Wealth

Flexible Spending Accounts (FSA)

We provide you with an opportunity to participate in up to two different flexible spending accounts (FSAs) administered through [CARRIER]. FSAs allow you to set aside a portion of your income, before taxes, to pay for qualified health care and/or dependent care expenses. Because that portion of your income is not taxed, you pay less in federal income, Social Security and Medicare taxes.

Health Care FSA

Health Care FSA

For 2018, you may contribute up to $2,650 to cover eligible healthcare expenses incurred by you, your spouse and your children up to age 26. Some eligible expenses include:

  •  Coinsurance
  • Copayments
  • Deductibles
  • Prescriptions
  • Dental treatment
  • Orthodontia
  • Eye exams/eyeglasses
  • Lasik eye surgery

Click here for a complete list of eligible expenses.

Limited Purpose Health Care FSA

Limited Purpose Health Care FSA (for HSA participants)

If you enroll in the HSA medical plan, you may only participate in a limited-purpose Health Care
FSA. This type of FSA allows you to be reimbursed for eligible dental, orthodontia and vision expenses
while preserving your HSA funds for eligible medical expenses.

Dependent Care FSA

Dependent Care FSA

For 2018, you may contribute up to $5,000 (per family) to cover eligible dependent care expenses ($2,500 if you and your spouse file separate tax returns). Some eligible expenses include:

  • Care of a dependent child under the age of 13 by babysitters, nursery schools, pre-school or daycare centers
  • Care of a household member who is physically or mentally incapable of caring for him/herself and qualifies as your federal tax dependent

Click here for a complete list of eligible expenses.

FSA Rules

You must enroll each year to participate.

Because FSAs can give you a significant tax advantage, they must be administered according to specific IRS rules:

Health care FSA: Unused funds of up to $500 from one year can carry over to the following year. Carryover funds will not count against or offset the amount that you can contribute annually. Unused funds over $500 will NOT be returned to you or carried over to the following year.

Dependent care FSA: Unused funds will NOT be returned to you or carried over to the following year.

You can incur expenses through [DATE], and must file claims by [DATE].

Life and AD&D Insurance

Life insurance provides your named beneficiary(ies) with a benefit in the event of your death.

Accidental Death and Dismemberment (AD&D) insurance provides specified benefits to you in the
event of a covered accidental bodily injury that directly causes dismemberment (i.e., the loss of a hand, foot or eye). In the event that your death occurs due to a covered accident, both the life and the AD&D benefit would be payable.

Basic Life and AD&D Insurance

Basic Life/AD&D (Company-paid)

This benefit is provided at NO COST to you through [CARRIER].

Your Basic Life and AD&D coverage amount: 1 times your base annual salary up to a $200,000 maximum.

Supplemental Life and AD&D

Supplemental Life/AD&D (Employee-paid)

If you determine you need more than the Company-paid Basic Life/AD&D coverage, you may purchase additional coverage through [CARRIER] for yourself and your eligible family members.

Coverage Options

  • Employee: $10,000 increments; minimum of $10,000 up to $500,000; $150,000 guarantee issue*
  • Spouse/DP: $5,000 increments; minimum of $5,000 up to $250,000 (not to exceed 50% of your additional life coverage); $10,000 guarantee issue*
  • Child(ren): Under age 26 – Up to $10,000; $10,000 guarantee issue*

*During your initial eligibility period only, you can receive coverage up to the Guaranteed Issue
amounts without having to provide Evidence of Insurability (EOI, or information about your health).
Coverage amounts that require EOI will not be effective unless approved by the insurance carrier.

Disability Insurance

Disability insurance provides benefits that replace part of your lost income when you become unable to work due to a covered injury or illness.

Short-Term Disability

Short-Term Disability (Company-paid)

Provided at [NO COST to you/an affordable group rate] through [CARRIER].

  • Benefit Percentage: 60%
  • Weekly Benefit Maximum: $600
  • When Benefits Begin: After 7th day of disability
  • Maximum Benefit Duration: 13 weeks

Long-Term Disability

Long-Term Disability (Company-paid)

Provided at [NO COST to you/an affordable group rate] through [CARRIER].

  • Benefit Percentage: 60%
  • Monthly Benefit Maximum: $10,000
  • When Benefits Begin: After 90th day of disability
  • Maximum Benefit Duration: Social Security Normal Retirement Age (SSNRA)
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