Benefits Brochure 2017 Final

2017Summary of Employee Benefits 1

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Table of ContentsInsurance Carrier Informa on…………………..………………….……………4Medical Plan………………………………………………...……………….……….6-7Health Reimbursement Account……………..…………………….………….8Dental Plan…………………………………………………………………….………...9Vision Plan…………………………………………..……………...…………….10-11Basic Life Insurance and AD&D Benefits………………...……………….12Voluntary Life Insurance and AD&D Benefits…………..……………..13New York State Statutory Disability…………………………….………....14Long Term Disability…………………………………………………….………...15Flexible Spending & Dependent Care Account…………………..16-17401(k) Plan……………………………………………………………………………..18Employee Assistance Program………………………………………………..19Pet Insurance………………………………………………………………………...20Employee Discounts……………………………………………………………….21Fitness Reimbursement………………………………………………………...22 3

Independent Healthwww.independenthealth.comGroup # 32823Customer Service: 716-631-8701Health Reimbursement AccountGroup # BCII55www.mywealthcareonline.com/myhnasCustomer Service—(800)518-8332Flexible Spending/Dependent CareAccountGroup # BCII55www.mywealthcareonline.com/myhnasCustomer Service—(800)518-8332401(k) - Vanguardwww.vanguard.com/re rementplansPlan # 097545Customer Service—(800)523-1188 4

MetLife DentalGroup # 5941621MetLife VisionGroup # 5941621MetLife Basic & Voluntary LifeGroup # 5941621ShelterPoint Short Term DisabilityGroup # DBL496580www.shelterpoint.com 5

Medical InsuranceCoverage Cost per paycheck Annual CostSingle $5.00 $120.00Family $241.69 $5800.56 Passport Plan Select– 32823 In-Network BenefitsDeduc ble $1,000/$2,000Out-of-pocket Max $3,000/$6,000Primary Office Visit $25 copay/visitSpecialist Office Visit $25 copay/visitTelemedicine Program $10 copay/consulta onLaboratory Tes ng $0 copay/visitEmergency Room Deduc ble then 20% coinsuranceAmbulance Deduc ble then 20% coinsuranceUrgent Care Center $75 copay/visitInpa ent Hospital Deduc ble then 20% coinsuranceOutpa ent Surgical Procedures 20% coinsuranceRou ne Radiology 20% coinsurancePhysician prenatal and postnatal $0 copay/visitInpa ent Maternity Delivery: Deduc ble then 20% coin-PT/OT/Speech 20% coinsurancePrescrip on Drug Tiers $10/$30/$50Addi onal Benefits $250 Wellness card 6

Medical InsuranceCoverage Cost per paycheck Annual CostSingleFamily $2.00 $48.00 $150.00 $3600.00 iDirect 1 Series C– 32823 In-Network BenefitsDeduc ble $1,500/$3,000Out-of-pocket Max $5,000/$10,000Primary Office Visit Deduc ble then $20 copay/visitSpecialist Office Visit Deduc ble then $20 copay/visitTelemedicine Program $10 copay/consulta onLaboratory Tes ng Deduc ble then $0 copay/visitEmergency Room Deduc ble then $125 copay/visitAmbulance Deduc ble then $25 copay/tripUrgent Care Center Deduc ble $75 copay/visitInpa ent Hospital Deduc ble then $750 copay/admissionOutpa ent Surgical Procedures Deduc ble then $150 copay/visitRou ne Radiology Deduc ble then $20 copay/visitPhysician prenatal and postnatal care $0 copay/visitInpa ent Maternity Delivery: Deduc ble then $750 copayPT/OT/Speech Deduc ble then $15 copay/visitPrescrip on Drug Tiers $10/$30/$75Addi onal Benefits $250 Wellness card 7

Health Reimbursement Account Group BCII55Coverage AmountSingle iDirect $750Single Passport $375Family iDirect $1500Family Passport $750Employees who enroll in Summit’s Independent Health medicalplan will automa cally receive a Health Reimbursement Account(HRA) administered by HealthNow Administra ve Services Employees will receive a debit card that can be used for out of pocket medical expenses—prescrip ons, copays, etc. Unused funds rollover into next year Save your receipts—you may need to verify your purchases as per IRS regula ons 8

Dental InsuranceCoverage Cost per paycheck Annual CostSingleFamily FREE FREE $19.25 $462.00Services In-network Out-of-networkPreven ve Services 100% 100%(Cleanings,Basic care (Fillings, periodon- 90% 80%tal maintenance, root canal) 50%Major Care (bridges, den- 60%tures, single crowns) 50% 50% $50—singleOrthodon a (life me max $150—family $1,250Deduc ble None 26Annual Maximum BenefitDependent Age Limit 9

Vision Insurance—High Op onCoverage Group #5941621 Cost per paycheck Annual CostSingle $5.30 $127.20Family $12.45 $298.80Services In-network BenefitsExams Copay $10 copaySingle Vision, bifocal, Covered in full a er $10 eyewear copaytrifocal and len cular $130 Allowance a er $10 eyewear copayFrames *You will receive an addi onal 20% savings on the amount you pay over your allow-Contact Lenses $130 AllowanceContact lens fi ng Covered in full with max copay of $60Service Frequencies Every calendar year 10

Vision Insurance—Low Op onCoverage Group #5941621 Cost per paycheck Annual CostSingle $3.38 $81.12Family $7.94 $190.56Services In-network BenefitsExams Copay $20 copaySingle Vision, bifocal, Covered in full a er $20 eyewear copaytrifocal and len cular $100 Allowance a er $20 eyewear copayFrames *You will receive an addi onal 20% savings on the amount you pay over your allow-Contact Lenses $100 AllowanceContact lens fi ng Covered in full with max copay of $60Service Frequencies Every calendar year 11

Basic Life and AD&DEmployer provided benefit for all full me employees—no cost to em- ployees.What your Benefits Cover: Basic LifeEmployee Benefit 150% of your annual salary, to a max of $200,000Accidental Death and Dis-memberment Basic life coverage includes Accidental Death and Dismemberment coverage equal to oneGuarantee Issue mes to employee’s life benefits. You are not required to answer health ques- ons to qualify for coverage. 12

Voluntary Term LifeCost is based on employee’s age and volume of life insuranceWhat your Benefits Cover: Voluntary Term LifeEmployee Benefit $10,000 increments to a maximum ofAccidental Death and Dis- Enhanced employee, spouse, and child(ren)memberment coverage. Maximum 1 mes life amountSpouse/Domes c Partner $5,000 increments to a maximum ofBenefit $100,000Child Benefit Your dependent children age 14 days to 20 years (26 if full me student) $1,000 incre- ments to a maximum of $10,000. 13

Short-Term DisabilityEmployer provided benefit for all employees—no cost to employees.What your Benefits Cov- Short-term DisabilityCoverage Amount 50% of earnings up to $170/week for 26Benefits Begin A er day 7 of being disabled*You will receive benefit payments while you are unable to work in your job 14

Long-Term DisabilityEmployer provided benefit for all full me employees—no cost to employees. What your Benefits Long-Term DisabilityCoverage Amount 66.7% of salary to maximum $4000/monthBenefits Begin A er day 181 of being disabledPre-exis ng condi ons A pre-exis ng condi on includes any condi on/ symptom for which you, in the specified me period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. 3 Months look back; 12 months a er limita on *You will receive benefit payments while you are unable to work in your jobTypically employees are on Short-term disability prior to receiving LTD benefits 15

Dependent Care Spending Account Employees can choose to make pre-tax deduc ons out of their paycheck to pay for daycare expensesWhat your Benefits Cover: Dependent CareAmount Annual maximum $5000RolloverContribu ons Unused funds do not rollover Must contribute to the plan before re- ques ng reimbursement*Daycare provider must have a tax ID number 16

Flexible Spending AccountEmployees can choose to make pre-tax deduc ons out of their paycheck to pay for unreimbursed medical expensesWhat your Benefits FSACover: Maximum $2600 plan yearAmountRollover Up to $500 of funds can rollover in to the nextContribu ons plan year. Anything above that amount will be forfeited Employee makes contribu ons each paycheck but total dollar amount is received up front . 17

401(k)Eligibility 21+ years oldDeferral AmountsAnnual Maximum 1—60% of salaryEmployer Match $18,000Ves ng Schedule Dollar for dollar up to 4% Employer Match—immediately Profit Sharing—3 years of serviceAt the discre on of the agency, a profit sharing contribu on is madeto your 401(k) re rement account on an annual basis. To be eligible you must be 21, complete 6 months and 1000 hours of service. 18

Employee Assistance Program Phone—1-800-511-3920 Website—www.members.mhn.com Company Code: metlifeeap1The Employee Assistance program is a free benefit providing guidancefor personal issues that you might be facing and informa on about otherconcerns that affect your life, whether it’s a life event or on a day-to-daybasis. EAP offers help with:Educa on: Dependent Care & Care Giving: Admissions tes ng & procedures  Adop on Assistance Adult re-entry programs  Before/a er school programs College planning  Day Care/Elder Care Financial aid resources  In-home servicesLifestyle & Fitness Management: Legal and Financial: Anxiety & depression  Basic tax planning Divorce & separa on  Credit & collec ons Drugs & alcohol  Debt counseling  Home buying  Immigra on Working Smarter:  Career development  Effec ve Managing  Reloca on 19

Pet InsurancePet insurance reimburses you for vet bills when your pet is sick orinjured, to help take the financial worry out of vet visits.Employees receive up to a 10% discount for pet insurance. Ratesare based on breed and age.Get an instant quote at: www.petsbest.com/summitpet or call 888-984-8700 and reference code SUMMITPET 20

Employee PerksThe Summit Center offers a variety discounted ckets/membershipsfor purchase in the Human Resources office including the following: Regal movie ckets AMC movie ckets Darien Lake Mar n’s Fantasy Island Erie County Fair Delta Sonic Tim Horton’s gi cards BJ’s Wholesale Club membershipsHR is always looking for new ideas for employee incen ves. If youhave a sugges on please email any member of HR. 21

Fitness Reimbursement ProgramThe Summit Center is commi ed to encouraging our employee’s to lead an ac ve lifestyle. We have implemented a Fitness Reimbursement Program to mo vate employees to make exercise a part of their regular rou ne by a ending any local fitness center. HOW CAN I PARTICIPATE?1. Obtain a membership at a fitness center of your choice.2. Complete the Fitness Reimbursement Registra on form found on MySummit3. Exercise at your fitness center a minimum of 8 mes per month.4. Obtain verifica on of your a endance from your gym on a monthly basis, and return the report to HR. HOW WILL I RECEIVE REIMBURSEMENT?The Summit Center will provide a reimbursement of $20 per month.. You musta end your gym at least 8 mes per month in order to receive reimbursement. PAYMENT OCCURS DURING JANUARY, APRIL, JULY, & OCTOBER Track October, November, December to be paid out in January. Track January, February, March to be paid out in April. Track April, May, June to be paid out in July. Track July, August, September to be paid out in October. 22

For ques ons regarding benefits, please contact: Ka e Harris Benefits Administrator at 629-3465 or [email protected] 23

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