Your benefits experience begins here. 2019benefits.filice.com/egain/2019/benguide.pdfTracy led a...
Transcript of Your benefits experience begins here. 2019benefits.filice.com/egain/2019/benguide.pdfTracy led a...
employee benefit guide
Y o u r b e n e f i t s e x p e r i e n c e b e g i n s h e r e .
20192019
Welcome to eGain! This guide provides an overview of
coverage choices and enrollment information
so you can build the best benefits package for you and your family.
Employee Benefits Overview / Eligibility RequirementseGain is committed to providing exceptional benefits to our employees. Keeping in mind the unique and diverse needs of our employees, we have put together a benefits program that will help protect the personal and financial well being of you and your family.
Upon joining EGain your benefits begin the first of the month following your date of hire. The plan and dependent elections that you make when you are hired or during annual open enrollment are effective for the entire calendar year unless you experience a qualifying event (marriage, birth, adop-tion, or loss of coverage).
eGain holds an annual Open Enrollment for a January 1st effective date. During that time, you can make changes to your benefit plan elections such as adding or deleting your spouse, dependents and/or changing health plans.
If you experience a Qualifying Event after open enrollment, you must log into Easecentral and initiate a Qualifying Event within 30 days, otherwise you will be required to wait until the next Open Enroll-ment to make any changes to your benefit plan elections.
Eligible Dependents You may cover your dependents under many of the benefit plans as long as they are one of the following:
lYour spouse or registered domestic partner
lYour child(ren) up to age 26 regardless of student or marital status
lYour handicapped child(ren) regardless of age if incapable of self-sustaining employment, and if the hand-icap began before the limiting age
How Do I Enroll in Benefits?New hires will receive an email following orientation with a link to the Easecentral enrollment system. Login instructions will be included in the email. You will have 30 days from date of hire to enroll.
Within Easecentral, you can enroll yourself and eligible dependents in the plans that fit you and your family best. For more information about the plans offered visit https://egain.easecentral.com/
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to review plan designs, required notices, evidence of coverage, documents and much more. Contact Human Resources if you have questions or unresolved issues after contacting member services at one of our insurance providers. For ad-ditional questions please contact:
Falon BerryEmail: [email protected]: 408.350.8440
Please Note: Regardless if you are electing benefits or if you declining ben-efits you MUST log into the website and complete the process.
To enroll or view your benefits please visit your benefits website for further explanation of benefits at benefits2.filice.com/egain
Your Medical Plan Premium Costs Employee costs per pay period are shown below are deducted from payroll on a pre-tax basis. These premiums will be in effect from January 1, 2019 to December 31, 2019. Please review the table below carefully when making your benefit elections.
Type of Coverage Kaiser HSA California Only
Kaiser HMO California Only
Blue Shield 1500 HSA
Blue Shield PPO 500
Employee Only $55.25 $58.38 $73.27 $85.52
Employee & Spouse $151.69 $163.48 $202.15 $239.46
Employee & Child(ren) $138.12 $145.97 $164.19 $188.15
Employee & Family $205.99 $233.54 $287.55 $354.92
eGain Contribution PercentageseGain contributes 80% of the employee premium and 70% of the dependent premium for medical and dental. eGain also pays 100% of the vision for the employee only coverage and the group Life, AD&D, Short Term Disability and Long-Term Disability premiums for the employee.
Health Savings Account (HSA) Contributions by eGain in 2019If you elect the Blue Shield or Kaiser HSA plan, eGain will contribute the following amounts into your HSA:
$100 per month for Employee Only Coverage$200 per month for Employee with Dependents Coverage
If you work
30 hours or more, you are
eligible to enroll in the benefit
plans.
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Medical and Prescription Drugs (California Only) The following chart shows what you pay on the medical and prescription plans when using any Kaiser Permanente facility in the Northern California region. Through the Kaiser plans, Primary Care Physicians (PCP) play an important role in coordinating care. For more detailed benefit information please refer to the Kaiser plan summaries on the group benefits website. Kaiser is available only to employees residing in California.
Plan Highlights Kaiser HSA Kaiser HMO Deductible (calendar year)
- Individual $1,500 NONE
- Family $3,000 ($2,700/single) NONE
Preventive Care (see EOC for covered services)
$0 $0
Physician Visit 10% after deductible $20
Diagnostic Lab & X-ray 10% after deductible No Charge
Hospitalization 10% after deductible No Charge
Outpatient Surgery 10% after deductible $20
Emergency Room 10% after deductible $50
Prescriptions
Generic / Brand Name Plan deductible, then $10 / $30 $15 / $30
Out-of-Pocket Max (calendar year)
- Individual $3,000 $1,500
- Family $6,000 ($3,000/single) $3,000
Using KP.org or Kaiser’s mobile application you can:
lE-mail your doctor’s office.
lOrder prescription refills.
lSchedule routine appointments.
lSee most lab test results.
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Medical and Prescription Drugs The following chart shows what you pay on the medical plans when using Preferred Providers Only (Refer to the evidence of coverage for out of network benefits and other covered services). NOTE: Plan deductibles and Out-of-Pocket maximums run on a calendar year cycle, so please take that into consideration when making your selection.
Plan Highlights Blue Shield HSA 1500 Blue Shield PPO 500 Deductible (calendar year)
- Individual $1,500 $500
- Family $3,000 ($2,700/single) $1,000
Preventive Care (see EOC for covered services)
$0 $0
Physician Visit 10% after deductible $20
Diagnostic Lab & X-ray 10% after deductible $20 after deductible
Hospitalization $100 + 10% after deductible $100 + 20% after deductible
Outpatient Surgery 15% after deductible 25% after deductible
Emergency Room $150 + 10% after deductible $150 + 20% after deductible
Prescriptions
Tier 1 / Tier 2 / Tier 3 Plan deductible, then $10 / $25 / $40 $5 / $10 / $25
Out-of-Pocket Max (cal yr)
- Individual $3,500 $3,000
- Family $7,000 ($3,500/single) $6,000
Find Urgent CareSave time and money by avoiding trips to the ER. Get real-time, turn-by-turn directions to the closest urgent care center nearest you under your plan.
View Plan SummaryYou will always know what care is covered, what your copay costs are for your doctor’s visits and other covered services.
View ClaimsNo time to shu�e through paper bills? See your recent claims, even while you’re sitting in the waiting room with extra time on your hands.
View ID CardForgot you member ID card? No problem – access it on the go. It should be as much a part of you as your mobile phone.
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Supplemental Accident You may elect supplemental accident coverage for you and your family members through Allstate Benefits. Amounts shown below are payments that would go directly to you, regardless of what your base medical plan may or may not cover. This is a perfect supplement to any health plan to help cov-er the unforeseen costs associated with an accident or injury. Conversion may be available if your employment ends.
Plan Highlights* Benefit Payments*Accidental Death $40,000 Employee / $20,000 Spouse / $10,000 Child
Initial Hospitalization $1,000 (once per policy)
Hospital Confinement$200 per day, or $400 per day in ICU (up to 90 days per accidental injury)
Medical Expenses Up to $500 (per accidental injury)
Ambulance $200 Ground or $600 Air
Dislocations and Fractures$120-$4000 per accidental injury
(see plan brochure for benefit schedule)
Outpatient Physician Treatment (no accident required)
$50 per visit if treated by a physician for any cause outside of the hospital, including preventive care visits
(2 visits per year – single, or 4 visits per year – family)
Employee Cost per pay period (pre-tax)
Employee only – $7.76 Employee & Child(ren) – $15.93
Employee & Spouse – $14.44 Employee & Family – $19.64
Case Study: Meet Mike Case Study: Meet TracyMike recently was injured after falling off his mountain bike. Mike filed a claim with his Allstate Accident Plan and this is what he received:
Tracy did not experience any accidents or injuries this year. She did go to the doctor for her annual physical and for one office visit. Tracy filed a claim with her Allstate Accident Plan and this is what she received:
Ambulance service - $200 Annual physical - $50
Initial hospital confinement - $1,000 Office visit - $50
Two day hospital stay - $400
Medical expenses - $500
Multiple rib fractures - $600
Two follow-up office visits - $100
Total cash benefits paid to Mike $2,800 Total cash benefits paid to Tracy $100
*Please see Allstate Accident Plan brochure for a full listing of plan features and cash benefits.Contact Samantha Arreola at 408.350.5729 or [email protected] for questions or claims filing assistance.
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Dental Dental coverage is provided for you and your family members through Beam Dental. You may seek services from a dentist of your choice. However, the out of pocket costs will be much lower if you utilize the services of a provider listed in the directory. Charges from out of network dentists are subject to Reasonable and Customary limits. Please see the plan summary on the benefits website for all covered services.
Services Benefit Features and Premium CostsAnnual Maximum $2,000 annual benefit per individual.
Deductible Applies to basic and major services only – $50 individual; $150 Family.
Preventive Services Exams, cleanings, x-rays: In–Network 100% / *Out-of-Network 100%
Basic Services Fillings, simple extractions: In–Network 80% / *Out-of-Network 80%
Major Services Crowns, Bridges, Dentures: In–Network 50% / *Out-of-Network 50%
Orthodontia Services 50% with a lifetime maximum of $2,000 (Adult and Children)
Employee Cost per pay period (pre-tax)
Employee only – $4.52 Employee & Child(ren) – $16.50
Employee & Spouse – $12.05 Employee & Family – $26.73
*Out-of-Network dental services are subject to usual, customary and reasonable (UCR) fees, services are paid out at 90th percentile.
Beam Perks: All members enrolled will receive the following delivered to your door every 6 months:
lBeam Brush Sonic powered, smart, electric toothbrush
lBeam Paste High-quality, custom, formulated toothpaste.
lReplacement heads Soft bristle brush heads made specifically for your brush.
lAA battery We’ll keep your brush powered and ready to go
Free shipping Delivered to your door, right when you need it
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Vision Vision coverage is provided for you and your family members through Anthem Blue Cross. If you utilize the services of a provider listed in the Blue View Vision network, you will maximize the benefit allowances shown below. NOTE: Vision benefits are based on last service date.
(Refer to the plan summary for more coverage details and out of network plan allowances).
Services Benefit Features and Premium CostsMember Copayment $10 Exams / $25 Materials
Well Vision Exams Plan pays 100% after Copayment every 12 months
Lenses Plan pays for standard lenses after Copayment every 12 months
Frames Plan pays up to $130 for a wide selection of frames every 12 months. You also receive 20% off the amount over your allowance.
Contact Lens Care (in lieu of other benefits)
Plan pays up to $130 every 12 months. Allowance includes contacts and the contact lens exam (fitting and evaluation).
Employee Cost per pay period (pre-tax)
Employee only – $0 Employee & Child(ren) – $0.90
Employee & Spouse – $0.79 Employee & Family – $1.92
Members of Anthem vision plans receive discounts on health-related products and services with SpecialOffers@Anthem: including:
lLensCrafters - Up to 30% savings on prescription eyeglasses
lTruVision - Substantial savings on laser surgery
Life and Disability eGain provides eligible employees group term life, accidental death and dismemberment (AD&D), short term disability and long-term disability through Lincoln Financial Group and pays 100% of the cost of this benefit. Life Insurance conversion is available if your employment ends.
lYou may update your beneficiary information for this plan at any time.
lLife Insurance Reduction Schedule: Benefit is reduced to 65% at age 65 years; to 40% at age 70 years.
Coverage Benefit Features
Life Insurance and AD&D $50,000 Life / $50,000 AD&D per employee
Short Term Disability offset against SDI benefits
60% of earnings up to $2,300 per week, 7 day elimination period (Example: if your state disability benefit is $1,000 per week, that amount will
be deducted from the benefit listed above)
Long Term Disability 60% of earnings up to $10,000 per month, 360 day elimination period
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Employee Assitance Program, Travel Assistance and Identity Theft Three additional benefits offered through Lincoln Financial Group to eGain employees include access to a confidential Employee Assistance Program (EAP), a Travel Assistance plan and Identity Theft. Resources are available through Lincoln Financial at no cost to employees.
EAP Employees have access to the following resources and reference services through Lincoln Financial:
lToll-free phone and Web access 24/7
lPhone access to legal counsel and a 25% discount on follow-up services
lAssistance for you or an immediate household family member who is age 16 or older (Children ages 12 to 15 are eligible to participate in group family sessions)
lIn person help with short-term issues
lWork/life services for assistance with: childcare, eldercare, adoption, relationships, and financial is-sues.
lCall 855-891-3684 or visit GuidanceResources.com (Web ID= LifeKeys)
Travel AssistanceToll-free travel assistance is available through TravelConnect which includes 24/7 emergency assi-tance when employees and their families are travling 100 miles or more from home.
lAssistance with hospital admission outside the US and necessary medical evacuations to a facility to obtain care.
lMedical care monitoring and supervised repatriation if required.
lLost or stolen travel documents assistance
lSecurity and political evacuation assistance
lCall 800.527.0218 (MEDEX ID = 322541) or email: [email protected]
Identity TheftAs one of the fastest-growing crimes in the U.S. we want you to have the information you need to recognize and prevent it.
lSpot the warning signs
lTake steps to protect your cell phone, computer and tax records from fraud
lMedical care monitoring and supervised repatriation if required.
lLifeKeys services - Call 855-891-3684 or visit GuidanceResources.com (Web ID=LifeKeys)
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Health Savings Account (HSA) If you participate in the Kaiser HSA or Blue Shield HSA plan, you can set up an account with Tech-nology Credit Union (instructions will be sent to you on how to create an account) to make contri-butions in a Health Savings Account (HSA) to pay for eligible medical, dental and vision expenses. To maintain HSA eligibility, you cannot be covered elsewhere, cannot be enrolled in Medicare, and cannot be claimed as a dependent on someone else’s tax return.
When your HSA account is active with the bank, you may make tax deferred contributions to the account. The funds in your HSA may then be used to pay for eligible health care expenses for you and your family. More information is available on the benefits website regarding eligible expenses. After visiting a physician, facility, or pharmacy your medical claim will be submitted to your medical insurance carrier for processing to obtain the available discounts through your high deductible plan. Once your insurance carrier processes the claim and sends you an Explanation of Benefits (EOB), you may then pay your provider with HSA dollars per the EOB. HSA dollars can be used to pay your out-of-pocket expenses (deductibles and coinsurance) billed by the physician, facility, or pharmacy.
The maximum amount that you can contribute in 2019 to an HSA is $3,500 for individual coverage and $7,000 for family coverage. Additionally, if you turn age 55 or older during the year, you may make an additional “catch-up” contribution of $1,000 annually.
If you enroll in an HSA in the middle of a year, you are allowed to make a full year’s contribution, pro-vided that you remain covered by the HSA for at least the 12-month period following that year. In addition to qualified medical expenses, the following insurance premiums may be reim-bursed from an HSA:
lCOBRA premiums.
lHealth insurance premiums while receiving unemployment benefits.
lQualified long-term care premiums.
lHealth insurance premiums paid, other than for a Medicare supplemental policy, by individuals age 65+.
The following expenses may not be reimbursed from an HSA: lPremiums for Medicare supplemental policies.
lExpenses covered by another insurance plan.
lExpenses incurred prior to the date the HSA was established.
Advantages of an HSA: lThe tax benefits – contributions and interest earned are exempt from federal income tax.
lThe funds in an HSA can be used to pay for health care expenses of family members.
lYou manage your health care expenses and pay out of pocket if you choose to save your HSA dollars for a future health care expense.
lThe funds in an HSA may be invested much like 401(k) funds are invested.
lUnused money in an HSA account is not forfeited at the end of the year and is carried forward.
lYour HSA account is yours to keep and you can take it with you if you change jobs or retire.
l If you have a balance in your HSA after your retirement, you may withdraw the money as cash.
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Health Care and Dependent Care FSA eGain provides you the opportunity to pay for out-of-pocket medical, dental, vision, and dependent care expenses with pre-tax dollars through the Flexible Spending Accounts (FSA). If you have a Health Savings Account (HSA) and elect to participate, your healthcare FSA will be limited to dental and vision expenses.
You must enroll/re-enroll in the plan each year to participate for the plan year January 1st to December 31st.
Please note: Qualified Medical Expenses will conform to the definition used for the itemized tax deduction. This means a prescription for over-the-counter drugs may be required if you are making a claim for reim-bursement from the FSA plan administrator.
Highlights of Flexible Spending Accounts: lA health care FSA is used to reimburse out-of-pocket medical expenses incurred by you and your depen-dents. The maximum contribution allowed in 2019 is $2,700.
lA dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse work. The maximum that you can contribute to the Dependent Care Flexible Spending Ac-count is $5,000 if you are a single employee or married filing jointly, or $2,500 if you are married and filing separately.
lYou can save approximately 25% of each dollar spent on these expenses when you participate in a FSA.
lContributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don’t pay federal income tax, Social Security taxes, and state and local income taxes on the portion of your paycheck you contribute to your FSA.
l It is best to contribute the amount of money you expect to pay for out-of-pocket eligible expenses for the FSA plan period. If you enroll after the beginning of the plan year, budget for the remaining number of months.
lThe health care FSA has a “use-it-or-lose-it rule”. $500 of unused FSA funds will be rolled over to the following year. Anything over $500 remaining in your account will be forfeited.
The following example shows how you can save money with a flexible spending account. Bob and Jane’s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult orthodontia and $3,300 for day care next plan year, they decide to direct a total of $5,300 into their FSAs.
Without FSAs With FSAsGross income: $30,000 $30,000
FSA contributions: 0 -5,300
Gross income: 30,000 24,700
Estimated taxes:Federal -2,550* -1,755*
State -900** -741**
FICA -2,295 -1,890
After-tax earnings: 24,255 20,314
Eligible out-of-pocketMedical and dependent care expenses: -5,300 0
Remaining spendable income: $18,955 $20,314
Spendable income increase: $1,359*Assumes standard deductions and four exemptions. ** Suggested, assumes 3%.
The example above is for illustrative purposes only. Every situation varies and we recommend that you consult a tax advisor for all tax advice.
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Commuter Benefits The Transit Commuter Reimbursement Account allows you to set aside pre-tax dollars from your paycheck to pay for qualified commuter expenses. Submit claims to The Advantage Group (TAG) for reimbursement. Visit the benefits website for a list of eligible expenses:
l$265 per month for commuter transit vehicles or transit passes
l$265 per month for parking
Cost Worksheet
Plan Cost Per Pay Period
Medical $
Accident $
Dental $
Vision $
Total Cost For All Plans Per Pay Period $
Waiver of ParticipationPlease refer to the benefits website for an explanation of this option.
Medical Dental
Employee Only $125.00 per month $15.00 per month
Employee + Child(ren) $175.00 per month $30.00 per month
Notes:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Summary of Premiums - Per Pay Period Type of Coverage Kaiser HSA
California OnlyKaiser HMO
California OnlyBlue Shield 1500 HSA
Blue Shield PPO 500
Employee Only $55.25 $58.38 $73.27 $85.52
Employee & Spouse $151.69 $163.48 $202.15 $239.46
Employee & Child(ren) $138.12 $145.97 $164.19 $188.15
Employee & Family $205.99 $233.54 $287.55 $354.92
Type of Coverage Dental
Employee Only $4.52
Employee & Spouse $12.05
Employee & Child(ren) $16.50
Employee & Family $26.73
Type of Coverage Vision
Employee Only $0
Employee & Spouse $0.79
Employee & Child(ren) $0.90
Employee & Family $1.92
Type of Coverage Accident
Employee Only $7.76
Employee & Spouse $14.44
Employee & Child(ren) $15.93
Employee & Family $19.64
Type of Coverage HSA Contributions per Month
Employee Only $100.00
Employee+Dependents $200.00
Waiver of Participation Medical Dental
Employee Only $125.00 per month $15.00 per month
Employee + Child(ren) $175.00 per month $30.00 per month
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Important Benefit Contact Information
Carrier / Vendor Reference/Group numbers Phone Website / Email
Kaiser – HMO 38814-0 800.464.4000 www.kaiserpermanente.org
Kaiser – HSA 38814-1 800.464.4000 www.kaiserpermanente.org
Blue Shield W0065800 888.256.1915 www.blueshieldca.com
BEAM Dental CA00915 800.648.1179 beam.dental
Allstate Benefits 19495 800.521.3535 www.allstateatwork.com/mybenefits
Anthem – Vision Plan 277145 866.723.0515 www.anthem.com/ca
Lincoln Financial Group –
Life and Disability 10157533 800.423.2765 www.LincolnFinancial.com
Short Term Disability 10157535 800.423.2765 www.LincolnFinancial.com
Long Term Disability 10157534 800.423.2765 www.LincolnFinancial.com
Employee Assistance Program Connect 877.757.7587 www.eapadvantage.com
Travel Assistance 322541 800.527.0218 www.jpfic.com
FSA and Commuter The Advantage Group 877.506.1660 www.flexasap.com
Health Savings Account Technology CU 800.553.0880 www.techcu.com
eGain Benefits Administrator Eve Shih 408.636.4432 [email protected]
REQUIRED NOTICES All official documents relating to the eGain Employee Benefits Program, including the Sum-mary Plan Descriptions, Summary of Benefits and Coverage, HIPAA Privacy Notice, Initial COBRA Notice, Medicare Part D notice, and any other relevant plan documents or notices, are available electronically through the benefits website. You may also receive a paper copy by contacting Human Resources.
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Your Insurance Broker
Your Broker is Steve Arreola, your Client Service Manager is Falon Berry. They are available to assist with your benefit questions throughout the year. Please feel free to contact Steve at 408-350-5704 [email protected] or Falon at 408-350-8440 [email protected] or visit:
benefits2.filice.com/egain
The benefits information in this Benefits Enrollment Guide is presented for illustrative purposes. The text contained in this Guide was taken from various summary plan descriptions and benefits information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. eGain reserves the right to modify any content of this document at any time.
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