2022 BENEFIT GUIDE for hourly employees - Robins & Morton
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2022 BENEFIT GUIDE for hourly employees
THINGS TO KNOW FOR 2022
· New Benefits: Robins & Morton has added three new benefits · R&M HSA deposits: Robins & Morton will match your weekly
for your wellbeing--a Care.com subscription, Virta, and contribution dollar for dollar until the R&M deposit limit has
SimpleHSA. been reached based on your coverage tier in the medical plan.
· HSA Contributions: The IRS sets the amounts you can · 401k Contributions: The 2022 annual limit is $20,000, with a
contribute to an HSA for 2022. If your coverage is employee $6,500 catch up for those age 50 and over.
only, you may contribute up to $3,650 and families may
contribute $7,300 in 2022. This total includes the annual · Blue Cross Blue Shield updated their contract cards. All
Robins & Morton contribution. There is an additional $1,000 employees enrolled in the medical plan will receive a new card.
catch-up amount allowed for employees 55 years and older.
· The annual dental plan maximum has increased to $2500 per
Manage your weekly contributions online through Fidelity at
enrolled person.
www.401k.com.
WHAT HAPPENS IF I DON’T ENROLL?
EXISTING EMPLOYEES
If you do not enroll during this time, you will be re-enrolled in the same plan you had in 2021. You must go through Open
Enrollment and enroll in the Limited Purpose Flexible Spending Account and Dependent Care Account or you will not
have a deduction in 2022. This does not carryover from year to year. Your next opportunity to enroll will be in the fall
of 2022 during the Open Enrollment period for the 2023 plan year.
NEW HIRES
If you choose not to enroll, you will not be covered for 2022. You are eligible to enroll in benefits after 90 days
of employment. You have 30 days from the eligibility date to enroll in benefits.
EMPLOYEES WITH LIFE EVENTS
If you have a qualifying life event (marriage, divorce, birth of a child, etc.), you are eligible to enroll in benefits within 30
days of the event date. Please contact HR if you have a life event during the year.
BUILDING FORWARD® & BENEFITS
Collaboration and innovation apply to your benefit programs, just as it does to the job. The improved 401k has lower cost
investments and allows immediate participation at your hire date. Fidelity has reduced the minimum to invest your HSA
to $1 on some investments so you can build your fund sooner. While some changes are small wins, let’s celebrate these
in our Building Forward culture. The wins are not only the benefits themselves, but also how the benefits provide good
value to you that are easy to use at an affordable cost.
(205) 803-0102
HR Remember, the HR Helpline is available to answer your
HELPLINE questions from 8am to 4pm CST Monday–Thursday and
8am to 2pm CST on Friday, with messages checked daily.
Benefits Guide
FOR HOURLY EMPLOYEES
H O U R LY E N R O L L M E N T F O R M 4 OT H E R B E N E F I T S 20
Dependent Care Account (DCA) 20
MEDICAL INSURANCE 7
Limited Purpose Flexible Spending Account (LPFSA) 20
Hourly Medical Plan 7
Care.com 21
Health Savings Account 8
Benefit Cards & Access 22
Prescription Plan 10
Telemedicine 11
H O U R LY M E D I C A L P L A N 24
Virta 12
D E LTA D E N TA L B E N E F I T S 26
D E N TA L I N S U R A N C E 13 VSP VISION BENEFITS 27
VISION INSURANCE 14 MET LIFE ACCIDENT INSURANCE 28
DISABILITY INSURANCE 15 MET LIFE INDEMNITY INSURANCE 28
Short Term Disability 15
G LO S S A R Y 29
Long Term Disability 15
Employee Assistance Program 16 YO U R R I G H T S , L E G A L N OT I C E S ,
AND DISCLAIMERS 31
Accident Insurance 17
HAS TERMS AND CONDITIONS 36
Indemnity Insurance 18
401(K) 19
The Robins & Morton Retirement Savings Plan 19
TWO WAYS TO ENROLL:
Enroll online at Complete the enrollment form that begins
hr.robinsmorton.net on the next page, then
· return it to the jobsite and
· e-mail to rmenroll@robinsmorton.com or
· fax to 205.439.8630
ENROLLMENT FORM
FOR OFFICE USE ONLY:
Date Received: ________________________ Date Entered:_________________________
Entered by: __________________________ Username/Password: __________________
Hourly Benefit
Enrollment Form
Please complete this form and your elections will be entered in the system for you. You may return the com-
pleted form to the jobsite, email to rmenroll@robinsmorton.com or fax the form to (205) 439-8630.
Name Date of Birth
Address City State Zip
- -
Social Security Number Email Address
Phone Number Alternate Phone Number
In the section below, please enter all dependents which will be covered in your benefits. If you need additional space, please add a page
to this form. Do not include any dependent below that will not be covered.
MEDICAL INSURANCE
WAIVE Medical Insurance
Employee Only Employee + Spouse Employee + Children Family
COVERED DEPENDENTS
NAME RELATIONSHIP SSN DOB ADDRESS CITY STATE ZIP
All dependents MUST have a social security number to be enrolled.
H E A LT H S AV I N G S A C C O U N T
Manage your contributions with Fidelity on 401k.com. If you do not have an open HSA with Fidelity, you must agree to the
terms and conditions in order to have an account opened for you. Please refer to the SimpleHSA terms and conditions on
page 36.
Check here if you agree to these terms and conditions.
WAIVE Health Savings Account Contribution
LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNT
DISCLAIMER: Use it or lose it, and can only be used for dental and vision expenses.
WAIVE Limited Purpose Flexible Spending Account Contribution
Amount:———————————————— per week ($2,750 maximum yearly contribution or $52.88 weekly maximum).
QUESTIONS? 205.803.0102
DEPENDENT CARE ACCOUNT
WAIVE Dependent Care Flexible Spending
Amount:————————————————— per week (maximum of $5,000.00 annually)
Please list the dependents to be covered by the dependent care flexible spending account:
Name
D E N TA L I N S U R A N C E
WAIVE Dental Benefit
Employee Only Employee + Spouse Employee + Children Family
Please indicate which dependents listed above should be covered by dental insurance:
Name
VISION INSURANCE
WAIVE Vision Benefit
Employee Only Employee + Spouse Employee + Children Family
Please indicate which dependents listed above should be covered by vision insurance:
Name
SHORT TERM DISABILITY INSURANCE
WAIVE Short Term Disability
ELECT Short Term Disability
LO N G T E R M D I S A B I L I T Y I N S U R A N C E
WAIVE Long Term Disability
ELECT Long Term Disability
MY.ROBINSMORTON.COMACCIDENT INSURANCE
You can elect insurance on yourself, your spouse and your child(ren). Please indicate the plan level of coverage, who is covered
then the beneficiaries of the policy.
WAIVE Accident Insurance
Level of Election—Accident Plan:
Low Plan High Plan
Employee Only Employee + Spouse Employee + Child Family
Dependent Covered Beneficiary Primary % Contingent % SSN DOB
You
Your dependent
INDEMNITY INSURANCE
WAIVE Hospital Indemnity Insurance
Level of Election—Indemnity Plan:
Low Plan High Plan
Employee Only Employee + Spouse Employee + Child Family
Please indicate which dependents listed above should be covered by indemnity insurance:
Name
I understand Robins & Morton has offered the benefits on this enrollment form and
acknowledge my selections.
Name:___________________________________________ Date:__________________
QUESTIONS? 205.803.0102MEDICAL INSURANCE
Medical Plan
This plan is designed to give you the maximum flexibility when it comes to your healthcare.
Using a tax advantaged savings opportunity, the Health Savings Account, you can save
and invest for future healthcare expenses, even into retirement.
PLAN DESIGN: The Plan has a $2,800 deductible for individuals, OTHER COVERED EXPENSES: All other expenses are subject
and a $5,000 aggregate deductible for families. The plan also to a deductible. After you meet the deductible, the Plan will
limits out-of-pocket costs after meeting the deductible. The pay 80% of the cost. An HSA can help you pay deductibles and
plan focuses on a very low premium in return for reasonable coinsurance. Once the HSA is exhausted, you will pay your
point of service costs and provides a large incentive to act as share of the cost of your medical care until you have met the
consumers of healthcare using your Health Savings Account. out of pocket maximum. At that point, the Plan pays 100% of
the cost of your covered expenses.
PREVENTIVE CARE: The Plan pays 100% of the cost of
preventive care for each covered member of your family. This HSA: Robins & Morton will match your weekly contribution
ensures that you can get the regular check-ups and tests dollar for dollar until the R&M deposit limit has been
recommended for your age and gender. In addition, diagnostic reached based on your coverage tier in the medical plan.
tests are covered under the preventive care benefit, including Please see page 8 for more details. You can also deposit
colonoscopies, mammograms, and cervical exams (if you money into your HSA on a pre-tax basis. The HSA will help
meet age or health requirements). you pay for out-of-pocket expenses. The money in your
HSA can be used to pay the deductible, coinsurance, and
PRESCRIPTION DRUGS: Once you have met the annual prescription drugs for any eligible medical expense, or you
deductible, you pay a copay for prescription drugs as long as can save your HSA to use in retirement.
you use a network pharmacy. Prescription drugs are subject
to the deductible, except generic preventive drugs. Generic MENTAL HEALTH & SUBSTANCE ABUSE: Mental Health &
preventative drug copays are $0. Substance Abuse benefits are provided through Blue Cross
Blue Shield as part of your health plan at no additional cost
to you. These are covered at the same benefit level as the
medical benefits.
OUT OF POCKET COSTS FOR THE HOURLY PLAN
DEDUCTIBLE MEDICAL OUT OF POCKET MAX
Individual Family Individual Family
$2,800 $5,000 $4,000 $8,000
COST OF HOURLY MEDICAL
EMPLOYEE ONLY EMPLOYEE+SPOUSE EMPLOYEE+CHILDREN FAMILY
Total Cost: $694 $1,488 $1,100 $1,620
R&M Pays: $623 $1,331 $986 $1,449
Monthly: $71 $157 $114 $171
Weekly: $16.38 $36.23 $26.31 $39.46
7
QUESTIONS? 205.803.0102MEDICAL INSURANCE
Health Savings
Account
A Health Savings Account (HSA) allows you to set aside money to pay for out of pocket
healthcare expenses. The HSA is your money that you control and invest, and you don’t
pay taxes on the HSA money you contribute.
LEARN ABOUT THE HSA MATCH
Robins & Morton will match your weekly contribution dollar for dollar until your annual company contribution has been reached.
The company contribution is based on your enrollment in the medical plan. See chart below for details.
For example, if you are enrolled as employee only in the medical plan and contribute $100 per week to your HSA, Robins &
Morton will contribute $100 per week until the $500 limit has been reached.
Eligible expenses include medical copays, medical coinsurance, deductibles, and prescription copays. Vision and dental
charges are also reimbursable by the HSA. If you don’t use all of the money in your HSA during the year, those dollars are yours
to keep and invest. While the IRS limits the amount you can contribute each year, there is no limit on the balance for your HSA.
You can pay medical bills from your HSA with a debit card that will be mailed to your address on file with Robins & Morton, after
your account has been opened.
HSA CONTRIBUTION LIMITS FOR 2022
HOW TO OPEN AN HSA SINGLE FAMILY
After your enrollment has been processed, go to www.401k.com TOTAL Limit $3,650 $7,300
and open your account. You can also call 1-800-544-3716 to set
OVER 55 CATCH UP $1,000 $1,000
up your account.
HOW MUCH CAN I PUT IN MY HSA? ROBINS & MORTON CONTRIBUTION
The annual contribution limit for your HSA depends on who YOUR ENROLLMENT ANNUAL SEED MONEY
you enroll in the health plan, the age of the employee and the
EMPLOYEE ONLY $500
amount contributed by Robins & Morton. Robins & Morton will
make a contribution each quarter, up to $1,000 for the year, as EMPLOYEE+SPOUSE $750
long as you have opened your HSA account at Fidelity. EMPLOYEE+CHILDREN $750
Use the calculator below to determine your contribution limit FAMILY $1,000
and the weekly amount you can contribute from your check.
EXAMPLE: Kris is enrolled in employee plus spouse coverage and will turn 55 on June 21, 2022. The maximum the IRS will
allow to contribute to the HSA is $7,300, plus another $1,000 for being over age 55. Robins & Morton will contribute $750 of
that total leaving a total of $7,550, or $145.19 per week that Kris could contribute during the full year to the HSA.
MANAGE YOUR HSA
Weekly contributions are now managed and processed at www.401k.com. You can change your contribution amount as many
times throughout the year, according to your own personal circumstances. Your HSA dollars can also be invested like your
401K, producing tax-saving gains on your investments.
COMPUTE YOUR FAMILY
What is your TOTAL Limit?
EXAMPLE
$7,300
YOU
YOUR Enter $1,000 if you will be 55 or older on December 31, 2021 $1,000
SUBTOTAL $8,300
WEEKLY Subtract your annual seed money ($750)
MAXIMUM ANNUAL CONTRIBUTION $7,550
CONTRIBUTION Divide by 52 to find the maximum WEEKLY contribution $145.19
8 my.robinsmorton.comMEDICAL INSURANCE
How to use the HSA
A Health Savings Account (HSA) allows you to set aside money to pay for out of pocket
healthcare expenses. The HSA is your money that you control and invest, and you don’t pay
taxes on the HSA money you contribute. It can also be a tool used for longterm investing,
savings and retirement planning.
ROBINS & MORTON CONTRIBUTION
HOW DOES IT WORK? ANNUAL
YOUR ENROLLMENT SEED
MONEY
You make
weekly R&M matches EMPLOYEE ONLY $500
contributions, your contribution
as much or as until you reach the
After opening the little as you’d EMPLOYEE+SPOUSE $750
company limit.
account, set your like.
contributions. EMPLOYEE+CHILDREN $750
These can be
changed at any FAMILY $1,000
time of the year.
Any money you don’t use by
Open open the end of the year is yours to
an your keep! Fidelity makes it easier
HSA HSA to invest the money for medical
expenses.
Money ready to use, set aside
to pay for qualified medical
expenses.
HOW DO YOU INVEST IT?
Fidelity has a feature called a “trigger amount.” This allows you to keep some money in your account
for medical expenses. Anything you contribute over the trigger amount will automatically flow into
the investment side. This feature helps ensure that you and your family are financially prepared for
a medical need, while also allowing you to be in control of your money and investments.
For example, Kris decides to keep $500 in the savings portion of his HSA. Anything he contributes
over $500 will pour into the investment portion of his HSA. After a doctor’s visit, he pays his
medical bill using his HSA savings. Now his contributions will go toward his savings account until
he reaches his trigger amount ($500).
TRIPLE TAX ADVANTAGE
An HSA is often called a “triple tax advantage” account. These advantages are:
• You make contributions before tax deductions
• You don’t pay taxes when you pay for a medical expense
• You don’t pay taxes on your investment and interest earnings
SimpleHSA
Now it’s easier than ever to save money for medical expenses.
This programs allows your HSA to begin without the need to manually open the
account. As soon as you enroll in the HSA, your account is ready for you to make
9 contributions.MEDICAL INSURANCE
Prescription Plan
The prescription drug plan is administered through CVS Health. You will be automatically
enrolled for prescription drug coverage in CVS Health when you enroll in the Robins & Morton
health plan. We encourage you to discuss with your doctor and pharmacist the availability of
generic preventive drugs for your maintenance conditions. You can find a list of the preventive
generics for $0 at www.caremark.com/portal/asset/preventive_dl.pdf.
While the copays for preventative generics are not subject to the deductible, you must meet
the full deductible before the copays will apply to other prescription drugs.
PRESCRIPTION PLAN
GENERIC PREVENTIVE GENERIC OTHER PREFERRED NON-PREFERRED SPECIALTY
1-34 Days Supply $0 $10 $30 $70 $150
90 Day Supply $0 $25 $75 $175
CVS HEALTH ALSO PROVIDES THESE PREVENTIVE VACCINATIONS AT THEIR STORES AT NO COST TO YOU:
CHILDREN UP TO AGE 18 CHILDREN & ADULTS ADULTS
Haemophilus B Diptheria, Tetanus Rotavirus Hepatitis B Pneumonia Hepatitis A & B
Measles, Mumps, Haemophilus B, Hep- Meningiococcal, Measles, Mumps, Human Papilloma- Tetanus, Dipthe-
Rubella, Varicella atitis B Haemophilus B, Rubella virus ria Toxoids
Tetanus
Diptheria, Tetanus, Diptheria, Tetanus, Diptheria, Tetanus, Meningiococcal Hepatitis A Zoster (Zostavax)
Pertussis, Haemoph- Pertussis, Inactivated Pertussis
ilus B Poliovirus
Diptheria, Tetanus, Diptheria, Tetanus, Inactivated Polio- Varicella Tetanus Influenza
Pertussis, Inactivated Pertussis, Inactivated virus
Poliovirus, Haemoph- Poliovirus, Hepatitis B
ilus B
10 my.robinsmorton.comMEDICAL INSURANCE
Telemedicine
Amwell offers an affordable, easy, and convenient way to consult with
a doctor by phone, web or a mobile device. You have your choice of
U.S. board-certified doctors with no appointment and no waiting. With
24/7/365 access via the web or your mobile device, you can have a
consultation, diagnoses and prescriptions.
SEE A DOCTOR ONLINE,
ANY TIME, ANYWHERE.
You can’t predict getting sick, but you can be prepared. Amwell makes seeing
a doctor 24/7 as simple as picking up a smartphone or tablet. The service is
affordable, convenient, and secure.
• Cough / Sore Throat • Fever • Headache
• Pinkeye • Sinus Infection • Flu
• Bronchitis • Allergies • Ear Infection
Three easy ways to connect to a doctor fast:
MOBILE WEB PHONE
Video visit via the Amwell Dial 1-844-SEE-DOCS
Visit www.amwell.com
mobile app (1-844-733-3627)
Make sure to enter Service Key ROBINSMORTON at enrollment.
Sign up now, so your account is ready when you need it.
11MEDICAL INSURANCE
Virta
With Virta, naturally reverse Type 2 Diabetes at no cost to you.
New for 2022, Robins & Morton is happy to introduce Virta as a new benefit for our teams. Virta specializes in
reversing Type 2 diabetes by natural causes -- without the need for excessive exercise, constant medication
and extreme dieting. With a sustainable method, healthy weight loss is just one of the benefits of Virta.
Robins & Morton will fully cover the cost of Virta for all employees, spouses, and adult dependents with type
2 diabetes and prediabetes who are enrolled in a BCBS AL medical plan.
WHAT IS VIRTA?
Virta is a medically supervised, research-backed treatment that reverses type 2 diabetes, meaning that
patients can lower their blood sugar and A1c, all while reducing diabetes medications and losing weight.
HOW DOES IT WORK?
Virta uses nutritional ketosis to naturally lower blood sugar and turn the body into a fat-burning machine. There
is no surgery, required exercise, or calorie counting on Virta.
With Virta’s personalized treatment plan, each patient gets medical supervision from a physician-led care team,
a one-on-one health coach, diabetes testing supplies, educational tools like videos and recipes, and a private
online support community.
Virta provides around-the-clock monitoring and care—there are no waiting rooms and no lines. With an easy-to-
use mobile and desktop app, Virta can be done from anywhere.
GETTING STARTED
To get started with Virta, go to www.virtahealth.com/join or email support@virtahealth.com.
12 my.robinsmorton.comDENTAL INSURANCE
Dental
The Delta Dental PPO plan makes it easy for you to find a dentist, and easy to
control your costs when you visit a network dentist.
Here are some of the great things you’ll need to know about · Since Delta Dental offers access to one of the largest
enrolling with Delta Dental: dental networks in the U.S., chances are there’s a wide
choice of network dentists near your home or office. Many
· Our PPO network dentists accept reduced fees for dentists nationwide are contracted Delta Dental dentists,
covered services they provide you, so you’ll usually pay giving more enrollees convenient access to more dentists.
the least when you visit a PPO network dentist. This also Visit us at www.DeltaDentalIns.com to search our dentist
ensures Delta Dental PPO dentists won’t balance bill you directory by location or specialty.
the difference between the contracted amount and their
usual fee. · When you visit a Delta Dental dentist, pay only your portion
for services. Delta Dental dentists will file claim forms for
· Visit the dentist of your choice. You can visit any licensed you and receive payment directly from us.
dentist, but your costs are usually lowest when you see a
PPO dentist. · Access your benefits and eligibility, order ID cards and get
information about your claims with Delta Dental’s online
services. Check www.DeltaDentalIns.com, Delta Dental’s
oral health resources for tips and information that can help
keep your smile healthy.
COST OF HOURLY MEDICAL
EMPLOYEE ONLY EMPLOYEE+SPOUSE EMPLOYEE+CHILDREN FAMILY
Total Cost: $21 $47 $45 $62
R&M Pays: $10 $23 $22 $31
Monthly: $11 $24 $23 $31
Weekly: $2.54 $5.54 $5.31 $7.15
Download the app
1. Open the App Store or Google Play.
2. Search for “Delta Dental.”
3. Download the free app titled Delta Dental by
Delta Dental Plans Association.
Review your plan details, pull up your ID card and
try out the musical toothbrush timer.
Delta Dental en Espanol es.deltadentalins.com
Questions? 205.803.0102 13VISION INSURANCE
Vision Insurance
Why enroll in VSP? Your eyes deserve the best care to keep them healthy year after year. Plus with VSP,
you’ll get a great value on your eye care and eye wear. Please visit www.vsp.com.
VALUE & SAVINGS
You'll get great benefits on your exam and eye wear at an affordable price.
PERSONALIZED CARE
You’ll get quality care that focuses on your eyes and overall wellness through a WellVision Exam® from a VSP doctor. When
you see a VSP doctor, you’ll get the most out of your benefit and have lower out-of-pocket costs.
SAFETY GLASSES HEARING AID DISCOUNT
The TruHearing MemberPlus Program includes:
The ProTec Safety Glasses
Program includes:
· Savings of up to 50% on hearing aids
· $10 copay for prescription
safety lenses · Yearly comprehensive hearing exams for $75
· Safety glasses in addition to standard eyewear are covered · 3 visits with a hearing professional after purchase (fitting,
by VSP, subject to copay programming and/or adjustments)
· To find a provider go to vsp.com > find a doctor > and check · Manufacturer’s coverage for a one-time loss or
"Safety/Pro Tec Eyewear" under products damage for three years (replacement fee paid
to manufacturer)
· 3-year repair warranty
· 48 batteries per purchased hearing aid
· VSP members may also add up to four guest members
(parents, grandparents, siblings) for a VSP-exclusive rate
of $71 each. Best of all, if a member already has a hearing
aid benefit from their health plan or employer, they can
combine it with this program to maximize the benefit and
reduce their out-of-pocket expense.
Please refer to the plan matrix on page 26.
VSP VISION PLAN
YOU PAY EMPLOYEE ONLY EMPLOYEE +SPOUSE EMPLOYEE +CHILDREN FAMILY
Monthly: $8.98 $15.43 $15.72 $24.73
Weekly: $2.07 $3.56 $3.63 $5.71
14 my.robinsmorton.comDISABILITY INSURANCE
Short & Long Term
Disability
The Short Term Disability Plan provides financial protection STD Insurance pays 60% of your base salary up to $750
for you by paying part of your salary when you become for days 6–90 of your disability. The cost of the insurance
disabled. The amount you receive is based on your base program depends on your income and your age as of
salary when your disability began. This benefit is fully January 1, 2021. The example below calculates premiums
insured at Lincoln Financial and paid by your contributions. based on a $750 benefit:
SHORT TERM DISABILITY
AGE up to-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69
Monthly: $55.50 $55.50 $55.50 $55.50 $55.50 $58.13 $72.00 $90.63 $110.13 $120.75
Weekly: $12.81 $12.81 $12.81 $12.81 $12.81 $13.41 $16.62 $20.91 $25.41 $27.87
If you suffer a covered disability while insured by Long Term The cost of the insurance program depends on your income
Disability Insurance, you will receive monetary benefits de- and your age as of January 1 of the current year. The exam-
signed to help you maintain your normal lifestyle. This pro- ple below calculates premiums based on a monthly income
gram covers disabling injuries or sicknesses that last be- of $4,000.
yond the 90 day elimination period. This plan pays a benefit
up to 60% of your monthly covered earnings with maximum
of $12,500 per month.
LONG TERM DISABILITY
AGE up to-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69
Monthly: $3.12 $3.96 $7.56 $11.84 $17.72 $23.80 $32.96 $34.96 $36.92 $38.36
Weekly: $0.72 $0.91 $1.74 $2.73 $4.09 $5.49 $7.61 $8.07 $8.52 $8.85
Questions? 205.803.0102 15DISABILITY INSURANCE
Employee
Assistance Program
We are pleased to have Lincoln Financial Group as the administrator of the Employee
Assistance Program (EAP) for you and your family.
Short or Long Term Disability must be elected to take advantage of this program.
Life has its share of ups and downs — and sometimes you may need a little guidance through the “downs.”
EmployeeConnectSM services included with your employer’s long-term disability insurance offer an array of confidential
services to help you and your loved ones meet the challenges that life, work, and relationships can bring.
UNLIMITED 24/7 ASSISTANCE
You can access the following services anytime, online or with a toll-free call:
· Information, resources, and referrals on family matters, such as child and elder
care; kennels and pet care, event and vacation planning, moving and relocation,
car buying, college planning, and more EmployeeConnectSM
Services:
· Legal information and referrals for situations requiring expertise in family law,
estate planning, landlord/tenant relations, consumer and civil law, and more · Company sponsored
· Strictly confidential
· Guidance with financial matters, including household budgeting, and short- and
· Provided at no charge to you
long-term planning
· Available to you and your
IN-PERSON GUIDANCE dependents 24/7
Some matters are best resolved by meeting with a professional in person. With Em-
You get:
ployeeConnect, you get:
· In-person help for short-term issues (up to five* sessions with a counselor per · Unlimited phone access to legal,
person, per issue, per year) financial, and work-life services
· In-person help with short-term
· In-person consultations with network lawyers, including one free 30-minute in-
issues
person consultation per legal issue, and subsequent meetings at a reduced fee
· Up to five* sessions per person,
ONLINE RESOURCES per issue, per year
EmployeeConnect offers a wide range of information and resources that you can *In California, up to three sessions in six months,
research and access on your own just by visiting GuidanceResources.com. You’ll starting with initial contact by employee.
find:
· Articles and tutorials
· Streaming videos
· Interactive tools — including financial calculators, budgeting spreadsheets, and more
EMPLOYEECONNECTSM COUNSELORS ARE EXPERIENCED AND CREDENTIALED
When you call our toll-free line, you’ll talk to an experienced professional who will provide counseling, work-life advice,
and referrals. All counselors hold master’s degrees, with broad-based clinical skills and at least three years of experi-
ence in counseling on a variety of issues. For face-to-face meetings, you will be referred to a fully credentialed, state-li-
censed counselor.
YOU’LL RECEIVE A CUSTOMIZED INFORMATION PACKET FOR EACH OF THE WORK-LIFE SERVICES YOU USE.
16DISABILITY INSURANCE
Accident Insurance
Accidents can happen when you least expect them.
You can’t plan for accidents, but you can financially prepare for them
when they happen. In 2018, there were more than 45,000,000 trips to THINK ABOUT THE LIKELIHOOD OF HAVING
the emergency room in the U.S. due to accidents. With an average cost AN ACCIDENT:
of $1,318 per visit to the ER, accident coverage make life’s unpredictable
moments more financially manageable. · Your child gets hurt
playing sports or on the
Group Accident Insurance can help you be better prepared by providing school playground
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 · You injure yourself while
will be in addition to any other insurance you may have. This payment doing home repairs or while on vacation
can help you focus more on getting back on track and less on the extra · Your spouse slips and falls
expenses an accident may bring. on the stairs or on a slippery floor
ACCIDENT INSURANCE – LOW PLAN
YOU PAY EMPLOYEE ONLY EMPLOYEE+SPOUSE EMPLOYEE+CHILDREN FAMILY
Monthly: $9.03 $17.80 $20.63 $25.23
Weekly: $2.08 $4.11 $4.76 $5.827
ACCIDENT INSURANCE – HIGH PLAN
YOU PAY EMPLOYEE ONLY EMPLOYEE+SPOUSE EMPLOYEE+CHILDREN FAMILY
Monthly: $12.74 $24.97 $28.83 $35.28
Weekly: $2.94 $5.76 $6.65 $8.14
HOW DOES ACCIDENT INSURANCE HELP ME?
This plan provides a lump sum payment for over 150 different You receive a lump sum payment when you have these
covered events, such as these: covered medical services/treatments:
· Fractures · Concussions
· Ambulance · Medical Testing Benefits
· Dislocations · Cuts/Lacerations including:
· Emergency care - X-rays
· Second and third degree · Eye injuries
burns · Inpatient surgery - MRIs
· Coma
- CT scans
· Skin grafts · Outpatient surgery
· Broken teeth
· Torn knee cartilage · Transportation · Therapy services
including:
· Ruptured disc · Home modifications - Physical and
occupational
· Physician therapy
follow-up visits
MetLife Accident Insurance also pays for hospital stays, Intensive Care Unit stays, inpatient rehab, companion lodging,
accidental death, loss, paralysis and more.
Please refer to the plan matrix on page 28 for complete coverage and benefit information. Questions? 205.803.0102 17DISABILITY INSURANCE
Indemnity Insurance
Indemnity Insurance provides cash to help pay for a hospitalization.
WHY IS HOSPITAL INDEMNITY INSURANCE IMPORTANT?
Even with good medical coverage, the cost of a hospital stay · Guaranteed acceptance—For you and your eligible family
can really add up. In fact, the average price of a hospital stay members, as long as you are actively at work. That means
in the U.S. is $10,000. While hospital stays can be unexpected, no medical exams and no hassle.
they don't have to be financially devastating. Protect your
· Payroll deduction—Automatic payroll deduction makes it
budget and enroll in Hospital Indemnity Insurance today.
convenient. Employee rates make it less expensive.
Don't worry, you're covered—Hospital Indemnity Insurance
· Portable—Take it with you if you leave the company or
from MetLife provides you with a lump-sum payment when
retire.
you are admitted or confined to a hospital due to a sickness
or accident. Please refer to the plan matrix on page 28 for complete
coverage and benefit information.
Your name is on the check—Payments are made directly
to you. You decide how to spend the money for medical
expenses not covered by your medical plan, like copays,
deductibles, or out-of-network care, or for non-medical
needs like household bills, childcare or home modifications.
Added features just for you:
INDEMNITY INSURANCE – LOW PLAN
YOU PAY EMPLOYEE ONLY EMPLOYEE+SPOUSE EMPLOYEE+CHILDREN FAMILY
Monthly: $19.57 $32.33 $32.33 $47.00
Weekly: $4.52 $7.46 $7.46 $10.85
INDEMNITY INSURANCE – HIGH PLAN
YOU PAY EMPLOYEE ONLY EMPLOYEE+SPOUSE EMPLOYEE+CHILDREN FAMILY
Monthly: $39.13 $63.46 $63.46 $92.34
Weekly: $9.03 $14.64 $14.64 $21.31
*Hospital Indemnity Insurance does not replace the Hourly Medical Plan. This is not major medical.
18401(k)
The Robins & Morton
Retirement Savings Plan
You can simplify saving for retirement with the Robins & Morton Retirement Savings Plan. The
plan offers you the ease of payroll deduction, tax advantages and the experience of Fidelity
Investments to make saving easy.
With a number of different funds to choose from, you can position
yourself for the retirement of your dreams.
You may contribute up to 90% of your wages to the plan each pay
401(K) CONTRIBUTION LIMITS
period and invest your money in a wide range of investment alternatives
to fit your personal risk tolerance. The IRS does have a dollar limit on % of Salary 90%
your contributions and allows participants over age 50 to contribute Maximum $20,000
an additional catch-up amount. To fit your particular tax situation, you Over 50 catch up $6,500
may choose to invest your dollars on a pre-tax basis or on an after tax
basis in the ROTH option. The plan also has a profit sharing feature for
employees after they complete one year of service. The profit share is a
discretionary contribution from Robins & Morton to encourage everyone
to save for retirement. The profit sharing contribution becomes fully 401(K) VESTING SCHEDULE
vested after six years. Less than 2 years 0%
All employees over age 18 become eligible to participate on their 2 Years of service 20%
hire date. You will be automatically enrolled in the plan with a starting 3 Years of service 40%
contribution of 4% of your salary unless you change your contribution
4 Years of service 60%
percentage on the Fidelity website, www.401k.com, or by calling Fidelity
at 800.835.5097. 5 Years of service 80%
6 Years of service 100%
To help you with your choices of investments, CAPTRUST Financial
Advisors are available to you at no cost. They can help you design your
retirement portfolio specific to your financial goals and discuss your
personal retirement savings situation. You can reach them by calling
800.967.9948.
NEED FINANCIAL ADVICE?
You can find more detailed information about the plan on the Fidelity
website, www.401k.com or at my.robinsmorton.com.
Call 800.967.9948 or visit
www.captrust401k.com
Check out WWW.401K.COM
Change your Review Update
contributions Investments beneficiaries
Call 800.835.5097 for English or 800.587.5282 for Español.
Questions? 205.803.0102 19OTHER BENEFITS
Dependent Care
Account
You can establish a Dependent Care Account (DCA) to pay for eligible child and adult care
expenses like daycare, before and after school care, preschool, summer day camp, and in-
home aid while you are at work. Funds are for your dependent(s) age 12 or younger, or a spouse
or eligible dependent incapable of self-care. The dependent must be able to be claimed as a
dependent on the employee's federal tax return. You can contribute pretax dollars from your
paycheck, up to the IRS limit of $5,000. File claims for reimbursement at www.payflex.com or
using the mobile app.
Limited Purpose
Flexible Spending
Account
You can contribute pretax dollars from your paycheck, up to the IRS limit of $2,750. Your full
contribution is available at the start of the plan year to pay for eligible dental and vision
expenses only. It covers you and your enrolled dependents for dental expenses like othodontia,
crowns, bridges, and vision expenses like LASIK eye surgery, glasses, and contacts. Pay with
ease using your account debit card, file a claim at www.payflex.com, or use PayFlex's online
feature to pay your provider directly.
20 my.robinsmorton.comOTHER BENEFITS
Care.com Membership
Make sure your loved ones have the care they need with a Care.com premuim membership.
Care.com is an online caregiving platform that Care.com services include:
allows you to search, interview and screen
caregivers to find the right care for your needs. • Background checks for caregivers
With a care.com membership, it makes finding a
• Childcare
caregiver easy. Robins & Morton is happy to cover
the cost of the premium membership to ensure your • Senior care
family has the care it needs.
• School support
Please note that while Robins & Morton will cover
the cost of a premium membership, employees will • Housekeeping
remain responsible for the actual cost of care.
• Daycare
To enroll in this benefit, purchase a membership and submit a reimbursement through Concur.
Questions? 205.803.0102 21OTHER BENEFITS
Benefit Cards &
Access
Knowing the benefit cards in your wallet and benefit apps on your phone will simplify your life. You have two kinds of
benefit cards with the Robins & Morton plan; cards that identify you as a plan participant and debit cards to provide
convenient payment options.
You will not receive a new card unless you request one from the vendor or the HR Helpline at 205.803.0102. You can also
download the cards and save them to your mobile device.
IDENTIFICATION CARDS
ALABAMA BLUE
Blue Cross Blue Shield of Alabama administers the medical benefits for Robins
Subscriber Name In-Ntwk Ded: $xxxx
JOHN Q PUBLIC Out-of-Ntwk Ded: $xxxx & Morton. Present this card when you visit your doctor, hospitals, laboratories
Contract Number In-Ntwk OOP: $xxxx
RGT123456789 Out-of-Ntwk OOP: $xxxx and others that provide you medical serices. You can also access the mobile
Group Number
Effective Date
12345
01-01-2022
app for your card. Most providers will ask for your ID card with each visit so
keep this card with you for all visits and emergencies.
HEALTH PAC PPO Customer Service: Website:
800.292.2262 http://www.bcbsal.org
CVS CAREMARK
Prescription Card Your prescription drug benefits are provided by CVS/Caremark. Present this
RxBIN 004336
RxPCN ADV card at your pharmacy to fill your prescriptions. In most cases, you will only
RxGRP XXXXX need to present this card once to a pharmacy. You will receive this card upon
Issuer [80840] 9151014609
ID 123456789 enrollment in the medical plan.
0 NAME JOHN Q SAMPLE
0
0
1
Customer Service: Website:
800.334.8134 http://www.cvs.com
Delta Dental Insurance Company DELTA DENTAL
P.O Box 1809
Alpharetta, GA 30083-1809
We use the Delta Dental PPO and Delta Premier networks for our dental plan.
This card is for information purposes only and us not a
guarantee of coverae. For curent eligibility and benefits, You will need to show this card at the dentist.
please call the number below or visit our website.
Automated information Line - (800) 521 - 2651 You can obtain additional cards on the Delta Dental website or by downloading
the Delta Dental Mobile App available on both iTunes and the Android App
Enrollee Name: FIRST LASTNAME
Enrollee ID number: 30-1111-2222-33333 Store.
Group Name: GROUP NAME HERE
Customer Service: Website:
Group Number: 9999-0000
800.521.2651 http://www.deltadentalins.com
22 my.robinsmorton.comOTHER BENEFITS
VSP VISION CARE
You eyes are amazing.
We’ll treat them amazingly well. VSP is paperless and does not issue identification cards. VSP provides our
voluntary vision care program to Robins & Morton. At your next visit tell your
Let us help you: vision provider your coverage is VSP. The office will locate you in the VSP
• find the right VSP doctor for you,
• keep your eyes healthy with a WellVision Exam, system. You can obtain a card that does not show your name on the VSP
• love how you look in great eyewear,
• save money!
website or by downloading the VSP Mobile site at https://www.vsp.com.
Customer Service: Website:
800.877.7195 https://www.vsp.com
DEBIT CARDS
PAYFLEX MOBILE
Debit cards from PayFlex provide Robins & Morton employees with point-
of-purchase access to their Limited Purpose Flexible Spending Account.
Remember, you fund the LPFSA with contributions from your paycheck to pay
for vision or dental expenses only.
This is a MasterCard debit card and you will receive periodic replacements
about 30 days before the date shown on the front of the card. If your card is
lost or stolen, please contact PayFlex immediately to prevent unauthorized use
of your card.
Customer Service: Website:
844.729.3539 http://mypayflex.com
Lost or stolen card:
844.729.3539
Fidelity HSA Debit Card NETBENEFITS
For those that enrolled in the Health Plan, you have access to a Health Savings
Account at Fidelity Investments. You must go to the Fidelity website and open
your HSA before any contributions can be deposited to your account. Robins
1234 5678 9000 0000
4447
DEBIT
& Morton will make monthly deposits to the HSA along with any contributions
GOOD
JOHN Q SAMPLE
THRU 10/2026
you make, up to the IRS limits. You may use this card to access your HSA funds
to pay for medical expenses.
REMEMBER: You must open your account on the Fidelity website. Open your
account by going to the website, log in just like you would to access your
401(k) and click the word OPEN next to the Health Savings Account and answer
several questions.
This is a Visa debit card and you will receive periodic replacements. If your card
is lost or stolen, please contact Fidelity immediately to prevent unauthorized
use of your card.
HSA Customer Service: Website:
800.544.3716 http://www.401k.com
Lost or stolen card:
888.377.0323
Questions? 205.803.0102 23Hourly Medical Plan Benefits
Benefit payments are based on the amount of the provider’s charge that Blue Cross and Blue Shield recognizes for
payment of benefits. The allowed amount may vary depending upon the type provider and where services are received.
BENEFIT IN-NETWORK OUT-OF-NETWORK
SUMMARY OF COST SHARING PROVISIONS (Includes Mental Health Disorders and Substance Abuse)
Calendar year deductibles and out-of-pocket maximums will be calculated in accordance with the applicable Federal law.
Calendar Year Deductible (CYD)
For individual coverage, no benefits, except
preventive care, are paid by the plan until
medical expenses paid by the individual equal
the deductible amount. For family coverage, no $2,800 Individual $5,600 Individual
benefits, except preventive care, are paid by $5,000 Family $10,000 Family
the plan to a family member until that individual
family member meets the individual deductible
amount or the total medical expenses paid by
the family equal the family deductible amount.
Self-only coverage: $4,000, including self-only
Calendar Year Out-of-Pocket Maximum calendar year deductible
(including the calendar year deductible) For family coverage: $8,000, including family
calendar year deductible There is no out-of-pocket maximum for
Deductibles, copays and coinsurance for in-
network services and out-of-network mental After you reach Calendar Year Out-of-Pocket Maximum out-of-network services.
health disorders/substance abuse emergency (even if you are covered under family coverage), applicable
services apply to the out-of-pocket maximum. expenses for you will be covered at 100% of the allowed
amount for remainder of calendar year.
Prescription Drug
Prescription drug benefits are not
administered by Blue Cross and Blue
Shield of Alabama
INPATIENT HOSPITAL AND PHYSICIAN BENEFITS (Includes Mental Health Disorders and Substance Abuse)
Precertification is required for all inpatient admissions (except medical emergency hospital admissions and maternity); notification within 48
hours for emergencies. Generally, if precertification is not obtained, no benefits are available. Call 1-800-248-2342 (toll free) for precertification.
Covered at 80% of the allowed amount subject to Covered at 60% of the allowed amount
Inpatient Hospital
calendar year deductible subject to calendar year deductible
Inpatient Physician Visits and Covered at 80% of the allowed amount subject to Covered at 60% of the allowed amount
Consultations calendar year deductible subject to calendar year deductible
OUTPATIENT HOSPITAL BENEFITS (Includes Mental Health Disorders and Substance Abuse)
Precertification is required for some outpatient hospital benefits. Precertification is also required for provider-adminstered drugs; visit
AlabamaBlue.com/ProviderAdministeredPrecertificationDrugList. If precertification is not obtained, no benefits are available.
Outpatient Surgery (Including Ambulatory Covered at 80% of the allowed amount subject to Covered at 60% of the allowed amount
Surgical Centers) calendar year deductible subject to calendar year deductible
Covered at 80% of the allowed amount
subject to calendar year deductible
Emergency Room (Medical Emergency)
Covered at 80% of the allowed amount subject to Mental Health Disorders and Substance Abuse
calendar year deductible Services covered at 80% subject to the in-
network calendar year deductible and out-of-
pocket maximum
Covered at 80% of the allowed amount
Emergency Room (Accident)
subject to calendar year deductible for
Note: If you have a medical emergency
Covered at 80% of the allowed amount subject to services within 72 hours; thereafter and
as defined by the plan after 72 hours of
calendar year deductible when not a medical emergency as defined
an accident, refer to Emergency Room
by the plan, 60% subject to calendar year
(Medical Emergency) above.
deductible
Covered at 100% of the allowed amount
subject to calendar year deductible
Covered at 100% of the allowed amount subject to Mental Health Disorders and Substance
Emergency Room Physician
calendar year deductible Abuse Services covered at 100% subject
to the in-network calendar year deductible
and out-of-pocket maximum
Outpatient Diagnostic Lab, X-ray,
Covered at 80% of the allowed amount subject to Covered at 60% of the allowed amount
Pathology, Dialysis, IV Therapy,
calendar year deductible subject to calendar year deductible
Chemotherapy & Radiation Therapy
Intensive Outpatient Program (IOP) and Covered at 80% of the allowed amount subject to Covered at 60% subject to calendar year
Partial Hospitalization Program (PHP) calendar year deductible deductible; in Alabama, not covered
24 my.robinsmorton.comBENEFIT IN-NETWORK OUT-OF-NETWORK
PHYSICIAN BENEFITS (Includes Mental Health Disorders and Substance Abuse)
Precertification is required for some physician benefits. Precertification is also required for provider-adminstered drugs; visit AlabamaBlue.
com/ProviderAdministeredPrecertificationDrugList. If precertification is not obtained, no benefits are available.
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Office Visits & Consultations
subject to calendar year deductible subject to calendar year deductible
Covered at 100% subject to calendar year Covered at 60% of the allowed amount
Second Surgical Opinion
deductible subject to calendar year deductible
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Surgery & Anesthesia
subject to calendar year deductible subject to calendar year deductible
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Maternity Care
subject to calendar year deductible subject to calendar year deductible
Diagnostic Lab, X-ray, Pathology,
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Dialysis, IV Therapy, Chemotherapy & Radiation
subject to calendar year deductible subject to calendar year deductible
Therapy
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Applied Behavioral Analysis (ABA) Therapy
subject to the calendar year deductible subject to the calendar year deductible
PREVENTIVE CARE BENEFITS
Routine Immunizations and Preventive Services
See AlabamaBlue.com/preventiveservices for a
listing of the specific immunizations and preventive Covered at 100%, no copay or deductible Not covered
services or call our Customer Service Department for
a printed copy
Routine OB/GYN Exam
One visit per calendar year for females age 18 Covered at 100%, no copay or deductible Not covered
and older. This is in addition to your annual PCP
routine office visit.
Other Routine Screenings: One per calendar
year with no age limitations:
- Cholesterol Test (to include total
cholesterol, HDL, LDL and Triglycerides) Covered at 100%, no copay or deductible Not covered
- Glucose Test
- Complete Blood Count
- Urinalysis
Note: In some cases, office visit copays or facility copays may apply. Blue Cross and Blue Shield of Alabama will process these claims as required
by section 1557 of the Affordable Care Act.
BENEFITS FOR OTHER COVERED SERVICES (Includes Mental Health Disorders and Substance Abuse)
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Allergy Testing & Treatment
subject to calendar year deductible subject to calendar year deductible
Covered at 80% of the allowed amount Covered at 80% of the allowed amount
Ambulance Service
subject to calendar year deductible subject to calendar year deductible
Participating Chiropractic Services Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Limited to 20 visits per calendar year subject to calendar year deductible subject to calendar year deductible
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
Durable Medical Equipment (DME)
subject to calendar year deductible subject to calendar year deductible
Rehabilitative Occupational, Physical and
Speech Therapy
Occupational, physical and speech therapy Covered at 80% of the allowed amount Covered at 60% of the allowed amount
limited to combined maximum of 30 visits per subject to calendar year deductible subject to calendar year deductible
year
*Unlimited therapy for Autism Spectrum disorders
Habilitative Occupational, Physical and Speech
Therapy
Occupational, physical and speech therapy
Covered at 80% of the allowed amount Covered at 60% of the allowed amount
limited to combined maximum of 30 visits per
subject to calendar year deductible subject to calendar year deductible
calendar year
*Unlimited therapy for Autism Spectrum
disorders
Covered at 100% of the allowed amount Covered at 60% of the allowed amount
Home Health and Hospice
subject to calendar year deductible subject to calendar year deductible
Questions? 205.803.0102 25HEALTH MANAGEMENT BENEFITS (Includes Mental Health Disorders and Substance Abuse)
Coordinates care in event of catastrophic or lengthy illness or injury. For more information,
Individual Case Management
please call 1-800-821-7231.
Coordinates care for chronic conditions such as asthma, diabetes, coronary artery disease,
Chronic Condition Management congestive heart failure, chronic obstructive pulmonary disease and other specialized
conditions.
A maternity program; For more information, please call 1-800-222-4379. You can also enroll
Baby Yourself
online at AlabamaBlue.com.
Covers prescription contraceptives, which include: injectables, IUDs, and other non-
Contraceptive Management experimental FDA approved contraceptives; subject to applicable deductibles, copays and
coinsurance.
USEFUL INFORMATION TO MAXIMIZE BENEFITS
· To maximize your benefits, always use in-network providers for services covered by your health benefit plan. To find in-network
providers, check a provider directory, provider finder website (AlabamaBlue.com) or call 1-800-810-BLUE (2583).
· In-network hospitals, physicians and other healthcare providers have a contract with a Blue Cross and/or Blue Shield Plan
for furnishing healthcare services at a reduced price (examples: BlueCard PPO, PMD, Preferred Care). In-network pharmacies
are pharmacies that participate with Blue Cross and Blue Shield of Alabama or its Pharmacy Benefit Manager(s). In Alabama,
in-network services provided by mental health disorders and substance abuse professionals are available through the Blue
Choice Behavioral Health Network.
· Out-of-network providers generally do not contract with Blue Cross and/or Blue Shield Plans. If you use out-of-network
providers, you may be responsible for filing your own claims and paying the difference between the provider’s charge and the
allowed amount. The allowed amount may be based on the negotiated rate payable to in-network providers in the same area or
the average charge for care in the area.
· Please be aware that providers/specialists may be listed in a PPO directory or provider finder website, but not covered under
this benefit plan. Please check your benefit booklet for more detailed coverage information.
Delta Dental Benefits
Primary enrollee, spouse, and children up to age 26
$50 per person/
Deductibles
$150 per family each calendar year
Deductibles waived for Diagnostic & Preventive Yes
Maximums $2,500 per person each calendar year
Diagnostic & Preventive counts toward maximum Yes
BENEFITS AND COVERED SERVICES* Percent of Allowed Amount**
Diagnostic & Preventive Services: exams, cleanings, x-rays, sealants 100%
Basic Services: fillings, simple tooth extractions 80%
Endodontics (root canals) covered under basic services 80%
Periodontics (gum treatment) covered under major services 50%
Oral surgery covered under basic services 80%
Major Services: crowns, inlays, onlays and cast restorations, bridges and dentures 50%
Prosthodontics: bridges and dentures 50%
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not
necessarily each dentist's submitted fees.
** Reimbursement is based on PPO contracted fees for PPO dentists, PPO contracted fees for Premier dentists and PPO contracted fees for non-Delta Dental dentists.
26 my.robinsmorton.comVSP Vision Benefits
BENEFIT DESCRIPTION COPAY FREQUENCY
YOUR COVERAGE WITH A VSP PROVIDER
WellVision Exam Focuses on your eyes and overall wellness $10 Every calendar year
Prescription Glasses $10 See frame and lenses
Frame · $150 allowance for a wide selection of frames
· $170 allowance for featured frame brands Included in
Every other
Prescription
· 20% savings on the amount over your allowance calendar year
Glasses
· $80 Walmart®/Costco® frame allowance
Lenses · Single vision, lined bifocal, and lined trifocal lenses Included in
Prescription Every calendar year
· Polycarbonate lenses for dependent children Glasses
Lens Enhancements · Standard progressive lenses
$0
· Premium progressive lenses
$95–$105 Every calendar year
· Custom progressive lenses
$150–$175
· Average savings of 20-25% on other lens enhancements
Contacts · $150 allowance for contacts; copay does not apply
Up to $60 Every calendar year
(Instead of glasses) · Contact lens exam (fitting and evaluation)
· As a VSP member, you can visit your VSP doctor for medical and urgent
eyecare. Your VSP doctor can diagnose, treat, and monitor common eye
Primary Eyecare conditions like pink eye, and more serious conditions like sudden vision $20 As needed
loss, glaucoma, diabetic eye disease, and cataracts. Ask your VSP doctor
for details.
PROTEC SAFETY® (EMPLOYEE-ONLY COVERAGE)
· Fully covered when you choose a safety frame from your VSP doctor's
ProTec Eyewear® collection $10 for frame
Frame Every 24 months
· Certified according to the American National Standards Institute (ANSI) and lenses
guidelines for impact protection
· Prescription single vision, lined bifocal, and lined trifocal
Combined
Lenses · Certified according to the American National Standards Institute (ANSI) Every 12 months
with frame
guidelines for impact protection
EXTRA SAVINGS
· Extra $20 to spend on featured frame brands. Go to vsp.com/offers for details.
Glasses and
Sunglasses · 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12
months of your last WellVision Exam.
Retinal Screening · No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Laser Vision
· Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities
Correction
Questions? 205.803.0102 27Met Life Accident Insurance
With MetLife, you’ll have a choice of two comprehensive plans which provide payments in addition to any other
insurance payments you may receive. Here are just some of the covered events/services. For full details, see the
MetLife accident information on my.robinsmorton.com. This plan does not cover accidents on the job.
BENEFIT LOW PLAN PAYS YOU HIGH PLAN PAYS YOU
INJURIES
Fractures $100–$4,000 $200–$5,000
Dislocations $100–$4,000 $200–$5,000
Second & Third Degree Burns $75–$10,000 $100–$15,000
Concussions $250 $500
Cuts/Lacerations $50–$400 $75–$700
Eye Injuries $300 $400
MEDICAL SERVICES & TREATMENT
Ambulance $300–$1,000 $400–$1,250
Emergency Care $75–$150 $100–$200
Non-Emergency Care $75 $100
Physician Follow-Up $75 $100
Therapy Services (inc. physical therapy) $35 $50
Medical Testing Benefit $150 $200
Medical Appliances $75–$750 $150–$1,000
Inpatient Surgery $150–$1,500 $200–$2,000
ACCIDENTAL DEATH
Employee receives 100% of amount shown, spouse $25,000 $50,000
receives 50% and children receive 20% of amount
shown. $75,000 for common carrier $150,000 for common carrier
DISMEMBERMENT, LOSS, & PARALYSIS
Dismemberment, Loss, & Paralysis $750–$10,000 per injury $1,000–$15,000 per injury
Met Life Indemnity Insurance
With MetLife, you’ll have a choice of two comprehensive plans which provide payments in addition to any other
insurance payments you may receive. Here are just some of the covered benefits/services, when an accident or illness
puts you in the hospital. This plan does not cover accidents on the job.
BENEFIT1 LOW PLAN PAYS YOU HIGH PLAN PAYS YOU
HOSPITAL BENEFITS (ACCIDENT)
Admission (must occur within 180 days after the accident) $500–$1,000 per accident $1,000–$2,000 per accident
Confinement (non-ICU confinement paid for up to 365 days.
$100 (non-ICU)–$200 (ICU) a day $200 (non-ICU)–$400 (ICU) a day
ICU confinement paid for 30 days)
Inpatient Rehab (Stay must occur immediately following
hospital confinement and occur within 365 days of $100 a day, up to 15 days $200 a day, up to 15 days
accident)
HOSPITAL BENEFITS (SICKNESS)
Admission (payable 1x per calendar year) $500 – $1,000 per sickness $1,000 – $2,000 per sickness
$100 (non-ICU)–$200 (ICU) a day $200 (non-ICU)–$400 (ICU) a day
Confinement (paid per sickness)
(payable up to 31 days per sickness) (payable up to 31 days per sickness)
28 my.robinsmorton.comYou can also read
