EPIC 2011 Employee s January 1 December 31, 2011 Edgewood Partners Insurance Center CA License 0B29370 1 CA License 0B29370
Basics Employee Eligibility Group benefits are available to all regular part time and full time employees working at least 25 hours per week. Dependent Eligibility Spouses Same & Opposite Sex Domestic Partners Biological, Step & Adopted Child(ren) to age 26 for medical; under age 19 (or up to age 25 if a full time timecollege student) for all otherplans. When Coverage Begins. All eligible employees can elect the benefits of their choosing immediately upon hire. All benefits, except the medical and health care flexible spending plans, become effective on the first of the month following or coinciding with the employee s date of hire. The medical and health care flexible spendingplans plans are effective on the employee s date of hire. Special Considerations This document only summarizes some key offering of EPIC's benefit plans. If there is a discrepancy between the information in this document and the official plan documents, the plan documents will always govern. While EPIC intends to continue these plans, it reserves the right to change, amend or terminate them at any time for any reason. Edgewood Partners Insurance Center CA License 0B29370 2
HMO Medical & Prescription Drug Coverage Anthem Blue Cross HMO (not available for non CA employees) Lifetime Maximum Calendar Year Copay Maximum Doctor Office Visits Preventative Care Maternity Care Lab Services Inpatient Hospital Outpatient Hospital Emergency Room Physical Therapy (limited to 60 day period of care after illness or injury) Chiropractic Prescription Drugs (not subject to deductible) In Network Coverage $2,500/individual & $5,000/family $30 copay per visit No charge $30 copay per visit No charge; $100 copay for MRI, PET & CT. $500 copay per admission $250 copay per admission $150 copay per visit (waived if admitted) $30 copay per visit if performed in non hospital facility. No charge if performed in hospital. Not covered Generic ~ $10 copay ($20 for mail order) Brand Name ~ $25 copay ($50 for mail order) Non Formulary ~ $40 copay ($80 for mail order) Kaiser HMO (not available for non CA employees) Lifetime Maximum Calendar Year Copay Maximum Doctor Office Visits Preventative Care Maternity Care Lab Services Inpatient Hospital Outpatient Hospital Emergency Room Physical Therapy Chiropractic Prescription Drugs In Network Coverage $1,500/individual & $3,000/family $30 copay per visit No charge No charge for prenatal care and first postpartum visit No charge $500 copay per admission $30 copay per procedure $50 copay per visit (waived if admitted) $30 copay per visit Not covered Generic ~ $10 copay ($20 for mail order) Brand Name ~ $25 copay ($50 for mail order) Edgewood Partners Insurance Center CA License 0B29370 3
Traditional PPO Medical & Prescription Drug Coverage Anthem Blue Cross PPO In Network Coverage Out of Network Coverage $250/individual & $750/family Lifetime Maximum Unlimited Calendar Year Copay Maximum $3,000/individual & $6,000/family $10,000/individual & $20,000/family Doctor Office Visits $20 copay per visit Plan pays 60% Preventative Care No charge Plan pays 60% Maternity Care $20 copay for prenatal and postnatal physician office visits Plan pays 60% for prenatal and postnatal physician office visits Lab Services Plan pays 80% Plan pays 60% Inpatient Hospital Plan pays 80% Plan pays 60% Outpatient Hospital Planpays80% Planpays 60% Emergency Room Plan pays 80% after $100 copay Physical Therapy (up to 24 visits per Plan pays 80% Plan pays 60%, up to $25 per visit calendar year) Chiropractic (up to 24 visits per Plan pays 80% Plan pays 60%, up to $25 per visit calendar year) Prescription Drugs (not subject to deductible) Generic ~ $10 copay ($10 for mail order) Member pays all copays as listed under in network and 50% of the remaining Brand Name ~ $25 copay ($50 for mail order) Non Formulary ~ $40 copay prescription drug maximum allowed amount and any excess costs. Mail order is not available. ($80 for mail order) Edgewood Partners Insurance Center CA License 0B29370 4
HSA Compatible PPO Medical & Prescription Drug Coverage Anthem Blue Cross High PPO Plan (HSA Compatible) In Network Coverage Out of Network Coverage $2,500/individual & $5,000/family Lifetime Maximum Unlimited Calendar Year Copay Maximum $3,500/individual & $7,000/family $5,000/individual & $10,000/family Doctor Office Visits Plan pays 100% after deductible Plan pays 70% after deductible Preventative Care No charge Plan pays 70% after deductible Maternity Care Plan pays 100% after deductible Plan pays 70% after deductible Lab Services Plan pays 100% after deductible Plan pays 70% after deductible Inpatient Hospital Plan pays 100% after deductible Plan pays 70% after deductible Outpatient Hospital Plan pays 100% after deductible Plan pays 70% after deductible Emergency Room Plan pays 100% after deductible Physical Therapy (up to 24 visits per Plan pays 100% after deductible Plan pays 70% after deductible calendar year) Chiropractic (up to 24 visits per Plan pays 100% after deductible Plan pays 70% after deductible calendar year) Prescription Drugs (subject to deductible) Generic ~ $10 copay ($10 for mail order) Brand Name ~ $30 copay Member pays all copays as listed under in network and 30% of the remaining prescription drug maximum allowed ($60 for mail order) Non Formulary ~ $50 copay ($100 for mail order) amount and any excess costs. Mail order is not available. Edgewood Partners Insurance Center CA License 0B29370 5
Dental & Vision Coverage Enrollment in the dental and vision plans is bundled which means that if you elect dental you must also elect vision, and visa versa. The enrollment levels also must match with the dental and vision (everyone enrolled in one plan must also be enrolled in the other). The Dental Monthly Swing plan allows you to switch between the HMO and PPO options, on a monthly basis. Please keep in mind that if you switch from the HMO to the PPO or visa versa, all enrolled dependents are also switched to the chosen plan. Guardian Monthly Swing Plan PPO Option In Network Coverage Out of Network Coverage $50/individual & $150/family Calendar Year Maximum $2,000/individual Preventative Services Plan pays 100% Plan pays 100% Basic Services Planpays 90% Planpays 80% Major Services Plan pays 60% Plan pays 50% Orthodontics (adult & child) Plan pays 50% up to lifetime maximum of $1,000/individual Implant Services Plan pays 60% Plan pays 50% Guardian Monthly Swing Plan HMO Option Calendar Year Maximum Office Visits Preventative Services Basic Services Major Services Orthodontics (adult & child) Implant Services In Network Coverage $5 copay per visit Subject to fee schedule Subject to fee schedule Subject to fee schedule hdl $2,500 copay for children & $2,800 copay for adults Not covered Vision Service Plan (VSP) In Network Coverage Out of Network Coverage Copay $25 copay Exam (once every 12 months) No charge Plan pays up to $45 Lenses (once every 12 months) No charge Plan pays up to $45, $65 or $85 depending on type of lens Frame (once every 24 months) Plan pays up to $130 Plan pays up to $47 Contacts Plan pays up to $130 Plan pays up to $105 Laser Vision ii Correction Discounts available No discounts available Edgewood Partners Insurance Center CA License 0B29370 6
Health Care & Dependent Care Flexible Spending Accounts Flexible spending accounts are a great way to pay pyfor health care, dependent care, parking or mass transit expenses on a pre tax basis, saving you 25 40% on your eligible expenses. An FSA is the only benefit that actually saves you money on the cost of health care, day care, transit and parking expenses, all while reducing your taxable income. Health Care FSA In Network Coverage Maximum Employee Contribution $5,000 annually Grace Period You have 2 ½ months after the plan year in which to spend any money left in your account Claim Deadline March 31, 2012 Eligible Expenses Expenses not covered by your health plan and most unreimbursed medical, dental, vision and/or hearing expenses per IRS guidelines. Limitations Employees enrolled in the Blue Shield High plan are limited to reimbursement for post deductible medical, dental and vision expenses. Dependent Care FSA In Network Coverage Maximum Employee Contribution $5,000 annually or $2,500 if married and filing a separate tax return Grace Period You have 2 ½ months after the plan year in which to spend any money left in your account Claim Deadline March 31, 2012 Eligible ibl Expenses Expenses for the care of your eligible ibl dependents d so that you or your spouse can work Limitations Eligible dependents include children to age 13 or a dependent of any age who is physically or mentally unable to care for himself Edgewood Partners Insurance Center CA License 0B29370 7
Mass Transit & Parking Flexible Spending Accounts Transit Reimbursement Account Maximum Employee Contribution Eligible Expenses Limitations Coverage $230 monthly ($2,760 annually) Bus vouchers, passes, tokens, ferry passes, vanpooling, commuter rail and mass transit passes. Only expenses for the employee are eligible. Toll fares, parking costs and transit expenses reimbursed by another source are not eligible. Parking Reimbursement Account Maximum Employee Contribution Eligible Expenses Limitations Coverage $230 monthly ($2,760 annually) Parking at or near EPIC s worksite or at a facility from which an employee commutes via transit, vanpool or carpool. Only expenses for the employee are eligible. Transit costs and expenses reimbursed by another source are not eligible. Edgewood Partners Insurance Center CA License 0B29370 8
Income Protection Coverage Guardian Life/AD&D and Disability Plans Core Life/AD&D Equal to 1x your eligible earnings, up to $500,000 Voluntary Employee Life $100,000 000 guarantee issue $500,000 maximum with evidence of insurability Voluntary Spouse Life Equal to 50% of Voluntary Employee Life up to $50,000 guarantee issue and up to $250,000 with evidence of insurability Voluntary Child Life Equal to 50% of Voluntary Employee Life up to $10,000 Core Long Term Disability Plan pays 60% of your monthly earnings, up to $2,500 per month Voluntary Long Term Disability Plan pays 66.67% of your monthly earnings, up to $10,000 per month Employee Cost Core Plans: EPIC pays 100% Voluntary Plans: Employees are responsible for 100% of cost Unum Long Term Care Plans Core Long Term Care Voluntary Long Term Care $3,000/month Nursing Facility, Residential & Home Care, Community/Immediate Family Care Coverage for employees Allows increases in coverage limits/benefits as well as coverage for eligible family such as children, spouse, grandparents, parents, etc. Employee Cost Core Plans: EPIC pays 100% Voluntary Plans: Employees are responsible for 100% of cost Hartford Business Travel Accident Insurance Amounts Principal Sum $500,000 Adaptive Home/Vehicle 3% of principal sum, up to $3,000 Rehab 3% of principal p sum, up to $, $3,000 Education 3% of principal sum, up to $3,000 Seat Belt 10% of principal sum, up to $10,000 Employee Cost EPIC pays 100% Edgewood Partners Insurance Center CA License 0B29370 9
Retirement & College Savings Fidelity 401(k) Retirement Savings Plan Eligibility Waiting Period Maximum Employee Contribution Vesting Investment Options Employer Match Financial Planning All employees are eligible to participate. Elections become effective first of the month following the enrollment or change. You can defer between 1% and 90% of your eligible pay 100% immediate vesting in all forms of contributions EPIC offers both Traditional (pre tax) and Roth (after tax) options Discretionary At no cost to you, EPIC provides access to a financial planner Fidelity College Savings Plan This plan allows you to set aside after tax money for your children s education in a savings account. The funds grow tax deferred so when the money is deducted for an eligible college expense, there are no negative tax consequences for you on the principal or the earnings. Others are allowed to contribute to the account (grandparents, etc.). EPIC offers the option for you to make your contributions to this account via payroll deductions, making saving easy and convenient. Since EPIC is sponsoring this benefit, you are able to take advantage of some of the lowest fees available, as opposed to opening your own private account. Since this is an individual id plan, the account is portable and not dependent d upon your employment with EPIC. There s a credit card that you can apply for with a rewards system that provides for incentives towards your savings. Edgewood Partners Insurance Center CA License 0B29370 10