1. Dachser USA Benefits

2. Short Term Disability
60% of weekly earnings up to $300 weekly based upon employee status
Begins after the 8th day of illness/accident (non work related)
Benefit period is 13 weeks
Premiums paid by Dachser USA

3. Long Term Disability 60% of earnings up to $6,000 of monthly salary
Begins at the cessation of the Short Term Disability
90 day waiting period
Benefits payable to age 65
Three month survivor benefit
Partial disability covered
Residual disability covered
Premiums paid by Dachser USA

4. Group Term Life Insurance
One times annual earnings up to $200,000
Accidental death benefits of one time annual earnings up to $200,000
Premiums paid by Dachser USA

5. Employee Voluntary Life Insurance
Benefit amounts available from $10,000 to $100,000
Spouse and dependent children benefits available
Coverage is portable after 12 months
Premiums paid by employee

6. Cost of Insurance
Open Access Plan CIGNA
Annual Gross Income Employee Employee Employee Family
+ Child(ren) Spouse
$40,000 - Under $ $ $ $230.00
$40,001 - $60,000 $ $ $ $250.00
$60,001 – Above $ $ $ $270.00
Deductions are per pay period and include medical, dental & vision insurance.

7. Medical Benefits CIGNA Open Access Plus Co-Pay
CIGNA In-Network Providers Calendar Year Deductible Individual $ Family $1, (Up to 3 members) Out of Pocket Maximum (Includes Deductible) Individual $2, Family $7,200.00
CIGNA Out-Of-Network Providers Calendar Year Deductible Individual $ 2, Family $ 7, (Up to 3 members) Out of Pocket Maximum (Includes Deductible) Individual $ 9, Family $28,800.00

8. Medical Benefits CIGNA Open Access Plus Co-Pay
CIGNA In-Network Providers Physician Office Visits Primary Care Physician $15 Co-Pay then 90% Specialist $30 Co-Pay then 90% Urgent Care $50 Co-Pay then 90% Preventive/Routine Services 100% Covered Emergency Room visit $ Co-Pay
CIGNA Out-Of-Network Providers All Physician Office Visits Subject to deductible and then 60% then 70% $ Co-Pay

9. Medical Benefits After the Deductible
CIGNA Open Access Plus Co-Pay
CIGNA In-Network Providers Inpatient Mental/Chemical Dependency 90% after the deductible Hospice and Home Care covered at 90% after the Deductible. Chiropractic, Occupational, Physical, and Speech therapy limit 20 visits annually $15 Co-Pay Primary Physician $30 Co-Pay Specialist
CIGNA Out-Of-Network Providers 60% after deductible

10. No Annual Maximum Yearly or Lifetime
Medical Benefits
CIGNA Open Access Plus Co-Pay
Retail Prescription Drugs Generic $15 Co-Pay Brand Name $40 Co-Pay Non-Preferred $60 Co-Pay
Mail Order (3 Months) Prescription Drugs Generic $ 30 Co-Pay Brand Name $ 80 Co-Pay Non-Preferred $120 Co-Pay
No Annual Maximum Yearly or Lifetime

11. Health Reimbursement Account CIGNA
Cost of Insurance
Health Reimbursement Account CIGNA
Annual Gross Income Employee Employee Employee Family
+ Child(ren) Spouse
$40,000 - Under $ $ $ $210.00
$40,001 - $60,000 $ $ $ $230.00
$60,001 – Above $ $ $ $250.00
Deductions are per pay period and include medical, dental and vision insurance.

12. CIGNA Health Reimbursement Account
Medical Benefits
CIGNA Health Reimbursement Account
Dachser USA will fund the first $1,000 (individual) and the first $2,000 (family) of the calendar year deductible. If not used during the year, the amount will carry over.
CIGNA In-Network Providers Calendar Year Deductible Individual $2, Family $4, (Up to 3 members) Out of Pocket Maximum (Includes Deductible) Individual $4, Family $8,000.00
CIGNA Out-Of-Network Providers Calendar Year Deductible Individual $ 8, Family $16, (Up to 3 members) Out of Pocket Maximum (Includes Deductible) Individual $16, Family $30,000.00

13. Medical Benefits CIGNA Health Reimbursement Account
CIGNA In-Network Providers All Physician Office Visits 90% After Deductible Routine/Preventive Care 100% Covered Emergency Room visit
CIGNA Out-Of-Network Providers All Physician Office Visits 60% After Deductible Routine/Preventive Care 70% After Deductible Emergency Room visit

14. Medical Benefits After the Deductible
CIGNA Health Reimbursement Account
CIGNA In-Network Providers Inpatient Mental/Chemical Dependency 90% after Deductible Hospice and Home Care 90% after Deductible. Chiropractic, Occupational, Physical, and Speech therapy limit 20 visits annually
CIGNA Out-Of-Network Providers 60% after deductible

15. Medical Benefits After the Deductible
CIGNA Health Reimbursement Account
CIGNA In-Network Providers (MRI, MRA, CAT Scan, PET Scan, etc.) at Physician office 90% after Deductible MRI, MRA, CAT Scan, PET Scan, etc.) Inpatient/Outpatient at hospital covered at 90% after deductible In-Patient Hospitalization
CIGNA Out-Of-Network Providers 60% after Deductible

16. No Annual Maximum Yearly or Lifetime
Medical Benefits
CIGNA Health Reimbursement Account
Retail Prescription Drugs Generic $15 Co-Pay Brand Name $40 Co-Pay Non-Preferred $60 Co-Pay
Mail Order (3 Months) Prescription Drugs Generic $ 30 Co-Pay Brand Name $ 80 Co-Pay Non-Preferred $120 Co-Pay
No Annual Maximum Yearly or Lifetime

17. Dental Benefits CIGNA Open Access Plus & Health Reimbursement Account
Preventive Services 100% Deductible Waived Calendar Year Deductible Individual $ 50 Family $150

18. Dental Benefits CIGNA Open Access Plus & Health Reimbursement Account
Basic Services 80% After Deductible Major Services 50% After Deductible Calendar Year Maximum $1, Orthodontia coverage 50% After Deductible up to Age 19. Maximum coverage $1000

19. Vision Care CIGNA Open Access Plus & Health Reimbursement Account
Vision Benefits
CIGNA In-Network Out-Of-Network Benefit
Routine Eye Exams Maximum Benefit
$ Copay per 12 Months Up to $45.00
Eyeglass Lenses (12) month Period
Single Vision 100% After Co-Pay Up to $32.00
Bifocial % After Co-Pay Up to $55.00
Trifocal % After Co-Pay Up to $65.00
Lenticular % After Co-Pay Up to $80.00
Frames (24) month Period
Up to $ Up to $66.00
Contacts (12) month Period
Elective Up to $ Up to $98.00
Therapeutic 100% Up to $210.00

20. CIGNA Global Health Benefits *must be a non USA citizen
Cost of Insurance
CIGNA Global Health Benefits *must be a non USA citizen
Annual Gross Income Employee Employee Employee Family
+ Child(ren) Spouse
$40,000 - Under $ $ $ $230.00
$40,001 - $60,000 $ $ $ $250.00
$60,001 – Above $ $ $ $270.00
Deductions are per pay period and include medical, dental & vision insurance.

21. Medical Benefits
CIGNA Global Health Benefits *must be a non USA citizen

22. Medical Benefits After the Deductible
CIGNA Global Health Benefits *must be a non USA citizen

23. Medical Benefits- Prescriptions
CIGNA Global Health (prescriptions) Benefits *must be a non USA citizen
No Annual Maximum Yearly or Lifetime

24. Dental Benefits Global Access Plan
CIGNA Global Health Benefits *must be a non USA citizen
- DENTAL

25. Vision Global Access Plan Benefits
CIGNA Global Vision Benefits *must be a non USA citizen

26. Flexible Spending
The Flexible Benefit Plan is an employer-sponsored plan that allows you to pay for certain premiums, eligible medical expenses and dependent care expenses on a pre-tax basis. Paying for these expenses with pre-tax dollars saves you money by lowering your taxable income.
Health Care Reimbursement FSA: $2,500 maximum per plan year. Dependent Care FSA: $5,000 per plan year maximum if married filing jointly or $2,500 per plan year maximum if single or married but filing separately.
You should only set aside amounts that you expect to incur during the plan year, January 1st – December 31st, Amounts can include expenses for yourself, your spouse or your dependents as long as you claim them as a dependent.
Any amounts left in your account at the end of the plan year will be forfeited; essentially use-it-or-lose-it. Therefore, please plan carefully when making your election. It cannot be changed during the plan year unless you have a qualified status change.