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20XX BENEFITS ENROLLMENT
20XX BENEFITS ENROLLMENT

















TABLE OF CONTENTS
Your 2020 Beneits ....................2 Life and Disability Insurance ............ .9
Medical and Prescription Drug ........... .3 Employee Assistance Program (EAP) .......10
Health Savings Account (HSA) ........... .5 Retirement Savings Plan 401(k) ..........11
Flexible Spending Account (FSA) ..........6 Additional Voluntary Coverage ...........12
Dental ............................ .7 Contact Information ..................14
Vision ............................ .8
This Beneit Enrollment Guide is only intended to highlight some of the major beneit provisions of
This publication contains important information the Company plan and should not be relied upon as a complete detailed representation of the plan.
Please refer to the plan’s Summary Plan Descriptions for further detail. Should this guide difer from
about your employee benefit program. the Summary Plan Descriptions, the Summary Plan Descriptions prevail.
Please read thoroughly. © 2019 Lockton, Inc. All rights reserved.
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YOUR 2020 BENEFITS MEDICAL AND What is a Network?
At [Company Name], we offer a competitive and You must make changes to your beneits within [30/31] PRESCRIPTION DRUG A network is a group of providers your plan contracts
with at discounted rates. You will almost always pay less
comprehensive beneits program to recognize how days of your qualifying life event. If you do not make [Client Name] partners with [Carrier] to offer you medical when you receive care in-network.
important you are to the company. This beneits guide changes during this time, you may have to wait until next and prescription drug insurance.
summarizes our program in a quick and easy-to- year’s annual enrollment to make your change. If you choose to see an out-of-network provider,
you may be balance billed, which means you will be
understand way. Please review your plan documents for responsible for charges above [Carrier]’s reimbursement
more details. Benefits Eligibility Plan Highlights amount.
You have the option of choosing one of [X] plans. Our
New Hire Enrollment Covering Yourself plans offer coverage for most healthcare services. When Important Insurance Terms
you receive care in-network you beneit from our negotiated
Welcome to our team! As a new employee, you are You may enroll in the beneits program if you are a discounts with [Carrier]. „ Deductible: the amount of money you are
regular full-time employee who is actively working a
eligible for coverage on your [XX] day of employment. minimum of 30 hours per week. responsible for paying up-front before your plan
You must enroll in beneits within [XX] days of your shares your costs
date of hire. [Carrier] Member Site „ Coinsurance: the percentage you and the plan
Covering Your Family Members Visit www.[Carrier].com to take advantage of all the helpful pay; in our plans, you pay a smaller percentage
Annual Enrollment Eligible dependents generally include your legally tools and resources available including the following. „ and the plan pays a larger percentage
married spouse and children up to age 26. Some age
Copay: a ixed amount for certain services you
Annual enrollment is your yearly opportunity to limitations may apply to speciic insurance programs. „ In-network provider and pharmacy searches pay in some of our plans
review your current beneits and make changes for the Children may include natural, adopted, step-children, „ A list of prescription drugs covered by our plans „ Out-of-pocket maximum: the limit on your
upcoming plan year. During annual enrollment you can or children obtained through court-appointed legal „ Access to temporary ID cards and means to order expenses; once you reach this limit, the plan
add, change, or decline coverage. You can also add and/ guardianship. another ID card covers all eligible expenses for the remainder of
or drop family members for coverage during this time. the plan year
This year’s annual enrollment will take place [Month Eligibility Documentation „ Information regarding paid and pending claims
XX–XX, 20XX]. Please be prepared to share dependent eligibility Employee [Monthly/Weekly/Bi-Weekly]
Changing Your Benefits Mid-Year information during enrollment including date of birth Medical Contributions
and Social Security Numbers. Other documentation may
Once you make your elections, you will not be able to be required depending on your elections. Employee Only [Plan 1] [Plan 2]
make changes until next year’s annual enrollment unless Employee and Spouse $ $
you experience a qualifying life event. Examples of Employee and Child(ren) $ $
qualifying events include the following. Family $ $ $ $
RISK MANAGEMENT • EMPLOYEE BENEFITS • RETIREMENT SERVICES
„
Change of legal marital status (e.g., marriage,
divorce, death of spouse, legal separation)
„ Change in number of dependents (e.g., birth,
adoption, death of dependent, ineligibility due to
Our Mission | To be the worldwide value and service leader in insurance brokerage,
age)
Change in employment or job status
„
risk management, employee benefi ts and retirement services
LOCKTON.COM
2 2020 Benefits Enrollment [Client Name] 3
Our Goal | To be the best place to do business and to work
© 2020 Lockton, Inc. All rights reserved.
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