Page 6 - 2022 Penn Engineering Guide

Your 2022 Benefit Offerings

The Company offers two options to provide you with the medical coverage you need. You
choose the option that’s right for you and your family.
• PPO Plan
• Consumer Driven Health Plan (CDHP)

Your Benefit Guide
This Benefit Guide summarizes the benefit options available to you for the 2022 Plan year. After
you’ve made your decisions, complete your benefits enrollment in MyADP. Even if you aren’t
making any changes, you must log-onto ADP to ensure that your 2022 coverage elections are
correct and select your beneficiaries. All employees electing CDHP medical coverage other than
Single tier are required to complete the Coverage Certification Form.

Adding New Dependents
New dependents are not automatically added. You must make all changes through MyADP
(declare an event) within 30 days to ensure coverage. Notifications received after 30 days may
not be eligible for coverage until next open enrollment.

Weekly Dependent Surcharge for all Medical Plans
There will be a $25.00 weekly Spouse/ Dependent surcharge on healthcare premiums for
employees whose spouse/dependent(s) have health coverage available through his/her
employer. You must complete the Coverage Certification section on MyADP if you elect any
other coverage tier other than Single.

Weekly Tobacco Surcharge for all Medical Plans
There is a $25.00 weekly Employee and/or Spouse surcharge on Healthcare premiums for
Employees or Spouses who use Tobacco products in any form. Must be tobacco-free for a 12-
month period to be eligible for the standard premium. Smoking cessation program is available
to avoid this surcharge.

Flexible Spending Accounts
If you wish to participate in Flexible Spending Accounts for the new plan year, be sure to elect
when you re-enroll on MyADP. You must re-enroll annually for the new Plan Year.

Additional Life Insurance and Dependent Life Insurance
If you are not currently enrolled in Additional Life or Dependent Life Insurance and now wish to
join the Plans, or if you wish to change the level of your coverage, please make your new
election on MyADP. If you or your eligible dependents are enrolling for the first time or you are
increasing coverage, you will be required to provide evidence of insurability unless the Company
is offering an approved open enrollment.

Consumer Driven Health Plan (CDHP) High Deductible PPO Plan
A CDHP is a high deductible PPO Plan as defined by the IRS. The CDHP is designed to cover
eligible medical expenses after an annual deductible is met. No payments from the Plan will
occur until the annual deductible is met. Preventive services, such as annual physicals in the
doctor’s office, mammograms, colonoscopies, and well-baby visits are covered at 100%. The
chart beginning on page 10 summarizes the levels of coverage. 5