1. PARTNERS BENEFITS AT A GLANCE 11/1/2015 – 10/31/2016
Our Commitment To You: Plans designed for your needs
Our benefit plans are designed to recognize the diverse needs of our workforce. Our goal is to offer you competitive benefit options that allow you to design your own plan based on your individual needs.
We encourage you to review all of your options before making your benefit elections. Please visit to access your employment forms, carrier enrollment forms and vital plan documents .
BENEFIT BASICS
Once you elect your Fisher Broyles benefit options, your elections remain in effect for the plan year through You may only change coverage due to a qualifying life event and must do so within 30 days of the event.
QUALIFYING LIFE EVENT
Change in status, which includes: marriage, birth/adoption of a child, employment changes, changes in residence, dependent satisfies or ceases to satisfy eligibility requirements
Dependent’s Open Enrollment through their employer
Significant cost or coverage changes
HIPAA special enrollment rights
FMLA special requirements
Changes due to a judgment, decree or court order
Entitlement to Medicare or Medicaid
ELIGIBILITY
Fisher Broyles employees are eligible for benefits the first day of active employment. Following the date of hire. Eligible dependents are defined as spouses, domestic partners, and/or dependent children up to age 26. Employee coverage must be elected in order for dependent coverage to be valid.
About this guide This document is a summary of the benefits provided under a group insurance plan. The summary is an outline only and is not a contract. This plan contains certain exclusions and limitations as well as terms under which coverage may be continued or discontinued. Please refer to the certificate of insurance for a complete description of actual plan benefits and terms of coverage.

2. MEDICAL PLAN OPTIONS

3. 100% EMPLOYER PAID Employee Benefit: $15,000
DENTAL & VISION PLANS
Dental Principal
PPO DENTAL BENEFITS
Preventive Services
PAID AT 100%, NO DEDUCTIBLE
Routine Cleanings | Sealants | X-Rays
Basic Services
PAID AT 80%
Composite Fillings| Endodontics| Periodontics
Major Services
PAID AT 50%
Crowns | Dentures| Inlays | Onlays | Bridges
Orthodontic Services
(Children under age 19)
N/A
Calendar Year Maximum
$1,500
Annual Deductible
Individual / Family
$50 / $150
Monthly Employee Contributions
Employee Only
$46.58
Employee + Spouse
$89.00
Employee + Child(ren)
$96.00
Family $144.00
100% EMPLOYER PAID
Employee Benefit:
$15,000
Vision Principal
In Network Shown – See summary for complete Out of Network Reimbursement Schedule
Eye Exam / Materials
(every 12 months)
Plan pays 100% after $10 copay
Lenses (every 12 months)
Plan pays 100% after $25 copay
Frames (every 24 months)
Plan pays $130 retail allowance, then 20% off remaining balance
Contact Lenses (every 12 months in lieu of lenses/frames)
- Medically Necessary
$150 allowance, then 20% off remaining balance Plan pays up to $60 for fitting
$25 Copay
Monthly Employee Contributions
Employee Only
$9.51
Employee + Spouse
$18.00
Employee + Child(ren)
$19.00
Family $30.00

4. LONG TERM DISABILITY & EAP
Long Term Disability Principal
Eligible Members
All active, full time employees (except seasonal, temporary, or contract workers) who work at least 30 hours per week
Primary Monthly Benefit
60% or your predisability earnings up to $10,000
Benefit Amount/Definition of Earnings
Primary monthly benefit less other income sources/ Base Wage
Orthodontic Services
(Children under age 19)
N/A
Calendar Year Maximum
$1,500
Annual Deductible
Individual / Family
$50 / $150
Monthly Employee Contributions are based on the Employee’s Age
100% EMPLOYER PAID
Employee Benefit:
$15,000
Employee Assistance Program - Magellan Healthcare
Benefits / Enrollment / Claims Questions
Questions about Claims or Utilizing your Health Benefits?
Contact Kerri Ortiz at The Benefit Company
or Sloane Murray at or
In some cases, a HIPAA Authorization form may be requested
to allow us to serve as your advocate