2022 Benefit Brochure - Birlasoft

2022 BENEFIT BROCHURE

This is a summary of the medical, dental, vision, and ancillary benefits offered by Birlasoft. Please read the formal plan
documents and the summary plan description for more details regarding the benefits. To the extent any of the material
contained in this summary is inconsistent with the official plan documents, the provisions of the official plan documents
will govern.

OVERVIEW
We offer comprehensive medical, dental, and vision coverage. Your share of the cost is deducted from your paycheck on
a pre-tax basis. After making your coverage selection, you may not change your plan options until the next open enrollment
period, unless you qualify for a life event (described later).
In addition to the benefits discussed above, Birlasoft also provides employees with the following:

 Basic Life Insurance – company paid benefit
 Accidental Death & Dismemberment Insurance (AD&D) – company paid benefit
 Short-Term Disability (STD) – company paid benefit
 Long-Term Disability (LTD) – company paid benefit
 Employee, Spouse, & Dependent Voluntary Term-Life – must be elected by employee
 Health Savings Account (HSA) – must be elected by employee
 Medical Flexible Spending Account (FSA) – must be elected by employee
 Limited Purpose Flexible Spending Account (LPFSA) – must be elected by employee
 Dependent Care Flexible Spending Account (DCA) – must be elected by employee
 Voluntary Accidental Injury, Critical Illness, and Hospital Indemnity – must be elected by employee
 Voluntary Legal Services Plan – must be elected by employee
 Voluntary Discounted Auto and Home Insurance – must be elected by employee

ELIGIBILITY
You are eligible for benefits if you are a full-time employee, working at least 30 hours per week. Your coverage begins
on your date of hire. You may enroll your spouse, domestic partner, and/or eligible dependent children in the medical,
dental, vision, and applicable voluntary benefits.

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MEDICAL BENEFITS

Birlasoft offers employees comprehensive medical coverage through Aetna. You have the option to choose between the
three plans outlined below:

Medical Benefits Aetna HSA EPO 1500 Aetna EPO 1500 Aetna POS 500

In-Network Calendar Year Calendar Year Calendar Year
Deductible Reset $1,500/$3,000 $1,500/$3,000 $500/$1,000
Deductible (Single/Family)
Coinsurance Level 80% 80% 80%
Out-of-Pocket Max (incl. ded) $4,500/$9,000 $4,500/$9,000 $3,000/$6,000
Office Visits (Primary/Specialist) 20% after deductible $25/$25 Copay $25/$25 Copay
Preventive Care
Emergency Room No Charge No Charge No Charge
Urgent Care 20% after deductible $100 Copay $100 Copay
20% after deductible $50 Copay $50 Copay
Lab/X-Ray
Outpatient Facility/Independent Lab 20% after deductible 20% after deductible 20% after deductible
Physician’s Office 20% after deductible
Covered same as Office Visit Covered same as Office Visit

Major Diagnostics (CAT/MRI) 20% after deductible 20% after deductible 20% after deductible
Outpatient Facility 20% after deductible
Physician’s Office Covered same as Office Visit Covered same as Office Visit
20% after deductible
Inpatient Hospital/Surgery 20% after deductible 20% after deductible 20% after deductible
Outpatient Hospital/Surgery 20% after deductible 20% after deductible
Out-of-Network
Deductible (Single/Family) N/A N/A $1,500/$3,000
Coinsurance Level N/A N/A 60%
Out-of-Pocket Max (incl. ded) N/A N/A $10,000/$20,000
Prescription Coverage
Tier 1 (Generic) $10 after deductible $15 Copay $15 Copay
Tier 2 (Brand) $25 after deductible $30 Copay $30 Copay
Tier 3 (Non-Preferred Brand) $40 after deductible $45 Copay $45 Copay
Contributions (Semi-Monthly)
Employee Only $45.00 $70.00 $110.00
Employee + Spouse $90.00 $135.00 $220.00
Employee + Child(ren) $90.00 $135.00 $220.00
Employee + Family $137.50 $210.00 $302.50

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HEALTH SAVINGS ACCOUNT (HSA) – Administered by American Benefits Group

An HSA is a personal savings account that can be used to pay for medical, dental, vision and other qualified expenses.
To contribute to an HSA, you must be enrolled in a qualified high-deductible health plan (Aetna HSA EPO 1500) and
your contributions are limited annually.

Health Savings Account* 2022 IRS Contribution Limits
Employee Only $3,650
Employee + 1, Employee + Family $7,300
Catch Up Contribution (Age 55 or older) +$1,000

*Employee must enroll in the Aetna HSA EPO 1500 medical plan in order to qualify for this benefit.

DENTAL BENEFITS
Birlasoft provides employees with the option to enroll in a dental insurance plan offered through MetLife. The benefits
of this plan are outlined in the summary below:

Dental Benefits MetLife Dental PPO

In-Network Out-of-Network

Deductible (Single/Family) $25/$75

Annual Maximum Benefit $1,500

Preventive Care 100% 100%

Basic Care 90% 90%

Major Care 60% 60%

UCR Level* N/A 99th Percentile

Orthodontia Coinsurance 50% 50%

Orthodontia Lifetime Maximum (Child Only)** $2,000

Contributions (Semi-Monthly)

Employee Only $4.00

Employee + 1 dependent $17.50

Employee + 2 or more dependents $32.50

*Usual, Customary, and Reasonable reimbursement level.
**Orthodontia coverage is Child only (up to age 19).
To find MetLife In-Network providers, print ID Cards, and to obtain claim forms, please visit their website; www.metlife.com.

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VISION BENEFITS
Birlasoft offers employees the option of enrolling on the vision benefit plan offered through MetLife. The network of
vision providers is the Superior Vision network. The benefits of this plan are outlined in the summary below:

Vision Benefits MetLife Vision PPO

In-Network Out-of-Network

Copay (Exams/Materials) $20/$0

Eye Exams

Frequency Once Every 12 months Once Every 12 months

Benefit $20 Copay Up to $45

Lenses

Frequency Once Every 12 months Once Every 12 months

Single Vision $0 Copay Up to $30

Bifocal $0 Copay Up to $50

Trifocal $0 Copay Up to $65

Lenticular $0 Copay Up to $100

Contact Lenses

Frequency Once Every 12 months Once Every 12 months
Benefit Up to $150 + 15% discount on Up to $105
Frames amount above your allowance*

Frequency Once Every 12 months Once Every 12 months
Benefit Up to $150 + 20% discount on Up to $70
Contributions (Semi-Monthly) amount above your allowance*

Employee Only $1.00

Employee + 1 dependent $2.50

Employee + 2 or more dependents $5.00

To find MetLife In-Network providers, print ID Cards, and to obtain claim forms, please visit their website; www.metlife.com.

*Discounts are not available at Walmart and Sam’s Club. Some additional restrictions may apply to discounts, so it is important that
you check with your in-network vision provider for confirmation.

4|Page

ANCILLARY BENEFITS
Birlasoft provides all full-time eligible employees with STD, LTD, Life Insurance, and AD&D coverage through Equitable.
These benefits are provided at no cost to our employees.

Equitable Short-Term Disability
Weekly Benefit 55% of weekly salary to a maximum of $1,011
Duration of Benefits
Elimination Period (Accident/Sickness) 13 Weeks
7 Days / 7 Days

Equitable Long-Term Disability
Monthly Benefit 60% of monthly salary to a maximum of $10,000/month
Duration of Benefits
Elimination Period SSNRA
90 days

Equitable Basic Life & AD&D Insurance
Benefit Amount
Maximum Benefit 2x Annual Salary
Guaranteed Issue Amount
$150,000
Age Reduction Schedule
(Benefit Amount reduces to) $150,000

Benefit
Age Reduces to
65 75%
70 50%

AD&D Benefit Amount is equal to the Life Benefit Amount.

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VOLUNTARY TERM LIFE & AD&D INSURANCE

Birlasoft provides all full-time eligible employees with the ability to purchase additional Life Insurance coverage through
Equitable. The cost of this benefit varies based on age and the amount of coverage elected. You can view your cost
when making your election in the Benefits Connect portal.

Equitable Employee
Benefit Amount
Maximum Benefit Coverage can be purchased in increments of $10,000
**Guaranteed Issue Amount
$500,000
Age Reduction Schedule
(Benefit Amount reduces to) Life Insurance: $150,000
AD&D Insurance: $500,000

Age Benefit Reduces to
70 45%
75 30%
80 20%
85 15%
90 10%

Equitable Spouse
Benefit Amount Coverage can be purchased in increments of $5,000
Maximum Benefit
Lesser of 50% of EE benefit amount or $250,000
**Guaranteed Issue Amount
Life Insurance: $25,000
Age Reduction Schedule AD&D Insurance: $250,000

Spousal coverage terminates at age 70

Equitable Child
Benefit Amount
Maximum Benefit Coverage can be purchased in increments of $5,000
Guaranteed Issue Amount
$10,000
Age Reduction Schedule
Life Insurance: $10,000
AD&D Insurance: $10,000

Children covered to age 26
(From live birth to 6 months of age, coverage is limited to $500.
Upon reaching 6 months of age, elected benefit amount will apply).

*In order to purchase Vol AD&D coverage, employees must elect at least the minimum amount of Vol Life
Coverage (Minimum Vol Life Benefits Amounts: EE - $10,000; Spouse and Child - $5,000).

**Guaranteed Issue amounts shown above are only applicable for newly eligible employees (upon initial eligibility
date). Any existing employees who are not currently enrolled but wish to purchase voluntary employee/spouse
life coverage will be required to submit an Evidence of Insurability (EOI) form.

6|Page

FLEXIBLE SPENDING ACCOUNTS – administered by American Benefits Group
Medical FSA
A medical FSA helps you pay for eligible out-of-pocket medical, dental, vision, hearing and prescription drug expenses for
you, your spouse and your tax dependents. You can contribute pretax dollars from your paycheck, up to the Internal
Revenue Service (IRS) limit of $2,850. Your full contribution is available at the start of the plan year to pay for eligible
health care expenses.
*If you elect to contribute to a Health Savings Account, you will not be eligible for the Medical FSA. You may
elect to contribute to the Limited Purpose FSA as an alternative.
Limited Purpose FSA
A Limited Purpose FSA helps you pay for eligible dental and vision expenses. You can contribute pretax dollars from your
paycheck, up to the Internal Revenue Service (IRS) limit of $2,850. Your full contribution is available at the start of the
plan year to pay for eligible dental and vision expenses. You can only enroll in a Limited Purpose FSA if you have a
Health Savings Account. A Limited Purpose FSA can help you save your HSA funds for the future.
Dependent Care FSA (DCA)
A Dependent Care FSA helps you pay for eligible child or adult day care expenses. You can contribute pretax dollars from
your paycheck, up to the IRS limit of $5,000. Funds are for your dependent(s) age twelve or younger, or a spouse or
dependent incapable of self-care. Your contributions can be used to pay for eligible child and adult care expenses, such as
day care, preschool and nursery school, in-home aid and more.

Grace Period Rule for FSAs:
Generally, funds left in an FSA at the end of the year are forfeited. This is the FSA “use-it-or-lose-it” rule. However, your
plan offers a “grace period” feature, which provides you with an additional two months and 15 days after the end of your
plan year to spend your FSA funds.

Example: The plan year for Birlasoft’s FSA is 08/01/2022 through 07/31/2023. This means that you typically have to
incur expenses during this time for the FSA to reimburse you. However, because the FSA has a grace period, you have
until 10/15/2023 to incur eligible expenses. The grace period is 08/01/2023 through 10/15/2023. If you still have funds in
the FSA during the grace period, the FSA will reimburse you for eligible expenses that you incur. You just need to make
sure to submit your claims by the end of your run out period.

7|Page

VOLUNTARY BENEFITS
Accidental Injury – MetLife
Accidental Injury insurance provides a fixed benefit for covered accidents suffered away from work. It provides a lump
sum payment to you, based on a schedule of covered injuries. The money can be used as you see fit – there are no co-
pays, deductibles, coinsurance, restrictions, or network requirements to satisfy. Coverage continues even after the first
accident to provide additional protection for future accident events.

Critical Illness – MetLife
Critical Illness pays a percentage of a lump-sum benefit in the event you or a covered family member is faced with a
covered critical illness like cancer, heart attack or stroke. What you do with the payment is up to you. It can be used
for expenses beyond direct medical costs, including travel, room and board for medical treatment, childcare, everyday
household bills, etc.

Hospital Indemnity – MetLife
MetLife’s hospital indemnity insurance policy helps members pay for costs associated with unexpected medical bills when
they are admitted to a hospital for a covered injury or illness. The plan pays individuals a lump sum to use as they see fit
for a covered hospitalization.

Legal Services Plan - MetLife
The MetLife legal services plan known as MetLaw from Hyatt Legal Plans, provides easy, direct access to a national
network of attorneys who provide telephone advice and office consultations on an unlimited number of personal legal
matters and fully covered services for the most frequently needed personal legal matters (excluding employment issues).
Participants may also receive service from out-of-network attorneys.

Auto & Home Discount Program – MetLife
The MetLife Auto & Home Group Insurance Program offers insurance policies that are individually underwritten.
Availability and rates are based on the profile of the individual applicant and the insurance policies and coverages that he
or she elects. On a quarterly basis, MetLife will send a mailing outlining benefit options that are available to you. As the
coverage is individually underwritten, employees do not enroll but apply directly with MetLife for the individual insurance
product that they choose.

A full description of each product’s covered services & benefits are included in the appendix section of the
brochure. You can view your cost for each of these coverages when making your benefits election in the Benefits
Connect portal.

8|Page

MAKING CHANGES TO YOUR BENEFITS
Once you have selected your benefit coverages upon employment, you can only make changes to your benefits during
the annual enrollment period OR when you have a life-altering, qualifying event that yields a change in status. A change
in status includes:

 Your marriage or divorce;
 Death of a spouse or child;
 Birth, adoption or foster placement of a child;
 Change in eligibility of a child;
 Your spouse’s gaining or losing employment.
Changes in family status must be submitted to the HR Department within 30 days of the qualifying event. If you
fail to notify the HR department, you will not be able to change your benefit status until the next open
enrollment period.

Birlasoft HR Contact
Archana Huckoo
(732) 287-5000

[email protected]

9|Page

ACCOUNT MANAGEMENT TEAM
To provide our employees with the highest level of service, we now have dedicated service representatives for all our
corporate benefits. They serve as a liaison between our employees and the insurance carriers. If any employee needs
assistance regarding any of the benefits outlined in this brochure, please contact them directly.

Account Management Team
Help Desk

[email protected]

CONTACT INFORMATION

Member Services
(877) 238-6200
www.aetna.com

Member Services
(800) 638-5000
www.metlife.com

Member Services
(800) 499-3539
www.amben.com

Member Services
Auto & Home
(800) Get-Met8

www.metlife.com/insurance/auto-insurance/

Member Services
Legal Services Plan

(800) 821-6400
www.info.legalplans.com

10 | P a g e

Your benefits.
Your way.

AT HOME ON THE GO

Stay on top of your health care, when and where it works for you.

Understand and manage your benefits Register now to get started
• Review benefits and coverage details specific to your plan.
• See what your health care costs, how much is covered Visit myaetnawebsite.com
to register for your member
by your plan and where you are with your deductible website.
and out-of-pocket maximum.
• View and pay claims for your whole family. Get the Aetna HealthSM app
• Access your ID card whenever you need it. by texting “AETNA” to 90156
to receive a download link.
Connect to care and stay healthy Message and data rates
• Find in-network providers, including those offering may apply.*

telemedicine services, as well as walk-in clinics and
urgent cares near you.
• Get cost estimates before you get care.
• View ratings and reviews of providers.
• Talk with a doctor anytime by phone or video chat.
• Receive personalized reminders to help you improve
your health.

*Terms and Conditions: aet.na/Terms Privacy Policy: aetna.com/legal-notices/privacy.html By texting 90156, you consent
to receive a one-time marketing automated text message from Aetna® with a link to download the Aetna HealthSM app. Consent
is not required to download the app. You can also download by going to the Apple® App Store® or Google Play.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies,
including Aetna Life Insurance Company and its affiliates (Aetna).
Estimated costs are not available in all markets or for all services. We provide an estimate for the amount you would owe for a
particular service based on your plan at that very point in time. It is not a guarantee. Actual costs may differ from an estimate for
various reasons including claims processing times for other services, providers joining or leaving our network or changes to your
plan. Health maintenance organization (HMO) members can only get estimated costs for doctor and outpatient facility services.

Aetna.com

©2021 Aetna Inc.
95.03.392.1 B (6/21)

See if your provider is in our network —
or find a new one

You can locate a provider through our provider search tool, which is updated six days a week.
Please keep in mind that the availability of any particular provider cannot be guaranteed.

Steps to locating a doctor

1. Click here to access the search tool.
2. Enter your ZIP code or city/state and click search. This will allow you to search the entire

directory or search for a specific doctor.

3. Select plan choice under the "Aetna Open Access Plans" section and click continue to search
for doctor.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including
Aetna Life Insurance Company and its affiliates (Aetna).
©2018 Aetna Inc.
68.03.304.1 (10/18)

PropPrireotpariyetary

4. Search by doctor name or select a category.

5. Click or search for a specific provider type and your list will appear.

This material is for information only. Providers are independent contractors and are not agents of Aetna. Provider participation may
change without notice. Aetna does not provide care or guarantee access to dental services. Information is believed to be accurate as of
the production date; however, it is subject to change.
©2018 Aetna Inc.
68.03.304.1 (10/18)

PropPrireotpariyetary

You deserve it


Aetna® discount programs
Savings for you

DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access

to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes
no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before
using these discount offers, as those benefits may give you lower costs than these discounts. Not available to NY
policyholders.

Aetna.com

00.02.333.1 O (8/20)

Options with you in mind


Savings on eyewear Savings on healthy
and exams lifestyle choices

Healthy vision A fit, fabulous you

Savings you can see Save on gym memberships, health coaching, fitness
gear and nutrition products that support a healthy
If your vision isn’t 20/20, you’ll love discounts on: lifestyle. You get access to local and national discounts
• Designer frames on brands you know.
• Prescription lenses
• Lens options like scratch coating and tint Health coaching
• Non-disposable contact lenses, and more
Try one-on-one coaching to lose weight, ease stress
Great rates on eye exams or reach another goal.

Your eye exams are always discounted. So even if At-home weight-loss program
your plan covers your first exam, you can save on
another one from any participating doctor. Get weight-loss tips and menus, and track progress
from the privacy of your home.
Lots of locations
Healthy food options
You can visit many doctors in private practice. Plus,
national chains like LensCrafters®, Target Optical® Enjoy healthy food options like meal delivery to your
and Pearle Vision®. Check your member website at home, on your schedule.
Aetna.com for a full list.
Even more savings
More eye-openers
You also save on:
• Savings on LASIK laser eye surgery • Wearable fitness devices
• Replacement contact lenses, delivered to your door • Yoga, meditation and wellness programs
• Savings on eyeglass chains, lens cases and cleaners, • Group fitness on demand

and nonprescription sunglasses

Built-in plan discounts with
no referrals, claims or limits.
Your family can use them, too.

Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc.,
Aetna Health Insurance Company of New York, Aetna Health Insurance Company, Aetna HealthAssurance
Pennsylvania Inc. and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life
Insurance Company. In Utah and Wyoming, by Aetna Health of Utah Inc. and Aetna Life Insurance Company. In
Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial
responsibility for its own products.



























Dislocation Benefit (Closed)

Lower Jaw $750 $1,000
$1,000 $1,500
Collarbone (sternoclavicular) $750 $1,000
$750 $1,000
Collarbone (acromioclavicular and separation) $750 $1,000
$750 $1,000
Shoulder (glenohumeral) $750 $1,000
$750 $1,000
Rib If more than one joint is $4,000 $5,000
Elbow dislocated, the amount we will $2,000 $2,500
Wrist $750 $1,000
Bone or Bones of the Hand (other than fingers) pay for all dislocations combined $100 $200
Hip will be no more than 2 times the
25% 25%
highest Dislocation Benefit.
$1,500 $2,000
Knee (except patella) $2,000 $3,000
$1,500 $2,000
Ankle - Bone or bones of the Foot (other than toes) $1,500 $2,000
$1,500 $2,000
One Toe or Finger $1,500 $2,000
$1,500 $2,000
Partial Dislocation $1,500 $2,000
$8,000 $10,000
Dislocation Benefit (Open) $4,000 $5,000
$1,500 $2,000
Lower Jaw $200 $400

Collarbone (sternoclavicular) 25% 25%

Collarbone (acromioclavicular and separation) $75 $100
$150 $200
Shoulder (glenohumeral) $500 $750
$1,000 $1,500
Rib If more than one joint is $1,000 $1,500
Elbow dislocated, the amount we will $1,500 $2,000
Wrist pay for all dislocations combined $5,000 $7,500
Bone or Bones of the Hand (other than fingers) will be no more than 2 times the $10,000 $15,000
Hip
highest Dislocation Benefit.

Knee (except patella)

Ankle - Bone or bones of the Foot (other than toes)

One Toe or Finger

Partial Dislocation

Burn Benefit

2nd Degree w/ less than 10% of surface skin burnt

2nd Degree 10-25% surface skin burnt

2nd Degree 25-35% surface skin burnt

2nd Degree 35% or more of surface skin burnt 1 time per accident;
3rd Degree w/ less than 10% of surface skin burnt Unlimited time(s) per calendar

year

3rd Degree 10-25% surface skin burnt

3rd Degree 25-35% surface skin burnt

3rd Degree 35% or more of surface skin burnt

Concussion Benefit

Concussion 1 time(s) per calendar year $250 $500
$7,500 $10,000
Coma Coma Benefit
$50 $75
1 time(s) per accident; $75 $125
Unlimited time(s) per calendar $200 $350
$400 $700
year
$200 $300
Laceration Benefit
$100 $150
Without repair by stiches
$25 $50
Repaired by stiches but less than 2 inches long 1 time per accident;
Repaired by stiches and 2-6 inches long 3 time(s) per calendar year $300 $400

Repaired by stiches and over 6 inches long

Broken Tooth Benefit

Crown 1 time(s) per accident;
Unlimited time(s) per calendar
year (applies to all procedures)

Extraction 1 time(s) per accident;
Unlimited time(s) per calendar
year (applies to all procedures)

Filling 1 time(s) per accident;
Eye Injury Unlimited time(s) per calendar
year (applies to all procedures)

Eye Injury Benefit

1 time(s) per accident;
Unlimited time(s) per calendar

year

BENEFIT BENEFIT LIMITS LOW HIGH
PLAN PLAN
Ground Ambulance MEDICAL TREATMENT AND SERVICES BENEFITS CATEGORY
ALL ALL
Air Ambulance Ground Ambulance Benefit COVERED COVERED
PERSONS PERSONS
Emergency Room 1 time(s) per accident;
Physician’s Office Unlimited time(s) per calendar $300 $400
Urgent Care
year $1,000 $1,250

Air Ambulance Benefit $150 $200
$75 $100
1 time(s) per accident; $75 $100
Unlimited time(s) per calendar

year

Emergency Care Benefit

1 time per accident (combined
with Non-Emergency Initial Care
Benefit). Payable within 96 hours

after the accident.

Non-Emergency Initial Care Benefit

Non-Emergency Initial Care 1 time per accident (combined $75 $100
with Emergency Care Benefit)
$10 $50
Medical Testing Benefit
$50 $75
Medical Testing (X-rays, MRI/MR, Ultrasound, NCV, 2 time(s) per accident;
CT/CAT, EEG) Unlimited time(s) per calendar $300 $400

year $35 $50
$35 $50
Physician Follow-Up Benefit $35 $50
$35 $50
Physician Follow-Up Visit 2 time(s) per accident; $35 $50
6 time(s) per calendar year $35 $50
$35 $50
Transportation Transportation Benefit $35 $50

1 time(s) per accident; $75 $100
2 time(s) per calendar year
$750 $1,000
Acupuncture Therapy Services Benefit $1,500 $2,000
Chiropractic Therapy
Cognitive Behavioral Therapy 10 time(s) per accident; $75 $150
Occupational Therapy Unlimited time(s) per calendar $75 $150
Physical Therapy $75 $150
Respiratory therapy year $150 $200
Speech Therapy $300 $400
Vocational Therapy Pain Benefit $75 $150
1 time(s) per accident; $200 $300
Pain Management (for Epidural Anesthesia) $750 $1,000
Unlimited time(s) per calendar $75 $150
One Device Only year
More than One Device
Prosthetic Device Benefit
Brace 1 time(s) per accident;

Unlimited time(s) per calendar
year

Medical Appliance Benefit

Cane

Crutches
Walker - expected use < 1yr
Walker - expected use >=1 yr
Walking Boot

Wheel chair or motorized scooter - expected use < 1yr

Wheel chair or motorized scooter - expected use >=1yr
Other medical device used for Mobility

Medical Appliance Benefit Limit (for all appliances $750 $1,000
combined per accident)
$1,000 $1,500
Modification Modification Benefit
$400 $500
1 time(s) per accident;
Unlimited time(s) per calendar $1,500 $2,000
$150 $200
year $750 $1,500
50% 50%
Blood/Plasma/Platelets Blood/ Plasma/ Platelets Benefit $750 $1,500
$750 $1,000
1 time(s) per accident; $1,500 $2,000
Unlimited time(s) per calendar $1,500 $2,000
$150 $200
year
$300 $400
Surgery Benefits

Surgical Repair – Cranial

Surgical Repair – Hernia

Surgical Repair – Ruptured Disc

Surgical Repair – Skin Graft (% of Burn Benefit )

Surgical Repair – Torn Cartilage in Knee 1 time(s) per accident;
Unlimited time(s) per calendar
Surgical Repair – Torn tendon/ligament/rotator cuff - one
year
Surgical Repair – Torn tendon/ligament/rotator cuff - two
or more
Surgical Repair – Thoracic Cavity or Abdominal Pelvic
Cavity

Exploratory Surgery (for any Surgery Benefit procedure)

Other Outpatient Surgery Benefit Other Outpatient Surgery Benefit

1 time(s) per accident;
Unlimited time(s) per calendar

year

BENEFIT BENEFIT LIMITS LOW HIGH
PLAN PLAN
ACCIDENT – HOSPITAL BENEFITS CATEGORY
ALL ALL
Hospital Admission Benefit COVERED COVERED
PERSONS PERSONS
Admission 1 time per accident;
Unlimited times per calendar $1,000 $1,500
ICU Supplemental Admission (paid in addition to $1,000 $1,500
Admission) year
$200 $300
Hospital Confinement Benefit $200 $300

Confinement 15 days per accident. Payable $150 $200
after the first day of admission.
ICU Supplemental Confinement (paid in addition to ICU Supplemental Confinement
Confinement) will pay an additional benefit for

15 of those days.

Inpatient Rehabilitation Benefit

Inpatient Rehabilitation 15 days per accident;

30 days per calendar year

BENEFIT BENEFIT LIMITS LOW HIGH
PLAN PLAN
OTHER BENEFITS CATEGORY
15 day(s) per calendar year ALL ALL
COVERED COVERED

PERSONS PERSONS

Lodging Benefit $100 $200

Notes Regarding Certain Benefits:

• Lodging Benefit: The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a
covered insured while hospitalized, provided that lodging is at least 50 miles from the insured’s primary residence.

Please contact MetLife for detailed definitions and state variations of covered benefits.

Critical Illness Insurance

Plan Design

Underwriting Offer Guaranteed Issue1

Benefit Amount Employees will be offered 5k, 10k, or 20k Guaranteed Issue Coverage. Their
Spouse/Domestic Partner will be offered 50% and child(ren) will be offered 25% of
employee benefit amount.

Benefits are paid directly to the employee based on flat schedule (not reimbursement)
and there is no coordination with other insurance coverage.

Total Benefit Amount 300% of the initial benefit amount elected. MetLife will pay benefits for each covered
(TBA) person until the Total Benefit Amount for that person is reached.

Pre-Existing Condition Not Included
Limitation

Portability (Continuation Will be made available on a direct bill basis for terminated and retired employees at

of Insurance with active group rates.
Premium Payment)2

Survival Period None

Table

1 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents are not subject to medical
restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage.
Additional restrictions apply to dependents serving in the armed forces or living overseas.

2 Eligibility for portability through the Continued Insurance with Premium Payment provision may be subject to certain eligibility
requirements and limitations. For more information, contact your MetLife representative.

Plan Design

Benefit for Covered Conditions Initial Benefit Recurrence Benefit
Alzheimer’s Disease 100% of Benefit Amount NONE
Coronary Artery Bypass Graft 100% of Benefit Amount
Full Benefit Cancer 100% of Benefit Amount 50% of Benefit Amount
Partial Benefit Cancer 25% of Benefit Amount 50% of Benefit Amount
Heart Attack 100% of Benefit Amount 12.5% of Benefit Amount
Kidney Failure 100% of Benefit Amount 50% of Benefit Amount
Major Organ Transplant 100% of Benefit Amount
Stroke 100% of Benefit Amount NONE
Listed Conditions: NONE
50% of Benefit Amount
Benefit Suspension Period
Receive 25% of the initial benefit amount for 22 conditions:

Addison’s disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou
Gehrig’s disease); cerebrospinal meningitis (bacterial); cerebral palsy; cystic
fibrosis; diphtheria; encephalitis; Huntington’s disease (Huntington’s chorea);
Legionnaire’s disease; malaria; multiple sclerosis (definitive diagnosis);
muscular dystrophy; myasthenia gravis; necrotizing fasciitis; osteomyelitis;
poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic
lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and
tuberculosis.

A Covered Person may only receive one benefit payment for a Listed
Condition in his/her lifetime.

After a covered condition occurs there is a 365 days Benefit Suspension
Period during which the plan does not pay Recurrence benefits. The Benefit
Suspension Period does not apply to first occurrences of distinct covered
conditions.

We will not pay Recurrence benefits for Full Benefit Cancer or Partial Benefit
Cancer benefits unless the insured has not been treated nor had symptoms for
at least 180 days.

Hospital Indemnity Insurance

Covered Benefits

Please contact MetLife for detailed definitions and state variations of covered benefits.

Subcategory Benefit Limits Benefit Benefit
Hospital Benefits (Applies to Subcategory) Amounts
Admission Benefit
Admission $600
Confinement Benefit $250
4 time(s) per calendar year¹ ICU Supplemental Admission $50
(Benefit paid concurrently with the Admission $50
benefit when a Covered Person is admitted to ICU)

31 days per confinement³ Confinement⁴
ICU Supplemental
ICU Supplemental Confinement
Confinement will pay an (Benefit paid concurrently with the Confinement
additional benefit for 15 of benefit when a Covered Person is admitted to ICU)
those days

1 If a covered person is readmitted within 90 days for the same or related sickness/injury for which we paid an Admission Benefit, an additional
Admission Benefit is not payable.
3 If a covered person is confined again within 90 days for the same or related sickness/injury, we will treat the subsequent confinement as a
continuation of the previous confinement.
4 If the Admission Benefit is payable for a Confinement, the Confinement Benefit will begin to be payable the day after Admission.

Please contact MetLife for detailed definitions and state variations of covered benefits.

7

Legal Services

Expert legal advice
for your employees’ peace of mind

We’ll all need an attorney at some
point in our lives, whether it’s when
starting a family, buying a house
or caring for elderly parents. But it
doesn’t have to be expensive — or
stressful. With MetLaw®, a group
legal plan offered through Hyatt
Legal Plans, your employees can
have access to legal expertise for
less than $1 a day.

Our network of attorneys is here to Top attorneys your employees can rely on
make your employees’ lives easier.
When it comes to legal support, choosing the right attorney isn’t a snap decision. Your employees
Getting want peace of mind. Someone with the experience, the expertise, the professionalism, and the
married courtesy to help them navigate through life’s major milestones. Every attorney that joins our network
has to meet these requirements. We take care of the selection, so you can be confident your
Buying or employees have professional and experienced attorneys on their side, whenever they need them.
selling a home
How do we get top attorneys to join our network? By providing exceptional service to your
Starting employees, attorneys are more likely to get referrals, resulting in more clients for them.
a family And even the most experienced attorneys want to grow their practice. That’s how MetLaw
has created one of the largest and most experienced attorney networks — with attorneys
Dealing with averaging 25 years of experience.
identity theft
Tailored service makes life easier
Sending kids
off college While some legal plans only offer self-service or phone consultations, MetLaw gives
employees a choice of options. They can meet an attorney in-person, or contact them over
Caring for the phone, or online using our attorney e-Panel. And we have a range of self-service tools to
aging parents give employees a helping hand and a little guidance.

For some legal matters, our attorneys can even appear on your employee’s behalf in court,
so they don’t have to take time away from work or their families to attend a court hearing.

Services for everyone

Navigating life’s milestones is easier with MetLaw. MetLaw provides legal assistance for a
wide range of personal legal matters, and that’s with:
• unlimited use of legal services covered by your plan
• no waiting periods, deductibles, or copays to worry about
• and no claim forms — all billing is between the network attorney and MetLaw.

If one of your employees needs an attorney who doesn’t participate in our network, that’s
okay, too. They can be reimbursed for some of the costs.1

Helping your employees navigate life’s twists and turns.

Money Matters • Identity Theft Defense • Tax Audit Representation • Tax Collection Defense
Home & Real • Personal Bankruptcy • Debt Collection Defense • Promissory Notes
Estate • Negotiations with Creditors
Estate Planning • Sale or Purchase of Primary and • Refinancing & Home Equity
Family & Personal • Foreclosure Vacation Home Loan of Primary and Vacation
• Tenant Negotiations Home
Civil Lawsuits • Boundary & Title Disputes • Eviction Defense
Elder-Care Issues • Deeds • Property Tax Assessments • Security Deposit Assistance
Vehicle & Driving • Mortgages • Zoning Applications
• Simple Wills
• Complex Wills • Powers of Attorney (Healthcare, • Living Wills
• Revocable & Irrevocable Trusts Financial, Childcare, • Codicils
Immigration)
• Adoption • Affidavits
• Guardianship • Healthcare Proxies • Garnishment Defense
• Conservatorship • Protection from Domestic
• Prenuptial Agreement • Juvenile Court Defense
• Name Change Including Criminal Matters Violence
• Review of ANY Personal Legal • Review of Immigration
• Parental Responsibility Matters
Document • School Hearings Documents
• Demand Letters
• Civil Litigation Defense • Personal Property Issues • Incompetency Defense
• Disputes Over Consumer Goods • Pet Liabilities
• Small Claims Assistance
& Services • Administrative Hearings • Deeds
• Wills
Consultation & Document Review for • Prescription Plans • Powers of Attorney
issues related to your parents: • Nursing Home Agreements
• Medicare • Leases • License Suspension Due to DUI
• Medicaid • Notes

• Repossession • Driving Privileges Restoration
• Defense of Traffic Tickets2

A legal plan you can count on.

You can feel confident that when you offer MetLaw to your employees, you’re providing a benefit that your employees can really use. It’s the
reason why 86% of our plan participants stay in the plan year over year.3

And, it’s easy for you too. With no benefits cost to you, it’s simple to add MetLaw to your employee benefits program. You can be confident
that your employees will have professional and experienced attorneys on their side, whenever they need them.

Cost per employee per month (covers spouse and dependents)4: $19.75

Get expert guidance for confident decisions — for your organization and your employees.
Contact your MetLife representative today.

1. The Participant will be reimbursed according to the set fee schedule, the lesser of the maximum reimbursement amount or the attorney’s actual charge. Your employees will be
responsible to pay the difference, if any, between the plan’s payment and the non-plan attorney’s charge for services.Hyatt Legal Plans is not responsible for legal work performed
by out-of-network attorneys.

2. Does not cover DUI.
3. Internal data, Hyatt Legal Plans, 2017.
4. Minimum participation requirements may apply.

metlife.com

Group legal plans are provided by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, OH. In certain states, group legal plans are provided through insurance coverage
underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, RI. Payroll deduction required for group legal plans. For costs and
complete details of the coverage, call or write the company.

Some services not available in all states. No service, including consultations, will be provided for: 1) employment-related matters, including company or statutory benefits;
2) matters involving the employer, MetLife and affiliates and plan attorneys; 3) matters in which there is a conflict of interest between the employee and spouse or
dependents in which case services are excluded for the spouse and dependents; 4) appeals and class actions; 5) farm and business matters, including rental issues when
the participant is the landlord; 6) patent, trademark and copyright matters; 7) costs and fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client
relationship exists prior to the participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Additional
representation is also included for certain matters.

Please see the plan description for details.

Hyatt Legal Plans, Inc., A MetLife Company | 1111 Superior Avenue, Suite 800 | Cleveland, OH 44114

L0118501897[exp0319][All States][DC,GU,MP,PR,VI] ©2018 HYATT LEGAL PLANS, INC.

Overview Auto and Home Insurance

Why is having quality auto and
home insurance so important?

Because you need to protect your possessions, but you don’t need
to pay too much or settle for coverage that’s less than the best.

Auto and home insurance should meet your specific needs. That’s why insurance from
MetLife Auto & Home® is designed so that you’re not surprised by coverage gaps or
unexpected costs. We offer simplicity in our insurance packages and professional advice.

Auto
MetLife Auto & Home provides insurance coverage that eliminates gaps and surprises.
Our Auto AdvantageSM features go beyond basic liability and collision coverage to offer
you more complete coverage and benefits, including:

• Convenient • 24/7/365 • Identity Theft Apply today!
payment options claim service Protection Services
For questions,
• Replacement costs • Enhanced rental car • Towing/roadside please call MetLife at
for Total Loss1 damage coverage2 assistance 1 800 GET-MET8
(1-800-438-6388)
• Replacement costs • Deductible Savings • Windshield repair
for Special Parts2 Benefit3 without a deductible Why should I
apply now?
For 40 years, MetLife Auto & Home has been
protecting drivers with outstanding coverage. • Employee discounts

Home* • Superior insurance
Our homeowners products offer uncommon protection called Coverage A Plus, which is an optional coverage that protects
benefit with any Standard or Platinum Homeowners Policy. This coverage is designed so that in the you from gaps and
event of a loss, your home would be fully replaced without you incurring extra costs. Additional surprises
benefits include:
• Extra savings and
• Maximum coverage equal to the replacement cost at the time the repair is made. convenience with
• Materials of “like kind and quality” for rebuilding your house. payroll deduction/
• An insurance benefit amount that meets the current construction costs to rebuild it — monthly bank account
deduction
even if costs exceed your dwelling limit, which is currently a unique benefit in the
Homeowners Insurance industry. • Don’t wait until your
current policy is about
We also offer replacement cost on home contents, so there are no surprises with unexpected to expire — we can
out-of-pocket expenses. In the event of a covered loss, it replaces personal property without help you switch and
deduction for depreciation. save now.

Switching auto and home insurance carriers has never been easier. Call us today and we’ll take care
of the rest, regardless of when your current policy expires. Don’t wait — others have saved up to
$536.4 See how much you could save by switching your auto insurance to MetLife Auto & Home.

How can having MetLife Auto & Home For added convenience,
Insurance benefit you? MetLife Auto & Home’s
mobile application is
We can provide you with the coverage you need and the savings now available on your
and service you deserve for your valuable property. App Store.

You will have access to generous discounts and unique features, all the while keeping After downloading this
your personal insurance information private from your employer, and allowing you to app,6 you can use it to
take the policy with you if you switch employers.
submit an auto claim, pay
Even if you change jobs, retire, or your employment
status changes, your coverage doesn’t have to end. your auto and home bill,
You can keep your MetLife Auto & Home Insurance and view account
policy, as long as you pay the premiums due.
information.
Trust MetLife Auto & Home for other value-added products.
MetLife Auto & Home is here to provide the personal touch you expect when addressing
your insurance needs.

• Automobile • Motorcycle • Boat
• Renters • Motorhome • Scheduled Personal
• Personal Excess Liability • Homeowners
• Landlord’s Rental Dwelling • Condominium Property
• Snowmobile

And don’t forget about our discounts for multi-policy, good student, safe driver,
anti-theft devices and more.5

*Home Insurance is not part of MetLife Auto & Home’s benefit offering in MA & FL.
1. Does not apply to leased, substitute, or non-owned autos. Applies within the first 12 months you own or the first 15,000 miles you drive

a new auto, whichever comes first. See policy for restrictions. Subject to deductible.
2. See policy for restrictions. Subject to deductible. Not available in all states, such as NC.
3. Not available in all states. In New York, drivers must pay a state required minimum deductible before using this benefit. Benefit can be earned for up to 5

years. Depending on your policy form, the benefit could be up to $250 or $500.
4. Average annual savings based on our 2017 countrywide research of new call center customers’ annual average savings in 2016.
5. Available in most states to those who qualify.
6. Before using the MetLife Mobile app, you must register at www.metlife.com/mybenefits from a computer. Registration cannot be done from

your mobile device.
MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates: Economy Preferred Insurance Company,
Metropolitan Casualty Insurance Company, Metropolitan Direct Property and Casualty Insurance Company, Metropolitan General Insurance Company,
Metropolitan Group Property and Casualty Insurance Company, and Metropolitan Lloyds Insurance Company of Texas, all with administrative home
offices in Warwick, RI. Coverage, rates, discounts and policy features vary by state and product, and are available in most states to those who qualify. Met P&C®,
MetCasSM, and MetGenSM are licensed in Minnesota.

MetLife Auto & Home | 700 Quaker Lane | Warwick, RI 02887

1705 856493NN L1017499677[exp0920][All States][DC] © 2017 MetLife Auto & Home