AbilityOne

Goodwill of Western Missouri & Eastern Kansas

Goodwill | 2018 Benefits Overview

Blue Cross Blue Shield of Kansas City: PPO Medical Plans – Eligible for employees working 30+ hours per week.

Preferred-Care Blue Network PPO 2000 Premium Plan PPO 6500 – Value Plan

Deductible: Individual $2,000 $6,500

Deductible: Family $6,000 $13,000

Member Co-Insurance 100% 100%

Out-of-Pocket Maximum: Individual $2,000 $6,500

Out-of-Pocket Maximum: Family $6,000 $13,000

Preventive Care Covered at 100% Covered at 100%

Office Visit (PCP / Specialist) $30 Copay / $60 Copay Deductible

Urgent Care $60 Copay Deductible

Emergency Room Deductible Deductible

Hi Tech Diagnostics (MRI, MRA, etc.) Deductible Deductible

Inpatient Hospital Deductible Deductible

Outpatient Hospital Deductible Deductible

Retail Prescriptions: Tier 1/ Tier 2/ Tier 3 $10 / $30 / $50 $12 for tier 1/Deductible for Tier 2 and 3

Mail Order Prescriptions: Tier 1/ Tier 2/ Tier 3 $30 / $90 / $150 $30 for tier 1/Deductible for Tier 2 and 3

Health Risk Assessment Incentive Visit “A Healthier You” on www.mokangoodwill.org/benefits to take your Health Risk Assessment today for theopportunity to reduce your monthly premiums by $25 each month. You and your covered spouse may complete this assessment.

Delta Dental of Kansas: Dental Plan

Premier & PPO Networks

Preventive 100%

Deductible: Individual $50 (applies to Basic & Major only)

Deductible: Family $150 (applies to Basic & Major only)

Basic 80%

Major 50%

Annual Benefit Maximum $1,000 per person

Orthodontia 50% (Lifetime max $1,000)

Ameriflex: Flexible Spending Account

You can reallocate your annual compensation to pay for eligible health costs that may not be covered by your benefit plan and/or dependent care expenses. In essence, you will be paying for these expenses on a pre-tax basis. This is a voluntary plan and the amount you designate as your Annual Salary Reallocation should be conservative. Participants can roll over up to $500 of unused FSA dollars to the next year.

Medical Expenses: Set aside up to $2,600 pre-tax to pay for unreimbursed qualified healthcare expenses

Dependent Care Expenses: Set aside up to $5,000 (or $2,500 if married filing separately) for qualified dependent care

Out of Pocket Maximum includes deductible, coinsurance, and copayments.

BELOW IS A BRIEF OUTLINE OF IN-NETWORK BENEFITS

For additional details and Out of Network benefits, please refer to the Summary Plan Descriptions at www.mokangoodwill.org/benefit .

Includes orthodontic appliances and treatment, interceptive and corrective, for dependent children under age nineteen (19).

SunLife: Vision Plan

VSP Signature Network Frequency Benefit

Examination Every 12 months $10 Copay

Single Vision Lenses Every 12 months $25 Copay

Lined Bifocal Lenses Every 12 months $25 Copay

Line Trifocal Lenses Every 12 months $25 Copay

Frames Every 24 months $130 Allowance, 20% off balance over $130

Contact Lenses Every 12 months $130 Allowance

Lasik Discount Once Per Lifetime 15% off retail price, 5% off promotional price

MetLife: Voluntary Short Term Disability – Eligible for employees working 30+ hours per week.

Elimination Period 14th day Accident or Sickness

Short Term Disability Benefit 60% of weekly earnings to a maximum of $1,000

Benefit Duration 11 Weeks

MetLife: Voluntary Life and Accidental Death & Dismemberment – Eligible for employees working 30+ hours per week.

Benefit Increments Guarantee Issue Maximum

Employee Coverage Up to 5 times base salary $10,000 $150,000 $500,000

Spouse Coverage Up to 50% of employee coverage $5,000 $50,000 $250,000

Child(ren) coverage Up to 50% of employee coverage for amounts of $1,000 ,$2,000, $4,000, $5,000 or $10,000

USAble: Voluntary Life and Accidental Death & Dismemberment

Life and AD&D Coverage $10,000 for employee only

SunLife: Voluntary Accident and Critical Illness

Type of Plan Benefit

Accident Insurance Coverage: Off the Job (Including Wellness Benefit)

Fixed benefits based on the type of injury & treatment received. Pays

cash dollars directly to you regardless of medical insurance benefits.

$50 per year wellness benefit for each covered individual for a covered health screening.

Critical Illness Insurance Coverage: (Including Wellness Benefit)

Lump sum benefit (depending on the level of coverage selected)

upon diagnosis of a critical illness; Heart Attack, Stroke, Cancer. Pays

cash dollars directly to you regardless of medical insurance benefits.

$50 per year wellness benefit for each covered employee and spouse for a covered health screening.

All Life and AD&D amounts are subject to an age reduction schedule.

To purchase Spouse &/or Child(ren) coverage, you must have coverage on yourself. Guarantee Issue is applicable at initial eligibility only.

Short Term disability includes a pre-existing condition clause.

Goodwill | 2018 Rate Grids – Supplement to Benefit Overview

Employee Life and AD&D Semi-Monthly Premiums

Premiums are based on the employee's age on each policy anniversary

Benefit in Age

000’s thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$20 1.24 1.44 1.74 2.14 3.34 5.14 8.54 14.24 26.84 43.34

$30 1.86 2.16 2.61 3.21 5.01 7.71 12.81 21.36 40.26 65.01

$40 2.48 2.88 3.48 4.28 6.68 10.28 17.08 28.48 53.68 86.68

$50 3.10 3.60 4.35 5.35 8.35 12.85 21.35 35.60 67.10 108.35

$60 3.72 4.32 5.22 6.42 10.02 15.42 25.62 42.72 80.52 130.02

$70 4.34 5.04 6.09 7.49 11.69 17.99 29.89 49.84 93.94 151.69

$80 4.96 5.76 6.96 8.56 13.36 20.56 34.16 56.96 107.36 173.36

$90 5.58 6.48 7.83 9.63 15.03 23.13 38.43 64.08 120.78 195.03

$100 6.20 7.20 8.70 10.70 16.70 25.70 42.70 71.20 134.20 216.70

$110 6.82 7.92 9.57 11.77 18.37 28.27 46.97 78.32 147.62 238.37

$120 7.44 8.64 10.44 12.84 20.04 30.84 51.24 85.44 161.04 260.04

$130 8.06 9.36 11.31 13.91 21.71 33.41 55.51 92.56 174.46 281.71

$140 8.68 10.08 12.18 14.98 23.38 35.98 59.78 99.68 187.88 303.38

$150 9.30 10.80 13.05 16.05 25.05 38.55 64.05 106.80 201.30 325.05

Spouse Life and AD&D Semi-Monthly Premiums

Premiums are based on the employee's age on each policy anniversary

Benefit in Age

000’s Thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

$5 .31 .36 .44 .54 .84 1.29 2.14 3.56 6.71 10.84

$10 .62 .72 .87 1.07 1.67 2.57 4.27 7.12 13.42 21.67

$15 .93 1.08 1.31 1.61 2.51 3.86 6.41 10.68 20.13 32.51

$20 1.24 1.44 1.74 2.14 3.34 5.14 8.54 14.24 26.84 43.34

$25 1.55 1.80 2.18 2.68 4.18 6.43 10.68 17.80 33.55 54.18

$30 1.86 2.16 2.61 3.21 5.01 7.71 12.81 21.36 40.26 65.01

$35 2.17 2.52 3.05 3.75 5.85 9.00 14.95 24.92 46.97 75.85

$40 2.48 2.88 3.48 4.28 6.68 10.28 17.08 28.48 53.68 86.68

$45 2.79 3.24 3.92 4.82 7.52 11.57 19.22 32.04 60.39 97.52

$50 3.10 3.60 4.35 5.35 8.35 12.85 21.35 35.60 67.10 108.35

Child Amount for Voluntary Life $1,000 $5,000 $10,000

Child Life and AD&D Premium 0.145 0.73 1.46

MetLife: Voluntary Life and AD&D Premiums

Coverage available up to 50% of employee elected amount. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies.

Coverage available up to $500,000 depending on employee salary. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies.

*Employee must also be enrolled in coverage to elect for Child Life and AD&D.

USAble All Staff Coverage: Voluntary Life and AD&D

$10,000 of coverage $1.60 semi-monthly deduction

Semi-Monthly Accident Premiums

Employee Only $7.94

Employee & Spouse $10.40

Employee & Child(ren) $12.29

Family $14.75

MAXIMUM WEEKLY BENEFITAGE SCHEDULE WITH SEMI-MONTHLY DEDUCTION

<44 45-49 50-54 55-59 60+

$100 2.70 2.55 2.90 3.80 4.15

$150 4.05 3.83 4.35 5.70 6.23

$200 5.40 5.10 5.80 7.60 8.30

$250 6.75 6.38 7.25 9.50 10.38

$300 8.10 7.65 8.70 11.40 12.45

$350 9.45 8.93 10.15 13.30 14.53

$400 10.80 1.20 11.60 15.20 16.60

$450 12.15 11.48 13.05 17.10 18.68

$500 13.50 12.75 14.50 19.00 20.75

$550 14.85 14.03 15.95 20.90 22.83

$600 16.20 15.30 17.40 22.80 24.90

$650 17.55 16.58 18.85 24.70 26.98

$700 18.90 17.85 20.30 26.60 29.05

$750 20.25 19.13 21.75 28.50 31.13

$800 21.60 20.40 23.20 30.40 33.20

$850 22.95 21.68 24.65 32.30 35.28

$900 24.30 22.95 26.10 34.20 37.35

$950 25.65 24.23 27.55 36.10 39.43

$1,000 27.00 25.50 29.00 38.00 41.50

USAble: Voluntary Life Premiums

MetLife: Short Term Disability Premiums

*Coverage available up to 60% of your weekly income. Coverage is rounded to the nearest $50.

SunLife: Accident Premiums

SunLife: Critical Illness Premium

Goodwill | 2018 Benefits Overview

Type of Coverage Employee Semi-Monthly Rates

Medical: PPO 2000 – Premium Plan

Employee Only $308.15Employee & Spouse $708.77Employee & Child(ren) $585.50Family $862.85Medical: PPO 6500 – Value Plan

Employee Only $245.91Employee & Spouse $565.60Employee & Child(ren) $467.23Family $688.56Dental:

Employee Only $13.71Employee & Spouse $26.72Employee & Child(ren) $25.57Family $38.99Vision:

Employee Only $3.95

Employee & Spouse $7.86

Employee & Child(ren) $8.46

Family $12.48

CONTACT INFORMATION

Contact for questions about benefits and enrollments

(816) 842-7425 Extension 252

benefits@mokangoodwill.orgwww.mokangoodwill.org/benefits

Contact for questions about claims, issues, and coverage

Nathan Johnson (913)643-4146njohnson@trussadvantage.com

Kara Vincent (913)754-5927 kvincent@trussadvantage.com

Blue Cross Blue Shield of Kansas City Medical 888-989-8842 or 816-395-2950

www.bluekc.com

Delta Dental of Kansas Dental 800-733-5823

www.deltadentalks.com

SunLife Vision, Voluntary Benefits 800-733-7879

www.assurantemployeebenefits.com

USAble Basic Life/AD&D 800-370-5856

www.usablelife.com

MetLife Voluntary Life/AD&D, Disability 800-638-5433

www.metlife.com

Ameriflex Flexible Spending Account 888-868-3539

www.myameriflex.com

New Directions Behavioral Health Employee Assistance Program 800-528-5763

www.ndbh.com

Vacation Chart for 2018Eligibility Years of

Service Annual Amount

Awarded How and when this is

awarded? What if I don’t use all my vacation?

What happens to it if I leave the agency?

No minimum number of hours. All employees are eligible.

1-7 10 days Vacation time is awarded on each anniversary date and is pro-rated based on the number of hours worked each week.

Vacation needs to be used within 12 months. If not, remaining vacation will be paid out.

If you leave the Agency, you will be paid any unused vacation time as of the date of separation.

8-14 15 days

15+ 20 days

All Ability one employees receive up to 10 vacation days after being employed with the agency for one year. These vacation days do not roll over from year to year, but each employee is paid any remaining vacation hours on their anniversary. Please refer to your handbook for updated and complete information. Above is the Ability One Vacation Annual Amounts considering Years of Service. There is no waiting period for holiday pay.

This is a brief description of your benefits. If a discrepancy exists, benefits outlined in the carrier certificate will prevail.