2016 Program Overview - ACT€¦ · (limited to health coaching sessions for eligible team members...

TEAM MEMBER BENEFITS2016 Program Overview

Table of Contents

Introduction ..........................................................................1

Benefit Eligibility & Enrollment .........................................2

Medical Plans ......................................................................4

Prescription Drug Plan ......................................................8

UI Quick Care......................................................................9

On-site Nurse Practitioner ............................................. 10

Dental Plan ........................................................................ 11

Vision Plan ......................................................................... 13

Flex Spending Accounts ................................................ 14

Life, Accident and Travel Insurance Plans .................. 15

Legal Assistance Plan .................................................... 17

Retirement Savings Plans .............................................. 18

Tuition Reimbursement & Dependent Scholarship Plans ....................................... 20

Leave Programs ............................................................... 21

Wellness Program ........................................................... 24

Policies, Procedures, & Resources .............................. 25

Rates .................................................................................. 26

Section Page

Clickable Links

ACT is proud to offer our team members a comprehensive,

competitive and flexible suite of team member benefits that

exceed market standards. We work closely with our various plan

providers to ensure team members have access to the best

resources available when it comes to taking care of themselves

and their families.

We strive to offer benefits that are generous, unique, personalized

and integrated with the needs of our team members. All the while,

we keep team member costs low and provide flexibility within our

plans in a changing health care landscape.

In this document, you’ll find a high-level overview of the programs

offered highlighting key aspects for each program.

We welcome feedback on our benefit offerings. If you’d like to

share your thoughts on our plans or have questions regarding

open enrollment, please reach out to us at [email protected].

Introduction

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All full-time (≥32 hours/week) and part-time (≥18.75 hours/week) permanent ACT team members are eligible for the benefits described in this document unless noted. Coverage for new team members is effective upon date of hire.

Team members are also eligible to cover eligible dependents. Dependents include:

• A spouse

• A domestic partner, subject to affidavit

• A child

A child includes:

• A natural child

• A legally adopted child

• A child for whom a team member has legal guardianship

• A stepchild

• A foster child

Dependent children are eligible for medical, dental, and vision coverage up to age 26. Beyond age 26, a child may continue coverage due to certain permanent disabilities. Other limits may apply for life insurance. Refer to the life insurance section of this document for information on dependent ages related to those plans.

Benefit Eligibility

For more information on dependent eligibility, please contact [email protected] or refer to www.act.org/benefits for specifics within each plan.

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Benefit Enrollment

Team members may elect to carry different levels of coverage for various plans (i.e., medical, dental and/or vision plans). For example, they may choose Team Member Only for medical, Team Member+1 for dental, and waive vision.

Team members may make benefit changes during the annual benefits open enrollment period generally held each November for the following calendar year. Elections are generally irrevocable during the year unless a qualifying event occurs.

Team members may make changes when a qualifying family status change event occurs, which may permit them to elect/drop benefits, change their coverage level, add or drop a dependent from their benefits, or change from one plan to another under limited circumstances. A request to change benefits due to a family status change event must be completed within 31 days of the qualifying event. Documentation may be required to support the qualifying event.

Examples of qualifying events considered a family status change include:

• Marriage

• Divorce

• Birth/adoption of a child

• Death of a spouse/domestic partner or dependent

• Loss/gain of spouse’s/domestic partner’s coverage

• Loss/gain of a dependent for tax purposes

• Change of employment status by a team member or their spouse/domestic partner that affects eligibility for coverage (e.g., part-time to full-time or vice versa)

Please refer to the summary plan descriptions for each plan for an inclusive list of permissible change events.

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Medical Plans

ACT offers team members two (2) medical options, both administered through Wellmark Blue Cross Blue Shield.

Medical Plan Options

1. Blue Access—New in 2016; limited to team members residing in Iowa2. Alliance Select

Plan provisions within the two options are mostly the same and details can be found in the Summary Plan Descriptions (SPDs). However, the Blue Access network is limited to health care providers within the state of Iowa due to Wellmark’s ability to negotiate greater network discounts. Treatment received outside of Iowa on the Blue Access network is limited to emergency services. In addition, children of Iowa-based team members living outside of Iowa (e.g., students in out-of-state college) may qualify for “guest membership” allowing care to be received as “in-network”.

Blue Access is the default network for team members residing in Iowa. However, Iowa-based team members may opt out and be covered under the Alliance Select network. Team members residing outside of Iowa will be covered under the Alliance Select network.

The following pages highlight key provisions of the two medical options offered. This summary does not contain all of the provisions or limitations/exclusions that may apply. Refer to Summary Plan Descriptions at www.act.org/benefits for more detail.

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MEDICAL

Blue Access Alliance Select

In-Network In-Network Out of Network

Lifetime Maximum Payment Unlimited Unlimited

Calendar Year Deductibles The amount team members must generally pay before benefits begin under the plan.

• $300 Team Member• $500 Team Member + 1• $700 Team Member + Family

• $300 Team Member• $500 Team Member + 1• $700 Team Member + Family

Annual Out of Pocket MaximumThe maximum amount team members must pay each calendar year. Once this level is reached, additional eligible expenses will be paid 100% by the plan.

• $700 Team Member• $900 Team Member + 1• $1,100 Team Member + Family

• $700 Team Member• $900 Team Member + 1• $1,100 Team Member + Family

MEDICAL



Co-Insurance* 20% 20% 30%

Emergency Room Services $150 Co-PayDeductible and Co-Insurance Applies (Co-insurance is waived if admitted to hospital)

$150 Co-PayDeductible and Co-Insurance Applies (Co-insurance is waived if admitted to hospital)

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Preventive Care Includes services such as:• Preventive Physical Exams• Preventive Gynecological Exams• Flu Shots• Preventive Colonoscopies• Preventive Mammograms &

Breast Exams• Well Child Care• Immunizations• Preventive Diagnostic Tests,

and associated Lab & X-Rays

0% co-insurance 0% co-insurance

0% co-insurance

MEDICAL



Physician Visit/ServicesIncludes Specialist and Other Practitioner (e.g., Chiropractor)


30% co-insurance

Urgent Care ServicesServices received in a Physician’s office must be billed as urgent care to be covered at 100%.

0% co-insurance(deductible waived)



Immunizations 0% co-insurance(deductible waived)



Laboratory Testing(e.g., x-ray or blood work not considered preventive)




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Imaging (e.g., CT/PET scans, MRI’s) Failure to obtain prior authorization for these types of services, when necessary, may result in a denial of benefits.


30% co-insurance

Inpatient Facility & Practitioner ServicesFailure to obtain prior authorization for these types of services, when necessary, may result in a denial of benefits.


30% co-insurance

MEDICAL



Maternity Services 20% co-insurance 20% co-insurance

30% co-insurance

Outpatient Surgery and Physician ServicesFailure to obtain prior authorization for these types of services, when necessary, may result in a denial of benefits.




Home Health Services 20% co-insurance 20% co-insurance

30% co-insurance

Mental Health/Behavioral Health/Substance Abuse



30% co-insurance (office)

0% co-insurance (facility)

Prescription Drugs 20% co-insurance(See Prescription Drug Section for more information)

20% co-insurance(See Prescription Drug Section for more information)

* Co-Insurance rates may be less depending on the type of service received. For example, preventive services as defined under the Affordable Care Act are covered at 100% by the plan. Additionally, ACT has chosen to waive the annual deductible and co-insurance rates for certain services received through the plan.

For more comprehensive information on the medical coverage and to review the Summary Plan Description, refer to www.act.org/benefits.

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The following table describes ACT’s prescription drug coverage.

Note: This summary does not contain all of the provisions or limitations/exclusions that may apply. Refer to www.act.org/benefits for full plan documentation.

Prescription Drugs— Blue Complete RX

PRESCRIPTION DRUGS—BLUE RX COMPLETE PROGRAM



Co-Insurance (Regular Rx) 20% co-insurance 20% co-insurance

Specialty DrugsSpecialty drugs may be covered under team member’s medical benefits or under Blue Rx Complete prescription drug benefits. Contact Wellmark for information.

Team members must purchase specialty drugs through the specialty pharmacy program. If they purchase specialty drugs outside the specialty pharmacy program, they are responsible for the entire cost of the drug.


Not Covered

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UI Quick Care

ACT also offers team members and dependents the opportunity to visit any UI Quick Care location for urgent care needs at no cost to the team member.

• Visits are covered at 100% with no deductible or co-insurance

• Team members who are not enrolled in the ACT medical plan can also take advantage of this benefit

• Available for team member, spouse and dependent children

• Team members must show their ACT ID badge

• Significant savings compared to emergency room visits

• UI Quick Care services and locations can be found at www.uihealthcare.org/quickcare

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ACT provides team members located in Iowa City the opportunity to visit an on-site nurse practitioner located in the Davidsen Building, Room DC112 (first floor, C wing east).

The on-site nurse practitioner hours* are:

• Monday and Wednesday mornings from 9:00 a.m.–11:30 a.m.

• Tuesday mornings from 9:00 a.m.–10:30 a.m. (limited to health coaching sessions for eligible team members —see the Wellness Program section for details)

• Thursday afternoons from 12:30 p.m.–3:00 p.m.

The nurse practitioner can:

• Diagnose and treat minor illnesses and injuries

• Perform on-site lab tests

• Monitor health or chronic conditions such as asthma, hypertension, and diabetes

• Provide health education and promote health maintenance

• Make referrals for other services or tests

• Assist in finding and using community resources

There is no cost to any ACT team member for these services.

Contact the nurse by email at [email protected] or phone at ext. 2306 to schedule an appointment. Walk-in appointments are also available on a first-come, first-served basis.

On-Site Nurse Practitioner

*Hours are subject to change at any time based on demand.

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Dental Plan

DELTA DENTAL PREMIER

Calendar Year Deductible None

Maximum Annual Benefit $1,500

Lifetime Maximum $1,500 on orthodontia

Check-Ups and Teeth Cleaning (Diagnostic and Preventive Services)

20% Co-insurance

1. Dental Cleaning2. Oral Evaluation3. Fluoride Applications

4. X-rays5. Sealant Applications6. Space Maintainers

Cavity Repair and Tooth Extractions (Routine and Restorative Services)

30% Co-insurance

1. Emergency Treatment2. General Anesthesia/

Sedation3. Restoration of Decayed

or Fractured Teeth

4. Limited Occlusal Adjustment5. Routine Oral Surgery6. Consultations7. Posterior Composites

ACT offers comprehensive dental coverage through the Delta Dental of Iowa Premier benefit option.

Note: This summary does not contain all of the provisions or limitations/exclusions that may apply. Refer to www.act.org/benefits for full plan documentation.

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DELTA DENTAL PREMIER

Root Canals (Endodontic Services)

30% Co-insurance

1. Apicoectomy2. Direct Pulp Cap3. Pulpotomy

4. Retrograde Fillings5. Root Canal Therapy

Gum and Bone Diseases (Periodontal Services)

1. Conservative Procedures2. Complex Procedures3. Maintenance Therapy

30% Co-insurance

High Cost Restorations (Cast Restorations)

30% Co-insurance

1. Cast Restorations a. Crowns b. Inlays

c. Onlaysd. Posts and Cores

Dentures and Bridges (Prosthetics)

1. Bridges2. Dentures3. Dental Implants

30% Co-insurance

Straighter Teeth(Orthodontics)

50% Co-insurance

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Vision Plan

ACT offers team members and their families high quality vision coverage for in-network and out-of-network vision providers. Vision insurance is provided through Avesis. For a list of network providers, refer to the Avesis website at www.avesis.com.

VISION INSURANCE

Services Frequency Team Member Cost

Vision Exam Every 12 months $20

Spectacle Lenses Every 12 months $20

Frames Every 24 months $20

Contact Lenses Every 12 months $20

Other out-of-network reimbursements are available, including discounts on progressive lenses, specialty lenses and LASIK. Refer to www.act.org/benefits for more specifics on plan benefits.

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Flexible spending accounts (FSAs) provide an important tax advantage by helping team members pay for health-related care and dependent care expenses on a pre-tax basis. The ACT flexible spending accounts are administered by Discovery Benefits, Inc. Eligible expenses under a flexible spending account are the same expenses that qualify for an IRS healthcare deduction or dependent care tax credit.

ACT offers team members two types of flexible spending accounts:

1. Health Care FSA. Covers unreimbursed medical, dental, and vision expenses, which meet the federal guidelines as eligible expenses. These expenses may include, but are not limited to, health insurance deductibles, out-of-pocket expenses for diagnosis, care, or treatment not covered by insurance. Over-the-Counter (OTC) drugs are not eligible unless prescribed by a physician. Team members may contribute up to the 2016 IRS maximum of $2,550 annually. For a complete listing of eligible expenses, please see IRS Publication 502 at http://www.irs.gov/publications/p502/index.html.

2. Dependent Care FSA. Covers expenses related to care of dependents, including, but not limited to, child care costs a team member incurs in order to work full-time. The IRS maximum amount to elect per year for dependent care expenses in 2016 is $5,000.

FSA funds not used by the end of the calendar year, or through the grace period, are forfeited.

Flexible Spending Accounts

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Life, Accident and Travel Insurance

Life, accident and travel insurance is offered to help provide financial protection for team members and their dependents in the event of a death or a serious accident. ACT provides all eligible team members with group life, accident, and travel insurance at no cost to the team member.

The table below describes the coverage provided automatically by ACT:

COVERAGE TYPE DESCRIPTION COVERAGE LEVEL

Basic Group Term Life Insurance (Team Member)

Group Term Life insurancepays benefits to team member’s chosen beneficiary in the event of their death.

1½ times team member’s salary, rounded to the next highest $1,000 up to $1M.

Coverage levels decrease upon reaching certain ages.


Basic Group Term Life Insurance (Spouse)

Spouse Group Term Life insurance pays benefits in the event team member’s qualifying spouse dies.

$2,000

Basic Group Term Life Insurance (Child)

Child Group Term Life insurance pays benefits in the event team member’s qualifying child dies.

$100 up to age 6 months$2,000 age 6 months—19 yrsCoverage may be extended to age 23 if FT student

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Accidental Death & Dismemberment

(AD&D)

AD&D insurance will pay team member’s beneficiary the benefit amount if any kind of accident is the cause of their death. The “dismemberment” benefit of this insurance means that if a team member loses an extremity or the sight of an eye, they will receive a specific benefit amount.

If an accident causes a team member’s death, their beneficiary will receive an amount of AD&D equal to their group term life benefit. This payment will be in addition to their group term life benefit.

Generally, 1½ times team member’s salary but specific benefit limits for dismemberment apply.

Coverage levels decrease upon reaching certain ages.

Travel Accident Insurance Travel Accident Insurance provides payment for certain services should a team member become ill or injured while traveling for either business or pleasure.

Varies—see UNUM Travel Assistance Wallet Card at www.act.org/benefits for more information.

Supplemental Life Insurance

In addition to the ACT provided Basic Life Insurance, team members may elect to purchase additional life insurance for themselves or their spouses at low group rates through UNUM.

• Supplemental life insurance for the team member may be purchased in increments of ½, 1, or 1½ times annual earnings.

• Supplemental life insurance for a team member’s spouse may be purchased in increments of $10,000 up to a maximum of $500,000 not to exceed 50% of the team member amount.

Supplemental life insurance may be subject to medical underwriting (i.e., Evidence of Insurability). To find out more, refer to www.act.org/benefits.

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Legal Assistance Plan

For more information refer to ARAGLegalCenter.com and enter Access Code 17912act.

ACT offers a legal assistance plan through ARAG to help team members take control of any legal matters that may cause stress, hardships, or financial challenges.

ARAG’s Ultimate Advisor plan helps team members plan for, protect against, and resolve legal issues. Telephone and in-office legal services and support, legal guidance, and in-court representation are included in the plan.

With Ultimate Advisor team members have access to a wide range of covered legal matters, most of which are covered 100% when they work with a Network Attorney.

Legal matters may include, but are not limited to:

• Civil Damage Claims (Defense)

• Consumer Protection Issues

• Criminal Matters

• Debt-Related Matters

• Family Law

• Government Benefits

• Landlord/Tenant Matters

• Real Estate Matters

• Small Claims Court

• Tax Issues

• Traffic Matters

• Wills and Estate Planning

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https://www.araglegalcenter.com

ACT offers two 403(b) savings plans to help team members prepare for financial security during retirement. Both plans are administered by TIAA-CREF. TIAA and CREF are companion organizations that provide retirement and tax-deferred annuity plans for colleges, universities, independent schools, and certain other nonprofit and tax-exempt educational and research institutions and their team members.

The 2 plans include:

• The ACT Defined Contribution Plan• The ACT Tax Deferred Annuity Plan (also referred

to as the Supplemental Retirement Annuity “SRA”)

Defined Contribution Retirement Plan

ACT team members automatically receive an employer paid contribution of 6% of their salary into the Defined Contribution Retirement Plan.

Note: Different contribution amounts apply to team members hired prior to 2008.

General Provisions:• Team members may contribute up to 3% of salary on a pre-tax or post-tax

(i.e., ROTH) basis into the Defined Contribution plan.• ACT matches team member contributions at a rate of 100% up to 3%.• Team members may contribute to the plan upon date of hire but must be

age 21 to receive employer matching contributions. • Loans and withdrawals are not permitted from this plan. • The matching and employer contributions are subject to the following

vesting schedule. Team members are always 100% vested in their own salary reduction contributions.

Retirement Savings Plans

YEARS OF SERVICE VESTING PERCENTAGE

1 year 20%

2 years 40%

3 years 60%

4 years 80%

5 years 100%

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Tax Deferred Annuity Plan (aka, Supplemental Retirement Annuity Plan)

Team members may also participate in the tax deferred annuity plan to supplement the amount they contribute to the Defined Contribution Plan. This plan allows team members to defer additional compensation on a pre-tax or post-tax (i.e., ROTH) basis.

General Provisions:

• Team members may contribute up to 100% of salary on a pre-tax or post-tax (i.e., ROTH) basis, subject to IRS maximums.

• No employer matching contributions.• Team members are eligible to contribute upon date of hire. • Loans and withdrawals are permitted from this plan. • No vesting schedule applies as team members are always 100% vested in their

own salary reduction contributions.

Annual Contribution Limits

Contributions made by team members to the Defined Contribution Plan and/or the Tax Deferred Annuity Plan are aggregated together when determining the IRS maximum contribution amount.

For 2016, the maximum contribution amount a team member may contribute between these 2 plans is:

• $18,000, or• $24,000 (for those who are over age 50 or

will attain age 50 within the 2016 calendar year)

Team members may change salary deferral amounts to either plan at any time during the year.

For more information on ACT’s Retirement Savings Plans, refer to www.act.org/benefits or www.tiaa-cref.com.

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In addition to many internal training offerings, ACT offers a tuition reimbursement program that enables team members to continue their professional development. ACT will reimburse team members up to $5,250 of tuition per calendar year for eligible classes and expenses. Refer to the Tuition Reimbursement Policy on www.act.org/benefits for additional information including the forms and procedures.

Tuition Reimbursement

ACT offers a scholarship program for eligible dependents of team members to help pay tuition and fees related to post-secondary education. Team members are eligible after 1 year of employment and may receive up to four scholarships per eligible dependent. Each scholarship is up to $1,500 per academic school year. Refer to the Dependent Scholarship Policy on www.act.org/benefits for additional information including the forms and procedures.

Dependent Scholarship

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Leave Programs

ACT offers team members many ways to enjoy time off with family and friends during the year. ACT’s Leave Policies also support team members during illness or any unforeseen event that may result in the need for time away.

2016 is a transitional year for the ACT leave programs as the organization is preparing for a full conversion to a Paid Time Off (PTO) program for all team members effective January 1, 2017.

For team members hired on or after January 1, 2016 and current team members who elected to participate in the organization’s vacation Buy-Back transition program, the following will apply for 2016:

LEAVE POLICY

Program Description/Allotment

Paid Time Off (PTO) Each year, team members receive an annual allotment of 30 PTO days. These days may be used for time away from work for vacation, illness/sickness, leave of absence, personal days, floating holidays, etc.

Specifics regarding the PTO program (including carry-over rules, proration for newly hired team members, and payout upon termination) can be found in the Team Member Handbook.

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In addition to the Leave Policies outlined above, ACT also offers the following leave programs that apply to all team members:

Paid Holidays

ACT recognizes 11 paid holidays.

Summer Hours

ACT provides team members the ability to take Friday afternoons off during summer months if they have worked 37.5 hours earlier in the week.

Bereavement Leave

ACT provides up to 5 paid days for team members dealing with the loss of a loved one.

LEAVE POLICY

Program Description/Allotment

Vacation Team members accrue vacation based on a schedule taking into account years of service and exempt/non-exempt status.

Specifics regarding the vacation program can be found in the Team Member Handbook.

Floating Holidays 3 days per calendar year (used only for holidays not included by ACT)

Personal Days 3 days per calendar year (used only for medical or personal absences)

Career Development and Innovation Days

3 days per calendar year (used only for training, innovation projects or other forms of career development)

Volunteer Time Off 1 day per calendar year (used only for volunteering outside ACT)

Sick Leave Up to 10 days per calendar year (used only for illness)

For team members who did not elect to participate in the PTO transition program for 2016, the following will apply for 2016:

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Short-Term Disability

When a team member must be absent for more than 10 calendar days due to a serious health condition, they may be eligible for short-term disability income replacement. If approved, team members will receive income replacement equal to 60% of their base salary. Note—work related injuries are not covered under short-term disability. See the Workers’ Compensation section for information.

Long-Term Disability

When a team member’s absence due to medical reasons becomes long-term, they may qualify under the long-term disability insurance administered by Unum. If approved, team members will receive income replacement equal to 60% of their base salary, up to a maximum monthly benefit. See the Long-Term Disability Policy on www.act.org/benefits for additional information.

Parental Leave

Team members are granted up to 6 weeks paid time off following the birth and/or adoption of a child.

Workers’ Compensation

ACT provides a comprehensive workers’ compensation insurance program. This program covers any injury sustained in the course of employment. In most cases, workers’ compensation insurance provides benefits after a short waiting period. If you sustain a work-related injury, you should contact Talent Strategy at [email protected] immediately.

To ensure you receive every benefit you might be entitled to, it is imperative that every incident, no matter how minor, be reported timely.

For more information on our leave policies, refer to www.act.org/benefits.

Leave Bank

ACT’s leave bank allows team members, not covered under the Paid Time Off program, to donate up to 37.5 hours of unused vacation to a bank for others facing serious or catastrophic personal or family member situations and who have no or limited paid time available. Team members facing such catastrophic situations may be approved to use up to 75 hours of leave for each occurrence.

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Wellness at ACT is a voluntary program providing a variety of offerings for ACT team members. The mission of the Wellness Program is to encourage, inspire, and empower team members to improve their health, happiness and overall well-being.

ACT provides team members with the following amenities designed to support overall well-being:

• A state-of-the-art onsite fitness center• A tobacco-free worksite• Free onsite fitness classes and health education programs• Healthy dining and vending machine options• Physical activity and weight loss programs• Walking trails at main campus • Walking workstations at every building on main campus• Access to onsite services including nurse practitioner,

chair massage and flu shots• Onsite convenience services such as dry cleaning

pick up/delivery and weekly CSA food box delivery

ACT Wellness 36 Club

In addition to the great offerings outlined above, ACT encourages team members to participate in the ACT Wellness 36 Club. This program is a fun way to set and monitor personal goals, achieve targets, and be recognized for reaching certain milestones.

Wellness Program

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ACT Policies, Procedures, & Resources

Policies & Procedures

In addition to the benefits outlined in this overview, there are a number of policies and procedures team members should review and understand. Information can be found at www.act.org/benefits and in the Team Member Handbook, found in Convercent.

Resources

Many resources are available on www.act.org/benefits to help team members better understand the benefits outlined in this document. Resources include:

1. Summary Plan Descriptions—describe the specific provisions applicable under certain benefit programs.

2. Policies—describe the specific provisions applicable under certain company policies. These may be found at www.act.org/benefits or within the Team Member Handbook within Convercent.

3. Procedures and Forms—provide team members direction for completing certain requests.

4. Record-Keeper/Vendor Contact List—provides a listing of ACT’s various benefits administrators and third parties.

Contacts

For specific questions regarding benefits or coverage, contact ACT’s Benefits team at [email protected].

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ACT is proud to offer team members benefit plan rates that are well below national averages.

The table below shows the costs associated for various benefit plan options in 2016. The first highlighted column shows the amount of the cost paid by the team member through bi-weekly payroll deductions. The second column shows the portion paid by ACT and the associated total cost.

Rates

MEDICAL

Blue Access(Team Members Residing in Iowa)

Team Member Cost Per Pay Period

ACT Cost Per Pay Period

Total Cost Per Pay Period

Team Member Only $39.34 $157.34 $196.68

Team Member + 1 $90.08 $360.31 $450.39

Team Member + Family $119.58 $478.32 $597.90

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DENTAL




Team Member Only $2.93 $11.87 $14.80

Team Member + 1 $5.91 $23.29 $29.20


VISION




Team Member Only $3.19 $0.00 $3.19

Team Member + 1 $5.59 $0.00 $5.59


MEDICAL

Alliance Select(Team Members Residing in Iowa)




Team Member Only $52.64 $157.93 $210.57

Team Member + 1 $120.55 $361.66 $482.21


Alliance Select(Team Members Not Residing in Iowa)




Team Member Only $42.11 $168.46 $210.57

Team Member + 1 $96.44 $385.77 $482.21


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PRE-PAID LEGAL




Single Level of Coverage $9.92 $0.00 $9.92

SUPPLEMENTAL LIFE INSURANCE

Additional Life Insurance Cost Per Month (premium per $1,000 of coverage)

Age Cost Per Month

< 40 $0.06

40 – 49 $0.09

50 – 54 $0.15

55 – 59 $0.27

60 – 64 $0.41

65 – 69 $0.60

70 – 74 $1.75

75 > $1.75

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The information contained in this summary should in no way be construed as a guarantee of employment. ACT reserves the right to modify, amend, suspend or terminate any plan/program at any time for any reason. If there is a conflict between the information contained here and the actual plan documents or policies, the plan documents or policies will always govern. Details, changes and definition of terms used in this overview can be obtained by reviewing current descriptions and/or policies.

It’s important you understand the benefits provided to you by ACT. This document is not intended to constitute a Summary Plan Description (SPD) under ERISA. For specific details about your eligibility for benefits, coverage and limitations under the various plans, and your responsibilities please review the SPDs.

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www.act.org/benefits

Copyright © 2015 ACT, Inc. All rights reserved.

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2016 Program Overview - ACT€¦ · (limited to health coaching sessions for eligible team members...

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