Handcrafted Excellence - uba-ebc.portals.s3.amazonaws.comuba-ebc.portals.s3.amazonaws.com/108190_Simon Pearce BAAG 20… · Simon Pearce is proud to offer an extremely competitive

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Employee Benef i t s Gu ide

Handcrafted Excellence

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Simon Pearce is proud to offer an extremely competitive benefits package. We

want you to get the most out of your benefits!

This guide is not an employee/employer contract. It is not intended to cover all

provisions of all plans, but rather a quick reference to help cover most of your

questions. Please visit our Employee Online Benefit Center for more detailed

information at:

http://ebc.ubabenefits.com/simonpearce

User name: SimonPearce Password: Benefits

Included in this guide are summary explanations of the benefits, as well as

contact information for each provider. We encourage you to review each section

and use it as a reference throughout the year. We hope this guide will give you

an overview of your benefits and help you be better prepared for the online

enrollment process.

Benefit Summary 2019

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Benefit Eligibility

Benefit eligible employees are provided an opportunity to participate in

the Simon Pearce sponsored benefits program upon initial hire, annually

at open enrollment, or if you have a qualified life event.

You are eligible on the first day of the month after hire date if you are a

regular employee scheduled to work 30 hours or more per week.

Spouse coverage rule: Spouses are not eligible to enroll in Simon

Pearce’s Medical Plan if they are eligible for coverage with their employer.

They can, however be enrolled in Dental and Vision.

The implementation of the Employer Mandate provision of the

Affordable Care Act was effective January 1, 2015. Compliance with this

mandate requires Simon Pearce to offer health insurance benefits to at

least 95% of the employees who work a minimum of 30 hours per week.

We continuously monitor and track actual hours worked to determine

eligibility. If it is determined that variable hour (non-benefits eligible)

employees will work, or has worked, an average of 30 hours our more

during either the initial or ongoing measurement periods, they will be

eligible for medical insurance. The Simon Pearce measurement period is

November 1 to October 31.

Benefit enrollments will be completed through our Bswift portal. You will

be notified once your enrollment window is available:

https://secure.bswift.com/default.aspx?abbrev=simonpearce

https://secure.bswift.com/default.aspx?abbrev=simonpearce

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Bro

nze

Plan

Medical Option 1

Bronze Plan

Simon Pearce is pleased to offer you the choice of three (3) plan designs. The Bronze Plan is a traditional plan

that has co-pays and coinsurance with a higher annual deductible and lower premium.

Plan Highlights Cigna Open Access Plus

Preventative Medicine

(annual physical exams, well child/baby exams & immunizations, pap smears,

mammograms & preventative testing)

Covered at 100%

Out-of-Pocket Maximum

Single/Family

$7,150/$14,300

Physician Office Visits (Primary Care/Specialist) $50 Copay

Speech, Physical & Occupational TherapyPlan pays 60% until Out-of-Pocket Max is

met, then plan pays 100%

Chiropractic (Prior approval required after 12 visits)Plan pays 60% until Out-of-Pocket Max is


Diagnostic, X-Ray and Lab ServicesPlan pays 60% until Out-of-Pocket Max is


Emergency & Urgent Care Services $250 Copay

Outpatient Surgical ProcedurePlan pays 60% until Out-of-Pocket Max is


Ambulance ServicesPlan pays 60% until Out-of-Pocket Max is


Hospital Admission (semi-private) Plan pays 60% until Out-of-Pocket Max is


Skilled Nursing FacilityPlan pays 60% until Out-of-Pocket Max is


Home Health CarePlan pays 60% until Out-of-Pocket Max is


Hospice CarePlan pays 60% until Out-of-Pocket Max is


Durable Medical Equipment Plan pays 60% until Out-of-Pocket Max is


Mental Health & Substance Abuse Services – Inpatient & Outpatient Plan pays 60% until Out-of-Pocket Max is


Prescription Drugs

Retail (Generic/Brand/Non-Preferred Brand)

Mail-order (Generic/Brand/Non-Preferred Brand)

$5/$20/$40

$12.50/$50/$100

Employee Only Employee + SpouseEmployee +

Child(ren)Employee + Family

Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$16.00

$31.00

$31.00

$62.00

$28.00

$56.00

$47.00

$94.00

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Silv

er

Pla

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Medical Option 2

Silver Plan

Simon Pearce is pleased to offer you the choice of three (3) plan designs. The Silver Plan is a Qualified High Deductible

Health Plan (HDHP) with a Health Savings Account (HSA) through the broader, national Cigna network. Simon Pearce

will contribute to an HSA based upon the level of coverage chosen by each employee.



(annual physical exams, well child/baby exams & immunizations, pap smears, mammograms &

preventative testing)Covered at 100%

Deductible

Out-of-Pocket Maximum (includes deductible)

Preventative Medication costs do not go towards the deductible, but do apply to the out of pocket

maximum.

Single/Family

Ded - $2,700/$5,400

OOP - $5,000/$10,000

Employer HSA Contributions (deposited per pay period into the HSA)

$20 Employee Only

$40 Employee + Spouse

$40 Employee + Child(ren)

$60 Family

Physician Office Visits (Primary Care/Specialist) Deductible, then plan pays 80%

Speech, Physical & Occupational Therapy Deductible, then plan pays 80%

Chiropractic (Prior approval required after 12 visits) Deductible, then plan pays 80%

Diagnostic, X-Ray and Lab Services Deductible, then plan pays 80%

Emergency & Urgent Care Services Deductible, then plan pays 80%

Outpatient Surgical Procedure Deductible, then plan pays 80%

Ambulance Services Deductible, then plan pays 80%

Hospital Admission (semi-private) Deductible, then plan pays 80%

Skilled Nursing Facility Deductible, then plan pays 80%

Home Health Care Deductible, then plan pays 80%

Hospice Care Deductible, then plan pays 80%

Durable Medical Equipment Deductible, then plan pays 80%

Mental Health & Substance Abuse Services – Inpatient & Outpatient Deductible, then plan pays 80%

Prescription Drugs - (Deducible must be met first, then coinsurance applies)

Preventative Medications (A list of preventative medications is available on the EBC)



Deductible, then plan pays 40%

Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$34.00

$69.00

$70.00

$139.00

$62.00

$125.00

$105.00

$210.00

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Go

ld P

lan

Medical Option 3

Gold Plan

Simon Pearce is pleased to offer you the choice of three (3) plan designs. The Gold Plan offers a Health

Reimbursement Account (HRA) which allows you to use funds to pay for your deductible and coinsurance

expenses. Pharmacy expenses cannot be paid with HRA funds. Simon Pearce will contribute to this HRA based

upon the level of coverage chosen by each employee.



(annual physical exams, well child/baby exams & immunizations, pap smears, mammograms &

preventative testing)

Covered at 100%

Deductible

Out-of-Pocket Maximum (includes deductible) The deductible and out of pocket maximum on this

plan are embedded, meaning that if an employee enrolls one or more family members that the

individual deductible of $1,750 applies to each member of the family up to the family deductible of

$3,500. Prescription copays do not apply to the deductible or out of pocket maximum.

Single/Family

Ded - $1,750/$3,500

OOP - $2,500/$5,000

Employer HRA Contributions (pro-rated based on enrollment date)

Contributions cap at $1875/$3750

$750 Employee Only

$1,500 All other tiers

Physician Office Visits (Primary Care/Specialist) Deductible, then plan pays 80%

Speech, Physical & Occupational Therapy Deductible, then plan pays 80%

Chiropractic (Prior approval required after 12 visits) Deductible, then plan pays 80%

Diagnostic, X-Ray and Lab Services Deductible, then plan pays 80%

Emergency & Urgent Care Services Deductible, then plan pays 80%

Outpatient Surgical Procedure Deductible, then plan pays 80%

Ambulance Services Deductible, then plan pays 80%

Hospital Admission (semi-private) Deductible, then plan pays 80%

Skilled Nursing Facility Deductible, then plan pays 80%

Home Health Care Deductible, then plan pays 80%

Hospice Care Deductible, then plan pays 80%

Durable Medical Equipment Deductible, then plan pays 80%

Mental Health & Substance Abuse Services – Inpatient & Outpatient Deductible, then plan pays 80%

Prescription Drugs



$5/$20/$40

$12.50/$50/$100


Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$68.00

$135.00

$137.00

$275.00

$123.00

$245.00

$206.00

$412.00

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Spending Accounts – HSA & HRA

Simon Pearce is offering you several choices to help offset your deductible, qualified medical expenses, and/or

dependent care expenses.

Account DetailsHSA

Silver Plan

HRA

Gold Plan

Account Name Health Savings Account Health Reimbursement

Availability Auto-Enrolled with Silver Plan Auto-Enrolled in Gold Plan

Expenses AllowedAll eligible Medical, Dental & Vision

(IRS Code Section 213)Medical Only

Simon Pearce Contribution

$20 Employee Only

$40 Employee + Spouse

$40 Employee + Child(ren)

$60 Family

Per Pay Check

Up to $750 Employee Only

$1,500 All other tiers

Annually

Employee Contribution Yes No

2019 Funding Annual Maximum$3,500 Employee Only

$7,000 FamilyN/A

2019 Catchup Provisions $1,000 N/A

“Use it or Lose it” Provision Not applicable – ALL funds rollover Contributions cap at $1,875/$3,750

Pre-tax dollars Yes N/A

Fund Ownership Employee Simon Pearce

Ability to pay providers directly online Yes, multiple options available online Claims automatically paid by Cigna

Debit Card Yes No

Ability to invest funds Yes No

Carrier Health Equity Cigna

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ccou

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Spending Accounts –

Flexible Spending & Dependent Care

Simon Pearce is offering you several choices to help offset your deductible, qualified medical expenses, and/or

dependent care expenses.

Account DetailsLimited FSA

(Silver Plan Only)General FSA DCA

Account Name Limited Purpose FSA General Purpose FSADependent Care Account

Plan

AvailabilityAvailable only with Silver

Plan

Available to any employee

not enrolled on the Silver

Plan

Available to all employees

Expenses allowed Dental & Vision Only

All eligible Medical, Dental

& Vision (IRS Code

Section (213)

Dependent care expenses

only

Simon Pearce

ContributionNone None None

Employee Contribution Yes Yes Yes

2019 Funding Annual

Maximum$2,700 $2,700

$5,000 married & filing

jointly

$2,500 single or married &

filing separately

2019 Catch Up Provision None None None

“Use it or Lose it”

ProvisionUp to $500 will rollover Up to $500 will rollover Yes

Pre-tax dollars Yes Yes Yes

Fund Ownership Employee Employee Employee

Ability to pay providers

directly onlineVia debit card Via debit card No

Debit Card Yes Yes Yes

Ability to invest funds No No No

Carrier HealthEquity HealthEquity HealthEquity

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Spending Accounts, cont.

Health Reimbursement Account (HRA) – Cigna

This account is automatically provided to you when you enroll in the Simon Pearce Medical Gold

Plan. A Health Reimbursement Account (HRA) is a pool of money your employer has provided to offset

your deductible and/or other qualified medical expenses. Claims will be automatically paid for out of the HRA

by Cigna until the fund are exhausted. This is an employer owned account and you cannot contribute

additional money to this account.

Health Savings Account (HSA) - HealthEquity

This account is automatically provided to you when you enroll in the Simon Pearce Medical Silver

Plan. A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in

the United States who are enrolled in a high-deductible health plan (HDHP). Your employer will be

contributing to this account (again, based upon your enrollment level), however, HSA’s are owned by the

employee. You may make additional tax-free contributions to this account. Refer to your enrollment materials

to learn more.

General Purpose Flexible Spending Account (General FSA) - HealthEquity

This option is not available to those who enroll in the Silver HSA Plan. You must choose to enroll in

this account. A General-Purpose FSA Account allows you to save money from your paycheck on a tax-fee

basis for medical, dental and other health-related expenses not covered by your insurance plan. Covered

expenses may include co-pays, deductibles & certain OTC services.

Limited Purpose Flexible Spending Account (Limited FSA) -HealthEquity

For use for those who enroll in the Silver HSA Plan. You must choose to enroll in this account. A

Limited Purpose Flexible Spending Account works in conjunction with your Health Savings Account (HSA).

You can save money on taxes by contributing from your paycheck on a tax-free basis for dental and vision

expenses, while preserving your HSA funds for other purposes, including simply saving those funds for the

future.

Dependent Care Reimbursement Account (DCA) - HealthEquity

Available to everyone, regardless of your medical plan selection. You must choose to enroll in this

account. A Dependent Care Reimbursement Account allows you to save money from your paycheck on a

tax-free basis to cover certain costs associated with providing your dependent(s) – under the age of 13 (other

dependents may also qualify) with day care, while you and your spouse are at work.

Simon Pearce is pleased to offer you a comprehensive dental plan through Delta Dental’s Nationwide Network.

Outline of Covered ServicesCoverage

Level

Calendar Year Maximum per person for services under A, B & C $1,500

Calendar Year Deductible per person/Family (Coverage B & C only) $25/$75

Coverage A

Preventative/

Diagnostic

Evaluations: Two in a 12-mo period

X-rays: Complete series or panoramic film once in a 5-yr period, Bitewing X-rays once in a

12-mo period, X-rays of individual teeth as needed

Oral Cancer screening: Once in a 12-mo period

Preventative: Cleanings Two in a 12-mo period

Fluoride Treatment: Once in a 12-mo period to age 19

Space maintainers: To age 16

Sealant application: For permanent molars once in a 3-yr period per tooth for children to age 19

100%

Coverage B

Basic

Restorative: Amalgam (silver) filling, composite (white) fillings (anterior teeth only)

Oral Surgery: Surgical & routine extractions

Endodontics: Root canal therapy

Periodontics: Periodontal Maintenance (cleaning) two in a 12-mo period

Note: Cleanings may be any combination of routine (Coverage A) or periodontal (Coverage B)

but are limited to the total number of allowed cleanings

Clinical Crown Lengthening: Once per lifetime per site

Denture Repair: Repair of a removable denture to its original condition

Emergency Palliative Treatment

80%

Coverage C

Major

Prosthodontics: Removable and fixed partial dentures (bridge); complete dentures

Rebase and reline dentures

Crowns, Onlays & Implants

50%

Orthodontic Lifetime Maximum (per child to age 19)50% up to

$1,000

The plan also includes a rollover benefit which allows members to rollover $250 if they have had an oral exam or a cleaning in

the previous year AND their total dental payout from Delta was no more than $500. The rollover will be available to those

employees who qualify in 2019 based upon the requirements described in this provision.

Benefit percentages shown are based upon the actual charge submitted to a maximum of the participating dentist's approved

fees, or Delta Dental's allowance for non-participating dentists.

Health through Oral Wellness Program (HOW) is a comprehensive, patient-centered wellness program designed to help

members maintain optimal oral health through education, risk assessment, and evidence based models of care. Patients with a

greater risk for oral diseases or medical complications related to oral health will be eligible for enhanced preventive benefits.

Register for free at www.healththroughoralwellness.com


Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$5.49

$15.32

$10.66

$29.46

$11.42

$33.34

$17.12

$50.35

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De

ntal In

suran

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Dental Insurance

http://www.healththroughoralwellness.com/

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Vis

ion

Insu

ran

ce

Vision Insurance

Simon Pearce is pleased to offer you a stand-alone vision plan with VSP. You can elect to

enroll at any tier. Visit www.vsp.com for more information.

Coverage Cost to Member

Well Vision Exam $10 Copay, once per calendar year

Prescription Glasses $25 Copay

Lenses: Once per calendar year

• Single vision, lined bifocal, & lined trifocal lenses

• Polycarbonate lenses for dependent children

Frames: Once every other calendar year

• $130 allowance for frame of your choice, then 20% off the amount over your

allowance

Contact Lens Care Up to $60 copay for contact lens exam (varies by provider)

$130 allowance for the contacts, once per calendar year

Extra Discounts Glasses & Sunglasses: 30% off additional glasses & sunglasses, including lens options,

from the same VSP doctor on the same day as your Well Vision Exam, OR get 20% from

any VSP doctor within 12 months of your last Well Vision Exam

Laser Vision Correction: Average 15% off the regular price or 5% off the promotional

price.

Discounts only available from contracted facilities

Employee OnlyEmployee +

Spouse

Employee +

Child(ren)

Employee +

Family

Bi-Weekly Cost- FT

Bi-Weekly Cost- PT$3.86 $6.18 $6.31 $10.17

http://www.vsp.com/

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Life &

Disab

ility Insu

rance

Life & Disability Insurance

Life & AD&D Insurance (Paid for 100% by Simon Pearce)Reliance Standard Life Insurance

Coverage begins the first day of the month following first day of employment and you must

work 30 hours per week to be eligible.

● 1 times prior year W2 earnings (including incentive pay) to maximum of $50,000

● Benefits reduce by 50% upon reaching age 70

Long-Term Disability Insurance (Paid for 100% by Simon Pearce)Reliance Standard Life Insurance

Coverage begins the first day of the month following first day of employment and you must

work 30 hours per week to be eligible.

● Benefit is 60% of prior year W2 monthly earnings up to $5,000 per month

● Payment of benefits begin after 90 days from the start of a qualified disability

● Benefits are payable up to age 65 if disability begins prior to age 60; Please refer to the

schedule of benefits when disability begins after age 60

● Policy pays for benefits if you are disabled from your own occupation for 24 months

● Policy includes a Rehabilitation and Return to Work Assistance Program

Simon Pearce highly recommends that all employees review and update their beneficiary designationson Life and Disability insurance, as well as retirement plans, on an annual basis or as “life events”occur. A life event can be marriage, divorce, birth/adoption of a child, etc.

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Voluntary Benefits

Voluntary Life & AD&D Insurance (Paid for 100% by employee; age rated premiums)Reliance Standard Life Insurance

● Choice of coverage in $10,000 increments up to 5x prior year W2 earnings or $500,000, whichever is

less

● Benefits reduce by 50% upon reaching age 70

● Employees are required to give satisfactory evidence of insurability for supplemental life amounts over

$130,000 upon initial eligibility; after initial eligibility all benefit amounts require evidence of insurability

● Employees may increase their coverage, up to the Guarantee Issue amount of $130,000, annually during

open enrollment as long as they enrolled with at least $10,000 of coverage with RSLI when they were

initially eligible.

Voluntary Dependent Life Insurance (Paid for 100% by employee; age rated premiums)Reliance Standard Life Insurance

● Choice of coverage for a spouse in increments of $5,000

● Spouse will be required to give satisfactory evidence of insurability for supplemental life amounts above

$25,000 upon initial eligibility; after initial eligibility all benefit amounts are subject to evidence of

insurability

● The maximum benefit of life insurance for a spouse is the lesser of 100% of your amount of insurance

or $500,000

● Dependent children from birth to age 19, or 26 if a full time student, are eligible for up to a $10,000

benefit. Benefits are reduced for children from birth to 6 months of age.

Voluntary Short-Term Disability Insurance (Paid for 100% by employee; age rated

premiums)Reliance Standard Life Insurance

● Benefit begins on the day of a disability due to an injury and on day 8 of a disability due to a sickness

● Benefit is 60% of prior year weekly W2 earnings (including incentive pay) to a maximum of $750/week

● The maximum benefit period is 13 weeks per eligible disability.

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tary Be

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fits

Voluntary Benefits

Voluntary Accident & Critical Illness Coverage (Paid for 100% by employee)

Reliance Standard Life InsuranceAvailable to Full Time, Regular Part Time and working 20+ hours per week..

Accident Insurance• Available to help covered employees pay expenses that can follow an accidental injury.

• Pays benefits to members who enroll in coverage for on & off the job accidents

• Coverage can be chosen for an employee, spouse & dependent children

• Benefits are paid for receiving care related to an accident. See RSLI benefit in your Online

Employee Benefit Center for a complete list of coverage.

• Benefits are paid on a tax-free basis since premiums are paid post-tax through payroll

deductions

Critical Illness Insurance• Pays benefits to members who enroll in coverage should a member develop a Critical Illness

• Some of the Critical Illnesses include: Cancer, Heart Attack, Major Organ Failure, Blindness.

For a complete list of covered illnesses, please see the plan description in the Online

Employee Benefit Center.

• Benefit amounts may be chosen for purchase from $5,000 - $50,000 in $5,000 increments for

an employee

• Benefit amounts may be chosen for purchase from $5,000 - $10,000 in $5,000 increments for

a spouse

• Eligible dependent children are automatically covered for 25% of the employee’s elected

amount when the employee enrolls in this coverage.

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Re

tire

me

nt

40

1K

Retirement 401K

401(k) Retirement Savings PlanHickok & Boardman

Simon Pearce encourages employees to save for their retirement. All employees who are 18

years of age are eligible participate in the Simon Pearce 401(k) Retirement Plan the first day of

the month following first day of employment. The Simon Pearce 401(k) Retirement Plan offers

several different investment options within the fund group. There are 2 components to the

retirement plan:

• 401(k) plan: Eligible employees can defer from their paycheck on a pretax and/or after tax

basis up to 50% of their eligible earning up to the IRS maximum. Participants are always

100% vested in this money.

• Employer matching contribution: Simon Pearce matches contributions with each pay period.

Details of the match and vesting schedules can be found with the 401(k) enrollment packet,

provided during onboarding.

Financial AdviceHickok & Boardman

Simon Pearce offers on-site consultations with a financial advisor from Hickok& Boardman.

The advisor can provide you with the information you need to make educated investment

decisions. They continue to review your portfolio and help you make revisions as your

circumstances change. From investment advice to outside money management, H&B has the

knowledge, tools, and resources to help make your financial goals come true. Phone

consultations can also be scheduled at any time during the year. Simon Pearce offers this

service at no cost to you.

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Mo

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efits

More Benefits

Tuition Reimbursement ProgramEach position at Simon Pearce requires certain skills and abilities and we encourage employees to continue to

develop their capabilities. After one year of employment, you are eligible for reimbursement of tuition up to

$1,000 per calendar year for course(s) taken at accredited colleges or universities. These courses must be directly

related to a current position or potential future positions. Employees must work 30 or more hours per week to be

eligible.

Employee Product SavingsAs an employee of Simon Pearce, you are eligible to receive a 50% savings on all pottery and glass made by the

company, as well as the Way of Living and Design for Living books. You will also be eligible for a 20% savings on

everything else (this includes non-manufactured home accents such as lampshades and flatware, Andrew Pearce

bowls and products, charity items including LoveYourBrain, etc). Items that are excluded from this discount

program altogether are sale items, discounted prices and engraving. Any purchase must be for the employee’s own

personal use or a gift. In our restaurant, bar and café you will receive a savings of 50% on all menu items,

excluding alcoholic beverages, for the employee and one guest. Tips must be made on the entire amount of the

check before discount. Black out dates do apply. Please check your employee card for more details.

Complimentary DiscountsBecause Simon Pearce is a member of Vermont Attractions Association (VAA), this entitles Simon Pearce

employees to complimentary discounts at other VAA member locations. View specific details about each discount

on the EBC Website under employee perks at http://ebc.ubabenefits.com/simonpearce/default.aspx?t=16103617

User id: SimonPearce Password: Benefits

GradFin – Student Loan ConsolidationThe Simon Pearce Student Loan Repayment program is designed to help Simon Pearce employees pay back

student loan debt and improve their financial well-being. Utilizing Simon Pearce’s relationship with The Richards

Group, consultation services provided through GradFin are provided free of charge. GradFin is a new employee

benefit program that is revolutionizing the way employees can reduce their student loan debt.

GradFin will:

• Provide one-on-one education consultations with GradFin Consultation Experts to review your current loan

status and discuss personalized payoff options to save on your loans.

• Offer a competitive interest rate reduction when you refinance your loans.

• Provide up to a $300 bonus to you when you refinance your loans with GradFin. The $300 bonus will be

applied to the principal balance of the closed loan.

• Offer the lowest interest rates in the industry through their lending platform which is made up of ten lenders to

maximize the chances that you will be approved for a new loan.

For more information or to schedule a one-on-one consultation visit:

https://www.gradfin.com/TRG.html or call 610-639-7840

http://ebc.ubabenefits.com/simonpearce/default.aspx?t=16103617

https://www.gradfin.com/TRG.html

ACI Specialty BenefitsEmployee Assistance Program (EAP)

Life can be challenging and stressful. Everyone needs support from time to time. Simon Pearce

provides an Employee Assistance Program to all employees and their families, at no cost to the

employee. This program provides confidential counseling services for a variety of needs,

including substance abuse, relationship, legal or financial issues. For more information, please

go to https://rsli.acieap.com/or call 855-775-4357.

User Id: Valid Email Address

Password: RSLI859

Health AdvocateClaims & Plan-Related Assistance

Health Advocate provides personalized assistance to help you and your eligible family members

resolve healthcare issues to save time and money. Health Advocate can help you solve medical

claim problems, complex healthcare issues, insurance-related problems and red tape by working

directly with your insurance company and your doctor. Available 24/7, Health Advocate can

be reached at 866-695-8622 or at www.healthadvocate.com. Simon Pearce offers this service at

no cost to you.

Wellness/Health ProgramsThroughout the year, Simon Pearce offers a variety of programs that motivates challenges and

supports the values of choosing a healthy lifestyle. More information is made available to

employees as programs are made available.

Work United Resource Coordinator & Emergency LoanWorking Bridges at Simon Pearce is a program dedicated to improving workplace productivity,

retention, advancement, and financial stability for employees. Too often, barriers such as

childcare, reliable transportation and acute need for emergency financial assistance get in the way

of continuous employment and derail good employees. Work United helps to minimize these

employment barriers by providing an onsite Resource Coordinator and an Emergency Loan

Program.

17

EAP

, He

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Ad

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We

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ss

Employee Assistance Program

Health Advocate & Wellness

https://rsli.acieap.com/

http://www.healthadvocate.com/

Qu

alifying Eve

nts an

d C

OB

RA

Qualifying Events and COBRA

Qualifying EventsThere are 4 basic types of qualifying life events. (The following are examples, not a full list.)

Loss of health coverage

• Losing existing health coverage, including job-based, individual, and student plans

• Losing eligibility for Medicare, Medicaid or CHIP

• Turning 26 and losing coverage through a parent’s plan

Changes in household

• Getting married or divorced

• Having a baby or adopting a child

• Death in the family

Changes in residence

• Moving to a different ZIP code or country

• A student moving to or from the place they attend school

• A seasonal worker moving to or from the place they both live and work

• Moving to or from a shelter or other transitional housing

Other qualifying events:

• Changes in your income that affect the coverage you qualify for

• Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act

(ANCSA)

• Becoming a US Citizen

• Leaving incarceration (jail or prison)

• AmeriCorps members starting or ending their service

You must advise Human Resources within 31 days of the qualifying event.

COBRACOBRA gives those who have voluntarily resigned, or have been terminated for any reason other than “gross

misconduct”, an opportunity to continue their healthcare benefit up to 18 months. The employee/beneficiary pays

the full premium plus a service charge. Qualified Beneficiaries: A qualified beneficiary generally is an individual

covered by a group health plan on the day before a qualifying event who is either an employee, the employee’s

spouse, or an employee’s dependent child.

Qualifying Events: These are certain events that would cause an individual to have a change in health coverage.

Qualifying Events for Employees:

• Voluntary or involuntary termination of employment for reasons other than gross misconduct

• Reduction in the number of hours of employment

Qualifying Events for Spouses:

• Voluntary or involuntary of the covered employee’s employment for any reason other than gross misconduct

• Reduction in the hours worked by the covered employee

• Covered employee’s becoming entitled to Medicare

• Divorce or legal separation of the covered employee

• Death of the covered employee

Qualifying events for dependent children are the same as for the spouse with one addition:

• Loss of dependent child status under the plan rules

18

Em

plo

ye

e C

on

trib

utio

ns

Employee Contributions



Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$34.00

$69.00

$70.00

$139.00

$62.00

$125.00

$105.00

$210.00

Silver Medical Plan Rates



Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$16.00

$31.00

$31.00

$62.00

$28.00

$56.00

$47.00

$94.00

Bronze Medical Plan Rates



Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$68.00

$135.00

$137.00

$275.00

$123.00

$245.00

$206.00

$412.00

Gold Medical Plan Rates


Spouse

Employee +


Bi-Weekly Cost- FT

Bi-Weekly Cost- PT

$5.49

$15.32

$10.66

$29.46

$11.42

$33.34

$17.12

$50.35

Dental Plan Rates


Spouse

Employee +


Bi-Weekly Cost- FT

Bi-Weekly Cost- PT$3.86 $6.18 $6.31 $10.17

Vision Plan Rates

19

Bswift: Online Enrollment System

https://SimonPearce.bswift.com

User Name:________________ Password: Last 4 digits of SSN

20

Co

ntact In

form

ation

Contact Information

Please refer to the list below when contacting one of the benefit vendors:

Cigna Medical Insurance, Health Reimbursement Account

Group Number: 623907 | 1-800-244-6224 | www.cigna.com

User Name:________________ Password:________________

Delta Dental: Dental Insurance

Group Number: 70081|1-800-832-5700 | www.nedelta.com


VSP: Vision Insurance

Group Number: 30045226 | 1-800-877-7195 | www.vsp.com


Health Equity Health Savings Account (HSA), Flexible Spending, Dependent Care

1-866-346-5800 | www.healthequity.com


Health Advocate: Claims & Plan-related Assistance

866-695-8622 | www.healthadvocate.com

RSLI: Life Insurance, Short & Long Term Disability Insurance & Supplemental

Life Insurance Voluntary Accident & Critical Illness Coverage

Contact: |1-800-351-7500 | www.reliancestandard.com

ACI Specialty Benefits: Work-Life Balance Employee Assistance Program (EAP)

User ID: Email – Password: RSLI859|(EAP) 855-775-4357|https://rsli.acieap.com/

Hickok & Boardman: 401(k) Retirement Plan

1-800-488-8715| https://www.mykplan.com

User Name:________________ Password:_______________

Cathy Sullivan: Simon Pearce Benefit Specialist

1-802-230-2431 | [email protected]

The text contained in this Guide was taken from various summary plan descriptions and benefit information. In

the case of a discrepancy between the Guide and the actual plan documents, the actual plan documents will

prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act

(HIPAA) of 1996. If you have any questions about your Guide, contact Human Resources.

http://www.cigna.com/

http://www.nedelta.com/

http://www.vsp.com/

http://www.healthequity.com/

http://www.healthadvocate.com/

http://www.reliancestandard.com/

https://rsli.acieap.com/

https://www.mykplan.com/

Handcrafted Excellence - uba-ebc.portals.s3.amazonaws.comuba-ebc.portals.s3.amazonaws.com/108190_Simon Pearce BAAG 20… · Simon Pearce is proud to offer an extremely competitive

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