2023 SFSL OE Guide

SANTAFE SENIOR LIVING



OPEN ENROLLMENT GUIDE

Contents














































Things to Health &




Know Wellness





What to Expect for Medical 9-16
3
2023
How the Plans Work 9-10
Open Enrollment
4
Dates Plan Features 11-12

Effective Dates 4 Copay Plans 13-14

Who is Eligible 5
HDHPs 15-16

How to Enroll 6 Vision 22


Open Enrollment 6 Dental 23-24
Status
1
Premiums 7-8

Savings & Income




Assistance Protection





Flexible Spending 17-18 Life & Disability
25-26
Accounts Insurance

Health Savings 19-20 Accident Plan 27-28
Account
Hospital Plan 27-28
PLANselect 21
Cancer Plans 27-28

Legal Plan 27-28


ID Theft 27-28




2

Things to Know








The Time is Now!

Open enrollment is your annual opportunity to take a fresh look at your
entire benefits package and make any changes for next year. This guide

provides an overview of benefits offered for the 2023 plan year so you
can make informed decisions. We encourage you to make the most of
your benefits by becoming familiar with all the offerings available to you

and carefully making your elections to ensure you and your family have
the coverage you need.



What to Expect for 2023


1. DENTAL: Plan 1 will cover up to four

dental cleanings per member per
plan year, starting January 1,
2023. Plan 2 will continue with two

cleaning per year. Premiums for
both plans are increasing slightly by

2.1% for 2023.
2. MEDICAL: The five medical plans will
continue to be offered for 2023.

There will be no change in benefits
or coverage and only a modest

increase in premiums.
3. HSA: Generous employer HSA
contributions remain the same for

2023. Associates that enroll in an
HDHP for 2023 and are eligible for

HSA contributions will receive their
first 2023 employer contribution at
the same time as their first 2023 pay.







3

Open Enrollment Dates:

October 31 – November 14




Effective Dates

1/1/2023: First day of the plan year

Benefit elections made during open
enrollment are effective, except for any
coverage that must be approved by

Standard prior to taking effect.



1/6/2023: First paycheck of 2023
• FSA deductions will start this pay.
• Employer HSA contributions will

start this pay.
• Associate HSA contributions will 1/20/2023: Second paycheck

start this pay. 2023 benefit deductions will
• All other benefit deductions on this begin this pay period.
pay will reflect 2022 benefits and

premiums due to pay period dates.





All Elections are Final!


You will not be able to make
changes to your 2023 benefits

outside of open enrollment unless
you experience a qualifying life
event or status change such as

marriage, divorce, birth of a child,
etc. Watch the video to learn more!





Finding more information is easy!


1. Log in to UKG with your credentials
2. Navigate to Myself > My Company > Company Benefits Info
3. Review benefit plan videos and information

4

Who is Eligible







Current Domestic
Full Time Associates Child(ren) Who Pays?
Spouse Partner
Scheduled to work Up to age 26
a minimum 30 hrs/week except as noted
Medical 9 9 9 9 You + SFSL

Dental 9 9 9 You + SFSL

Vision 9 9 9 You
Basic Life Insurance 9 SFSL

Long Term Disability 9 SFSL

Spouse Life Insurance 9 You


Child Life Insurance 9 You
Supplemental Life
9 You
Insurance


Short Term Disability 9 You


Accident Plan 9 9 9 You
Legal Plan/Identity
9 9 9 9 You
Theft Protection
Up to age 18

Hospital Plan 9 9 9 You


Dependent Documentation: For any newly added Documentation Required by Dependent Type
dependent(s), you will need their birth dates, SSN, and you will
be required to submit documentation by dependent type. Spouse Official State Marriage certificate
Submit documentation to [email protected] by the
open enrollment deadline of 11/14/22. Domestic Certification of Domestic Partnership
.Partner issued by the County

Domestic Partner Tax Implication: When covering a domestic Child(ren) Official State Birth certificate(s)
partner on your medical, you will be taxed on the full value of
the domestic partner’s portion of the premium including the Step Official State Birth certificate(s) AND
company paid portion of their coverage. .Child(ren) Official State Marriage Certificate

Dependent 26 – 30 years old: When covering a dependent Child(ren) of Official State Birth certificate(s) AND
child on your medical plan that is age 26 – 30, you will be taxed .Domestic Certification of Domestic Partnership
on the full value of the child(ren)’s portion of the premium .Partner issued by the County
including the company paid portion of their coverage. Adopted
Legal adoption documentation
.Child(ren)
5

How to Enroll







1. Log in to UKG from any computer at

Want to make e13.ultipro.com using your user ID and
password
changes to your 2. Select Menu > Myself > Open Enrollment
benefits? 3. Select Make New Elections
4. Either elect or waive each benefit option
5. Submit your enrollment by clicking Submit




1. Log in to UKG from any computer at
e13.ultipro.com using your user ID and
Want to keep all your
password
benefits the same? 2. Select Menu > Myself > Open Enrollment
3. Select Stay Enrolled in Current Benefit Plans
then click OK



If your open enrollment status is…

Your elections have not been submitted. If you leave your session in this status,
your current coverage will rollover into 2023 except for FSAs. New rates will
In Progress
apply. The rollover will be binding with no changes allowed unless due to a
qualifying event.

You have not started your session at all. If you leave your session in this status,
your current coverage will rollover into 2023 except for FSAs. New rates will
Not Started
apply. The rollover will be binding with no changes allowed unless due to a
qualifying event.

You submitted elections at least once, but then reopened to make changes to
Reopened your elections. If you leave your session in this status, then your most recently
submitted elections will be effective 1/1/2023.

Passive You elected to not make any changes to your current benefits, and they will
Enrollment rollover into 2023 except for FSAs.

Complete You have submitted your elections successfully!

Please Review and Remember:
• If you have a current FSA for 2022, IT WILL NOT ROLLOVER. If you are eligible to enroll in
the 2023 FSAs, you must go through open enrollment to elect it for 2023.
• It is your responsibility to remove a dependent who no longer meets eligibility

requirements.
• If you currently have an HSA payroll deduction it will continue into 2023 unless you are no

longer eligible for an HSA in 2023 based on your medical plan election, or you change it
6
through the UKG HSA life event.

SFSL Premiums












Pre-tax Self Only Self + Spouse


Medical Copay HMO 1 9 $72.48 $289.86

Medical Copay HMO 2 9 $66.20 $264.85

Medical CHOICE 9 $73.70 $353.70


Medical HDHP HMO 1 * 9 $46.78 $163.69



Medical HDHP HMO 2 * 9 $0.00 $137.12


Dental Plan 1 9 $9.91 $30.09

Dental Plan 2 9 $5.10 $19.68


Vision 9 $3.88 $7.59

Hospital Plan $8.98 $19.02

Accident Plan $9.56 $18.12

Cancer Plan A $17.30 $31.60

Cancer Plan B $10.48 $19.14


Legal Plan

Identity Theft Plan


Legal + ID Theft Bundle



Premium Reminder:
• Domestic Partner Tax Implication: When covering a domestic partner on your
medical plan, you will be taxed on the full value of the domestic partner’s portion of

the premium including the company paid portion of their coverage.
• Dependent 26 – 30 years old: When covering a dependent child on your medical

plan that is age 26 – 30, you will be taxed on the full value of the child(ren)’s portion
of the premium including the company paid portion of their coverage.

7

Self + Child(ren) Family


$220.30 $324.67

$201.52 $296.65

$224.03 $377.23 * HSA Biweekly Employer Contribution


$133.31 $187.08
HDHP HDHP
HMO 1 HMO 2
$108.56 $146.29


$31.26 $49.18 Self Only $23.08 $9.62

$20.31 $32.39
Self + $34.62 $57.69

$6.30 $10.23 Spouse

$17.38 $29.24
Self +
$16.54 $25.10 Child(ren) $34.62 $57.69

$19.81 $31.60

$12.05 $19.14 Family $46.15 $76.92


$4.60

$8.77


$11.98




Questions?




Contact the benefits office via email at


[email protected]



8

How the Medical Plans Work





You have the option of enrolling in any of the five plans offered for 2023. There are
three copayment plans, which include two HMO plans with in-network benefits
only and one CHOICE plan offering in and out-of-network benefits. There are also

two high deductible health plans (HDHP), which offer in-network benefits only.



GL OSS A R Y Watch the video below to learn more!
• Deductible: The amount you pay for covered
services before your insurance starts to share
in the cost.
• Copayment (Copay): A fixed amount you pay
for a covered healthcare services or
prescription drug.
• Coinsurance: The percentage of costs you

pay for a covered healthcare service.
• Out-Of-Pocket Maximum: The most you pay

per plan year for covered healthcare
expenses including prescription drugs.



How do the copay plans work?




Throughout the plan year, you’ll only be charged a copayment for most
1 in-network services including office visits, immediate medical care, and

prescriptions. Copays do not count towards the annual deductible, but

do count towards the out-of-pocket maximum.



For a few in-network hospital and outpatient services, and for all out-of-
2 network services on the CHOICE plan, you must meet the annual

deductible first and then pay a copayment or coinsurance.





Upon meeting the out-of-pocket maximum the plan will pay 100% of
3 eligible service. Copayments, coinsurance, and deductible amounts all

count towards the out-of-pocket maximum.





9

How do the HDHPs work?




From the beginning of the plan year, you’ll pay the full contracted rate
1 for any in-network covered services including prescriptions until you

meet your annual deductible.





Upon meeting the individual annual deductible, or when 2 or more

2 members combine to meet the family annual deductible, you’ll share
the cost of care by paying a copayment or coinsurance until you meet

your annual out-of-pocket maximum.




Upon meeting the individual out-of-pocket maximum, or when 2 or
3 more members combine to meet the family out-of-pocket maximum,

the plan will pay 100% of eligible services through the end of the plan
year.




HMO1 HMO2 CHOICE HDHP1 HDHP2

Copayment Plan 9 9 9

High Deductible Health Plan 9 9

In-network preventive care
covered at 100% 9 9 9 9 9
Annual wellness exams,
immunizations, etc.
Open Access
No referral needed for most 9 9 9 9 9
specialists

In-network benefits only 9 9 9 9

In and out-of-network 9
benefits

Eligible for HealthCare 9 9 9
Flexible Spending Account

Eligible for Health Savings 9 9
Account



10

Medical Plan Features






Extended Eligibility

You can extend your dependent’s medical coverage through the end of the calendar year in which they
turn 30 if they meet the eligibility requirements. Please note, you will be taxed on the dependent’s portion
of premiums including the company paid portion. Eligibility requirements are listed on the affidavit found
on UKG: Myself > My Company > Company Benefits Info


Away from Home (AFH)

This program allows access to a nationwide provider network through Private Healthcare Systems, Inc.
(PHCS) for covered dependent children who reside outside of the AvMed service area on a temporary
basis and are enrolled in an accredited college or university. If eligible, your covered dependent child(ren)
may use PHCS providers and receive the in-network benefit level. To determine if PHCS providers are
available where your dependent child(ren) resides temporarily, please check the website here.

To obtain access to the PHCS network for your eligible dependent child(ren) you must complete and
submit a SFHC AFH enrollment form each plan year your dependent child(ren) are eligible. All required
plan procedures and guidelines must still be followed for claims to be approved for payment. The AFH
form can be found on UKG: Myself > My Company > Company Benefits Info



SmartShopper

Get a reward for your next medical procedure!

How does it work?
1. Compare prices and rewards by shopping
online or calling AvMed’s Personal Assistant Watch the video to learn more!
Team at 1-866-285-7453.
2. Schedule your appointment or let the
Personal Assistant Team do it for you.
3. Earn your reward by having your
appointment within the year.

How to get started:
1. Log in to your Member Portal by visiting
here or callimg the SmartShopper
Personal Assistant Team at 1-866-285-
7453
2. Select the “Find Physicians & Facilities”
drop down
3. Click “Cost Calculator” to access
SmartShopper




11

Telehealth Virtual Visits: MDLive

Avoid the wait!
What you get:
• See a doctor by video or phone 24/7/365
• Board-certified and licensed doctors with

an average of 15 years of experience.
• Doctors can send prescriptions right to
the nearest pharmacy.


Why use AvMed Virtual Visit?
• The nation’s largest telehealth network
• Quality care on your schedule

• Private and secure consultations Watch the video to learn more!
• Peace of mind for you and your family





Rx Savings Solutions (RxSS)

Stop overpaying for prescriptions! Watch the video to learn more!
How it works:
1. RxSS looks at the medications a

member takes and finds other
options that may save them money.
2. Their online account shows which
lower cost prescriptions are available
and lets them compare prices.
3. Switch to a lower cost option with
ease. RxSS will handle everything
with their doctor and pharmacy. Members can activate their account now.
4. RxSS will contact you anytime you can Call: 1-800-268-4476

be spending less. Visit: AvMed.org
























12

Copay Plans







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 MAXIMUM
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 (MD Live) 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

Ambulance (Ground) $150 copay / one-way transport $150 copay / one-way transport
OUTPATIENT SERVICES
Outpatient Radiology
Complex (CT/PET scans, MRIs, etc.) $200 copay $200 copay
Independent Facility
Complex (CT/PET scans, MRIs, etc.) $400 copay after deductible $400 copay after deductible
Hospital Owned/Affiliated Facility

Other $50 copay / visit $50 copay / visit
(X-ray, ultrasound, etc.)

Outpatient Routine Lab No charge No charge

Durable Medical Equipment $250 copay per episode of illness $250 copay per episode of illness

Outpatient Surgery 10% coinsurance after deductible 10% coinsurance after deductible

HOSPITAL
Inpatient 10% coinsurance after deductible 10% coinsurance after deductible

PRESCRIPTION DRUGS
Retail Mail Order Retail 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% N/A 50% N/A



13

AvMed Member
Engagement:
Please Note: This is only an overview. For more information, (888) 882-8633
review the Summary of Benefits & Coverage for each plan located
in UKG at Myself > My Company > Company Benefits Info


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





$200 copay $200 copay 40% coinsurance after deductible


$400 copay after deductible $400 copay after deductible 40% coinsurance after deductible


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

No charge No charge 40% coinsurance after deductible


$250 copay per episode of illness $250 copay per episode of illness 40% coinsurance after deductible

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



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

Only at AvMed Participating Pharmacies
Retail Mail Order Retail Mail Order Retail Mail Order
$20 $50 $20 $50 $20 $50
$30 $75 $30 $75 $30 $75
$50 $125 $50 $125 $50 $125
$100 $250 $100 $250 $100 $250
50% N/A 50% N/A 50% N/A



14

HDHPs








HDHP 1
CALENDAR YEAR DEDUCTIBLE in-Network
[Self] / Individual / Family $3,000 / $6,000
OUT-OF-POCKET MAX
[Self] / Individual / Family $6,750 / $13,500
OFFICE SERVICES
Primary Care Physician (PCP) $25 copay after deductible / visit

Specialist $50 copay after deductible / visit

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
Emergency Room $250 copay after deductible / visit


Ambulance (Ground) $150 copay after deductible / 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

Durable Medical Equipment $250 copay after deductible per episode of illness


Outpatient Surgery Facility $500 copay after deductible / visit

Outpatient Surgery Physician Services No charge after deductible

HOSPITAL
Inpatient $1,000 copay after deductible per admission
PRESCRIPTION DRUGS Only at AvMed Participating Pharmacies
Retail Mail
Value Generic $10 after deductible $25 after deductible

Generic $20 after deductible $50 after deductible
Preferred $50 after deductible $125 after deductible
Non Preferred $100 after deductible $250 after deductible
Specialty 30% after deductible N/A



15

AvMed Member
Engagement:
Please Note: This is only an overview. For more information, (888) 882-8633
review the Summary of Benefits & Coverage for each plan located
in UKG at Myself > My Company > Company Benefits Info




HDHP 2
in-Network
$5,000 / $10,000


$5,000 / $10,000 Health Savings Account


To help pay for current and future eligible
healthcare expenses, your employer will
No charge after deductible
automatically open and contribute to an HSA
on your behalf if you enroll in either of the
HDHPs, and if you meet the eligibility

requirements. You can also contribute to
your HSA tax-free every pay period. More
details can be found on pg. 17.
No charge after deductible


SFSL HSA Biweekly Employer Contribution




HDHP 1 HDHP 2



Self Only $38.46 $46.15
No charge after deductible


Self + Spouse $69.23 $76.92



Self + $69.23 $76.92
Child(ren)

No charge after deductible
Family $69.23 $76.92
Only at AvMed Participating Pharmacies
Retail Mail




No charge after
deductible No charge after deductible







16

Flexible Spending Accounts






Flexible Spending Accounts (FSAs) are a great way to save money for eligible expenses
and to lower your taxable income by allowing you to set aside money directly from your
paycheck before taxes are taken out. There are two options to choose from, the
Healthcare FSA and the Dependent Care Reimbursement Account (DCRA).




Healthcare FSA
• You must enroll in one of the

three copay medical plans to
elect the Healthcare FSA.
• Funds can be used for qualified
expenses including medical,
dental, vision, deductibles, co-
payments, coinsurance,
prescriptions, orthodontia,
glasses, and more.
• Funds can be used for yourself

and/or your IRS dependent(s).




Why choose a Healthcare FSA?

Significant tax savings
1 Since each dollar you contribute to your FSA is tax-deductible, you save on taxes and

pay for qualified medical expenses with tax-free dollars.
Get your money right away
2 You’ll have access to your entire elected amount after the first payroll deduction of

the plan year. That means you can spend now and contribute through-out the year.

Simple saving and spending
3 Pre-tax payroll contributions along with easy-to-use payment options through your
HealthEquity portal make managing your account convenient and hassle-free.

Spend beyond the doctor
4 Your FSA dollars can help pay for thousands of eligible medical expenses, including

over-the-counter meds, dental and vision expenses.






17

Why choose a Dependent Care RA?
Dependent Care RA
• Funds can be used to reimburse Significant tax savings

expenses related to the care of 1 Since each dollar you contribute to
eligible dependents while you work your DCRA is tax-deductible, you save
such as after school care or preschool. on taxes and pay for eligible daycare
• Dependent Criteria for DCRA: expenses with tax-free dollars.
• Child under the age of 13
• Spouse who is physically or
mentally unable to care for Cover more than you think
himself/herself 2 Use DCRA dollars to cover a wide
• Any adult claimed on your tax variety of eligible dependent care

return who is physically or expenses, including daycare, pre-
mentally unable to care for school, summer day camp, before and
himself/herself afterschool programs, and elder care.






3 Simple saving
It’s a smart, simple way to save money
while taking care of your loved ones
so that you can continue to work.








Watch the video to learn how to optimize your Reminder:
FSA dollars! FSAs DO NOT ROLLOVER. Per IRS
requirements, you must enroll in a FSA

each year that you want to have it. If you
want a FSA for 2023, you must elect it in
open enrollment and submit your
elections. If you do not complete open
enrollment or you elect to stay enrolled in
current benefit plans, then your FSA (if
applicable) will terminate on 12/31/2022.




USE IT OR LOSE IT!
FSA funds do not roll over into the following plan year! As required by the IRS, FSAs have
a use it or lose it provision stating that any unused funds at the end of the plan year will
be forfeited and not carried over to the next year. For more details, see IRS publication
969 or consult a tax advisor.

18

Health Savings Account






A Health Savings Account (HSA) is an individual account used in conjunction with an
HSA-eligible high deductible health plan (HDHP) to pay for out-of-pocket qualified
healthcare expenses with pre-tax dollars. If you enroll in one of the two HDHPs and
meet eligibility, you will be automatically enrolled in an HSA.


HSA Key Features: HSA Eligibility:

• If eligible, your employer will make a • You must be enrolled in one of the

biweekly contribution to your HSA. two high deductible health plans
• You can make tax-free contributions via • You cannot be enrolled in any part
payroll deductions. To contribute, of Medicare or Tricare
complete the HSA life event located on • You cannot be claimed as a
UKG at Menu > Myself > Life Events. dependent on someone else’s tax
• Use your HSA dollars, tax-free, to pay return
eligible out-of-pocket medical • You cannot have any other medical
expenses, as well as dental and vision coverage (such as through your

expenses, or you can save the money spouse’s employer) unless it is also
for future health care expenses. an HSA-qualified HDHP
• Your HSA balance rolls over from year to • You can still enroll in one of the high

year so you can use it or save it for deductible health plans even if you
future health care expenses incurred are not eligible for the HSA
even after you retire. If you leave or
retire, you take your HSA with you,
including the employer contributions. SFSL HSA Biweekly Employer
• Pay your portion of qualified expenses Contribution

with the HSA debit card provided by
HDHP 1 HDHP 2
HealthEquity, by a check from your HSA,
or an alternative source and then
reimburse yourself from your HSA. Self Only $38.46 $46.15


2023 HSA Annual Contribution Maximums Self + $69.23 $76.92

Includes employee and employer contributions Spouse

Self Only $3,850 Self + $69.23 $76.92
Child(ren)
Family $7,750

Family $69.23 $76.92
$1,000 Catch-Up for those 55+ years old



19

How an HSA works









Pre-tax Tax-free
Company You
Qualified Medical
HSA
Expenses





Watch the video to learn more!






























What will happen to my HSA if I don’t enroll in a HDHP in 2023?


• You will still be able to use the funds for qualified medical expenses in 2023 until the
funds run out, however, the monthly service fee for the account will no longer be
paid by your employer effective 12/31/2022.
• You will have the option to keep your account open with HealthEquity or to close it.
• If you choose to keep your account open in order to easily use the funds, a monthly

administrative fee will be deducted from your account as long as you have funds
remaining.
• If you choose to close your account, then you will receive your remaining funds
directly. However, you must either deposit the funds into another HSA or use the
funds for qualified medical expenses within 60 days after you receive them to avoid
taxes and penalties.




For more information contact HealthEquity: (866) 346-5800 20

PLANselect







PLANselect is a decision support tool that assists you in selecting the best medical plan for
you! By answering just four simple questions, PLANselect will make a recommendation
based on your family’s needs. Your recommendations will be completely confidential and
your responses will not be shared or stored in the system. Also included in PLANselect is
assistance with how much to contribute to a health savings account if you are matched with
a high deductible health plan, and assistance with what dental and supplemental plans
would work best for your family. Watch the video below to learn more!






















How to Access

UKG:
• Myself > My Company > Company Benefits Info

• Click on PLANselect under the Open Enrollment heading


Mobile Phone (SFSL):
• Hover your smartphone’s camera over the QR code here.


























To learn more about PLANselect log in to UKG and go to Myself > My Company > Company Benefits
21 Info under the Open Enrollment heading.

EyeMed Customer
Service
(866) 939-3633
Vision





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. The
vision plan offered to full time associates is through EyeMed.


In-Network Out-of-Network

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


Cost over $130
You Pay: 100%
20% discount off remaining balance
Frames
Once per 12 months Reimburses up to
Plan $130 allowance $65/frames and
Pays: Applies to frames or contacts
$80/contacts
Lenses for Glasses or $25 deductible
Contacts You Pay: For contacts only: Cost over $130 + receive 100%
Once per 12 months 15% discount off remaining balance

Single Vision Lenses Reimburses up to $25
Plan For glasses lenses: 100%
Bifocal Lenses Reimburses up to $40
Pays: For contacts: $130 allowance
Trifocal Lenses Reimburses up to $55


Watch the video to learn more!




















Protect Your Eyes with a Vision Care Plan



Visit eyemed.com to find in-network providers. This is only an overview. For more information, review the
plan document located in UKG at Myself > My Company > Company Benefits Info 22

Dental






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.


Plan 1 Plan 2

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

Maximum Benefit $1500 $1500

100% In-
100% of the
Type 1 Plan Pays: 100% 90% U&C 100% Network
Preventive Contracted Rate
Services Remainder of Remainder of
You Pay: $0 $0
cost cost


80% of the 90% 80% In-Network
Plan Pays: 80% 80%
U&C Contracted Rate
Type 2
Basic Services
$50 lifetime $50 lifetime
You Pay: deductible Remainder of deductible Remainder of
cost cost
then 20% then 20%


50% of the 90% 50% In-Network
Plan Pays: 50% 50%
U&C Contracted Rate
Type 3
Major Services $50 per $50 per
calendar year Remainder of calendar year Remainder of
You Pay:
deductible cost deductible cost
then 50% then 50%

50% of 90%
50% up to 50% up to 50% In-Network
$1000 lifetime U&C up to $1000 lifetime Contracted Rate
Orthodontia Plan Pays: maximum $1000 lifetime maximum up to $1000
Adults & benefit maximum benefit max
Children benefit
Remainder of Remainder of Remainder of Remainder of
You Pay:
cost cost cost cost

Visit Standard.com/dental to find in-network dental providers. This is only an overview. For more
23 information, review the plan document located in UKG at Myself > My Company > Company Benefits Info

Standard
Watch the video to learn more! Customer Service
(800) 547-9515



















The importance of dental care





In-Network vs. Out-of-Network Example

PLAN 1
Based on submitted Both Plans PLAN 2
dental charges of Out-of-Network Out-of-Network
$200 In- Network Pays 90% of Usual & Pays In-Network Contracted Rate
Customary

Covered Amount
Amount of submitted Contract rate 90% Usual & Customary In-network contract rate
charges the plan $155 $200 * 90% = $180 $155
covers

Preventive 100% You pay: $0 $200 - $180 = you pay $20 $200 - $155 = you pay $45


Basic 80% You pay: $31 $200 - $144 = you pay $56 $200 - $124 = you pay $76

$200 - $77.50 = you pay
Major 50% You pay: $77.50 $200 - $90 = you pay $110
$122.50


Max Builder: Increase your maximum benefit by an additional $1,000!
Feature on both plans


Submit at
Enroll in a least one
dental plan Visit a claim $250
(both plans dentist at during the Added to
least once max benefit
have a during the plan year &
$1,500 max plan year. total claims for the next

benefit). less than plan year.

$750.



24

Life & Disability






Insurance






The company provides basic life and disability coverage at no cost to you. In addition, you
may purchase supplemental life insurance or disability coverage through payroll deduction. If
you want to add or increase any supplemental coverage, with the exception of child life
insurance, you must complete a medical history statement and be approved by The Standard
before coverage will be effective. To access the medical history statement, you may click on
the hyperlink on this page or click on the link in the UKG open enrollment session. PLEASE
NOTE: You are not required to complete a medical history statement for any supplemental
coverage amounts you currently have.




Supplemental Life Insurance

SFSL: $10,000 increments up to a maximum of $500,000

The Terraces, East Ridge, The Village: $5,000 increments up to
maximum of $500,000

Supplemental
Coverage Spouse Life Insurance

Associate Cost
$5,000 increments and/or flat rate of $5,000 or $10,000 up to a
combined maximum of $250,000



Child Life Insurance

$1,000, $2,000, $5,000 or $10,000 for children through age 25























25

Standard Customer
Service
(800) 628-8600
Policy # 133459






Basic Coverage
SFSL Paid - No cost to associate


Life Insurance

SFSL Two times annual base salary rounded up to the next $1,000 to a max
of $250,000

The Terraces Non exempt associates: $25,000

Exempt associates: Two times annual base salary rounded to next
$1,000 up to max of $100,000

The Village Non exempt associates: $25,000
Exempt associates: Two times annual base salary rounded to next
$1,000 up to max of $100,000


East Ridge Non-management associates: Annual base salary rounded to the next
$1,000 up to max of $100,000
Management associates: Two times annual base salary rounded to the
next $1,000 up to a max of $100,000


Long Term Disability


SFSL 70% of monthly base salary to a max of $10,000 per month

The Terraces 60% of monthly base salary to a max of $3,000 per month

The Village 60% of monthly base salary to a max of $3,000 per month

East Ridge 60% of monthly base salary to a max of $3,000 per month

Short Term Disability


SFSL 60% of weekly base salary

The Terraces 70% of weekly base salary up to a max of $1,000 per week

The Village 70% of weekly base salary up to a max of $1,000 per week


East Ridge 70% of weekly base salary up to a max of $1,000 per week


This is only an overview. For more information, review the plan documents located in
UKG at Myself > My Company > Company Benefits Info
26

Supplemental Plans







Supplemental plans pick up where other benefits such as health plans leave off. They also pay

benefits directly to you, not a health care provider. We offer full time associates the following
options including a hospital plan, accident indemnity plan, cancer plans, legal plan, and
identity theft plan.



Allstate Standard

Accident Plan Hospital Plan



• Helps you to offset the out-of-pocket • Helps to offset the hospital deductible
costs of your health insurance. and out-of-pocket costs on your health
• Offers protection for accidental injuries insurance.
on or off the job, 24 hours a day. • Provides a direct cash benefit to you for
• Cash benefits paid directly to you for hospital admission, confinement, and
covered services directly related to an critical care.

accident. • Covers hospitalizations for both accident
• Benefits include: and illness.
• Accidental death: $150,000 • Benefits are:
• Leg/arm fracture: $6,600 • Hospital admission: $1,000
• Medical expenses: up to $900 • Daily hospital confinement: $250
• General anesthesia: $600 up to 31 days per stay
• Hospital admission: $3,000 • Critical care unit confinement:
• Daily hospital confinement: $1,200 Additional $50 per day up to 31
• Injury related payments for covered days per stay
spouse & children are paid at 50% & 25% • A cash incentive is payable once a year
• A cash incentive payable twice a year for having a covered wellness screening.
when you see a physician for any reason.






















27

• Two plans offered, both have the same benefits, however Plan A pays
out more per benefit than Plan B.
• Pays continuing benefits to you if diagnosed with and treated for
cancer or other specified diseases such as cystic fibrosis, lupus, and
more.
• Cash benefits include but are not limited to:
• Initial cancer diagnosis: $1,000 on either plan
• Hospital confinement: $300 Plan A / $200 Plan B

• In-patient surgery: $3,000 Plan A / $2,000 Plan B
TransAmerica • Skin cancer removal: $225 Plan A / $150 Plan B
Cancer Plans • Additional skin cancer removal: $105 Plan A / $70 Plan B

• A cash incentive payable once a year for having a covered cancer
screening.




IMPORTANT: The cancer plans will NOT be included in the UKG Open
Enrollment session. If you currently have the cancer coverage, it will roll
over to 2023. If you wish to add cancer coverage or cancel your cancer
coverage effective 12/31/2022 you must contact Karen Torchia, the plan
representative. Email: [email protected]



• Offers free comprehensive legal counsel via phone 24/7, and lawyers
are available who are fluent in English, Spanish, and Creole.
• Access to a statewide network of lawyers at a discounted rate when
formal representation is needed.
• Covered legal issues include but are not limited to:
Legal Plan
• Divorce
By Preferred • Traffic offenses
Legal • Loan modifications & foreclosures

• Wills & trusts
• Buying or selling a home
• Preferred legal will send letters and make phone calls on member’s
behalf to third parties to resolve miscellaneous disputes for free!



• Offers surveillance alerts for credit bureaus, internet and dark web

monitoring, protection of registered bank accounts and credit cards,
Identity Theft and more.

Plan • Members have access to a complete Experian credit report available
By Experian daily.
• Plan will pay up to $1,000,000 in identity theft insurance to cover
items such as illegal electronic fun transfers, lost wages, etc.
28