Hitachi Vantara Benefits Guide - JANUARY 2022
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Hitachi
Vantara
Benefits
Guide
JANUARY 2022
BENE FI T S F O R W H AT ’S NE X T
Welcome 2 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
NOVEMBER 2021
Colleagues:
During the past year, we focused on moving forward together as One Hitachi and harmonizing our benefits and systems.
After a year of big changes, we are staying the course with our benefit offerings in 2022. Open Enrollment begins
Wednesday, November 3, 2021. This gives you an opportunity to take a fresh look at your options to make sure you have
the right fit for your needs.
In today’s ever-changing world, our Hitachi Vantara benefits are stable and steady — and we’re holding costs steady, too. For
2022, we’re pleased to announce that you will see no increase in your paycheck deductions for our medical, dental and vision
plans — and you will continue to have the comprehensive coverage you and your family members depend upon.
As always, our benefits are here to support your total well-being, including your physical, mental and emotional health.
We’re excited to announce that we’ll be rolling out an additional wellness app in the new year, called myStrength, which can
help you manage stress, anxiety and other life challenges anytime, anywhere. More information and how to register will be
communicated soon.
Please take the time to review this guide, and visit benefits.hitachivantara.com for information about all your benefit options.
When you’re ready, review your current coverage, and make any changes at hitachi.us/benefitpool for 2022 from November
3 through 17, 2021. Your elections take effect January 1, 2022.
If you need help or have any questions, call the Hitachi Benefit Pool Service Center at 1-844-318-3274, Monday-Friday,
7 a.m. - 7 p.m. CT.
Thank you for your service and dedication to our customers and our company.
Yours in good health,
Peter Kurlander,
Vice President, Global Total Rewards
3 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Your 2022 Benefits Guide and
Open Enrollment
This Guide is intended as a summary of your 2022 benefits. Please use it
as a resource to help you make your benefit choices. It is important that
you take the time to understand your options, ask questions and make
your choices accordingly.
The details of the benefit plans described in this guide are contained in the official plan and policy documents,
including insurance contracts. This guide is only meant to highlight major points of each plan and does not contain
all the policy provisions, limitations and exclusions that are included in the official plan documents and Summary
Plan Descriptions (SPD).
You can review these documents at benefits.hitachivantara.com.
If there is ever a question about one of these plans or policies, or if there is a conflict between the information
contained in this benefits guide and the official plan documents, the official plan documents will govern.
QUESTIONS?
Hitachi Benefit Pool Service Center
Phone: 1-844-318-3274
Monday–Friday, 7 a.m.–7 p.m. CT
4 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Table of Contents
Your 2022 Benefits Guide and Open Enrollment........................................... 4 Paid Family Leave...................................................................................... 44
Benefit Updates for 2022.............................................................................. 6 Life and AD&D Insurance........................................................................... 46
Introduction................................................................................................. 7 Basic Life and AD&D Insurance.................................................................. 47
Open Enrollment 2022.................................................................................. 8 Optional Life and AD&D Insurance............................................................. 48
The Anthem Silver CDHP, Anthem Bronze CDHP and Kaiser CDHP............... 9 Extra Benefits............................................................................................ 50
Plan Costs for 2022.................................................................................... 13 Commuter Program................................................................................... 51
Medical...................................................................................................... 15 Credit Monitoring/Identity Theft Protection......................................................... 52
Prescription Drug Coverage....................................................................... 22 Child Care/Elder Care Back Up................................................................... 53
Dental........................................................................................................ 24 Elder Care Caregiving Support................................................................... 54
Vision......................................................................................................... 27 Adoption Assistance Program.................................................................... 55
Flexible Spending Accounts (FSAs)........................................................... 30 Auto and Home Insurance.......................................................................... 56
Wellbeing Support..................................................................................... 34 Legal Services Plan.................................................................................... 57
Amino......................................................................................................... 35 Voluntary Pet Insurance ............................................................................ 58
Employee Assistance Program................................................................... 36 Time Off..................................................................................................... 59
Livongo...................................................................................................... 37 Education................................................................................................... 60
Hinge Health.............................................................................................. 38 Student Loan Program............................................................................... 61
FertilityIQ................................................................................................... 39 Voya—Group Supplemental Insurance........................................................ 62
Rethink Benefits......................................................................................... 40 Frequently Asked Questions...................................................................... 65
Wellness Programs and Benefits............................................................... 41 Required Notices....................................................................................... 70
Disability Insurance................................................................................... 42 Contact Information................................................................................... 77
5 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Benefit Updates for 2022
THE FOLLOWING CHANGES WILL TAKE EFFECT JANUARY 1, 2022
Medical
Good news! After a year of big changes, very little is changing for 2022. We’re staying the
course with our benefits offerings. We’re also absorbing cost increases to our core benefits
(medical, dental and vision) so employees will see no increase in paycheck deductions.
There are also no changes to the medical, dental and vision plans for 2022.
The Anthem Gold PPO plan was frozen to new enrollment for 2021 for legacy Hitachi
Consulting employees. It will be eliminated for 2022. Anyone currently enrolled in this plan
will be automatically enrolled in the Anthem Silver CDHP unless you take action during
Open Enrollment.
Health Savings Account (HSA)
The maximum amount you can contribute to your HSA in 2022 will increase to $3,650 (employee only
coverage) and $7,300 (family coverage). These amounts include the contribution Hitachi Vantara makes to your
account, combined with your personal, pre-tax payroll deductions.
Hitachi Vantara will continue to make a sizable contribution to your HSA, regardless of the CDHP you choose.
Flexible Spending Accounts (FSAs)
If you are currently enrolled and wish to continue contributing to an FSA, you will need to actively re-enroll during Open
Enrollment. Annual enrollment in an FSA is required by the IRS. The maximum amount you can contribute pre-tax to your
Health Care FSA is $2,850 in 2022. The commuter pre-tax maximum is $280 each for transit and parking.
Short-Term Disability
All eligible employees outside of California will automatically be enrolled in our Short-Term Disability plan, even if
you previously waived STD coverage. If you would like to waive this coverage, you’ll need to take action during Open
Enrollment. Remember, you must be enrolled in Short-Term Disability in order to qualify for benefits while out on a
maternity or paternity leave or any medical disability that lasts less than 12 months. If you waive Short Term Disability,
you are also waiving Hitachi’s Paid Family Leave benefit. Short-term disability coverage remains mandatory for our
California employees, in compliance with state law.
Additional Support for Your Unique Needs
Hitachi will be introducing a new plan: myStrength through Livongo. With this benefit, you will get a personalized program
to help with stress, anxiety, sleep and so much more. Look for more information on this program closer to January 1.
6 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Introduction
At Hitachi Vantara, your benefits are an TERMINATION OF COVERAGE
Your Medical, Dental and Vision coverage ends on the last day of the month in which
important part of our company’s investment your active service ends. Your Life/AD&D Insurance, Disability and Flexible Spending
in your total rewards package. Hitachi Vantara Accounts will terminate on the date your employment ends.
continuously reviews our benefits program, MAKING CHANGES
You cannot make changes during the year unless you have a change in family status
focusing on its value to employees, market (a qualifying event), as defined by the IRS.
competitiveness, legislative changes and costs. Qualifying events include:
• Marriage or divorce
Hitachi Vantara provides you the opportunity to select the benefits coverage that best
fits your needs when you are first hired and subsequently at each Open Enrollment. • Birth, adoption or custody change of an eligible dependent
Healthcare is a major component of our offering and related company expenses; • The loss of coverage due to the death of a spouse or domestic partner
therefore, one of our long term goals is to help educate our employees so that we all • The loss of coverage due to a change in the employment status of you,
make good, informed choices not only during Open Enrollment, but any time we use your spouse or domestic partner
healthcare services. Along with healthcare, Hitachi Vantara provides you with a wide
• A change in employment (either yours, your spouse’s or domestic partner’s) that
array of benefit options. The goal of this Guide is to walk you through and help you results in losing or gaining coverage
understand the options available to you.
If you have a qualifying event any time other than Open Enrollment, you may change
For additional information on the benefits Hitachi Vantara offers, visit your benefits through your benefits administration system within 31 days of the event.
benefits.hitachivantara.com. The change in your benefits must be consistent with the change in your family status.
For example, if you have a new baby, you can enroll the child as a dependent under
WHO IS ELIGIBLE your medical plan, but you may not remove another dependent who is already covered.
All Hitachi Vantara regular full-time active employees who work twenty (20) hours or Remember that newly eligible dependents, including newborns, spouses and domestic
more per week are eligible for benefits on your date of hire. You may also choose to partners, must be added to your plans within 31 days of first becoming eligible.
enroll your eligible dependents, which include:
• Your spouse or qualified domestic partner
• Your children up to age 26, regardless of student or marital status,
including adopted children and children of your domestic partner.
(For HSA contribution purposes, your child must be a tax dependent
and under age 24.)
• Any dependent child who is incapable of self-support due to a mental
or physical disability
7 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Open Enrollment 2022
YOU MUST VISIT THE HITACHI BENEFIT POOL WEBSITE OR CALL THE HITACHI
BENEFIT POOL SERVICE CENTER TO MAKE CHANGES TO YOUR 2022 ELECTIONS.
• Elect your Medical, Dental and Vision Coverage for 2022
― If you are currently enrolled in Medical and don’t take action during Open Enrollment, you will remain enrolled in your
current plan unless you are a legacy HCC employee enrolled in the Anthem PPO plan. Anthem Gold PPO enrollees will
be moved to the Anthem Silver CDHP. Kaiser members will remain enrolled in the Kaiser CDHP unless you make another
election during Open Enrollment.
ENROLL ONLINE
― If you are currently enrolled in Dental and don’t take action during Open Enrollment, your current coverage will continue.
OR BY PHONE
You will receive an email ― If you are currently enrolled in VSP and don’t take action during Open Enrollment, your current coverage will continue.
announcement from HR Total Rewards • Change Dependent Coverage Option (i.e., adding or dropping coverage for your spouse) Eligible dependents for the Hitachi
America when Open Enrollment Vantara health plans include: legal spouse, qualified domestic partner and children up to age 26, regardless of student or
begins. Once you receive this email, marital status.
log in to the Hitachi Benefit Pool
website at hitachi.us/benefitpool. • Elect to Participate in the Flexible Spending Accounts (FSAs) – Health Care, Limited Purpose Health Care or Dependent Care
Enter “hitachi” (lowercase) for the If you plan on participating in the FSAs, you must enroll each year per IRS regulations. You will need to estimate your health
Company Key if prompted. and/or dependent care expenses carefully when deciding how much money to put into these accounts. The IRS requires that
you forfeit any FSA amounts that you don’t use by December 31st.
You can also call the Hitachi
• All employees enrolled in the Anthem Silver CDHP, Anthem Bronze CDHP or Kaiser CDHP will have an HSA through HSA Bank.
Benefit Pool Service Center at
By accepting the terms and conditions, you are giving HSA Bank permission to open your HSA for you. HSA Bank may request
1-844-318-3274 to make your
additional verification details.
elections with a representative.
It is also a good opportunity to:
• Verify/update your emergency contacts in HiNext.
• Review your beneficiary designations and update them if necessary. 401k and Deferred Compensation beneficiary
designations are housed within Fidelity. Review your beneficiary designations at www.401k.com.
• Add your dependents’ Social Security numbers if you have not done so already, and if they are over the age of 1.
8 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
The Anthem Silver CDHP,
Anthem Bronze CDHP and
Kaiser CDHP
9 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
You have the option to enroll in the Anthem Silver CDHP, the Anthem Bronze CDHP or the Kaiser
CDHP (if you live within the Kaiser service area in California).
In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act was passed and it added section 223 to the Internal Revenue Code to permit eligible employees
to establish health savings accounts (HSAs). In order to qualify for the HSA, you MUST enroll in one of the Consumer Driven Health Plans (CDHPs): the Anthem Silver or
Bronze CDHP, or the Kaiser CDHP. HSA plans must meet certain criteria each year as defined by the Treasury Department. The Anthem Silver and Bronze CDHPs and the Kaiser
CDHP all satisfy those criteria.
HEALTH SAVINGS ACCOUNT CONTRIBUTIONS
An HSA is a tax-advantaged bank account that can be used to pay for qualified health expenses (including dental and vision) tax-free (federal tax-free for all, state taxes apply
in California and New Jersey). Both eligible employees and Hitachi Vantara may contribute to the HSA, except for Medicare enrollees and those receiving veteran benefits. The
account belongs to you and any money left in your account carries over from year to year. It remains your money even if you change health insurance, leave Hitachi Vantara or
retire. The maximum contribution for 2022 is $3,650 for employee only coverage or $7,300 for family coverage. Hitachi Vantara will contribute to your HSA regardless of the plan
you choose (Anthem Silver CDHP, Anthem Bronze CDHP or Kaiser CDHP).
You cannot use your HSA funds to pay for your domestic partner’s expenses unless they also qualify as your IRS tax dependent. Hitachi Vantara pays the set-up and
maintenance fees associated with your HSA, regardless of which CDHP plan you enroll in. If you leave Hitachi Vantara, you can keep your HSA but you will be responsible for
any fees or HSA charges associated with the administration of your HSA.
ANTHEM SILVER CDHP (all employees)
For the Anthem Silver CDHP, Hitachi Vantara will contribute $1,000 for a single employee and $2,000 for employees covering one or more dependents for 2022. Hitachi Vantara
will deposit half of that contribution to your HSA in January and the remaining half in July of 2022 for all employees enrolled as of January 1, 2022.
ANTHEM BRONZE CDHP (all employees)
Hitachi Vantara will contribute $750 for a single employee and $1,500 for employees covering one or more dependents. Hitachi Vantara will deposit half of that contribution to
your HSA in January and the remaining half in July of 2022 for all employees enrolled as of January 1, 2022.
KAISER CDHP (employees in Northern or Southern California only)
For the Kaiser CDHP, Hitachi Vantara will contribute $1,000 for a single employee and $2,000 for employees covering one or more dependents. Hitachi Vantara will deposit half
of that contribution to your HSA in January and the remaining half in July of 2022 for all employees enrolled as of January 1, 2022.
CATCH-UP CONTRIBUTION
If you are age 55 to 64 or turn age 55 in 2022, you can also contribute an additional “catch-up” contribution of $1,000 per year (your spouse can also contribute an additional
$1,000 if they are age 55 or older or turn age 55 in 2022 and have established their own HSA).
10 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TELIGIBILITY
To be eligible to open and contribute to an HSA, you must be covered by a health plan that meets IRS requirements. The following rules apply:
• You must not be covered by other health insurance.
• The HSA must not apply to specific injury insurance and accident, disability, dental care, vision care, long term care or other high deductible health plans that meet IRS
requirements.
• Enrollment in a spouse’s non-qualified health plan, and eligibility for a spouse’s Health Care FSA or HRA will disqualify you even if you don’t use your spouse’s FSA or HRA to
reimburse your own medical expenses.
• You must not be enrolled in Medicare. Remember, enrolling in SSI (the income portion of Social Security) automatically enrolls you for Medicare Part A, making you
ineligible for HSA contributions.
• You may not be claimed as a dependent on someone else’s tax return.
HSA PLANS
IRS regulations state that in order to contribute to an HSA, it must be accompanied by a qualified health plan with minimum deductibles (determined by the IRS and indexed
and increased annually).
If you enroll as a single employee prior to reaching the individual deductible limit, you will receive all medical services at Anthem’s discounted rate as long as you stay in-
network. If you elect the Kaiser CDHP, you must receive all services from Kaiser, unless there is an emergency or Kaiser otherwise authorizes care from another provider. You
will be responsible for paying your provider either from your HSA (if funds are available) or out-of-pocket. If HSA funds are not available, you can reimburse yourself from your
HSA once funds become available.
If you enroll in one of the Anthem CDHP Plans as an employee with one or more dependents, you must satisfy the entire family deductible before the plan begins to pay claims.
The family deductible can be satisfied by one person, or it can be accumulated by several family members until the family deductible has been met for the year. Note, if you
enroll in the Kaiser CDHP, different rules apply in compliance with California law. See the Kaiser section of this guide for additional details (page 20).
IRS regulations allow preventive care to be covered at 100% with no deductible or co-pay (in-network only). Here is the list of preventive services covered under the Anthem
and Kaiser CDHPs (including but not limited to):
• Routine colonoscopy when provided in accordance with the American Cancer Society guidelines
• Routine annual physical exam
• Annual GYN exam and Pap Smear
• Annual Mammograms for women age 40 and older
• Routine hearing screenings
• Well Child Check Ups per guidelines
All other medical services, including prescription drugs, are subject to the deductible and coinsurance. Please see pages 16–20 for a summary of the Hitachi Vantara Plans.
11 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X THOW THE CDHPS WORK WITH AN HSA QUALIFIED EXPENSES AND HEALTH SAVINGS
Here’s how the CDHPs’ medical coverage will work in conjunction with your Health ACCOUNT DISTRIBUTIONS
Savings Account:
How does a Health Savings Account work?
Provider submits claims for covered HSA funds can be used for both qualified and non-qualified expenses.
services However, only funds withdrawn for qualified healthcare expenses (defined by
Premium High
(less than IRS Code Sec.213(d)) are tax-free. A full list of qualified expenses can be found at
Deductible Member billed by provider after
traditional plan) www.irs.gov/publications/p502. Examples of qualified expenses include:
Insurance network discounts applied and claim
is paid by plan. • Office visits (including deductibles and co-insurance)
• Chiropractic services
Use to meet deductible • Prescription drugs
• Over-the-counter drugs (pain/cold meds, etc.) with a prescription
Use for qualified purchases and care
not covered by health plan • Dental expenses
• Vision expenses
Deposit Health Accumulate funds for the future. • Lab fees
(via pretax No “use-it-or-lose” rule!
Savings • COBRA, Medicare (Parts B, C and D but not Part A) and qualified Long Term Care
payroll
deduction) Account premiums
Account is 100% owned by the
Distributions are tax-free if used for qualified healthcare expenses for the account
employee and portable if he/she
changes jobs or insurance. holder, their spouse and/or their dependents (must be eligible to be claimed as a
dependent on account holder’s federal tax return). Spouses and dependents under
the age of 24 don’t need to be covered by the HSA plan for account funds to be used
Triple tax advantages: Deposits to pay for their out-of-pocket eligible healthcare expenses. Currently, HSA account
not taxed, withdrawals for eligible
expenses not taxed and balances and funds cannot be used to pay for a domestic partner’s healthcare expenses or for the
investment earnings grow tax-free.* expenses of a domestic partner’s children.
Funds withdrawn for non-qualified expenses are considered as income and subject
* State taxes apply if you live in California or New Jersey. to income taxes plus a 20% penalty. However, that 20% penalty will not apply when
funds are withdrawn after the account holder becomes eligible for (and enrolls in)
Medicare or becomes disabled. Additionally, this applies if a beneficiary receives the
balance in the account after the death of the account holder.
Another advantage of an HSA is that you can grow your account tax-free, both
through saving and investing. As your balance rolls over from year to year, it earns
interest. When your balance is large enough, you can invest it tax-free, the same way
you can invest dollars from other retirement accounts.
12 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TPlan Costs for 2022 13 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
YOUR 2022 MONTHLY COSTS FOR BENEFITS COVERAGE
Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
Medical
Anthem Silver CDHP $85.07 $161.35 $141.66 $239.00
Anthem Bronze CDHP $0.00 $0.00 $0.00 $0.00
Anthem Gold PPO* (closed to new enrollment) $207.66 $422.58 $395.59 $640.62
Kaiser CDHP—Northern California $94.14 $207.10 $188.26 $282.43
Kaiser CDHP—Southern California $59.16 $130.15 $118.32 $177.49
Dental
Delta Dental Platinum PPO $18.00 $27.00 $35.00 $45.00
Delta Dental Gold PPO $12.00 $24.00 $26.00 $38.00
Vision
VSP Vision Plan $5.50 $9.00 $7.50 $13.00
* Available to Legacy HCC employees only
Note: Premium contributions are deducted from your paycheck on a pretax basis unless otherwise requested by you in writing. ”Spouse” can also refer to Domestic
Partner. The value of Domestic Partner coverage will be taxable to you.
14 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TMedical 15 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
SUMMARY OF THE MEDICAL PLANS
Plan Features Anthem Silver and Bronze CDHPs Kaiser CDHP
Availability Available to all employees Available to employees in California in the Kaiser Service area
Anthem is both the plan administrator (they pay the claims) and the
network of providers. You may use providers outside the Anthem
Network You must use Kaiser providers.
network, but you pay more out of pocket. When you use in-network
providers, you receive a higher level of benefit coverage.
There is an annual deductible – see the benefit comparison on the next There is an annual deductible – see the benefit comparison on the
Deductible
page for more information. following pages for more information.
You decide each time you need medical care whether you want to use You have the option to choose a primary care physician who will play an
Managing Care
in-network providers or out-of-network providers. important role in coordinating your healthcare needs.
You will pay a percentage of the cost (coinsurance) including office visits
You pay a flat fee (co-pay) for most services, including office visits,
Paying for Services and prescription drugs after the deductible. You may choose to use your
hospital stays and emergency care after the annual deductible.
HSA to pay for qualified services, HSA balance permitting.
You must file a claim form for reimbursement of medical expenses for
No claim forms are required except for emergency claims at a non-Kaiser
Claim Forms services received from out-of-network providers, and you will be subject
facility.
to Usual, Customary and Reasonable (UCR) charges.
Applicable to out-of-network providers only. Anthem pays based on
Usual, Customary and Reasonable Not applicable
what 80% of the providers in that zip code charge for a given service.
Out-of-Area Coverage at an
You are covered for medical emergencies anywhere in the world. You are covered for medical emergencies anywhere in the world.
in-network rate
16 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TANTHEM SILVER AND BRONZE CDHPS
Anthem Silver CDHP Anthem Bronze CDHP
Plan Features In-Network Out-of-Network In-Network Out-of-Network
General Information You may select any provider you wish for your healthcare. When you obtain You may select any provider you wish for your healthcare. When you obtain
services from providers in network, you will receive a higher level of services from providers in network, you will receive a higher level of coverage with
coverage with lower out-of-pocket costs (1) (2) lower out-of-pocket costs (1) (2)
Annual Deductible $1,500 per individual(1)(2) $3,000 per individual $2,750 per individual(1)(2) $5,500 per individual
$3,000 per family $6,000 per family $5,500 per family $11,000 per family
Annual Out-of-Pocket Maximum $3,750 per individual $7,500 per individual $5,950 per individual $11,900 per individual
(includes deductible) $6,850 per individual within a family $7,500 per individual within a family $6,850 per individual within a family $11,900 per individual within a family
$7,500 per family $15,000 per family $11,900 per family $23,800 per family
Lifetime Maximum Benefit Unlimited Unlimited Unlimited Unlimited
Physician Office Visits 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Annual Routine Physical Exam No charge 40% coinsurance after deductible No charge 40% coinsurance after deductible
(screening and lab work included) (screening and lab work included)
Well Baby/Child Care No charge 40% coinsurance after deductible No charge 40% coinsurance after deductible
(screening and lab work included) (screening and lab work included)
Diagnostic Lab and X-Ray 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Outpatient Surgery Services 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Hospitalization 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
(Room and Board)
Emergency Room Services 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible
(co-pay waived if admitted)
Chiropractic Care 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Acupuncture 20% coinsurance after deductible; 40% coinsurance after deductible; 20% coinsurance after deductible; limited 40% coinsurance after deductible;
limited to $1,000 per calendar year limited to $1,000 per calendar year to $1,000 per calendar year in- and out-of- limited to $1,000 per calendar year
in- and out-of-network combined in- and out-of-network combined network combined in- and out-of-network combined
(1) Hitachi Vantara will contribute $1,000 single; $2,000 employee plus dependents for employees who enroll in the Anthem Silver CDHP Plan and $750 single, $1,500 for employees who enroll in the Anthem Bronze CDHP Plan. To qualify for
the contribution you must establish a Health Savings Account. See the Frequently Asked Questions section of this guide for more information. When covering one or more dependents, you must satisfy the entire family deductible before the plan
begins to pay claims (with the exception of preventive care). That family deductible can be satisfied by one person or it can be accumulated by several family members. For example, the employee could satisfy $1,000 of the family deductible and
his/her spouse could satisfy the other $2,000.
(2) You can cover your domestic partner under this plan but you cannot use your HSA funds to pay for your domestic partner’s or your domestic partner’s children’s expenses unless they are your tax dependent.
17 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TANTHEM SILVER AND BRONZE CDHPS
The Anthem CDHPs are available to all Hitachi Vantara employees.
Anthem Silver CDHP Anthem Bronze CDHP
Plan Features In-Network Out-of-Network In-Network Out-of-Network
Prescription Drugs
Retail Pharmacies Through CVS Caremark: 20% Covered same as In-Network Through CVS Caremark: 20% Covered same as In-Network
coinsurance after deductible. Once the coinsurance after deductible. Once the
out-of-pocket maximum is reached for out-of-pocket maximum is reached for
the year, the plan pays 100% of costs for the year, the plan pays 100% of costs
that year. for that year.
The deductible is waived for certain The deductible is waived for certain
preventive prescription drugs (3) preventive prescription drugs (3)
Mail Order 20% coinsurance after deductible Covered same as In-Network 20% coinsurance after deductible Covered same as In-Network
Mental Health
Inpatient Services 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Outpatient Services 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Substance Abuse
Inpatient Services 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Outpatient Services 20% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
(3) Please refer to the CVS Preventive Drug list for eligible medications.
18 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TVIRTUAL VISITS THROUGH LIVEHEALTH ONLINE
Anthem now offers Virtual Visits through LiveHealth Online, which lets you see and talk to a doctor from your mobile
device or computer without an appointment. Most visits take about 10–15 minutes, and doctors can write a prescription,
if needed, that you can pick up at your local pharmacy.
Virtual Visits are great for instances when your doctor is unavailable, you become ill while traveling or you need urgent
(non-emergency) care. Log on to www.livehealthonline.com or download the app and register on your mobile device to
access this benefit.
To visit a licensed behavioral health therapist in four days or less, or a board-certified psychiatrist within two weeks,
call 1-888-548-3432.
You will pay the cost (typically $59) for the visit unless you have already met your deductible. If you have met the
Deductibles are the amount you pay
deductible, coinsurance applies the same way it works when you see your physician at his or her office.
before the insurance plan begins
paying the benefits.
ANTHEM HEALTH GUIDE
Coinsurance is the percentage
When you have questions about how your health benefits work or need to get connected to services and support,
amount you pay for the cost of a
Anthem Health Guide can help. You can reach an Anthem Health Guide by phone, mobile app, email or online chat.
procedure. The insurance plan pays
Your Health Guide can: the difference.
• Get answers to questions about your health plan benefits or claims Annual Out-of-Pocket Maximum
means the maximum you will have
• Find the right provider for the care and services you need
to pay in eligible expenses in a
• Obtain referrals for care by partnering with you and your doctors calendar year. It includes deductibles
• Connect to tools and resources you might not know you had, like the EAP and Virtual Visits and co-pays.
Call 1-877-411-1637 or visit www.anthem.com.
19 Hitachi Vantara 2022 Benefits Guide BE NEFI T S F O R W H AT ’S NE X TKAISER CDHP
The Kaiser CDHP is available to employees who live within the service area of Northern and Southern California only.
Plan Features Kaiser CDHP
General Information You must seek services through a Kaiser provider. Services obtained from non-authorized providers will not be covered by Kaiser (1)
Annual Deductible $2,000 per individual
$2,800 per individual within a family
$4,000 per family (2)(3)
Annual Out-of-Pocket Maximum $3,000 per individual
$3,000 per individual within a family
$6,000 per family
Lifetime Maximum Benefit Unlimited
Physician Office Visits $30 co-pay, after deductible
Annual Routine Physical Exam No charge
Well Baby/Child Care No charge
Diagnostic Lab and X-Ray $10 co-pay, after deductible
Outpatient Surgery Services $150 co-pay per procedure, after deductible
Hospitalization (Room and Board) $250 co-pay per admission, after deductible
Emergency Room Services $100 co-pay, waived if admitted, after deductible
(co-pay waived if admitted)
Chiropractic Care $15 co-pay after deductible; limited to 20 visits per calendar year
Acupuncture Not covered unless prescribed by Kaiser for treatment of nausea or as part of a comprehensive pain management program for chronic pain
Prescription Drugs
Retail Pharmacies 30-day supply
After the deductible, Generic—$10 co-pay | Brand—$30 co-pay
Mail Order 100-day supply
After the deductible, Generic—$20 co-pay | Brand—$60 co-pay
Mental Health
Inpatient Services $250 per admission, after deductible
Outpatient Services $30 co-pay ($15 co-pay for group therapy), after deductible
Substance Abuse
Inpatient Services $250 per admission, after deductible for inpatient detoxification services
Outpatient Services $30 co-pay ($5 co-pay for group therapy), after deductible
(1) Except for emergency services or referral by Kaiser.
(2) Hitachi Vantara will contribute 50% of the deductible annually: $1,000 single; $2,000 for employee plus dependents. To qualify for the contribution you must establish a Health Savings Account. See the Frequently Asked Questions section of
this guide for more information. When covering one or more dependents, you no longer need to meet the family deductible before the plan begins to pay claims (with the exception of preventive care) which is always covered at 100%). The plan
will begin paying claims for an individual within that family once that individual meets a $2,600 deductible. The plan will also being paying claims if no single individual meets $2,800 but the family collectively meets the family deductible of $4,000.
Likewise, the plan will begin paying 100% of eligible charges for an individual once that individual meets the out-of-pocket maximum of $3,000. If no individual within a family meets $3,000, the family collectively must meet the $6,000 family out-
of-pocket maximum before the plan begins paying 100%.
(3) You can cover your domestic partner under this plan but you cannot use your HSA funds to pay for your domestic partner’s or your domestic partner’s children’s expenses unless they are your tax dependent.
20 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TMedical Carrier ANTHEM
Log in to: www.anthem.com
Websites and Provider
On the site, you will find information on:
• Benefits
• Preventive Care
Searches • Transition of Care (if you are currently using a doctor or medical facility that is
not contracted with Anthem)
• Provider Searches
• Videos and links to interactive sites to help you learn more about your medical
plan options
• Health and Education Resources
KAISER—CALIFORNIA ONLY
Kaiser’s website includes information about providers you can select. Follow the
instructions below to find a participating provider located near you.
Log in to: www.kp.org
Select “Choose Your Region” in the upper right section of the page
Click on: Find a Doctor
• Select Northern or Southern California Region
• Click on link to “Search all doctors” or “Search doctors accepting
new patients”
• This will take you to the online “Clinical Staff Directory”
21 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TPrescription Drug
Coverage
22 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TWhen you enroll in a medical plan, you (and your eligible dependents) automatically receive
prescription drug coverage.
ANTHEM SILVER CDHP AND BRONZE CDHP Follow the steps below to receive maintenance medications via mail order:
(PROVIDED BY CVS CAREMARK) • Obtain a written prescription: If you are currently taking a medication to treat an
ongoing health condition, ask your physician to write two prescriptions, one for
CVS Caremark Welcome Booklet a sufficient supply of medication to be filled at a local pharmacy to cover your
Employees who enroll in an Anthem CDHP for the first time will receive a Welcome immediate needs and one for a 90-day supply with refills (up to one year, if
Booklet from CVS Caremark. It will have information on how your prescription appropriate) to send to the mail order pharmacy.
drug plan will work, including information on how to find a list of participating • Enroll: In order to start using the mail order services and enroll in home delivery,
pharmacies, manage your prescriptions and enroll in mail order. contact CVS Caremark by calling them at the number on your prescription drug
ID card.
Filling Prescriptions
For employees who enroll in the Anthem Silver CDHP or Bronze CDHP, you will
Prior Authorization (CVS Caremark only)
present your prescription drug ID card to the pharmacist, but your prescriptions will Some prescription drugs require prior approval before they can be dispensed.
be covered subject to your deductible and coinsurance. You can use your HSA debit When the pharmacist enters your prescription information at the pharmacy, the
card to pay for the charges if you have a sufficient balance in your HSA. Remember, pharmacist will receive an alert and give a phone number for your physician to call.
you cannot use your debit card for OTC drugs unless you have a prescription. As a Your physician will have to call the number provided in order to get an approval. This
reminder, if you use your HSA funds for non-qualified expenses, you will be taxed as process may take approximately two business days for standard prior authorization
well as subject to a 20% penalty tax unless you are age 65. and approximately one business day for an urgent request. If authorization is
granted, your prescription will be filled. If authorization is not granted, you have
Specialty Medications are often injectables used to treat complex, chronic health
two choices: pay the entire cost of the drug yourself, or you may ask your doctor to
conditions and often require special monitoring and careful coordination of
prescribe an alternative drug covered by your benefit, if available.
therapies. Due to these requirements, enhanced member services are provided to
assist with these unique prescription products. You will be responsible for 20% of the PRESCRIPTION DRUG COVERAGE FOR THE
cost for a 30-day supply after the annual deductible is satisfied.
KAISER CDHP
• Retail Pharmacies: You can receive up to a 30-day supply of a covered medication.
For employees who enroll in the Kaiser CDHP, you will present your ID card to the
To locate a participating retail pharmacy near you, call the phone number on your
Kaiser pharmacy but your prescriptions will be subject to the deductible before the
prescription drug ID card or check online at www.caremark.com. You can also ask
co-pays apply. You can use your HSA debit card to pay for the charges if you have a
your pharmacist if his/her pharmacy is a participating pharmacy.
sufficient balance in your HSA.
• Mail Order: For maintenance prescription drugs, you can receive up to a 90-day
supply, but the deductible and coinsurance will continue to apply. Maintenance • Kaiser Pharmacies: You can receive up to a 30-day supply of a covered
medications are drugs you take regularly for ongoing conditions, such as diabetes, medication.
high blood pressure and asthma.
• Mail Order: For maintenance prescription drugs, you can receive up to a 100-day
supply for two co-pays.
• You must satisfy the Annual Deductible before you begin paying co-pays.
23 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TDental 24 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
The Delta Dental Platinum and Gold PPO plans are available to all employees.
DELTA DENTAL PPO PLANS
The Delta Dental Platinum and Gold PPO plans allow you to choose your own dentist. As preferred provider organizations (PPO), these plans utilize a network of dentists and
specialists who have agreed to provide dental care at discounted fees. Though you are free to visit any dentist you choose, if you go to an in-network dentist, you will pay less
for your dental services due to those fee discounts.
If you choose to go to a non-network dentist, you’re still covered, but you won’t qualify for reduced rates and your claims will be reimbursed at a lower coinsurance percentage.
You will also be responsible for paying the difference between what the plan covers and the amount your out-of-network dentist charges. Further, out-of-network dentists
may require you to pay for services up front, which means you may have to file a claim for reimbursment through your plan.
Please consult the chart below for a summary of your dental plan benefits:
Plan Features Platinum Dental PPO Gold Dental PPO
In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible $50 / $150 $50 / $150 $50 / $150 $100 / $300
(waived for Preventive and Diagnostic Services)
Annual Maximum Benefit $2,000 $1,750 $1,500 $1,250
Preventive and Diagnostic Services No charge* No charge 20%
(Exams, X-rays and sealants) Preventive care includes 3 cleanings per year Preventive care includes 2 Preventive care includes 2
cleanings per year cleanings per year
Basic Services 10% 20% 20% 40%
(Fillings, extractions, endodontics, periodontics and oral
surgery)
Major Services 40% 50% 50% 50%
(implants, crowns, bridges, dentures, etc.)
Orthodontia Services 50% 50% Not covered Not covered
(Children and Adults)
Lifetime Maximum Orthodontia $2,000 $1,750 N/A N/A
* Preventive care does not apply to the annual maximum.
25 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TDental Plan Provider Search
Instructions
DELTA DENTAL
Locating a Delta Dental PPO Dentist
You can visit Delta Dental’s national online directory to find a Delta Dental PPO dentist near you. Simply click on
the Dentist Search area to find a Delta Dental PPO dentist anywhere nationwide. Then follow these steps:
Log in to: www.deltadentalins.com
• Select “Find a Dentist”
• Enter your zip code
• Select Your Dental Network: ”Delta Dental PPO”
• You can also call Delta Dental at 1-800-932-0783 to speak with customer service.
26 Hitachi Vantara 2022 Benefits Guide BE NEFI T S F O R W H AT ’S NE X TVision 27 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Hitachi Vantara offers you vision care coverage through Vision
Service Plan (VSP).
You can receive vision care services from any provider you choose. However, you will receive the highest level of coverage
when you use in-network providers. Vision care accessed from out-of-network providers is covered at lower levels with
greater out-of-pocket costs.
Vision Service Plan
Plan Features In-Network Out-of-Network
Eye Examination $15 co-pay Up to $45
Frequency Once every calendar year Co-pays are the amount you pay for
Lenses an eyecare exam or eyewear.
Single Vision $15 co-pay Up to $30
If you use out-of-network providers,
Bifocal $15 co-pay Up to $50 the dollar amounts shown are the
Trifocal $15 co-pay Up to $65 maximums you will be reimbursed by
Options the carrier.
UV Coating Single–$16; Multifocal–$16 Not covered
Photochromic Single–$75; Multifocal–$75 Not covered
Standard Scratch Resistance Single–$17; Multifocal–$17 Not covered
Standard Polycarbonate Single–$31; Multifocal–$35 Not covered
Anti-Reflective Coating Single–$41; Multifocal–$41 Not covered
Standard Progressive Single–N/A; Multifocal–$0 Not covered
Frequency Once every calendar year
Frames Covered up to $200 allowance, plus 20% Up to $70
off any out-of-pocket costs
Contact Lenses
Conventional Covered up to $200 allowance Up to $105
Disposable Covered up to $200 allowance Up to $105
Medical Necessary Covered at no charge Up to $210
Contact Lens Exam and Fitting Up to $60 co-pay Up to $105
(combined with elective contact
lens allowance)
Frequency Once every calendar year
(Contact lenses are in lieu of lenses and frames)
Laser Vision Correction 15% off the regular price Not covered
at contracted laser centers
of 5% off the center’s promotional price
28 Hitachi Vantara 2022 Benefits Guide BE NEFI T S F O R W H AT ’S NE X TVision Plan Provider Search
Instructions
VISION SERVICE PLAN
Locating a VSP Provider:
• Log in to: www.vsp.com
• Select “Find a Doctor” under “Members”
• If you are a member, log in or follow the instructions to register.
If you are not, follow instructions to enter your zip code or use other
search features to find a VSP provider.
• You can also call VSP at 1-800-877-7195 to speak with
customer service:
― Monday through Friday, 5 am – 8 pm PT
― Saturday, 7 am – 8 pm PT
― Sunday 7 am – 7 pm PT
29 Hitachi Vantara 2022 Benefits Guide BE NEFI T S F O R W H AT ’S NE X TFlexible Spending
Accounts (FSAs)
30 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TA flexible spending account (FSA) allows you to set aside a portion of your income, tax-free,
to help pay for eligible healthcare, child care and elder care expenses incurred in the plan year
(January 1st to December 31st).
YOU SAVE MONEY BECAUSE YOU DON’T PAY TAXES ON WHAT YOU SET ASIDE IN THESE ACCOUNTS.
The FSAs include three accounts:
• Health Care FSA: Use to pay your out-of-pocket healthcare expenses for you and your eligible dependents.
• Limited Purpose Health Care FSA: Use to pay your out-of-pocket dental and vision expenses (for CDHP/HSA members only).
• Dependent Care FSA: Use to pay eligible expenses for children or dependent elders.
During each annual enrollment period, you decide whether to participate in one or both accounts for the upcoming plan year; FSA elections do not roll over from one plan
year to the next.
Please note—According to IRS rules, your domestic partner or domestic partner’s children are not considered eligible dependents for this plan unless they are also your
qualified IRS dependent.
THE EXAMPLE BELOW SHOWS HOW AN FSA CAN SAVE YOU MONEY.
Plan Features If you do participate If you don’t participate
Annual Salary $100,000 $100,000
Health Care FSA Contribution - 2,000 -0
Dependent Care FSA Contribution - 3,000 -0
Taxable Income $ 95,000 $100,000
Income Taxes and Social Security—Approx. 30% - 28,500 - 30,000
(assumes 15% federal tax rate, 8% state and 7% FICA)
Take Home Pay $ 66,500 $ 70,000
Health Care Expenses* -0 - 2,000
Dependent Care Expenses* -0 - 3,000
Spendable Income $ 66,500 $ 65,000
Tax savings $ 1,500 $0
* You are reimbursed for eligible expenses from your health care or dependent care FSA.
31 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X THEALTH CARE FSA
You can elect to deduct up to $2,850 per plan year on a pre-tax basis for deposit into your health care spending account. This is
the maximum the IRS allows in 2022. This account may be used to pay for eligible healthcare expenses incurred by yourself or
your eligible dependents that are not covered by
your medical, dental or vision plans. Some examples include deductibles, co-insurance, co-payments and orthodontia.
Please note: If you enroll in the Anthem Silver CDHP, Anthem Bronze CDHP or the Kaiser CDHP, you cannot participate in the
Health Care FSA—but you can enroll in the Limited Purpose Health Care FSA.
LIMITED PURPOSE HEALTH CARE FSA
You can elect to deduct up to $2,850 per plan year on a pre-tax basis for deposit into your limited purpose health care spending
account. This is the maximum the IRS allows in 2022. This account may be used to pay for eligible dental and vision expenses
incurred by yourself or your eligible dependents that are not covered by your dental or vision plans. Some examples include
deductibles, co-insurance, co-payments and orthodontia.
You can only elect the Limited Purpose Health Care FSA if you are enrolled in the Anthem Silver CDHP, Anthem Bronze CDHP
or the Kaiser CDHP.
DEPENDENT CARE FSA
You can elect to deduct up to $5,000 per plan year on a pre-tax basis for deposit into your dependent care FSA. This account may
be used to pay for the care of your child under age 13 or a disabled spouse or parent while you (or you and your spouse) work.
If your spouse also participates in a dependent care FSA, the combined annual pre-tax deduction cannot exceed $5,000.
32 Hitachi Vantara 2022 Benefits Guide BE NEFI T S F O R W H AT ’S NE X TIMPORTANT
SUBMITTING CLAIMS
INFORMATION ON
The FSAs are administered by Businessolver using their proprietary MyChoice account administration technology. Once
enrolled for the first time, you’ll receive a MasterCard debit card to use for your FSA expenses. SUBMITTING CLAIMS
Please keep all receipts as
USE IT OR LOSE IT substantiation of claims as they
Plan carefully—the IRS requires you to forfeit any money remaining in your account(s) at the end of the plan year. You have until may be requested by WageWorks
at a later date.
March 31 of the following calendar year to submit claims for eligible expenses incurred during the previous year. Unless you
have a qualified life event, you cannot change your allocation amounts during the year.
2021 CLAIMS
Any claims incurred in 2021 must be submitted to WageWorks or MyChoice by March 31, 2022. Claims received past that date
will not be eligible for reimbursement and will be considered forfeit.
OVER-THE-COUNTER DRUGS AND MEDICATIONS
As part of health care reform, OTC drugs and medications are not eligible expenses through your FSA unless you have a
doctor’s prescription.
33 Hitachi Vantara 2022 Benefits Guide BE NEFI T S F O R W H AT ’S NE X TWellbeing Support 34 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X T
Amino
Amino is an employee benefits advocate program available to
help you when you are initially hired, during Open Enrollment
and throughout the year. Amino is available to assist all Hitachi
Vantara employees covered by our health plans in becoming better
healthcare consumers.
Amino’s goal is to make your health care experience to be as stress-free as possible. A Health Advocate will listen to
your concerns, ask questions, guide you to the right resources and intervene on your behalf when needed. Amino Health
Advocates are not affiliated with your health insurance carrier, nor do they provide medical advice. Hitachi Vantara offers
this benefit to you free of charge to help you understand and navigate the complexities of your health care benefits. Areas
where they can assist are:
HEALTHCARE SEARCH
Find care with simplified search terms like “back pain” or “headache.” with more than 1,000 search terms, Amino can direct
you to the right care.
SMART MATCHES
Easily see the best choice with Smart Match. Providers proven to be highly experienced and cost effective.
BOOK APPOINTMENTS
Never play phone tag with your doctor again. Simply pick a physician on Amino and let an Amino Assistant handle the rest.
PHONE ADVOCACY
Call your dedicated Amino Phone Advocates to get help resolving billing errors, find second opinions, or understand your
medical benefits for you, your parents or dependents.
35 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TEmployee Assistance Program
The Employee Assistance Program (EAP) is a free service offered
through Anthem, designed to assist you and your dependents
in resolving personal issues and concerns through confidential
counseling.
Eligible employees and family members who live with them are covered under the EAP regardless of whether they are
enrolled in a Hitachi Vantara medical plan. Hitachi Vantara pays the full cost of participation in this program.
The EAP provides you and your family members with up to eight sessions, per incident, with a counselor at no cost to you.
If additional counseling is required, you may be able to obtain coverage under your medical plan.
To access services of the EAP, call Anthem at 1-800-865-1044 or visit www.anthemeap.com, login: Hitachi
Counseling services are staffed 24 hours a day, seven days a week.
36 Hitachi Vantara 2022 Benefits Guide BENE FI T S F O R W H AT ’S NE X TYou can also read
