Page 8 - 2013-14 Advantage One FCU Benefits & Notices

Advantage One FCU 2013-14

Benefits Provided to Our Employees

Medical Coverage
Dental Coverage
Vision Coverage
Health Reimbursement Arrangement (HRA) Program
Group Life Insurance
Group Accidental Death and Dismemberment (AD&D) Insurance
Short-Term Disability (STD) Insurance
Long-Term Disability (LTD) Insurance

Employee Share of Benefits Cost

Eligible employees enrolled in the medical coverage have a portion of the premium deducted from each
pay period. These amounts are deducted on a pre-tax basis.

How Much Do I Pay for Medical Coverage Per Pay?
One Person EE + Sp EE + CHILD Family
BCBSM HRA 1500 $ 15.53 $ 36.57 $ 36.57 $ 46.93

Waiver of Medical Coverage – Opt Out Option

You may elect to waive medical coverage from Advantage One Federal
Credit Union if you have and can provide proof of existing coverage from
another source (spouse, parent, etc.). When proof of coverage is provided to
Human Resources and validated, you will be eligible to enroll in the dental
and/or vision plans. The Opt Out Option provides no monetary subsidy to
the eligible employee.

Should you suffer a HIPAA status change event, you may be added to
Advantage One Federal Credit Union’s medical plan mid-year only if
notification is given to Human Resources no later than 30 days of the event.

Summary of Benefits & Coverage

In accordance with the changes mandated by federal health care reform effective the first plan year
following 09/23/2012, this is your Summary of Benefits & Coverage (SBC) for our medical plan.

The purpose of the SBC is to provide an explanation of your medical and prescription benefits (if any) in
an easy to read format. The SBC should look the same for any health plan from any employer since the
format, developed by the federal Department of Labor (DOL), is mandatory.

The SBC should be used in conjunction with the benefit table in the Medical Coverage section of this
booklet and the benefit guide found in the Member Section of the carrier’s website or by clicking here.

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