Page 4 - Razer Benefits At A Glance Guide 1-19
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DENTAL                         AETNA DMO (CA ONLY)                 OTHER BENEFITS

         Benefits                                   Network                 CIGNA
         Calendar Year Maximum                     Unlimited                Group Term Life (GTL) / AD&D
         Annual Deductible                            $0                    $100,000
         Preventive Services                      Copays Apply              Voluntary Term Life (VTL) / AD&D
         Basic Services                           Copays Apply              Employee: $500,000 max. (GI: $100,000*)
                                                                            Spouse: $250,000 max. (GI: $30,000*)
         Major Services                           Copays Apply              Child(ren): $10,000 max. (GI: $30,000*)
         Orthodontia (Child / Adult)      $1,945 Copay / $1,945 Copay       *Guarantee Issue (GI): Evidence of Insurability (EoI)
         Employee Contributions                  Per Pay Period             required for the elected coverage over GI)
                                                                            Short Term Disability (STD)
         •  Employee Only                            $0.00                  60% of earnings, $2,308/week max
         •  Employee + Spouse                        $1.30                  Voluntary buy up option also available.
         •  Employee + Child(ren)                    $2.79                  Long Term Disability (LTD)
         •  Employee + Family                        $4.57                  60% of earnings, $10,000/month max.
         DENTAL                                 AETNA PPO                   Employee Assistance Program (EAP)
                                                                            24/7 confidential counseling and referral
         Benefits                          Network        Non-Network       service including 3 face-to-face counseling
         Calendar Year Benefit Max                  $2,500                  sessions per person per year for employees
         Annual Deductible                            $0                    and household family members.
         Preventive Services               No Cost           No Cost        Travel Assistance Program
                                                                            24/7 pre-trip planning, traveling assistance,
         Basic Services                      10%               10%          and Emergency assistance for employees
         Major Services                      40%               40%          and covered family members.
         Orthodontia (Child / Adult)   50% with $2,000 Lifetime Benefit Max
         Employee Contributions                  Per Pay Period             DISCOVERY BENEFITS
         •  Employee Only                            $0.00                  Flexible Spending Accounts (FSA)
         •  Employee + Spouse                        $7.21                  Pre-Tax program for qualified health and
         •  Employee + Child(ren)                    $7.91                  childcare or elder dependent care.
         •  Employee + Family                        $15.95                 Health Care FSA/Limited HCFSA (HSA only):

         VISION                                   VSP PPO                   $2,700/year max.
                                                                            Dependent Care FSA: $5,000/year max.
         Benefits                          Network        Non-Network       ($2,500 if married but file taxes separately)
         Exam (Every 12 Months)           $10 Copay       $45 Allowance     Commuter Reimbursement Account (CRA)
         Lenses (Every 12 Months)         $10 Copay      Allowance Varies   Pre-Tax program for qualified expenses
         Frames (Every 12 Months)        $180-$200        $70 Allowance     Transit & Vanpooling: $265/month max.
                                                                            Parking: $265/month max.
                                          Allowance
         Elective Contact Lenses       Up to $60 Copay,  $105 Allowance     ADP RETIREMENT SERVICES
         In Lieu of Frames/Lenses      $150 Allowance                       401(k) Retirement Savings
         Employee Contributions                  Per Pay Period             Comprehensive retirement plan with
         •  Employee Only                            $0.00                  employer match of 100% on the first 3% of
         •  Employee + Spouse                        $1.06                  eligible earnings, and an additional 50% on
         •  Employee + Child(ren)                    $1.11                  the next 2% of eligible earnings.
         •  Employee + Family                        $2.70
                                                                            UNITED PET CARE &
        RESOURCES & CONTACTS                                                NATIONWIDE

        Benefits Enrollment Portal: razer.ultipro.com                       Pet Discount and Insurance Plans
        HR/Benefits: rusa_hr@razer.com                                      ID SHIELD / LEGAL SHEILD
        Burnham Advocate Help-Line: 800-391-6812                            Identity Theft Protection / Legal Services



                                                                                                      Rev.  11/26/2018
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