Benefits Enrollment Guide

Transcription

1 Benefits Enrollment Guide Welcome to EverBank! This enrollment guide offers important details about your medical, dental, vision, life insurance, long-term disability, health savings account (HSA) and flexible spending account (FSA) options. Please read this enrollment guide carefully before making your new hire elections online using Employee Self Service (ESS) Contents: Your initial benefit enrollment period is open for 30 days from your date of hire. Benefit elections are made online on the ESS website. You must go online within 30 days of your hire date to make your elections. Coverage is effective the first of the month coincident with or following your date of hire. After your initial enrollment period has ended, you will be unable to make changes to your benefit elections until the next Open Enrollment (each June) unless you experience a qualified family status change and notify the benefits department of your event within 30 days. You will find a list of qualified family status change scenarios in the Forms Library on the ESS website. You must notify the Benefits Department as soon as possible, and make changes to your elections online within 30 days of the qualified event. Approved changes to coverage will be effective on the date the event is keyed in ESS. Changes to coverage cannot be made retroactively with the exception of a birth/adoption or gain/loss of a Child Health Insurance Program event. Employee Cost Per-Pay-Period...page 5 Coverage Eligibility...page 1 General Information...page 1 Your EverBank Benefits Package...page 2 Enrolling for Coverage...page 3 Medical Insurance...page 5 Health Saving Account (HSA)...page 7 Dental Insurance...page 9 Vision Insurance...page 9 Flexible Spending Accounts...page 10

2 Coverage Eligibility All regular full-time and part-time employees who are normally scheduled to work at least 30 hours or more per week are eligible for benefits. Eligible dependents are described below: Spouse Dependent Child(ren): - Newborn to age 18 your legal, dependent children are eligible through the end of the calendar year in which they turn 18 - Age 19 to 25 unmarried children, who are primarily supported by you and either living in your household or enrolled as a full-time or part-time student, are eligible through the end of the calendar year in which they turn 25* (proof of dependent status is required annually after age 19) - Age unmarried and disabled children who were previously covered prior to age 25*; - Age 25 to 30** (for medical coverage only) - unmarried children, who have no dependents of their own, who are Florida residents or are enrolled as a full-time or part-time student, and who do not currently have individual or group health coverage elsewhere under Title XVIII of the Social Security Act, are eligible through the end of the calendar year in which they turn 30 (proof of dependent status is required annually). *Must check the student or disabled radio button when enrolling the dependent in ESS. **For more details on coverage to age 30, please contact the Benefits Department at option 8. Note: Additional Life and AD&D insurance eligibility for dependent child(ren): Coverage birth to age 18 for legal dependent children. Coverage age 19 to 25 for legal dependent children who are also full-time students. Coverage 25+ if the dependent is disabled and covered prior to age 25 (affidavit of disabled child form must be completed). General Information and Resources Detailed descriptions of the benefits listed in this guide are found: In the online Employee Handbook located in the HR section of the company intranet In the online HR Policy and Procedures located in the HR section of the company Intranet In the Forms Library on the ESS website ( listed by benefit title In each plan s individual and detailed Summary Plan Description (SPD) located in the Forms Library on the ESS website. As this guide is a summary, legal plan documents will prevail in the event of any discrepancies. Plan Administrator Website Phone Number EverBank Family of Companies - Solution Center EverBank Benefits Department ADP N/A Diana Mills Nancy Preble Deedria Burchfield Diana.mills@everbank.com Nancy.preble@everbank.com Deedria.burchfield@everbank.com Medical & Dental Insurance CIGNA Healthcare or (for your personal account) Health Savings Account (HSA) Fifth Third Bank Vision Insurance Humana/ CompBenefits Flexible Spending Accounts ADP EverBank Profit Sharing & Savings Plan 401(k) Merrill Lynch EverBank Benefits Enrollment Guide

3 Your EverBank Benefits Package EverBank provides certain benefits automatically to all eligible employees. Coverage or participation begins the first of the month coincident with or following date of hire unless otherwise stated. The following benefits are available based on program guidelines and eligibility: Basic Life and Accidental Death and Dismemberment (AD&D) Insurance 1 times your annual salary (maximum $500,000). Business Travel Accident Insurance 5 times your annual salary (maximum $1,000,000) when you travel on behalf of the company. Employee Assistance Program 24-hour resource for counseling and support services for you and your family. EverBank Profit Sharing Plan Receive discretionary contributions to your company retirement account. Refer to the 401(k) guide in the Forms Library on the Employee Self Service (ESS) website ( for more information. Leaves of Absence Time off for military, personal or medical leave of absence, worker s compensation injuries, or Family and Medical Leave Act (FMLA) are available to qualified employees. Long-Term Disability Protection against loss of wages after six months of continuous disability. Paid Time Off (following 60 days of employment not available to fully commissioned employees) Sick time, personal time and vacation time are available based on date of hire and officer status. Jury duty and funeral leave are also available. EverBank observes 10 paid holidays per year. Salary Continuation (following 6 months of employment not available to fully commissioned employees) Sick pay benefits for personal illness requiring six or more consecutive business day of leave. Tuition Assistance Program (following 6 months of employment) Financial assistance for educational expenses in pursuit of a business-related undergraduate or graduate degree. Employee Discount Services Check the employee discounts on the company intranet. Click on the Banking tab for information about Employee Banking and Loan programs. Click on HR, then Benefits to review discounts on recreational activities and services (discounts subject to vendor location and may not be available in all states). EverBank also provides voluntary benefits which you should consider during your initial enrollment period. Coverage or participation begins the first of the month coincident with or following your date of hire. Medical, Dental & Vision insurance Comprehensive coverage for you and your family with multiple options and tier levels available to fit your needs. Coverage is available on a pre-tax basis. Flexible Spending Account (FSA) Health Care and Dependent Care FSA accounts are available on a pre-tax basis. The FSA plan year is June 1 to May 31. Health Savings Account (HSA) and HSA Catch-Up A savings/investment account can be set up on a pre-tax basis with Fifth Third Bank for employees electing the high-deductible health plan medical option (PPO HSA). HSA participants over age 55 may contribute an additional catch-up amount on a pre-tax basis. Additional Life Insurance Elect additional life insurance on yourself (maximum $750,000) with a one-time guaranteed issue amount up to $300,000 during this initial enrollment period only. Upon electing additional coverage on yourself, you may elect additional coverage on your eligible dependents: Spouse election (50% of your own coverage amount up to $100,000) with a one-time guaranteed issue amount up to $30,000 during this initial enrollment period only. Dependent child(ren) election (50% of your own coverage amount up to $10,000.) Elections made above the guaranteed issue amount and/or elections or increases to additional life insurance made after this initial enrollment period will require that you complete Evidence of Insurability (EOI) information online at within 30 days of your election. Additional AD&D insurance Elect additional AD&D coverage on yourself and your eligible dependents (maximum $500,000). Coverage above $250,000 may not exceed 10 times your annual salary. Retirement and Savings Plan 401(k) Elect to defer between 1% and 18% of your salary with pre-tax contributions to your own retirement account. You are automatically vested in the company match, which is $1 for $1 on the first 3% of eligible compensation you contribute, then $.50 on the $1 for the next 2% of eligible compensation that you contribute. Refer to the 401(k) guide in the Forms Library on the ESS website ( for more information. EverBank Benefits Enrollment Guide

4 Enrolling For Coverage What You Need to Do We encourage you to review all of your options before making your benefit elections. Online tools and services are available to help you become a better health care consumer and make informed decisions. The insurance carrier s web tools and services are designed to help maximize our benefits, learn more about health conditions, get information on treatment, and effectively allocate health care dollars. While your benefit plan may not require you to use a primary care physician, it remains your responsibility to make sure you are using in-network providers in order to enjoy the maximum provider discount. STEP 1: Carefully read the information in this guide and review your personal Benefits Enrollment Worksheet. Your Benefits Enrollment Worksheet is mailed separately to your home address. Use the worksheet to compare plan option costs and to jot down your election choices. Keep your worksheet handy when you log into the online enrollment system. STEP 2: Carefully compare your enrollment options and find in-network providers. Medical Options: Review medical plan highlights in this guide, as well as the CIGNA Summary of Benefits for the OAP and PPO plans. You have four medical options which is the best fit for you and your family? Review and compare not only the per-pay-period cost of coverage, but also the copays, deductibles and coinsurance for each plan. Health Savings Account (HSA) election: If you are electing CIGNA PPO HSA as your medical option, EverBank will contribute $300 for individual coverage ($150 if hired between December 2 and May 1), or $600 for family coverage ($300 if hired between December 2 and May 1) to your HSA account for you and your family to offset initial medical expenses. An account will be established for you once your elections have processed. You will receive account registration information, and will need to complete your HSA account set-up online at Information about the HSA account is included in your assigned benefit review material, and is also available in the Forms Library on ESS. Contact Fifth Third bank at: or visit to find a location near you. Funds in the HSA are for qualified medical, dental, or vision expenses (as defined by the IRS), and can be used to pay for your deductible, coinsurance and prescriptions, for example. You may elect to contribute additional pre-tax dollars into the HSA up to the IRS calendar year contribution maximum, or you may elect to waive additional contributions. Note: If you are enrolling in the CIGNA PPO HSA option, you cannot participate in the HealthCare FSA. Medical Providers: Go to Find a Doctor Be sure to search in the network that correlates to your enrollment selection: CIGNA OAP Low or High Plans: Choose the Open Access Plus Only Plan CIGNA PPO or PPO HSA Plans: Choose the Preferred Provider Organization (PPO) Plan NOTE: Mayo Clinic and Mayo physicians are in-network for the CIGNA PPO and CIGNA PPO HSA plans only. 3 EverBank Benefits Enrollment Guide

5 Dental Options: Review the CIGNA Dental plan highlights in this guide. You will have two dental plans available to choose from, dependent upon your state of residence. If you elect the dental DHMO coverage you will be prompted to select a specific dentist to be assigned to. Dental Providers: Go to Find a Doctor or Dentist Be sure to click on the dentist radio button to find dental providers, then select the dental plan that correlates with your enrollment selection: CIGNA DHMO Plan: Choose the HMO Dental Care Network Plan The DHMO Plan requires you to provide a 6-digit office ID # found under the provider s name in the online listing. The DHMO dental plan is available in AL, AZ, CA, CO, CT, FL, GA, IL, IN, KY, MA, MD, MO, NC, NJ, NY, OH, OK, PA, TX, UT, VA, WA CIGNA DPPO Low Plan: Choose the PPO CORE Network Plan. This plan is not available in states that have DHMO coverage (see above) CIGNA DPPO High Plan: Choose the PPO RADIUS Network Plan Vision Option: Review the vision plan highlights in this guide. Find an in-network provider to maximize your savings under this plan. Vision Providers: Find an In-Network provider to maximize your savings under this plan. Go to and click on Providers/Search, Find Vision Providers, then Vision Care Plan. Flexible Spending Accounts (FSA): The Plan year runs June 1 to May 31. Your participation in the account begins the first of the month coincident with or following your date of hire, and ends with the plan year on May 31. An FSA provides a way to pay for out-of-pocket health care or dependent care (child or adult daycare) expenses with pre-tax dollars. Review the FSA information in this guide for more detailed information. FSA Contributions: The minimum contribution for Dependent Care and Healthcare FSA is $ per plan year. The maximum contribution for the Dependent Care FSA is $5,000 per plan year (or $2,500 if married and filing separately). The maximum contribution for the Healthcare FSA is $6,000 per plan year. Additional Life Insurance and AD&D Insurance: You can elect Additional Life Insurance on yourself and your dependents. Guaranteed issue amounts described on page 2 of this guide are available on during this initial enrollment period. View the per-pay-period price for coverage online when you make your election(s). STEP 3: Enroll online within 30 days of your date of hire. Log on to Employee Self Service (ESS) at From the menu bar, select the Benefits tab, and click on the Manage My Benefits link. Click continue on the welcome screen, and select the Newly Eligible option to make your benefit elections. Haven t registered yet, or forgot your user id and password? Employee Self Service instructions can be found among your assigned online benefit review material. STEP 4: Print a confirmation of your elections. Once you have made your benefit elections online, be sure to print a confirmation statement for your records. Be confident of your benefit elections! You can make as many changes to your benefit elections as necessary during your 30 day initial enrollment period. You will receive a confirmation letter of your elections at your home address. Please review the confirmation letter for accuracy. After your initial enrollment period has ended, you will be unable to make any changes to your benefit elections until the next Open Enrollment (each June) unless you experience a qualified family status change and go online to ESS to make your changes within 30 days of the event. EverBank Benefits Enrollment Guide

6 Insurance Benefits - Employee Cost Per-Pay-Period Employee Only Employee + Spouse Employee + Child(ren) Family CIGNA OAP Low Medical $40.43 $ $ $ CIGNA OAP High Medical $52.52 $ $ $ CIGNA PPO Medical $79.87 $ $ $ CIGNA PPO HSA Medical $38.49 $ $ $ CIGNA Dental DHMO $2.07 $5.79 $5.83 $8.40 CIGNA Dental DPPO Low $3.16 $9.81 $9.38 $14.97 CIGNA Dental DPPO High $6.24 $14.15 $13.71 $20.18 VisionCare Plan $2.90 $5.79 $5.50 $10.82 Medical Insurance What you should know about your CIGNA Healthcare: You have four health plans to choose from. CIGNA OAP Low Plan: utilizes the Open Access Plus Only network of physicians. Lower premiums; higher out of pocket expenses (when compared to the OAP High) CIGNA OAP High Plan: utilizes the Open Access Plus Only network of physicians. Mid-range premiums; moderate out of pocket expenses CIGNA PPO Plan: utilizes the Preferred Provider Organization network of physicians. Highest premiums; moderate out of pocket expenses after plan deductible is met; includes Mayo Clinic and physicians CIGNA PPO HSA Plan: a true high-deductible health plan; utilizes the Preferred Provider Organization network of physicians. Lowest premiums; 1st dollar out of pocket expense to meet a higher deductible prior to plan payments beginning; includes Mayo Clinic and physicians Mail Order Pharmacy Program: If you are on a maintenance medication, you can save money on your pharmacy copays by filling a three month supply of your prescriptions, via mail, and paying only two copays. Online tools and resources: Go to to access your personal claims, request ID cards, download forms and review details of your elected coverage. Also review CIGNA Healthy Rewards discount programs, take a personal Health Risk Assessment, and get access to round-the-clock registered nurses search for medical providers: Go to Find Physicians or dentists OAP Low or High Plan: Search in the Open Access Plus Only network PPO or PPO HSA Plan: Search in the Preferred Provider Organization (PPO) network 5 EverBank Benefits Enrollment Guide

7 Review the plan highlights below, as well as the CIGNA OAP and PPO Summary of Benefits, found among your assigned online benefit review material, for more detailed information. Calendar Year Deductible (CYD) OAP Low Plan OAP High Plan PPO Plan PPO HSA Plan* In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Individual $1,000 $2,000 $500 $1,000 $1,000 $2,000 $2,000* $4,000* Family $2,000 $4,000 $1,000 $2,000 $2,000 $4,000 $4,000* $8,000* Coinsurance Out-of -Pocket Maximum** 20% 40% 20% 40% 10% 30% 20% 40% Individual $4,500 $9,000 $2,500 $5,000 $2,500 $7,500 $4,000 $8,000 Family $9,000 $18,000 $5,000 $10,000 $7,500 $18,500 $8,000 $16,000 Office Services Physician $35 CYD+40% $25 CYD+40% $25 CYD+30% CCYD+20% CCYD+40% Specialist $50 CYD+40% $40 CYD+40% $40 CYD+30% CCYD+20% CCYD+40% Hospital/Surgical/Emergency Care Inpatient $750 $1,500 $400 $800 $400, CYD+10% $800, CYD+30% CCYD+20% CCYD+40% Outpatient $300 $600 $200 $400 $200, CYD+10% $400, CYD+30% CCYD+20% CCYD+40% ER, per visit $350 $350 $250 $250 $250 $250 CCYD+20% CCYD+40% Provider Services 20% CYD+40% 20% CYD+40% CYD+10% CYD+30% CCYD+20% CCYD+40% Urgent Care $50 $50 $40 $40 $75 $75 CCYD+20% CCYD+40% Prescriptions Generic $7 N/A $7 N/A $7 N/A CCYD+$7 N/A Brand $35 N/A $30 N/A $30 N/A CCYD+$35 N/A Non-Preferred $60 N/A $60 N/A $60 N/A CCYD+$60 N/A Specialty $100 N/A $100 N/A $100 N/A CCYD+$100 N/A Mail Order (90-Day Supply) Advanced Advanced Imaging Services 2 x copay N/A 2 x copay N/A 2 x copay N/A CCYD+ 2 x copay $150 $300 $150 $300 CYD+10% CYD+30% CCYD+20% CCYD+40% Preventive / Adult Wellness: the benefit maximum has been removed from all plans. N/A *The PPO HSA Plan Calendar year family deductible is a collective deductible in which all claims go towards the deductible until it is met. The deductible must be met before any plan benefits are paid. Prescription copays will apply after the deductible has been met up to the out-of-pocket maximum. The PPO HSA Plan Out-of-pocket maximum includes CYD, copays, coinsurance & prescriptions. The PPO HSA Plan covers annual preventive procedures and services in-network at100% without applying to CYD or Out of Pocket Maximum. **The OAP Low and High Plan Out-of-pocket maximum includes CYD, copays & coinsurance. The CIGNA PPO Plan Out-of-pocket maximum includes coinsurance only. This is a summary of benefits and not a contract. All benefits are subject to the provisions, exclusions, and limitations set forth in the master contract. It is the insured s sole responsibility to select and verify a provider s network participation status at the time services are rendered. EverBank Benefits Enrollment Guide

8 Health Savings Account (HSA) Information The CIGNA PPO HSA medical option is a high deductible health plan with a Health Savings Account option that combines traditional medical coverage with a savings account and investment options. The calendar year collective family deductible is the portion of covered medical and pharmacy expenses that you pay before the plan will begin to cover healthcare expenses. Only covered services count toward the calendar year collective family deductible. Once your plan deductible has been met, your plan begins providing coverage for eligible services as described in your medical plan description. All covered expenses (including those expenses applied to the plan deductible) benefit from CIGNA HealthCare s negotiated discounts with participating providers and pharmacies. Preventive care provided by an in-network physician is provided at no cost to you. You cannot be enrolled in any other medical plan if you choose to enroll in the CIGNA PPO HSA plan. How the Fifth Third Bank HSA works: You can make tax-free contributions into the HSA up to federal limits. For 2010, your annual contribution is limited to $3,050 for individuals and $6,150 for families. If you are age 55 or older, and not enrolled in Medicare, you may make an additional contribution of up to $1,000 to your HSA until the age of 65 as long as you remain in a qualified HDHP plan. Once you turn 65 and/or enroll in Medicare, you can no longer contribute to your HSA; however, you may continue to use any remaining funds toward qualified healthcare expenses. Maximum contributions are based upon maintaining enrollment in a qualified HDHP plan on the first day of the month for the 12 months of the calendar year. If you enroll for less than 12 months of the calendar year, you are eligible to contribute 1/12 of the calendar year maximum for every month you are enrolled in a qualified HDHP. You are allowed to contribute up to the full annual maximum but must satisfy specific requirements to avoid any tax penalties. You must remain enrolled in the HDHP through December 1 of the taxable year. You must maintain continuous enrollment in the plan for an additional 12 months through the end of the following calendar year. You can use your HSA card to pay at the point of service for qualified healthcare expenses incurred by you, your spouse or eligible dependents, even if your dependents are not enrolled under your health plan. Keep in mind that unlike a Health Care Flexible Spending Account (FSA), the funds must be deposited into your account before available for use, much like a debit card. Qualified expenses include medical, dental and vision expenses as defined under Section 213(d) of the tax code and include expenses not covered by your HSA qualified medical plan. You can be penalized by the IRS with a 10% tax in addition to the taxation of goods/services if funds are not used for qualified healthcare expenses, as defined by IRS publication 502. Make sure to save all of your receipts in case of an IRS audit. Any dollars remaining in your savings account at the end of the plan year (June 1 to May 31) will carry over to the next year. If you change employers or retire, you may take any dollars in your savings account with you. The CIGNA PPO HSA plan provides medical and pharmacy coverage with a tax-free* health savings account you establish through Fifth Third Bank. The HSA account must be funded prior to use, and you decide how and when to use the money in your account. Use it to pay for health expenses during the plan year or save the money and earn interest and investment returns (minimum account balance required) on deposited money. *Tax-free federal taxes and for most state taxes. Some states have not enacted legislation to allow pretax treatment of HSA contributions or earnings. EverBank will fund your HSA account upon your enrollment based on your hire date and the length of time you will be participating in the PPO HSA plan (Plan year is June 1 to May 31). If you were hired May 2 to December 1, EverBank will contribute to your HSA: $300 for individual coverage, or $600 for employee + spouse, employee + child(ren) or family coverage If you were hired December 2 to May 1, EverBank will contribute to your HSA: $150 for individual coverage, or $300 for employee + spouse, employee + child(ren) or family coverage Please consult with your tax advisor for further information. 7 EverBank Benefits Enrollment Guide

9 These EverBank funds accumulate toward the IRS contribution maximums that run calendar year (January 1 December 31). You may elect to contribute additional pre-tax funds into your account (up to the contribution maximum), to help fund your medical expenses and deductible. First Step: Set up your HSA account: Your account will be opened once your enrollment processes. You will be provided registration information and will need to complete your account set-up online at Once the account is open, payroll contributions, if you decide to contribute pretax dollars into the account, start to accumulate and earn interest. You can access funds in your account through your debit card, an ATM or by writing a check. There is also an option to fund the account with after-tax funds. Please contact the Benefits Department for more details. Paying for care - you decide how: You can choose how you pay for medical expenses that are submitted through your qualified HSA medical plan. You may pay for medical expenses on a claim-by-claim basis using the debit card or checkbook that come with your HSA. (Remember to save your receipts) You may choose to cover your expenses using your own personal funds. This allows you to save your HSA dollars for future years. How your doctor gets paid when you are covered by CIGNA PPO HSA: At the doctor s office: Present your CIGNA ID card. In most cases, your in-network doctor will not collect any money at the time of your office visit. The doctor s office will bill CIGNA directly, and CIGNA will process the claim. How the claim is paid: CIGNA sends you an explanation of benefits (EOB) showing how much you owe for the service Your doctor bills you directly for any amount that you owe. You choose how to pay the bill. You can use your HSA debit card or checkbook (if there is money in your account), or other personal funds. Please note that costs will generally be higher if you use an out-of-network doctor. Verify your bill: If you receive a bill from your doctor, make sure the claim has been sent to CIGNA before you pay the bill. Check your claim and account activity on Check whether you received an explanation of benefits (EOB) from CIGNA. Call CIGNA Customer Service to find out the status of your claim, or log on to Making the most of your preventive health coverage! The CIGNA PPO HSA medical option focuses on keeping you well, rather than just providing coverage for covered illness or injury. The PPO HSA plan covers preventive care such as periodic well visits, routine immunizations and screenings 100% when you utilize an in-network CIGNA HealthCare provider. This means that preventive care is provided at no cost to you! Note: The visit must be strictly preventive. If you go in for a routine exam and a test results in medical findings, the visit will then be considered (and medically coded) as a diagnostic visit, and will be subject to the plan deductible. Your doctor will determine the tests that are right for you based on your age, gender, and family history. With the CIGNA PPO HSA medical option, you will pay a calendar year collective family deductible before your health plan begins to pay for eligible expenses. You can establish a tax-free* health savings account that both you and EverBank can contribute to. As long as funds are used for qualified health care expenses, you can decide how and when to use the money, and the account is yours to take with you when you leave the plan, change employers, or retire. *Tax-free federal taxes and for most state taxes. Some states have not enacted legislation to allow pretax treatment of HSA contributions or earnings. EverBank Benefits Enrollment Guide

10 Dental Insurance You have two dental plans to choose from. Three plans are offered; however, only two plans are available to each employee dependent upon your state of residence. If you waive coverage at this initial enrollment period, you could be subject to late entrant limitations at a future enrollment. Deductible - Individual / Family Preventive Care Two cleanings per year Vision Insurance Vision coverage is through Humana/Comp Benefits VisionCare Plan. In-Network Out-of-Network Vision Exam (every 12 months) $10 Reimbursed up to $35 after $10 copay Basic Lenses* (every 12 months) $15 Reimbursed up to $25 after $15 copay Frames (every 24 months) Paid in full (up to $60 wholesale value) Reimbursed up to $45 after $15 copay Elective Contact Lenses (every 12 months) DPPO Low DPPO High DHMO In-Network Out-of-Network In-Network Out-of-Network $0 $0 $0 $0 $0 Basic Services $50 / $150 $50 / $150 $50 / $150 $50 / $150 N/A Major Services $50 / $150 $50 / $150 $50 / $150 $50 / $150 N/A Coinsurance (paid by insurance) Preventive Care 100% 100% 100% 100% 100% Basic Services 80% 50% 80% 80% Major Services 50% 25% 50% 50% Orthodontia 50% 50% 50% 50% Benefit Maximums Benefit Max* - calendar year Lifetime Max - orthodontia $150 allowance Reimbursed up to $150 Laser vision correction** **discount N/A *Bifocal and Trifocal lenses are also available. Please view the summary plan description in the forms Library in ESS for more details. **Contact Humana/CompBenefits at for a list of providers and a refractive care ID card. Based on DHMO fee schedule $1,500 $1,500 $1,500 $1,500 N/A $1,500 Adults and Children $1,500 Adults and Children $1,500 Adults and Children $1,500 Adults and Children *The DPPO Low and High Calendar Year Benefit Maximum is a progressive benefit which can grow an additional $100 per year (up to three years/$1,800 maximum) if individual members have two preventive cleanings each year. The DHMO Fee schedule is available in the Forms Library in ESS. Based on DHMO fee schedule A Late Entrant Limitation may apply to participants who elect coverage outside the initial enrollment period. Under this limitation, CIGNA s dental coverage will be reduced to 25% coverage on major services for the first 12 months that you are on the plan and to 25% coverage on orthodontic services for the first 24 months that you are enrolled. Note: You cannot receive benefits for both elective contact lenses and eyeglass lenses/frames within the same year. If you prefer contact lenses, the plan provides an allowance for your contacts in lieu of eyeglass lenses and frames. Benefit frequency allowance begins from when the benefits are used, and will not be restored at the end of the calendar year, but rather after 12 months have elapsed. The contact lens allowance will not be restored until 12 months after the benefit has been used in full (i.e. maximize the benefit by spending the entire contact lens allowance in one purchase). 9 EverBank Benefits Enrollment Guide

11 Flexible Spending Accounts The FSA Plan Year runs June 1 to May 31. Enrollment in the FSA account is independent of enrollment in any other benefit you do not need to enroll for EverBank benefit coverage in order to participate in an FSA account. You may not participate in the Health Care FSA account if you elect to enroll in the CIGNA PPO HSA medical plan, or are enrolled in a spouse s high deductible health plan with HSA. The FSA is a way to pay for out-of-pocket health care or dependent care (child or adult daycare) expenses with pre-tax dollars. USE IT OR LOSE IT. You must be able to spend your elected FSA funds on eligible expenses during the plan year (June 1 to May 31) or your funds will be forfeit. Participation is irrevocable unless you experience a qualified family status change. Save all receipts from your health care FSA debit card purchases, and be prepared to substantiate the purchases by faxing your receipt and a substantiation form to ADP. Paper Claim Reimbursement: Health Care FSA participants who do not use the FSA debit card for a purchase may complete and fax a claim reimbursement form, along with a purchase receipt, for reimbursement from their account. Eligible receipts must be faxed no later than August 31 (3 months following the end of the plan year). Dependent Care FSA participants must fax a reimbursement form along with a copy of their eligible receipts for services rendered. Funds are mailed to the participant s home address or may be direct deposited into a bank account. Online access to the FSA account: Keep track of your balance and substantiation requests by registering online at Substantiation forms, claim forms, and lists of eligible FSA expenses are also located on the website. Health Care FSA Dependent Care FSA (You are ineligible to enroll in a Dependent Care account if your annual income is above $110,000) Use For: Qualified medical, dental, and vision care expenses (copays, deductibles, eyeglasses, contacts, prescriptions, etc.) for you and your dependents Dependent care expenses (daycare, after or before school programs, elder care programs, summer day camps) that enable you and your spouse to work or go to school full-time Contribution: $100 plan year minimum $6,000 plan year maximum $100 plan year minimum $5,000 plan year maximum (or $2,500 if married and filing separately) This communication is for internal purposes only and should not be shared outside of the company. EverBank Benefits Enrollment Guide