Hello! Welcome to our benefits - 2021/2022 EMPLOYEE BENEFITS SUMMARY - Filice Insurance
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Hello!
Welcome to our benefits.
2021/2022 EMPLOYEE BENEFITS SUMMARY
YOUR NEIGHBORHOOD
BEVERAGE STORE
What’s Happening With Benefits This Year?
We are happy to announce the Open Enrollment period for our benefit plan year of July 2021 — June 2022.
The Benefits Summary Brochure describes plan details, rates and eligibility.
We are continuing the two-tier benefit plan design which provides participants with a discount on their contributions to the
plan if they get their yearly wellbeing exam with their primary physician and return the physician affidavit. The affidavit
declares you have had your wellness exam but no health data, results, test etc. are shared. This is a voluntary program
applicable to employees who are enrolled in the Anthem HMO or Anthem HIA PPO plan. Please contact the benefits team
for further details at benefits@bevmo.com.
Medical and Dental Benefits for 2021-2022 Other Offerings
You and BevMo! share the cost of these benefits You pay 100% of the cost for the following benefits
• Anthem Health Incentive Account (HIA) +PPO • Pre-Tax savings plan for health and dependent
• Anthem HMO (Select Network) care
• Anthem Dental Complete PPO • Voluntary Vision Plan
• Anthem Dental Net Dental HMO • Voluntary Accident, Life & Disability Plans
• Dependent children up to age 26 • Voluntary Term Life Insurance for full-time
can be added to the medical, dental and employees
vision plans regardless of their student status • Commuter Benefits (Transportation & Parking)
Open Enrollment Process
BevMologists who are eligible for benefits should attend a benefit webinar to learn about the plans in detail. During the
benefits webinar, we will go over your coverage options, explain the current plans, any changes for the new plan year, and
walk you through the online enrollment system. Prior to the webinar, please review your current coverage (by logging into
MyADP), and the information contained in this booklet, to decide what type of coverage will best suit your needs, as benefit
options vary by employment status. You will have the opportunity to ask questions about your BevMo! benefits during the
webinars. Separate webinars will be available for part-time and full-time employees.
During Open Enrollment, BevMologists wishing to make changes to their benefits must complete their elections online
through MyADP. If you are not making any changes, your current elections will carry over into the new plan year. Please
note: the Flexible Spending Account for medical and dependent care expenses must be elected in order to par-
ticipate in plan year 2021-2022.
Changes Outside of Open Enrollment (Qualifying Events):
If you experience a Qualifying Life Event (QLE) outside of Open Enrollment, including a change in status from part-time
to full-time, log onto MyADP within 30 days from the QLE to report the qualifying event and make any applicable benefit
changes. These changes will generally be effective the first of the month following the QLE. Any benefit election changes
you make must be consistent with your Qualifying Event. If you miss your 30-day enrollment window, you will need to wait
until Open Enrollment to make benefit changes.
Qualifying events may include: change in marital or registered domestic partner status, spouse gains or loses coverage,
birth or adoption, dependent loses eligibility, or change in employment status. Please review the Summary Plan Descrip-
tion for a full list of qualifying events. You will be required to provide supporting documentation to validate your QLE.
Participation: If you enroll in BevMo! benefits, your participation will begin on the first of the month following
your date of hire.
What’s Next?
Should you have questions, please contact:
Eric Pogue, Insurance Broker, (925) 299-7212
BevMo! Benefits
benefits@bevmo.com
Thank you for your contributions to BevMo!’s
success and “Cheers!” to a healthy 2021-2022. 2
2015/2016 EMPLOYEE
BENEFITS SUMMARY
Table of Contents
Plan Eligibility ...................................................................................4
Anthem Blue Cross Medical Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Anthem Blue Cross Dental Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Anthem Blue Cross Blue View Vision Plan (100% employee-paid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ceridian (LifeWorks) Employee Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Navia Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0
Prudential Group Term Life/AD&D (100% employee-paid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1
401(k) Retirement Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2
Unum Interest-Sensitive Whole Life Insurance (100% employee-paid). . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . 1 3
Unum Accident Insurance (100% employee-paid) ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3
Unum Individual Short-Term Disability Insurance (100% employee-paid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 4
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6
3
Plan Eligibility
Benefit eligibility is based on BevMologist status.
4
Plan Eligibility
Over-age Dependent Eligibility (Medical, Dental & Vision) Over-age dependents between ages 19 and 26
are eligible to enroll, regardless of student or IRS status. You can only enroll your over-age dependent during
Open Enrollment or with a Qualifying Life Event (QLE). Plus, in order for your dependent to be enrolled, you
must also be enrolled in the applicable benefit(s).
Effective Date of Benefits If you enroll in benefits, your participation in the elected benefit begins the first
of the month following (or coincident with) your hire date or QLE. For example, if you are hired on August 12
and enroll in benefits within 30 days, your benefits will begin on September 1. If you are hired on August 1,
and enroll in benefits within 30 days, your benefits will begin on August 1.
*Full-time employees (designated status of full-time and generally work 32+ hours per week). New full-time
employees are eligible on the first of the month following their date of hire and must enroll within 30 days of
becoming a full-time employee.
Upon hire, full-time employees are eligible to enroll in Medical, Dental, Term-Life as well as the flexible spend-
ing accounts (FSAs). You are also eligible to enroll in the 401k, after you have completed your waiting period.
*Part-time employees (designated status of part-time and work less than 30 hours per week):
NOTE: Part-time employee hours will be reviewed monthly for both minimum hours for eligibility and potential
eligibility for medical coverage under the Affordable Care Act (ACA) legislation. As a part-time employee, if
you average 30+ hours per week, during your Measurement Period, you may be eligible for medical bene-
fits. If you meet the criteria for eligibility, you will be notified by email and offered an opportunity to enroll in
medical coverage. Please contact the benefits department if you have any additional questions, at benefits@
bevmo.com.
Upon hire, part-time employees are eligible to enroll in Vision and the flexible spending accounts (FSAs). You
are also eligible to enroll in the 401k, after you have completed your waiting period.
If you later become a full-time employee, you will become eligible for Medical, Dental and Term Life insur-
ance, in addition to the part-time benefits. If you become a full-time employee and want to participate in the
Medical, Dental or Term Life insurance plans, you must enroll within 30 days of your status change to full-
time. If you enroll within 30 days, your participation in those plans will begin the first of the month following
your move to full-time employee status.
5
Medical Insurance
BevMo! benefits program offers 2 medical plans through Anthem Blue Cross. Each plan provides comprehensive,
high-quality health care. The plans differ in the way they manage your care and structure out-of-pocket expenses.
• Anthem Blue Cross HMO (Network = Select HMO)
• Anthem Blue Cross HIA Plus PPO (Network = Prudent Buyer PPO)
You can look up providers at www.anthem.com/ca or by calling 855-333-5730
Your cost per pay period - Bi-Weekly
Tier 1 Tier 2
Anthem Blue Cross HMO - CA HMO - Employee per pay period HMO - Employee per pay period
Employee Only $103.41 $134.44
Employee + Spouse $248.37 $322.88
Employee + Child(ren) $206.98 $269.07
Employee + Family $351.87 $457.43
Tier 1 Tier 2
Anthem Blue Cross HIA Plus PPO PPO HIA - Employee per pay period PPO HIA - Employee per pay period
Employee Only $69.94 $90.92
Employee + Spouse $175.05 $227.57
Employee + Child(ren) $145.88 $189.64
Employee + Family $247.99 $322.39
Anthem Blue Cross HMO Plan
Under the Anthem Blue Cross HMO Plan, benefits are covered only when services are provided or coordinated by
the assigned Primary Care Physician (PCP) and authorized by the assigned medical group or Independent Practice
Association (IPA). A member receives services from the HMO providers for a set copay and there is an annual out-
of-pocket maximum for the plan. This means that when a subscriber or his or her family member reaches the out-
of-pocket limit, benefits for that person are paid at 100% of covered expenses for the balance of the calendar year.
Please note that not all copays are applied towards the annual maximum, such as outpatient prescriptions or infertility
services. Please refer to the plan Evidence of Coverage (EOC) for complete list.
Anthem Blue Cross Health Incentive Account (HIA) Plus PPO Plan
Under the Anthem Blue Cross Health Incentive Account (HIA) Plus PPO Plan, members can choose from two cover-
age options each time they need medical care, in order to get the health care that best meets their needs.
In-network: A member may receive care from a provider in the contracted network. The member is responsible for
meeting a deductible and paying co-insurance for services. The first half of the deductible is funded under the HIA.
Out-of-network: A member may receive care from any licensed provider or hospital that is not a part of the health
plan’s network of contracted providers. When a member chooses this option, he or she will generally have higher
out-of-pocket expenses than if they had used contracted providers. The member is also responsible for satisfying a
deductible and/or paying co-insurance charges, and may also be balance-billed from the providers.
Balance-Billing is when out-of-network providers bill patients for amounts that exceed the reasonable and customary
charges paid for by the plan. The patient is responsible for these charges.
IMPORTANT NOTE: This information constitutes a summary description of the Medical and Dental Plans. These
descriptions don’t cover every provision of the plan. Many complex concepts have been simplified or omitted to pres-
ent more understandable plan descriptions. If these plan descriptions are incomplete, or if there’s any inconsistency
between the information provided here and the Evidence of Coverage of Plan Texts, the provisions of the Evidence of
Coverage or Plan Text documents will prevail. 6Anthem Blue Cross Group #: 165629
Website: www.anthem.com/ca
HMO Customer Service: 800-227-3613
HMO Network = Select HMO
Health Incentive Account (HIA) PPO Customer Service: 866-207-9878
HIA Network = Prudent Buyer PPO
Anthem HMO Anthem HIA Plus PPO
Medical Plan Features In-Network In-Network Out-of-Network
Medical Deductible: Calendar Year Plan Year (07/01/21 - 06/30/22)
Per Person $0 $3,000* (refer to HIA Plus Allocation below)
Per Family $0 $6,000* (refer to HIA Plus Allocation below)
HIA+ Allocation:* N/A $1,500
(portion of deductible funded $3,000
by Anthem) Covered expenses incurred are paid from this allocation first, un-
til the HIA Allocation dollars are exhausted. Allocation is applied
toward Plan Year deductible & Out-of-Pocket Maximums
Annual Out-of-Pocket Max:
Per Person $2,000 $4,000^ $6,000^
(less $1,500 Anthem HIA) (less $1,500 Anthem HIA)
Per Family $4,000 $8,000^ $12,000^
(less $3,000 Anthem HIA) (less $3,000 Anthem HIA)
Preventive Care:
Physicals / Screenings No Charge No Charge 30% after deductible*
Lab & X-ray No Charge No Charge 30% after deductible*
Office Visits/Specialists: $20/$40 10% after deductible* 30% after deductible*
Outpatient Lab & X-ray: $0 10% after deductible* 30% after deductible*
(limited benefit to $350/admit)
Durable Medical Equipment: 20% 50% after deductible* 50% after deductible*
Hospital Medical Services:
Inpatient $250 / admit 10% after deductible* 30% after deductible*
(limited benefit to $1,000/day)
Outpatient $125 / admit 10% after deductible* 30% after deductible*
(limited benefit to $350/admit)
Emergency: $100/visit 10% after deductible*
Urgent Care: $20/visit 10% after deductible* 30% after deductible*
Chiropractic: $20 10% after deductible* 30% after deductible*
(limited to 60-days period of care) (limited to 30 visits/Plan Year) (combined with in-network limit)
Acupuncture: $20 10% after deductible* 30% after deductible*
(no limit) (limited to 20 visits/Plan Year) (combined with in-network limit)
Pharmacy Deductible: Calendar Year Included in the medical deductible
$100/member ($300/family max)
Prescription Drugs: Pharmacy deductible (see above)
Preventive $0 (no deductible) retail only $0 (no deductible) retail only
Tier 1 (Generic Rx) $10 (no deductible) $15 *
Tier 2 (Brand Name Rx) $25 after deductible $50 * 30% coinsurance up to $250 per
Tier 3 (Non-Formulary Rx) $40 after deductible $70 * prescription (retail only)
Tier 4 (Specialty Rx) 30% coinsurance up to $250 per Rx 30% coinsurance up to $250 per
(retail & home delivery) Rx (retail & home delivery) *
• New-Hires: HIA Plus PPO Allocation is pro-rated, based on the number of months remaining in the plan year
• Unused HIA Plus PPO dollars roll over year-to-year
• Rewards dollars are offered for participants of the HIA Plus PPO plan for enrolling in various Health Lifestyle programs
• HMO Plan limits are based on the calendar year, Jan 1st to Dec 31st
• HIA Plus PPO Plan is based on the Plan Year, July 1st to June 30th
• ^ In-network/out-of-network out-of-pocket maximums are exclusive of each other; includes plan year deductible.
7
• * All Anthem HIA copayments and coinsurance costs shown are after your deductible has been met, if a deductible applies.Dental Insurance
BevMo! benefits program includes 2 dental plans through Anthem Blue Cross Dental:
• Dental Net HMO
• Dental Complete PPO
You can look up providers at www.anthem.com/ca or by calling Dental Services at 888-209-7852
Each plan provides comprehensive, high-quality dental care. The plans differ in the way they manage your care and
structure out-of-pocket expenses.
Your cost per pay period - Bi-Weekly
Plan Employee Only Employee + Spouse Employee + Children Employee + Family
Dental Net HMO $5.77 $11.53 $11.53 $18.74
Dental Complete PPO $12.23 $24.40 $32.01 $43.65
Dental Net HMO: With a Pre-Paid Dental plan from Anthem Blue Cross, employees have access to Anthem Blue
Cross’ Dental Net HMO Network. Enrolled members select from a panel of Primary Care Dentists. These dentists
manage their patients’ comprehensive dental needs, including referrals to specialists. There are no annual benefit
maximums or deductible, and there are set copayments for services you receive.
Dental Complete PPO: With a PPO Dental plan from Anthem Blue Cross, employees have access to Anthem Blue
Cross’ Dental Complete Network. Participating dentists agree to fee schedules as payment in full. The PPO dental
plan allows you to visit any licensed dentist or specialist you want. If you use a provider outside of the network, you
might be balance-billed for amounts above what is considered usual and customary.
Anthem Blue Cross Group #: 165629
Website: www.anthem.com/ca - click on Find a Doctor (Dentist)
Customer Service (Dental Net HMO): 888-209-7852
Customer Service (Dental Complete PPO): 800-627-0004
Dental Net Dental HMO Dental Complete PPO
Dental Plan Features In-Network In-Network Out-of-Network
Calendar Year Deductible:
• For Self-only $0 $50
• For Family $0 $150
Calendar Year Maximum: None $1,500 per person
Orthodontics Maximum: None $1,000 Lifetime maximum per person
Preventive & Diagnostic Services: 100% 100%
Basic Services: See copayment schedule 80% 80%
Major Services: See copayment schedule 50% 50%
Orthodontic Benefits:
See copayment schedule 50% 50%
(adults and children)
Network: Dental Net Dental Complete
8Vision Insurance
BevMo! benefits program also include a vision plan through Anthem Blue Cross:
• Blue View Vision Plan
You have many choices when it comes to using your benefits. As a Blue View Vision plan member, you have
access to one of the nation’s largest vision networks. You may choose from many private practice doctors, local
optical stores, and national retail stores including LensCrafters, Target Optical, Sears Optical, and JC Penny Opti-
cal. You may also use your in-network benefits to order eyewear online at Glasses.com and ContactsDirect.com. To
locate a participating network eye care doctor or location, log in at anthem.com/ca, or from the home page menu
under Care, select Find a Doctor. You may also call Member Services for assistance at 866-723-0515.
Out-of-Network - If you choose to, you may instead receive covered benefits outside of the Blue View Vision net-
work. Just pay in full at the time of service, obtain an itemized receipt, and file a claim for reimbursement up to your
out-of-network maximum allowance.
Your cost per pay period - Bi-Weekly
Plan Employee Only Employee + 1 Family Member Employee + 2 or more family members
Blue View Vision $2.56 $4.87 $7.46
Blue View Vision Group #: 165629007
Website: anthem.com/ca
Customer Service: 866-723-0515
Blue View Vision Plan
Vision Plan Features In-Network Out-of-Network Allowance
Routine Eye Exam:
(once every 12 months) $20 Up to $49
Eyeglass Frames $130 allowance, then 20% off any
Up to $50
(once every 12 months) remaining balance
Eyeglass Lenses (instead of contacts)
Single Vision = Up to $35
(once every 12 months) $20
Bifocal = Up to $49
One pair of standard prescription lenses
Trifocal = Up to $74
Contact Lenses (instead of lenses)
$130 allowance, then 15% off any
(once every 12 months)
remaining balance Up to $92
Elective Conventional (non-disposable)
Ceridian (LifeWorks) Employee Assistance Program
Whether you’re having trouble staying on top of your monthly bills, caring for older relatives, or coping with a personal
or family problem, LifeWorks is here for you. LifeWorks is a service provided by your organization that offers free,
confidential help with personal and work-related issues, 24/7. You can visit the website at www.lifeworks.com (User
ID: bevmo / Password: eap) or call toll-free anytime to speak with a LifeWorks consultant. You may also have up to
three face-to-face visits with a local counselor. Whether you have a simple question or a complex problem, LifeWorks
can help you with almost any issue.
Life Family Money Work Health
Stress and overload Parenting Budgeting Time management Exercise
Addiction and recovery Child care Debt management Job stress and burnout Nutrition
Relationships Teenagers Credit and collections Retirement planning Sleep
Depression Single parenting Saving and investing Personal well-being
Work-life balance Caring for seniors Bankruptcy
Divorce and separation
Grief and loss 9Navia Flexible Spending Accounts (FSA)
BevMo! benefits program includes an optional benefit that allows you to pay for eligible expenses using pre-tax dollars
called Flexible Spending Account (FSA). Monies deducted from your paycheck and contributed into an FSA are not subject
to payroll taxes, resulting in overall savings to you. BevMo! offers both a Health Care FSA and Dependent Care FSA. For
both of these accounts, you must submit claims no later than 90 days after the end of the plan year.
You can find more information about Navia at www.naviabenefits.com / phone: 800-669-3539. In addition, YouTube video
links are available in the Flex Spending section of the Filice benefits website (benefits.filice.com/bevmo) to assist you.
Health Care Flexible Spending Account
2021 IRS Contribution Limit - $2,750
Allowed Carryover Amount - $550
A Health Care FSA can reimburse you or help you pay for eligible health care expenses not covered by your health plan
such as copays, deductibles, eye exams, glasses, dental work, hearing aids, prescriptions, etc.
Note: All expenses must be qualified medical, pharmacy, dental or vision benefit expenses, as defined in Section 213(d) of
the Internal Revenue Code.
Dependent Care Flexible Spending Account
2021 IRS Contribution Limit for Singles or Married Filing Jointly - $5,000
2021 IRS Contribution Limit for Married Filing Separate - $2,500
No carryover of unused Dependent Care funds is allowed
A Dependent Care FSA helps reimburse you for the work-related cost of care for a qualifying dependent. A qualifying de-
pendent is:
• A tax dependent of yours who is under age 13 , or
• Any other tax dependent of yours, such as an elderly parent, who is physically or mentally incapable of self-care and
has the same principle residence as you
• A spouse who is physically or mentally incapable of self-care and has the same principle
residence as you
Using a Navia Debit Card with your Flexible Spending Account
You will receive a Navia Debit Card as part of your FSA benefit. When you use your Navia Debit Card, you don’t have to
pay for eligible Health Care or Dependent Care expenses out of pocket and you don’t have to spend time filling out and
submitting claim forms for reimbursement. There are mobile apps (iPhone & Android) to assist you with managing your FSA
account. The mobile app will allow you to photograph your claim and upload receipts via the app.
How Does the Navia Debit Card Work?
Your Navia Debit Card acts like a traditional bank debit card. It will be “attached” – or assigned – to your specific Flexible
Spending Account. Then, when your card is swiped through an electronic reader, either at the point of purchase or at the
time you receive an eligible health care service, the appropriate funds are deducted directly from your FSA. This eliminates
the need to pay for all of your health care expenses out-of-pocket.
NOTE: You will keep the same Navia debit card for three years. Debit cards are only re-issued every three years.
10Group Term Life and AD&D
Open Enrollment: If you elected any amount of coverage when you were initially eligible to enroll, and you were not
previously denied coverage, you have the ability to elect up to $50,000 of additional coverage at each subsequent
Open Enrollment, subject to the Guarantee Issue limit of $200,000. Any amount exceeding the Guarantee Issue will be
subject to Evidence of Insurability (EOI). You can elect amounts in increments of $10,000. This option is only available
to the employee.
BevMo! also offers Voluntary Term Life Insurance with Accidental Death & Dismemberment feature as part of their
benefits program through Prudential. Anyone with a financial commitment, family obligation, or a desire to leave a
legacy for their children, grandchildren, or charity should consider buying Life insurance. Term Life insurance provides
affordable coverage for a specific amount of time with important features such as guaranteed coverage, family options,
waiver of premiums, additional payments for covered accident-related claims, and early payouts for terminal illness.
AD&D feature covers death by accidental means (rather than natural causes) and dismemberment, which includes loss
of the use of certain body parts (including limbs or eyesight). If you elect Life, you are automatically enrolled in AD&D.
Guarantee Issue: During your initial eligibility period, you can elect up to $200,000 without having to submit Evidence
of Insurability (health questionnaire). If you try to enroll in Voluntary Life after you were initially eligible, any amount
elected would be subject to Evidence of Insurability (EOI). EOI is required for late entrants and anyone previously
denied coverage.
Portability: If you leave BevMo!, you can take this coverage with you and at these group rates.
Reasons to consider this coverage:
• Guaranteed coverage, if you sign up during your initial eligibility period
• Convenience to pay your premium from your paycheck and affordable group rates
Coverage amounts for Life insurance benefits (these amounts will reduce, even if you are an active employee)
Age 65: 65% of the original amount (reduced until you reach age 70)
Age 70: 40% of the original amount (reduced until you reach age 75)
Age 75 or more: 30% of the original amount (no more reductions)
Prudential Group #: 06932
Website: www.prudential.com
Customer Service: 800-524-0542
Voluntary Term Life and AD&D
Paid By: Employee
Employee: Up to 500% of your annual Salary;
Increments of $10,000 ($500,000 Maximum)
Guaranteed Issue: $200,000 (initial enrollment only)
Open Enrollment: Up to an additional $50,000
Spouse: Up to 50% of the Employee’s amount;
Benefit Amount:
Increments of $5,000 ($125,000 maximum)
Guaranteed Issue: $25,000 (initial enrollment only)
Child: Up to 50% of Employee’s amount;
Increments of $5,000 ($10,000 maximum)
Guaranteed Issue: All amounts are guaranteed 11Group Term Life and AD&D
Rate per $1,000 of coverage per month
Employee Age Bracket Spouse Age Bracket Child Monthly Rates
0 to 24 0.086 0 to 24 0.086 One premium rate covers all
25 to 29 0.086 25 to 29 0.086 eligible children
30 to 34 0.105 30 to 34 0.105 0.192
35 to 39 0.133 35 to 39 0.133
40 to 44 0.200 40 to 44 0.200 AD&D (automatic with Life
45 to 49 0.323 45 to 49 0.323 insurance)
50 to 54 0.561 50 to 54 0.561
55 to 59 0.941 55 to 59 0.941 Employee Only 0.038
60 to 64 1.349 60 to 64 1.349 Spouse 0.029
65 to 69 2.242 65 to 69 2.242 Child 0.029
70 to 74 2.242 70 to 74 2.242
Rate Calculation Example (45 year old electing $40,000 of coverage):
Number of units per thousand 40 Amount you owe
Rate per thousand (based on age) 0.323 $12.92 (40 units x rate of $0.323)
401(k) Retirement Plan
Fidelity Plan #: 29610
Website: www.401k.com or www.netbenefits.com
Fidelity Retirement Benefits Line: 800-835-5097
BevMo! sponsors a 401K retirement plan as part of their Benefits Program to both full-time and part-time employees. As
a supplement to other retirement benefits or savings that you may have, this voluntary plan allows you to save and invest
for your retirement with tax-deferred dollars.
Employee contributions are 100% vested. Employer contributions are vested on a 5-year vesting schedule.
2021 IRS Contribution Limit - $19,500**
**If you are age 50 or older in the current calendar year, you may contribute an additional $6,500, up to a total of $26,000
per year.
You are eligible, if:
• You’ve completed 3 months of employment, full-time or part-time
• You’re at least 21 years of age
Enrollment Periods:
• Entry dates into the plan are January 1st, April 1st, July 1st, and October 1st of each year.
• Enroll online at Fidelity: www.netbenefits.com
Contribution Amount and Limits:
• BevMo! matches 25% up to 6% of your per period payroll contribution.
• You may contribute up to 80% of your salary into this plan on a pre-tax basis.
• You can change your contribution percentage at any time.
Loan and Limits:
• A loan may be requested against 50% of your 401K vested account balance.
• Limited to maximum amount of $50,000, with minimum $1,000.
• An employee is limited to one active loan at a time and must wait 60 days after a loan is paid off to apply for a new
loan. 12
11Unum Interest-Sensitive Whole Life Insurance
This plan is only available during the annual Open Enrollment.
Unum Call Center: Tuesday, 05-25-21 through Tuesday, 06-08-21 (5 am to 5 pm PST & excluding weekends)
Unum Call Center # 866-832-5583
Unum’s interest-sensitive whole life insurance is designed to provide death benefits to your beneficiaries if you pass
away, but it can also potentially build cash value that you can utilize while you are still alive. At an affordable guar-
anteed level premium, you can have the added financial protection you and your family may need during times of
uncertainty.
Advantages of the Plan
• Unum’s interest-sensitive whole life insurance plan is voluntary, which means you can choose whether or not to
purchase coverage, and buy only the amount that is right for your needs
• In addition to providing death benefits, the policy can build cash value, which can be utilized during your working
years
• The policy’s accumulated cash value may also be used to buy a smaller, “paid up” policy on which no further
premiums are due
• Available for employees ages 15-80 who meet the eligibility requirements
• Coverage for dependents is available
• Optional rider available; includes children’s term rider
• The policy includes a Living Benefit Option as a basic feature to all employee, spouse, and child/grandchild poli-
cies. This feature allows the policy owner to request up to 100% of the death benefit, to a maximum of $150,000,
if the insured is diagnosed with a medical condition that limits life expectancy to 12 months or less. MAY VARY
IN SOME STATES.
Eligible employees must be actively at work to apply for coverage. Being “actively at work” means that on the day you
apply for coverage, you are working at one of your company’s business locations, or you are working at a location
where you are required to represent your company. If you are applying for coverage on a day that is not one of your
scheduled workdays, then you will be considered actively at work if you meet this definition as of your last scheduled
workday. You are not considered actively at work if your normal duties are limited or altered due to your health, or
if you are on a leave of absence.
Unum Accident Insurance
This plan is only available during the annual Open Enrollment.
Unum Call Center: Tuesday, 05-25-21 through Tuesday, 06-08-21 (5 am to 5 pm PST & excluding weekends)
Unum Call Center # 866-832-5583
Unum’s supplemental accident insurance provides benefits for covered injuries and specified accident-related ex-
penses for an individual or family. Since health insurance only goes so far, this individual policy is designed to help
cover the out-of-pocket expenses that can result from a sudden accident.
Advantages of the Plan
• Available to employees ages 17 - 80 (64 in CA) who are actively at work with a minimum of 20 hours per week
• Base plan covers a wide variety of injuries and accident-related expenses such as hospitalization, physical ther-
apy, emergency room treatment, doctor’s visits, fractures and dislocations, transportation, lodging, and more
• Benefits are paid for accidents that occur off the job
• Several family coverage options are available
13Unum Individual Short-Term Disability Insurance
This plan is only available during the annual Open Enrollment
Unum Call Center: Tuesday, 05-25-21 through Tuesday, 06-08-21 (5 am to 5 pm PST & excluding weekends)
Unum Call Center # 866-832-5583
It’s estimated that an accident or illness will keep three out of every 10 employees between the ages of 35 and 65
out of work for a period of three months or longer. Accidents and illnesses that keep you off the job can happen to
anyone and are more common than you might think. In fact, the five leading causes for Unum STD claims lasting
less than six months include:
• Normal pregnancy
• Digestive/intestinal diseases
• Reproductive/urinary system diseases
• Injuries (not including back)
• Self-reported conditions
Disability insurance can help replace a portion of your salary during a covered disability. Unum individual short-term
disability insurance replaces a portion of your income if you are unable to work due to a covered injury or sickness.
This means you can have some income during a time of need.
Advantages of the Plan
• Choose a monthly benefit from $400 to $5,000 for an illness or off-the-job injury. Coverage of up to 40% of your
gross monthly salary may be offered (60% in AZ & WA)
• Choose from three plans - all plans have a 7-day Elimination Period (one week from date of disability before
benefits become payable) with monthly benefits paid for up to 6 months, 12 months or 24 months.
• Affordable coverage. Your premiums are based on your age when you buy the insurance and will not increase
as you get older.
• Available to eligible employees 17 - 69 (64 in CA) who are actively at work.
• Premiums are conveniently deducted from your paycheck.
• You own the policy. If you leave, you can take your policy with you and pay the same premium. Unum will bill you
directly at home.
Policy Provisions
Pre-existing condition limitation — If you have a pre-existing condition* within a 12-month period before your cover-
age effective date, benefits will not be paid for a disability period if it begins during the first 12 months the policy is
in force.
*A pre-existing condition is a condition for which symptoms existed (within 12 months before your coverage effective
date) that would cause a person to seek treatment from a physician or for which a person was treated or received
medical advice from a physician, or took prescribed medicine for. The determination on whether your condition qual-
ifies as pre-existing will be based on the date of disability and not the date you notify Unum.
Pregnancy — Nine months after coverage becomes effective, pregnancy is considered the same as any other cov-
ered illness. The available monthly benefits will be paid upon fulfillment of the elimination period. Benefits will not be
paid if the insured individual gives birth within nine months after the coverage becomes effective. However, medical
complications of pregnancy may be considered as any other covered sickness, subject to the pre-existing condition
14Notes
15Resources
Benefit Carrier Phone Number Website
Medical Anthem Blue Cross Select HMO 800-227-3613
www.anthem.com/ca
Health Incentive Account (HIA) 866-207-9878
Plus PPO
Dental Anthem Blue Cross 888-209-7852 www.anthem.com/ca
Dental Net Dental HMO
Dental Complete PPO
Vision Anthem Blue Cross 866-723-0515 www.anthem.com/ca
Blue View Vision
Employee Assistance Program Ceridian www.lifeworks.com
888-456-1324
(EAP) user id: bevmo
password: eap
Flexible Spending Account Navia 800-669-3539 www.naviabenefits.com
(FSA)
Voluntary Term Life / AD&D Prudential 800-524-0542 www.prudential.com
Interest-Sensitive Whole Life Unum 800-635-5597 www.unum.com
Accident Unum Enrollment Available during the
Call Center annual Open Enrollment only
Individual Short-Term Disability 866-832-5583 Tuesday, 05-25-21 through Tues-
day, 06-08-21 (excluding weekends)
Hours 5 am to 5 pm PST
401(k) Fidelity 800-835-5097 www.401k.com or
www.netbenefits.com
Employee Self-Service ADP www.MyADP.com
(ADP) Registration Code:bevmo-cheers
Benefit Questions Filice Insurance 925-299-7212 benefits.filice.com/bevmo
2020-2021 EMPLOYEE
16
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