2025 BENEFIT GUIDE
January 1, 2025 - December 31, 2025
Your benefits are an important part of your overall compensation.We are pleased to offer a comprehensive array of valuable benefits to protect your health, your family and your way of life. This guide answers some of the basic questions you may have about your benefits.
Employee
Assistance Program (EAP)
We are proud to provide a confidential program dedicated to supporting the emotional health and well-being of you and your family.An Employee Assistance Program is provided at NO COST to you.The EAP can help with situations involving mental health, relationships, substance use, child and eldercare, grief and loss, legal or financial issues among others. Up to [#] in-person or virtual sessions are available for you and your household members.
Benefits-At-A-Glance
Benefit
• PPO and High Deductible Medical Plans
• Prescription Plan
• Confidential Counseling Services
• Core and Enhanced Dental Plans
• Vision Plan
• Basic Life and AD&D
• Voluntary Life and AD&D
• Short-term and Long-term Disability
• Family Medical Leave (FMLA)
• Health Savings Account
• Flexible Spending Accounts
• Accident
• Critical Illness
• Hospital Indemnity
• ID Protection and Security
• Retirement Savings Plans
• Health Advocate
• Travel Assistance
• Financial, Legal and Estate Support
2024 Updates-At-A-Glance
• We are moving from [Carrier 1] to [Carrier 2] for our medical insurance.
• By changing carriers to [Carrier 2], we were able to reduce the proposed increase in medical premiums presented by [Carrier 1] for the 2025 benefit year.
• There will be a modest increase in premiums for health and dental insurance, and a decrease in your vision premiums.
• We are moving from [PBM 1] to [PBM 2] as our Pharmacy Benefit Manager (PBM).
• This is an update only to the administrator.There will be no change to our current pharmacy plan/benefits.
• All current prior authorizations and enrollments in assistance programs will automatically transfer.
• You will need to show your new ID card to the retail/mail order pharmacist with your first prescription fill.
BENEFIT ELIGIBILITY
Who is Eligible Dependent Information
The following individuals are eligible to participate in [GROUP]’s benefits program:
• Active, full-time employees on the first of the month following
• [##] days of employment for [insert benefits]
• [#] months of employment for [insert benefits]
• Your legally married spouse
• Your dependent children up to age 26
• Your unmarried children aged 26 or older who are mentally or physically disabled and who rely on you for support and care
• There is a spousal surcharge of [$$$] per pay period if eligible for medical coverage through his/her own employer.
• To enroll your eligible dependents in benefits, you must provide their full legal names, Social Security numbers and dates of birth, so keep this information handy when making your benefit elections online.
BENEFIT ENROLLMENT
Enrollment Periods
New Hire and Newly Eligible Enrollment
Newly hired or newly eligible employees must complete their online enrollment within 30 days of the date they become eligible.
Annual Open Enrollment
Every year, [GROUP] conducts an Open Enrollment. This is the time for you to reevaluate your needs and elect benefit options for the new plan year. Open Enrollment is an opportunity to make changes to your benefits without a qualifying life event.
Between Enrollment Periods
You may make changes to your benefit elections outside of the annual Open Enrollment ONLY if you experience an IRS Qualifying Life Event (QLE). Benefit changes must also be consistent and made within 30 days of the QLE. Qualifying life events (QLEs) that may allow you to make benefit changes:
• Change in legal marital status
• Change in your eligibility
• Change in the number of eligible children
• Gain a benefit option or lose coverage
Enroll Online through [BenAdmin]
Enrolling in benefits is easy! [BenAdmin] is available 24 hours a day, seven days a week, so you can visit the site anytime and anywhere you have computer access.
Step 1:
Go to [www.website.com]. From the home screen, click on the Benefits tab and select “Start Your Enrollment”.
Step 2:
Confirm your personal information as well as any family members who will be named as a dependent and/or beneficiary.
Step 3:
Continue through each section to elect or waive your benefits. Don’t forget to elect beneficiaries where applicable!
Step 4:
IMPORTANT! Click “Submit” to lock in your elections and review your Enrollment Summary thoroughly to ensure your benefit elections have been recorded correctly. Report any errors to the Human Resources Department immediately. Print/Save your Enrollment Summary for future reference.
You may log back into your enrollment and view or update elections as many times as you wish during your enrollment period. NOTE: With every login, you must click “SUBMIT” to lock in your elections. If you do not hit submit your benefits will default to waived.
MEDICAL/Rx COVERAGE
New Member ID Cards
You will receive a new medical insurance card from [Carrier 2] and new prescription card from [PBM 2].They will likely arrive in plain white envelopes. Please do not discard!
PPO
The Preferred Provider Organization (PPO) plan, provided through [Carrier 2], gives you the freedom to seek care from any provider of your choice. However, you will maximize your benefits and lower your out-of-pocket costs if you choose a provider who participates in the network.
High Deductible Health Plan (HDHP)
The HDHP + HSA (High-Deductible Health Plan + Health Savings Account) is an insurance plan that offers lower premiums and higher deductibles. The highlight of this plan is that it allows you to open an HSA, which is a taxadvantaged personal savings account that lets you save pre-tax dollars to pay for any qualified health-related expenses (state taxation rules may apply).This includes most medical care and services, prescriptions, dental, vision and expenses related to meeting the plan’s deductible. For a complete list of qualified health-related expenses, visit IRS Publication 502 (https://www.irs.gov/forms-pubs/about-publication-502)
[Carrier 1 Network Name]
(through [Virtual Health Name])
Mail Order (Up to 90-day Supply 6)
1 Deductible and Out of Pocket Maximums “reset” every year in January.
$$ Copay $$ Copay Covered In Full (after OV Copay) $$-$$ Copay
Copay
then ##% Deductible, then ##% Deductible, then ##% $$ Access Fee
2 The deductible is embedded.This means that once a family member meets their individual deductible, the plan will begin to pay coinsurance for that family member.
3 The deductible is non-embedded.With a non-embedded deductible, the full family deductible must be met before coinsurance applies to any individual family member.
4 The out-of-pocket maximum is embedded.This means that, once an individual family member meets their out-of-pocket maximum, that individual’s expenses are covered at 100%.
5 The out-of-pocket maximum is non-embedded.With a non-embedded out-of-pocket maximum, the full family out-of-pocket maximum must be met before any individual family member’s expenses are covered at 100%.
6 90-day prescription required for a 90-day fill
HEALTH SAVINGS ACCOUNT
The High Deductible Health Plan features a Health Savings Account (HSA) provided through [CDA Carrier]. The HSA lets you set aside pre-tax dollars to help offset your annual deductible and pay for qualified health care expenses.
Contribution Limits
FLEXIBLE SPENDING ACCOUNTS
The flexible spending accounts (FSAs), provided through [CDA Carrier], are tax-advantaged accounts that can help you cover certain qualified out-of-pocket expenses. Each account works in much the same way but has different eligibility requirements, list of qualified expenses and contribution limits. You may choose to enroll in the following accounts. Health
Care FSA (HCFSA)
FSA (LFSA)
Care FSA (DCFSA)
Eligibility Requirements
Examples of Qualified Expenses
You must be benefits eligible; enrollment in an HCFSA disqualifies you from making or receiving HSA contributions
• Coinsurance
• Copayments
• Deductibles
• Dental treatment
• Eye exams/eyeglasses
• LASIK eye surgery
• Orthodontia
• Prescriptions
Important FSA Rules
You must be benefits eligible; most employers also require enrollment in a qualified highdeductible health plan
• Dental and vision coinsurance only
• Dental and vision deductibles only
• Dental treatment
• Eye exams/eyeglasses
• LASIK eye surgery
• Orthodontia
Available to all employees
• Care of a dependent child under the age of 13 by babysitters, nursery schools, pre-school or daycare centers
• Care of household members who are physically or mentally incapable of caring for themselves and who qualify as your federal tax dependent
$5,000 per family (or $2,500 each if you are married and file separate tax returns)
Because FSAs can give you a significant tax advantage, they must be administered according to specific IRS rules:
• FSAs must be actively elected each year.
• Keep all FSA claim itemized, detailed receipts. Supporting documentation is required by the IRS for FSA claims. If a claim is unable to automatically substantiated based on plan design or debit card transaction, additional documentation will be requested. Please promptly submit itemized receipts to Bank of America.
• HCFSA: Unused funds [between $$ and $$$] may carry over from the current plan year to the following plan year. Carryover funds will not count against or offset the amount that you can contribute annually. Unused funds [less than $$ or greater than $$$] will not be returned to you or carried over.
• LFSA: This type of account can be used with the High Deductible Health Plan and applies toward eligible dental and vision expenses only. The Carryover Provision applies to the LFSA as well.
• DCFSA: Unused funds will NOT be returned to you or carried over to the following year.
*The IRS may increase the 2025 annual maximum after Open Enrollment elections end. If you elect the maximum, you will be contacted and have the opportunity to increase your election to the increased amount.
DENTAL COVERAGE
Good oral and dental hygiene can help prevent bad breath, tooth decay and gum disease which will help you keep your teeth as you get older. It may also help you ward off medical disorders. Note, the Annual Maximum is the highest benefit you will receive during the benefit year, not to be confused with the medical out-ofpocket maximum (the most you will pay during a benefit year).
VISION COVERAGE
Your eyesight is an integral part of your overall health and a key component of safety.This plan gives you the freedom to seek care from the provider of your choice. If you decide to use an out-of-network provider, you will pay the provider in full at the time of your appointment and submit a claim form for reimbursement up to the amount allowed by the plan.
(non-disposable)
· Medically Necessary Up to $$$ Allowance plus ##% off balance Up to $$$ Allowance (no additional discount) Covered in full
Add-Ons
· Polycarbonate Lenses
· Standard Scratch Coating · Other Lens Options
In-Network Only
Covered in full
Covered in full
off Retail
[Dental Carrier Network Name]
Carrier Network Name]
LIFE & DISABILITY INSURANCE
Life insurance provides your named beneficiaries with a benefit following your death, while accidental death and dismemberment (AD&D) insurance provides a benefit to you following a covered accident that leads to dismemberment (such as the loss of a hand, foot or eye). Should your death occur due to a covered accident, both the life benefit and the AD&D benefit would be payable.
Basic and Supplemental Life and AD&D
[GROUP] provides a Basic Life and Accidental Death and Dismemberment benefit for you at no cost to you.
If you determine you need more than the basic coverage, you may purchase supplemental insurance for yourself and your eligible family members. During your initial eligibility period, you can secure coverage up to the Guaranteed Issue limits without the need for Evidence of Insurability (EOI) or answering health questions. During Annual Open Enrollments, you may increase your election [#] increments (up to Guaranteed Issue limits) without the need for EOI. Please note, coverage amounts requiring EOI will only go into effect once the insurance carrier approves them.
Incremental Amount (Units) Employee: $$$$$$
Child(ren): $$$$$
Guaranteed Issue (GI): Employee: Lesser of 5x BAE1 or $$$$$
Child(ren): $$$$$
Spouse: $$$$$
Spouse: $$$$$
Disability
Max Coverage Amount: Employee: Lesser of 5x BAE1 or $$$$$
Child(ren): $$$$$
Spouse: $$$$$
Disability insurance provides benefits that replace part of your lost income when you cannot work due to a covered illness or injury.
Short-term Disability (STD) provided at NO COST to you
Benefit
Maximum
Elimination
Long-term Disability (LTD) provided at an affordable group rate
Benefit Percentage ##% of base salary Maximum Benefit Up to $$$$ per month
Elimination
VOLUNTARY BENEFITS
Our voluntary benefits are designed to complement your health care coverage and allow you to customize our benefits to you and your family’s needs.You can enroll in these plans during your initial enrollment period or during Open Enrollment. They’re completely voluntary, which means you are responsible for paying for coverage at affordable group rates.
Accident, Critical Illness and Hospital Indemnity Insurance
Accident insurance can soften the financial impact of an accidental injury by paying a benefit to you to help cover the unexpected out-of-pocket costs related to treating your injuries.With critical illness insurance, you’ll receive a lump-sum benefit if you are diagnosed with a covered condition.You can use this benefit however you like, including to help pay for: treatments, prescriptions, travel, increased living expenses and more. Hospital indemnity insurance can help reduce costs by paying you or a covered dependent a benefit to help cover your deductible, coinsurance and other out-of-pocket costs due to a covered hospitalization.Accident, Critical Illness and Hospital Indemnity plans are purchased separately.
ID Theft
NortonLifeLock scans your online data, monitors your credit score reports and social media accounts, reduces unwanted solicitation attempts, and lets you manage alerts in real-time. If you are the victim of identity theft or fraud, a privacy advocate will work with you to restore your identity. Note, if you currently have an individual plan, you may receive lower rates with [GROUP]’s group plan.
Other Added details
PREMIUM DISCOUNTS
2 Wellness Premium Discount
Add details of wellness program.
• Medical rates are based on participation in this voluntary program.
4 Non-Tobacco Premium Discount
Testing for Cotinine (nicotine) is automatically done within the annual biometric screening. [Add details of program].
For more information about the Non-Tobacco Premium Discount or Smoking Cessation Program, contact the Human Resources Department.
PLAN CONTRIBUTIONS
Your contributions toward the cost of benefits are automatically deducted from your paycheck.The amount will depend on the plan you select and if you choose to cover eligible family members.
IMPORTANT CONTACTS
This brochure summarizes the benefit plans that are available to [GROUP] eligible employees and their dependents. Official plan documents, policies and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits.These documents govern your benefits program. If there is any conflict, the official documents prevail.
To review benefit details, Benefit Summaries and full Certificates of Coverage can be found at [Location].
Information provided in this brochure is not a guarantee of benefits.
