Page 2 - HIMSS 2021 Benefits At A Glance
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SUPPLEMENTAL MEDICAL PLANS
VOLUNTARY ACCIDENT INSURANCE VOLUNTARY CRITICAL ILLNESS INSURANCE
Just as it sounds, accident insurance can help you pay for costs A critical illness can keep you from working and can make it
you may incur after an accidental injury. This type of injury difficult to do simple, everyday things. Critical Illness insurance
includes things such as a car accident, a fall while skiing, or even pays a fixed one-time benefit amount if you are diagnosed with a
a fall down the stairs at home. This benefit is paid regardless of covered disease or illness (such as a heart attack, stroke or organ
any other insurance coverage you might have (including your failure). You can use this money for any purpose you like.
medical coverage).
HEALTH SAVINGS ACCOUNT (HSA)
An HSA is a personal savings account you can use to pay for qualified out-of-pocket medical expenses with pretax dollars.
HOW A HEALTH SAVINGS ACCOUNT (HSA) WORKS
Eligibility
You must be enrolled in the BCBS High Deductible PPO + HSA Plan.
Your Contributions
The company contributes $500 to your HSA for individual coverage and $1,000 for family coverage (amounts are prorated
for new hires). You can also contribute on a pretax basis and can change how much you contribute from each paycheck up
to the IRS maximum of $3,600 for individual coverage or $7,200 for family coverage (your contribution and the company’s
contribution should not exceed the maximum). You can make an additional catch-up contribution if you are age 55.
Eligible Expenses
Eligible expenses include medical, dental, vision, prescription, and over-the-counter drug expenses incurred by you and
your eligible family members. If you want to enroll in a Healthcare FSA, you are eligible to enroll in a Limited Purpose FSA,
which covers dental and vision expenses only.
Remaining Funds
Money left in your HSA at the end of the year will roll over to the next year — you’ll never lose your HSA dollars. If
you leave the company or retire, you can take your HSA with you, and continue to pay and save for future eligible
healthcare expenses.
DENTAL PLAN
The dental plan through Delta Dental of Illinois covers preventive care (including regular checkups) as well as fillings, bridges, crowns
and other dental services.
DELTA PREMIER NETWORK /
DELTA PPO NETWORK
OUT-OF-NETWORK**
ANNUAL DEDUCTIBLE
Individual $50 $50
Family $150 $150
ANNUAL MAXIMUM
Per Individual $1,500
YOU PAY
DIAGNOSTIC AND PREVENTIVE
Cleanings, Fluoride Treatments, Sealants $0 $0
and X-rays
BASIC SERVICES
Fillings, Periodontics, Scaling and Root 10%* 20%*
Planning and Oral Surgery
MAJOR SERVICES
Crowns, Bridges, Full and 40%* 50%*
Partial Dentures
ORTHODONTIA (CHILD ONLY UP TO AGE 19)
50%*; $1,500 lifetime maximum
*After deductible is met.
**Delta Premier Network claims are based on an agreed upon fee schedule. Out-of-network claim payment will be based on usual & customary charges.
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VOLUNTARY ACCIDENT INSURANCE VOLUNTARY CRITICAL ILLNESS INSURANCE
Just as it sounds, accident insurance can help you pay for costs A critical illness can keep you from working and can make it
you may incur after an accidental injury. This type of injury difficult to do simple, everyday things. Critical Illness insurance
includes things such as a car accident, a fall while skiing, or even pays a fixed one-time benefit amount if you are diagnosed with a
a fall down the stairs at home. This benefit is paid regardless of covered disease or illness (such as a heart attack, stroke or organ
any other insurance coverage you might have (including your failure). You can use this money for any purpose you like.
medical coverage).
HEALTH SAVINGS ACCOUNT (HSA)
An HSA is a personal savings account you can use to pay for qualified out-of-pocket medical expenses with pretax dollars.
HOW A HEALTH SAVINGS ACCOUNT (HSA) WORKS
Eligibility
You must be enrolled in the BCBS High Deductible PPO + HSA Plan.
Your Contributions
The company contributes $500 to your HSA for individual coverage and $1,000 for family coverage (amounts are prorated
for new hires). You can also contribute on a pretax basis and can change how much you contribute from each paycheck up
to the IRS maximum of $3,600 for individual coverage or $7,200 for family coverage (your contribution and the company’s
contribution should not exceed the maximum). You can make an additional catch-up contribution if you are age 55.
Eligible Expenses
Eligible expenses include medical, dental, vision, prescription, and over-the-counter drug expenses incurred by you and
your eligible family members. If you want to enroll in a Healthcare FSA, you are eligible to enroll in a Limited Purpose FSA,
which covers dental and vision expenses only.
Remaining Funds
Money left in your HSA at the end of the year will roll over to the next year — you’ll never lose your HSA dollars. If
you leave the company or retire, you can take your HSA with you, and continue to pay and save for future eligible
healthcare expenses.
DENTAL PLAN
The dental plan through Delta Dental of Illinois covers preventive care (including regular checkups) as well as fillings, bridges, crowns
and other dental services.
DELTA PREMIER NETWORK /
DELTA PPO NETWORK
OUT-OF-NETWORK**
ANNUAL DEDUCTIBLE
Individual $50 $50
Family $150 $150
ANNUAL MAXIMUM
Per Individual $1,500
YOU PAY
DIAGNOSTIC AND PREVENTIVE
Cleanings, Fluoride Treatments, Sealants $0 $0
and X-rays
BASIC SERVICES
Fillings, Periodontics, Scaling and Root 10%* 20%*
Planning and Oral Surgery
MAJOR SERVICES
Crowns, Bridges, Full and 40%* 50%*
Partial Dentures
ORTHODONTIA (CHILD ONLY UP TO AGE 19)
50%*; $1,500 lifetime maximum
*After deductible is met.
**Delta Premier Network claims are based on an agreed upon fee schedule. Out-of-network claim payment will be based on usual & customary charges.
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