Your Total Compensation Statement Setting Us Apart From The Competition
Contact Information: Benefit Plan Enrollment: www. Smartben.com Employee Self-Service: https://portal.adp.com/public/index.htm Hub\Human Resources Hub\Wellness Health Insurance: Community Blue PPO, Traditional, DenteMax and VSP Email: EmployeeInquiry@bcbsm.com Note: Be sure to include your contract number (off of your insurance card) as well as your group number in all communications. BCN Ombudsman s Office: 1-888-265-4703 Web sites: www.bcbsm.com www.dentemax.com www.vsp.com Address Mail Code X-310 600 Lafayette East Dept. 1703 Detroit, MI 48226 Accident Fund Group #: 38110 Prescription Refill Center: 1-800-651-0155 Medco Member Services: 1-800-903-8346 Dental Services: 1-877-258-0167 Other Helpful Numbers: BCBSM Mail Code: B-183 Emergency/Weather hotline: 1-888-WORK4AF RITE Call: 1-800-852-8757 ADP Cobra Services: 1-800-526-2720 BCBSM Retirement Administration: retirementadministration@bcbsm.com or 1-800- 922-0699 or (313) 225-9609 Employee Assistance Program: EAP Consultants - 1-800-869-0276 or www.eapconsultants.com Fidelity Investments: 1-800-378-4015 or www.401k.com Flexible Spending Accounts: 1-800-654-6695 or www.flexdirect.adp.com Group Universal Life Insurance Company: Marsh@WorkSolutions - 1-800-621-2358 Group Life Insurance Company: Reliastar - 1-800-955-7736 IncentaHealth: http://accidentfund.incentahealth.com Long-Term Disability: 1-800-707-2288 Service Awards: OC Tanner 1-800-453-7490 or http://www.eawardcenter.com/rb/0000101591/8 Short-Term Disability/Integrated Disability Management: Lana McDowell, R.N. (517) 367-6370 or lanam@accidentfund.com
your total compensation statement 2010 Category Your Total Compensation January 2009 December 2009 Accident Fund Contribution Your Contribution Direct Pay Regular Pay $35,029.71 $0.00 Annual/School Leave $3,279.30 $0.00 Sick Leave $1,413.03 $0.00 Personal Leave $308.64 $0.00 Holiday Leave $1,697.52 $0.00 Overtime $29.16 $0.00 Incentive Pay $773.98 $0.00 Other Pay 1 $3,000.00 $0.00 Total Direct Pay $45,531.34 $0.00 Required Benefits Social Security Taxes $2,871.67 $2,871.67 Medicare $671.60 $671.60 Unemployment $344.00 $0.00 Workers Compensation $136.42 $0.00 Health Benefits Medical and Prescription $13,088.64 $0.00 Dental $1,407.24 $0.00 Vision $261.84 $0.00 Employee Assistance Program $26.04 $0.00 Life and Disability Benefits Basic Life and AD&D $278.40 $0.00 Long-Term Disability $228.43 $100.36 Retirement Benefits 401(k) Plan $517.78 $1,035.52 Pension Plan 2 $3,517.38 $0.00 Health Promotion Benefits Fund Advantage $750.00 $0.00 Health Promotion/Wellness 3 $115.00 $0.00 Additional Benefits Parking $1,344.00 $0.00 Your Total Compensation $71,089.78 $4,679.15 Note: The information above is based on data as of 12/31/2009 and may not reflect mid-year changes to plan type or contributions. 1 Other Pay includes one or more of the following pay categories: Bereavement, Birthday, Court, Jury, Mileage, Military, On Call, Relocation, SRA, STD, and Vehicle Stipend. 2 The pension plan amount represents the average employer cost of pension benefits for 2009 applied to your base pay. 3 The Wellness program amount Includes average cost per employee for all e-balance programming and incentives. A Picture is Worth a Thousand Words This chart illustrates your total compensation package 2010 Benefit Plans The following information reflects your 2010 benefit elections including highlights of the plans in which you are enrolled. For more information about a specific benefit plan, please refer to the benefit descriptions on the Human Resources website. Questions about your individual coverage may be directed to Human Resources or the appropriate insurance carrier. All contact information is listed on the inside front cover of this statement. Health Care Plans Medical and Prescription Insurance Accident Fund offers a choice of three medical plans: Community Blue PPO, Blue Care Network HMO and Healthy Blue Living HMO. Our records show you have EE + Family coverage in the following medical plan. Community Blue PPO Your In-Network Cost Deductible $250 per member, $500 per family Preventive Care Services Covered at 100% - one per calendar year Office Visits & Urgent Care $10 copay Emergency Room $50 copay for facility; 100% for ER professional fees Inpatient Hospital Care Covered at 100% after deductible Prescription Retail (30 days) Copay: $7 generic, $15 formulary, $30 non-formulary Prescription Mail Order (90 days) Copay: $14 generic, $30 formulary, $60 non-formulary Dental Insurance Accident Fund offers a choice of two Dental plans: Exclusive Dental Plan and Traditional Plus Plan. Our records show you have EE + Family coverage in the following dental plan. Traditional Plus Plan Your Cost Preventive Services Covered at 100% Diagnostic Services Covered at 100% Restorative Services & Adjunctive Procedures Covered at 75% Oral Surgery, Periodontics & Endodontics Covered at 75% Prosthondontics Covered at 50% Orthodontic Services Covered at 50%; lifetime max of $2,400 Annual Maximum (calendar year) $2,300 per member Vision Insurance Accident Fund offers the Blue Vision (VSP) and the Blue Traditional vision plans. Our records show you have EE + Family coverage in the following vision plan. VSP Vision In-Network Out-of-Network Provider Eye Exam $5 copay Reimbursed up to $35 less $5 copay Eyeglasses $7.50 copay, maximum $150 $7.50 copay, up to predetermined amt Contact Lenses (medically necessary) $7.50 copay Reimbursed up to $210 after $7.50 copay Flexible Spending Accounts (FSAs) Employees may pay for health and/or dependent care expenses with pre-tax dollars, which will be payroll deducted for your convenience. The annual maximum for each account is $5,000. Health Care Flex Spending Account You have not elected to contribute to the Health Care Flex Spending Account. Dependent Day Care Flex Spending Account You have elected to contribute $2,500 annually to the Dependent Care Flex Spending Account. Life and Disability Benefits Life and AD&D Insurance Accident Fund provides basic life insurance equal to two times your annual base salary and also occupational accidental death and dismemberment (AD&D) insurance. Accident Fund pays 100% of the cost of this benefit. Our records show you have $80,000.00 of basic life and $100,000.00 AD&D coverage. Group Travel Accident Plan Group Travel Accident insurance is provided by Blue Cross Blue Shield of Michigan. This plan provides coverage for you in the event you die or lose a hand, foot and/or eyesight as a result of an accident while traveling on company business as an employee of Accident Fund. Short-Term Disability (STD) Short-term disability works in conjunction with Accident Fund's leave programs. After fifteen consecutive days of a qualifying disability, short-term disability benefits take effect, paying 66 2/3% of base salary for up to 90 days. Long-Term Disability (LTD) Accident Fund offers a company-paid LTD plan that provides a benefit equal to 66 2/3% of your gross income after 90 days of disability. All insurance premiums, including medical and dental, will also continue to be paid for the first three months on LTD. 6% 8% 23% 63% Premium Only Plan (POP) POP allows employees to deduct medical insurance premiums for their paycheck pretax. Cost savings are achieved because Social Security and federal and state income taxes are not applied to the premium deductions. DIRECT PAY RETIREMENT & OTHER HEALTH, LIFE & DISABILITY REQUIRED
your total compensation statement 2010 Retirement Benefits Long-term planning is a critical part of your financial security. Accident Fund offers two retirement plans (in addition to Social Security benefits) to help you achieve financial security in your retirement years. 401(k) Savings Plan Employees are eligible to participate in the company s 401(k) plan through Fidelity Investments after completing three months of service. Contributions are allowed between 1% and 96.5% (in half percent increments) of your bi-weekly base compensation on a pre-tax basis. Employees who are 50 years of age or older are also eligible to make catchup contributions. After one year of service, Accident Fund will make contributions equal to 50% of the amount contributed, up to 10% of your base bi-weekly compensation. The maximum the company matches is 5%. All contributions are subject to IRS limits. In 2010 the maximum electives deferred is $16,500 and the maximum catchup contribution for those age 50 and older is $5,500. Your employee contribution as of January 1, 2010, is 6.0%. Pension - Retirement Income Plan Accident Fund provides a fully company paid retirement account plan. All represented employees over 21 years of age, hired prior to January 1, 2010, with one year of service begin earning service credits as of their hire date. Vesting ocurs after five years of credited service or at age 65 regardless of number of years of service. In 2010, the multiplier for the minimum benefit factor is $38 per month. To learn more about your individual benefits under this plan, go to https://bcbsmi.pensionpath.com. Social Security Both you and Accident Fund contribute a percentage of your earnings to Social Security. For more information call 1.800.772.1213 or visit www.ssa.gov. Paid Time Off Annual Leave Annual leave is be used to cover absences for vacation and necessary personal business. The number of annual leave hours you accrue per 80 hours of paid service depends on your total service credit. Annual leave accumulation is capped based on years of service. Sick Leave Sick leave may be used to cover medical appointments, illness, injury or disability. You earn four hours of sick leave each bi-weekly pay period in which eighty hours of service is completed. Holiday Leave You receive 11 holidays each year: New Year s Day, Martin Luther King Day, Good Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day after Thanksgiving, Christmas Eve, Christmas and a Christmas Floating Day. Additionally, in years when Independence Day falls on a Tuesday or Thursday, the Monday before or the Friday after the holiday is also granted as a paid holiday. Birthday Holiday Employees with 15 or more years of service are eligible to receive their birthday off with pay. Additional Leave Employees are also entitled to paid time off for Bereavement Leave, Jury Duty, and Military Leave. Health Promotion Benefits ebalance Our enterprise wide ebalance program provides comprehensive wellness and health promotion programs that address all areas of health. Employee Assistance Program (EAP) Accident Fund s EAP provider is EAP Consultants. They offer assessment, shortterm counseling, and referral services for a wide range of personal problems, as well as a variety of work/life issues. This benefit is 100% paid by Accident Fund. Fund Advantage This cafeteria-style, miscellaneous benefit plan reimburses employees for eligible expenses. Fund Advantage offers employees up to $500 annually after one year of service, $750 after ten years of service, or $1,000 after 20 years of service are completed. Reimbursements are issued with payroll checks and are taxable income. Eligible expenses include: Fitness membership & equipment Computer Packages Weight loss programs Dependent Care Supplemental Health Insurance Additional Employee Tuition Supplemental Life Insurance Dependent Tuition Additional Benefits L-HOPE L-HOPE is designed to encourage Lansing area employees to buy a home in the community where they work. This program annually provides up to five eligible employees with a loan to be used for costs associated with purchasing either a home or rental property in Lansing. L-HOPE loans are offered on a first-come first-served basis to employees who do not currently own a home in the Lansing city limits. Paid Parking Employees who work in the Lansing offices receive 100% company paid parking. RITE Call High standards are more than a slogan or catch phrase, they are a way of doing business. Maintaining high standards of Respect, Integrity, Truth and Ethics are key components when building a reputation for trust and excellence. Accident Fund s RITE Call program offers a hotline at 1-877-852-8757, which is available 24 hours a day / 7 days a week when all other internal avenues have been explored. Tuition Assistance Accident Fund offers a generous tuition assistance program as a benefit to help our employees attain their educational goals. This benefit covers 100% of all qualifying tuition, tests, fees, books and other required expenses up to an annual tuition limit. For an undergraduate degree, the limit is $5,000 annually. For employees pursuing a graduate level degree, the limit is $5,500 annually (up to $5,250 is available tax-free). Harry Hardworker - 100-630 Presenting Your 2009 Total Compensation Statement To: Harry Hardworker We are pleased to present you with your personal 2009 Total Compensation Statement. It is designed to help you understand the full value of your annual compensation and benefits. Pay is an important part of our compensation strategy, but it is only one part. Your total compensation package includes your base salary, annual incentive award, health and welfare benefits, retirement benefits, health promotion/wellness benefits and other benefits. As you review the value of your 2009 total compensation package, you will also find information about the 2010 benefit plans in which you participate, as well as optional coverage that is available to you. Please review your Total Compensation statement carefully and keep it for reference, just as you keep your other important documents. If you should have any questions about your statement, please call your Human Resources office. We appreciate all you do to contribute to the success of the company. Thank you for helping to make Accident Fund and United Heartland great places to work! Sincerely, Darcy Kerr, Vice President, Human Resources
Other Benefits: AFLAC (Accident Fund Only) Alternative Work Schedules Community Involvement Life Secure Long Term Care Insurance (Accident Fund Only) Service Recognition Supplemental Life Insurance Training Programs Voluntary AD&D Insurance Wellness: As an enterprise we understand that our employees are our greatest asset, and that their health is important. To ensure our employees have the opportunity to be healthy our internal health promotion program, ebalance, takes a comprehensive approach to address health and well being. The ultimate goal is an improved quality of life for employees. ebalance is committed to establishing an environment that supports a healthy lifestyle. We provide programs that address total health. An example of the offerings provided: incentahealth (exercise, nutrition, motivation/support) Onsite education and exercise classes Financial assistance for health related products Employee Assistance Program To take advantage of the many health promotion benefits you will want to enroll in the incentahealth program, as this is the portal for all ebalance programs. About this statement This statement is based on information made available from Accident Fund/United Heartland s records, summary plan descriptions, policy manuals, and other sources of data. All information is as of December 31, 2009 unless otherwise noted. All insurance rates and elections are as of January 1, 2010. The preparation and distribution of this statement is not deemed a guarantee of continued employment for any period. While every effort has been made to report information accurately, all details furnished, including eligibility for benefits, must be governed by the provisions of the plan documents. Please bring any errors to the attention of the Human Resources department. The benefits descriptions in this statement are provided for information purposes only. Nothing in this statement should be read or interpreted to guarantee you any benefits for a specific period of time. Accident Fund/United Heartland reserves the right to change or eliminate any of these benefits in its sole discretion to the extent allowed by applicable law.
Prepared Exclusively For Harry Hardworker 123 This Street Thattown, US 99999