Summary of Program
Summary of Benefits and Coverage
Summary Plan Description
Temporary ID Cards
Other Forms
Covered Drug Lists
Program Information
Benefit Fast Facts
Benefit Summary
Compliance
Certificate
Non-Discrimination
User Agreement
Missed Premium Payment Coupon
Benefit Fast Facts
Benefit Summary
Compliance
Certificate
Non-Discrimination
User Agreement
Missed Premium Payment Coupon
Supplemental Life and Accidental Death & Personal Loss
Accident
Hospital Indemnity
Critical Illness
Group Term Life
Supplemental Short-Term Disability
Legal
Compliance Notices
Medicare Part D Notice
Plan Document
Privacy
Summary of Benefits and Coverage
Summary Plan Description
Wrap Summary Plan Document
Claims Procedures
$60/day | 3/year
$60/day | 4/year
$1,000/day | 1/year
$1,000/day | 1/year
$100/day | Up to 90 days
$300/day | Up to 90 days
$50/day | 1/year
$50/day | 1/year
$30/day | Up to 2/year
$40/day | Up to 4/year
$500/day | Up to 2/year
$500/day | Up to 2/year
$25/day | Up to 7/year
$25/day | Up to 12/year
Reliance Standard
Reliance Standard
Do you take prescription medications regularly? With MedImpact Direct, you can have them conveniently delivered right to your door. No more standing in line at the pharmacy.
✓ Medications delivered anywhere in the U.S.
✓ Free standard shipping
✓ Up to a 90-day supply of your medications
✓ Access to expert pharmacist advice
Specialty medications are complex and used to treat chronic conditions such as cancer or
hepatitis C.
✓ MedImpact will call you to get started
✓ Your doctor will fax your medication referral to MedImpact
✓ MedImpact's dispensing pharmacy will call you to start therapy
MedImpact
In-Network Benefits | Aetna Dental HMO | Aetna Dental PPO | |
---|---|---|---|
Network Options | Aetna Dental HMO Network | Aetna DPPO Advantage Network | Non-Network |
Annual Deductible | $0 | $50 / $150 | |
Calendar Year Maximum | N/A | $2,000 | |
Basic Services | Copay | 80% after deductible | Deductible, then 50% of reasonable and customary charges |
Major Services | Copay | 50% after deductible | Deductible, then 50% of reasonable and customary charges |
Orthodontic Services | Copay | 50% no deductible | Deductible, then 50% of reasonable and customary charges |
Orthodontia Lifetime Max | N/A | $2,000 | |
Weekly Premium
Employee-Only Employee + Spouse Employee + Child(ren) Family |
$2.18 $3.73 $4.26 $6.25 |
$5.25 $10.45 $13.54 $18.56 |
Find a Dentist
Summary of Benefits
Compliance
Aetna
In-Network Benefits | VSP Base |
VSP Premier |
---|---|---|
Copay | $10 exam | $10 exam |
Prescription Glasses | $25 | $25 |
Lenses | Included in Prescription Glasses | Included in Prescription Glasses |
Frames | $150 allowance / $80 Costco | $200 allowance / $110 Costco |
Contact Lenses in lieu of glasses |
$150 | $200 |
Weekly Premium
Employee-Only Employee + Spouse Employee + Child(ren) Family |
$0.64 $1.26 $1.35 $2.14 |
$1.56 $3.10 $3.33 $5.29 |
Aetna
HSAs are savings accounts funded by pre-tax contributions from your paycheck. These accounts
earn interest tax free and can be used to help pay for a wide range of medical,
prescription, dental and vision expenses.
The money in this account is yours and rolls over from year to year. You can save it or
use it for qualified expenses now or anytime in the future. It’s also portable, so if you
retire or leave 99 Cents Only Stores, you can take it with you.
The HSA is paired with our Premier Care Lifestyle HSA plan.
✓ Contributions are pre-tax and are automatically deducted
✓ Funds roll over from year-to-year and are yours to keep
✓ Catch-up contributions are for those aged 55 and older
PayFlex
An FSA saves you money by reducing your income taxes. You must choose how much to contribute
each year, up to the stated limit. Your FSA contributions are automatically deducted from
your pay BEFORE any taxes are calculated, and are not reported as income to the IRS.
The FSA
plan is effective January 1 to December 31 (calendar year). Funds do not roll over from year
to year. Any unused funds at the end of year will be forfeited. Existing employees may
enroll
during Open Enrollment. New hires must fulfill their eligibility requirements prior to
enrolling.
✓ Contributions are pre-tax and are automatically deducted
✓ Funds do not roll over from year to year
Quick Reference Guides
Filing a Claim
PayFlex
With this coverage, you can deliver peace of mind to your family in the event of your unexpected death.
✓ Receive up to 2x your annual salary up to a maximum of $250,000
✓ Living Benefit allows you to collect 80% of your policy while living in the event you are diagnosed with a terminal illness
✓ You may be able to keep coverage if you leave the company, retire, or change the number of hours you work
Compliance
Certificate
Life Certificate (Dirs/Mgrs) → Life Certificate (Non-Exec) → Life Certificate (Exec) → Life Schedule of Benefits → Life Bundle →If you’re suddenly unable to earn a paycheck due to illness or an accident, short term disability insurance through your employer can replace a portion of your income during the initial weeks of your disability.
✓ Receive a portion of your salary for 26 weeks
✓ Off-the-job coverage
Compliance
Certificate
Short-Term Disability Certificate → Short-Term Disability Schedule of Benefits →Long-term disability insurance through your employer can provide a steady stream of income to help cover essential expenses during an extended illness or after a disabling accident.
✓ Offers additional coverage beyond your initial Short-term disability coverage
Compliance
Certificate
Long-Term Disability Certificate (Dirs/Mgrs) → Long-Term Disability Certificate (Corp Officers) → Long-Term Disability Schedule of Benefits →MetLife
Plan Option 1 includes $250 for an emergency room visit, up to $1,200 hospital admission.
✓ Pays benefits directly to you
✓ Family options available
✓ Payroll-deducted premiums
Provides a case payment of $1,000 (once per calendar year) if you are hospitalized, and $150 per day for a maximum of 31 days per hospital stay.
✓ No lifetime maximum
✓ No waiting period
✓ Benefits paid directly to the insured
Critical illness pays a tax-free lump sum if you’re diagnosed with a covered critical illness. Choose a benefit amount up to $30,000. A cash benefit is payable to you at time of diagnosis of a covered critical illness and is paid regardless of any other coverage.
✓ No lifetime maximum
✓ No waiting period
✓ Benefits paid directly to you
Provides you with up to 60% of your income if you live in AZ, NV, TX or WA (up to 30% in CA) and are faced with an unexpected sickness or off-the-job injury.
✓ Financial Protection for up to 60% of your salary (30% in CA)
✓ Elimination period and monthly benefits that fit your needs
✓ Waiver of premium for total disability
Legal assistance for the most needed personal legal matters. There are no copays or deductibles to pay and no claim forms to complete when you use a Network Attorney.
✓ Nationwide network of more than 2,500 law firms
✓ Get help with things like wills, trusts, bankruptcy and more
Transamerica
MetLife
Get immediate access to specialized professionals in counseling, social work, human services and psychology. You have access to the LifeWorks network of thousands of master’s level counselors and affiliates.
✓ Get support with financial and legal issues
✓ Receive 5 free appointments included in your 99 Cents Only benefits
✓ Enjoy hassle-free scheduling with LifeWork's easy-to-use app
LifeWorks