2024.25 Company Benefits Summary_Dean HMO

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

1

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.

2

Medical

CENTURY 21 Affiliated provides group health insurance through Dean Health Plan with three (3) HMO options. Under the HMO plan, you must see a provider within network for coverage.

For more information on the health insurance and to find in-network providers, visit www.deancare.com .

OPTION

HMO OPTION 1

HMO OPTION 2

HMO OPTION 3

Network Name

Dean $5000 HMO

Dean $1000 HMO

Dean $500 HMO

Group Number

17FGHEG

17FGHEG

17FGHEG

Benefits

In-Network

Non-Network

In-Network

Non-Network

In-Network

Non-Network

Deductible Ind/Family

$5,000 / $10,000

N/A

$1,000 / $3,000

N/A

$500 / $1,000

N/A

$10 / $50 / $80 / 25% coinsurance

$10 / $50 / $80 / 25% coinsurance

$10 / $15 / $60 / $100

RX Benefit

Not Covered

Not Covered

Not Covered

PCP Office Visits

$20 Copayment

Not Covered

$20 Copayment

Not Covered

$25 Copayment

Not Covered

Specialty Office Visits

$60 Copayment

Not Covered

$60 Copayment

Not Covered

$50 Copayment

Not Covered

Chiropractic Services

$20 Copayment

Not Covered

$20 Copayment

Not Covered

$20 Copayment

Not Covered

Preventive Exams

$0 Copayment

Not covered

$0 Copayment

Not Covered

$0 Copayment

Not Covered

$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

Hospital Services

20% coinsurance after deductible

20% coinsurance after deductible

20% coinsurance after deductible

Out-of-Pocket Maximum

$7,350 / $14,700

N/A

$4,000 / $12,000

N/A

$1,000 / $2,000

N/A

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

3

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

4

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) $14.46

Progressive

Pay $65 plus $10 copay

Up to $40

Family $21.54

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

5

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

6

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

60 ‐ 64

Funding Type

Voluntary

<29

$0.058

$1.141

$10,000 Increments

30 ‐ 34

65 ‐ 69

Plan

$0.067

$3.508

35 ‐ 39

Max Benefit

$500,000

$0.100

70 & Over

$5.626

Under 70: $150,000 Over 70: $10,000

Included with Voluntary Life election

40 ‐ 44

Guarantee Issue

$0.146

AD&D

45 ‐ 49

Spouse Max

$100,000

$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

7

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

8

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

9

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/.

10

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.

11

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.

12

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