Transcription

2022BenefitsMedical2022Sana Health gramWe are pleased to offer acomprehensive benefitsprogram to our valuedemployees. Thesebenefits available to you,and your eligible lovedones, represent asignificant component ofyour compensationpackage. They alsorepresent the importancewe place on your healthand well-being becausewe want you to feel greatand thrive. We hopethese benefits help youmaintain feeling goodphysically andemotionally and, meet theneeds of you and thepeople you love. Pleaseuse this guide as aresource to help youidentify the benefits thatare right for you, and tomake the most of them.Questions? [email protected],Disability &MuchMore!MonthlyCostBenefitResourcesEmployee EligibilityActive, regular, full-time employeesworking a minimum of 30 hours perweek are eligible for all benefits effectiveon their date of hire.Dependent Eligibility Your legal spouse or domesticpartner; or Your dependent children (includingyour step-children and legally adoptedchildren) up to age 26; or A child which includes your naturalchild, adopted child, child placed withyou for adoption, stepchild, domesticpartner’s child, or a child for whomyou, your spouse, or DomesticPartner are the legal guardian;or Any dependent child who reaches theage limit and is incapable of selfsupport because of a mental orphysical disability.Benefits portal

stanceProgramLife,Disability &MuchMore!MonthlyCostBenefitResourcesPremera PPOKaiser HMO WAKaiser HMO CA 200 individual 400 familyNoneNone100% / 0%N/A for most servicesN/A for most services 3,200 individual 6,400 family 1,500 individual 3,000 family 1,500 individual 3,000 familyCovered in fullCovered in fullCovered in fullOffice Visit(includes telemedicine via regular providers) 25 copay 15 copay 15 copayVirtual Visits - primary care 10 copayNo chargeNo chargeMental Health - outpatient 25 copay 15 copay 15 copayDoctoronDemand andTalkspaceCalm and myStrengthCalm and myStrengthOutpatient Rehabilitation(Physical / Occupational / Speech Therapies) 25 copay, 45 visits percalendar year 15 copay, 60 visits percalendar year 15 copayLab, X-ray and Complex Imaging CT, PET, MRIs0% Deductible waivedNo chargeNo charge 25 copay 15 copay 15 copay 200 copayER copay waived if admitted 100 copay 100 copayPrescription Drugs – 30 days Retail(Tier 1, Tier 2, Tier 3 / Specialty) 10 / 30 / 60 10 / 20 / 50% up to 150 10 / 20 / 20% up to 250Prescription Drugs - 90-100 days Mail Order(30 days max Rx on specialty drugs) 20 / 60 / 120 20 / 40 20 / 40WA: HeritageNationally: Blue Card PPOGlobal: BCBS Global CoreKaiser PermanenteKaiser PermanenteSee plan SBC and SummaryEmergency OnlyEmergency OnlyDeductible per calendar yearApplies first unless copay only or otherwise notedCoinsurance - Carrier / MemberOut-of-Pocket Maximum per calendar yearIncludes deductible, coinsurance and all copaysPreventive Care – Visits, Screenings, ImmunizationsOffice VisitsMental Health – additional toolsUrgent Care Visit (free standing facility)Emergency RoomPlan NetworkOut of Network CoverageQuestions? [email protected] portal

rogramDelta Dental PPODentalLife,Disability &MuchMore!In-NetworkDeductible (per Calendar Year)Waived for Class 1 & Class 4 servicesBenefitResourcesPremier andNon-Participating 25 individual 75 familyMaximum (per Calendar Year)Max benefit carrier will pay per yearClass 1 do not applyYour Delta Dental of WA Dental PlanMonthlyCost 2,000 per individualClass 1 –Preventive CareExam, Cleaning, X-rays0%0%Class 2 –Basic ServicesSimple restorations10%20%Class 3 –Major TreatmentComplex restorations50%50%Class 4 – Orthodontia(Adult and child)50%50% 2,500 2,500Orthodontia Maximum (per lifetime)Good dental care supports your overall health. Delta Dental of WA is a nationwide plan, not justfor WA, and provides a national network of dentists. In-network providers have agreed toaccept a reduced rate for their services, so you will pay less out of your pocket for care. Youhave the freedom to use out-of-network licensed dental providers; however, you will pay moreout of your pocket for care and can be balance billed the excess over the allowed amount.Helpful TipsIf you plan to enter a course of treatment with any Class 3 treatment, please ask your providerto submit a pre-treatment estimate. A pre-treatment estimate gives your carrier the chance toreview what the claim may look like before you’ve received the services and incurredcharges. Upon review, they’ll send both you and your dentist an estimate of what will becovered by the plan. This allows you to: Preview what services will/won’t be covered Negotiate a payment arrangement with yourprovider See in advance what your anticipated costswill be, or negotiate a different treatment Budget for your out-of-pocket costsplanQuestions? [email protected] portal

eeAssistanceProgramNon-NetworkPlan CopaysEye Exam 25 copayHardware (lenses and frames)Combined with examContacts (standard fitting and evaluation)Up to 60 copayBenefit FrequencyEye ExamOnce every calendar yearLensesOnce every calendar yearFramesOnce every two calendar yearsContacts (in lieu of lenses and frames)Once every calendar yearBenefit AllowanceEye Exam100%Up to 45Up to 200Up to 70Single100%Up to 30Lined Bifocals or Standard Progressives100%Up to 50Lined Trifocals100%Up to 65FramesLensesElective Contacts (in lieu of lenses andframes)Up to 200Up to 105Lens EnhancementsStandard Anti-Reflective CoatingComplex Progressive LensesFactory Applied Scratch Resistant Coating 41 copayNot covered 150- 175 copayUp to 50 17 copayNot coveredQuestions? [email protected],Disability &MuchMore!MonthlyCostBenefitResourcesYour VSP Vision PlanKeep your vision clear and your eyes ingood health with regular eyeexams. You’ll save money by visiting innetwork providers. Your vision planprovides a national network ofindependent optometrists andophthalmologists. In-network providershave agreed to accept a reduced rate fortheir services, so you will pay less out ofyour pocket for care.You have the freedom to use out-ofnetwork providers; however, you will berequired to pay up-front for your careand submit claims for reimbursement.The out-of-network benefit schedule isbased on fixed dollar reimbursements soyou could end up paying significantlymore.Costco is an out-of-network provider,however they have a specialarrangement with VSP where they willbill direct onsite, so your out of networkreimbursement can be claimed on thespot at the point of sale when youpurchase eyeglasses via Costco. Thisapplies to in-store purchases only.VSP doesn’t issue ID cards. Simplyuse your SSN to confirm coverage.Benefits portal

VisionEmployeeAssistanceProgramLife,Disability &MuchMore!MonthlyCostBenefitResourcesConcern Employee Assistance ProgramConcern offers assessment, crisis intervention, referrals, and confidential short-termcounseling for personal issues for up to 6 visits per member, per issue, per year. Askilled Concern counselor can assist with: Difficulty with relationshipsEmotional distressJob stressCommunication/conflict issuesAlcohol or drug problemsLoss and deathVisit employees.concernhealth.com and log in with your company code Sana foreasy access to all available Concern services, including online therapy, or call 800344-4222Banister Lifespan NavigationBanister provides life crisis navigation services and support to you in your time ofneed and can help you make important decisions during health concerns, elder careneeds, end of life, closing an estate, or managing what's ahead.Banister covers 100% of evaluation and community resource sharing, referrals torelevant legal, financial, healthcare, and other professionals, and up to 8 hours ofLifespan Navigation services per qualifying situation. For anything beyond this, youwill receive a 10% discounted rate.To learn more and schedule a confidential conversation:Email [email protected] or call 206-485-0555. Online, find Banister atbanisteradvisors.comQuestions? [email protected] portal

2022BenefitsMedicalDentalLife, Disability & Much More!Life and AD&D Benefits – The StandardEmployer Paid Basic Life / AD&D 2x annual salary, up to a maximum of 500,000Voluntary Life / AD&D Employee 7x annual salary, up to a maximum of 1,000,000 and Spousal, up to 500,000, (not to exceed 100% of employeecoverage) Child(ren) up to 10,000 per child, (not to exceed 100% ofemployee coverage)Disability - The lity& MuchMore!MonthlyCostBenefitResourcesPaid Time Off 15 days per year for FT employees - pro-rated for PT employeesworking 30 hours per week Regularly observed holidays per year Holiday week paid shutdown at the end of the year 5 days Important Life Stuff days Sick timeFinancial & Learning 401(k) Plan with 100% employer paid match to 4,000 max,immediate vest Origin financial advisor wellness program Employee Stock Purchase Plan (ESPP) Learning Choice – Student Loan & Tuition AssistanceFamilyShort-Term Disability 60% of salary up to 5,000 per week for a maximum of 12weeks; 7-day elimination period Family Support - 18 weeks fully paid Parent Leave Sana Bucks for Care - 500 monthly reimbursement forchildcare and elder care expensesLong-Term Disability 60% of salary, up to 15,000 per month, until Social SecurityNormal Retirement Age; 90-day elimination periodLegal – ARAGFlexible Spending Accounts (FSA) – Navia Healthcare FSA - Plan year contribution limit: 2,850 Dependent Care FSA – Plan year contribution limit: 5,000(limit per household)Questions? [email protected] Affordable voluntary legal coverage when you need an attorneyOther Perks Commuter Assistance – site specific reimbursement see pagefor details Cell Phone Reimbursement – up to 130/month for Sana relatedemail and cellphone usageBenefits portal

rogramLife,Disability &MuchMore!MonthlyCostBenefitResourcesSana proudly pays 100% of the employee only premium and 90% of the premium for you and your dependents.If you cover your dependents on your benefits, you pay only 10% of the cost.Monthly CostEmployee OnlyEmployee SpouseEmployee Child(ren)Employee FamilyPremera PPO 0.00 202.93 157.83 270.57Kaiser HMO (CA) 0.00 145.05 112.81 193.39Kaiser HMO (CA) 0.00 137.70 107.10 183.60Dental 0.00 11.59 12.53 19.34Vision 0.00 0.97 0.99 1.60Domestic PartnershipYou may enroll your domestic partner in lieu of a spouse. To qualify as a domestic partnership, you must meet the guidelines listed here. Please note thatthe IRS requires that premiums for Domestic Partners and their children who are not your tax dependents be taken on a post-tax basis. We are required toadd the company’s portion of the cost of coverage for non-tax dependents to your taxable income.Questions? [email protected] portal

rogramLife,Disability &MuchMore!MonthlyCostBenefitResourcesBenefit ResourcesCarrierCustomer Service InformationMedical & PrescriptionPremera Blue CrossVirtual CareDoctor on Demandgroup number: 4020791customer service: 800-722-1471network: Heritage Plus/BlueCard PPO/BCBS Globalwebsite: www.premera.comwebsite: www.doctorondemand.com/premerawebsite: www.98point6.com/premerawebsite: www.talkspace.com/premeraTalkspace phone: 1-855-835-236298point6TalkspaceMedical & PrescriptionKaisergroup number: 27079customer service: 800-464-4000website: www.kp.orgDentalDelta Dental of WAgroup number: 09710customer service: 800-554-1907network: PPOwebsite: www.deltadentalwa.comVisionVSPgroup number: 30101264customer service: 800-877-7195network: Choicewebsite: www.vsp.comDisabilityThe Standardgroup number: 165009 (LTD) & 758845 (STD)customer service: 800-368-2859 (STD)customer service: 800-368-1135 (LTD)website: www.standard.comLife and AD&DThe Standardgroup number: 165009customer service: 800-628-2600website: www.standard.comFlexible Spending Accounts (FSA)Navia Benefit Solutionscustomer service: 800-669-3539website: www.naviabenefits.comcompany code: SBG401(k)Vanguardcustomer service: 866-679-3054website: my.vanguardplan.comFinancial WellnessOriginwebsite: www.useorigin.comLegal ServicesARAGcustomer service: 800-247-4184website: www.araglegal.com/myinfocompany code: 18867sbEmployee Assistance Program (EAP)Concerncustomer service: 800-344-4222website: www.employees.concernhealth.comcompany code: SanaLifespan NavigationBanistercustomer service: 206-485-0555website: www.banisteradvisors.comEmail: [email protected]? [email protected] portal

rogramLife,Disability &MuchMore!MonthlyCostBenefitResourcesThis guide highlights the main features of the plans in the Sana Employee Benefits Program. It is intended to help you choose thebenefits that are best suited for you. It does not include all plan rules and details, including limitations and exclusions. The plans aregoverned by plan documents, insurance contracts and company policies. Should there be any inconsistencies between this guide andthose materials, the plan documents, insurance contracts and company policies will govern. These documents are available toemployees upon request.Sana reserves the sole and exclusive right to alter, reduce or eliminate any pay practice, policy or benefit at any time, without advancednotice, except for those provisions required by law. Employees and eligible former employees will be entitled to only those benefits inplace at the time of termination of employment. Health and welfare benefits are not vested benefits.Questions? [email protected] portal

2022 Benefits Medical Dental Vision Employee Assistance Program Life, Disability & Much More! Monthly Cost Benefit Resources Medical Premera PPO Kaiser HMO WA Kaiser HMO CA Deductible per calendar year Applies fi