2015 benefits enrollment booklet for new hires and newly eligible team members

Transcription

1 Important benefits information 2015 benefits enrollment booklet for new hires and newly eligible team members Action required: Enroll before your enrollment period deadline

2 Welcome to Wells Fargo Congratulations on your new position. We value and support our people as a competitive advantage. We strive to attract, develop, retain and motivate the most talented people we can find. These people become our team members and are a treasured resource in whom we invest. As part of that investment, Wells Fargo is proud to offer you a competitive benefits package with a comprehensive selection of benefits. Our aim is to support you so you can learn about your plans, gain confidence when making benefits choices, plan for your future, and reach your personal health, well-being, and retirement goals. Using the booklet Some benefits are provided at no additional cost to you and you are automatically enrolled when you become eligible for benefits. These benefits are noted in this booklet by this symbol: PAID FOR You and Wells Fargo share the cost for most benefits. There are optional benefits in which you pay the total cost if you elect them, designated by this symbol: YOUR CHOICE Use the Enrollment Worksheet on page 8 to keep track of the coverage you re interested in for you and your eligible dependents. Keep in mind that this booklet is intended to provide only an overview and does not contain all the provisions of the Wells Fargo-sponsored benefits plans. It is very important that you refer to the Benefits Book, available on Teamworks, which contains the provisions of the Wells Fargo-sponsored benefit plans.

3 Inside the booklet Don t miss your benefits enrollment period...4 How to enroll...5 Enrollment worksheet optional...8 Medical coverage...10 Account-based medical plans overview The HRA-Based Medical Plan...12 The HSA-based medical plans...14 Health and wellness dollars...17 Prescription drug coverage under the account-based plans...18 Comparing the account-based medical plans...20 How does your account get funded?...23 The Kaiser HMO and HDHP Kaiser medical plan Health and well-being Your medical plan resources Flexible spending accounts...30 Dental and vision coverage...31 Financial protection: Long-Term Care Plan Financial protection: Disability coverage...35 Financial protection: Life insurance coverage...37 Financial protection: Business Travel Accident and Accidental Death and Dismemberment Naming a beneficiary...40 Financial protection: Legal Services Plan...41 Other benefits: Commuter Benefit Program Claims administrators contact info Tools and resources...45 Important information and disclosures

4 Don t miss your benefits enrollment period If you want to elect certain benefits, you must enroll during your designated enrollment period: If you are hired, rehired, or become newly eligible from You must enroll by Your benefits take effect on January 2 to February 1 February 14 March 1 February 2 to March 1 March 14 April 1 March 2 to April 1 April 14 May 1 April 2 to May 1 May 14 June 1 May 2 to June 1 June 14 July 1 June 2 to July 1 July 14 August 1 July 2 to August 1 August 14 September 1 August 2 to September 1 September 14 October 1 September 2 to October 1 October 14 November 1 October 2 to November 1 November 14 December 1 November 2 to December 1 December 14 January 1 December 2 to January 1 January 14 February 1 Note: Your designated enrollment period ends at 11:59 p.m. Central Time on the last day of the enrollment period. Please note that online enrollment is unavailable on certain nights after 8:45 p.m. Central Time. Why is electing your benefits during your enrollment period so important? Some benefits, such as medical, dental, vision, Accidental Death and Dismemberment, legal services, and flexible spending accounts, may be elected only during your designated enrollment period. If you do not enroll during your designated enrollment period, you must generally wait until the next Annual Benefits Enrollment period to enroll yourself and your eligible dependents, unless you experience a Qualified Event. Other benefits, such as life insurance, optional longterm disability, and long-term care, may be elected without proof of good health only during this first designated enrollment period. Changes to your life insurance coverage, optional long-term disability or long-term care after your initial designated enrollment period (or Qualified Event for life insurance) must be approved under the applicable proof of good health or evidence of insurability process. For additional details, see the section titled Making Changes after Your Designated Enrollment Period on page 7, and the Benefits Book. 4

5 How to enroll Online To enroll, go to the Your Benefits tool on Teamworks or Teamworks at Home (teamworks.wellsfargo.com). Sign on to the Your Benefits tool using your Wells Fargo username and password. Click the help links if you have ID or password questions. For more detailed help with the steps listed below, click the Help Center button in the Your Benefits tool at any time. Use the Enrollment Worksheet, beginning on page 8, to choose and keep track of your benefit elections, Enroll early for the best possible response time in the online Your Benefits tool. Delays or disruptions might occur during evening hours, when payroll functions are running. Go to teamworks.wellsfargo.com. From work From home Click Pay & Benefits, then Benefits Tools, then Your Benefits. Click Your Benefits. 1. On the Your Benefits tool home page, click Benefits Enrollment. This link is active during your enrollment and change periods only. 2. Click Review Personal Information. Check your address and other information and update it, if necessary. (You must do this only the first time you view this site during a new enrollment period.) 3. After reviewing your personal information, you must agree to the terms of the benefits enrollment before you can proceed. 4. When finished, click Return to Benefits Enrollment at the bottom of the page. Choose and save your plan elections 5. In the Enrollment Events table, click Select. The Enrollment Summary page lists each benefit and shows your current and new selections. To make changes to a benefits selection or to see all of that benefit plan s choices and costs, click Choose. 6. On the enrollment page for each benefit, click one choice to elect a plan or waive coverage. Add dependent information if necessary (see If You Have Eligible Dependents on page 6). Note: You can change elections at any time until your designated enrollment period ends. Any elections you save will display when you return, so you can verify or make more changes. 7. To save your election, click Next, review the Confirmation page, and click Save. You ll return to the Enrollment Summary page. Repeat steps 5 to 7 until you have selected all the plans in which you want to enroll. If you need to end your session before completing all your benefits elections, complete step 7 and return later to finish enrolling. 8. When you ve completed your benefits elections, click Finish. The last page provides timing information for the enrollment and change periods and a link to your Benefits Confirmation Statement, which you should review for accuracy. To exit the Your Benefits tool, click Sign Off at the top of the page. By phone If you do not have online access from a computer or have trouble signing on, call the HR Service Center at HRWELLS ( ), option 2, Monday through Friday, from 8:00 a.m. to 5:00 p.m. in your time zone. The HR Service Center accepts relay service calls. TDD/TTY users may call Confirm or correct your benefits elections After you make your benefits elections, you will receive an containing a link to access your Benefits Confirmation Statement to review and print a copy for your records. This statement is also available from the Your Benefits tool. Review your Benefits Confirmation Statement carefully. If you need to make changes to your benefits elections, follow the instructions on the statement. If you make corrections during your change period, your benefits administrators might not have a record of the changes by the date on which your benefits become effective; your updated ID cards could be delayed as a result. Note: If you receive your Benefits Confirmation Statement by (or similar electronic delivery), you may request to have a paper copy sent to you at no cost either by sending an to hrsddistributionfulfillment@wellsfargo.com or by calling the HR Service Center at HRWELLS ( ), option 2. The HR Service Center accepts relay service calls. TDD/TTY users may call

6 This paper copy will be the same version that you can print from the Your Benefits tool. If you don t have a valid Wells Fargo address, you will receive a paper Benefits Confirmation Statement through the U.S. mail. If you don t have at-home or at-work access to the Your Benefits tool, call the HR Service Center with your changes or corrections. If you have eligible dependents You are eligible for benefits described in this booklet if you are classified as either a regular team member who is scheduled with standard hours of 30 or more hours per week or a part-time team member who is scheduled with standard hours of between 17.5 and 29 hours per week. In general, your eligible dependents include: Your spouse or domestic partner. Your or your spouse or domestic partner s naturalborn or legally adopted child until his or her 26th birthday. A child for whom you, your spouse, or your domestic partner is the agency- or court-appointed legal guardian or foster parent. See the Benefits Book on Teamworks and Teamworks at Home (teamworks.wellsfargo.com) for complete dependent eligibility requirements. Note: Enrolling a dependent who does not meet Wells Fargo s eligibility criteria is a violation of the Code of Ethics and may result in disciplinary action, including termination of your employment with Wells Fargo. Wells Fargo reserves the right to conduct audits and reviews of all dependent eligibility. To add eligible dependents 1. Click Add Dependent Details on the enrollment page for any benefit that allows dependent enrollment. Note that you must enroll in the plan yourself first. 2 On the Dependent/Beneficiary Personal Information page, enter the required information. 3. Review the information carefully you won t be able to update it online later (except for a spouse or domestic partner s smoker status). Click Save. 4. The new dependent will be shown on the enrollment page for any benefit that allows dependent enrollment. Repeat steps 1 to 3 to list more dependents. 5. Any dependents you listed will now appear with checkboxes that allow you to add them to your benefits coverage. 6. Check the Enroll checkboxes next to the names of the dependents you want to enroll. 7. Click Next. Follow the certification instructions. To certify newly enrolled eligible dependents If you enroll an eligible dependent in coverage, you re required to complete a brief certification of benefits eligibility. Certification is triggered for these dependents after you select the Enroll checkbox and click Next on the benefits enrollment page. 1. Read the overview page and click Continue. 2. The certification page includes the eligible dependent s name and the benefits eligibility requirements specific to the eligible dependent s relationship to you. Read it and enter any required information. If your dependent qualifies, click I Certify. For any who don t qualify, click I Do Not Certify. You will not be able to enroll an uncertified dependent. If you have several eligible dependents to certify, you ll see a page for each one. When certifying an eligible dependent child of a domestic partner, you may need to certify the domestic partner first, even if you aren t enrolling the domestic partner in benefits coverage. 3. When you finish certifying, you ll see the enrollment confirmation page. Review it and click Save. You ll return to the Enrollment Summary page. After you certify an eligible dependent in one plan, you may enroll him or her in any additional benefits plans without repeating the certification steps. Certification is not the same as enrollment you will still need to select the enrollment checkboxes for your eligible dependents on every plan in which you want them enrolled. 6

7 Making changes after your designated enrollment period If you experience a Qualified Event such as a change of marital or employment status or the birth or adoption of a child you may be able to change certain benefits elections by calling the HR Service Center within 60 days of the Qualified Event to update your coverage. See the Benefits Book for more information about Qualified Events. If you don t contact the HR Service Center within 60 days of your Qualified Event, you ll have to wait until the next Annual Benefits Enrollment period to change your benefits elections. 7

8 Enrollment worksheet optional About this page: You will be able to select from the benefits below during your designated benefits enrollment period. As you read through this booklet, you can use this worksheet to record your choices. This is not an enrollment form you won t need to send or fax it anywhere but it may help you be prepared for the decisions you ll need to make when you enroll online. My choices are: From the Your Benefits tool, my per-pay-period costs are: Medical Enroll in plan name: $ Waive Enroll eligible dependents (see list on next page): Dental Enroll in Delta Dental Standard $ Waive Enroll in Delta Dental Enhanced Enroll eligible dependents (see list on next page): Vision Enroll in Vision Plan $ Waive Enroll eligible dependents (see list on next page): Limited Dental/Vision Flexible Spending Account (FSA) Contribute $ annually, divided by the number of pay checks remaining in the year $ Note: Consider this FSA if you are enrolling in the HSA- Based Medical Plan Gold, the HSA-Based Medical Plan Silver, or the HDHP Kaiser medical plan. Waive Full-Purpose Health Care FSA Contribute $ annually, divided by the number of pay checks remaining in the year $ Note: If you enroll in the HSA- Based Medical Plan Gold, the HSA-Based Medical Plan Silver, or the HDHP Kaiser medical plan, you cannot enroll in this FSA. Consider enrolling in the Limited Dental/Vision FSA instead. Waive Day Care FSA Waive Contribute $ annually, divided by the number of pay checks remaining in the year $ Optional Term Life Waive Enroll in coverage of (1 to 8) times covered pay (coverage greater than 4 times your covered pay requires proof of good health).* $ 8

9 My choices are: From the Your Benefits tool, my per-pay-period costs are: Spouse/Partner Optional Term Life Waive Enroll spouse or domestic partner in coverage of $ (multiples of $25,000; coverage over $25,000 requires proof of good health).* $ Dependent Term Life Enroll in coverage $ Waive Accidental Death and Dismemberment Plan Waive Enroll in coverage of $75,000: Me only $150,000: Me only $ $300,000: Me only $600,000: Me only $75,000: Me + family $150,000: Me + family $300,000: Me + family $600,000: Me + family Long-Term Care Plan Enroll in coverage of $ Waive $100 per day $150 per day $210 per day $250 per day Optional Long-Term Disability (LTD) Plan Enroll in coverage $ Waive Legal Services Plan Enroll in coverage of $ Waive Me only Me + family *For more information on the proof of good health form for each type of coverage, see that plan s chapter in the Benefits Book on Teamworks. The eligible dependents I want to enroll are: Name Birthdate Relationship Social Security Number* *You will be asked to enter the Social Security Number for any dependents when you enroll them on Your Benefits. However, for security purposes, do not write down Social Security numbers where others may have access to them. 9

10 Medical coverage YOUR CHOICE All our medical plans offer: Eligible preventive care services covered at 100% when you use in-network providers. Comprehensive medical coverage that includes routine care, emergency care, and mental health and substance abuse services. Comprehensive prescription drug benefits. Annual limits on what you might pay to provide financial protection. A large network of doctors, hospitals, and other providers that offer services at negotiated rates. Personalized one-on-one programs to help you and your covered dependents improve or maintain your health and well-being. Wells Fargo gives you a choice of three medical plans that come with accounts the Health Reimbursement Account (HRA)-Based Medical Plan and two health savings account (HSA)-based medical plans: the HSA-Based Medical Plan Gold and the HSA-Based Medical Plan Silver. Another account-based plan, the High-Deductible Health Plan (HDHP) Kaiser medical plan, is also available in select locations. If you live in Any state except Hawaii Kaiser available in the following service areas within California, Colorado (Denver and Colorado Springs areas), Oregon (Portland and Salem areas), or Washington (Vancouver, Longview, and Kelso areas) Hawaii These plans are available to you HRA-Based Medical Plan HSA-Based Medical Plan Gold HSA-Based Medical Plan Silver HDHP Kaiser medical plan Kaiser HMO medical plan POS Kaiser Added Choice Each medical plan s claims, networks, and provider fees are handled by a claims administrator. For contact information for the administrators, see page 43. Medical Plan Claims administrator State or territory HRA-Based Medical Plan HSA-Based Medical Plan Indemnity Medical Plan Anthem BCBS UnitedHealthcare Anthem BCBS HealthPartners Anthem BCBS Alabama, Arizona, Arkansas, Colorado, District of Columbia, Florida, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Utah, Wisconsin, Wyoming Alaska, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Kansas, Kentucky, Michigan, Montana, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia Minnesota Puerto Rico, Guam, and the Northern Mariana Islands (Saipan). Not available in the 50 United States or in the District of Columbia CVS/caremark is the prescription drug administrator for all the medical plans listed above Kaiser medical plans* POS Kaiser Added Choice Hawaii* Kaiser Permanente Kaiser Permanente Residents of Kaiser service areas within California, Colorado (Denver and Colorado Springs areas), Oregon (Portland and Salem areas), and Washington (Vancouver, Longview, and Kelso areas) Hawaii 10 * The Kaiser HMO, HDHP Kaiser medical plan, and the POS Kaiser Added Choice are fully insured medical plans under the Wells Fargo & Company Health Plan. The benefits described in this booklet do not apply. The descriptions of plan benefits for the various Kaiser medical plans are provided in separate documentation that will be sent to you by Kaiser if you enroll in the applicable plan. The information that comprises the complete Summary Plan Description for the applicable Kaiser plan is noted in Chapter 1 of the Benefits Book. Note: If you live in Puerto Rico, Guam, or the Northern Mariana Islands (Saipan) or are an expatriate, view the plan options shown on the Your Benefits tool.

11 Account-based medical plans overview Wells Fargo sponsors a choice of three national accountbased health plans in the continental United States: The HRA-Based Medical Plan. The HSA-Based Medical Plan Gold. The HSA-Based Medical Plan Silver. Our medical plans help you manage your health care expenses with comprehensive medical and prescription drug coverage and the advantages of a health reimbursement or health savings account. These account-based medical plans allow you to use a health reimbursement account (HRA) or a health savings account (HSA) to plan and pay for qualified medical expenses. You are responsible for understanding how your plans work, how they pay for services, and how your account supports your benefits throughout the year. Check out the Quick Comparison Chart on page 20 for more information. For additional details about the medical plans, see Chapter 2 of the Benefits Book. Thinking and acting like a health care consumer Understand how your medical plan works: you and your plan share the responsibility of paying for eligible medical services. Wells Fargo pays the majority of your costs for coverage on average, 75% of your medical premiums and you are responsible for the rest. Knowing what your plan covers and your share of the cost can help you make informed decisions throughout the year. Research each plan you re considering to understand all covered services and costs. Use the Medical Plan Comparison Tool and the CVS/ caremark website to help guide your decisions. Take control of your important health care decisions, from choosing a plan to knowing where to go for care when you need it. Save money and time by making sure that all your providers are in your plan s network. Once you ve selected a plan, use your claims administrator s online tools to research the cost of any service you may need. Work closely with your doctor by following care regimens, seeking guidance on maintaining your health, and asking questions. Never avoid getting care when you need it. You can further manage your costs by considering the flexible spending account (FSA) options available to you, depending on the plan in which you enroll. Also, if you complete the health and wellness activities, you and your covered spouse or domestic partner may each be able to earn up to $800 in health and wellness dollars for your HRA or HSA. Eligible preventive care benefits are covered at 100% in network The Wells Fargo-sponsored medical plans cover 100% of the cost of eligible in-network preventive care services, such as the types of services listed in the charts below. To be covered at 100%, your provider must code the eligible service as preventive care. Read more about preventive care coverage in Chapter 2 of the Benefits Book. 11

12 The HRA-Based Medical Plan The HRA-Based Medical Plan is a comprehensive medical plan accompanied by a health reimbursement account. The HRA is designed to help you pay for your medical care, including your deductible and eligible out-of-pocket expenses. Your account is funded in two ways: 1. Wells Fargo-contributed HRA dollars. The amount of HRA dollars that Wells Fargo may contribute to your HRA depends on your HRA-eligible compensation category and the coverage level you elect. These dollars will be available in your account as of the effective date of your HRA-Based Medical Plan coverage. Sign on to the Your Benefits tool on Teamworks to view your HRA compensation category. HRA annualized contribution amount for 2015* Coverage level HRA-eligible compensation category Category 1 Less than $60,000 Category 2 $60,000 less than $100,000 Category 3 $100,000 less than $150,000 Category 4 $150,000 or more You $700 $600 $200 $0 You + spouse** $700 $600 $200 $0 You + children $1,200 $1,000 $400 $0 You + spouse** + children $1,200 $1,000 $400 $0 * HRA contributions are prorated for the months you are enrolled in the plan. **Spouse includes your spouse or domestic partner. Note: HRA allocations are prorated for the months you are enrolled in the plan. Amounts allocated to an HRA, including health and wellness dollars, are not vested and are subject to forfeiture. Wells Fargo & Company reserves the unilateral right to amend or modify the HRA at any time for any reason, with or without notice, including placing limitations or restrictions on amounts allocated to an HRA or terminating the HRA. 2. Health and wellness dollars. You and your spouse or domestic partner each have the opportunity to earn up to $800 in health and wellness dollars by completing the health and wellness activities. See page 17 to learn how to earn health and wellness dollars in Health and wellness dollars are prorated for the months you are enrolled in the plan. Key HRA-based medical plan terms: Annual deductible Coinsurance This is the amount that you must pay toward the eligible expenses for covered health services before the plan begins to pay any portion of the cost of eligible medical expenses you have incurred. Available HRA dollars may help cover the cost of the deductible. If you use up your HRA dollars during the plan year, you then pay your eligible medical expenses yourself, out of pocket, until you reach your annual deductible. If you enroll midyear in the HRA-Based Medical Plan, the annual deductible will be prorated for the months you are enrolled in the plan. This is the percentage of charges that you are required to pay for most eligible medical expenses after your annual deductible is met. After you have met the annual deductible, you pay 20% of the cost of in-network expenses for covered health services and the plan pays 80%. 12

13 Annual out-of-pocket maximum Primary care, mental health, and substance abuse care This is the annual maximum you pay each year for covered health services. When the combined total of your deductible and medical coinsurance payments reaches the annual out-of-pocket maximum, the plan then pays 100% of eligible in-network medical care through the rest of the plan year. Your annual out-of-pocket maximum amount includes costs for eligible medical expenses. If you enroll midyear in the HRA-Based Medical Plan, the annual out-of-pocket maximum will be prorated for the months you are enrolled in the plan. For primary care or mental health care in-network, outpatient office visits, you pay 20% with no deductible, and this amount is deducted from your HRA if available. Additional services incurred during an office visit may be subject to the annual deductible and coinsurance. A primary care provider is a family medicine physician, general practice physician, internal medicine physician, nurse practitioner, obstetrician and gynecologist, pediatrician, or physician assistant. How the HRA-Based Medical Plan pays for in-network claims January Benefit plan year December Plan pays 100% for eligible preventive care Deductible Coinsurance Out-of-pocket maximum Your HRA pays You pay remaining expenses out of pocket HRA pays expenses to help satisfy the annual deductible. If expenses exceed HRA funds, you pay out of pocket, up to the annual deductible. Plan pays 80% (90% for maternity) You pay 20% (10% for maternity) If you reach your annual deductible, you and the plan share responsibility for payment. HRA funds help to pay coinsurance. Your responsibility Plan pays Once reached, plan pays 100% If you reach your out-of-pocket annual maximum, you pay nothing more for the rest of the year. (Note: Out-of-pocket maximums apply separately for medical and prescription drug expenses.) This summary does not cover all account-based plan features, and it does not show compatibility with the flexible spending accounts. Visit the Health & Well- Being website or see the Benefits Book for details. Outof-network services are priced differently and could result in more out-of-pocket costs to you. HRA-Based Medical Plan Out of Area, where applicable: Benefits-eligible team members who live outside the network area can elect HRA-Based Medical Plan Out-of-Area coverage. This coverage allows you to choose any doctor or hospital. For further details, refer to the applicable Summary of Benefits and Coverage and rates provided with your benefits materials and available on Teamworks. Save more with a Flexible Spending Account You can use before-tax dollars in a Full-Purpose Health Care Flexible Spending Account (FSA) to pay for eligible medical, dental, vision, and prescription expenses that are not reimbursed by another source. For more information about FSAs, see page

14 HSA-Based Medical Plans (Gold and Silver) The HSA-Based Medical Plan Gold and the HSA- Based Medical Plan Silver are comprehensive highdeductible health plans that are compatible with health savings accounts and are designed to help you save and pay for your medical care, mental health and substance abuse services, and prescription expenses. You decide when to use your available HSA balance to pay for eligible services: Key HSA-based medical plan terms: Annual deductible Coinsurance Annual out-ofpocket maximum This is the amount you pay each year toward the eligible expenses for covered health services before the plan begins to pay any portion of the cost of eligible medical expenses. You pay 100% of health care costs, including prescription drugs that are not on the preventive therapy drug list, from your HSA or out of pocket, until you meet the annual deductible. The percentage of charges you are required to pay for most eligible medical expenses after your annual deductible is met. The plan pays the rest for covered health services. This is the annual maximum you would ever pay each year for covered health services. If your coinsurance payments reach the annual out-of-pocket maximum, the plan then covers eligible in-network medical care at 100% through the rest of the plan year. Your annual out-of-pocket maximum includes costs for eligible medical, mental health, and prescription drugs. Both the HSA-Based Medical Plan Gold and the HSA- Based Medical Plan Silver: Cover 100% of your eligible in-network preventive care, subject to certain limitations. Cover 80% of costs for prescription drugs on the Preventive Therapy Drug List, purchased at innetwork pharmacies or from the CVS/caremark Mail Service pharmacy; you pay only 20% and have no deductible. The HSA-Based Medical Plan Silver pays 80% (you pay only 20%) of the cost of in-network medical services and prescription drugs after you meet the innetwork deductible. The HSA-Based Medical Plan Gold pays 80% (you pay only 20%) of the cost of in-network medical services and prescription drugs after you meet the innetwork deductible. While still a high-deductible plan, the HSA-Based Medical Plan Gold offers a lower annual deductible and lower annual out-of-pocket maximum than the HSA-Based Medical Plan Silver. 14