, you’ll pay
first and then pay a copayment or a copayment or coinsurance until
coinsurance. you meet your annual out-of-pocket
maximum.

Upon meeting the out-of-pocket Upon meeting the individual out-of-
maximum, the plan will pay 100% of pocket maximum, or when 2 or
eligible services. Copayments, more members combine to meet
3 coinsurance, and deductible amounts the family out-of-pocket maximum,
all count towards the out-of-pocket the plan will pay 100% of eligible
maximum. services through the end of the plan
year.

9

Medical Comparison Chart - Cop





COPAY HMO 1 COPAY HMO 2

CALENDAR YEAR DEDUCTIBLE In Network In Network
Individual / Family $1,000 / $2,000 $2,500 / $5,000
OUT-OF-POCKET MAX

Individual / Family $5,500 / $11,000 $6,500 / $13,000
OFFICE SERVICES
Primary Care Physician (PCP) $25 copay / visit $25 copay / visit
Specialist $50 copay / visit $50 copay / visit

Telehealth Virtual Visit No charge No charge
IMMEDIATE MEDICAL CARE
Retail Clinic $25 copay / visit $25 copay / visit
Urgent Care $75 copay / visit $75 copay / visit

Emergency Room $350 copay / visit $350 copay / visit
$150 copay / $150 copay /
Ambulance (Ground)
one-way transport one-way transport
OUTPATIENT SERVICES
Complex (CT/PET scans, MRIs,
etc.) Independent Facility $200 copay $200 copay
Complex (CT/PET scans, MRIs,
etc.) Hospital Owned/ Affiliated $400 copay after deductible $400 copay after deductible
Facility
Other (X-ray, ultrasound, etc.) $50 copay / visit $50 copay / visit
Outpatient Routine Lab No charge No charge

Durable Medical Equipment $250 copay per episode of illness $250 copay per episode of illness
10% coinsurance after 10% coinsurance after
Outpatient Surgery
deductible deductible
HOSPITAL
10% coinsurance after 10% coinsurance after
Inpatient
deductible deductible
PRESCRIPTION DRUGS
Retail Rx Copay Per Prescription Retail Rx Mail Order Retail Rx Mail Order
Value Generic $20 $50 $20 $50

Generic $30 $75 $30 $75
Preferred $50 $125 $50 $125
Non-Preferred $100 $250 $100 $250
Specialty 50% NA 50% NA


10 Find a participating provider

ay Plans





CHOICE

In Network PHCS Out of Network
$2,500 / $5,000 $2,500 / $5,000 $7,500 / $15,000



$6,500 / $13,000 $6,500 / $13,000 $19,500 / $39,000


$25 copay / visit $25 copay / visit 40% coinsurance after deductible
$50 copay / visit $50 copay / visit 40% coinsurance after deductible

No charge Not Covered Not Covered


$25 copay / visit $25 copay / visit 40% coinsurance after deductible
$75 copay / visit $75 copay / visit 40% coinsurance after deductible

$350 copay / visit $350 copay / visit $350 copay / visit
$150 copay / one-way $150 copay / one-way $150 copay / one-way transport
transport transport


$200 copay $200 copay 40% coinsurance after deductible

$400 copay after $400 copay after 40% coinsurance after deductible
deductible deductible
$50 copay / visit $50 copay / visit 40% coinsurance after deductible
No charge No charge 40% coinsurance after deductible
$250 copay per episode of $250 copay per episode of
illness illness 40% coinsurance after deductible
10% coinsurance after 10% coinsurance after 40% coinsurance after deductible
deductible deductible


10% coinsurance after 10% coinsurance after 40% coinsurance after deductible
deductible deductible

Only at AvMed Participating Pharmacies
Retail Rx Mail Order
$20 $50

$30 $75
$50 $125
$100 $250
50% N/A


Log in to AvMed.org and click on Menu under Find Doctor & Facilities. 11

Medical Comparison Chart - HDHP





HDHP HMO 1 HDHP HMO 2
CALENDAR YEAR DEDUCTIBLE In Network In Network

[Self] / Individual / Family $3,000 / $6,000 $5,000 / $10,000
OUT-OF-POCKET MAX
[Self] / Individual / Family $6,750 / $13,500 $5,000 / $10,000

OFFICE SERVICES
Primary Care Physician (PCP) $25 copay after deductible / visit
Specialist $50 copay after deductible / visit No charge after deductible
Telehealth Virtual Visit $10 copay after deductible / visit
IMMEDIATE MEDICAL CARE

Retail Clinic $25 copay after deductible / visit
Urgent Care $50 copay after deductible / visit
No charge after deductible
Emergency Room $250 copay after deductible / visit
$150 copay after deductible /
Ambulance (Ground)
one-way transport
OUTPATIENT SERVICES
Complex (CT/PET scans, MRIs, etc.) $250 copay after deductible / visit

Other (X-ray, ultrasound, etc.) $30 copay after deductible / visit
Outpatient Routine Lab No charge after deductible
$250 copay after deductible per No charge after deductible
Durable Medical Equipment
episode of illness
Outpatient Surgery Facility $500 copay after deductible / visit
Outpatient Surgery Physician No charge after deductible
Services
HOSPITAL
$1,000 copay after deductible per
Inpatient No charge after deductible
admission
PRESCRIPTION DRUGS Only at AvMed Participating Pharmacies
Retail Rx Mail Order Rx Retail Rx Mail Order Rx
Value Generic $10 after ded $25 after ded

Generic $20 after ded $50 after ded
Preferred $50 after ded $125 after ded No charge after deductible
Non-Preferred $100 after ded $250 after ded
30% after
Specialty N/A
deductible




12

Health Savings Accounts - HealthEquity




Associates who enroll in one of the High Deductible Health Plans may be eligible
to open a Health Savings Account (HSA) and save money on a tax-free basis to
help offset out-of-pocket health care expenses, such as copayments or
coinsurance, prescription medications, eyeglasses, lab work, and dental
expenses. The amount your employer will contribute to your health savings
account is based on the plan you select and the family members you cover.
Your employer will contribute to your account even if you do not.


Eligibility to contribute to a health savings account, or to receive
employer HSA contributions:

You must be enrolled in one of the High Deductible Health Plans offered .

You may not be covered by any other NON-high deductible health plan.


You may not be claimed as a dependent on another person’s tax return.

You may not be enrolled in any part of Medicare.


If your employment ends:

You may keep your current HSA and pay monthly account maintenance fees,
or
You may withdraw your funds and deposit them directly in another qualifying
HSA within 60 days of withdrawing funds to avoid taxes and additional 20%
penalty.


How to pay with your HSA:


You may use your HSA debit card to pay the provider directly.


You may authorize a payment by check from your HSA.

You may pay a provider through an alternative source and reimburse yourself
from your HSA.


2023 HSA Contribution Limit Self Only: $3,850
Family: $7,750
HSA Catch-Up Contribution $1,000
(age 55 or older)




13

FSA
Flexible Spending Accounts - HealthEquity


Flexible spending accounts (FSAs) provide you with an important tax advantage
that can help you pay healthcare and dependent care expenses on a pre-tax
basis. By anticipating your family’s healthcare and dependent care costs for the
plan year, you can lower your taxes.


Healthcare FSA


If you enroll in one of the copay medical plans, you are eligible to contribute
to a healthcare flexible spending account (HCFSA). A healthcare FSA
enables you to set aside pre-tax dollars to pay for qualified expenses
including medical, dental, and vision. You can also use your FSA funds to pay
for qualified expenses of your spouse and tax dependents. For information on
qualified expenses visit HealthEquity.com/QME. With healthcare FSAs, the
entire elected amount is available to you after your first payroll deduction of
the year.

Use your healthcare FSA funds
When you sign up, you will receive a debit card that can be used to pay for
qualified expenses. An alternative method would be to submit the expenses
through the online tool for reimbursement. Remember to save all receipts for
reimbursement and validation. HealthEquity offers an easy-to-use
documentation library that allows you to upload and store receipts within the
member portal. Visit www.fsastore.com for a variety of items that qualify for
healthcare FSA funds.


Yearly Contribution Minimum Maximum

Healthcare FSA $100 $2,000






Use It or Lose It


The healthcare FSA and the dependent
This means that the amounts in either
cannot be carried over to the following
grace period at the end of the plan
reimbursement for qualified expenses
during the plan year. Additionally, if you
have 30 days from your date of termination
qualified expenses that occurred while
during the plan year.



14

Dependent Care Reimbursement Account



Any benefit eligible associate with eligible dependents and qualified
dependent care expenses can contribute to a dependent care
reimbursement account (DCRA). A DCRA enables you to set aside pre-tax
dollars to pay for qualified dependent care expenses. Funds can be used to
pay for daycare, preschool, elderly care or other dependent care. To qualify
for a DCRA, the IRS requires that the dependent care is necessary for you and
your spouse (if applicable) to work, look for work, or attend school full-time.

Qualified Dependents
To be considered eligible, dependents must meet one of the following
criteria:
• Children under the age of 13
• A spouse who is physically or mentally unable to care for him/herself
• Any adult you claim as a dependent on your tax return that is physically
or mentally unable to care for him/herself


Reimbursement for Dependent Care Expenses
You must pay for dependent care costs out-of-pocket and submit for
reimbursement either through the HealthEquity member portal, or by using
HealthEquity’s DCRA reimbursement form. Remember to save all receipts for
reimbursement and validation of expenses.



Yearly Contribution Minimum Maximum

Dependent care RA $100 $5,000





Use It or Lose It


dependent care RA are ”use it or lose it” plans.
either account at the end of the plan year
following year. However, there is a 75-day
plan year during which you may request
expenses that occurred while you were eligible
if you terminate employment, you only
termination to request reimbursement for
while you were employed and eligible





15

Dental Plans




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last Yes; see Change in
31 day of full-time
st
Standard day of full-time Status/Special Yes
employment
employment Enrollment
Two dental plans are offered through The Standard. Both plans have in and out-
of-network benefits. The in-network benefits and coverage are mostly the same on
both plans. The differences between the plans include the number of cleanings
covered per year, Plan 1 allows four while Plan 2 allows two. The other difference is
how Standard pays the out-of-network dentists, which affects how much you will
have to pay out-of-pocket if you go to an out-of-network provider for services.


What are the differences between Plan 1 and Plan 2?


Plan 1 Plan 2


Covers 4 cleanings per year Covers 2 cleanings per year

Plan 1 pays out-of-network dentists Plan 2 pays out-of-network dentists
more, which means you will typically less, which means you will typically
pay less out-of-pocket if you go to an pay more out-of-pocket if you go to
out-of-network dentist. This plan pays an out-of-network dentist. This plan
out-of-network dentists based on 90% pays out-of-network dentists at the in-
of the usual and customary (U&C) of network contracted rate. This rate is
what 9 out of 10 dentists charge in the usually lower than 90% U&C.
geographic area.


Higher Premiums Lower Premiums





Annual Maximum Benefit $1,500 per enrolled member

The maximum benefit can be increased by $250 annually to a
maximum of $2,250 per enrolled member through the Max
Builder Feature which is automatically applied to each member.
To learn more, review the Dental Max Builder on UKG at Myself >
My Company > Company Benefits Info



Visit Standard.com/dental to find in-network dental providers.



16

Plan 1 Plan 2

Out-of- In- Out-of-
In-Network
Network Network Network

100% of the 100% in-network
Type 1 Plan Pays: 100% 90% U&C 100% contracted rate
Preventive
Services You Pay: $0 Remainder of $0 Remainder of
cost cost

80% of the 80% in-network
Plan Pays: 80% 80%
Type 2 90% U&C contracted rate
Basic $50 lifetime $50 lifetime
Services You Pay: deductible Remainder of deductible Remainder of
then 20% cost then 20% cost
50% of the 50% in-network
Plan Pays: 50% 50%
90% U&C contracted rate
Type 3 $50
Major $50 calendar calendar
Services You Pay: year Remainder of year Remainder of
deductible cost deductible cost
then 50%
then 50%
50% up to 50% of 90% 50% up to
$1000 U&C up to $1000 50% in-network
Orthodontia Plan Pays: lifetime $1000 lifetime lifetime contracted rate
Adults & maximum maximum maximum up to $1000 max
Children benefit benefit benefit
Remainder of Remainder of Remainder Remainder of
You Pay:
cost cost of cost cost


Some of the more common services included in each Type:
See policy posted in UKG for complete listing
Routine exam, bitewing x-rays, full mouth/panoramic x-rays,
Type 1 periapical x-rays, cleaning, fluoride for children 18 and under,
sealants, space maintainers.

Restorative amalgams, restorative composites, periodontics
Type 2 (nonsurgical), endodontics (nonsurgical), denture repair,
simple & complex extractions, anesthesia.

Type 3 Onlays, crowns, crown repair, endodontics, prosthodontics.






17

Vision Plan




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last Yes; see Change in
31 day of full-time
st
EyeMed day of full-time Status/Special Yes
employment
employment Enrollment
Vision benefits are more than an eye exam. They help you save money, stay
healthy and see everything life has to offer. If you currently wear glasses or
contacts, vision insurance can significantly reduce your costs for routine preventive
eye care and prescription eyewear.

In-Network Out-of-Network


Annual Eye Exam You Pay: $10 deductible 100%
Once per 12-month
period Plan Pays: 100% Reimburses up to $35

Cost of frame or
You Pay: 100%
Frames contacts over $130
Once per 12-month Reimburses up to
period Plan Pays: Up to $130 $65/frames and
$80/contacts

Contacts or Lenses
for Glasses You Pay: $25 deductible 100%
Once per 12-month
period

Single Vision Reimburses up to $25


Bifocal Plan Pays: 100% Reimburses up to $40


Trifocal Reimburses up to $55

In-Network Discounts

Contacts: 15% discount of the remaining balance in excess of the conventional contact
lens allowance
Frames: 20% discount off the remaining balance in excess of the frame allowance



Visit eyemedvisioncare.com to find in-network vision providers.






18

Life Insurance - Associate




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last
31 day of full-time May only change
st
Standard day of full-time N/A
employment beneficiary
employment

AvMed Basic Life - Company Paid

1x annual base salary rounded to the next $1,000 with a
max of $1,000,000

Supplemental Life – Associate Paid

Purchase amount available: $10,000 increments

Maximum: $500,000

Up to $350,000 for newly
Guaranteed issue amount:
eligible associates

Approval required by Standard for:

1. Requests for over the $350,000 guaranteed issue
amount by any newly eligible associate, and/or

2. Requests for any increase in coverage during annual
open enrollment.


Insurance premiums for supplemental coverage are adjusted annually to reflect
current salary and age as of January 1st. (see rate chart on next page)

Amount of coverage will be reduced to 65% at age 70 and 50% at age 75.

Waiver of premium provision applies if totally disabled and less than 60 years of
age at the time disability begins.

Accidental death & dismemberment benefits are equal to amount of life
insurance in force.
The value of any combined coverage over $50,000, whether employer or
associate paid, will be included as imputed income. For further explanation,
see “Imputed Income” on page 7.





19

Life Insurance - Spouse




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last Yes; see Change in
31 day of full-time
st
Standard day of full-time Status/Special N/A
employment
employment Enrollment
Flat Rate Plan $5,000 or $10,000

$10,000 increments to a

Incremental Plan maximum of $250,000 or 100%
Cost is based on spouse’s age of associates life coverage
whichever is less

$20,000 combined total (flat
Guaranteed issue rate & incremental) for newly
amount
eligible associates

Approval required by Standard for:

1. Requests for over the $20,000 guaranteed issue
amount by any newly eligible associate, and/or

2. Requests for any increase in coverage during annual
open enrollment.



Cost for Incremental Insurance
Age Per $1000 Per Month Age Per $1000 Per Month

< 25 0.08 45-49 0.25
25-29 0.07 50-54 0.41
30-34 0.09 55-59 0.66
35-39 0.11 60-64 0.84

40-44 0.17 65-69 1.43
70 and Over 3.81

Both flat rate and age banded spouse coverage will be reduced to
65% at age 70, and 50% at age 75.








20

Life Insurance - Child




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last Yes; see Change in
31 day of full-time
st
Standard day of full-time Status/Special N/A
employment
employment Enrollment
All full-time regular associates are eligible to purchase life insurance
for their unmarried children and/or stepchildren under the age of 26
who are dependent on the associate for support and living with the
associate in a regular parent-child relationship.



Amount/Covers all Eligible
Children Cost per pay

$1,000 $0.15

$2,000 $0.35
$5,000 $0.80

$10,000 $1.60


Any level of child life insurance can be elected at the time of
initial enrollment or during open enrollment.



































21

Disability – Long Term




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last
31 day of full-time
st
Standard day of full-time No N/A
employment
employment
All full-time regular AvMed associates are eligible for company-paid long-term
disability coverage. This benefit provides income protection in the event of a
long-term illness or injury that prevents the associate from working.

Basic LTD - Company Paid

60% of base monthly salary to a maximum of $9,000 per
month

Additional LTD – Associate Paid

66 & 2/3% or 70% of base
Buy-up amounts:
monthly salary

66 & 2/3% or 70% for newly
Guaranteed issue amount:
eligible associates

Approval required by Standard for:

Requests for buy-up during annual open enrollment


Biweekly premiums for LTD buy-up amounts are based on current salary.

Benefits are payable after 90 consecutive days of disability; coverage must be in
effect before the onset of disability.

Limited to 24 months due to mental disorder, substance abuse and other limited
conditions, otherwise benefits are paid for the length of the disability or to age 65.


Pre-Existing Condition

You are not covered for a disability caused or contributed to by a pre-existing
condition or for a medical or surgical treatment of a pre-existing condition unless,
on the date you become disabled you have been continuously insured under this
plan for 12 months and you have been actively at work for at least one full day
after the end of the 12 months.





22

Disability – Short Term




TERMINATION CHANGE IN COBRA
PROVIDER EFFECTIVE DATE
DATE STATUS ALLOWED ELIGIBLE
12 midnight on last
31 day of full-time
st
Standard day of full-time No N/A
employment
employment
All full-time regular AvMed associates have the option of purchasing short term
disability coverage to replace a portion of their salary in the event of a temporary
disability.



Biweekly premiums are based on current salary.


Plan pays 70% of weekly base salary to a maximum of
$1,000/week.

Benefits are payable on the 15 th day of injury or illness,
including maternity.

Benefits are paid for the length of the disability to a
maximum 11 weeks.

Coverage must be effective before the onset of disability.

Accrued PTO and/or EIB time may be paid out in addition
to any disability benefits.

Does not cover occupational illnesses or injuries.

Work and rehabilitation incentives are available.


























23

Supplemental Plans




TERMINATION CHANGE IN STATUS COBRA
PROVIDER EFFECTIVE DATE
DATE ALLOWED ELIGIBLE
Allstate
Standard 1st of the month 12 midnight on last Yes; see Change in
following 31st
Transamerica day of full-time day of full-time Status/Special N/A
Preferred employment employment Enrollment
Legal


Allstate Accident Plan

Pays cash benefits to you for accidental injuries on or off the job, 24 hours/day.
Cash benefits are paid directly to you, not the doctor or hospital.

Pays $75 to you if you see a physician for any reason. Maximum of 2 visits/year,
maximum of 4 if dependents are covered.

Standard Hospital Indemnity Plan

Helps pick up where other insurance leaves off and provides a direct benefit to
you in the event of a hospitalization regardless of treatment costs.

Benefits include coverage for hospital admission, confinement, critical care,
and a cash incentive when you receive a health maintenance screening.

Transamerica Cancer Plan
Pays continuing benefits to insured member if diagnosed with and treated for
cancer, or for 29 other specified diseases.

Pays a cash benefit if you see a provider for an annual cancer screening.
Preferred Legal Plan

Offers comprehensive legal assistance 24/7, advise and discounted
representation on all types of legal services such as divorce, traffic offenses,
wills, trusts, buying or selling a home, etc.
Members have access to a statewide network of lawyers at a discounted rate
when formal representation is needed, and the in-person consultation is free.
Identity Theft Protection Plan

Receive surveillance alerts via email or text for credit bureau and internet
monitoring, dark web monitoring, and protection of registered bank accounts,
credit cards, etc.

Offers $1,000,000 identity theft insurance to cover items such as illegal
electronic fund transfers, lost wages, etc.





24

Employee Assistance Program





Optima EAP (Employee Assistance Program) is a resource to help you overcome
life’s challenges, solve personal problems, and address work-related issues. It is
provided for all full-time and part-time associates. Coverage is effective on the
st
1 day of employment. EAP services are confidential, short-term, and solution-
focused. Counselors are professional and caring, and all eligible associates and
their dependents can access EAP services at NO CHARGE. You, your spouse or
qualified domestic partner, and your dependents are all eligible.


Optima EAP can help you improve a relationship, support a child or elderly family
member, find tools to manage stress, handle conflict with a coworker or an
employee, and much more. Turn to Optima EAP before an issue or concern
severely impacts your home life or work performance. Optima EAP can help you
manage stress or anger, improve family dynamics, care for sick or elderly family
members, address substance abuse/dependency, deal with grief or a loss, build
resilience, balance work and life obligations. Inspirational posts, videos, webinars,
articles and other resources are waiting for you at OptimaEAP.com. There are in-
person and online trainings available and designed to help build personal and
professional skills.

What you can expect when you contact Optima EAP
On the Call:
Friendly, helpful staff will collect basic information about you, such as your
name, employer, and the reason you are contacting Optima EAP. During
the call Optima EAP will:
• Confirm your benefits
• Share your counseling options: in-person, over the phone, or virtual
• Help you schedule an appointment with a licensed counselor
At Your First Appointment:
After completing a brief intake form your counselor will ask what brought
you to Optima EAP and, in general, how well you are managing at home
and at work. Each session lasts about 45 minutes. Your EAP counselor will
help you develop strategies to deal with you concerns When needed,
they will also provide you with information about community resources
and support groups.
Confidentiality:
Confidentiality is an important component of Optima’s EAP program.
Discussions with our counselors are protected by strict Protected Health
Information (PHI) privacy laws. Optima EAP will not share any PHI, either in
written or verbal form, unless required by law or if you give prior consent.

To contact Optima EAP, call 1-800-899-8174 or send a
confidential email on OptimaEAP.com.





25

401(k) Retirement Savings Plan



AvMed, Inc. 401(k) Retirement Savings Plan is offered through Lincoln Financial
Group (LFG). Lincoln offers specialization, growth, flexibility, competitive rates and
personal service.


Eligibility requirements to become a participant in the 401(k) Retirement Savings
Plan are met on the first of the month after attainment of age 18 and completion
of 3 months of employment. On the first of the month after completion of 3 months
of employment, the associate may register for an online account with Lincoln. At
that time, the associate can go to lfg.com/register and follow the prompts. One
month after meeting eligibility requirements, regular full-time or part-time
associates will automatically be enrolled in the 401k Savings Plan at a 3% deferral
rate. Associates that do not wish to be automatically enrolled or make a salary
deferral to the plan, must opt-out through Lincoln’s website once eligible to register
for an on-line account, or you must contact a Lincoln retirement consultant.
Contact information for the retirement consultants can be found in UKG; go to
Myself > Company Benefits Info. You may elect the percentage of pay or flat rate
per pay period that you wish to contribute at any time during the year by
establishing your Lincoln Financial account online at www.LFG.com, and making
your deferral election in your online account.


Eligible participants may contribute on a pre-tax or post-tax basis up to the annual
IRS dollar limit. Associates reaching age 50 or older can contribute additional
catch-up contributions. Associates that contribute to the 401(k) Retirement
Savings Plan will be eligible to receive the Plan’s Matching Contributions described
below on the first of the month upon attainment of age 21 and completion of one
year of service and at least 1000 hours. Associates are always 100% vested in the
company’s Matching Contributions.

When You Contribute… The Plan Will Match…
Up to 3% of pay 100% of your contribution
Over 3% and up to 5% of pay 50% of your contribution
Over 5% of pay 0%

At the end of each year, subject to the discretion of the Board of Directors,
associates may receive an annual Target Contribution if the associate meets the
eligibility requirements and is actively employed on the last day of the year. The
Target Contribution is estimated at 2%-4% of pay but is tied to Company
performance so it may differ depending on how the Company does each year.
Eligible Associates will receive this contribution even if they do not contribute to the
401(k) Retirement Savings Plan. Vesting for the annual Target Contribution is graded
over a 2-to-6-year period.
26

Additional Benefits – AvMed




Hours per
Paid Time Off Accrual Pay Period Maximum
Hours
th
st
1 day to 35 month of employment 5.54 216.06
rd
3 employment anniversary 5.85 228.15
th
4 employment anniversary 6.15 239.85
th
5 employment anniversary 6.46 251.94
6 employment anniversary 6.77 264.03
th
7 employment anniversary 7.07 275.73
th
8 employment anniversary 7.38 287.82
th
th
9 employment anniversary 7.69 299.91
th
10 employment anniversary 8.00 312.00
15 employment anniversary 8.62 336.18
th
20 employment anniversary 9.23 359.97
th


Extended Illness Bank Accrual Hours per Maximum
Pay Period Hours
st
1 day of employment 1.54 500

Company Paid Holidays/Personal Days

New Year’s Day Thanksgiving Day

Memorial Day Day after Thanksgiving
Independence Day Christmas Day
Labor Day 2 Personal Days



Educational Assistance

Available on a first-come first-served basis
College Degree/Certification Continuing Education
6 months full time satisfactory
1-year full-time satisfactory performance in a position
employment & performance
that requires a license
Must be in a degree or certification program that benefits
the company, or to maintain a license required by current
position. Must be taken at a recognized, accredited
educational institution or professional association.



27