2018Summary of Employee Benefits 1
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Table of ContentsInsurance Carrier Information…………………..………………….……………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/retirementplansPlan # 097545Customer Service—(800)523-1188 4
MetLife DentalGroup # 5941621Customer Service—1-800-275-4638MetLife VisionGroup # 5941621Customer Service—1-800-275-4638MetLife Basic & Voluntary LifeGroup # 5941621Customer Service—1-800-275-4638ShelterPoint 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 BenefitsDeductible $1,000/$2,000Out-of-pocket Max $3,000/$6,000Primary Office Visit $35 copay/visitSpecialist Office Visit $35 copay/visitTelemedicine Program $0 copay/consultationLaboratory Testing $0 copay/visitEmergency Room Deductible then 20% coinsuranceAmbulance Deductible then 20% coinsuranceUrgent Care Center $75 copay/visitInpatient Hospital Deductible then 20% coinsuranceOutpatient Surgical Procedures 20% coinsuranceRoutine Radiology 20% coinsurancePhysician prenatal and postnatal $0 copay/visitInpatient Maternity Delivery: Deductible then 20% coin-PT/OT/Speech 20% coinsurancePrescription Drug Tiers $10/$30/50%Additional Benefits $250 Wellness card 6
Medical InsuranceCoverage Cost per paycheck Annual CostSingle $2.00 $48.00Family $150.00 $3600.00 iDirect 1 Series C– 32823 In-Network BenefitsDeductible $1,500/$3,000Out-of-pocket Max $5,000/$10,000Primary Office Visit Deductible then $20 copay/visitSpecialist Office Visit Deductible then $20 copay/visitTelemedicine Program $0 copay/consultationLaboratory Testing Deductible then $0 copay/visitEmergency Room Deductible then $125 copay/visitAmbulance Deductible then $25 copay/tripUrgent Care Center Deductible $75 copay/visitInpatient Hospital Deductible then $750 copay/admissionOutpatient Surgical Procedures Deductible then $150 copay/visitRoutine Radiology Deductible then $20 copay/visitPhysician prenatal and postnatal care $0 copay/visitInpatient Maternity Delivery: Deductible then $750 copayPT/OT/Speech Deductible then $15 copay/visitPrescription Drug Tiers $10/$30/$75Additional 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 automatically receive a Health Reimbursement Account(HRA) administered by HealthNow Administrative Services Employees will receive a debit card that can be used for out of pocket medical expenses—prescriptions, copays, etc. Unused funds rollover into next year Save your receipts—you may need to verify your purchases as per IRS regulations 8
Dental Insurance Coverage PDP Plus Network Single Family Cost per paycheck Annual CostServices $1.0 $24.00 $19.25 $462.00 Group #5941621 Out-of-network In-networkPreventive 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—singleOrthodontia (lifetime max $150—family $1,250Deductible None 26Annual Maximum BenefitDependent Age Limit 9
Vision Insurance—High OptionCoverage 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 after $10 eyewear copaytrifocal and lenticular $130 Allowance after $10 eyewear copayFrames *You will receive an additional 20% savings on the amount you pay over your allow-Contact Lenses $130 AllowanceContact lens fitting Covered in full with max copay of $60Service Frequencies Every calendar year 10
Vision Insurance—Low OptionCoverage 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 after $20 eyewear copaytrifocal and lenticular $100 Allowance after $20 eyewear copayFrames *You will receive an additional 20% savings on the amount you pay over your allow-Contact Lenses $100 AllowanceContact lens fitting Covered in full with max copay of $60Service Frequencies Every calendar year 11
Basic Life and AD&DEmployer provided benefit for all full time employees—no cost to em- ployees.What your Benefits Cover: Basic LifeEmployee Benefit Two times your annual salary, to a max of $400,000Accidental Death and Dis-memberment Basic life coverage includes Accidental Death and Dismemberment coverage equal to oneGuarantee Issue times to employee’s life benefits. You are not required to answer health ques- tions 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 times life amountSpouse/Domestic Partner $5,000 increments to a maximum ofBenefit $100,000Child Benefit Your dependent children age 14 days to 20 years (26 if full time 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 After 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 time employees—no cost to employees. What your Benefits Long-Term DisabilityCoverage Amount 66.7% of salary to maximum $4000/monthBenefits Begin After day 181 of being disabledPre-existing conditions A pre-existing condition includes any condition/ symptom for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. 3 Months look back; 12 months after limitation *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 deductions out of their paycheck to pay for daycare expensesWhat your Benefits Cover: Dependent CareAmount Annual maximum $5000RolloverContributions Unused funds do not rollover Must contribute to the plan before re- questing reimbursement*Daycare provider must have a tax ID number 16
Flexible Spending AccountEmployees can choose to make pre-tax deductions 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 nextContributions plan year. Anything above that amount will be forfeited Employee makes contributions each paycheck but total dollar amount is received up front . 17
401(k)Eligibility 21+ years oldDeferral AmountsAnnual Maximum 1—60% of salaryEmployer Match $18,000Vesting Schedule Dollar for dollar up to 4% Employer Match—immediately Profit Sharing—3 years of serviceAt the discretion of the agency, a profit sharing contribution is madeto your 401(k) retirement 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—1-888-319-7819 Website—www.metlifeeap.lifeworks.com User Name: metlifeeap Password: eapThe Employee Assistance program is a free benefit providing guidancefor personal issues that you might be facing and information about otherconcerns that affect your life, whether it’s a life event or on a day-to-daybasis. EAP offers help with:Education: Dependent Care & Care Giving: Admissions testing & procedures Adoption Assistance Adult re-entry programs Before/after 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 & separation Credit & collections Drugs & alcohol Debt counseling Home buying Immigration Working Smarter: Career development Effective Managing Relocation 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 tickets/membershipsfor purchase in the Human Resources office including the following: Regal movie tickets AMC movie tickets Darien Lake Martin’s Fantasy Island Erie County Fair Delta Sonic Tim Horton’s gift cards BJ’s Wholesale Club membershipsHR is always looking for new ideas for employee incentives. If youhave a suggestion please email any member of HR. 21
Fitness Reimbursement ProgramThe Summit Center is committed to encouraging our employee’s to lead an active lifestyle. We have implemented a Fitness Reimbursement Program to motivate employees to make exercise a part of their regular routine by attending any local fitness center. HOW CAN I PARTICIPATE?1. Obtain a membership at a fitness center of your choice.2. Complete the Fitness Reimbursement Registration form found on MySummit3. Exercise at your fitness center a minimum of 8 times per month.4. Obtain verification of your attendance 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 mustattend your gym at least 8 times 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 questions regarding benefits, please contact: Katie Harris Benefits Administrator at 629-3465 or [email protected] 23
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