Page 2 - First Bank- Open Enrollment Guide 2015
P. 2
Open
Enrollment
Benefits Summary Information for the 2015 Plan
Year
The following information is intended to provide summary
information to assist you in the Enrollment process for the 2015
Table of Contents Plan Year of First Bank’s employee beneit programs. The summary
Medical . . . . . . . . . . . . . . . . . .3 information provided is intended to briely outline coverage in the
Dental . . . . . . . . . . . . . . . . . . .5 following plans.
Vision . . . . . . . . . . . . . . . . . . .6 X Medical
Life, AD&D, Long Term Disability, X Dental
Short Term Disability, and Long X Vision
Term Care . . . . . . . . . . . . .7
Flexible Spending Accounts . . . .9 X Life and Supplemental Life
Employee Contribution Rates . .10 X Accidental Death and Dismemberment (AD&D)
X Long Term Disability (LTD)
X Short Term Disability (STD)
X Life with Long Term Care Protection
X Healthcare Reimbursement Account
X Dependent Care Reimbursement Account
The following is summary information intended only to assist
you in the Enrollment process. The entire provisions of eligibility,
beneits, and exclusions for each Plan above are contained in the Plan
Document or Group Contract that applies speciically to each Plan.
In the event of a conlict between the appropriate Plan Document or
Group Contract and this description, the Plan Document or Group
Contract, whichever is in place, will prevail.
2
Enrollment
Benefits Summary Information for the 2015 Plan
Year
The following information is intended to provide summary
information to assist you in the Enrollment process for the 2015
Table of Contents Plan Year of First Bank’s employee beneit programs. The summary
Medical . . . . . . . . . . . . . . . . . .3 information provided is intended to briely outline coverage in the
Dental . . . . . . . . . . . . . . . . . . .5 following plans.
Vision . . . . . . . . . . . . . . . . . . .6 X Medical
Life, AD&D, Long Term Disability, X Dental
Short Term Disability, and Long X Vision
Term Care . . . . . . . . . . . . .7
Flexible Spending Accounts . . . .9 X Life and Supplemental Life
Employee Contribution Rates . .10 X Accidental Death and Dismemberment (AD&D)
X Long Term Disability (LTD)
X Short Term Disability (STD)
X Life with Long Term Care Protection
X Healthcare Reimbursement Account
X Dependent Care Reimbursement Account
The following is summary information intended only to assist
you in the Enrollment process. The entire provisions of eligibility,
beneits, and exclusions for each Plan above are contained in the Plan
Document or Group Contract that applies speciically to each Plan.
In the event of a conlict between the appropriate Plan Document or
Group Contract and this description, the Plan Document or Group
Contract, whichever is in place, will prevail.
2
