employee benefits portfolio - save mart · pdf filein case of conflict between the information...

BenefitsPortfolioEmployee

2017PUTTING OUR

PEOPLE

FIRST

This Guide is intended to be only an overview of the plans and benefits offered under The Save Mart Companies’ Select Benefits Program. Not all plan provisions, limitations or exclusions are described in this Guide. In case of conflict between the information in this Guide and the actual plan documents and insurance contracts, the plan documents and insurance contracts will govern. For more details on your benefit plans, refer to the Summary Plan Descriptions or contact the Save Mart Companies’ Benefits Department.

The Save Mart Companies reserves the right to change or terminate benefits at any time. Neither the benefits nor this Guide should be interpreted as a guarantee of future benefits.

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Table of CONTENTSTHE SAVE MART COMPANIES’ SELECT BENEFITS PROGRAM 2

MEDICAL PLAN CHOICES 5

DENTAL PLAN 8

VISION PLAN 9

FLEXIBLE SPENDING ACCOUNTS PLAN 10Health Care Spending AccountDependent Care Spending Account

INCOME PROTECTION PLANS 12Basic Group Term Life InsuranceBasic Accidental Death & Dismemberment (AD&D) InsuranceDependent Group Term Life InsuranceLong Term Disability Income Insurance

VOLUNTARY PLANS 14Voluntary Whole Life InsuranceVoluntary Term Life InsuranceVoluntary Critical Illness InsuranceVoluntary Accident InsuranceVoluntary Legal PlanVoluntary Identity Theft Protection Plan

OTHER BENEFITS 16Employee Assistance ProgramPurchasing Power Program

HOW TO ENROLL 17

HEALTHIER YOU 18

EMPLOYEE COST SHARING 19

CONTACT INFORMATION 20

IMPORTANT INFORMATION 21

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WHO IS ELIGIBLE

Active Employees

Full-time employees working 130 hours or more per month are eligible for the Save Mart Select Benefits Program described in this brochure on the first of the month following the completion of 60 days of continuous employment.

Employees working less than 130 hours per month are subject to a 12-month measurement period before they may enroll in benefits, in accordance with the Affordable Care Act (ACA). The measurement period begins October 3rd and ends October 2nd of the following year.

Dependents

You may enroll your eligible dependents in The Save Mart Companies’ Select medical, dental, and vision care plans.

Eligible dependents* are defined as:

• Legal Spouse: Your spouse under a legally valid marriage.

• Registered Domestic Partner (California residents only): Your domestic partner under a legally-registered and valid domestic partnership. Registered domestic partners are those individuals who are same-sex couples, or opposite-sex couples in which one partner is at least age 62, and who have registered and received a Domestic Partnership Certificate from the Secretary of State. For additional information on spouse or registered domestic partner benefit eligibility see next page.

• Dependent Child: Your or your spouse’s/registered domestic partner’s natural child, stepchild, legally adopted child, or a child for whom you or your spouse/registered domestic partner has been appointed legal guardian by a court of law, subject to the following:

• The child is under 26 years of age,

• A dependent child who is incapable of self-support because of a physical or mental disability,

• A child who is in the process of being adopted is considered a legally adopted child if we receive legal evidence of both: (i) the intent to adopt; and (ii) that the employee, spouse or registered domestic partner have either (a) the right to control the health care of the child; or (b) assumed a legal obligation for full or partial financial responsibility for the child in anticipation of the child’s adoption.

Non-California registered domestic partners, parents, grandparents, aunts, uncles, siblings or dependents who do not meet the definition of dependents as described above are not eligible for coverage under the Save Mart Select Benefits Program.

Please Note: Employees married to employees of The Save Mart Companies may not cover each other as dependents.

* Employees must provide proof of dependent eligibility at time of enrollment (e.g., marriage certificate, birth certificate). A list of the documents that meet proof of dependent eligibility requirements is available in The Save Mart Companies’ Benefits Department.

THE SAVE MART SELECT Benefits PROGRAM

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WHEN COVERAGE BEGINSCoverage for the The Save Mart Companies’ Select Benefits Program begins on the first of the month following 60 days of continuous, active employment. For example, if your first date of active employment is January 4, 2017, your coverage is effective April 1, 2017.

CHANGES TO YOUR ENROLLMENTEach year you have the opportunity to make changes to your benefit plan enrollment during The Save Mart Companies’ Open Enrollment period. All changes made during Open Enrollment are effective for the next 12 months (January 1 through December 31), unless you experience a Qualifying Event.

CHANGES IN FAMILY STATUS – QUALIFYING EVENTSThe IRS requires you to have a Qualifying Event (change in family status) in order to make changes to your benefits during the plan year. Examples of changes in family status include:

• Marriage, divorce, or legal separation

• Birth, adoption, or custody change of an eligible dependent

• Beginning or ending of a spouse’s/registered domestic partner’s employment

• Unpaid leave of absence taken by you or your spouse/registered domestic partner resulting in loss of coverage

• Change in employment (either yours or your spouse’s/registered domestic partner’s) from part-time to full-time, etc.

Any changes to your benefits must be consistent with the change in your family status. For example, if you have a child, you can enroll the child as a dependent, but you may not remove another dependent who is already covered at that time unless a separate change in family status has occurred.

You must notify The Save Mart Companies within 31 days of a change in family status by contacting Secova at 1-888-926-5674 or visiting www.savemartbenefits.ielect.com. If you do not contact Secova within 31 days, you will not be able to make any benefit plan enrollment changes until the next annual Open Enrollment period.

If you do not notify the The Save Mart Companies’ within 31 days of a change in family status that results in the loss of eligibility (e.g., divorce) for you or your enrolled dependent(s), you will be responsible for any health care expenses that are incurred after the family status change date. In addition, The Save Mart Companies retains the right to recoup claim payments from you for any health care expenses incurred after the change in family status and you will be held accountable.

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THE SAVE MART SELECT Benefits PROGRAMWHEN COVERAGE ENDSCoverage under the Save Mart Select Benefits Program ends if:

• You work less than the minimum hours required.

• Your employment is terminated; coverage ends on the date of termination.

• You are on a Leave of Absence (LOA) that is pending and has not been approved.

Once your leave has been approved, you should contact the Benefits Department to verify you qualify for a benefits extension based on your qualified leave status. After the extended benefit period ends, you may be eligible to purchase continued medical, dental, and vision coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). If you do not continue your coverage under COBRA and later return to work, you must meet the 60-day waiting period requirement to resume coverage.

DECLINING COVERAGEYou have the option to decline coverage for the medical, dental, and vision care plans. Should you choose to decline coverage, you must contact the Benefits Department to advise of your declination. If you are declining coverage because of other health insurance coverage, you must provide proof of other coverage to the Benefits Department. You will not be able to enroll in the medical, dental, and vision care plans until the next annual Open Enrollment period, or unless you experience a Qualifying Event.

Please Note: You must be enrolled in medical to be eligible for the company-provided income protection plans (Basic Life, AD&D and Long Term Disability Insurance).

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Medical PLAN CHOICESYou have a choice of five medical plan options – four Blue Shield of California Select Medical Plans [with Preferred Provider Organization (PPO) networks] and one Kaiser Permanente Health Maintenance Organization (HMO) Plan.

BLUE SHIELD OF CALIFORNIA SELECT MEDICAL PLAN OPTIONSThere are four Blue Shield of California Select Medical Plans from which to choose:

Each plan covers most of the same services; however out-of-pocket expenses (e.g., deductibles, copays and coinsurance amounts) vary with each plan.

When you enroll in one of the Blue Shield of California Select Medical Plans, you may obtain services from any provider you wish. When you obtain services from providers within the Blue Shield of California PPO network, your benefits are greater. When you obtain services from providers who are not part of the PPO network, your out-of-pocket expenses are greater. In most cases, you must file a claim form when you receive services from out-of-network providers.

To find a physician in the Blue Shield of California network, visit www.blueshieldca.com.

TELADOC

Blue Shield members have access to Teladoc 24/7. Teladoc allows you to set up an online consultation with a doctor so you don’t have to go to the doctor’s office for things like cold symptoms, rashes, and pink eye. You’ll pay only a $5 copay for an office visit with the convenience of doing it all from home. If you enroll in a Blue Shield plan, you’ll receive a packet at home explaining how to use Teladoc.

BLUE SHIELD’S NEW COST ESTIMATOR TOOLBlue Shield has introduced the Cost Estimator tool that provides PPO plan members with estimates of both the total cost and out-of-pocket expenses for common treatments and services. This helps members to budget and plan for future healthcare expenses.

• Estimates are based on plan enrollment and deductible balances.

• Results display provider information, facility location, distance from member’s home, and identification of Blue Distinction Centers, where applicable.

Members can access the Treatment Cost Estimator free of charge by logging in at www.blueshieldca.com.

KAISER PERMANENTE SELECT HMO MEDICAL PLANWhen you enroll in the Kaiser Permanente Select HMO Plan, you must receive all your care from a Kaiser physician or specialist at Kaiser facilities, and you must obtain your prescriptions from Kaiser pharmacies. Most services are covered at 100%. Copays are required for certain services. No claim forms are required for this plan.

To find a physician in Kaiser Permanente’s network, visit www.kp.org.

• Select Deluxe Medical Plan

• Select Value Medical Plan

• Select Essential Medical Plan

• Select Basic Medical Plan

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Medical PLAN CHOICES CONTINUED

1 This is a summary only; for more detailed information, please refer to the Summary Plan Description or Plan Summary for each plan.2 Deductible waived.3 See Summary Plan Description for number of visits covered per year and out-of-network plan payment maximums.4 Blue Shield’s allowable amount is $600 per day. Members are responsible for coinsurance plus all charges in excess of the allowable amount.

Plan Highlights1 Blue Shield of California Select Deluxe Medical Plan

Blue Shield of California Select Value Medical Plan

Blue Shield of California Select Essential Medical Plan

Blue Shield of California Select Basic Medical Plan Kaiser Select HMO Plan

In-NetworkEmployee Cost Share

Out-of-NetworkEmployee Cost Share







Kaiser Permanente Providers and FacilitiesEmployee Cost Share

Calendar Year Deductible (applies to all services unless otherwise indicated)

$200/person; $400/family max



$600/person; $1,200/family max



$2,000/person; $4,000/family max Not applicable

Calendar Year Out-of-Pocket Maximum $1,300/person; $2,600/family max

None $2,500/person; $5,000/family max


None $5,000/person; $10,000/family max $1,500/person; $3,000/family max

Lifetime Maximum Benefit Unlimited Unlimited Unlimited Unlimited Unlimited

Doctor’s Office Visits $152 40% $20 2 50% $25 2 50% 30% 50% $20

Specialist Office Visits $302 40% $35 2 50% $40 2 50% 30% 50% $20

Preventive Care No charge2 40% No charge 2 50% No charge 2 50% No charge 2 50% No charge

Diagnostic X-Ray and Lab Tests 20% 40% 25% 50% 30% 50% 30% 50% No charge

Chiropractic Care $152, 3 40%3 $202, 3 50%3 $252, 3 50%3 30%3 50%3 $15; up to 30 visits/year

Prescription Drug BenefitsSave Mart Pharmacies: Up to 30 Day Supply

Generic: $5Brand Formulary: $15Non-Formulary: $25

Not applicable Generic: $10Brand Formulary: $20Non-Formulary: $30



Not applicable Generic: $10Brand Name: $20

(Kaiser pharmacies only)(All prescriptions subject to deductible)

Retail Pharmacies: 30 Day SupplySave Mart Pharmacies: 31 – 90 Day Supply


Not covered Generic: $20Brand Formulary: $45Non-Formulary: $80



Not covered Not applicable

Mail Order SaveMart Pharmacies Only: Up to 90 Day Supply






Kaiser Mail Order: Up to 100 Day Supply

Not applicable Not applicable Not applicable Not applicable Generic: $20 Brand Name: $40

Inpatient Hospital Services/Surgeon’s Fees 20% 40%4 25% 50%4 30% 50%4 30% 50%4 $200/admission

Emergency Room 20% after $150 ($150 waived if admitted): 50% penalty for non-emergency services

25% after $150 ($150 waived if admitted); 50% penalty for non-emergency services


30%; 50% penalty for non-emergency services

$75 (waived if admitted)

Mental Health/Substance Abuse Outpatient Services

$152 40% $202 50% $252 50% 30% 50% Individual therapy: $20; Group therapy: $10/Mental Health; $5/Substance Abuse

Mental Health/Substance Abuse Inpatient Services

20% 40%4 25% 50%4 30% 50%4 30% 50%4 $200/admission; Substance Abuse: Detox Only; $100 for transitional residential treatment

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Plan Highlights1 Blue Shield of California Select Deluxe Medical Plan

Blue Shield of California Select Value Medical Plan

Blue Shield of California Select Essential Medical Plan

Blue Shield of California Select Basic Medical Plan Kaiser Select HMO Plan









Kaiser Permanente Providers and FacilitiesEmployee Cost Share

Calendar Year Deductible (applies to all services unless otherwise indicated)







$2,000/person; $4,000/family max Not applicable

Calendar Year Out-of-Pocket Maximum $1,300/person; $2,600/family max



None $5,000/person; $10,000/family max $1,500/person; $3,000/family max

Lifetime Maximum Benefit Unlimited Unlimited Unlimited Unlimited Unlimited

Doctor’s Office Visits $152 40% $20 2 50% $25 2 50% 30% 50% $20

Specialist Office Visits $302 40% $35 2 50% $40 2 50% 30% 50% $20

Preventive Care No charge2 40% No charge 2 50% No charge 2 50% No charge 2 50% No charge

Diagnostic X-Ray and Lab Tests 20% 40% 25% 50% 30% 50% 30% 50% No charge

Chiropractic Care $152, 3 40%3 $202, 3 50%3 $252, 3 50%3 30%3 50%3 $15; up to 30 visits/year

Prescription Drug BenefitsSave Mart Pharmacies: Up to 30 Day Supply





Not applicable Generic: $10Brand Name: $20

(Kaiser pharmacies only)(All prescriptions subject to deductible)

Retail Pharmacies: 30 Day SupplySave Mart Pharmacies: 31 – 90 Day Supply






Mail Order SaveMart Pharmacies Only: Up to 90 Day Supply






Kaiser Mail Order: Up to 100 Day Supply

Not applicable Not applicable Not applicable Not applicable Generic: $20 Brand Name: $40

Inpatient Hospital Services/Surgeon’s Fees 20% 40%4 25% 50%4 30% 50%4 30% 50%4 $200/admission

Emergency Room 20% after $150 ($150 waived if admitted): 50% penalty for non-emergency services



30%; 50% penalty for non-emergency services

$75 (waived if admitted)

Mental Health/Substance Abuse Outpatient Services

$152 40% $202 50% $252 50% 30% 50% Individual therapy: $20; Group therapy: $10/Mental Health; $5/Substance Abuse

Mental Health/Substance Abuse Inpatient Services

20% 40%4 25% 50%4 30% 50%4 30% 50%4 $200/admission; Substance Abuse: Detox Only; $100 for transitional residential treatment

Summary Health InformationAs an employee, the health benefits available to you represent a significant component of your total rewards package. They also provide important protection for you and your family in the case of illness or injury. The Save Mart Companies offers a number of health coverage options. Choosing a health coverage option is important and to help you make an informed decision, The Save Mart Companies makes available a Summary of Benefits and Coverage (SBC). The SBC summarizes important information about any health coverage option in a standard format, so that you may compare options. The Save Mart Companies’ medical plan SBCs are available on the Employee Self Service website and on The Save Mart Connection/Achievers website. A paper copy is also available, free of charge, by calling:

• Kaiser Member Services: 1-800-464-4000 • Blue Shield Member Services: 1-888-235-1765

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You may elect medical, dental, and vision coverage separately, but you must have the same coverage level for all plans you enroll in. For example, if you elect “Employee plus Spouse” for medical coverage and you enroll in dental, your dental coverage must be “Employee plus Spouse.”

METLIFE SELECT DENTAL PLANUnder the MetLife Select Dental Plan, you may obtain services from any dentist you wish. If you obtain services from a provider within the MetLife PDP Plus dental network, you have the opportunity to save money. Network dentists agree to discount their fees, and benefits are based on the discounted fees. You may also obtain services from dentists who do not participate in the PPO dental network, however since fees are not discounted (as they are with PPO providers), your out-of pocket expenses may be greater.

To find a dentist in the MetLife PDP Plus network, visit www.metlife.com.

Plan Highlights MetLife Dental Plan

In-Network1

Employee Cost Share*Out-of-Network

Employee Cost Share*

Calendar Year Deductible $50/person; $150/family max

Calendar Year Benefit Maximum $2,000/person

Preventive Care Benefits – X-Rays, Routine Exams and Two Semi-Annual Teeth Cleanings

No charge; deductible waived No charge; subject to deductible

Basic Care Benefits – Fillings, Extractions, Endodontics, Periodontics, and Oral Surgery

20%; subject to deductible 20%; subject to deductible

Major Care Benefits – Crowns, Inlays, Onlays, Bridges, Dentures, and Restorations

20%; subject to deductible 20%; subject to deductible

Orthodontia Benefits – Adults and Children 20%; $2,000 Lifetime Maximum Benefit

1 Paid at negotiated rates.* Amounts shown reflect employee cost-sharing.

Dental PLAN

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Vision PLANYou may elect medical, dental, and vision coverage separately, but you must have the same coverage level for all plans you enroll in. For example, if you elect “Employee plus Spouse” for medical coverage and you enroll in vision, your vision coverage must be “Employee plus Spouse.”

VISION SERVICE PLAN (VSP) SELECT VISION PLANThe Save Mart Companies provides vision care coverage through Vision Service Plan (VSP). This plan allows you to receive vision care services from any provider you wish. When you access vision care from VSP network providers, most eligible services are covered at 100%. Vision care accessed from out-of-network providers is reimbursed to the patient up to the allowed maximums.

Please Note: Your VSP ID number is 0529 plus your 5-digit Save Mart employee number. If your employee number is more than 5 digits, the VSP ID number is 529 plus your Save Mart employee number. For example, if your employee number is 12345, your VSP ID number is 052912345. If your employee number is 123456, your VSP ID number is 529123456.

Plan Highlights Vision Service Plan (VSP) Select Vision Plan

In-Network Employee Cost Share*

Out-of-Network Employee Cost Share*

Copays – Exams, Lenses & Frames Combined

$15

Exams (once every 12 months) $15 After copay, reimbursement up to $50

Contact Lenses Fitting and Evaluation 15% discount if performed in addition to the routine eye exam; maximum copay of $60

Lenses (once every 12 months) $151 After copay, reimbursement up to:Single Vision: $50Lined Bifocal: $75

Lined Trifocal: $100Lenticular: $125

Frames (once every 12 months) Covered to a maximum of $1202 after copay

After copay, reimbursement up to $70

Contact Lenses (In lieu of lenses and frames) Medically Necessary Elective (once every 12 months)

$15

Covered up to a maximum of $300 after copay3

After copay, reimbursement up to $210

Reimbursed up to $300

Laser Vision Care VSP offers discounts for PRK and LASIK surgeries through contracted laser centers. Details regarding this program are available at the VSP website at www.vsp.com

1 Tints and photochromatic lenses are covered. Extra lens options such as scratch resistant coatings are available at VSP member preferred pricing.2 20% discount for additional sunglasses and frames that exceed the Plan Allowance.3 Applies to the cost of contact lenses and contact lenses exam.

* Amounts shown reflect employee cost-sharing.

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Flexible SPENDING ACCOUNTS PLANThe Flexible Spending Accounts (FSA) Plan allows you to pay certain qualifying expenses with pre-tax dollars. Because deductions for these expenses are subtracted from your gross pay, your taxable income is reduced, less taxes are withheld, and your take-home pay may be greater. In addition, your medical and dental plan premium contributions are deducted from your paycheck on a pre-tax basis. See the next page for an example of how an FSA works to help you save on taxes. The Save Mart Companies’ FSA is administered by Chard-Snyder. To learn how much you can personally save by enrolling in one or both of the FSAs, visit www.chard-snyder.com/secora.

Health Care Spending Account

The Health Care Spending Account allows you to set aside pre-tax dollars to pay for qualifying out-of-pocket medical, dental, vision and prescription drug expenses, including deductibles, coinsurance payments and copays for yourself or your dependents to a maximum of $2,600 per plan year. Expenses for dependents who are not covered through the The Save Mart Companies’ Select health care plans may also qualify for reimbursement.

Benny Debit Card

The Benny Visa debit card is a debit card that enables you to pay for eligible health care expenses directly from your Health Care FSA. Your Health Care FSA is electronically debited whenever you use the card. IRS regulations require that you provide documentation to verify eligibility of certain expenses but you don’t have to wait for reimbursement. The Benny card is accepted by doctors’ offices and eligible merchants such as pharmacies, Save Mart pharmacies and other merchants. You may also elect to have your reimbursements directly deposited into your bank account.

DEPENDENT CARE SPENDING ACCOUNTThe Dependent Care Spending Account is designed for people whose dependents need care so that they can work. Dependent Care can be for your children (up to age 13), spouse/registered domestic partner or parents. Dependents must live with you and be claimed as a dependent on your Federal income tax return. The most you can contribute per year to the Dependent Care FSA is a maximum of $5,000 per IRS household.

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FLEXIBLE SPENDING ACCOUNT RULES

1. You must designate how much money you wish to contribute annually to each account at the beginning

of the Plan Year. Monies set aside for one account cannot be moved to another account.

2. You may change your annual contributions only if you experience a Qualifying Event, such as marriage,

divorce, addition or loss of a dependent, or a change in your spouse/registered domestic partner’s employment.

3. You have a 21/2 month grace period after the calendar year to use unspent FSA funds. You can use your 2017

FSA to pay claims through March 15, 2018. Funds not used within the allotted time are forfeited, based on

IRS regulations, referred to as the “Use It Or Lose It” rule.

HOW AN FSA HELPS YOU SAVE ON TAXES

Without An FSA With An FSA

Gross Monthly Salary $3,000 $3,000

Monthly Pre-Tax Health Care FSA Deductions $0 -$200

Taxable Salary $3,000 $2,800

Less: Federal & State Taxes -$750 -$700

Take Home Pay $2,250 $2,100

Post-Tax Health Care Expenses -$200 $0

Total Net Take Home Pay $2,050 $2,100

Monthly Tax Savings $0 $50

Annual Tax Savings $0 $600

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INCOME Protection PLANSBASIC GROUP TERM LIFE INSURANCEBasic Group Term Life Insurance is provided through MetLife. This benefit is paid entirely by The Save Mart Companies; there is no cost to employees. Your coverage amount depends on your length of employment. If your death occurs while you are covered under this plan, your beneficiary will receive:

• For eligible employees Grade 15 and below who have completed 60 days of continuous employment: $10,000. Coverage is effective on the first of the month following 60 days of continuous employment.

• For eligible employees Grade 15 and below who have completed one year of continuous employment: $20,000. Coverage is effective on January 1 following one year of continuous employment.

• For eligible employees Grade 15 and below who have completed five or more years of continuous service: $250,000. Coverage is effective on January 1 following five years of continuous employment.

• For eligible Grade 16–19 employees and who have completed 60 days of continuous employment: one times your annual salary to a maximum of $150,000. Coverage is effective on the first of the month following 60 days of continuous employment.

• For eligible Grade 20–22 employees who have completed 60 days of continuous employment: two times your annual salary to a maximum of $400,000. Coverage is effective on the first of the month following 60 days of continuous employment.

• For eligible Grade 23–31 employees who have completed 60 days of continuous employment: three times your annual salary to a maximum of $1,000,000. Coverage is effective on the first of the month following 60 days of continuous employment.

• For eligible Pharmacists who have completed 60 days of continuous employment: one times your annual salary to a maximum of $250,000. Coverage is effective on the first of the month following 60 days of continuous employment.

BASIC ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCEAD&D insurance is provided through MetLife. This benefit is paid entirely by The Save Mart Companies; there is no cost to employees. Your AD&D coverage insures you for a benefit amount equal to your Basic Group Term Life Insurance coverage. This benefit is payable to your beneficiary in the event of your accidental death. You will receive a percentage of the full amount in the event of a covered accident which results in serious injury (e.g., loss of limbs or eyesight).

Please Note: To be eligible for Basic Term Life and Basic Accidental Death & Dismemberment Insurance, you must be enrolled in a Save Mart Select medical plan.

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DEPENDENT GROUP TERM LIFE INSURANCELife insurance coverage is provided through MetLife for eligible dependents. This coverage is paid for entirely by The Save Mart Companies; there is no cost to employees.

Spouses or registered domestic partners are insured for an amount equal to $5,000.

Dependent children up to 26 years of age are insured at the following levels, depending on your length of employment:

• For dependent children of employees who have completed 60 days of continuous employment: $2,000. Coverage is effective on the first of the month following 60 days of continuous employment.

• For dependent children of Grade 16 or above employees and Pharmacists who have completed 60 days of continuous employment: $5,000. Coverage is effective on the first of the month following 60 days of continuous employment.

• For dependent children of employees who have completed five or more years of continuous employment: $5,000. Coverage is effective on the January 1 following five years of continuous employment.

LONG TERM DISABILITY INCOME INSURANCEThe Save Mart Companies provides Long Term Disability Insurance (LTD) coverage through the MetLife Monthly Income Insurance Plan. The LTD Plan provides continuing income if you become disabled and are unable to work because of illness or injury. The cost for LTD coverage is paid entirely by The Save Mart Companies.

The LTD Plan begins paying benefits on the 180th day of a covered injury or illness. The monthly benefit is equal to 662/3% of your basic monthly earnings to a maximum of $4,800 per month. Benefits are integrated with, and reduced by, any other income you are eligible to receive so that the total of all payments does not exceed 662/3% of your basic monthly earnings.

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Voluntary PLANSYou have the opportunity to apply for insurance coverage offered through MetLife.

VOLUNTARY WHOLE LIFE INSURANCE*

Whole Life Insurance provides flexible insurance protection and includes:

• Life Insurance death benefits

• No increases to premiums

Employees ages 17 to 49 may apply for Whole Life Insurance, not to exceed $100,000, with no medical questionnaires or exams. Amounts over $100,000 are subject to medical underwriting and approval by the insurer. Premiums start as low as $2 per pay period and policy amounts start at $10,000.

Employees ages 50 to 70 may apply for coverage not to exceed $50,000 with no question or exams.

You may also apply for life insurance for your spouse/registered domestic partner, up to $5,000 with limited medical questionnaires or exams. Amounts over $5,000 are subject to medical underwriting. The policy amount may not exceed $100,000. You may apply for coverage for your children and grandchildren in policy amount of $10,000. You do not need to apply for coverage for yourself to apply for coverage for your spouse/registered domestic partner or children and grandchildren.

VOLUNTARY CRITICAL ILLNESS INSURANCE*

Voluntary Critical Illness Insurance, a limited benefit policy, is designed to help you offset the costs of certain covered critical illnesses such as stroke, coma, permanent paralysis, heart attack, cancer and major organ failure. If diagnosed with a covered condition, you will receive a lump-sum benefit that you can use for expenses such as deductibles, copayments, transportation, etc.

The Voluntary Critical Illness insurance plan also includes an optional Wellness Rider. This rider pays a benefit for having certain health screening tests.

You may apply for Critical Illness Insurance coverage in the amount of $10,000, $25,000, or $50,000 with no medical questionnaires or exams, dependent upon your age. You may also apply for coverage for your spouse/registered domestic partner and dependent children.

VOLUNTARY ACCIDENT INSURANCE*

Accident Insurance is a limited benefit policy which pays you a specified benefit for various types of off-the-job accidents to help you cover the unexpected costs associated with an accident.

You may apply coverage for your spouse/registered domestic partner and/or children through the age of 26, provided you have purchased coverage for yourself.

TERM LIFE INSURANCE*This plan pays a lump sum benefit to your designated beneficiary if you die, as well as funeral planning services. Coverage can be purchased for you, your spouse/registered domestic partner or your unmarried child(ren) age 6 months to 26 years.

Coverage for Voluntary Term Life Insurance

Employee $10,000 – $500,000 (or 5x pay) in $10,000 increments

Spouse $5,000 – $250,000 (not to exceed 50% of employee coverage) in $10,000 increments

Child(ren) $10,000 per child

• Cash value accumulation• Portability – you own your policy and can take it with you when you

retire or leave The Save Mart Companies.

* This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the policy/certificate of coverage. All coverage is subject to the terms and conditions of the policy/ certificate of coverage. Applications for coverage after your initial eligibility period may be subject to medical questionnaires and approval by the insurer.

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METLAW LEGAL PLANYou have the option of electing coverage for legal services through MetLaw. By enrolling in MetLaw, you have access to unlimited telephone and office consultations for eligible legal services, including:

The cost of the legal plan is $16.50 per month, deducted from your paycheck on an after-tax basis. The plan covers you, your spouse, and your dependents. To use the legal plan or for more information about this benefit, call MetLaw’s confidential toll-free number at 1-800-821-6400 or visit www.legalplans.com. Visitors may access the website using the password “MetLaw.”

Please Note: If you elect this benefit, you must stay enrolled for the whole year. You may not cancel mid-year.

INFOARMOR IDENTITY THEFT PROTECTIONYou can elect Identity Theft Protection through InfoArmor’s Identity Theft Protection Plan.

To learn more about the Identity Theft plan services, call 1-800-789-2720 or visit www.myprivacyarmor.com. Services in this plan include:

• Preparation of will and trusts

• Real Estate matters

• Debt matters

• Consumer protection

• Document preparation and review

• Traffic and juvenile matters

• Family law, including adoptions

• Personal, medical, and financial data protection

• Privacy protection, detection, and removal

• Online account monitoring

• Fraud and privacy alerts

• Credit monitoring

• Lost wallet protection

• Cyber predator protection

• Cyberbullying detection

• Child ID theft scanning and protection

Coverage Level Monthly Cost

Employee Only $8.45

Employee plus Family $13.25

InfoArmor Identity Theft Protection Plan Monthly Rate

Please Note: You can cancel this benefit any time, even outside the open enrollment period.

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Other BENEFITSEMPLOYEE ASSISTANCE PROGRAM (EAP)The Save Mart Companies provides an Employee Assistance Program (EAP) through Claremont to all eligible employees. If you or a family member needs assistance balancing life’s demands, or require help with personal or family issues, you can contact the EAP for help.

The EAP offers no cost, confidential and comprehensive online, telephone and short term counseling services (up to five face-to-face sessions per situation, per year, at no cost to you) to help you deal with a variety of issues that can affect you at work or at home, such as:

• Managing stress and anxiety �Debt management and budgeting

• Difficulties in relationships �Alcohol or drug issues

• Depression �Grief and loss

The EAP also provides referrals for parenting and childcare resources, older adult services, legal consultations, financial counseling and pet care resources. Referral services may be accessed at any time.

You may contact the EAP directly 24 hours a day, seven days a week, for counseling, consultation, appointment scheduling and referrals. To access services, call 1-800-834-3773 or visit their website at www.claremonteap.com.

PURCHASING POWER PROGRAMPurchasing Power is a group purchasing program that makes it possible for The Save Mart Companies employees to buy name brand computers, electronics and home appliances by making payments through payroll deductions. There are no interest fees and payments are made over 12 months.

To participate in the plan, you must:

• Be at least 18 years of age,

• Be an active employee of Save Mart with at least 18 months of continuous service,

• Earn at least $21,000 per year,

• Have a bank account or credit card (to be used in case of non-payment when payroll deductions are not available).

To learn more about Purchasing Power or to order products, call 1-866-670-3479 or go to www.savemart.purchasingpower.com.

17

HOW TO EnrollENROLL ONLINEFollow these easy steps to enroll online.

1. Log on to The Save Mart Connection at http://savemart.achievers.com.

• Enter User ID and Password First time Users: Your User ID is your employee ID number; your temporary password is Welcome1.

• Select Connections

• Select The Benefits Connection

• Select Online Enrollment to enter Employee Self Service

• Click on the Sign Into Secova button

2. Once on the Secova site (savemartbenefits.ielect.com) enter the Company Code SaveMart

3. Enter your Username and PIN. Click the Submit and Login button.

First Time Users: Your Username is your employee ID number; your PIN is the first four letters of your first

name and the last four numbers of your social security number, for example, jane1234. Once you log in, you

will be prompted to create a new password and record a security question.

4. Click on Enroll Now under the Quick Links section.

5. Once complete, click Confirm Election.

6. Review your elections in the Election Summary. Print a hard copy, email a copy to yourself, or save it to your

computer as a PDF file.

You can also enroll online by logging in to savemartbenefits.ielect.com and following steps 2 through 6 above. If you need assistance with enrolling or locating which plan you are eligible for, call 1-888-926-5674 Monday through Friday, 8am through 8pm PST.

If you are enrolling dependents, be prepared with their birthdays and social security numbers. You will not be allowed to enroll them without this information. Dependent eligibility verification documents (copies of marriage an/or birth certificates) can be uploaded to the Secova website or faxed to 1-888-837-9623. Be sure to keep your confirmation.

18

PARTICIPATE IN THE BIOMETRIC SCREENING AND SAVE ON YOUR EMPLOYEE CONTRIBUTIONSAs part of The Save Mart Companies’ “Healthier You” program, you and your covered spouse/registered domestic partner have the opportunity to complete a free biometric health screening through Maxim Health Systems. By participating in the screening, you will receive valuable information about your health, and save on your employee contributions. Depending on the plans you enroll in and the dependents you cover, you could save up to $1,600 per year! To see how much you can save, refer to the 2017 contributions chart on page 20.

One of the best ways to stay healthy is to test regularly for potential health risk factors. That is why we are partnering with Maxim Health Systems to offer FREE biometric health screenings for our employees and covered spouses/registered domestic partners at local laboratories.

BENEFITS OF Biometric SCREENINGSBiometric Screenings will test for diabetes, blood pressure, BMI, and more, all at no cost to you. You can discuss these results with your doctor.

Your personal test results are completely confidential and are never shared with The Save Mart Companies.

In order to save on your 2017 contributions, you and your covered spouse/registered domestic partner must complete the biometric screening within 30 days of your health plan coverage date.

To register with Maxim, access through the Save Mart Connection, select Benefits Connection, and then click on the Biometric Screening button to launch the website.

Your login is your Employee ID Number (i.e. 12345) and you will also need to enter your date of birth.

Your spouse’s/registered domestic partner’s login is your Employee ID Number followed by “s” (i.e. 12345s) and your spouse’s/registered domestic partner’s date of birth.

Once you’ve registered, select one of two options:

Option 1: Visit a LabCorp facility

Select the Lab Visit option and print a voucher to take with you to a nearby LabCorp facility. Choose from a list of locations provided on the Maxim website.

Option 2: Visit your doctor

Select the Physicians Results option to download the Physician Results form to have your doctor verify your recent lab results, then fax the form to Maxim.

If you do not select an option or would like to select a different option, you may log back in to your account at a later time to make changes.

EMPLOYEE CONTRIBUTIONSThe amount of your employee health plan contributions depends on the health plans you choose, how many dependents you enroll and whether or not you and your covered spouse/domestic partner complete your screening. 2017 health plan contribution discounts will apply to all eligible employees who complete this screening program within 30 days of your health plan coverage effective date.

Healthier YOU

19

2017 EMPLOYEE COST SHARINGThe Save Mart Companies pays the majority of the cost for health plan coverage. Employees pay a portion of the cost of coverage as outlined below. All medical, dental, and vision employee contributions are deducted on a pre-tax basis.

Employee & Spouse/DP Participating in Screening

Not Participating in Screening

Annual Savings with Screening

2017 Weekly 2017 Annual 2017 Weekly 2017 Annual Annual DifferenceBlue Shield PPO Medical

Plan A (Select Deluxe)

Employee Only $21.00 $1,092.00 $31.00 $1,612.00 $520 00

Employee + Spouse/Domestic Partner $46.00 $2,392.00 $68.00 $3,536.00 $1,144 00

Employee + Child(ren) $41.00 $2,132.00 $62.00 $3,224.00 $1,092 00

Employee + Family $62.00 $3,224.00 $93.00 $4,836.00 $1,612 00Plan B (Select Value)Employee Only $11.00 $572.00 $16.00 $832.00 $260 00

Employee + Spouse/Domestic Partner $22.00 $1,144.00 $33.00 $1,716.00 $572 00

Employee + Child(ren) $21.00 $1,092.00 $31.00 $1,612.00 $520 00

Employee + Family $31.00 $1,612.00 $47.00 $2,444.00 $832 00Plan C (Select Essential)Employee Only $7.00 $364.00 $10.00 $520.00 $156 00

Employee + Spouse/Domestic Partner $15.00 $780.00 $20.00 $1,040.00 $260 00

Employee + Child(ren) $13.00 $676.00 $19.00 $988.00 $312 00

Employee + Family $19.00 $988.00 $28.00 $1,456.00 $468 00Plan D (Select Basic)Employee Only $2.00 $104.00 $3.00 $156.00 $52 00

Employee + Spouse/Domestic Partner $5.00 $260.00 $8.00 $416.00 $156 00


Employee + Family $6.00 $312.00 $9.00 $468.00 $156 00

Kaiser Select HMO Plan (Select Kaiser)

Employee Only $21.00 $1,092.00 $31.00 $1,612.00 $520 00

Employee + Spouse/Domestic Partner $46.00 $2,392.00 $68.00 $3,536.00 $1,144 00

Employee + Child(ren) $41.00 $2,132.00 $62.00 $3,224.00 $1,092 00

Employee + Family $62.00 $3,224.00 $93.00 $4,836.00 $1,612 00

MetLife Dental Plan (Select Dental)*

Employee Only $4.00 $208.00 $6.00 $312.00 $104 00



Employee + Family $8.00 $416.00 $12.00 $624.00 $208 00

Vision Service Plan (Select Vision)*Employee Only $2.00 $104.00 $3.00 $156.00 $52 00



Employee + Family $5.00 $260.00 $6.00 $312.00 $52 00

EMPLOYEE Cost SHARING

20

Contact INFORMATION

Benefit Plans Phone Website/Email Plan Number

Medical PlansBlue Shield of California 1-888-235-1765 www.blueshieldca.com 2024107

Kaiser Permanente 1-800-464-4000 (English)

1-800-788-0616 (Spanish)

www.kp.org Northern CA: 600526

Southern CA: 227440

Dental PlanMetLife 1-800-942-0854 www.metlife.com/mybenefits 312030

Vision PlanVision Service Plan (VSP) 1-800-877-7195 www.vsp.com 00103825

Flexible Spending Accounts PlanChard-Snyder 1-888-467-2718 www.chard-snyder.com/secora N/A

Basic Life and AD&D Insurance Plans

MetLife1-800-Get-Met8

(1-800-438-6388)www.metlife.com/mybenefits 312030

Long Term Disability Income Insurance Plan (LTD)

MetLife1-800-Get-Met8

(1-800-438-6388)www.metlife.com/mybenefits 312030

Voluntary Insurance PlansMetLife 1-800-Get-Met8

(1-800-438-6388)www.metlife.com/mybenefits N/A

Employee Assistance ProgramClaremont EAP 1-800-834-3773 www.claremonteap.com 14672

MetLaw Legal Plan 1-800-438-6388 www.legalplans.com N/A

InfoArmor Identity Theft Plan 1-800-789-2720 www.myprivacyarmor.com N/A

Purchasing ProgramPurchasing Power 1-866-670-3479 www.SaveMart.purchasingpower.com N/A

The Save Mart Companies Benefits Department 1-209-548-6507 [email protected] N/A

Benefits CenterSecova 1-888-926-5674

Fax: 1-888-837-9623www.savemartbenefits.ielect.com

Email: [email protected]/A

Employee Self Service: http://savemart achievers com

21

IMPORTANT InformationIMPORTANT INFORMATION

Your Payment Responsibility – Non-PPO ProvidersThe amount the plan pays for covered services provided by non-network providers is based on a maximum allowable amount for the specific service rendered. Although your plan stipulates an out-of-pocket maximum for out-of-network services, please note the maximum allowed amount for an eligible procedure may not be equal to amount charged by your out-of-network provider. Your out-of-network provider may bill you for the difference between the amount charged and the maximum allowed amount. This is called balance billing and the amount billed to you can be substantial. The out-of-pocket maximum outlined in your policy will not include amounts in excess of the allowable charge and other non-covered expenses as defined by your plan. The maximum reimbursable amount for non-network providers can be based on a number of schedules such as a percentage of reasonable and customary or a percentage of Medicare. Contact your claims payer or insurer for more information. The plan document or carrier’s master policy is the controlling document, and this Benefit Highlight does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual plan language.

Notice of Special Enrollment RightsIf you are declining enrollment for yourself or any of your dependents because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan (if you or your dependents lose eligibility for that other coverage). However, you must request enrollment within 30 days after other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. We urge you to notify us as soon as possible, including before the effective date of the event. To request special enrollment or obtain more information, contact the Benefits Department.

Notice Regarding the Newborns’ ActGroup health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information, please visit www.dol.gov/EBSA.

Notice of Women’s Health and Cancer Rights Act (WHCRA) Our medical plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all states of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema.

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed,

• Surgery and reconstruction of the other breast to produce a symmetrical appearance,

• Prostheses, and

• Treatment of physical complications of the mastectomy, including lymphedema.

continued...

22

IMPORTANT Information CONTINUED

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Please review the plan option you elected to determine the actual deductible and coinsurance provisions. Contact the Benefits Department for more information.

HIPAA Special Enrollment Notice Our records show that you are eligible to participate in the Health Plan. (To actually participate, you must complete an enrollment form and pay part of the premium through payroll deduction.)

A federal law called HIPAA requires that we notify you about an important provision in the plan: If you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect, and later lose that other coverage for certain qualifying reasons, you have a right to enroll in the plan under its “special enrollment provision”.

Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program)

If you decline enrollment for yourself or for an eligible dependent (including your spouse/registered domestic partner) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

Loss of Coverage for Medicaid or a State Children’s Health Insurance Program

If you decline enrollment for yourself or for an eligible dependent (including your spouse/registered domestic partner) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program.

New Dependent by Marriage, Birth, Adoption, or Placement for Adoption

If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

Eligibility for Medicaid or a State Children’s Health Insurance Program

If you or your dependents (including your spouse/registered domestic partner become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance. To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact the Payroll and Benefits Department.

Important Warning.

If you decline enrollment for yourself or for an eligible dependent, you must complete an Opt-Out or Waiver Affirmation form. On the form, you are required to state that coverage under another group health plan or other health insurance coverage (including Medicaid or a state children’s health insurance program) is the reason for declining enrollment, and you are asked to identify that coverage.

If you do not complete the form, you and your dependents will not be entitled to special enrollment rights upon a loss of other coverage as described above, but you will still have special enrollment rights when you have a new dependent by marriage, birth, adoption, or placement for adoption, or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, as described above.

continued...

23

IMPORTANT Information CONTINUED

Important WarningIf you do not gain special enrollment rights upon a loss of other coverage, you cannot enroll yourself or your dependents in the plan at any time other than the plan‘s annual open enrollment period, unless special enrollment rights apply because of a new dependent by marriage, birth, adoption, or placement for adoption, or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan. Further, anyone whom you enroll during annual open enrollment will be treated as a “late enrollee” (unless that person happens to be entitled to special enrollment during the annual open enrollment period).

Children’s Health Insurance Program (CHIP)If you lose our company health coverage and if you or your children are eligible for Medicaid or CHIP, your State may have a premium assistance program that can help pay for coverage. Some States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.

Summary of Benefits and CoverageAs an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across plans. The SBCs are available from our Benefits Department.

Continuation Of Coverage RightsYour group health plan may contain certain options to continue your and or your dependent’s health benefits following termination of coverage.

These continuation options may include federal COBRA rights, conversion rights, and/or state mandated continuation rights. Commencing January 1, 2014, State and Federal Marketplace exchanges can also provide medical coverage with no health questions plus you may be eligible to qualify for a subsidy to make the coverage affordable to you. Additionally, your group life insurance certificates or booklets may also include and describe certain continuation options that may be available to you. Please examine your options carefully before declining this coverage. You should be aware that companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage entirely.

Notice Of Availability Of Privacy PracticesOur company provides health care benefits and related benefits to eligible employees and their eligible dependents. By so doing, it may create, receive, use, and maintain health information about plan participants which is protected by federal law (protected health information or PHI). The Health Insurance Portability and Accountability Act (HIPAA) requires health plan(s) to provide plan participants and others with a notice of the plan’s privacy practices with regard to the health information it creates and maintains in the course of providing benefits (Notice of Privacy Practices). This Notice of Privacy Practices describes the ways the plan uses and discloses PHI. To obtain a copy of the plan’s Notice of Privacy Practices, you should contact the member services department for your health coverage. Their contact information is located on your ID card the notice is generally available on their respective websites. Additionally, you may contact our Benefits Department.

More InformationMore information about your rights can be found in your Summary Plan Description, insurance certificates or booklets, as well as any required notices that are sent to you separately regarding these rights. If you would like more information about any of these notices, please contact the Benefits Department.

BenefitsPortfolioEmployee

2017

Whole Life Insurance Product Overview

Why is having Whole Life insurance protection so important?

Because Whole Life insurance helps protect your loved ones for your entire life, not just during your employment, if something should happen to you. The group term life insurance your employer may offer is an excellent benefit to help protect your loved ones should something unexpected happen to you during your working years. An ideal complement to that group term life insurance is Whole Life insurance. Whether you’re single, have a spouse/domestic partner, or a growing family, someone depends on you.

Almost 9 in 10 Americans view life insurance as a necessity; however, only 6 of 10 Americans say they actually own some sort of life insurance, with half of American households saying they needed more life insurance.1 It’s important to take steps to make sure your family would be financially prepared if you were no longer there to handle expenses like:

o Mortgage or rent payments

o Utilities

o Insurance premiums

o Food

o Transportation

o Child care/education fees

Help protect your loved ones today and, more importantly, tomorrow.

Underwritten by Texas Life Insurance Company Distributed by your MetLife representative continued >>

Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 www.metlife.com

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1 LIMRA, 2013 Insure Your Love Fact Sheet. 2 “How Much Life Insurance Do I Need?” www.nolo.com, accessed 11/28/12. 3 Coverage can never be cancelled, as long as the insured pays the level premiums when due. 4 In most states, the Accelerated Death Benefit due to Terminal Illness Rider provides a death benefit of 92.6% (92% in CA, CT, DC, DE, FL, ND & SD) of the face amount less a $150 administration fee ($100 in Florida) in lieu of the policy death benefit. Conditions apply. Any outstanding loans will reduce the cash value and death benefit. (Policy form ULABR-11 or ICC11-ULABR-11) 5 Coverage and spouse/domestic partner eligibility may vary by state and is not available in all states. Coverage not available for children and grandchildren in Washington. In certain states, availability of an individual policy for spouses/domestic partners, dependent children and grandchildren is pending regulatory approval. The employee does not have to apply for the spouse/domestic partner, children and/or grandchildren to apply for an individual policy. (Policy form WLOTO-NI-11 or ICC11-WLOTO-NI-11)

Texas Life Whole Life Insurance is available through your MetLife representative and is underwritten by Texas Life Insurance Company, 900 Washington, Waco, Texas. Texas Life is not affiliated with Metropolitan Life Insurance Company or its affiliates. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. 13M122-C 1076 R1115 (TXLife). Please contact MetLife for more information.

Why should I apply now?

Your health may change inthe future.

The premiums are based onyour age at issue.

Now is a great time to take advantage of the affordable and convenient coverage being offered by your employer.

Do you have enough life insurance for now and in the future? 41% or 95 million adults in the U.S. have no life insurance at all.1

How can having Whole Life insurance benefit you? How much life insurance you need is a very individual matter, based on your own personal situation. Because of that, various experts suggest you have anywhere from 5 to 10 times your annual income in life insurance protection.2

Purchasing Whole Life insurance, underwritten by Texas Life Insurance Company, may be a great supplement to your employer-offered plan because it provides coverage for your entire life, not just while you’re working. Whole Life insurance is a policy that you own; it can never be cancelled, even if your health changes.3 Because you own it, you can take it with you when you change jobs or retire with no change in the premium. It helps ensure that short and long term financial obligations could be taken care of if something unforeseen should happen.

You may have the ability to purchase Whole Life Insurance coverage that includes the following features:

o Applying for coverage is easyYou can qualify if you are actively at work and answer a work statusquestion.

o Paid-up insurance at retirementPremiums are guaranteed to remain level until age 65 or for 20 years if thepolicy is purchased at age 46 or later. At that time, the policy becomes fullypaid up and no further premiums are due.

o Accelerated Death Benefit due to Terminal Illness rider4

Pays 92.6% of death benefit in most states if an insured becomes terminallyill.

o Spouse/domestic partner, dependent children andgrandchildren coverageCan be purchased through an individual policy. 5

o Portable coverageEnables you to take your coverage with you when you change jobsor retire.

Apply today!

Whole Life Insurance FAQs

Frequently Asked Questions

Q. What is Whole Life Insurance? A. Whole Life Insurance is the life insurance you own, even when you change jobs or retire.1 Whole Life Insurance, underwritten by Texas Life Insurance Company, is a great way to help protect your loved ones now and into retirement. It’s important to take steps to make sure your family would be financially prepared if you were no longer there to handle expenses like:

Mortgage or rent payments Insurance premiums Child care/education fees Utilities Transportation Aging parent costs

Q. Who is eligible to apply for this coverage? A. You, your spouse/domestic partner, your children and your grandchildren. Spouse/domestic partner, dependent children and grandchildren coverage can be purchased through an individual policy.2

Q. I have a Group Term Life plan at work. Why do I need Whole Life Insurance? A. Purchasing Whole Life Insurance may be a great supplement to your employer-offered plan because it protects your loved ones for your entire life, not just while you’re working. Whole Life Insurance is a policy that you own; it can never be cancelled, even if your health changes. Because you own it, you can take it with you when you change jobs or retire with no change in the premium. It helps ensure that short- and long-term financial obligations could be taken care of if something unforeseen should happen.

Q. Can I apply for this coverage without having to answer medical questions or take a medical exam? A. Because this coverage is available through your employer, you could qualify for coverage if you are actively at work and answer a work status question.

Underwritten by Texas Life Insurance Company Distributed by your MetLife representative

continued >>

Help protect your loved ones for your entire life, not just while you’re working.


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1 Coverage can never be cancelled, as long as the insured pays the level premiums when due. (Policy form WLOTO-NI-11 or ICC-11-WLOTO-NI-11) 2 Coverage and spouse/domestic partner eligibility may vary by state and is not available in all states. Coverage not available for children and grandchildren in Washington. In certain states, availability of an individual policy for spouses/domestic partners, dependent children and grandchildren is pending regulatory approval. The employee does not have to apply for the spouse/domestic partner, children and/or grandchildren to apply for an individual policy. 3 In most states, the Accelerated Death Benefit due to Terminal Illness Rider provides a death benefit of 92.6% (92% in CA, CT, DC, DE, FL, ND & SD) of the face amount less a $150 administration fee ($100 in Florida) in lieu of the policy death benefit. Conditions apply. Any outstanding loans will reduce the cash value and death benefit. (Policy form series ULABR-11 or ICC11-ULABR-11)

Texas Life Whole Life Insurance is available through your MetLife representative and is underwritten by Texas Life Insurance Company, 900 Washington, Waco, Texas. Texas Life is not affiliated with Metropolitan Life Insurance Company or its affiliates. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. 15M157-C 1072 (TXLife). Please contact MetLife for more information.

Q. How do I pay for my coverage? A. Premiums will be paid through convenient payroll deduction, so you don’t have to worry about writing a check or missing a payment. If you should change jobs or retire before the policy becomes paid up, you simply pay the monthly premium directly to MetLife by automatic bank draft or monthly bill.

Q. How much does Whole Life insurance cost? A. It may be less expensive than you think! This whole life insurance plan is an economical way for you to provide for your loved ones. Paid-up insurance at retirement means premiums are guaranteed to remain level until age 65 or for 20 years if the policy is purchased at age 46 or later. At that time, the policy becomes fully paid up and no further premiums are due.

Q. What if I become terminally ill? A. An accelerated death benefit due to terminal illness rider3 is included in your policy. To help cover extra expenses if you experience a terminal illness that is expected to result in death within 12 months, you may elect to claim an accelerated death benefit to use as you see fit while you are still living and is in lieu of the face amount payable at death. This benefit will be calculated and paid out as a lump sum, and you may elect to receive this lump sum benefit payable under one of the Optional Income Plans set forth in your base policy. For more information, refer to your enrollment materials.

HAVE OTHER QUESTIONS?

Please call MetLife directly at [1 800

GET-MET8 (1-800-438-6388)]

and talk with a benefits consultant.

Critical Illness Insurance Product Overview

Why is having Critical Illness Insurance so important? Your family’s expenses will continue if and when a critical illness occurs. Studies show that some families spend as much as $14,444 or more during a time of critical illness and recovery.1 And while financial experts recommend having 3 – 9 months of living expenses set aside to help in an emergency situation2 like undergoing a serious illness, with today’s economy, most families don’t have that kind of money in reserve.

Quality health and disability insurance plans aren’t always enough. There may still be coverage gaps. Disability income plans cover a portion of your income while health insurance may leave you with some expenses to pay including:

o Health plan deductibleso Prescription copayso Out-of-network treatmentso Alternative treatments

Critical illnesses can happen at any age and more often than you may think. The odds of you or a family member suffering a critical illness are actually quite surprising. Studies have shown:

o The average age for onset of a critical illness is 43.3

o Every year about 715,000 Americans have a heart attack.4

o 1 out of every 2 men will be diagnosed with cancer at some point intheir lives.5

o 1 out of every 3 women will be diagnosed with cancer at some pointin their lives.5

Critical Illness Insurance can help safeguard your finances by providing you with a lump-sum payment when your family needs it most. The payment you receive is yours to spend as you see fit and in addition to any other insurance you may have.

ADF# CI542.14

continued >>

Help protect yourself, your family, and your budget from the financial impact of a critical illness.


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1 MetLife Accident and Critical Illness Impact Study, October 2013. 2 www.bankrate.com, How big should your emergency fund be?, Accessed January 2016. 3 e-personalFinance.com, How Does Critical Illness Insurance Work, Accessed March 2014. 4 CDC, www.cdc.gov/HeartDisease/facts.htm. Accessed March 2014. 5 American Cancer Society, Cancer Facts and Figures 2013. 6 Eligible Family Members mean all persons eligible for coverage as defined in the Certificate. 7 Please review the Outline of Coverage/Disclosure Document for specific information about cancer benefits. Not all types

of cancer are covered. Some cancers are covered at less than the Initial Benefit Amount. For NH-sitused cases and NH residents, there is an Initial Benefit of $100 for All Other Cancer.

8 In certain states, the Covered Condition is Severe Stroke. 9 In NJ sitused cases, the Covered Condition is Coronary Artery Disease. 10 Please review the Outline of Coverage for specific information about Alzheimer’s disease. 11 MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount for each of the 22 Listed Conditions until

the Total Benefit Amount is reached. A Covered Person may only receive one payment for each Listed Condition in his/her lifetime. The Listed Conditions are: Addison’s disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou Gehrig’s disease); cerebrospinal meningitis (bacterial); cerebral palsy; cystic fibrosis; diphtheria; encephalitis; Huntington’s disease (Huntington’s chorea); Legionnaire’s disease; malaria; multiple sclerosis (definitive diagnosis); muscular dystrophy; myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis.

12 We will not pay a Recurrence Benefit for a Covered Condition that Recurs during a Benefit Suspension Period. We will not pay a Recurrence Benefit for either a Full Benefit Cancer or a Partial Benefit Cancer unless the Covered Person has not had symptoms of or been treated for the Full Benefit Cancer or Partial Benefit Cancer for which we paid an Initial Benefit during the Benefit Suspension Period.

13 Coverage is guaranteed provided (1) the employee is actively at work and (2) any dependents to be covered are not under medical restriction as described in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas. For CA sitused cases, coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of your job at the employer's place of business or at an alternate place approved by your employer (2) dependents are not subject to medical restrictions as set forth on the enrollment form and in the Certificate.

14 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative.

METLIFE’S CRITICAL ILLNESS INSURANCE (CII) IS A LIMITED BENEFIT GROUP INSURANCE POLICY. Like most group accident and health insurance policies, MetLife’s CII policies contain certain exclusions, limitations and terms for keeping them in force. Product features and availability may vary by state. In most plans, there is a preexisting condition exclusion. In most states, after a covered conditon occurs there is a benefit suspension period during which most plans do not pay recurrence benefits. Attained Age rates are based on 5-year age bands and will increase when a Covered Person reaches a new age band. A more detailed description of the benefits, limitations, and exclusions applicable to CII can be found in the applicable Disclosure Statement or Outline of Coverage/Disclosure Document available at time of enrollment. For complete details of coverage and availability, please refer to the group policy form GPNP07-CI or GPNP09-CI, or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York.

MetLife's Critical Illness Insurance is not intended to be a substitute for Medical Coverage providing benefits for medical treatment, including hospital, surgical and medical expenses. MetLife's Critical Illness Insurance does not provide reimbursement for such expenses.

Why should I enroll now?

Competitive employee rates

Your acceptance isguaranteed providing youare actively at work13

Enrollment period endssoon

Convenient payrolldeduction

Portable coverage enablesyou to take it with you ifyour employment statuschanges14

Enroll today!

How can having MetLife Critical Illness Insurance benefit you and your loved ones? MetLife Critical Illness Insurance provides a lump-sum payment if you or a covered family member6 is diagnosed with one of the following medical conditions and meets the policy and certificate requirements: Full Benefit Cancer,7 Partial Benefit Cancer,7 Heart Attack, Stroke,8 Coronary Artery Bypass Graft,9 Kidney Failure, Alzheimer’s disease,10 Major Organ Transplant and the 22 Listed Conditions.11 Your plan pays a Recurrence Benefit for the following Covered Conditions: Heart Attack, Stroke, Coronary Artery Bypass Graft, Full Benefit Cancer and Partial Benefit Cancer. A Recurrence Benefit is only available if an Initial Benefit has been paid for the Covered Condition. There is a Benefit Suspension Period between Recurrences.12

Payments will be made directly to you, not to the doctors, hospitals or other health care providers. You will receive a check mailed directly to your home. The payment you receive is yours to spend as you see fit and may be used to cover ongoing household bills like:

o Grocerieso Mortgage and car paymentso Child careo Or any other way you want; the choice is yours

http://www.bankrate.com/

http://www.cdc.gov/HeartDisease/facts.htm

Critical Illness Insurance FAQs

Frequently Asked Questions Q. What is Critical Illness Insurance? A. This is coverage that can help cover the extra expenses associated with a serious illness. When a serious illness happens to you or a loved one, this coverage provides you with a lump-sum payment of $15,000 or $30,000 in Initial Benefits upon diagnosis. The Total Benefit Amount available to you is 3 times the Initial Benefit Amount, which is $45,000 or $90,000, in the event that you suffer more than one Covered Condition. Payment(s) you receive will be made in addition to any other insurance you may have and may be spent as you see fit.

Q. What types of illnesses are covered under this plan? A. If you meet the group policy and certificate requirements, Critical Illness Insurance provides you with a lump-sum payment upon diagnosis of the following conditions:

Full Benefit Cancer1 Coronary Artery Bypass Graft3

Partial Benefit Cancer1 Alzheimer’s disease4

Heart Attack Major Organ Transplant Stroke2 22 Listed Conditions5 (see your Outline of

Coverage for details) Kidney Failure

Q. What happens if I have a recurrence? A. Your plan pays a Recurrence Benefit for the following covered conditions: Heart Attack, Stroke, Coronary Artery Bypass Graft, Full Benefit Cancer and Partial Benefit Cancer. A Recurrence Benefit is only available if an Initial Benefit has been paid for the Covered Condition. There is a Benefit Suspension Period between Recurrences.6

Q. Who is eligible to enroll for this coverage? A. You and your eligible family members!7 You just need to apply during your enrollment period.

Q. I have a good medical plan at work. Why do I need Critical Illness insurance? A. Even quality medical and disability income plans don’t always cover all of your expenses. For example, your medical coverage may have deductibles and copays and may not cover out-of-network treatments. And if you’re out on disability, only a portion of your income may be covered. With the average family spending thousands of dollars during a time of critical illness and recovery,8 most people will need the means to cover extra medical and daily living expenses. Such costs can include deductibles or items like groceries, housing expenses, car payments, and more.

Q. Can I enroll for this coverage without having to take a medical exam? A. Yes. Provided you are actively at work, your enrollment is guaranteed.9

Payments may be used to help pay for expenses generally not covered by medical and disability

income coverage.

ADF# CI543.14

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A. Yes. This plan provides a $50 annual benefit per calendar year for eligible health screenings/prevention measures. This benefit amount is above and beyond the Total Benefit Amount.10

Q. Are there any other benefits pay able under this Critical Illness insurance plan?

Q. How much does Critical Illness insurance cost? A. This coverage may be less expensive than you think! You can put this coverage in place as a way to supplement your medical and disability income plans. Exact rates can be found in the materials provided by your employer.

Q. How do I pay for my coverage? A. Premiums will be conveniently paid through payroll deduction, so you never have to worry about writing a check or missing a payment.

Q. Are payments made directly to me or my health care provider? A. Payments will be made directly to you, not to the doctors, hospitals or other health care providers. You will receive a check, mailed directly to your home.

Q. What happens if my employment status changes? Can I take my coverage with me? A. Yes. This coverage is “portable,” meaning you can take it with you if your employment status changes.11

1 Please review the Disclosure Statement or Outline of Coverage/Disclosure Document for specific information about cancer benefits. Not all types of cancer are covered. Some cancers are covered at less than the Initial Benefit Amount. For NH-sitused cases and NH residents, there is an initial benefit of $100 for All Other Cancer.

2 In certain states, the Covered Condition is Severe Stroke. 3 In NJ sitused cases, the Covered Condition is Coronary Artery Disease. 4 Please review the Outline of Coverage for specific information about Alzheimer’s disease. 5 MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount for each of the 22 Listed Conditions until the Total

Benefit Amount is reached. A Covered Person may only receive one payment for each Listed Condition in his/her lifetime. The Listed Conditions are: Addison’s disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou Gehrig’s disease); cerebrospinal meningitis (bacterial); cerebral palsy; cystic fibrosis; diphtheria; encephalitis; Huntington’s disease (Huntington’s chorea); Legionnaire’s disease; malaria; multiple sclerosis (definitive diagnosis); muscular dystrophy; myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis.

6 MetLife will not pay a Recurrence Benefit for a Covered Condition that Recurs during a Benefit Suspension Period. MetLife will not pay a Recurrence Benefit for either a Full Benefit Cancer or a Partial Benefit Cancer unless the Covered Person has not had symptoms of or been treated for the Full Benefit Cancer or Partial Benefit Cancer for which we paid an Initial Benefit during the Benefit Suspension Period.

7 Eligible Family Members means all persons eligible for coverage as defined in the Certificate. 8 MetLife Accident and Critical Illness Impact Study, October 2013. 9 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents are not subject to medical restrictions as

set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas. For CA sitused cases, coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of your job at the employer’s place of business or at an alternate place approved by your employer (2) dependents are not subject to medical restrictions as set forth on the enrollment form and in the Certificate.

10 The Health Screening Benefit is not available in all states. See your certificate for any applicable waiting periods. There is a separate mammogram benefit for MT residents and for cases sitused in CA and MT.

11 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative.

METLIFE’S CRITICAL ILLNESS INSURANCE (CII) IS A LIMITED BENEFIT GROUP INSURANCE POLICY. Like most group accident and health insurance policies, MetLife’s CII policies contain certain exclusions, limitations and terms for keeping them in force. Product features and availability may vary by state. In most plans, there is a preexisting condition exclusion. In most states, after a covered condition occurs there is a benefit suspension period during which most plans do not pay recurrence benefits. Attained Age rates are based on 5-year age bands and will increase when a Covered Person reaches a new age band. A more detailed description of the benefits, limitations, and exclusions applicable to CII can be found in the applicable Disclosure Statement or Outline of Coverage/Disclosure Document available at time of enrollment. For complete details of coverage and availability, please refer to the group policy form GPNP07-CI or GPNP09-CI, or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. MetLife’s Critical Illness Insurance is not intended to be a substitute for Medical Coverage providing benefits for medical treatment, including hospital, surgical and medical expenses. MetLife’s Critical Illness Insurance does not provide reimbursement for such expenses.


Please call MetLife directly at

1 800 GET-MET8 (1-800-438-6388)


Accident Insurance Product Overview

Why is having Accident insurance so important? Accidents can happen at any time and when you least expect them. Today’s active lifestyles may make you more susceptible, too.

Accidents can happen at any time: every 2 seconds at home … every 6 seconds at work … and every 9 seconds on the road.1 You can’t plan for accidents, but you can be better prepared financially to handle them when they happen. In the U.S. in 2011, there were more than 40,000,000 trips to the emergency room due to accidents.2 At an average cost of $1,354 per visit,3 it’s easy to see why having accident coverage makes good financial sense. Just think about the likelihood of having an accident:

o Your child gets hurt playing sports or on the school playgroundo You injure yourself while doing home repairs or while on vacation

Even the best medical plans may leave you with extra expenses to pay out of your own pocket.

As good as the health care is that you receive today, an accident can require a variety of treatments, tests, therapies and other care and services to assist in recovery. Each of these services usually means extra out-of-pocket costs for you to pay, beyond what your medical plan may cover, including:

o Medical plan deductibleso Copayments for doctor visits and specialist care, as well as

prescription drugso Extra costs for out-of-network care and treatment

Other household expenses may be harder to cover due to lost or reduced income, like your mortgage, car payment, child care or household upkeep while you recover.

Accident insurance can help you be better prepared by providing you with a payment to use as you see fit if you experience a covered event. There are no waiting periods for coverage to begin and payment will be in addition to any other insurance you may have. This payment can help you focus more on getting back on track and less on the extra expenses an accident may bring.

continued >>

You can’t plan for accidents, but you can be better prepared financially to handle them when they happen.

ADF# AI641.14


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1 National Safety Council (2012) Injury Facts, 2012 Edition. Itasca, IL: Author (based on a 2010 US resident population of 309.6 million with 19.9 million reported injuries).

2 National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables (based on 136.3 million total annual ER visits).

3 Agency for Healthcare Research and Quality. Emergency Room Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2011. Medical Expenditure Panel Survey Household Component Data. Generated interactively. (February 12, 2014)

4 Covered services/treatments must be the result of a covered accident as defined in the group policy/certificate. See the Disclosure Statement or Outline of Coverage/ Disclosure Document for more details.

5 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents to be covered are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.

METLIFE'S ACCIDENT INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. There is a preexisting condition exclusion for hospital sickness benefits, if applicable. There are benefit reductions that begin at age 65. And, like most group accident and health insurance policies, policies offered by MetLife may contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York.

Why should I enroll now?

ü You and your eligible family members are guaranteed acceptance.5

ü Competitive group rates

ü Convenient payroll deduction ensures continuous, worry-free coverage

Enroll today!

With MetLife Accident insurance, you can take your coverage with you if your employment status changes.

How can having MetLife Accident insurance benefit you? This plan provides a lump-sum payment for over 150 different covered events, such as these:

o Fractures o Concussionso Dislocations o Cuts/lacerationso Second and third degree burns o Eye injurieso Skin grafts o Comao Torn knee cartilage o Broken teetho Ruptured disc

You receive a lump-sum payment when you have these covered medical services/treatments:4 o Ambulance o Physician follow-up visitso Emergency care o Transportationo Inpatient surgery o Home modificationso Outpatient surgery o Therapy services including:o Medical Testing Benefits

including:− X-rays− MRIs− CT scans

− Physical and occupational therapy

This plan provides protection for covered events experienced while off the job only. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details on your coverage.

Accident InsuranceFAQs

1

Frequently Asked Questions Q. What is Accident insurance? A. Accident insurance coverage provides you with payment for a covered accident. It also pays if you undergo testing, receive medical services, treatment or care for any one of more than 150 covered events as defined in your group certificate. This includes hospitalization resulting from an accident and accidental death or dismemberment.

Payments are made directly to you to use as you see fit. They can be used to help pay for medical plan deductibles and copays, out-of-network treatments, your family’s everyday living expenses, or whatever else you need while recuperating from an accident.

Q. Who is eligible to enroll for this Accident coverage? A. You and your eligible family members! You just need to enroll during your enrollment period and be actively at work for coverage to be effective.

Q. I have a good medical plan at work. Why do I need Accident insurance? A. Because accidents can happen anytime, anywhere, when you least expect them, and they can be costly. You hurt your back while doing home repairs, your child is injured while on the playground or playing sports, or your spouse slips on the stairs.

Even quality medical plans can leave you with extra expenses to pay. Costs like plan deductibles, copays for doctor and emergency room care, testing and supplies, or extra costs for out-of-network care to name a few. Many people aren’t financially prepared to handle these extra costs. Having the extra financial support you may need when the time comes may mean less worry for you and your family.

Q. Can I enroll for this insurance without having to take a medical exam? A. Yes! Your Accident coverage is guaranteed issue1, which means your acceptance is guaranteed, regardless of your health. You just need to be actively at work for your coverage to be effective. There are no medical exams to take and no health questions to answer.

Q. How much does Accident coverage cost? A. It may be less expensive than you think! Accident insurance is designed to be an economical way for you to supplement your health care plan. Exact rates can be found in the enrollment materials provided by your employer.

ADF# AI368.12

[Employer Logo]

Accident insurance is designed to be an economical way for you to supplement your health care plan.

continued >>

1 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents to be covered are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.

METLIFE'S ACCIDENT INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. There is a preexisting condition exclusion for hospital sickness benefits, if applicable. There are benefit reductions that begin at age 65. And, like most group accident and health insurance policies, polices offered by MetLife may contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York.


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2

Q. How do I pay for my Accident coverage? A. Premiums will be conveniently paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment.

Q. Is there a waiting period before my coverage begins? A. No. Your Accident coverage will be in force on the effective date of your coverage. There are no waiting periods to satisfy.

Q. Are benefits paid directly to me or to my health care provider? A. Payments will be paid directly to you, not to the doctors, hospitals or other health care providers. You will receive a check, payable to you, for maximum convenience.

Q. What happens if my employment status changes? Can I take my coverage with me? A. Yes, you can take your accident insurance coverage with you. You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier.

Q. Does this plan cover any other out-of-pocket costs? A. Yes, you can use your payment as you see fit. Use it to help cover your medical insurance deductibles, copays, household bills and more.

Q. Is the claims process simple? A. Yes! Once all required information is received, claims are generally processed within 10 business days. Only one claim form is needed per accident and every claim is reviewed by a claims professional.


Please callMetLife directly at 1 800 GET-MET8 (1-800-438-6388)


You can’t plan for accidents,but you can be betterprepared financially tohandle them when they happen.

Call toll-free, 24 hours a day, seven days a week: 800-834-3773 Or visit us at: www.claremonteap.com

The Claremont Employee Assistance Program (EAP) helps you resolve personal issues before they become more serious and difficult to manage. You and your eligible family members can receive professional, confidential counseling at no cost. We also provide access to resources that can help you address virtually any personal concern or question. EAP is available to all Save Mart benefit-eligible employees and their families. Who provides the EAP? Claremont is a firm of select professionals who can help you with life’s challenges. You will be referred to a conveniently located counselor or resource with expertise in your area of concern.

Who will know? The EAP is a confidential service. Claremont understands the importance of maintaining your privacy. Your involvement with Claremont is afforded the maximum confidentiality permitted under the law.

At what cost? There is no cost to you or your covered dependents for EAP services.

What’s the first step? Call 800-834-3773 to discuss your question or issue with an experienced counselor who will refer you to the resources most appropriate for your needs.

Provided to Employees and Covered Dependents of Save Mart Supermarkets

800-834-3773 www.claremonteap.com

Counseling visits The EAP offers 5 free counseling visits per

incident per 12 months for almost any

personal issue. Our staff will work with you to

find the most appropriate counselor to meet

your needs.

• Marital/Relationship issues

Parenting/Family issues

• Work concerns

• Depression

• Anxiety

• Stress

• Substance abuse

• Other issues impacting your quality of life

Work/Life referrals* Our Work/Life consultants can provide you

with referrals and information for services such

as:

• Child care

• Elder care

• Pet care

• Adoption assistance

• School/College assistance

• Health and wellness

• Convenience referrals *The EAP cannot offer recommendations for Work/Life Referrals.

Individuals have the responsibility to evaluate and choose the

most appropriate services to meet their needs.

Legal consultation Attorneys are available to answer your

legal questions, either in-person or over

the phone. We provide up to 30

minutes of free consultation per issue.

On-going services, if required, are

offered at a 25% discount. The EAP can

assist with legal issues such as:

• Divorce

• Child custody

• Real estate

• Personal injury

• Criminal law

• Free simple will kits

Financial consultation The EAP offers one free 30-60 minute

telephonic consultation per issue for a

variety of important financial concerns,

including:

• Budgeting

• Debt management

• Financial planning

• First time home buyer program

• Tax questions

• Identity fraud service

• Free credit report/review

Save Mart Supermarkets

blueshieldca.com

Treatment Cost Estimator with member

out-of-pocket calculations

Blue Shield has rolled out a new Treatment Cost Estimator tool that provides PPO plan members with estimates of both the total cost and out-of-pocket expenses for common in-network medical treatments and services. These estimates provide the transparency and clarity to help our members’ budget and to plan for future healthcare expenses.

Online and Mobile Tools

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* The Treatment Cost Estimator tool allows PPO members to research treatment and service cost estimates for family members under the same plan who have been set up under the Manage Family tab.

Note: The information provided by the Treatment Cost Estimator tool is for reference only and actual out-of-pocket costs may vary. For full disclosure, visit https://www.blueshieldca.com/bsca/popups/treatment-cost-estimator-disclaimer.sp.

•Thereareestimatesformorethan400of the most common treatments and services by in-network providers.

•Costestimatesreflectclaimsdatagathered from Blue Shield’s provider network. For out-of-state searches, the Treatment Cost Estimator tool uses the nationwide provider network accessible to Blue Shield members.

•Memberout-of-pocketestimatesforsubscribers and their family members are based on current plan and deductible balances.*

•Treatmentsearchresultsaredisplayed on a scrolling carousel and include these and more: – Facility location information– Total treatment and service cost

estimates, which include estimated costs for the facility and doctors from admission to discharge

– Member’s estimated in-network out-of-pocket cost

– Each facility’s distance from subscriber’s home location

– Number of members treated– Identification of Blue Distinction

Centers,® a recognition program that identifies hospitals with proven expertise in delivering specialty care.

Treatment Cost Estimator with member out-of-pocket calculations

https://www.blueshieldca.com/bsca/popups/treatment-cost-estimator-disclaimer.sp

IMPORTANT NOTICE FROM SAVE MART SELECT HEALTH PLAN ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Save Mart Select Health Plan and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Save Mart Select Health Plan has determined that the prescription drug coverage offered by the Save Mart Select Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?If you decide to join a Medicare drug plan, your current Save Mart Select Health Plan coverage will be affected. Your current coverage pays for other health expenses in addition to prescription drug. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will [or will not] still be eligible to receive all of your current health and prescription drug benefits.If you do decide to join a Medicare drug plan and drop your current Save Mart Select Health Plan coverage, be aware that you and your dependents will not be able to get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?You should also know that if you drop or lose your current coverage with Save Mart Select Health Plan and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

continued...

For More Information About This Notice Or Your Current Prescription Drug Coverage…Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Save Mart Select Health Plan changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You”

handbook for their telephone number) for personalized help• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: 10/25/2016Name of Entity/Sender: The Save Mart Companies

Contact: Manager of Employee BenefitsAddress: 1800 Standiford Ave., Modesto, CA 95352

Phone Number: 1-209-548-6507Email Address: [email protected]

employee benefits portfolio - save mart · pdf filein case of conflict between the information...

Documents