Page 11 - VSolvit 2021 Benefits Brochure

Employee Contributions

Employee benefit contributions are automatically deducted from your paycheck on a pre‐tax basis. Rates below are
bi‐weekly (26 payroll periods). The amount depends on the plan and if you choose to cover eligible family members.

Medical High Deductible OAP HSA In‐Network Only OAP Low Deductible OAP
Employee Only $0.00 $67.46 $196.65
Employee + Spouse $108.29 $245.19 $540.76
Employee + Child(ren) $110.75 $205.89 $442.44
Employee + Family $228.88 $300.04 $741.68

Dental HMO PPO
Employee Only $0.00 $14.82
Employee + Spouse $5.49 $46.29
Employee + Child(ren) $5.63 $59.38
Employee + Family $11.12 $83.74

Vision
Employee Only $0.00
Employee + Spouse $2.22
Employee + Child(ren) $2.46
Employee + Family $4.77

Carrier Phone Website
Medical & Dental Plans Cigna 1‐866‐494‐2111 www.cigna.com
HSA Bank HSA Bank ‐ Cigna 1‐866‐494‐2111 www.mycigna.com

FSA, DCFSA, LPFSA Discovery 1‐866‐451‐3399 www.discoverybenefits.com

Vision EyeMed 1‐866‐804‐0982 www.eyemed.com

Life & Disability Unum 1‐866‐679‐3054 www.unum.com

EAP Unum 1‐800‐854‐1446 www.unum.com/lifebalance

Accident, Critical Illness Unum 1‐866‐679‐3054 www.unum.com

Pet Insurance Nationwide 1‐877‐738‐7874 www.petsnationwide.com/vsolvit

Your HR Benefits Team VSolvit 1‐805‐277‐4705 benefits@vsolvit.com
Ext 177
*Enrollment Questions

PLEASE NOTE: This booklet provides a summary of the benefits available but is not your Summary Plan Description (SPD). The Company
reserves the right to modify, amend, suspend, or terminate any plan at any time, and for any reason without prior notification. The plans
described in this book are governed by insurance contracts and plan documents, which are available for examination upon request. We have
attempted to make the explanations of the plans in this booklet as accurate as possible. However, should there be a discrepancy between
this booklet and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents
will govern. In addition, you should not rely on any oral descriptions of these plans since the written descriptions in the insurance contracts
or plan documents will always govern.