Goodwill 2017 Benefits Overview BELOW IS A BRIEF OUTLINE OF IN-NETWORK BENEFITS For additional details and Out of Network benefits, please refer to the Summary Plan Descriptions at www.mokangoodwill.org/benefit. Blue Cross Blue Shield of Kansas City: PPO Medical Plans Eligible for employees working 30+ hours per week. Preferred-Care Blue Network PPO 2000 Premium Plan PPO 6500 Value Plan Deductible: Individual $2,000 $6,500 Deductible: Family $6,000 $13,000 Member Co-Insurance Covered at 100% After Deductible Covered at 100% After Deductible Out-of-Pocket Maximum: Individual $2,000 $6,500 Out-of-Pocket Maximum: Family $6,000 $13,000 Preventive Care Covered at 100% Covered at 100% Office Visit (PCP / Specialist) $30 Copay / $60 Copay Covered at 100% After Deductible Urgent Care $60 Copay Covered at 100% After Deductible Emergency Room Covered at 100% After Deductible Covered at 100% After Deductible Hi Tech Diagnostics (MRI, MRA, etc.) Covered at 100% After Deductible Covered at 100% After Deductible Inpatient Hospital Covered at 100% After Deductible Covered at 100% After Deductible Outpatient Hospital Covered at 100% After Deductible Covered at 100% After Deductible Retail Prescriptions: Tier 1/ Tier 2/ Tier 3 $10 / $30 / $50 $12 for tier 1 / Covered at 100% Mail Order Prescriptions: Tier 1/ Tier 2/ Tier 3 $30 / $90 / $150 After Deductible for Tier 2 and 3 $30 for tier 1 / Covered at 100% After Deductible for Tier 2 and 3 Health Risk Assessment Incentive Visit A Healthier You on www.mokangoodwill.org/benefitplans to take your Health Risk Assessment today for the opportunity to reduce your monthly premiums by $25 each month. You and your covered spouse may complete this assessment. Out of Pocket Maximum includes deductible, coinsurance, and copayments. Ameriflex: Flexible Spending Account You can reallocate your annual compensation to pay for eligible health costs that may not be covered by your benefit plan and/or dependent care expenses. In essence, you will be paying for these expenses on a pre-tax basis. This is a voluntary plan and the amount you designate as your Annual Salary Reallocation should be conservative. Participants can roll over up to $500 of unused FSA dollars to the next year. Medical Expenses: Set aside up to $2,600 pre-tax to pay for unreimbursed qualified healthcare expenses Dependent Care Expenses: Set aside up to $5,000 (or $2,500 if married filing separately) for qualified dependent care Delta Dental of Kansas: Dental Plan Premier & PPO Networks Preventive 100% Deductible: Individual $50 (applies to Basic & Major only) Deductible: Family $150 (applies to Basic & Major only) Basic 80% Major 50% Annual Benefit Maximum $1,000 per person Orthodontia Not Covered
Assurant / SunLife: Vision Plan VSP Signature Network Frequency Benefit Examination Every 12 months $10 Copay Single Vision Lenses Every 12 months $25 Copay Lined Bifocal Lenses Every 12 months $25 Copay Line Trifocal Lenses Every 12 months $25 Copay Frames Every 24 months $130 Allowance, 20% off balance over $130 Contact Lenses Every 12 months $130 Allowance Lasik Discount Once Per Lifetime 15% off retail price, 5% off promotional price USAble: Voluntary Life and Accidental Death & Dismemberment Life and AD&D Coverage $10,000 for employee only Life and AD&D Coverage $25,000 for executive class All Life and AD&D amounts are subject to an age reduction schedule. MetLife: Voluntary Life and Accidental Death & Dismemberment Eligible for employees working 30+ hours per week. Benefit Increments Guarantee Issue Maximum Employee Coverage Up to 5 times base salary $10,000 $150,000 $500,000 Spouse Coverage Up to 50% of employee coverage $5,000 $50,000 $250,000 Child(ren) coverage Up to 50% of employee coverage for amounts of $1,000,$2,000, $4,000, $5,000 or $10,000 To purchase Spouse &/or Child(ren) coverage, you must have coverage on yourself. Guarantee Issue is applicable at initial eligibility only. MetLife: Voluntary Short Term Disability Eligible for employees working 30+ hours per week. Elimination Period 14 th day Accident or Sickness Short Term Disability Benefit 60% of weekly earnings to a maximum of $1,000 Benefit Duration 11 Weeks Assurant / SunLife: Voluntary Accident and Critical Illness Type of Plan Benefit Accident Insurance Coverage: Off the Job (Including Wellness Benefit) Critical Illness Insurance Coverage: (Including Wellness Benefit) Fixed benefits based on the type of injury & treatment received. Pays cash dollars directly to you regardless of medical insurance benefits. $50 per year wellness benefit for each covered individual for a covered health screening. Lump sum benefit (depending on the level of coverage selected) upon diagnosis of a critical illness; Heart Attack, Stroke, Cancer. Pays cash dollars directly to you regardless of medical insurance benefits. $50 per year wellness benefit for each covered employee and spouse for a covered health screening.
Goodwill 2017 Benefits Overview PTO Grid for 2017 Years of Service PTO A PTO B PTO C 0 0 3.69 4.27 1 2.15 3.69 4.27 2 2.15 5.23 5.81 3 2.15 5.23 5.81 4 2.15 5.23 5.81 5 2.15 6.77 7.35 6 2.15 6.77 7.35 7 2.15 6.77 7.35 8 2.15 8.31 8.89 9 2.15 8.31 8.89 10 2.15 9.23 9.81 Part-Time Employees (after one year of service) Full-Time Employees Retail Management (with required 45 hour work week) Type of Coverage Employee Semi-Monthly Rates Medical: PPO 2000 Premium Plan Employee Only $55.85 Employee & Spouse $128.45 Employee & Child(ren) $106.11 Family $156.38 Medical: PPO 6500 Value Plan Employee Only $22.28 Employee & Spouse $51.25 Employee & Child(ren) $42.34 Family $62.39 Dental: Employee Only $12.94 Employee & Spouse $25.21 Employee & Child(ren) $24.12 Family $36.78 Vision: Employee Only $3.95 Employee & Spouse $7.86 Employee & Child(ren) $8.46 Family $12.48 CONTACT INFORMATION Blue Cross Blue Shield of Kansas City Delta Dental of Kansas Assurant / SunLife USAble MetLife Ameriflex New Directions Behavioral Health Contact for questions about benefits and enrollments Contact for questions about claims, issues, and coverage Medical Dental Vision, Voluntary Benefits Basic Life/AD&D Voluntary Life/AD&D, Disability Flexible Spending Account Employee Assistance Program (816) 842-7425 Extension 252 benefits@mokangoodwill.org www.mokangoodwill.org/benefits Kyla Boyd-Seward (913)754-5941 kboyd-seward@trussadvantage.com Kara Vincent (913)754-5927 kvincent@trussadvantage.com 888-989-8842 or 816-395-2950 www.bluekc.com 800-733-5823 www.deltadentalks.com 800-733-7879 www.assurantemployeebenefits.com 800-370-5856 www.usablelife.com 800-638-5433 www.metlife.com 888-868-3539 www.myameriflex.com 800-528-5763 www.ndbh.com This is a brief description of your benefits. If a discrepancy exists, benefits outlined in the carrier certificate will prevail.
Goodwill 2017 Rate Grids Supplement to Benefit Overview MetLife: Voluntary Life and AD&D Premiums Employee Life and AD&D Semi-Monthly Premiums Premiums are based on the employee's age on each policy anniversary Benefit in 000 s thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Age $20 1.26 1.46 1.76 2.16 3.36 5.16 8.56 14.26 22.86 43.36 80.76 $30 1.89 2.19 2.64 3.24 5.04 7.74 12.84 21.39 34.29 65.04 121.14 $40 2.52 2.92 3.52 4.32 6.72 10.32 17.12 28.52 45.72 86.72 161.52 $50 3.15 3.65 4.40 5.40 8.40 12.90 21.40 35.65 57.15 108.40 201.90 $60 3.78 4.38 5.28 6.48 10.08 15.48 25.68 42.78 68.58 130.08 242.28 $70 4..41 5.11 6.16 7.56 11.76 18.06 29.96 49.91 80.01 151.76 282.66 $80 5.04 5.84 7.04 8.64 13.44 20.64 34.24 57.04 91.44 173.44 323.04 $90 5.67 6.57 7.92 9.72 15.12 23.22 38.52 64.17 102.87 195.12 363.42 $100 6.30 7.30 8.80 10.80 16.80 25.80 42.80 71.30 114.30 216.80 403.80 $110 6.93 8.03 9.68 11.88 18.48 28.38 47.08 78.43 125.73 238.48 444.18 $120 7.56 8.76 10.56 12.96 20.16 30.96 51.36 85.56 137.16 260.16 484.56 $130 8.19 9.49 11.44 14.04 21.84 33.54 55.64 92.69 148.59 281.84 524.94 $140 8.82 10.22 12.32 15.12 23.52 36.12 59.92 99.82 160.02 303.52 565.32 $150 9.45 10.95 13.20 16.20 25.20 38.70 64.20 106.95 171.45 325.20 605.70 Coverage available up to $500,000 depending on employee salary. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies. Spouse Life and AD&D Semi-Monthly Premiums Premiums are based on the employee's age on each policy anniversary Benefit in 000 s Thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Age $5 0.32 0.37 0.45 0.55 0.85 1.30 2.15 3.57 5.72 10.85 20.20 $10 0.63 0.73 0.88 1.08 1.68 2.58 4.28 7.13 11.43 21.68 40.38 $15 0.95 1.10 1.33 1.63 2.53 3.88 6.43 10.70 17.15 32.53 60.58 $20 1.26 1.46 1.76 2.16 3.36 5.16 8.56 14.26 22.86 43.36 80.76 $25 1.58 1.83 2.21 2.71 4.21 6.46 10.71 17.83 28.58 54.21 100.96 $30 1.89 2.19 2.64 3.24 5.04 7.74 12.84 21.39 34.29 65.04 121.14 $35 2.21 2.56 3.09 3.79 5.89 9.04 14.99 24.96 40.01 75.89 141.34 $40 2.52 2.92 3.52 4.32 6.72 10.32 17.12 28.52 45.72 86.72 161.52 $45 2.84 3.29 3.97 4.87 7.57 11.62 19.27 32.09 51.44 97.57 181.72 $50 3.15 3.65 4.40 5.40 8.40 12.90 21.40 35.65 57.16 108.40 201.90 Coverage available up to 50% of employee elected amount. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies. Child Amount for Voluntary Life $1,000 $5,000 $10,000 Child Life and AD&D Premium 0.12 0.58 1.15 *Employee must also be enrolled in coverage to elect for Child Life and AD&D.
USAble: Voluntary Life Premiums USAble All Staff Coverage: Voluntary Life and AD&D $10,000 of coverage $1.60 semi-monthly deduction USAble Executives Only Coverage: Voluntary Life and AD&D $25,000 of coverage $4.00 semi-monthly deduction MetLife: Short Term Disability Premiums MAXIMUM WEEKLY BENEFIT AGE SCHEDULE WITH SEMI-MONTHLY DEDUCTION THRU 39 40-49 50-59 60+ $100 3.19 4.44 5.08 5.75 $150 4.79 6.65 7.61 8.62 $200 6.38 8.87 10.15 11.49 $250 7.98 11.09 12.69 14.36 $300 9.57 13.31 15.23 17.24 $350 11.17 15.52 17.76 20.11 $400 12.76 17.74 20.30 22.98 $450 14.36 19.96 22.84 25.85 $500 15.95 22.18 25.38 28.73 $550 17.55 24.39 27.91 31.60 $600 19.14 26.61 30.45 34.47 $650 20.74 28.83 32.99 37.34 $700 22.33 31.05 35.53 40.22 $750 23.93 33.26 38.06 43.09 $800 25.52 35.48 40.60 45.96 $850 27.12 37.70 43.14 48.83 $900 28.71 39.92 45.68 51.71 $950 30.31 42.13 48.21 54.58 $1,000 31.90 44.35 50.75 57.45 *Coverage available up to 60% of your weekly income. Coverage is rounded to the nearest $50. Assurant: Accident Premiums Semi-Monthly Accident Premiums Employee Only $7.94 Employee & Spouse $10.40 Employee & Child(ren) $12.29 Family $14.75
Assurant: Critical Illness Premium SEMI-MONTHLY Critical Illness Premiums - Employee, Non-Tobacco Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 Thru Age 29 $2.10 $4.20 $6.30 $8.40 $10.50 $12.60 $14.70 $16.80 $18.90 $21.00 30-39 $3.40 $6.80 $10.20 $13.60 $17.00 $20.40 $23.80 $27.20 $30.60 $34.00 40-49 $5.45 $10.90 $16.35 $21.80 $27.25 $32.70 $38.15 $43.60 $49.05 $54.50 50-59 $10.40 $20.80 $31.20 $41.60 $52.00 $62.40 $72.80 $83.20 $93.60 $104.00 60-64 $15.08 $30.15 $45.23 $60.30 $75.38 $90.45 $105.53 $120.60 $135.68 $150.75 65 + $17.65 $35.30 $52.95 $70.60 $88.25 $105.90 $123.55 $141.20 $158.85 $176.50 SEMI-MONTHLY Critical Illness Premiums - Employee, Tobacco Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 Thru Age 29 $3.08 $6.15 $9.23 $12.30 $15.38 $18.45 $21.53 $24.60 $27.68 $30.75 30-39 $5.68 $11.35 $17.03 $22.70 $28.38 $34.05 $39.73 $45.40 $51.08 $56.75 40-49 $9.63 $19.25 $28.88 $38.50 $48.13 $57.75 $67.38 $77.00 $86.63 $96.25 50-59 $19.20 $38.40 $57.60 $76.80 $96.00 $115.20 $134.40 $153.60 $172.80 $192.00 60-64 $25.73 $51.45 $77.18 $102.90 $128.63 $154.35 $180.08 $205.80 $231.53 $257.25 65 + $27.20 $54.40 $81.60 $108.80 $136.00 $163.20 $190.40 $217.60 $244.80 $272.00 SEMI-MONTHLY Critical Illness Premiums - Spouse, Non-Tobacco Employee Age $2,500 5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000 Thru Age 29 $1.14 $2.28 $3.42 $4.55 $5.69 $6.83 $7.97 $9.10 $10.24 $11.38 30-39 $1.75 $3.50 $5.25 $7.00 $8.75 $10.50 $12.25 $14.00 $15.75 $17.50 40-49 $2.73 $5.45 $8.18 $10.90 $13.63 $16.35 $19.08 $21.80 $24.53 $27.25 50-59 $5.08 $10.15 $15.23 $20.30 $25.38 $30.45 $35.53 $40.60 $45.68 $50.75 60-64 $7.28 $14.55 $21.83 $29.10 $36.38 $43.65 $50.93 $58.20 $65.48 $72.75 65 + $8.53 $17.05 $25.58 $34.10 $42.63 $51.15 $59.68 $68.20 $76.73 $85.25 SEMI-MONTHLY Critical Illness Premiums - Spouse, Tobacco Employee Age $2,500 5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000 Thru Age 29 $1.62 $3.23 $4.84 $6.45 $8.07 $9.68 $11.29 $12.90 $14.52 $16.13 30-39 $2.84 $5.68 $8.52 $11.35 $14.19 $17.03 $19.87 $22.70 $25.54 $28.38 40-49 $4.75 $9.50 $14.25 $19.00 $23.75 $28.50 $33.25 $38.00 $42.75 $47.50 50-59 $9.34 $18.68 $28.02 $37.35 $46.69 $56.03 $65.37 $74.70 $84.04 $93.38 60-64 $12.48 $24.95 $37.43 $49.90 $62.38 $74.85 $87.33 $99.80 $112.28 $124.75 65 + $13.17 $26.33 $39.49 $52.65 $65.82 $78.98 $92.14 $105.30 $118.47 $131.63 SEMI-MONTHLY Child Premiums for all children, not per child $2,500 $0.22 $5,000 $0.43