2022 BENEFITS GUIDE - Tenstorrent
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*Prepared by Gallagher Benefit Services* 2022 BENEFITS GUIDE
PRE-TAX LIFE &
ELIGIBILITY MEDICAL
ACCOUNTS
DENTAL VISION
DISABILITY
Welcome to Your 2022 Benefits!
Tenstorrent is proud to offer you and your eligible family members a comprehensive and
valuable benefits package. We encourage you to take the time to educate yourself about your
options and choose the best health coverage and other benefit options for you and your family.
This brochure is only a summary of services. Please see your more detailed plan documents
for each line of coverage in order to find terms, conditions, limitations, and exclusions.
This brochure was prepared for Tenstorrent employees by Gallagher Benefit Services.
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Eligibility Who is Eligible?
How to Enroll
Family Changes To be eligible for benefits in this guide you must be a full-time benefits eligible employee (as
defined by company policy). You may also cover eligible dependents on many of these
benefits, which include your spouse, domestic partner, and child(ren) up to age 26.
When Do Benefits Begin?
If you are making elections during Open Enrollment, then your benefit changes will go into
effect on January 1 of the following year.
If you are new to Tenstorrent, then the elections you make will go into effect on your date of
hire.
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Eligibility How Do You Enroll?
How to Enroll
Family Changes You will make your elections or changes through Maxwell Health. Keep in mind, once your
benefits go into effect, you will not be able to make any changes until the next Open
Enrollment period. Questions regarding these benefits can be directed to Human Resources.
If Your Family Situation Changes
Although usually your elections must remain in effect until the next Open Enrollment period, there are some
instances where you can make changes during the year. You have 31 days from the date of most qualified life
events to change your benefit elections. If you miss the deadline, you will not be able to make changes until
the next Open Enrollment period.
Eligible life events include the following:
• Marriage, divorce, legal separation or annulment
• Birth, adoption or death of a dependent
• Dependents no longer meeting the eligibility requirements
• Court order
• Beginning or ending of benefits coverage through a spouse’s or domestic partner’s plan
• Changes in employment status due to termination, reduction of hours
4 Tenstorrent | 2022 Benefits GuidePRE-TAX LIFE &
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Rate Sheet Choose the Medical Plan That Fits Your Life
In-Network Medical
Out-of-Network Medical Tenstorrent offers a comprehensive benefits package for all our full-time employees. Our medical insurance is
going to be changing to Cigna effective January 1, 2022. We have two different plan designs to allow you and
Pharmacy
your family the flexibility to choose the plan that best fits your needs.
Kaiser Medical Benefits (California Only)
Provider Network
Our medical plans available through Cigna all access one of the nation’s largest provider networks, called the
Open Access Plus (OAP) network. Benefits will always be better if you visit an in-network provider, and you
can confirm whether your provider is in-network by visiting Cigna Health Care Provider Directory.
Consider the Health Savings Account (HSA)
If you select the eligible High Deductible Health Plan (HDHP) medical option, you have access to an HSA that
allows you to use pre-tax funds to pay for eligible out-of-pocket health care expenses now or to save for future
expenses.
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Rate Sheet Cigna Education Cigna Group # #00635360
In-Network Medical
Out-of-Network Medical Cigna has put together a website specific to Tenstorrent employees to explain the medical coverages offered.
Please use the link below to utilize the benefits education as needed!
Pharmacy
Kaiser Medical Benefits (California Only)
Cigna Education Site (benefitseducationcigna.com)
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Rate Sheet Medical HDHP (HSA
Monthly Payroll Deductions Medical Co-pay PPO
In-Network Medical Eligible)
Out-Of-Network Medical Employee Only $0.00 $0.00
Pharmacy
Employee + Spouse $0.00 $180.17
Kaiser Medical Benefits (California Only)
Employee + Child(ren) $0.00 $180.17
Family Coverage $0.00 $360.34
Monthly Payroll Deductions Dental Vision
Employee Only $0.00 $0.00
Employee + Spouse $14.26 $2.03
Employee + Child(ren) $20.68 $1.86
Family Coverage $42.07 $4.90
HDHP = High Deductible Health Plan
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Rate Sheet In-Network Medical Options & Coverage
In-Network Medical
Out-Of-Network Medical
2022 Medical Plan HDHP (HSA-Eligible) Co-pay PPO
Pharmacy Deductible
$1,500 / $3,000 $250 / $500
(Individual / Family)
Kaiser Medical Benefits (California Only)
Out of Pocket Maximum
$1,500 / $3,000 $1,500 / $3,000
(Individual / Family)
Deductible Type Aggregate Embedded
Note: The deductible is the amount of money you are
responsible for paying before your insurance starts to
What You Pay for Care
pay a portion of your bills. Deductibles are an annual
Coinsurance 0% 20%
amount, which means they reset each calendar year.
Preventive Visits Covered 100% Covered 100%
Primary Care / Specialist $0 after deductible $15 copay / $30 copay
Cigna Network
Emergency Room $0 after deductible $250 copay then 20% after deductible
Remember to make sure your providers are in
Urgent Care $0 after deductible $50 copay
network by searching for them at Cigna Health Care
Provider Directory
Inpatient Hospital $0 after deductible 20% after deductible
Outpatient Services $0 after deductible 20% after deductible
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Rate Sheet Out-Of-Network Medical Options & Coverage
In-Network Medical
Out-Of-Network Medical
2022 Medical Plan HDHP (HSA-Eligible) Co-pay PPO
Pharmacy Deductible
$3,000 / $6,000 $500 / $1,000
(Individual / Family)
Kaiser Medical Benefits (California Only)
Out of Pocket Maximum
$3,000 / $6,000 $3,000 / $6,000
(Individual / Family)
Deductible Type Aggregate Embedded
Note: The deductible is the amount of money you are
responsible for paying before your insurance starts to
What You Pay for Care
pay a portion of your bills. Deductibles are an annual
Coinsurance 50% after deductible 50% after deductible
amount, which means they reset each calendar year.
Preventive Visits 50% after deductible 50% after deductible
Primary Care / Specialist 50% after deductible 50% after deductible
Cigna Network
Emergency Room 50% after deductible 50% after deductible
Remember to make sure your providers are in
Urgent Care 50% after deductible 50% after deductible
network by searching for them at Cigna Health Care
Provider Directory
Inpatient Hospital 50% after deductible 50% after deductible
Outpatient Services 50% after deductible 50% after deductible
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Rate Sheet
Prescription Drugs Coverage
In-Network Medical
Out-Of-Network Medical
2022 Medical Plan HDHP (HSA-Eligible) Co-pay PPO
Pharmacy
Participating Pharmacy Prescription Drugs
Kaiser Medical Benefits (California Only)
Generic $0 after deductible $10 copay
Preferred Brand $0 after deductible $30 copay
Non-Preferred Brand $0 after deductible $50 copay
Mail Order Prescription Drugs
Generic $0 after deductible $30 copay
Preferred Brand $0 after deductible $90 copay
Visit Pharmacy Resources | Cigna for more
information! Non-Preferred Brand $0 after deductible $150 copay
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2022 Medical Plan Kaiser HMO (CALIFORNIA ONLY)
Deductible
$0 (no deductible)
Rate Sheet (Individual / Family)
In-Network Medical Out of Pocket Maximum
$3,000 / $6,000
(Individual / Family)
Out-Of-Network Medical
Pharmacy What You Pay for Care
Kaiser Medical Benefits (California Only) Preventive Visits Covered 100%
Primary Care / Specialist $10 copay / $20 copay
Emergency Room $200 copay
Urgent Care $10 copay
Note: The Kaiser Medical Plan is only available to Inpatient Hospital $500 admission
employees that reside in California. There are no Outpatient Surgery $300 copay
out of network benefits available for the Kaiser
HMO Plan. X-ray - $40 copay
Diagnostic Tests
Lab tests - $20 copay
Imaging (MRI, CT) $150 per procedure
Prescription Drugs
Generic Drugs $5 / $10 mail order
Preferred Brand Drugs $15 / $30 mail order
Non-Preferred Brand Drugs $15 / $30 mail order
Specialty Drugs 10% coinsurance up to $250 maximum
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Health Savings Account Administered by Wex
Health Savings Account Eligibility Requirements:
Flexible Spending Account In order to open a Health Savings Account, you MUST meet the following requirements:
Limited Purpose Flexible Spending Account
• Covered by the Tenstorrent HDHP/HSA Plan Option
Dependent Care Flexible Spending Account • NOT covered by another health insurance plan that is considered a non-qualified HDHP including:
- A spouse’s medical plan
- Medicare
- Tricare
• NOT participating in an employer-sponsored Medical Flexible Spending Account
• NOT claimed as a dependent on someone else’s tax return
Note: You may change your contribution at • Your spouse may NOT participate in a Flexible Spending Account.
anytime during the year!
HSAs allow:
• Tax-free contributions
• Tax-free growth of interest or investment earnings
• Tax-free distributions of principal and interest to pay for qualified medical expenses
• Accumulation of unused funds and portability between employers. No “Use it or Lose it” rules.
2022 IRS Health Savings Tenstorrent annual Your maximum
Account Maximum contribution contribution
Employee Only $3,650 $1,200 $2,450
Employee + Dependent(s) $7,300 $2,400 $4,900
Catch up contribution (age 55+) $1,000
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Flexible Spending Account Administered by Wex
Health Savings Account This plan is for participants that are not opening a health savings account (HSA), but still wanting to take
Flexible Spending Account advantage of pre-tax benefits
Limited Purpose Flexible Spending Account $2,850 annual maximum may be used for deductibles, co-pays, co-insurance, over-the-counter products
Dependent Care Flexible Spending Account (i.e. bandages, saline solutions)
FSA funds are available the first day that the plan is effective
Over-the-counter drugs require a prescription from your doctor. If your pharmacy runs the over-the-
counter drug as a prescription you can use your debit card for the purchase.
“Use it or Lose it” rule applies
Funds that are not spent during the plan year or during the two and a half month grace-period are
forfeited. Be sure to budget accordingly!
For a complete list of eligible expenses please visit http://www.irs.gov/publications/p502/
How do I submit a claim? Above Usual & Customary Charges
Chiropractor
Co-insurance
Deductibles
You can log into your Wex employee portal OR Dental Expenses
Eyeglasses & Contact Lenses Prescribed
You can download the Benefits Mobile App Hearing Aids
Birth Control
Please see your benefit guide for more information Psychologist
Special Medical Equipment
Special Tests (allergy, etc.)
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Limited Purpose Flexible Spending Account Administered by Wex
Health Savings Account This plan is for participants that are opening a health savings account (HSA), but are still wanting to take
Flexible Spending Account advantage of pre-tax benefits for Dental and Vision expenses.
Limited Purpose Flexible Spending Account $2,850 annual maximum may be used for Dental and Vision expenses only.
Dependent Care Flexible Spending Account
LFSA funds are available the first day that the plan is effective
“Use it or Lose it” rule applies
Funds that are not spent during the plan year or during the two and a half month grace-period are
forfeited. Be sure to budget accordingly!
For a complete list of eligible expenses please visit http://www.irs.gov/publications/p502/
How do I submit a claim? Above Usual & Customary Charges
Chiropractor
Co-insurance
Deductibles
You can log into your Wex employee portal OR Dental Expenses
Eyeglasses & Contact Lenses Prescribed
You can download the Benefits Mobile App Hearing Aids
Birth Control
Please see your benefit guide for more information Psychologist
Special Medical Equipment
Special Tests (allergy, etc.)
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Health Savings Account
Dependent Care Flexible Spending Account Administered by Wex
Flexible Spending Account
Limited Purpose Flexible Spending Account
Another important part of the FSA is the ability to pay for child care or day care services with before-tax
Dependent Care Flexible Spending Account dollars. Your savings will amount to 22% to 35% of your actual child care expense, depending on your
individual or family tax brackets. This benefit is used when you and/or your spouse are working, looking for
work or going to school. The maximum amount an employee can elect is $5,000 per plan year, per family.
Eligible expenses can include:
Nursery School
Private Pre-K
Baby-Sitting
Extended Day Care before and after school
How do I submit a claim?
You can log into your Wex employee portal OR
You can download the Benefits Mobile App
Please see your benefit guide for more information
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Dental
Dental Coverage Provided by SunLife
Vision
Basic Life
2022 Dental Plan In-Network Out-of-Network
Voluntary Life Deductible (Individual / Family) $25 / $75 $25 / $75
Disability
Maximum Annual Benefit $3,000 per person $3,000 per person
While there is a network of providers you can utilize, What You Pay for Care
benefit percentages are the same regardless of
whether you visit an in-network or out-of-network Preventive Procedures* $0 $0
provider. Utilizing an in-network provider will result in
a lower patient responsibility overall. Out-of-Network Basic Procedures** 20% after deductible 20% after deductible
benefits are subject to Reasonable and Customary
charges and you may be balance billed if your dentist Major Procedures*** 50% after deductible 50% after deductible
charges above this amount.
50% after deductible 50% after deductible
Orthodontia
Lifetime maximum of $2,000 Lifetime maximum of $2,000
*Preventive includes routine exams and cleanings (2 per year), bite wing X-rays (once per year), fluoride treatment for dependents
under age 14 (once per year), sealants for under age 14 (every 36 months)
**Basic includes fillings, stainless steel crowns, space maintainers under age 19, periodontics, endodontics, oral surgery and general
Visit www.sunlife.com to find an in-network dentist in anesthesia
your area!
***Major includes inlays, onlays, crowns, dentures and bridges
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Vision Coverage Provided by SunLife
Dental
Vision
2022 Vision Plan In-Network Out-of-Network
Basic Life
Voluntary Life Well Vision Exam (one per 12 months) $0 copay Up to $45 reimbursement
Disability
Frames (every 24 months) $0 copay; $130 allowance Up to $70 reimbursement
Lenses (every 12 months) $0 copay; discounts for enhanced Up to $30 reimbursement
Elective Contact Lens Exam (every 12 months) Up to $60 copay Up to $105 reimbursement
Elective Contact Lenses (every 12 months) $150 allowance Up to $505 reimbursement
Glasses and Sunglasses: You can save an average of 20% on additional glasses and sunglasses – including lens options – from any
VSP Network VSP provider within 12 months of your last covered vision exam
Even though coverage is through Principal, this plan Laser Vision Correction: As a participant in this plan, you can save an average of 15% on laser vision correction services provided by
uses the VSP Choice Network, so make sure to a contracted facility (5% if promotional pricing)
maximize your benefits by choosing a provider that is
in-network.
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Dental
Vision Employer Paid Life Insurance Provided by SunLife & Mutual of Omaha
Basic Life
Voluntary Life
As a full-time eligible employee of Tenstorrent, you will receive a life insurance benefit in the
Disability
amount of 3x your annual earnings up to $1,000,000 – paid for by Tenstorrent. This benefit
may be reduced depending on your age. If you were to pass away in an accident, your
beneficiaries would receive an additional 3x your annual earnings – this is called Accidental
Death & Dismemberment.
Be please sure to update your beneficiaries as
needed!
The employer sponsored life insurance plan is provided through two carriers. One policy is
written by Sunlife for 1.5x salary to $500k and another policy is written by Mutual of Omaha for
1.5x salary to $500k.
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Additional Life Insurance through Sunlife
You may purchase additional life and AD&D insurance in addition to the company-provided coverage. You may also purchase
Dental life and AD&D insurance for your dependents if you purchase additional coverage for yourself. You are guaranteed coverage
Vision without answering medical questions if you enroll when you are first eligible. Guarantee Issue amounts listed are only available
to new hires and their spouses after the initial offering. All other eligible employees and spouses will be required to submit
Basic Life Evidence of Insurability for any new coverage amount or increase in coverage amount.
Voluntary Life
Additional Life Insurance
Disability
5x your Annual Salary Up to $500,000 in increments of $10,000
Employee Coverage
Guarantee Issue: $100,000
Up to $250,000 in increments of $5,000
Spouse Coverage
Guarantee Issue: $30,000
Child Coverage Flat $10,000
Be please sure to update your beneficiaries as
needed! AD&D Benefit Same as Life Benefit
Rates per $1,000 Rates per $1,000
Spouse rates are based off of Employee age. (Excludes AD&D) EE & Spouse (Excludes AD&D) EE & SpousePRE-TAX LIFE &
ELIGIBILITY MEDICAL DENTAL VISION
ACCOUNTS DISABILITY
Dental
Vision
Disability Insurance Provided by SunLife
Basic Life
Short Term Disability
Voluntary Life
We want to protect you and your family’s financial well-being in the event that you become disabled and can
Disability
no longer work. As a result, Tenstorrent offers Short Term Disability insurance, which protects 67% of your
weekly income up to $3,000 per week. This benefit begins paying after 7 days of disability and continues for
up to 12 weeks. This policy includes coverage for pregnancy.
Long Term Disability
Should you become permanently disabled we want to make sure you and your family are still protected. This
is why Tenstorrent offers Long Term Disability insurance to protect you and provide salary continuation
payments up to 67% of your monthly income up to $15,000 per month in case you are injured and unable
to work for an extended period. This benefit begins after 90 days of disability.
Note: These coverages are 100% paid by the company!
20 Tenstorrent | 2022 Benefits GuideYou can also read
