Health

Medical

We are proud to offer you a choice between [NUMBER] different medical plans that provide comprehensive medical and prescription drug coverage. The plans also offer many resources and tools to help you maintain a healthy lifestyle. Following is a brief description of each plan.

CARRIER NAME HMO Plan

[CARRIER NAME] HMO PLAN

With the HMO plan, you select a primary care physician (PCP) from the participating network of providers who will coordinate your health care needs, refer you to specialists (if needed) and approve further medical treatment. Services received outside of the HMO’s network are not covered, except in the case of emergency medical care.

CARRIER NAME PPO Plan

[CARRIER NAME] PPO PLAN

The PPO plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the [CARRIER/NETWORK] network. The calendar-year deductible must be met before certain
services are covered.

CARRIER NAME HDHP with HSA Plan

[CARRIER NAME] HDHP WITH HSA PLAN

Like the PPO Plan, the High-Deductible Health Plan (HDHP) gives you the freedom to seek care from the provider of your choice. You will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the [CARRIER/NETWORK] network. In addition, the HDHP comes with a health savings account (HSA) that allows you to save pre-tax dollars* to pay for any qualified health care expenses as defined by the IRS, including most out-of-pocket medical, prescription drug, dental and vision expenses. Click here for a complete list of qualified health care expenses.

* Tax free under federal tax law (state taxation rules may apply).

Here’s how the HDHP with HSA Plan works:

  1. Annual Deductible: You must meet the entire annual deductible before the plan starts to pay for non-preventive medical and prescription drug expenses. NOTE: If you enroll one or more family members, you must meet the full FAMILY deductible before the plan starts to pay expenses for any one individual.
  2. Coinsurance: Once you’ve met the plan’s annual deductible, you are responsible for a percentage of your medical expenses, which is called coinsurance. For example, the plan may pay 80 percent and you may pay 20 percent.
  3. Annual Out-of-Pocket Maximum: Once your deductible and coinsurance add up to the plan’s annual out-of-pocket maximum, the plan will pay 100 percent of all eligible covered services for the rest of the calendar year. NOTE: If you enroll one or more family members, you must meet the full FAMILY out-of-pocket maximum before the plan starts to pay covered services at 100 percent for any one individual.
  4. Health Savings Account (HSA): You may contribute to your HSA through pre-tax payroll deductions to help offset your annual deductible and pay for qualified health care expenses. In addition, we will contribute $[AMOUNT] annually to your HSA if you enroll in employee-only
    coverage and $[AMOUNT] annually if you enroll yourself and one or more family members. To be eligible for the HSA, you cannot be covered through Medicare Part A or Part B or TRICARE programs. See the plan documents for full details.

Important: Your contributions, in addition to the company’s contributions [AND ANY INCENTIVES YOU EARN], may not exceed the annual IRS limits listed below.

Your HSA is yours for life. The money is yours to spend or save, regardless of whether you change health plans,* retire or leave the company. There is no “use it or lose it” rule. Your account grows tax free over time as you continue to roll over unused dollars from year to year. You decide how or if you want to spend your HSA funds. You can use it to pay for you and your dependents’ doctor’s visits, prescriptions, braces, glasses—even laser vision correction surgery.

*You must be enrolled in a qualified health plan to contribute to an HSA.

Medical Plan Highlights

Dental

We are proud to offer you a choice between [NUMBER] different dental plans.

CARRIER NAME DHMO

[CARRIER NAME] DHMO

With this plan, you choose a primary dental provider to manage your care. There are no charges for
most preventive services, no claim forms and no deductibles. Reduced, pre-set charges apply to other services.

CARRIER NAME DPPO

[CARRIER NAME] DPPO

This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will
maximize your benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the [CARRIER] network.

Dental Plan Highlights

Vision

We are proud to offer you a vision plan through [CARRIER]. This plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the [CARRIER/NETWORK] network.

Vision Plan Highlights

Employee Assistance Program (EAP)

Life is full of challenges, and sometimes balancing it is difficult. We are proud to provide a confidential program dedicated to supporting the emotional health and well-being of our employees and their families. The employee assistance program (EAP) is provided at NO COST to you through [CARRIER].

The EAP can help with the following issues, among others:

  • Mental health
  • Relationships or marital conflicts
  • Child and eldercare
  • Substance abuse
  • Grief and loss
  • Legal or financial issues

EAP Benefits

  • Assistance for you and your household members
  • Up to [# OF VISITS] in-person sessions with a counselor per issue, per year, per individual
  • Unlimited toll-free phone access and online resources

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