EQ brochure

SUMMARY OF EMPLOYEE BENEFITS
April 2018
Dedicated Service Representave:
Account Manager:
Ashlii Parn
Gabriela Goncalves
(408) 666-2600 (408 ) 213-5084
Ashlii@ExpertQuote.com
Gabriela@ExpertQuote.com

Medical
Plan Summaries
Network
In Network Only
Annual Deducble Individual/Family $0
Annual Deducble Family $3,500
Max OOP Individual (includes ded) $2,500
Max OOP Family (includes ded) $8,500
Office/Specialist Copay
$0;Use Benny Card
Well Visit
$0;Use Benny Card
Lab & X-Ray
$0;Use Benny Card
Hospital Inpaent
$0;Use Benny Card
Outpaent Surgery
$0;Use Benny Card
ER Charge
$0;Use Benny Card
Ambulance
$0;Use Benny Card
Rx Generic/Brand
$0;Use Benny Card
In Network Only
$2,000
$7,500
$3,050
$9,600
$0;Use Benny Card
$0;Use Benny Card
$0;Use Benny Card
$0;Use Benny Card
$0;Use Benny Card
$0;Use Benny Card
$0;Use Benny Card
$0;Use Benny Card
Dental
In Network
Out of Network
Deducble - Individual/ $25 $25
Deducble - Family $75 $75
Prevenve 100% 100%
Deducble Waived
YES (Diagnosc and Preventave)
Basic 90% (Endo/Perio) 80% (Endo/Perio
Major 60% 50%
Annual Maximum $5,000 $5,000
Ortho (Children under 26) Not Covered Not Covered
Ortho Lifeme Max Not Covered Not Covered
Vision Plan
In Network
Non-Network
Comprehensive Exam
Every 12 months
Eye Exams $10 up to $45
Lenses
Every 12 months
Single /Bifocal /Trifocal Vision $10 up to $30/$50/$65
Frames
Contacts
Every 12 months
$150 allowance + 20% over up to $70
Every 12 months
Elecve $150 allowance up to $105

FSA
Health Care—Employees may elect to contribute up to $2,650 on a pre-tax basis to the Health Care Flexible
Spending Account. This allows you to be reimbursed for out-of-pocket health care expenses that are not covered
by the medical, dental or vision plans.
Dependent Care—Employees may contribute up to $5,000 per year (household maximum) on pre-tax basis can
use this account for certain child care, elder care or other dependent care expenses.
Commuter Benefits—Employees may elect to contribute up to $260 monthly tax free for mass transit and
WHO IS ELIGIBLE
EMPLOYEES
All full me employees who work weekly on average at least 30 hours throughout the year are eligible for benefits.
Your benefits will begin the first of the month following date of hire.
ELIGIBLE DEPENDENTS
Your eligible dependents include your legally married spouse, registered domesc partner, and children. Due to
Health Care Reform, your medical plan covers dependents to age 26. However, for other plans, age limits may
apply. Coverage may be available for a mentally or physically disabled child who is age 26 or older. Requirements
for such coverage and documentaon of disability depend on the insurance carrier. Please contact your
Benefits Administrator if you believe this issue applies to your family.
WHEN CAN YOU ENROLL
NEW HIRES/NEWLY ELIGIBLE FOR BENEFITS
When you are first hired or become eligible for benefits, you have 30 days to enroll into benefits. If you do not
enroll within that me frame, you will not be eligible for benefits unl next Open Enrollment, unless you have a
Qualifying Event.
OPEN ENROLLMENT
During Open Enrollment, you will have the opportunity to make changes to your benefit elecons. You must enroll
by the Open Enrollment deadline for your benefits to be effecve January 1st. Except for a Qualifying Event,
you will not be able to change your elecons unl the next year’s Open Enrollment.
QUALIFYING EVENTS
If you have a qualifying event, you may be able to change your benefits before the next Open Enrollment. You
must nofy Human Resources within 30 days of the event.
QUALIFYING EVENTS
* Newly hired as full me benefits eligible employee
* Changing from Part-Time to Full-Time
* Loss of coverage for you, your spouse or dependents
* Change in marital status
* Birth of a child, adopon, legal guardianship
or custody.
* Change in residence causing loss of coverage
* Qualified Medical Child Support Order
(QMCSO)
Employer Contribuon
Plans Employee Dependents
Kaiser Permanente & Aenta 100% 0%
Beam-Dental 100% 0%
Beam-Vision 100% 0%

WHERE AND HOW TO USE YOUR BENNY VISA
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Use the Visa Card to make payments as requested by provider’s office when
checking in or via a bill sent to your home weeks later.
When paying your bills, simply write the card number, expiraon date, etc. at
the boom of bill.
You can also call Kaiser Permanente and pay the bill over the phone.
Use your Visa Card unl all funds for exhausted $3,500 for Single is loaded for
every employee and $3,500 for Family coverage.
Your Visa Card should be used at the pharmacy.
Your Visa Card is not an insurance card, it’s simply a form of payment provided
to you on behalf of your employer.
Carrier Contact Informaon
Medical: Kaiser Permanente 800-464-4000 Policy #713859 www.kp.org
Medical: Aetna 877-204-9186 Policy #776351 www.aetna.com
Dental: Beam 800-648-1179 Policy#CA00312 www.beam.com
Vision: Beam 800-648-1179 Policy #CA00312 www.beam.com
FSA: Benefit Resource 800-473-9595 N/A www.benefitresource.com
COBRA: Benefit Resource 877-262-7202 N/A www.benefitresource.com
Broker: Expert Quote 408-953-1000 N/A www.expertquote.com
HI Q - Human Resources
Germaine Yokoyama - Human Resources Manager 650-569-1122
germaine.yokoyama@healthiq.com
This guide is intended as a quick reference, not a comprehensive descripon.
There are limitaons and exclusions to these benefits that can be found in the official plan document.
The official plan documents and negoated contract will govern in case of any discrepancies.