Company Benefit Summary
CENTURY 21 Affiliated | 221 W. Beltline Hwy, Madison, WI 53713 | 608-221-2121
Table of Contents
About This Benefit Summary ................................................................................................................. 2 Medical ....................................................................................................................................................... 3 Dental .......................................................................................................................................................... 4 Vision ........................................................................................................................................................... 5 Employer Paid Short-Term Disability ................................................................................................... 6 Voluntary Term Life .................................................................................................................................. 7 Voluntary Critical Illness ......................................................................................................................... 8 Voluntary Accident ................................................................................................................................. 9 Flexible Spending Account ................................................................................................................. 10 Employee Assistance Program .......................................................................................................... 11 How to Enroll or Waive .......................................................................................................................... 12 Questions? ............................................................................................................................................... 12
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About This Benefit Summary
The benefits summary is a high-level overview of the benefits offered to CENTURY 21 Affiliated employees and is not intended to be a complete description of coverage. Every effort has been made to ensure the information in this summary is accurate. If there is a discrepancy between this summary and the plan documents, the language in the plan documents shall be considered accurate. CENTURY 21 Affiliated strives to provide you and your family with a comprehensive and valuable benefits package. We want to make sure you’re getting the most out of our benefits—that’s why we’ve put together this Benefits Summary . Important Dates To Know: - July 1 – June 30: Medical, dental, vision and supplemental insurances plan year - Late May / June: Open enrollment hosted for upcoming plan year For more information on specific coverages, please visit the website provided in each section of this benefit summary or reach out to Human Resources with questions.
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Medical CENTURY 21 Affiliated provides group health insurance through Dean Healthcare. To provide PPO members access to physicians and facilities throughout Wisconsin and outside of Wisconsin, DHP partners with First Health. Three (3) PPO options are below with election options and premium amounts. For more information on the health insurance and in-network providers, visit www.deancare.com/find-a-doctor/ppo-providers, then select “Find a First Health Provider”.
OPTION
PPO OPTION 1
PPO OPTION 2
PPO OPTION 3
Network Name
Dean $5000 PPO
Dean $1000 PPO
Dean $500 PPO
Benefits
In-Network
Non-Network
In-Network
Non-Network
In-Network
Non-Network
Deductible Ind/Family
$5,000 / $10,000
$10,000 / $20,000
$1,000 / $3,000
$2,000 / $6,000
$500 / $1,000
$1,000 / $2,000
1 & 2 Tier is 50% coins. 3 & 4 not covered 40% coinsurance after deductible
1 & 2 Tier is 50% coins. 3 & 4 not covered 40% coinsurance after deductible
1, 2, & 4 Tier is 50% coins. 3 Tier is not covered
$10 / $50 / $80 / 25% coinsurance
$10 / $50 / $80 / /25% coinsurance
$10 / $15 / $60/ $100
RX Benefit
40% coinsurance after deductible
PCP Office Visits
$20 Copayment
$20 Copayment
$25 Copayment
Specialty Office Visits
40% coinsurance after deductible
40% coinsurance after deductible
40% coinsurance after deductible
$20 Copayment
$20 Copayment
$25 Copayment
Chiropractic Services
40% coinsurance after deductible
40% coinsurance after deductible
40% coinsurance after deductible
$20 Copayment
$20 Copayment
$25 Copayment
Preventive Exams
40% coinsurance after deductible
40% coinsurance after deductible
40% coinsurance after deductible
$0 Copayment
$0 Copayment
$0 Copayment
$80 copay and/or 20% coinsurance after deductible
$80 copay and/or 20% coinsurance after deductible
$50 copay and/or 20% coinsurance after deductible
Urgent Care
Emergency Room
$350 copay and/or 20% coinsurance after deductible
$350 copay and/or 20% coinsurance after deductible
$150 copay and/or 20% coinsurance after deductible
20% coinsurance after deductible
40% coinsurance after deductible
20% coinsurance after deductible
40% coinsurance after deductible
20% coinsurance after deductible
40% coinsurance after deductible
Hospital Services
Out-of-Pocket Maximum
$7,350 / $14,700
$2,000 / $4,000
$14,700 / $29,400
$4,000 / $12,000
$8,000 / $24,000
$1,000 / $2,000
Employee Only $109.38 Employee / Spouse $368.44 Employee / Child(ren) $351.30 Family $582.64
Employee Only $206.63 Employee / Spouse $577.52 Employee / Child(ren) $550.66 Family $913.29
Employee Only $278.67 Employee / Spouse $732.41 Employee / Child(ren) $698.34 Family $1,158.23
Employee Monthly Premiums
Out-of-Pocket Maximum includes Deductible, Rx, Office, Urgent Care & Emergency Room Copays
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Dental
CENTURY 21 Affiliated provides group dental insurance through Delta Dental. This dental plan covers both PPO and Premier dentists, however, you will find the best coverage through a PPO network dentist. Orthodontic services are available for dependents on your plan who are 18 years of age or younger. For more information on the dental insurance and in-network providers, visit www.deltadentalwi.com .
Delta Premier/Out of Network
Employee Monthly Premiums
Benefits
Delta PPO Network
Deductible - Ind/Family
$50 / $150
$75 / $225
Ded. Applied for Preventive
No
Yes
Individual Annual Max
$1,500 per person
$1,000 per person
Employee Only $35.02
Preventive
100%
80%
Employee/Spouse $70.06
Basic Restorative (fillings)
80%
50%
Endo/Perio/ Oral Surgery
Employee/Child(ren) $74.92
80%
50%
Major Restorative (Crowns)
50%
40%
Family $121.58
Orthodontic (avail. dependents 18 & younger only)
70%
50%
Orthodontic Lifetime Max
$1,500
$1,000
Waiting Periods
No
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Vision
CENTURY 21 Affiliated also partners with Delta Dental to provide vision insurance through EyeMed. Seeing an EyeMed in-network vision provider will help you maximize your benefits and minimize out-of-pocket expenses. To find a provider in-network and learn more about the vision insurance, visit www.deltadentalwi.com .
Service/ Material Freq
Employee Monthly Premiums
In-Network
Non-Network
Exam | 12 Months
$10 copay
Up to $35
Frames | 24 Months
$150 Retail Allowance
Up to $75
Lenses | 12 Months
Employee Only $7.08
Single Vision
$10 copay
Up to $25
Employee/Spouse $14.16
Bifocal
$10 copay
Up to $40
Trifocal
$10 copay
Up to $55
Employee/Child(ren) $14.45
Progressive
Pay $65 plus $10 copay
Up to $40
Family $21.53
Contact Lenses 12 Months
(Contact Lenses are in lieu of frames and eyeglass lenses)
Elective
Up to $150 Allowance
Up to $120
Medically Necessary
Paid in full
Up to $200
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Employer Paid Short-Term Disability
Employer-Paid Short-Term Disability (STD) is a company-sponsored benefit through Principal Financial. It serves as a financial safeguard to pay a percentage of your salary should you ever have to be out of work for an extended period of time due to an injury or temporary disability such as illness, hospitalization, pregnancy, etc. This benefit is 100% employer-paid and eligible employees are automatically enrolled. A summary of the benefits offered is listed below. Refer to the plan certificate for detailed STD coverage information or visit www.principal.com .
BENEFITS
PRINCIPAL SHORT-TERM DISABILITY DETAILS
An employee will be considered disabled if, because of sickness, injury, or pregnancy, one of the following applies: - Unable to perform a majority of the substantial and material duties of his/her own job; OR Unable to earn 80% of his/her pre-disability income while working in his/her own job in a modified capacity
Definition of Disability
Elimination Period
1st Day Accident / 8th Day Sickness
First Day Hospital
No
Weekly Benefit
60% of pre-disability earnings to a max of $2,000
Max Benefit Duration
13 weeks
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Voluntary Term Life
Voluntary Term Life and AD&D coverage is a group benefit through Principal that gives you the peace of mind that your beneficiary (or beneficiaries) will be taken care of financially in the event you pass away, are in a serious accident or become dismembered. Newly eligible employees can elect up to the guaranteed amount without question. If employees elect over the guaranteed amount or make an election outside of their new hire/eligibility window, they will be subject to medical underwriting. A summary of the benefits offered is listed below. Refer to the plan certificate for detailed Voluntary Term Life coverage information or visit www.principal.com .
MONTHLY STEP RATES PER $1,000 OF BENEFIT (SPOUSE RATE IS BASED UPON HIS/HER INDIVIDUAL AGE)
BENEFITS
Funding Type
Voluntary
<29
$0.058
60 ‐ 64
$1.141
$10,000 Increments
Plan
30 ‐ 34
$0.067
65 ‐ 69
$3.508
Max Benefit
$500,000
35 ‐ 39
$0.100
70 & Over
$5.626
Under 70: $150,000 Over 70: $10,000
Included with Voluntary Life election
Guarantee Issue
40 ‐ 44
$0.146
AD&D
Spouse Max
$100,000
45 ‐ 49
$0.226
Child(ren)
$1.60/family
Under 70: $30,000 Over 70: $10,000
Spouse Guarantee Issue
50-54
$0.402
To calculate your monthly cost to the right, please use the following formula:
Benefit Amount ÷ $1,000 = ___ x Rate = Monthly Cost
Dependent Child Amount
$10,000
55-59
$0.664
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Voluntary Critical Illness
Voluntary Critical Illness through Principal Financial helps safeguard your financial security by paying you a tax-free, lump-sum benefit if you are diagnosed with a covered condition, regardless of any other coverage you may already have or your actual expenses. Covered conditions include: Cancer, Heart Attack, Stroke, and Major Organ Failure. A pre-existing condition clause of 6 month prior/12 months insured applies. A summary of the benefits offered is listed below. Refer to the plan certificate for detailed Voluntary Critical Illness coverage information or visit www.principal.com .
MINIMUM BENEFIT
GUARANTEED ISSUE
MAXIMUM BENEFIT
For You
$5,000
$15,000
$100,000
For Your Spouse
$2,500
$7,500
$50,000*
For Your Children
$2,500
$2,500
$2,500
*Spouse benefit cannot exceed 50% of employee’s benefit up to $50,000
Monthly Step Rates per $1,000 of Benefit (spouse rate is based upon his/her individual age) Age Employee Spouse <24 $0.48 $0.48 25-29 $0.559 $0.559 30-34 $0.66 $0.66 35-39 $0.819 $0.819 40-44 $1.108 $1.108 45-49 $1.701 $1.701 50-54 $2.483 $2.483
55-59
$3.510
$3.510
60-64
$5.370
$5.370
65-69
$7.103
$7.103
70 & Over
$9.590
$9.590
Child(ren) monthly rate
$0.75 for $2,500 of coverage/family
To calculate your monthly cost to the right, please use the following formula: Benefit Amount x ___ Rate = Cost
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Voluntary Accident
Voluntary Accident coverage pays benefits when you or your covered family member(s) is injured, outside of work, because of an accident, like falling down the stairs or off a ladder, getting hurt playing sports. A list of covered injuries is listed below. There is no overall annual or lifetime limit. Refer to the plan certificate for detailed Voluntary Accident coverage information or visit www.principal.com .
INJURY
BENEFIT
Burns
Up to $5,000
Comas
$15,000
Concussions
$500
Dental or eye injuries
$500
Dislocations
Up to $7,500
Fractures
Up to $10,000
Injuries not specifically listed
$100
Internal injuries
$1,500
Knee cartilage / ruptured disc / tendon / ligament/ rotator cuff injuries with surgical repair
$1,500
COVERAGE LEVEL
MONTHLY PREMIUM
Employee Only
$9.07
Employee & Spouse
$15.37
Employee & Child(ren)
$16.20
Family
$25.93
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Flexible Spending Account
CENTURY 21 Affiliated offers two Flexible Spending account options – healthcare FSA and dependent care FSA through Employee Benefits Corporation (EBC). Employees can enroll in one, both or neither. The Healthcare FSA is a special account you can use to pay for certain out of pocket healthcare expenses such as office visit co-pays, contacts or glasses, and so much more! This is a pre-tax benefit which means you’ll save on the amount equal to the taxes you would have paid on the money you set aside. The Dependent Care FSA is a pre-taxed benefit account used to pay for eligible dependent care services, such as pre-school, summer day camp, before and after school programs, and child or adult daycare. It’s a smart way to save money while taking care the ones you love! To learn more about the Healthcare and Dependent Care FSA and eligible expenses, visit https://www.ebcflex.com/eligibleexpenses/.
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Employee Assistance Program
CENTURY 21 Affiliated has teamed up with TELUS Health (formerly known as LifeWorks) to offer an Employee Assistance Program (EAP). The EAP is 100% confidential and available for use by any CENTURY 21 Affiliated employee, full or part-time, and dependents (including domestic partners). Any employee going through a difficult time or in need of resources can reach out to LifeWorks 24/7 hotline or login to their platform. Some of the services offered through the EAP include: o Online resources for your mental, physical, social and financial well being o Expert guidance from professional advisors on work-related or personal issues o Counseling
o Legal or financial guidance o Exclusive offers and savings o and More…
The Employee Assistance Program is a 100% employer paid benefit.
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How to Enroll or Waive
For a streamlined and paperless process, CENTURY 21 Affiliated and its sub-entities utilize Paycom for employees to enroll, waive, and manage insurance coverages. Paycom will automatically generate an email notification to new hires or newly eligible employees prompting them to login to make their benefit elections. Employees who are eligible for insurance will need to enroll or waive coverages within their first thirty (30) days of hire/eligibility. Any enrollments will go into effect the first of the month following their date of hire/eligibility. Employees who start on the 1 st of the month would be eligible to begin coverage that day (some exceptions per carrier policies may apply). Any elections made would be payroll deducted. Group insurance is an employee benefit which an employee is not required to enroll and no wage increases will be given for the waiver of coverage.
Questions?
If you have specific questions on coverages involving your personal health situation, we recommend calling the carrier directly and speaking to a representative. Their phone number can be found at any of the websites provided in their section of this Benefit Summary. Any additional questions, please contact CENTURY 21 Affiliated Human Resources department at (608) 221-2121 or email HR@c21affiliated.com.
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