2023 Sammons Financial Group
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TABLE OF CONTENTS What’s New for 2023 . . . . . . . . . . . . . . . . . . . . . . . 3 Eligibility Overview. . . . . . . . . . . . . . . . . . . . . . . . . 4 Castlight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Medical Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Prescription Drug Program. . . . . . . . . . . . . . . . . 10 Health Savings Account (HSA). . . . . . . . . . . . . . . 13 Flexible Spending Account (FSA) . . . . . . . . . . . . 18 Limited Purpose Flexible Spending Account (LPFSA) . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Dependent Care Flexible Spending Account (DCFSA). . . . . . . . . . . . . . . . . . . . . . . . . . 23 Non-Tobacco Incentive . . . . . . . . . . . . . . . . . . . . 25 Spousal Surcharge. . . . . . . . . . . . . . . . . . . . . . . . 25 Virgin Pulse Wellness Program. . . . . . . . . . . . . . 26 Dental Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Vision Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Aflac Supplemental Plans. . . . . . . . . . . . . . . . . . 30 Women’s Health and Cancer Rights Act . . . . . . 32 2023 Monthly Premiums . . . . . . . . . . . . . . . . . . 33 Frequently Asked Questions for Open Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . 34 Open Enrollment Instructions . . . . . . . . . . . . . . 35 2
2023 Benefits Guide WHAT’S NEW FOR 2023 Annual benefit enrollment is an important process, allowing employees to take full advantage of SFG’s employee offerings with a formal platform to review your benefits enrollment and ensure your current elections are best suited to your needs—and the needs of your family. Just as our business initiatives change each year, requiring frequent monitoring of market conditions, your Total Rewards Benefits team also monitors feedback from our employees and external market data to adjust and improve our Total Rewards offerings. The high-deductible medical plan offerings at SFG serve our Total Rewards strategy well by being both competitive and sustainable. Yet, through our Total Rewards employee survey, we heard feedback from some team members who want an option that allows lower out-of-pocket costs when initially seeking medical services. This request has led to the most notable change for benefit enrollment this year; the addition of a third HSA eligible health plan for 2023 in recognition that the diverse needs of our employee population may require equally diverse healthcare solutions. The addition of this health plan allows further choice in determining what you value in your medical coverage; do you prefer lower monthly premiums out of your paycheck? Or less exposure to paying a higher medical bill at the point of service? Perhaps an equal balance between these priorities is right for you? Within this guide you will find the information needed to learn about our benefit offerings as well as the resources that Sammons Financial Group provides for you to be a responsible consumer of health care. The following list highlights the few changes for 2023: New Medical Plan Consumer Basic Plan added for increased employee choice IRS Changes IRS increased HSA contribution limits: single $3,850/family $7,750 What Do I Need to Do? Use the “link” to find all information regarding open enrollment and your benefits Calculate your out-of-pocket expenses and what to anticipate for the next year Complete your enrollment elections through UKG Pro between November 2 through November 16, 2022; you will find open enrollment instructions on page 36 of this guide Confirm enrollment of dependents in appropriate plans Upload required documentation in Manage My Benefits Print or email confirmation of your elections for plan year 2023 for your own records To see a list of frequently asked questions related to open enrollment, please see page 34. 3
ELIGIBILITY OVERVIEW Medical Dental and Vision Employees regularly scheduled to work at least 30 hours per week are Eligible Employees Same as medical. eligible for medical coverage. Effective Date of Coverage begins the first day of the month following date of hire or Same as medical. Employee Coverage January 1st of the year proceeding a change in open enrollment elections. An eligible employee may also elect coverage for the following dependents: Spouse to whom an eligible employee is legally married by providing a Same as medical, foster copy of the marriage certificate; Eligible Dependents children are not eligible under Children, including biological children, step-children, adopted children, any SFG plans. children placed for adoption, and children for whom the employee (or spouse) serves as legal guardian or is otherwise legally obligated to support. The limiting age for children is 26. Effective Date of Dependents are eligible for coverage on the later of (i) the date the Same as medical. Dependent Coverage employee is eligible, or (ii) the date the person becomes a dependent. Reminder The only time that you as an employee can make changes to your elections (including dropping coverage) is at open enrollment, or if you should have a qualifying life event such as a birth/adoption, death, marriage, divorce, or loss of employment. You must make changes to your benefits within 31 days of your life event or wait until the next open enrollment period. 4
2023 Benefits Guide CASTLIGHT Castlight takes the guess work out of managing your benefits so you can make the best decisions for both Online Resources you and your family. It is a comprehensive digital Access your health and benefits in one place with resource that helps you navigate access to and cost Castlight. of your medical benefits, allowing you to focus on your health and wellbeing. 1. Benefits—confirm dependents covered under your plan, view your benefit highlights, and get Personalized Just For You answers to frequently asked questions. Information is based on your unique profile and 2. Claims Center—view claim details, including benefits payment amounts, a summary of your claims by Receive provider recommendations with date of visit, names of doctors, total charges, and background expertise relevant to your specific status. needs and conditions 3. Find Care—find provider reviews and treatment Get timely, regular notifications that help you pricing to help you make more informed manage your health, such as exam reminders healthcare decisions. Track and manage your spending to become a 4. Doctors and Hospitals—use the Provider Finder better healthcare consumer to locate a network doctor or hospital. Maximize the benefits and programs available 5. Message Center—receive notification of to you pending and finalized claims via secure messaging. 6. Quick Links—find all your benefits in one place, print or access a digital ID card, and review your health summary. Get started with Castlight by following these three easy steps: 1. Sign up for Castlight at 2. Submit your information (secure 3. Download the Castlight app on mycastlight.com/ and completely confidential) mobile or tablet sammonsfinancialgroup 5
BLUECROSS MEDICAL PLAN BLUESHIELD OF BlueCross BlueShield of Illinois (BCBSIL) helps you ILLINOIS maximize your healthcare benefits with Blue Access 800.458.6024 for Members (BAM). You and all covered dependents www.bcbsil.com over the age 18 can create a BAM account. With BAM, You Can: It’s Easy to Get Started! Use our Provider Finder® tool to search for a 1. Go to bcbsil.com/member healthcare provider, hospital or pharmacy 2. Click Register Here Request or print your ID card 3. Use the information on your BCBSIL ID card to Check the status or history of a claim sign up View or print Explanation of Benefits statements Use our Cost Estimator tool to find the price of Or, text* BCBSILAPP to 33633 to get the BCBSIL app hundreds of tests, treatments and procedures that lets you use BAM while you’re on the go. Download our app * Message and data rates may apply. Sign up for text or email alerts Confused About Where to Go for Care? If you are not having an emergency, you may save time and money by considering the choices you have to seek for non-emergency care. When you use in-network providers for your family’s health care, you usually pay less for care. Search for in-network providers in your area at bcbsil.com or by calling the Customer Service number on your member ID card. Important Note Regarding BlueCross BlueShield of Illinois (BCBSIL) You must contact BCBSIL’s Medical Service Advisory (MSA): If you or a member of your family goes to the emergency room for care and are admitted to the hospital, you must call to inform them of the hospitalization within 48 hours of or as soon as possible. For a scheduled admission, they need to call at least 24 hours in advance. If you or a member of your family undergoes an inpatient procedure. If the surgery is non-emergency, you must contact the MSA prior to undergoing any inpatient surgical procedure. If you are uncertain whether it is necessary to call, contact the MSA. If you do not call and you should have, you will be charged a $500 penalty. If it was not necessary for you to call, they will inform you of such. You want to make sure it gets recorded that you contacted them. The telephone number for the MSA is 800.232.7108. This telephone number can also be found on the back of the BCBSIL ID card you receive. 6
2023 Benefits Guide Benefit Overview Get a better understanding of how you and your health plan work together to pay for your healthcare services. Deductible Copay/Coinsurance Out-of-Pocket $ Coinsurance is the percentage of the The money you pay out of your own The total amount you must pay cost that a member pays out-of-pocket pocket for your healthcare services before before your plan starts paying towards a claim, i.e., 20% member your plan covers the rest of the cost. for part of your medical and coinsurance for a $100 claim would result prescription costs. in the member paying $20. Medical Plan Definitions Embedded vs. Non-Embedded Deductible NON-EMBEDDED DEDUCTIBLE EMBEDDED DEDUCTIBLE NEW Consumer Basic Family Consumer Family In-Network Deductible: $3,000 In-Network Deductible: $6,000 Family works as a team to meet the family deductible. Each individual works to meet their individual deductible There is no individual deductible. ($3,000). No individual can pay more than $3,000 towards The most a family will pay before moving to coinsurance the deductible. is $3,000. $700 $1,800 $500 $3,000 $3,000 $0 This plan has an embedded family deductible. A family member is treated as an individual, as if that member had single employee coverage. $3,000 If one family member reaches the $3,000 individual The Consumer Basic Plan has a non-embedded family deductible, the plan begins to cover services for that individual (also called aggregate) deductible. only. Any combination of family member expenses go toward The other remaining deductible amount of $3,000 needs the $3,000 deductible. Then the plan begins to cover to be reached by another family member and then the family services for all family members. deductible is met. Once deductible is met, the entire family will pay Instead of everyone working toward the family deductible coinsurance (10%) until the family out-of-pocket at the same time, family members first work toward their maximum is met. The most an individual can pay for the individual deductibles. out-of-pocket maximum is the individual out-of-pocket Once the family deductible is met through the cumulation maximum. of members’ individual deductibles, the entire family will pay coinsurance (10%) until the family out-of-pocket maximum is met. The most a family member can pay for their own claims is the individual out-of-pocket maximum. The Consumer Plus and Traditional are embedded and would follow the same example as the Consumer plan. 7
Medical Plan Summary Medical Plan Features Traditional (PPO)** NEW Consumer Basic Consumer (HD) ConsumerPlus (HD+) 2023 2023 2023 2023 $250 single/$500 family (Health Savings Account) $1 for $1 Sammons Financial Group Healthcare Spending provided match to HSA No Employer HSA $250 single/$500 family Accounts-Employer Not an HSA eligible plan account funding up to contribution (Health Savings Account) Contributions $500 Single/$1,000 family annually–in addition to funding listed above (Health Savings Account) Non-Embedded Calendar Year Deductible Embedded Deductible Embedded Deductible Embedded Deductible Deductible Individual $1,300 $1,500*** $3,000 $4,000 Family $2,600 $3,000 $6,000 $8,000 Medical Out-of-Pocket Maximum (Includes Deductible) Individual/Family $4,750/$9,500 $3,500/$7,000 $3,500/$7,000 $5,000/$10,000 Rx Out-of-Pocket Maximum (Includes Deductible) Rx counts towards the Rx costs count towards Rx costs count towards Individual/Family $2,100/$4,200 medical out-of-pocket the medical out-of- the medical out-of- maximum pocket maximum pocket maximum Lifetime Maximum Unlimited Unlimited Unlimited Unlimited 80% covered after 90% covered after 90% covered after 80% covered after Office Visit deductible deductible deductible deductible Wellness/Preventive– 100% covered 100% covered 100% covered 100% covered Adults/ Children Inpatient and Outpatient 80% covered after 90% covered after 90% covered after 80% covered after Services deductible deductible deductible deductible $200 copayment then 90% covered after 90% covered after 80% covered after Emergency Room Services 80% after the deductible deductible deductible deductible 80% covered after 90% covered after 90% covered after 80% covered after Diabetic Pumps deductible deductible deductible deductible * Embedded deductible: if one member of the family meets the embedded individual deductible, then the plan coinsurance would start to pay once that individual deductible is met. Sammons Financial Group’s Consumer and Consumer Plus plans are required to have a minimum embedded individual deductible of $3,000 to remain HSA qualified in 2023, due to IRS regulations. ** Those who are currently enrolled in the Traditional plan in 2022 will be able to re-elect this plan for the benefits year 2023. Those who choose to leave the Traditional plan will no longer be able to move back to the Traditional medical plan. *** Please note, the individual deductible applies only for those electing Employee Only Coverage. Please refer to the Summary of Benefits for a full description of benefits. 8
2023 Benefits Guide Prescription Drug Plan Summary Prescription Traditional (PPO) Consumer Basic Consumer (HD) ConsumerPlus (HD+) Drug Benefits Retail Mail Order Retail Mail Retail Mail Order Retail Mail Order Individual No No No No No No No individual Rx Rx $150 individual individual individual individual individual individual ded. Deductible Rx ded. Rx ded. Rx ded. Rx ded. Rx ded. Rx ded. Generic Drugs (including Diabetic 90% 90% 90% 90% 80% 80% Test Strips, $20 $20 covered covered covered covered covered covered Lancets, copayment per copayment–no after after after after after after Glucagon prescription (3 ded. medical medical medical medical medical medical Emergency month supply) ded. ded. ded. ded. ded. ded. Kits and Diabetic Pump Supplies) Your Your coinsurance coinsurance 90% 90% 90% 90% 80% 80% = 13.33%, Formulary = 20% after covered covered covered covered covered covered Minimum Brand Name ded., minimum after after after after after after cost of $60, Drugs cost of $45, medical medical medical medical medical medical maximum maximum $95 ded. ded. ded. ded. ded. ded. of $180 per prescription per prescription Your Your coinsurance coinsurance 90% 90% 90% 90% 80% 80% Non- = 26.67%, = 40% after covered covered covered covered covered covered Formulary Minimum ded., minimum after after after after after after Brand Name cost of $120, cost of $70, medical medical medical medical medical medical Drugs maximum maximum $185 ded. ded. ded. ded. ded. ded. of $360 per prescription per prescription Rx Out-of-Pocket Maximum (Includes Deductible) Rx costs count towards Rx costs count towards Rx costs count towards Individual/ $2,100/$4,200 the medical out-of- the medical out-of- the medical out-of- Family pocket maximum pocket maximum pocket maximum * There is not a separate Rx deductible for the Consumer Basic, Consumer, and ConsumerPlus plans. Rx costs count towards the medical deductible for these plans. 9
PRESCRIPTION DRUG PROGRAM SFG Medical Plan Strategies Pharmacy Cost Saving Tools Just as your medical plan covers visits to your doctor, your Express Scripts prescription plan covers EXPRESS SCRIPTS the medication your doctor prescribes. 800.818.6634 www.express-scripts.com Visit: www.express-scripts.com/sfg to: Remember that your Express Scripts ID card for the Explore plan options and benefits prescription drug program is separate from your BCBS medical ID card. Price medications (tip: have your prescription SFG Medical Plan Strategies bottles nearby so you’re ready to search) Find participating pharmacies in your area Pharmacy Cost Saving Tools $0 Copay Diabetes Prescription Prevention Drug Program Out-Of- Specialty Pocket Medication Protection Pharmacy (new in 2023) SaveOnSP (new in 2023) LOCKTON COMPANIES | 1 MOBILE APP It’s easy to manage your medicine anytime, anywhere. With the Express Scripts mobile app, you can have information and assistance right at your fingertips. With up-to-the-minute order status, a pharmacy locater, the handy “medicine cabinet” to keep track of prescriptions, and more, this app is a must have! For more information on this app, available on the iTunes and Google Play stores, please click here! 10
2023 Benefits Guide Express Scripts Programs 1 $0 Copay Prescription Drug Program Mail Order Preventative medications target many illnesses and Utilize the mail order pharmacy for ordering a 3-month medication supply to save time, maintain chronic conditions. If your medication is with online and over the phone refills and on the Copay Prescription Drug list, you pay zero take advantage of convenient home delivery dollars out-of-pocket! with free standard shipping. Mail order also offers you access to a licensed pharmacist by Specialty Medication Pharmacy phone and allows you to take advantage of wholesale prescription drug prices. ESI partners with focused pharmacy providers to offer a full-service specialty pharmacy on chronic 2 and complex conditions. Diabetes Prevention Pharmacy You always have the option to refill your Personalized weight management and healthy living prescriptions at one of the many in-network program as a preventative measure to diagnosis of pharmacies. a serious condition. Qualified enrollees in program 3 incur no cost! SaveOnSP (New in 2023) Smart90 Program The Smart90 program allows members to Maximizes manufacturer assistance dollars offered fill a 90-day retail supply at Walgreens or through drug companies in order to benefit the plan through Express Scripts mail order pharmacy. and allow for zero cost to you on over 320 specialty This partnership allows you to receive your 90-day supply at a discounted price, drugs. compared to filling a 30-day prescription every month. This program can be extremely Out-of-Pocket Protection beneficial for those who have continuous (New in 2023) medications, as you can save time and money using the Smart90 program. Maximizes manufacturer assistance dollars offered through drug companies for any specialty drugs not included in SaveOnSP and passes savings onto you, the healthcare consumer. Costs for the medication will run through insurance like normal; deductible and out-of-pocket maximums will apply — this does not include any discounts. 11
Options for Filling Prescriptions RETAIL DISPENSING LIMIT The dispensing limit at a retail location is a 30-day supply for all medical plans. If you have a medication that is prescribed for a longer period of time, you can take advantage of the Smart90 program described on the previous page to save time and money. SPECIALTY MEDICATIONS PHARMACY A dedicated pharmacy for specialty medications is available through the prescription drug plan. This type of pharmacy provides access to medications for complex medical conditions (e.g., multiple sclerosis, rheumatoid arthritis, cancer, etc.), as these medications generally require close monitoring and are normally very expensive. No benefits will be available for specialty medications purchased at any other pharmacy. $0 COPAY PRESCRIPTION DRUG PROGRAM In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. Sammons Financial Group partners with Express Scripts to offer many drugs as a $0 copay. The list includes but is not limited to certain drugs relating to: asthma, diabetes, bone disease, high blood pressure, cholesterol, smoking cessation, etc. To view the full list of preventive medications that are covered at a $0 copay, click here and choose your plan. 12
2023 Benefits Guide HEALTH SAVINGS BENEFITWALLET ACCOUNT (HSA) 877.635.5472 www.mybenefitwallet.com An HSA is a tax-advantaged savings account that allows you to pay for current qualified medical expenses and save for future qualified medical expenses on a tax-favored basis. To be eligible to set up and contribute to an HSA, you must be covered by a qualified HDHP and not have other coverage. Advantages of an HSA An HSA works similarly to a personal checking account; however, the money can only be used to pay for qualified medical expenses. Your HSA can pay for you and your eligible dependents’ medical expenses tax free. Other HSA advantages include: You can add tax free contributions and take the deduction when filing your taxes. This helps you save on most state and federal taxes. You can change the amount you contribute to your HSA at any time during the plan year by submitting a change through Manage My Benefits in UKG Pro. You can use the money in your account to pay for eligible out-of-pocket medical, dental, and vision expenses. You can pay COBRA and some Medicare premiums with your HSA. Any unused funds rollover from year to year and allows you to accumulate funds over time. An HSA belongs solely to you, which means you keep the account even if you change jobs or retire. Sammons Financial Group offers three high- deductible medical plans that meet the IRS qualifications to include an HSA and, depending on the medical plan in which you enroll may also provide you with employer funding. 13
It's your money Save, spend or invest with your HSA Your BenefitWallet® Health Savings Account (HSA) is a powerful savings tool that you can use to save, spend or invest for your – and your family's – health care expenses. Three ways to use your HSA 1 2 3 Save Spend Invest Contribute to your HSA Use your HSA to pay for Similar to a 401(k), your HSA regularly. Then, save your health care expenses and has investing features that HSA funds to build a safety extend the buying power of can be used once your net for unexpected health your income. balance reaches $1,000. care costs. Investing can grow your Save up to 35% on qualified savings over time. Anything you save rolls over medical expenses such as year to year, so there's no risk medications and medical, This is helpful since the of losing unspent funds. dental and vision care. average retired couple needs an estimated $390,000 to pay Will you be prepared? The more you spend, the for out-of-pocket expenses. more you save. $7,500 Watch your HSA grow. Potential cost of a $4,500 broken leg Annual out-of- pocket medical $$$ $30,000 costs $$$ $$$ Average cost of a 3-day hospital stay $2,515 $$$ $$$ $$$ Potential annual tax savings Year 10 Year 20 Year 30 14
2023 Benefits Guide How to open an HSA Fund your account Get started by depositing funds into your HSA, by enrolling in an HSA-qualified ideally through your employer's health plan and open your account. payroll or from your bank account. Things you should know 2023 contribution limits Always tax free In 2023 you can maximize your HSA deposits Tax • Contributions by contributing up to these amounts: free • Qualified expenses • Investment gains $3,850 $7,750 $1,000 Use any time Single Family Extra if you are coverage coverage 55 or older Funds never expire Qualified medical expenses Pay for medical expenses You can spend your HSA dollars on qualified For you and your family medical expenses such as: • deductibles and copays • prescription and over the counter medications We’re here to help • vision or dental care Visit mybenefitwallet.com or call View a full list of qualified expenses at the BenefitWallet Service Center irs.gov/pub/irs-pdf/p502.pdf. at 877.472.4200. © 2022 Conduent Inc. All rights reserved. Conduent, Conduent Agile Star and BenefitWallet® are trademarks of Conduent Inc. and/or its subsidiaries in the United States and/or other countries. HSA-M-1000-0721 15
2023 IRS HSA Contribution Limits Single: $3,850 Family: $7,750 Catch-up contribution (age 55 or older) $1,000 Consumer Basic (New) Consumer Consumer Plus Single SFG Contribution $0 $250 $250 Funds loaded to Employee HSA: 01/15/2023 SFG Match Match up to $250 of Employee $0 $0 First match loaded: 04/15/2023 contribution through 03/31/2023 Second SFG Contribution $0 $0 Match up to full annual match $500 Second match loaded: 11/15/2023 Family (Employee + 1) SFG Contribution $0 $500 $500 Funds loaded to Employee HSA: 01/15/2023 SFG Match Match up to $500 of Employee $0 $0 First match loaded: 04/15/2023 contribution through 03/31/2023 Second SFG Contribution $0 $0 Match up to full annual match $1,000 Second match loaded: 11/15/2023 In addition to the above, a catch-up contribution (age 55 or older) can contribute an additional $1,000. Employer funding counts towards the IRS maximum. When planning your own deductions, take the IRS maximum, subtract the employer funding, and the remainder is what you can defer. Medical Plan IRS Annual Maximum Potential SFG Funding Employee Funding Single Consumer $3,850 $250 $3,600 Family Consumer $7,750 $500 $7,250 Single Consumer Plus $3,850 $750 $3,100 Family Consumer Plus $7,750 $1,500 $6,250 Additional Catch-Up Contributions (55 - years or older) $1,000 N/A $1,000 Don’t Leave Money on the Table! What Steps Do I Need to Take to enroll in the HSA and Receive Employer Funding? 1. Open your account online through the Advantage Direct portal with three clicks! mybenefitwallet.com Use your name, Social Security number, date of birth, and ZIP code 2. Open your HSA within 60-days of being newly eligible in order to receive the employer funding. 3. Elect the amount of pre-tax funds you want to contribute through payroll deductions within the Open Enrollment election process. Please note, employees are not required to contribute to their own HSA account to receive employer funding. As long as their is an open account, Sammons Financial Group will fund as described above. Mid-year changes can be done at any time by completing a Life Event through the Manage My Benefits in UKG Pro. 16
2023 Benefits Guide Investment Options HSA Calculator BenefitWallet offers an integrated investment To help you determine how much you can contribute to platform with investment options from a variety your HSA and the amount of tax savings you may see, of funds. click here. You can open investments online once your HSA checking reaches $1,000. Have Questions? Rules and Restrictions Take charge of your family’s healthcare and learn how to In order to receive the employer funded portion of make the most of your HSA! the Health Savings Account, employees must open Click on the following link for all your questions and their account with Benefit Wallet within 60 days of answers! enrollment in the plan. You may open your account mybenefitwallet.com/CMS/portal/default/faqs.html with a different bank, but will forfeit the employer #/hsa/about-hsas funding and the ability to contribute on a pre-tax basis through your paycheck. For those that may have missed out on this opportunity in 2022 or in the past, you may receive the 2023 employer funding portion by opening your account with Benefit Wallet before the February 28, 2023 pay period. Please email HRbenefits@sfgmembers.com if you do not wish to receive ER funding. You should stop contributing to your HSA six months before you apply for Social Security retirement benefits to avoid potential tax penalties. Medicare and Your HSA Becoming eligible for Medicare does not impact your ability to make contributions or withdrawals from your HSA, assuming you otherwise remain HSA eligible. Once you enroll in Medicare you are no longer eligible to make contributions to your account but you can continue to pay for qualified medical expenses with your HSA. If you are planning to enroll in Social Security, you should consider discontinuing your HSA contributions at least six months before you apply for Social Security retirement benefits to avoid any adverse tax consequences. 17
FLEXIBLE BENEFITWALLET SPENDING 877.635.5472 www.mybenefitwallet.com ACCOUNT (FSA) A Health Care Flexible Spending Account (HCFSA) allows you to use pre-tax dollars to pay for eligible out- of-pocket health care expenses, saving you up to 35% in taxes. Use the funds to pay for a broad range of expenses for you, your spouse and your tax dependents—even if they aren’t covered by your health plan. Claim Reimbursement Run-Out Period The reimbursements are processed daily. If you All HCFSA incurred expenses for the 2022 plan have Direct Deposit setup with BenefitWallet, you year must be submitted to BenefitWallet, for should see reimbursements for claims sent to reimbursement no later than April 14, 2023. BenefitWallet in the account of your choice within 1-2 business days. Medical FSA and HSA? You can either submit claims through your online If you are a participant in the HSA plan, you can only account at www.mybenefitwallet.com, or you use the FSA to reimburse yourself for dental and can complete a paper claim form and mail it to the vision expenses. Your FSA will then be considered a below address: Limited-Use FSA. Please note that you will have to sign the affidavit that signifies your understanding BenefitWallet that the Limited-Use FSA is for dental and vision P.O. Box 18009, Suite A expenses only. Norfolk, VA 23501 Claim Extension (Grace Period) If you have money leftover in your HCFSA at the end of the year, you can use your 2022 money for Remember expenses incurred through March 15, 2023. This If you are electing the FSA, please see the Benefits Prime allows you more time to use your 2022 election page for instructions. You are required to re-enroll in the FSA program every year. Elections do not carry over. before the “use it or lose it” provision applies. CASTLIGHT You are highly encouraged to use Castlight to become a smarter and more economical healthcare consumer. Castlight can help you find the highest quality medical care at the lowest cost: 800.684.0510 or mycastlight.com/sammonsfinancialgroup. 18
2023 Benefits Guide Qualifying Expenses How It Works Estimate what you will spend on eligible out-of- Doctors, Labs, and pocket healthcare expenses for the year Hospitalization Enroll in an HCFSA through your employer Doctor’s office visits and procedures, Use your funds hospital services, health plan Important: You must save all receipts and deductibles and copayments submit to BenefitWallet® for reimbursement Alternative Care/Special Account Advantages Services Tax-free: You can save up to 35% on eligible healthcare costs Chiropractor, physical therapy, special Convenient: Make your payments with your education for learning disabilities HCFSA debit card (if offered with your plan), Medications and Medical BenefitWallet mobile app, online bill pay and Devices online claims submission Prescription drugs, over-the-counter medical items, insulin, hearing aids, hand sanitizer We’re Here to Help Eye Care Visit mybenefitwallet.com or call the Vision examinations, eye glasses, laser BenefitWallet Service Center at 855.236.8600. surgery, contact lenses Dental Care Dental cleanings/treatments, braces, extractions, dentures/artificial teeth You can view a complete list of qualified expenses at irs.gov/pub/irs-pdf/p502.pdf. 19
LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNT (LPFSA) Limited Purpose Flexible Spending Account The BenefitWallet® Limited Purpose Flexible Spending Account (LPFSA) allows you to use pre-tax dollars to pay for eligible out-of-pocket dental and vision expenses. The account is typically paired with a Health Savings Account (HSA), allowing you to maximize your tax savings. Use the funds to pay for a broad range of expenses for you, your spouse and your tax dependents – even if they aren’t covered by your health plan. How it works Qualifying expenses 1. Estimate what you will spend on eligible out-of- Eye care pocket dental and vision expenses for the year. • Vision exams • Laser surgery 2. Enroll in an LPFSA through your employer. • Eye glasses • Diagnostic Services 3. Use your funds. • Eye surgery • Eyeglass repair kits 4. Important: You must save all receipts and • Contact lenses • Copays/deductibles submit to BenefitWallet for reimbursement. • Saline solution Account advantages Dental care Tax-free: Save up to 35% on eligible vision and • Teeth cleanings • Diagnostic services dental care costs. See the FAQs for more information. • Dental x-rays • Extractions; fillings • Orthodontia • Copays/deductibles Convenient: Make payments with your LPFSA debit card (if offered with your plan), mobile app, online • Root canals • Dentures/implants bill pay, and online claims submission. • Devices/guards • Crowns/bridges We’re here to help Note: In general, LPFSA funds expire at the end of your plan year, though your employer Visit mybenefitwallet.com or call may offer options, such as a grace period, run- the BenefitWallet Service Center at out period, or rollover. These options all extend 855.236.8600. your ability to use current year funds into the next year. See the LPFSA FAQ section for more details. © 2022 Conduent Inc. All rights reserved. Conduent, Conduent Agile Star and BenefitWallet® are trademarks of Conduent Inc. and/or its subsidiaries in the United States and/or other countries. LPFSA-M-2003-0122 20
2023 Benefits Guide Limited Purpose Flexible Spending Account: Frequently asked questions What is a Limited Purpose FSA (LPFSA)? How does an LPFSA work? An LPFSA is an employee benefit provided by your 1. Funding: During open enrollment, you decide on employer that allows you to save money. With an a specific amount of pre-tax dollars with which to LPFSA, you set a specific amount of pre-tax dollars fund your account. Be sure to choose an amount to be withheld from your paycheck. You can then you will spend as leftover money is typically lost use those funds to pay for qualified dental and at the end of your plan year. vision expenses. 2. Paying for qualified expenses: Pay for eligible expenses using your LPFSA debit card (if offered What tax savings do I get with an LPFSA? with your plan). You could also pay out of pocket The money you have withheld from your paycheck is and request reimbursement online or through the pre-tax and not subject to federal and payroll taxes. BenefitWallet mobile app. You could save up to 35% if you paid 28% federal 3. Requesting reimbursement/substantiating and 7% payroll taxes on the portion of your income purchases: Each purchase you make must be that instead went into your LPFSA. Please consult a verified, or substantiated, typically with an tax advisor for more information on your potential itemized receipt and Evidence of Benefits. You LPFSA tax savings. can use mybenefitwallet.com or the mobile app to submit claims and request reimbursement. 4. Reimbursement claims processing: BenefitWallet promptly processes your request. If you paid out of pocket, we will reimburse you by direct deposit or check. Set up direct deposit at mybenefitwallet.com to receive faster reimbursements. Whose expenses can I pay with my LPFSA? Your LPFSA can be used to pay for your qualified dental and vision expenses and those of your spouse and tax dependents, if you have them. 21
What special account features does my Which should I spend first – LPFSA funds or employer offer? HSA funds? You will need to check with your employer This decision is up to you, but in general you should about special LPFSA features that could extend consider spending your LPFSA funds first because the timeframe for spending your annual funds. the funds typically expire if you don't use them in the Remember, in general LPFSA funds expire at the end same year you fund the account. Conversely, your of your plan year. Your employer may offer a grace HSA funds carry over year after year and never expire. period (allows you to use prior-year funds to pay for expenses incurred at the beginning of the following year), a run-out period (allows you to submit claims for prior-year expenses during the first couple months of the following year) or a rollover (allows you to roll over a maximum of $570 into the following plan year, to be used anytime during that next year). What happens to my LPFSA if my employment ends? Deductions for your LPFSA will end when your employment ends, unless your employer is obligated to offer you COBRA continuation and What kinds of expenses qualify? you elect this option. If you don’t choose COBRA, you are not eligible to be reimbursed for qualified An LPFSA covers out-of-pocket dental and vision medical expenses incurred after the termination expenses. These typically include dental cleanings, of your employment. Reimbursement requests fillings, crowns and braces. Covered vision for claims incurred while active under the LPFSA expenses include contacts, glasses, eye exams and plan must be submitted prior to the end of your vision correction procedures like laser surgery. employer’s plan year. View the complete list of qualified expenses at irs.gov/pub/irs-pdf/p502.pdf. Who is eligible to contribute to an LPFSA? Who do I contact with questions? If you have a Health Savings Account (HSA) and your employer offers an LPFSA (limited to dental Visit mybenefitwallet.com or call the BenefitWallet and vision expenses), you are eligible to contribute Service Center at 855.236.8600. to both a LPFSA and HSA. This allows you to maximize your tax savings benefits. © 2022 Conduent Inc. All rights reserved. Conduent, Conduent Agile Star and BenefitWallet® are trademarks of Conduent Inc. and/or its subsidiaries in the United States and/or other countries. LPFSA-M-2003-0122 22
2023 Benefits Guide DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (DCFSA) Dependent Care Flexible Spending Account A Dependent Care Flexible Spending Account (DCFSA) allows you to use pre-tax dollars to pay for eligible out-of-pocket day care expenses for a qualified tax dependent under age 13 or a spouse or relative who lives with you and is physically or mentally incapable of self-care. How your DCFSA works DCFSA eligible expenses • Estimate what you will spend on eligible You can use your DCFSA to pay for a wide variety of dependent care expenses for the year. dependent care services. The IRS determines which • Enroll in a DCFSA by electing a contribution expenses are eligible for reimbursement. For example: through your employer. School • Child day care center, nursery school, • Start using your DCFSA funds to reimburse before/after-school care yourself for expenses after services are rendered. • Placement fees for a dependent care • Submit your expenses with appropriate provider documentation and receipts for reimbursement. • Child care by a private sitter Only dependent care expenses that allow you to work • Summer or holiday day camps are eligible for reimbursement from your DCFSA. Your • Adult day care center, custodial elder DCFSA has a “use it or lose it” rule meaning the IRS care, day camp requires you to forfeit any unspent funds at the end Ineligible expenses include expenses for non- of the plan year. disabled children 13* and older, educational expenses including kindergarten or private school tuition Benefits of your DCFSA fees, overnight camp expenses, registration fees, Tax-free spending: Save up to 35% on eligible transportation expenses, payment for services not dependent care expenses. yet provided and medical care. Easy to use: Quickly and easily create your claim We’re here to help online or through the BenefitWallet® mobile app to upload your receipt documentation for Visit mybenefitwallet.com or call the reimbursement. Qualified providers can easily certify BenefitWallet Service Center at services they provide by placing their signature right 855.236.8600. in the app on your mobile device. * Please see your plan documents for age limits on dependent care eligibility. © 2022 Conduent Inc. All rights reserved. Conduent, Conduent Agile Star and BenefitWallet® are trademarks of Conduent Inc. and/or its subsidiaries in the United States and/or other countries. DCFSA-M-2002-0821 23
Dependent Care Flexible Spending Account: Frequently asked questions Who qualifies as a dependent for eligible How do I request reimbursement? DCFSA expenses? You can request a reimbursement through the A qualifying child under the age of 13* when the BenefitWallet member portal, mybenefitwallet.com care was provided; your spouse who is not physically or the BenefitWallet mobile app. You will need to or mentally able to care for his or herself and lives upload documents to substantiate or validate your with you for more than half the year; or a person claim. who is not physically able to care for his or herself, lives with you more than half the year, and is your How much can I elect to contribute? dependent. Other special tax situations may apply; Your contribution cannot exceed the maximum speak with a tax advisor for more details. amount specified by the Internal Revenue Code. Please consult a tax advisor for additional details. What requirements must be met for the care to qualify as dependent care? What if my dependent care expenses are In general, the care must be provided while you less than the amount I elected? work or look for work. If you are married, the care Money contributed to your DCFSA must be used to must be provided while your spouse works, looks reimburse qualified expenses incurred during the for work, goes to school full time, or is incapable of plan year. Any funds not used to reimburse eligible self-care. The care may be provided by a relative or expenses will be forfeited. non-relative but cannot be provided by your child under the age of 19, the child’s parent, or another tax dependent. For a complete list of eligible expenses, please see IRS Publication 503 at IRS.gov. Can I change the amount I elect to contribute during the year? Who do I contact with questions? The amount you contribute cannot be changed during the plan year unless you experience a Visit mybenefitwallet.com or call the BenefitWallet qualified change in status event that causes your Service Center at 855.236.8600. dependent to meet, or no longer meet, eligibility requirements. Qualified status changes include changes in marital status, the number of your dependents, or a change in employment status. * Please see your plan documents for age limits on dependent care eligibility. © 2022 Conduent Inc. All rights reserved. Conduent, Conduent Agile Star and BenefitWallet® are trademarks of Conduent Inc. and/or its subsidiaries in the United States and/or other countries. DCFSA-M-2002-0821 24
2023 Benefits Guide NON-TOBACCO SPOUSAL INCENTIVE SURCHARGE As an incentive towards a healthier lifestyle, The working spouse provision requires that if an Sammons Financial Group offers a Non-Tobacco employee covers their spouse on the Sammons Incentive for an individual (employee, spouse, and/ Financial Group medical plan and the spouse has or child) enrolled in a medical plan that does not use access to qualified healthcare through their own or has not used any tobacco products in the last 6 employer, an additional premium of $50 per month months a $45 monthly Non-Tobacco Incentive on will be deducted from the employee’s payroll. the medical plan premium. If you were a tobacco user, but can substantiate via an affidavit that the The working spouse surcharge will not be assessed if tobacco use has ceased for a minimum period of 6 a spouse: months, you will be eligible for the incentive. Any Does not work previously submitted affidavit forms will carryover Does not have access to qualified healthcare into 2023. through another employer Has access to veterans benefits, Native Starting and/or Ceasing to American benefits, Medicare, Medicaid, or other Use Tobacco Products state/federal healthcare Chooses to no longer enroll in the Sammons Please notify the Total Rewards Benefits Team Financial Group medical plan and enroll in their immediately if, at any time, you or any of your employers plan enrolled dependents begin using tobacco products. You will then lose eligibility for the If your spouse loses or obtains health coverage $45 monthly Non-Tobacco User Incentive. through their employer, you have 31 days to notify If you or any of your enrolled dependents cease the Total Rewards Benefits Team of such change. The using tobacco products at a later date for at Total Rewards Benefits Team needs to be notified in least 6 months and/or complete a cessation writing of all family status changes within 31 days program, you may be eligible for the Non- of when the change occurred. Failure to notify the Tobacco User Incentive. Please notify the Total Rewards Benefits Team and provide written Total Rewards Benefits Team in a timely manner will verification in this situation. bar you from making a change until the next annual open enrollment period. Attestation Requirement Within the open enrollment wizard in Manage My Benefits, you will be required to state whether or not you or any of your enrolled dependent(s) in the medical plan use tobacco products. * For the sole purpose of this policy, tobacco products include, but are not limited to, cigarettes, cigars, snuff, chewing tobacco, pipes, e-cigarettes, hookah, nicotine gels, dissolvable, etc. 25
VIRGIN PULSE WELLNESS PROGRAM REWARDS The more you do, the more you earn. It’s easy and fun to earn rewards with your sponsored wellness program from Sammons Financial Group. Complete healthy activities, engage in challenges, start healthy habits, compete with friends and watch your rewards grow. Complete the 3 priority steps of the Wellness Program in order to begin earning discounts on your medical premiums: Complete by Biometric Lab Screening September 30 Complete by Health Assessment December 31 Next-Steps Consult New Employee to SFG and first year enrolled in SFG medical plan? Complete the 3 required steps and receive a $10 incentive each month following completion of required steps. Actions reviewed on a quarterly basis and incentive will be back dated to month following completion of 3 required steps. Earn up to $750 in rewards! Participate in healthy activities from January 1 through December 31 to earn points and watch your Premium Discount add up. Simply finish your priority activities and build your points by December 31. Complete 3 Level 1 > Level 2 > Level 3 > Level 4 Priority Steps Points 7,000 25,000 40,000 60,000 Premium Discount $150 $150 $150 $150 $150 $750 See ways to earn points on the next page > VIRGIN PULSE member.virginpulse.com 888.671.9395 © Virgin Pulse 2021 support@virginpulse.com 26
2023 Benefits Guide Highlighted ways to earn points: Look for How to Earn in your account for a complete list of all the ways you can earn points. Do healthy things Earn points Complete registration 100 First login to mobile app 250 Connect first activity device 200 Getting started LabCorp Physician Form Completion1 250 Complete the Health Assessment2 REQUIRED Complete your Biometric Lab Screening REQUIRED Complete a Next-Steps Consult® appointment2 REQUIRED Upload steps from your activity tracker (per 1,000 steps) 10 Do your Daily Cards (2 per day) 20 Track your Healthy Habits (3 per day) 10 Track sleep nightly 20 Daily Sleep > 7 hours in a night 50 Complete a RethinkCare session 20 Browse healthy recipes 10 Complete a step in Journeys® 20 Win the promoted Healthy Habit Challenge 200 Complete 20 Daily Cards in a month 200 Track Healthy Habits 20 days in a month 300 Track sleep 10 days in a month 100 Monthly 20-Day Triple Tracker: 7,000 steps/15 active minutes/15 workout minutes 400 Take validated measurements 250 Join the company challenge 100 Complete a coaching appointment (4x per month) 500 Choose your eating type 250 Quarterly Choose your sleep profile 250 Complete a Journey (3x per quarter) 250 Set a wellbeing goal 200 Complete the Nicotine-Free Agreement 100 Yearly Invite a colleague to join 50 Screening Results: BMI, Blood Pressure, Cholesterol, Glucose 50/each 1 Available only to those not enrolled in the medical plan 2 Required only for those enrolled in medical plan and for non-medical earn 1000 points Who’s eligible: All employees are eligible to participate in the wellbeing program and earn rewards. Must be enrolled in the company’s medical plan in order to earn incentives toward monthly medical premiums. If you join the SFG medical plan during a qualifying life event the year following completion of points and priority steps, reach out to HRbenefits@sfgmembers.com and we will review incentive eligibility. Not a member yet? Don’t miss out on all the fun! Get the mobile app or go to join.virginpulse.com/SFG. © Virgin Pulse 2022 27
DENTAL PLANS DELTA DENTAL OF S.D. No Plan Provision 877.841.1478 Changes for 2023 www.deltadentalsd.com Plan Features Core Plan Enhanced Plan Seeing an in-network dentist can save you money! Calendar Year Deductible The “no balance billing” provisions for network Individual $50 None dentists reduces out-of-pocket costs for many Family $150 None Annual Benefit members. $1,500 $2,000 Diagnostic and Preventative Services Out-of-network dentists may balance bill patients Examinations and for charges that are higher than Delta’s maximum Cleanings (2 per year) 100% (no 100% (no Fluoride (up to age 19) deductible) deductible) allowed charges for service. X-rays Routine and Restorative Services Dental benefits help maintain mouth’s health. Brush Cavity Repair/Fillings up on the 3 areas in which you save when you use Tooth Extractions 80% after 90% Oral Surgery and deductible your dental plan: Emergency Treatment Endodontic and Periodontics Save your smile: visiting the dentist can help save Root Canals 50% after Gum and Bone Disease deductible 80% you from cavities, gum disease, and other oral Major Services health issues, and even catch them early before they Cast Restorations worsen (and become more expensive). People with 50% after 80% and Crowns Bridges and Dentures deductible 60% a dental plan are 70% more likely to visit the dentist Braces (Orthodontics) than those that do not enroll. 50% up to No coverage maximum Save yourself stress: it’s easy to find a dentist Orthodontia Lifetime Limit (per person) $2,000 (annual who accepts our dental plan and who you are N/A limit of $1,000) comfortable visiting. Visit Delta Dental of South Dakota’s website to search for in-network dentists. Please refer to the Summary Plan Descriptions for a full description of benefits. Save money: our dental plan gives you access to the reduced fees Delta Dental has negotiated with Prevention Pays—We want to encourage everyone to their in-network Dentists. If more expensive work get their preventive cleanings each year, so in addition to covering at no cost to you, these services will no longer is needed, you can work with your dentist to get a count towards your annual benefit maximum! pre-treatment estimate to understand what the plan covers and what additional costs to expect. Health Through Oral Wellness—In order to support better health for those fighting gum disease, tooth decay, or those at risk for certain dental conditions, we Boost your savings even more will provide additional cleanings, sealants, periodontal by brushing twice a day, flossing Please refer to maintenance, fluoride, and more for those patients who the Summary regularly, and eating and drinking of Benefits for a need it. Talk to your dentist for more information or to see if you qualify. less sugar. That’s a smile-winning full description plan! of benefits. 28
2023 Benefits Guide VISION PLAN VSP 800.877.7195 No Plan Provision Changes www.vsp.com for 2023 You and your eyes deserve to be healthy and happy. Using Your Benefits is Easy Enrolling in VSP Vision Care can create savings and you will receive quality eye care and eyewear at low out-of- Create an account on vsp.com to view your pocket costs. in-network coverage and find the VSP network doctor who’s right for you. Plan Feature 2023 Plan With access to over $3,000 in savings, discover Copays VSP Exclusive Member Extras to maximize your Exam $15 benefits and save even more. Prescription Glasses $25 Print a Member Vision Card—if you’d like one. Contacts None There’s no ID card necessary-just tell your Covered in full provider you have VSP. Exam every calendar year after copay Prescription Glasses Lenses You deserve personalized, affordable vision care, Covered in full delivered with your overall well-being in mind. Single vision, lined bifocal, and lined every calendar year trifocal lenses after copay We’re committed to helping you experience a Covered up to $150 lifetime of healthy vision: See well. Be Well. every calendar year Frames (plus 20% off any out- of-pocket costs) Contacts Please Note Allowance applies to the cost of your lenses. If you choose contact You will not receive an ID card from VSP, nor is one lenses, you will be eligible for a Covered up to $150 needed. Please have your SSN ready and available frame 12 months from the date every calendar when visiting your provider. Claims should be the contact lenses were obtained. handled by your provider, who will work directly year when you Current soft contact lens wearers choose contacts with VSP once they identify if you are enrolled in may qualify for a special contact instead of glasses the plan. lens program that includes a contact lens evaluation and initial supply of replacement lenses. Learn more from your doctor or vsp.com. Contact Lens Fitting and Evaluation This exam is in addition to your Maximum charge of vision exam to ensure proper fit $60 of contacts. Additional discounts for lens extras such as scratch resistant and anti-reflective coatings and progressives. Extra Discounts and Savings Please refer to Discount off of the Summary additional prescription of Benefits for a glasses and sunglasses. full description Discounts on laser of benefits. corrective surgery. 29
AFLAC SUPPLEMENTAL PLANS Why choose Aflac? Individual Aflac plans supplement the group health plan offerings. Aflac pays you cash, regardless of your enrollment in other insurance coverage. Your Aflac coverage is portable and all rates are fixed (if coverage is continuous). There are several plan offerings from which that you can choose and some of the offerings can cover your family members as well as yourself. Accident Indemnity Critical Illness Plans Advantage Plan Plan pays a first-occurrence benefit as well as Hospital Confinement and Continuing Care Provides cash compensation in the event you benefits when you or a covered member of your or a member of your family experiences an family experiences a covered critical illness. accident/injury that requires treatment. Covered specified health events include: heart Wellness benefit provides compensation attack, stroke, end stage renal failure, organ when you or a covered member of your transplant, third-degree burns, coma, and more. family undergoes routine examinations or preventative testing. Plan pays benefits when you or a covered member of your family is confined to ICU. Covers organ transplants. Popular for maternity and newborn claims. Cancer Care Plans Plan pays a first-occurrence benefit as well as hospital confinement, medical imaging, radiation and chemotherapy, and other benefits when you or one of your covered family members are diagnosed with cancer. Cancer Screening Wellness Benefit provides compensation when you or a covered member of your family undergo preventative cancer screenings that test for the presence of cancer. A cancer diagnosis is not required for this benefit to be payable. 30
2023 Benefits Guide Hospital Confinement Plan pays a first-occurrence and daily hospital confinement benefit in the event you or your covered member of your family experiences an illness or injury that results in a hospital stay. Pays other benefits such as physician visits, invasive diagnostic exams, and surgical benefits. Popular for maternity planning. Short-Term Disability Paycheck protection from $500-$6,000/month for up to three months. With the exception of the Short-Term Disability plan and the two lump sum plans, all Aflac deductions are taken on a pre-tax basis. To learn more about Aflac offerings and determine rates, please contact the Aflac representative for your location or visit AFLAC’s website, www.aflac.com/Sammons Financial Group. Aflac Contact Information Sioux Falls: Pamela Kreber, 605.359.2593 Des Moines: Mary Bishop Campbell, 515.343.9920 Fargo: Sandra Strandlien, 701.730.2179 Chicago: Michael Strang, 708.606.4612 Please refer to the Summary of Benefits for a full description of benefits. 31
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