Reliance Plan 1

Employee-Only: $19.71
Employee + Spouse: $37.69
Employee + Children: $40.98
Family: $65.31

Reliance Plan 2

Employee-Only: $23.42
Employee + Spouse: $46.66
Employee + Children: $49.57
Family: $79.60

Reliance Plan 1

$60/day | 3/year

Reliance Plan 2

$60/day | 4/year

Reliance Plan 1

$1,000/day | 1/year

Reliance Plan 2

$1,000/day | 1/year

Reliance Plan 1

$100/day | Up to 90 days

Reliance Plan 2

$300/day | Up to 90 days

Reliance Plan 1

$50/day | 1/year

Reliance Plan 2

$50/day | 1/year

Reliance Plan 1

$30/day | Up to 2/year

Reliance Plan 2

$40/day | Up to 4/year

Reliance Plan 1

$500/day | Up to 2/year

Reliance Plan 2

$500/day | Up to 2/year

Reliance Plan 1

$25/day | Up to 7/year

Reliance Plan 2

$25/day | Up to 12/year

Reliance Standard

800-351-7500

Reliance Standard

800-351-7500

Rx Home Delivery

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.

Product Highlights

✓ Medications delivered anywhere in the U.S.

✓ Free standard shipping

✓ Up to a 90-day supply of your medications

✓ Access to expert pharmacist advice

Get started

800-788-2949

Specialty Medication

Specialty medications are complex and used to treat chronic conditions such as cancer or hepatitis C.

Typical Process

✓ 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

More information

800-788-2949

MedImpact

800-788-2949

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

Cigna Brighter Dental Tool →
myCigna Introduction Video →

Summary of Benefits

Cigna Advantage Network Dental PPO Summary →
Cigna Advantage Network Dental PPO Summary (Texas) →
Dental DHMO Summary →

Compliance

Dental PPO Certificate →
Dental PPO Certificate (Texas) →
Dental DHMO Certificate →

Aetna

800-451-7715

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

800-973-3228

Health Savings Account

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.

Product Highlights

✓ 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

844-729-3539

Flexible Spending Account

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.

Product Highlights

✓ Contributions are pre-tax and are automatically deducted

✓ Funds do not roll over from year to year

Quick Reference Guides

Health Care and Dependent Care FSA (English) →
Health Care and Dependent Care FSA (Spanish) →

Filing a Claim

Health Care and Dependent Care Reimbursement Form →

PayFlex

844-729-3539

Life and Accidental Death & Personal Loss

With this coverage, you can deliver peace of mind to your family in the event of your unexpected death.

Product Highlights

✓ 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

800-251-7254

Compliance

Certificate

Life Certificate (Dirs/Mgrs) → Life Certificate (Non-Exec) → Life Certificate (Exec) → Life Schedule of Benefits → Life Bundle →

Short-Term Disability

For Managers (Excluding SM) and Above

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.

Product Highlights

✓ Receive a portion of your salary for 26 weeks

✓ Off-the-job coverage

800-638-5433

Compliance

Certificate

Short-Term Disability Certificate → Short-Term Disability Schedule of Benefits →

Long-Term Disability

For Managers (Excluding SM) and Above

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.

Product Highlights

✓ Offers additional coverage beyond your initial Short-term disability coverage

800-638-5433

Compliance

Certificate

Long-Term Disability Certificate (Dirs/Mgrs) → Long-Term Disability Certificate (Corp Officers) → Long-Term Disability Schedule of Benefits →

MetLife

800-638-5433

Accident

Plan Option 1 includes $250 for an emergency room visit, up to $1,200 hospital admission.

Product Highlights

✓ Pays benefits directly to you

✓ Family options available

✓ Payroll-deducted premiums

Hospital Indemnity

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.

Product Highlights

✓ No lifetime maximum

✓ No waiting period

✓ Benefits paid directly to the insured

Critical Illness

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.

Product Highlights

✓ No lifetime maximum

✓ No waiting period

✓ Benefits paid directly to you

Supplemental Short-Term Disability

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.

Product Highlights

✓ 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

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.

Product Highlights

✓ Nationwide network of more than 2,500 law firms

✓ Get help with things like wills, trusts, bankruptcy and more

Transamerica

800-797-2643

MetLife

800-638-5433

LifeWorks Employee Assistance Program

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.

Benefit Features

✓ 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

Get started

LifeWorks

Your Benefits

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2021/2022

Benefits Hub

Medical Plans

Reliance Plan 1

Reliance Plan 2

Dental Plan

Dental Plan

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Vision Plan

Vision Base

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Reliance Standard Term Life

Employee Assistance Program

Financial Protection

Included Benefits

Compliance

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2

Reliance Plan 1

Reliance Plan 2