Page 5 - Benefits Summary/New Hire Enrollment Guide

Cigna HRA Funding applies to LAST PART OF DEDUCTIBLE ONLY

Employee pays first: NHS pays last:
Employee $3,000.00 $2,000.00
Employee + Spouse $6,000.00 $4,000.00
Employee + Child(ren) $6,000.00 $4,000.00

Family $6,000.00 $4,000.00

This summary outlines the highlights of your plan. For a complete list of both covered and not-covered services, including benefits required
by your state, see your employer's insurance certificate or summary plan description -- the official plan documents. If there are any
differences between this summary and the plan documents, the information in the plan documents takes precedence.

New Employee Contribution numbers
Employee Contribution needed

Northern Human Services is committed to contributing significantly to the premium for your health coverage.
Following is a breakdown of your pre-tax contribution for the 2020-2021 plan year.

Employee Only
Employee & Employee & Family
($19.24 & up/hourly
Spouse Child(ren)
rate)

Weekly $ $ $ $

Bi-weekly $ $ $ $

ACA Adjusted Employee Only Rate for hourly rates up to and including $19.23 – The Affordable Safe Harbor
NHS uses is 9.78% of your hourly wage as of the first day of the plan year, multiplied by 130 hours per month
in a formula that will be calculated by your Office Manager.

myCigna New ACA Adjusted rate
needed?

On myCigna.com or the “myCigna” app you can find in-network providers, manage and track claims, see cost
estimates for medical procedures and prescription drugs, find retail pharmacies, compare quality of care for
doctors and hospitals and access a variety of health and wellness tools and resources. To register either go to
myCigna.com or launch the “myCigna” app on your smart phone and:

1) Select “Register Now”
2) Enter your personal information
3) Confirm your identity
4) Create your security information and provide your primary email address
5) Review, then select “Submit”

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