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By: Stefan Goodall
Professor Etti Barnoff
Employee Benefits
Employee Benefit Planning
2
Table of Contents
Introduction of the Business 3
Mission Statement 3
Group Life Insurance 4
Accidental and Health Risk 5
Health Plan 8
Group Dental 11
Long-Term Care 13
Flexible Spending Account 14
Defined Benefit Pension Plan 15
Defined Contribution Pension Plan 16
401(K) Plan 17
Conclusion 19
Reference 20
Comparison 21
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Introduction:
Virginia Energy & Savings Company (VESC) was formed in 2005 with over 1,000 employees in
Richmond, Virginia. By the year of 2015, we have expanded across the United States to New York and
California. Throughout the years that we have expanded our companies, we have also expanded
employment by tripling the amount the amount of when we initially started.We excel as a leader who will
provide clean, safe, renewable solar energy at a cost that outweighs our competitors. By trying to
implement widespread of energy efficiency retrofit project that is trying to pay for itself through the energy
savings can be complex undertaking. There has been a tremendous need to implement the energy efficiency
project throughout the world to reduce fossil fuel consumption, reduce greenhouse emis sions,reduce the
number of power plants being brought on the line, to reduce transmission and distribution line capacity
constraints,and to capture all the electricity that is being lost and wasted as it travels through the power
lines. With our company, we use renewable energy to harvest electricity, including wind, biomass fuel, and
water that will be able to power hydroelectric generating facilities. BESC operates one of the largest solar
power units with about 120 megawatts of solar capacity.
Mission Statement:
Virginia Energy & Savings Company is the largest solar power provider in the United States. Our company
makes energy that are available to homeowners, business,schools,non-profits and government
organizations for a lower price compared to what they are currently paying for energy that is being
generated by burning fossil fuels like coal, oil and natural gas.Our goal is to encourage customers and
public officials to think about putting energy efficiency first when they are making energy res ource
procurement or energy policy choices.
Equal Employment Opportunity:
Virginia Energy & Savings Company is an equal opportunity employer and is committed to having a
diverse workforce. Minorities, females, individuals with disabilities and veterans are encouraged to apply
for employment. BESC ensures a reasonable accommodation for all individuals protected by section 503 of
the Rehabilitation Act of 1973, the Vietnam Veterans’ Readjustment Act of 1972, and Title I of the
Americans with Disabilities Act of 1990, applicants that require accommodation in the application process
may contact 1-800-SAVINGS (728-4647) for assistance.
Benefits:
Virginia Energy & Savings Company strives to make your experience with our company as good as
possible by offering plans and programs with excellent coverage for employees and their families. All
employees are rewarded with a competitive salary and wide-ranging benefits. Here is a brief overview of
what may be included in your benefits:
 Medical Coverage
 Dental Coverage
 Vacation and Paid Holidays
 Long-Term Care Insurance
 Vision Coverage
 Short and Long-Term disability
 401(k) Plan
 Benefit Pension Plan
 Basic Life Insurance
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VESC Group Life Insurance:
Virginia Energy & Savings Company offers their full-time employees a term life insurance policy with a
death benefit that amounts to 1.5 times your annual base pay that is paid by us, the employers. In order to
be eligible for our benefits, you would have to be a full-time employee who is working 40 or more hours
per week. The coverage will begin after 30 days of employment. If you are covered underour group life
insurance plan, your beneficiary will receive a benefit that is equal to 1.5 times your annual salary. In the
charts that we have provided down below, you are able to see how much you or yourbeneficiaries will
receive from an accidental death or dismemberment on the ob. We also offer extra coverage for your
spouse ordependents.
Current 2015
Definitions of coverage and basic amounts Basic Group Life Insurance is equal to 1.5 times
your annual base pay (Employer pays)
Waiver of Premium in case of disability, life
coverage continues without any additional charges
(this is part of the Basic Group Coverage)
Convertibility, in case of termination of term life,
you as the employee may covert yourBasic Group
Life Insurance policy into a whole life policy
without evidence of insurability
Accelerated Benefit,, if an employee is diagnosed
with a terminal illness that is expected to result in
6 to 12 months (terminal illness includes AIDS, a
stroke, or Alzheimer’s disease), the employee can
collect up to 50% of the policy, up to a maximum
benefit of $50,000 to $250,000 while he/she is still
living
Accidental Death & Dismemberment Insurance is
equal to 1.5 times your annual base pay. Loss of
limb(s) or sight, the employer will pay 50% of
your AD&D coverage. Life Insurance will not pay
out of if you survive an accident; it pays only in
the event of your death (reference: 23: AD&D
Provisions). – Employer pays
Supplements & Additions (ALL) Additional Coverage (i.e. Supplement term life up
to 5 times your salary). This “additional” Coverage
is paid by the employee
Additional coverage (i.e. Accidental Death and
Dismemberment Insurance AD&D up to 5 times
your salary). Employer pays for Accidental Death
and Dismemberment (AD&D
Dependent Life Insurance can be purchased by full
time employee for spouse up to $25,000 in
benefits. Employee can purchase life insurance on
his/her own child, $5,000 per child
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Eligibility Regular, full-time employee working 40 hours per
week who are active at work
Financing (who pays for what coverage?) The Employer pays for AD&D based on the loss.
Loss of limb(s) or sight, the employer will pay
50% of your AD&D coverage.If multiple loss,
then the employer will pay 100% of your AD&D
coverage. Life Insurance will not pay out if you
survive an accident, it pays only in the event of
your death
The employer will pay 1.5 times your salary for
Basic Group Life Insurance
The employee pays for Dependent Life Insurance,
Supplemental and Accelerated Life insurances
Tax Implications Premium on coverage greater than $50,000 are
taxable income to you (based on the IRS Table
PS-58)
Death Benefits paid to the beneficiary are not
taxed (based on Dr. Baranoff’s Chapter 23)
Insurance Company Prudential Life Insurance Company (A+ Ratings
from A.M. Best)
Accelerated Death and Dismemberment (AD&D)
Current plans for 2015
What are the benefits for AD&D Accidental Death & Dismemberment Insurance is
equal to 1.5 times your annual base pay
Loss of limb(s) or sight, the employer will pay 5-
% of your AD&D coverage. Multiple Loss of the
employer will pay 100% of your AD&D coverage.
Life Insurance will not pay out if you survive an
accident, it will only pay out in the event of your
death (employer pays)
Eligibility Regular, full-time employees working 40 hours a
week who are active at work
Enrollment 30 days after employment
Cost and who pays for AD&D Company pays the full cost of Basic AD&D for
any full-time employee. Employees pay for any
supplemental coverage up to give times the annual
salary long-term
Evidence of Insurability Enrollment after the eligibility period means that
employee will have to provide evidence of
insurability (reference: Chapter 20: Provisions for
Eligibility)
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Provider: Insurance Co. with A.M. Best Rating Prudential Life Insurance Company (A+ Ratings
from A.M. Best)
Accelerated Death and Dismemberment (AD&D) Provisions:
Employee loss of: Percentage of loss from AD&D
Loss of hands 50%
Loss of eyes 50%
Loss of foot 50%
Multiple 100%
VESC Accident and Health Risks Coverage:
Sick life
Benefits for sick leave: The employee will receive regular pay for the time missed due to illness or injury
(non-occupational) up to seven days per calendar year.
Cost of sick time: Our company will pay 100% of the seven days
Short-Term Disability
Definition of disability: The total and continuous inability of the employee to preform each and every duty
of his or her regular occupation (inability to do your own job or a job for which you are qualified by
education and training, non-occupationaland occupational).
Benefits: Short-Term disability (STD) benefits are 70% of salary up to $5,000 per month after a seven-day
waiting period. The maximum length of benefits for STD is six months.
Premium: Virginia Energy & Savings Company pays STD premiums and deducts such as normal bus iness
expense.
Exclusions:
An employee cannot collect STD benefits underthe following conditions:
 For any period during which the employee is not under the care of physician
 Short-Term disability benefits are not paid for any period of disability caused by an intentionally
self-inflicted injury
 If the disability was incurred during war, whether declared or undeclared
 STD benefits are not paid for days during the period of disability used as sick-days personal
holidays, or vacation days
 If the employee is committing or attempting to commit a criminal act
Long-Term disability
Definition of disability: The total and continuous inability of the employee to engage in any and every
gainful occupation for which he or she is qualified or shall reasonably become qualified by reason of
training, education, or experience. (Inability to do a job for which you are qualified by education and
training, or inability to work at all, occupationaland non-occupational)
Benefits: LTD benefits are 60% of your basic monthly earnings, to a maximum of $5,000. Monthly LTD
benefit will be reduced by amounts received from other benefit programs such as Social Security, workers’
compensation, and any other coinciding retirement plan.
Cost of Coverage: The employee will pay the full cost through payroll deduction
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LTD Exclusions:
An employee cannot collect LTD benefits under the following conditions:
No benefits will be paid for disability caused by or resulting from:
 War or any act of war, whether declared or undeclared, or active, full-time military duty
 Attempted suicide or self-inflicted injury, while sane or insane
 Any act of aggression committed by the insured, or commission or attempted commission of a
felony or involvement in an illegal occupation
 Any preexisting conditions until the member has been enrolled in the program for at least 12
months
Taxations: Benefits are not taxable to the employee, because the employee pays the entire premium from
income after taxes
Termination: Your long-term disability insurance coverage will automatically terminate on the earliest of
the following:
 The date you are no longer actively employed
 The date you are eligible to retire without reduction of retirement benefits
 The date you enter the military force of any country for active, full-time duty
Current plans for 2015
What are the
Benefits
Sick Leave: 7 days,100% of pay, after the 7th day
then the employee will begin receiving Short-term
disability
STD: 7 days to 6 months, 70% of pay up to $5K
benefit per month
LTD: 6 months to age 65; 60% of pay up to $5K
per month coordinated with WC and SSDI
Eligibility Regular, full-time employees working 40 hours a
week who are active at work
Enrollment Coverage is automatic
When coverage begins 30 days after employment date
Cost and who pays for the STD and LTD? Company pays for short-term (full cost);
employees pay for long-term through payroll
deductions.
Definition of disability Definition of STD is from 7 days to 6 months,
unable to do your own job due to occupational and
non-occupationalrelated injury or illness.
Definition of LTD is from 6 months to 2 years,
unable to do any job related to yourtraining and
education; after 2 years unable to do any job due to
non-occupationaland occupationalinjury or
illness.
Evidence of Insurability Enrollment after the eligibility period means that
employee will have to provide evidence of
insurability (reference: Chapter 20: Provisions for
Eligibility)
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Provider (self-insured or insurance company),
A.M. Best Rating
Sick and Short term is Self-insured (Employer
pays)
Long Term Disability is insured by Aetna
Incorporated – A.M. Best Rating “A” for Excellent
(updated July 2015)
Tax Implication Employees do not pay taxes on premiums paid by
employer for STD; but in the case of receiving
benefits, taxes will be paid on the benefits
(reference: Chapter 23-Galaxy Max Company)
For LTD, employee pays the premium from
income after taxes, and benefits in the case of
disability are non-taxable.
VESC Health Plan
Virginia Energy & Saving Company has five health plans that only the employee can choose from, but if it
is for the employee and his family then the price will be doubled from what you see in the chart and we will
contribute $600 towards the premiums. Four of our plans are insured through Anthem BlueCross
BlueShield (rating A++), which are Indemnity, PPO HSA with a high deductible, and PPO. Our otherplan
is a HMO plan which is insured through Kaiser Permanente. Each of the plans has different premiums. The
indemnity and PPO has a premium that is paid by the employee after employer contribution,while the rest
are covered by the employer contribution. The deductibles vary also; the indemnity clause and PPO have
the lowest deductible while the HSA plans are respectively higher deductible, and the HMO has no
deductibles.
Anthem BCBS
Indemnity with
Networks
Anthem BCBS
PPO HSA with
high deductible
Anthem BCBS
PPO without
HSA with lowest
deductible
Kaiser
Permanente Staff
model HMO
Premiums that
employee has to
pay in addition
to employers
portion (if any)
$680 - $600 = $80
as an additional
fee from the
employee
$490 – $600 =
110
The employee
pays no additional
amount, but has
the option to put
$110 into his HSA
account
$630 - $600 = $30
as an additional fee
from the employee
$590 - $600 = $10
as an additional
monthly income
Benefits Comprehensive
medical package
with minimal
preventive care.
See any doctor
with no referrals
PCP & specialist,
Allergy testing,
Medical services
and supplies,x-
rays, laboratory,
hospital stay,
prescription drugs,
therapy visits,
maternity
Preventive care is
required by law is
covered, as in
other
comprehensive
plans (deductibles
does not apply)
x-rays
PCP
Specialist
Allergy testing
Prenatal
Prescription
Therapy visits
HSA: an account
where you put
Comprehensive
care medical
package with
minimal
preventive care,
with increased
preventive care
and well-baby
care. Medical
services &
Supplies,
inpatient/outpatient
care, doctorcare,
mental health care,
prescriptions, x-
rays, laboratory,
Most preventive
care, well baby,
baby physical
exams,
immunizations,
extended dental,
vision. And
prescription plans.
You have Low-
copay, accesses to
providers only in
quality
emergency.
Staff model:
facility (you can
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money in and use
it for medical use
It is transferable,
tax deductible,
contribute any
time of the year
therapy visits, ER
visits are waived if
admitted
go to a designated
facility) Need to
go see a
gatekeeper in
order to be
referred to a
specialist
Out of pocket
expenses
Deductible: $500
Coinsurance:
90/10
Copay:
20 for PCP
40 for specialist
Maximum per
year: $2,000
This is lower since
the premium is the
highest of the four
plans
$15 for
prescriptions
Deductible:
$2,550
Coinsurance:
80/20
Copay:
25 for PCP
45 for specialist
Maximum per
year: $6,550
$10 for
prescriptions
Deductible: $650
Coinsurance:
80/20
Copay:
35 for PCP
45 for specialist
Maximum per
year:
$2,500
$10 for
prescription
Deductible: $0
Coinsurance:
85/15
Copay:
15 for PCP
25 for specialist
Maximum per
year:
$1,500
$10 for
prescription
Choice of
providers (PCP,
specialist, etc)
No restrictions per
network can use
either with no
penalty
Access to any
provider in a large
network and
outside with
network (with
penalty)
Access to any
provider in a large
network and
outside with
network (with
penalty)
Staff model:
facility only.
Other models: in
networks only,
with PCP as a
gatekeeper
The way
providers are
being
reimbursed
FFS, subject to
usual, customary,
and reasonable
(UCR) limits
Discounted FFS Discounted FFS Staff model:
salaries + bonuses
COBRA:
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) health benefit provision
amended the Employee Retirement Income Security Act, the Internal Revenue Code and the public Health
Service Act to require employers with group health plans to offer employees the opportunity to continue
temporarily their group health care coverage undertheir employer’s plan if coverage ceases due to
termination, layoff, or change in employment status (commonly known as a qualifying events). Qualified
events are marriage, divorce, adoption of a child(ren), and death to a covered dependent,change in status or
eligibility of a dependent; that will cause the employee to lose eligibility.
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) will extend coverage for up to
eighteen (18) months when workers lose coverage because of termination or reduction of hours
(www.cobrainsurance.com/cobra_faq). The Act would extend coverage up to twenty-nine (29) months to
employees who are determined to have been disabled at any time during the first 60 days of COBRA
coverage. This applies to the disabled employee’s nondisabled qualified beneficiaries as well
(www.cobrainsurance.com/cobra_faq). The Act would extend up to thirty-six (36) months for spouses
and dependents facing a loss of employer-provided coverage due to an employee’s death,a divorce or legal
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separation,or other “qualifying events” (www.cobrainsurance.com/cobra_faq). COBRA insurance gives
you the exact same benefits and choices you had before leaving the company
(www.quickanddirtytips.com). The Employer does not have to pay for the premiums, and the premiums
may increase to the maximum rate allowed of the group rate.
Who is Eligible for COBRA Health Insurance?
You and your employer must meet certain requirements:
(a) Must provide a group health plan and have at least 20 or more employees on payroll. (Small
employer plans are exempt from COBRA; Certain church plans are not subject to COBRA)
(b) Eligible for COBRA when they voluntarily leave a job, have their work hours reduced and lost
benefits
(c) Or are terminated for any reason other than gross misconduct
(d) Spouses and dependent children of former employees are eligible if the covered worker, dies, is
eligible for Medicare, or if legally separated or divorced (www.quickanddirtytips.com ).
(e) An employer’s bankruptcy, only with respect to health coverage for retirees and their families
(www.cobrainsurance.com/cobra_faq)
(f) Federal Government’s Group Health Plans are not subject to COBRA. However a separate law,
Federal Employees Health Benefits Amendments Act of 1988 requires the Federal government to
offer its employee continuation coverage effective January 1, 1990
(www.cobrainsurance.com/cobra_faq).
How Would I receive COBRA Health Insurance Coverage?
 Employees must notify their Human Resources Department or Benefit Administrator within 30
days after one of the qualified events occurred.
 Beneficiaries of a qualified worker have up to 60 days to elect COBRA coverage after a qualifying
event(s), such as a divorce.
 After notifying your former employer of COBRA health coverage,they have to send you an
election notice within 14 days.
 After receiving the notice from your employer, you or your beneficiaries have up to 60 days to
decide whether or not to take the coverage. If you don’t make a decision by that time, you may
lose your right to claim COBRA benefits (www.quickanddirtytips.com)
If an employee waive COBRA coverage during the election period, can the employee still get coverage at a
later date? If a qualified beneficiary waives COBRA coverage during the election period, he or she may
revoke the waiver of coverage before the end of the election period. A beneficiary may then elect COBRA
coverage. Then, the plan need only provide continuation coverage beginning on the date the waiver is
revoked.
Who pays for COBRA coverage?
 The initial premium payment must be made within 45 days after the date of the COBRA election
by the qualified beneficiary. Payment generally must cover the period of coverage from the date
of COBRA election retroactive to the date of the loss of coverage due to the qualifying event.
Premiums for successive periods of coverage are due on the date stated in the plan with a 30-day
grace period for payments. Payment is considered to be made on the date it is sent to the plan.
 If premiums are not paid by the first day of the period of coverage, the plan has the option to
cancel coverage until payment is received and then reinstate coverage retroactively to the
beginning of the period of coverage.
HIPAA:
Health Insurance Portability and Accountability Act of 1996 (HIPPA) was enacted August 21, 1996 by the
United States Congress and signed by President Bill Clinton in 1996. This Act prohibits any insurer from
imposing pre-existing condition exclusions when an individual who is eligible transfers from one plan to
another. After an individual is covered in a health plan for twelve months, pre-existing condition
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exclusions no longer applies. Previous coverage would not qualify, if there is a break in health insurance
coverage for no more than sixty-three days. Most physician practices require you to sign a HIPAA privacy
act that includes written authorization of persons the ability to share information in yourmedical record.
Privacy Rules for HIPAA
The offices for Civil Rights enforce the HIPAA Privacy Rule, which will protect the privacy of individually
identifiable health information. The HIPAA Security Rule sets national standards for the security of
electronic protected health information. The HIPAA Notification Rule requires covered entities and
business associates to provide notification following a breach of unsecured protected health information
and the confidentiality provisions of the Patient Safety Rule, which will protect identifiable information
being used to analyze patient safety events and improve patient safety.
Protected Health Information (PHI)
Names Home Address Birthdate Fax Numbers
Biometric Finger
Prints
Certificate and License
Numbers
Telephone Numbers Admission Dates
Face Images Email Address Account Numbers Discharge Dates
Insurance Plan and
Recipient ID Numbers
Employer, Household
and Family Identifiers
Social Security
Numbers
Decease Dates
Health Plan
Beneficiary Numbers
Identifying Codes or
Characteristics
Medical Records
Numbers
Internet Protocol
Numbers
Group Dental Plan for VESC:
Virginia Energy Savings Company group dental provides coverage for dental work you may incur. Group
Dental plans are offered to our full-time employees working 40 or more hours per week and salaried
employees. Employees can enroll their spouse and children(s) to the dental plan with an additional
premium. Employees will be eligible and coverage is effective the first day of the month following
employment. Delta Dental has a mission statement for “Keeping Everyone Smiling”, Delta Dental of
Virginia offers access to the nation’s largest dentist network and delivering the best value for you as an
employee. With an A.M Best rating of A- for excellent, this company provides our employees a piece of
mind.
Participating Dentist will have a claim forms in the office and will complete and submit to Delta Dental at
no charge, Payments will be made directly to the dentist for covered benefits, and the dentist will accept
Delta Dental’s allowance for covered benefits (this means that you pay only the applicable coinsurance and
deductible for these covered services.
Non-Participating Dentist, you may be required to pay the non-participating dentist in advance for the
entire bill, complete claim forms and submit to Delta Dental. Payment will be made directly to you unless
dentist agrees to accept payment from Delta Dental. Non-participating dentists have not agreed to accept
Delta Dental’s allowance for their services. This means that, in addition to what delta Dental pays,you
must pay the applicable coinsurance and deductible and difference between the non-participating dentist’s
charges and Delta Dental’s payment for covered benefits.
Coverage Basic Expanded Benefit Limitations
Annual Benefit Maximum N/A $2,000/member
Annual Deductible N/A $50/member
$150/family
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Diagnostic and Preventive
1. Oral exams and
cleaning
2. Fluoride treatment
3. Bitewing X-rays
4. Full mouth or
panorex X-rays
 Emergency
treatment
 Space maintainers
5. Occlusal guards
6. TMJ orthotic devices
7. Sealants
100% 100% No deductible or Maximum
1. Twice in a plan
year
2. Twice in a plan
year for
dependents
under age 19
3. Twice in a plan
year
4. Once every
three years
5. Once every
three years
6. Once every
three years
7. Only for non-
carious, non-
restored 1st and
2nd permanent
molars for
dependent
children under
age 19, limited
to one
application per
tooth
Primary Dental Care
1. Restorative (silver
and toothcolored
filings; stainless stell
crowns, and other
restorative services)
2. Oral surgery (simple
extractions and other
minor surgical
procedures)
3. Endodontics (root
canal therapy and
other Endodontic
services)
4. Periodontics (scaling
and root planing, soft
tissue and bony
surgery, including
grafts, and other
Periodontic services)
N/A 80% Deductible Applies
1. Retreatment limited
to once per surface
in a 2 year period
2. Services covered
under medical
benefits are
excluded
3. Repeat treatment is
covered benefit only
after 2 years from
initial treatment
4. Limitation of 2-3
years applies based
on services rendered
twice in a plan year
5. Cost limited to ½
the cost of a new
denture or
prosthesis
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5. Denture repair and
recementation of
existing crowns,
bridges, and dentures
Major Dental Care
1. Crowns (single
crowns, inlays, and
onlays)
2. Prosthodontics
(partials or complete
dentures and fixed
bridges), Dental
Implants
N/A 50% Deductible Applies
1. Once per tooth
every 5 years,
crowns for
dependents under
the age of 12 are not
covered, inlays are
limited to the
benefit for resin
restoration unless
part of partial or
bridge abutment,
Onlays are limited
to the benefit for a
metallic restoration
2. Once every 5 years,
fixed bridges or
removable partials
are not covered for
dependents under
age 16.
Orthodontic Benefits
 Rmovable fixed
appliance therapy
and comprehensive
therapy
N/A 50% No Deductible
 For adults and
children.
Health Risk: Long-Term Care Insurance
Virginia Energy and Savings Company offer long-term insurance. This coverage will help cover cost you
may incur if you become unable to care for yourself in the future. These certain cost include nursing home
care, home-health care, or personal day care for employees who are over the age of 65.
You can begin receiving your benefits approximately 90 days after you have been identified as a
chronically ill person.Premium cost is deductible to the employer and they are non-taxable to the
employee. Once you have been identified then you do not have to continue paying for the premium.
All full –time working employees at VESC will be eligible for this type of coverage. A full-time employee
at VESC works at least 40 hours a week. An employee’s eligibility for this type of coverage depends on
their inability to preform a certain number of daily activities.
Benefits For the duration of 5 years, we will cover $300
of daily benefit
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Eligibility Regular, full-time employees (working 40 hours
per week and who are active)
When coverage begins You begin receiving your benefits approximately
90 days after you have been identified as a
chronically ill person
Tax Implication Employer premium payments are tax-deductible
Benefits underthe plan are not taxable to the
employee
Insurance Company State Farm with an A.M. Best Rating A++
Virginia Energy Savings Company Flexible Spending Account
The Virginia Energy Saving Company offers a flexible spending account (FSA) that can help you to pay
your out-of-pocket health care costs.The flexible spending account is a special account that you can put
money into without paying any taxes on this money. You can use the money to pay dependent care
expenses on a pretax dollar, medical, dental expense, and other miscellaneous such as eyeglasses.The
money deposited into the FSA is usable until the plan ends at the end of the year; therefore, if you don’t
spend the money before the plan ends at the end of the year, you lose the money (use it or lose it).
Virginia Energy and Savings Company’s FSA:
Eligibility Full-time employees who work 40 hours per
week and are active
When coverage starts Begins in employment or the beginning of each
year (January)
When coverage ends When your career ends as an employer for any
reasons or if your salary stops for any reasons such
as death, retirement or disability. You or your
survivor also can submit claims until the date you
left the payroll.
Contribution Employee can put up to $2,550 into FSA account
each year. To be used for qualified medical
expenses. Contributions will be deducted from
each paycheckbefore federal income tax.
Accounts Dependent day care accounts plus health care
accounts for health care expenses (tax-deductible
expense).
Maximum Dependent Care Assistance maximum is $5,000
Health care: $5,000 per year to each account.
If married and filing separate returns, the
maximum is $2,500.
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Reimbursement Eligible claims are paid monthly.
Reimbursements for insulin are allowed without a
prescription.
Minimum claim is $10 per month.
Also administrator must receive claims by June 1st
for the previous year’s expenses.
Unclaimed account balances must be forfeited.
Virginia Energy & Savings Company Standard Defined Benefit Pension Plan
Virginia Energy & Savings Company offers a standard defined benefit pension plan to its full-time
employees working 40 hours a week. The pension plan is a form of retirement plan to provide you as an
employee or yourbeneficiary with a monthly benefit.
Benefit Formula Using an unit credit formula, the Expected
Benefit at age 65 formula of 2.556% (allowed
compensation times 2.556% time Years of
Service to age 65).
Eligibility Full-time employees that are working 40 hours per
week. Must have worked 1,000 hours in a 12
month period
Normal Retirement Employee may retire and receive normal
retirement benefits or at retirement age 65
Early Retirement Employee may retire early and receive benefits on
or before age 65.
Employee is eligible for early retirement on the
first day or after age 65 with three years of vesting
service
Insured Defined Benefit Pension Plans are insured by the
Pension benefit Guaranty Corporation
Vesting Employee will become fully vested when you
complete three years o vesting services or reach
retirement at the age of 65
Payments:
Your payment plan will be paid out to you monthly at the end of each month. You also have the option for
a lump sum payment if the present value of your pension is less than your benefit payment options include:
 If you are single, you will receive a single life pension
 If you are married, you will receive a 50%, 75% or 100% joint and survivor annuity pension with
your spouse as the beneficiary. If you are married you can receive 50% survivorship pension with
your spouse as the beneficiary. If you are married and would like to receive your benefit in another
form, you will need to provide your spouse’s written consent.
16
The survivorship option pays out for as long as you live. Benefits that will be paid out depend on you r
age and your beneficiary’s age when you begin receiving payments.If you choose survivorship and the
beneficiary dies before you do, your amount will be increased to the amount you would receive under
the single life option. A social security leveling option is available with any of the benefit forms. This
leveling option pays a larger benefit until the participant is age 62 and then reduced payments after age
62.
The calculations for these plans can be seenbelow in the table:
Vesting
Virginia Energy & Savings Company chose to use a cliff vesting option for its employees. Employees
become 100% vested after three years of creditable service.
Loans
Loans are not available under the retirement pension plan
Distributions:
As a valued employee of VESC, you or yourbeneficiaries may choose one of the following distribution
options:
 Guaranteed Payment: you may choose to have your pension payments guaranteed for a certain
period of time after retirement. The payment options include five or ten years for a single lie
pension or five years for a survivorship pension benefit
 Lump-Sum Payment: you may request a lump-sum payment of $1,000 or more (in 100
increments) to your designated beneficiary or five years for a survivorship pension benefit
Pension Plan: Defined Contribution Plan:
VESC offers to its employees a money purchase defined contribution plan. This pension plan will offer you
and/oryour beneficiary with monthly benefits at retirement VESC sets the guidelines regarding eligibility,
retirement age, vesting schedules,and funding methods. Benefits at retirement are determined by the set
guidelines discussed furtherin the handbook.
Following the Employee Retirement Income Security Act (ERISA) guidelines, VESC can offer a maximum
of $265,000 compensation. Matching contributions are set at $53,000 or 100% of payroll.
Eligibility Regular full time or part time employees who work at least 1,000 hours in a 12
month period
Retirement Full benefits can be redeemed at the age of 65
Employees
Current
age Salary
Allowed
Comp.
Years of
service
Years of
service to
age 65 Max Benefit
Expected
Benefit at
age 65
(2.556%*Yrse
r*Comp)
Present value
of $1 annuity
for 20 years at
3%
Amount
needed at
Retirement
Years to
retirement
Future Value
of $1 annuity
at 3% for
period to
retirement
Annual
Contribution
at 3%
Top Employee 56 310,000 265,000 15 24 210,000 14.877 3,124,170.00$ 9 10.159 307,527.32$
VIRGINIA ENERGY AND SAVINGS COMPANY
Standard Defined Benefit Plan
17
Early retirement: early retirement benefits can be redeemed at the age of 65 with
five years of vesting service.
Insured Money purchase plans are not insured
Vesting Full vesting after completing 5 years of service or at retirement age of 65
Benefit Formula VESC will contribute a set 10% of annualearnings to the employee’s account up to
$53,000
Formula Calculations:
To further explain how the money purchase plan works, an example is provided in the following table:
At VESC we have a senior Engineer, John,who is 56 years old and has been with VESC for 24
years. He has an annual salary of $135,000 and chooses to match employer contributions of 10%
to his money purchase plan.
Salary Allowed
Compensation
(2014 ERISA
allows up to
$265,000)
Years
of
Service
Contribution
10%
($135,000 *
.10)
Years to
Retirement
Sum of
Annuity
of $1 at
10%
Potential Sum
of Retirement
(Annuity sum
at 10% *
annual
contribution)
$135,000 $135,000 24 $13,500 9 13.579 $183,316
The final sums of your retirement benefits vary by length of service, annual salary, retirement age, and
matching contributions by employee and by VESC
Creditable Service:
VESC counts services during times of approved leaves of absences,mandatory leaves for public service
(jury duty, military service, etc.) and periods defined under in long term disability, services considered as
creditable services. Part-time service is counted accordingly as it is.
Vesting Schedule:
VESC. uses a cliff vesting option for its employees. Employees are given 100% ownership in their
retirement plan after 6 years of service. Any termination or separation from VESC before that period,
employees have no right to the matching contributions made by VESC
See 401(k) Matching Contribution Vesting Schedule
Virginia Energy Savings Company 401 (K)
Virginia Energy Savings Company offers employees Section 401 (k) plan, which is also called VESC
401(k) plan, supplement to a retirement plan. Employees have the opportunity contribute the maximum
deferral of up to $18,000 on a pretax basis with Virginia Energy Savings Company cares about our
employees and to showthat we have an employer matching contributions to help build retirement savings.
Our 401(k) plan offers you several options of investing with varying portfolios to allow yoursavings to
grow in the future. The taxes are differed on the employer matching contributions,your pretax deferral,
and yourreturn on investments until withdraws are made from your account.
Eligibility
In order to be eligible for for Virginia Energy Savings Company 401(k) plan, you have to be a full-time
employee, completed one year of continuous service with the company, and must have completed a
minimum of 1,000 hours of services during a year. Enrollment starts on the first day of the following
month when you have completed that first year of the year of service. The employee does not qualify for a
401(k) plan if he or she is no longer employed.
Employer Matching
The employer matching contribution for any full-time employee will be 25 percent ($.25 for every $1.00)
that the employee contributes,up to 5 percent of yoursalary.
Vesting
18
Virginia Energy Savings Company's matching contribute have a vesting schedule of 20 percent for each
year of services and fully vested at after five years of services. Vesting is simply the right you have as a
employee to your money in your 401(k) account. Here is an example of our vesting schedule,if you as an
employee left VESC three years after joining the 401(k) plan and therefore you will have all the rights to
your investments and 60 percent of the matching funds.
Vesting Schedule for Matching Contribution:
Completed Yeas of Services Percentage Vested on Employer’s Matching
1 year 20%
2 year 40%
3 year 60%
4 year 80%
5 year 100%
Withdrawals
Employees can withdraw from their VESC 401(k) plans for certain hardships,as long two conditions are
met such as:
1. In order to withdraw from the 401(k) plan it must be a necessary and severe financial hardship such as:
-Medical expenses incurred by the participant or the participant's spouse or dependents
-Funeral or burial expenses for certain family members
-Preventing an eviction or foreclosure from a primary residence
-Expenses for repair of damage to an employee's principal residence
-Costs relating to the purchase of a principal residence
-Tuition and related educational fees and expenses
2. Funds from the VESC 401(k) plan are not available from any other resources. The requirements will be
deemed met from the following circumstances:
-Employee has obtain all distributions other than hardship distributions and non taxable loans are available
-Distribution does not go over the amount that is needed for the hardship
-Contributions will be suspended for12 months after the distribution and the maximum contribution in the
year following the suspension will be reduced by the amount contributed in the prior year.
Loans under the VESC 401(k)Plan
Loans taken from a VESC 401(k) plan has a minimum loan amount of $1,000 and maximum loan amount
is either $50,000 or 50 percent whichever is less of the vesting balance. There are two different option of
loans an employee can choose from:
-General Purpose: 6 to 60 months to repay back the loan
-Primary Residence: 61 to 180 months to repay back the loan. House, condominium, co-op, mobile home,
new home construction are eligible residence.
Investment
Employee bears all risk of investments associated with VESC 401(k) Savings Accounts. You as the
employee have several investment funds with Wells Fargo Bank, which you can select your own level of
risk.
-Virginia Energy Savings Company Stock Fund
-Wells Fargo Mutual Fund Center
-Invest Independently with WellsTrade
For more information contact a Wells Fargo Advisor, who can offer you the helpful support of an
investment professional
Termination
The VESC 401(k) plan will cease to exist when employment terminates.
Hypothetical Losses
The first loss/benefit payment scenario comes from the Life Insurance:
19
Mr. Smith, a 35-year-old full-time employee who makes an annual base salary of $42,250 dies in an
automobile accident on May 10, 2015 while leave church. The accident was not Mr. Smith fault. Claim
was reported on three days after the investigation on May 13, 2015. Mr. Smith is covered though VESC
Basic Life Insurance plan and Accidental Death & Dismemberment (AD&D).
The Beneficiary will receive the following benefits:
 1 ½ times pay of base salary or $63,375 from Prudential Insurance for basic life
 1 ½ times pay of base salary or $63,375 from Prudential Insurance for AD&D
Total amount of benefits received is $126,750.00
The second loss/benefit payment scenario comes from the Health Insurance:
Ms. Jane, a 30-year-old full time employee who has an emergency where she has to stay in the hospital for
four days with a cost of $300 per day for inpatient care. She also has to have 3 x-rays which cost $50 each.
Ms. Jane has health insurance from VESC, her coverage is a PPO plan with a low deductible. Her
coinsurance is 80/20, so she is responsible for 20 percent.
 Inpatient Hospital Services is $300 per stay
 $300 times 4 days equals a total of $1,200
 Her deductible is $650
 $1,200 minus the deductible $650 equals $550
 $550 * 20 percent equals $110
 $650 deductible plus $110 equals $760
 3 x-rays each cost $50 equals $150
 Total expense $760 plus $150 equals $910
 So Ms. Jane has to pay a total of $910.00
Conclusion
The management of VESC hopes that the benefits we offer are clear to you. Our studies indicate
that our benefits package far exceeds the norms of our industry. We are very interested in your
well-being, and this has motivated us to provide you with the best care possible. Should you have
questions, please contact our HR department at 11-800-SAVINGS (728-4647) or email us at
virginiaenergycorporate@vesc.com
20
References Page
Employee Benefit and Retirement Planning Textbook by Leimberg and McFadden
Enterprise and Individual Risk Management by Baranoff
Internal Revenue Service website
Dominion Resources website
Pension Benefit Guaranty Corporation website
Notes from class
“Spotlight on your benefits” published by Department of Human Resources
Management – Commonwealth of Virginia
21
This is a comparison of someone at Dominion Resources:
Dominion Medical Plan Summary of Benefits and Coverage Details: Anthem**
Option C
Website: anthem.com 1-800-348-1966;
Cost Sharing
Annual Individual Deductible $476 (in-network & out of network services
combined to satisfy deductible
Annual Family Deductible $952 (in-network & out of network services combined
to satisfy deductible
Out of Network Annual: Individual $476; Family $952; in-network & out of
network services combined to satisfy deductible
Lifetime Maximum: In network and Out of Net Work – No limit
Coinsurance Percentage: In Network: 80% covered; after the deductible is met
Coinsurance Percentage: Out of Network: 60% covered; after the deductible is
met
Annual Individual Out of Pocket Maximum $1912; includes deductible (in-
network)
Annual Family Out of Pocket Maximum $3824; includes deductible (in-network)
Out of Network Annual Individual Out of Pocket Maximum $3,346
Out of Network Annual Family Out of Pocket Maximum $6,692
Outpatient Services Option C
Primary Care (PCP) Office Copay: In Network: 80% covered; after the deductible
is met
Out of Network: 60% covered; after the deductible is met
Specialist Copay: In Network: 80% covered; after the deductible is met
Out of Network: 60% covered; after the deductible is met
Preventive Care Option C
Routine Exams In Network 100% Covered; Out of Network
Not covered
22
Other Preventive Services In Network 100% Covered; Out of Network
Not covered
Well woman exam (includes pap) In Network 100% Covered; Out of
Network Not covered
Mammogram In Network 100% Covered; Out of Network
Not covered
Immunizations In Network 100% Covered; Out of Network
Not covered
Pediatric Exams In Network 100% Covered; Out of Network
Not covered
Immunizations (child) In Network 100% Covered; Out of
Network Not covered
Outpatient Care
Outpatient lab/x-ray services In Network 80% Covered after deductible
is met;
Out of Network: 60% Covered after the
deductible is met
Outpatient X-ray In Network 80% Covered after deductible
is met;
Out of Network: 60% Covered after the
deductible is met
Outpatient surgery In Network 80% Covered after deductible
is met;
Out of Network: 60% Covered after the
deductible is met
Physical/Occupational therapy surgery In Network 80% Covered after
deductible is met;
Out of Network: 60% Covered after the
deductible is met
Family Planning/Maternity Care
Office Visit: Pre/postnatal In Network 80% Covered after deductible
is met;
Out of Network: 60% Covered after the
deductible is met
Hearing
Hearing Exams In Network: Not Covered
Out of Network: Not Covered
Hearing Aids In Network: Not Covered
Out of Network: Not Covered
Vision
23
Routine Vision Exams In Network: Not Covered
Out of Network: Not Covered
Glasses/contact lenses In Network: Not Covered
Out of Network: Not Covered
Inpatient Services
Inpatient Care
Inpatient lab and X-ray In Network: 80% covered; after deductible is met
Out of Network: 60% covered; after deductible is met; subject to
network allowance
Inpatient physician and surgeon services In Network: 80% covered; after
deductible is met
Out of Network: 60% covered; after deductible is met; subject to
network allowance
Inpatient Room and Board
Hospital Copay In Network: Not applicable; Out of Network: Not
applicable
Inpatient Hospital In Network: 80% covered after deductible is met;
preauthorization required;
Out of Network: 60% covered after deductible is met;
preauthorization required
Emergency Care
Emergency Room (not
followed by admission)
In Network $100 copay
(copay waived if
admitted)
then 80% covered after
deductible is met;
Out of Network $100
copay (copay waived if
admitted) then 80%
covered after deductible
is met
Urgent Care Clinic Visit In Network: 80% covered after deductible is met
Out of Network: 60% covered after deductible is met
Ambulance Services 80% covered after deductible is met
**Anthem; P. O. Box 105187 Atlanta GA 30348-5187
24
25
Basic Services Continued:
Routine Extractions, Endodontics (root canal therapy),Periodontics, Gingivoplasty
or gingivectomy:
In Network 90% covered; Out of Network: 80% Covered
Emergency Treatment for dental plan In Network: 100% covered; Out of
Network: 100% Covered
26
27
Tints In Network Covered in full; Out of Network: Not Covered
Frame Benefits In Network $0 copay; $80 retail allowance; 20% discount off
balance over $80; limited to one pair every other calendar year Out of Network
Up to $65 reimbursement; limited to one pair every other calendar year
Contact Lenses
Medically Necessary lenses In Network covered in full; Out of Network up to
$100 reimbursement
Elective Lenses In Network $0 copay; Up to $110 retail allowance; 15% discount
off balance over $110; limited to one pair every calendar year; in lieu of spectable
lenses.
28
Out of Network Up to $100 reimbursement
EyeMed Vision Care 4000 Luxottica Place Mason, Ohio 45040
29

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Virginia Energy & Savings Company

  • 1. 1 By: Stefan Goodall Professor Etti Barnoff Employee Benefits Employee Benefit Planning
  • 2. 2 Table of Contents Introduction of the Business 3 Mission Statement 3 Group Life Insurance 4 Accidental and Health Risk 5 Health Plan 8 Group Dental 11 Long-Term Care 13 Flexible Spending Account 14 Defined Benefit Pension Plan 15 Defined Contribution Pension Plan 16 401(K) Plan 17 Conclusion 19 Reference 20 Comparison 21
  • 3. 3 Introduction: Virginia Energy & Savings Company (VESC) was formed in 2005 with over 1,000 employees in Richmond, Virginia. By the year of 2015, we have expanded across the United States to New York and California. Throughout the years that we have expanded our companies, we have also expanded employment by tripling the amount the amount of when we initially started.We excel as a leader who will provide clean, safe, renewable solar energy at a cost that outweighs our competitors. By trying to implement widespread of energy efficiency retrofit project that is trying to pay for itself through the energy savings can be complex undertaking. There has been a tremendous need to implement the energy efficiency project throughout the world to reduce fossil fuel consumption, reduce greenhouse emis sions,reduce the number of power plants being brought on the line, to reduce transmission and distribution line capacity constraints,and to capture all the electricity that is being lost and wasted as it travels through the power lines. With our company, we use renewable energy to harvest electricity, including wind, biomass fuel, and water that will be able to power hydroelectric generating facilities. BESC operates one of the largest solar power units with about 120 megawatts of solar capacity. Mission Statement: Virginia Energy & Savings Company is the largest solar power provider in the United States. Our company makes energy that are available to homeowners, business,schools,non-profits and government organizations for a lower price compared to what they are currently paying for energy that is being generated by burning fossil fuels like coal, oil and natural gas.Our goal is to encourage customers and public officials to think about putting energy efficiency first when they are making energy res ource procurement or energy policy choices. Equal Employment Opportunity: Virginia Energy & Savings Company is an equal opportunity employer and is committed to having a diverse workforce. Minorities, females, individuals with disabilities and veterans are encouraged to apply for employment. BESC ensures a reasonable accommodation for all individuals protected by section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans’ Readjustment Act of 1972, and Title I of the Americans with Disabilities Act of 1990, applicants that require accommodation in the application process may contact 1-800-SAVINGS (728-4647) for assistance. Benefits: Virginia Energy & Savings Company strives to make your experience with our company as good as possible by offering plans and programs with excellent coverage for employees and their families. All employees are rewarded with a competitive salary and wide-ranging benefits. Here is a brief overview of what may be included in your benefits:  Medical Coverage  Dental Coverage  Vacation and Paid Holidays  Long-Term Care Insurance  Vision Coverage  Short and Long-Term disability  401(k) Plan  Benefit Pension Plan  Basic Life Insurance
  • 4. 4 VESC Group Life Insurance: Virginia Energy & Savings Company offers their full-time employees a term life insurance policy with a death benefit that amounts to 1.5 times your annual base pay that is paid by us, the employers. In order to be eligible for our benefits, you would have to be a full-time employee who is working 40 or more hours per week. The coverage will begin after 30 days of employment. If you are covered underour group life insurance plan, your beneficiary will receive a benefit that is equal to 1.5 times your annual salary. In the charts that we have provided down below, you are able to see how much you or yourbeneficiaries will receive from an accidental death or dismemberment on the ob. We also offer extra coverage for your spouse ordependents. Current 2015 Definitions of coverage and basic amounts Basic Group Life Insurance is equal to 1.5 times your annual base pay (Employer pays) Waiver of Premium in case of disability, life coverage continues without any additional charges (this is part of the Basic Group Coverage) Convertibility, in case of termination of term life, you as the employee may covert yourBasic Group Life Insurance policy into a whole life policy without evidence of insurability Accelerated Benefit,, if an employee is diagnosed with a terminal illness that is expected to result in 6 to 12 months (terminal illness includes AIDS, a stroke, or Alzheimer’s disease), the employee can collect up to 50% of the policy, up to a maximum benefit of $50,000 to $250,000 while he/she is still living Accidental Death & Dismemberment Insurance is equal to 1.5 times your annual base pay. Loss of limb(s) or sight, the employer will pay 50% of your AD&D coverage. Life Insurance will not pay out of if you survive an accident; it pays only in the event of your death (reference: 23: AD&D Provisions). – Employer pays Supplements & Additions (ALL) Additional Coverage (i.e. Supplement term life up to 5 times your salary). This “additional” Coverage is paid by the employee Additional coverage (i.e. Accidental Death and Dismemberment Insurance AD&D up to 5 times your salary). Employer pays for Accidental Death and Dismemberment (AD&D Dependent Life Insurance can be purchased by full time employee for spouse up to $25,000 in benefits. Employee can purchase life insurance on his/her own child, $5,000 per child
  • 5. 5 Eligibility Regular, full-time employee working 40 hours per week who are active at work Financing (who pays for what coverage?) The Employer pays for AD&D based on the loss. Loss of limb(s) or sight, the employer will pay 50% of your AD&D coverage.If multiple loss, then the employer will pay 100% of your AD&D coverage. Life Insurance will not pay out if you survive an accident, it pays only in the event of your death The employer will pay 1.5 times your salary for Basic Group Life Insurance The employee pays for Dependent Life Insurance, Supplemental and Accelerated Life insurances Tax Implications Premium on coverage greater than $50,000 are taxable income to you (based on the IRS Table PS-58) Death Benefits paid to the beneficiary are not taxed (based on Dr. Baranoff’s Chapter 23) Insurance Company Prudential Life Insurance Company (A+ Ratings from A.M. Best) Accelerated Death and Dismemberment (AD&D) Current plans for 2015 What are the benefits for AD&D Accidental Death & Dismemberment Insurance is equal to 1.5 times your annual base pay Loss of limb(s) or sight, the employer will pay 5- % of your AD&D coverage. Multiple Loss of the employer will pay 100% of your AD&D coverage. Life Insurance will not pay out if you survive an accident, it will only pay out in the event of your death (employer pays) Eligibility Regular, full-time employees working 40 hours a week who are active at work Enrollment 30 days after employment Cost and who pays for AD&D Company pays the full cost of Basic AD&D for any full-time employee. Employees pay for any supplemental coverage up to give times the annual salary long-term Evidence of Insurability Enrollment after the eligibility period means that employee will have to provide evidence of insurability (reference: Chapter 20: Provisions for Eligibility)
  • 6. 6 Provider: Insurance Co. with A.M. Best Rating Prudential Life Insurance Company (A+ Ratings from A.M. Best) Accelerated Death and Dismemberment (AD&D) Provisions: Employee loss of: Percentage of loss from AD&D Loss of hands 50% Loss of eyes 50% Loss of foot 50% Multiple 100% VESC Accident and Health Risks Coverage: Sick life Benefits for sick leave: The employee will receive regular pay for the time missed due to illness or injury (non-occupational) up to seven days per calendar year. Cost of sick time: Our company will pay 100% of the seven days Short-Term Disability Definition of disability: The total and continuous inability of the employee to preform each and every duty of his or her regular occupation (inability to do your own job or a job for which you are qualified by education and training, non-occupationaland occupational). Benefits: Short-Term disability (STD) benefits are 70% of salary up to $5,000 per month after a seven-day waiting period. The maximum length of benefits for STD is six months. Premium: Virginia Energy & Savings Company pays STD premiums and deducts such as normal bus iness expense. Exclusions: An employee cannot collect STD benefits underthe following conditions:  For any period during which the employee is not under the care of physician  Short-Term disability benefits are not paid for any period of disability caused by an intentionally self-inflicted injury  If the disability was incurred during war, whether declared or undeclared  STD benefits are not paid for days during the period of disability used as sick-days personal holidays, or vacation days  If the employee is committing or attempting to commit a criminal act Long-Term disability Definition of disability: The total and continuous inability of the employee to engage in any and every gainful occupation for which he or she is qualified or shall reasonably become qualified by reason of training, education, or experience. (Inability to do a job for which you are qualified by education and training, or inability to work at all, occupationaland non-occupational) Benefits: LTD benefits are 60% of your basic monthly earnings, to a maximum of $5,000. Monthly LTD benefit will be reduced by amounts received from other benefit programs such as Social Security, workers’ compensation, and any other coinciding retirement plan. Cost of Coverage: The employee will pay the full cost through payroll deduction
  • 7. 7 LTD Exclusions: An employee cannot collect LTD benefits under the following conditions: No benefits will be paid for disability caused by or resulting from:  War or any act of war, whether declared or undeclared, or active, full-time military duty  Attempted suicide or self-inflicted injury, while sane or insane  Any act of aggression committed by the insured, or commission or attempted commission of a felony or involvement in an illegal occupation  Any preexisting conditions until the member has been enrolled in the program for at least 12 months Taxations: Benefits are not taxable to the employee, because the employee pays the entire premium from income after taxes Termination: Your long-term disability insurance coverage will automatically terminate on the earliest of the following:  The date you are no longer actively employed  The date you are eligible to retire without reduction of retirement benefits  The date you enter the military force of any country for active, full-time duty Current plans for 2015 What are the Benefits Sick Leave: 7 days,100% of pay, after the 7th day then the employee will begin receiving Short-term disability STD: 7 days to 6 months, 70% of pay up to $5K benefit per month LTD: 6 months to age 65; 60% of pay up to $5K per month coordinated with WC and SSDI Eligibility Regular, full-time employees working 40 hours a week who are active at work Enrollment Coverage is automatic When coverage begins 30 days after employment date Cost and who pays for the STD and LTD? Company pays for short-term (full cost); employees pay for long-term through payroll deductions. Definition of disability Definition of STD is from 7 days to 6 months, unable to do your own job due to occupational and non-occupationalrelated injury or illness. Definition of LTD is from 6 months to 2 years, unable to do any job related to yourtraining and education; after 2 years unable to do any job due to non-occupationaland occupationalinjury or illness. Evidence of Insurability Enrollment after the eligibility period means that employee will have to provide evidence of insurability (reference: Chapter 20: Provisions for Eligibility)
  • 8. 8 Provider (self-insured or insurance company), A.M. Best Rating Sick and Short term is Self-insured (Employer pays) Long Term Disability is insured by Aetna Incorporated – A.M. Best Rating “A” for Excellent (updated July 2015) Tax Implication Employees do not pay taxes on premiums paid by employer for STD; but in the case of receiving benefits, taxes will be paid on the benefits (reference: Chapter 23-Galaxy Max Company) For LTD, employee pays the premium from income after taxes, and benefits in the case of disability are non-taxable. VESC Health Plan Virginia Energy & Saving Company has five health plans that only the employee can choose from, but if it is for the employee and his family then the price will be doubled from what you see in the chart and we will contribute $600 towards the premiums. Four of our plans are insured through Anthem BlueCross BlueShield (rating A++), which are Indemnity, PPO HSA with a high deductible, and PPO. Our otherplan is a HMO plan which is insured through Kaiser Permanente. Each of the plans has different premiums. The indemnity and PPO has a premium that is paid by the employee after employer contribution,while the rest are covered by the employer contribution. The deductibles vary also; the indemnity clause and PPO have the lowest deductible while the HSA plans are respectively higher deductible, and the HMO has no deductibles. Anthem BCBS Indemnity with Networks Anthem BCBS PPO HSA with high deductible Anthem BCBS PPO without HSA with lowest deductible Kaiser Permanente Staff model HMO Premiums that employee has to pay in addition to employers portion (if any) $680 - $600 = $80 as an additional fee from the employee $490 – $600 = 110 The employee pays no additional amount, but has the option to put $110 into his HSA account $630 - $600 = $30 as an additional fee from the employee $590 - $600 = $10 as an additional monthly income Benefits Comprehensive medical package with minimal preventive care. See any doctor with no referrals PCP & specialist, Allergy testing, Medical services and supplies,x- rays, laboratory, hospital stay, prescription drugs, therapy visits, maternity Preventive care is required by law is covered, as in other comprehensive plans (deductibles does not apply) x-rays PCP Specialist Allergy testing Prenatal Prescription Therapy visits HSA: an account where you put Comprehensive care medical package with minimal preventive care, with increased preventive care and well-baby care. Medical services & Supplies, inpatient/outpatient care, doctorcare, mental health care, prescriptions, x- rays, laboratory, Most preventive care, well baby, baby physical exams, immunizations, extended dental, vision. And prescription plans. You have Low- copay, accesses to providers only in quality emergency. Staff model: facility (you can
  • 9. 9 money in and use it for medical use It is transferable, tax deductible, contribute any time of the year therapy visits, ER visits are waived if admitted go to a designated facility) Need to go see a gatekeeper in order to be referred to a specialist Out of pocket expenses Deductible: $500 Coinsurance: 90/10 Copay: 20 for PCP 40 for specialist Maximum per year: $2,000 This is lower since the premium is the highest of the four plans $15 for prescriptions Deductible: $2,550 Coinsurance: 80/20 Copay: 25 for PCP 45 for specialist Maximum per year: $6,550 $10 for prescriptions Deductible: $650 Coinsurance: 80/20 Copay: 35 for PCP 45 for specialist Maximum per year: $2,500 $10 for prescription Deductible: $0 Coinsurance: 85/15 Copay: 15 for PCP 25 for specialist Maximum per year: $1,500 $10 for prescription Choice of providers (PCP, specialist, etc) No restrictions per network can use either with no penalty Access to any provider in a large network and outside with network (with penalty) Access to any provider in a large network and outside with network (with penalty) Staff model: facility only. Other models: in networks only, with PCP as a gatekeeper The way providers are being reimbursed FFS, subject to usual, customary, and reasonable (UCR) limits Discounted FFS Discounted FFS Staff model: salaries + bonuses COBRA: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) health benefit provision amended the Employee Retirement Income Security Act, the Internal Revenue Code and the public Health Service Act to require employers with group health plans to offer employees the opportunity to continue temporarily their group health care coverage undertheir employer’s plan if coverage ceases due to termination, layoff, or change in employment status (commonly known as a qualifying events). Qualified events are marriage, divorce, adoption of a child(ren), and death to a covered dependent,change in status or eligibility of a dependent; that will cause the employee to lose eligibility. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) will extend coverage for up to eighteen (18) months when workers lose coverage because of termination or reduction of hours (www.cobrainsurance.com/cobra_faq). The Act would extend coverage up to twenty-nine (29) months to employees who are determined to have been disabled at any time during the first 60 days of COBRA coverage. This applies to the disabled employee’s nondisabled qualified beneficiaries as well (www.cobrainsurance.com/cobra_faq). The Act would extend up to thirty-six (36) months for spouses and dependents facing a loss of employer-provided coverage due to an employee’s death,a divorce or legal
  • 10. 10 separation,or other “qualifying events” (www.cobrainsurance.com/cobra_faq). COBRA insurance gives you the exact same benefits and choices you had before leaving the company (www.quickanddirtytips.com). The Employer does not have to pay for the premiums, and the premiums may increase to the maximum rate allowed of the group rate. Who is Eligible for COBRA Health Insurance? You and your employer must meet certain requirements: (a) Must provide a group health plan and have at least 20 or more employees on payroll. (Small employer plans are exempt from COBRA; Certain church plans are not subject to COBRA) (b) Eligible for COBRA when they voluntarily leave a job, have their work hours reduced and lost benefits (c) Or are terminated for any reason other than gross misconduct (d) Spouses and dependent children of former employees are eligible if the covered worker, dies, is eligible for Medicare, or if legally separated or divorced (www.quickanddirtytips.com ). (e) An employer’s bankruptcy, only with respect to health coverage for retirees and their families (www.cobrainsurance.com/cobra_faq) (f) Federal Government’s Group Health Plans are not subject to COBRA. However a separate law, Federal Employees Health Benefits Amendments Act of 1988 requires the Federal government to offer its employee continuation coverage effective January 1, 1990 (www.cobrainsurance.com/cobra_faq). How Would I receive COBRA Health Insurance Coverage?  Employees must notify their Human Resources Department or Benefit Administrator within 30 days after one of the qualified events occurred.  Beneficiaries of a qualified worker have up to 60 days to elect COBRA coverage after a qualifying event(s), such as a divorce.  After notifying your former employer of COBRA health coverage,they have to send you an election notice within 14 days.  After receiving the notice from your employer, you or your beneficiaries have up to 60 days to decide whether or not to take the coverage. If you don’t make a decision by that time, you may lose your right to claim COBRA benefits (www.quickanddirtytips.com) If an employee waive COBRA coverage during the election period, can the employee still get coverage at a later date? If a qualified beneficiary waives COBRA coverage during the election period, he or she may revoke the waiver of coverage before the end of the election period. A beneficiary may then elect COBRA coverage. Then, the plan need only provide continuation coverage beginning on the date the waiver is revoked. Who pays for COBRA coverage?  The initial premium payment must be made within 45 days after the date of the COBRA election by the qualified beneficiary. Payment generally must cover the period of coverage from the date of COBRA election retroactive to the date of the loss of coverage due to the qualifying event. Premiums for successive periods of coverage are due on the date stated in the plan with a 30-day grace period for payments. Payment is considered to be made on the date it is sent to the plan.  If premiums are not paid by the first day of the period of coverage, the plan has the option to cancel coverage until payment is received and then reinstate coverage retroactively to the beginning of the period of coverage. HIPAA: Health Insurance Portability and Accountability Act of 1996 (HIPPA) was enacted August 21, 1996 by the United States Congress and signed by President Bill Clinton in 1996. This Act prohibits any insurer from imposing pre-existing condition exclusions when an individual who is eligible transfers from one plan to another. After an individual is covered in a health plan for twelve months, pre-existing condition
  • 11. 11 exclusions no longer applies. Previous coverage would not qualify, if there is a break in health insurance coverage for no more than sixty-three days. Most physician practices require you to sign a HIPAA privacy act that includes written authorization of persons the ability to share information in yourmedical record. Privacy Rules for HIPAA The offices for Civil Rights enforce the HIPAA Privacy Rule, which will protect the privacy of individually identifiable health information. The HIPAA Security Rule sets national standards for the security of electronic protected health information. The HIPAA Notification Rule requires covered entities and business associates to provide notification following a breach of unsecured protected health information and the confidentiality provisions of the Patient Safety Rule, which will protect identifiable information being used to analyze patient safety events and improve patient safety. Protected Health Information (PHI) Names Home Address Birthdate Fax Numbers Biometric Finger Prints Certificate and License Numbers Telephone Numbers Admission Dates Face Images Email Address Account Numbers Discharge Dates Insurance Plan and Recipient ID Numbers Employer, Household and Family Identifiers Social Security Numbers Decease Dates Health Plan Beneficiary Numbers Identifying Codes or Characteristics Medical Records Numbers Internet Protocol Numbers Group Dental Plan for VESC: Virginia Energy Savings Company group dental provides coverage for dental work you may incur. Group Dental plans are offered to our full-time employees working 40 or more hours per week and salaried employees. Employees can enroll their spouse and children(s) to the dental plan with an additional premium. Employees will be eligible and coverage is effective the first day of the month following employment. Delta Dental has a mission statement for “Keeping Everyone Smiling”, Delta Dental of Virginia offers access to the nation’s largest dentist network and delivering the best value for you as an employee. With an A.M Best rating of A- for excellent, this company provides our employees a piece of mind. Participating Dentist will have a claim forms in the office and will complete and submit to Delta Dental at no charge, Payments will be made directly to the dentist for covered benefits, and the dentist will accept Delta Dental’s allowance for covered benefits (this means that you pay only the applicable coinsurance and deductible for these covered services. Non-Participating Dentist, you may be required to pay the non-participating dentist in advance for the entire bill, complete claim forms and submit to Delta Dental. Payment will be made directly to you unless dentist agrees to accept payment from Delta Dental. Non-participating dentists have not agreed to accept Delta Dental’s allowance for their services. This means that, in addition to what delta Dental pays,you must pay the applicable coinsurance and deductible and difference between the non-participating dentist’s charges and Delta Dental’s payment for covered benefits. Coverage Basic Expanded Benefit Limitations Annual Benefit Maximum N/A $2,000/member Annual Deductible N/A $50/member $150/family
  • 12. 12 Diagnostic and Preventive 1. Oral exams and cleaning 2. Fluoride treatment 3. Bitewing X-rays 4. Full mouth or panorex X-rays  Emergency treatment  Space maintainers 5. Occlusal guards 6. TMJ orthotic devices 7. Sealants 100% 100% No deductible or Maximum 1. Twice in a plan year 2. Twice in a plan year for dependents under age 19 3. Twice in a plan year 4. Once every three years 5. Once every three years 6. Once every three years 7. Only for non- carious, non- restored 1st and 2nd permanent molars for dependent children under age 19, limited to one application per tooth Primary Dental Care 1. Restorative (silver and toothcolored filings; stainless stell crowns, and other restorative services) 2. Oral surgery (simple extractions and other minor surgical procedures) 3. Endodontics (root canal therapy and other Endodontic services) 4. Periodontics (scaling and root planing, soft tissue and bony surgery, including grafts, and other Periodontic services) N/A 80% Deductible Applies 1. Retreatment limited to once per surface in a 2 year period 2. Services covered under medical benefits are excluded 3. Repeat treatment is covered benefit only after 2 years from initial treatment 4. Limitation of 2-3 years applies based on services rendered twice in a plan year 5. Cost limited to ½ the cost of a new denture or prosthesis
  • 13. 13 5. Denture repair and recementation of existing crowns, bridges, and dentures Major Dental Care 1. Crowns (single crowns, inlays, and onlays) 2. Prosthodontics (partials or complete dentures and fixed bridges), Dental Implants N/A 50% Deductible Applies 1. Once per tooth every 5 years, crowns for dependents under the age of 12 are not covered, inlays are limited to the benefit for resin restoration unless part of partial or bridge abutment, Onlays are limited to the benefit for a metallic restoration 2. Once every 5 years, fixed bridges or removable partials are not covered for dependents under age 16. Orthodontic Benefits  Rmovable fixed appliance therapy and comprehensive therapy N/A 50% No Deductible  For adults and children. Health Risk: Long-Term Care Insurance Virginia Energy and Savings Company offer long-term insurance. This coverage will help cover cost you may incur if you become unable to care for yourself in the future. These certain cost include nursing home care, home-health care, or personal day care for employees who are over the age of 65. You can begin receiving your benefits approximately 90 days after you have been identified as a chronically ill person.Premium cost is deductible to the employer and they are non-taxable to the employee. Once you have been identified then you do not have to continue paying for the premium. All full –time working employees at VESC will be eligible for this type of coverage. A full-time employee at VESC works at least 40 hours a week. An employee’s eligibility for this type of coverage depends on their inability to preform a certain number of daily activities. Benefits For the duration of 5 years, we will cover $300 of daily benefit
  • 14. 14 Eligibility Regular, full-time employees (working 40 hours per week and who are active) When coverage begins You begin receiving your benefits approximately 90 days after you have been identified as a chronically ill person Tax Implication Employer premium payments are tax-deductible Benefits underthe plan are not taxable to the employee Insurance Company State Farm with an A.M. Best Rating A++ Virginia Energy Savings Company Flexible Spending Account The Virginia Energy Saving Company offers a flexible spending account (FSA) that can help you to pay your out-of-pocket health care costs.The flexible spending account is a special account that you can put money into without paying any taxes on this money. You can use the money to pay dependent care expenses on a pretax dollar, medical, dental expense, and other miscellaneous such as eyeglasses.The money deposited into the FSA is usable until the plan ends at the end of the year; therefore, if you don’t spend the money before the plan ends at the end of the year, you lose the money (use it or lose it). Virginia Energy and Savings Company’s FSA: Eligibility Full-time employees who work 40 hours per week and are active When coverage starts Begins in employment or the beginning of each year (January) When coverage ends When your career ends as an employer for any reasons or if your salary stops for any reasons such as death, retirement or disability. You or your survivor also can submit claims until the date you left the payroll. Contribution Employee can put up to $2,550 into FSA account each year. To be used for qualified medical expenses. Contributions will be deducted from each paycheckbefore federal income tax. Accounts Dependent day care accounts plus health care accounts for health care expenses (tax-deductible expense). Maximum Dependent Care Assistance maximum is $5,000 Health care: $5,000 per year to each account. If married and filing separate returns, the maximum is $2,500.
  • 15. 15 Reimbursement Eligible claims are paid monthly. Reimbursements for insulin are allowed without a prescription. Minimum claim is $10 per month. Also administrator must receive claims by June 1st for the previous year’s expenses. Unclaimed account balances must be forfeited. Virginia Energy & Savings Company Standard Defined Benefit Pension Plan Virginia Energy & Savings Company offers a standard defined benefit pension plan to its full-time employees working 40 hours a week. The pension plan is a form of retirement plan to provide you as an employee or yourbeneficiary with a monthly benefit. Benefit Formula Using an unit credit formula, the Expected Benefit at age 65 formula of 2.556% (allowed compensation times 2.556% time Years of Service to age 65). Eligibility Full-time employees that are working 40 hours per week. Must have worked 1,000 hours in a 12 month period Normal Retirement Employee may retire and receive normal retirement benefits or at retirement age 65 Early Retirement Employee may retire early and receive benefits on or before age 65. Employee is eligible for early retirement on the first day or after age 65 with three years of vesting service Insured Defined Benefit Pension Plans are insured by the Pension benefit Guaranty Corporation Vesting Employee will become fully vested when you complete three years o vesting services or reach retirement at the age of 65 Payments: Your payment plan will be paid out to you monthly at the end of each month. You also have the option for a lump sum payment if the present value of your pension is less than your benefit payment options include:  If you are single, you will receive a single life pension  If you are married, you will receive a 50%, 75% or 100% joint and survivor annuity pension with your spouse as the beneficiary. If you are married you can receive 50% survivorship pension with your spouse as the beneficiary. If you are married and would like to receive your benefit in another form, you will need to provide your spouse’s written consent.
  • 16. 16 The survivorship option pays out for as long as you live. Benefits that will be paid out depend on you r age and your beneficiary’s age when you begin receiving payments.If you choose survivorship and the beneficiary dies before you do, your amount will be increased to the amount you would receive under the single life option. A social security leveling option is available with any of the benefit forms. This leveling option pays a larger benefit until the participant is age 62 and then reduced payments after age 62. The calculations for these plans can be seenbelow in the table: Vesting Virginia Energy & Savings Company chose to use a cliff vesting option for its employees. Employees become 100% vested after three years of creditable service. Loans Loans are not available under the retirement pension plan Distributions: As a valued employee of VESC, you or yourbeneficiaries may choose one of the following distribution options:  Guaranteed Payment: you may choose to have your pension payments guaranteed for a certain period of time after retirement. The payment options include five or ten years for a single lie pension or five years for a survivorship pension benefit  Lump-Sum Payment: you may request a lump-sum payment of $1,000 or more (in 100 increments) to your designated beneficiary or five years for a survivorship pension benefit Pension Plan: Defined Contribution Plan: VESC offers to its employees a money purchase defined contribution plan. This pension plan will offer you and/oryour beneficiary with monthly benefits at retirement VESC sets the guidelines regarding eligibility, retirement age, vesting schedules,and funding methods. Benefits at retirement are determined by the set guidelines discussed furtherin the handbook. Following the Employee Retirement Income Security Act (ERISA) guidelines, VESC can offer a maximum of $265,000 compensation. Matching contributions are set at $53,000 or 100% of payroll. Eligibility Regular full time or part time employees who work at least 1,000 hours in a 12 month period Retirement Full benefits can be redeemed at the age of 65 Employees Current age Salary Allowed Comp. Years of service Years of service to age 65 Max Benefit Expected Benefit at age 65 (2.556%*Yrse r*Comp) Present value of $1 annuity for 20 years at 3% Amount needed at Retirement Years to retirement Future Value of $1 annuity at 3% for period to retirement Annual Contribution at 3% Top Employee 56 310,000 265,000 15 24 210,000 14.877 3,124,170.00$ 9 10.159 307,527.32$ VIRGINIA ENERGY AND SAVINGS COMPANY Standard Defined Benefit Plan
  • 17. 17 Early retirement: early retirement benefits can be redeemed at the age of 65 with five years of vesting service. Insured Money purchase plans are not insured Vesting Full vesting after completing 5 years of service or at retirement age of 65 Benefit Formula VESC will contribute a set 10% of annualearnings to the employee’s account up to $53,000 Formula Calculations: To further explain how the money purchase plan works, an example is provided in the following table: At VESC we have a senior Engineer, John,who is 56 years old and has been with VESC for 24 years. He has an annual salary of $135,000 and chooses to match employer contributions of 10% to his money purchase plan. Salary Allowed Compensation (2014 ERISA allows up to $265,000) Years of Service Contribution 10% ($135,000 * .10) Years to Retirement Sum of Annuity of $1 at 10% Potential Sum of Retirement (Annuity sum at 10% * annual contribution) $135,000 $135,000 24 $13,500 9 13.579 $183,316 The final sums of your retirement benefits vary by length of service, annual salary, retirement age, and matching contributions by employee and by VESC Creditable Service: VESC counts services during times of approved leaves of absences,mandatory leaves for public service (jury duty, military service, etc.) and periods defined under in long term disability, services considered as creditable services. Part-time service is counted accordingly as it is. Vesting Schedule: VESC. uses a cliff vesting option for its employees. Employees are given 100% ownership in their retirement plan after 6 years of service. Any termination or separation from VESC before that period, employees have no right to the matching contributions made by VESC See 401(k) Matching Contribution Vesting Schedule Virginia Energy Savings Company 401 (K) Virginia Energy Savings Company offers employees Section 401 (k) plan, which is also called VESC 401(k) plan, supplement to a retirement plan. Employees have the opportunity contribute the maximum deferral of up to $18,000 on a pretax basis with Virginia Energy Savings Company cares about our employees and to showthat we have an employer matching contributions to help build retirement savings. Our 401(k) plan offers you several options of investing with varying portfolios to allow yoursavings to grow in the future. The taxes are differed on the employer matching contributions,your pretax deferral, and yourreturn on investments until withdraws are made from your account. Eligibility In order to be eligible for for Virginia Energy Savings Company 401(k) plan, you have to be a full-time employee, completed one year of continuous service with the company, and must have completed a minimum of 1,000 hours of services during a year. Enrollment starts on the first day of the following month when you have completed that first year of the year of service. The employee does not qualify for a 401(k) plan if he or she is no longer employed. Employer Matching The employer matching contribution for any full-time employee will be 25 percent ($.25 for every $1.00) that the employee contributes,up to 5 percent of yoursalary. Vesting
  • 18. 18 Virginia Energy Savings Company's matching contribute have a vesting schedule of 20 percent for each year of services and fully vested at after five years of services. Vesting is simply the right you have as a employee to your money in your 401(k) account. Here is an example of our vesting schedule,if you as an employee left VESC three years after joining the 401(k) plan and therefore you will have all the rights to your investments and 60 percent of the matching funds. Vesting Schedule for Matching Contribution: Completed Yeas of Services Percentage Vested on Employer’s Matching 1 year 20% 2 year 40% 3 year 60% 4 year 80% 5 year 100% Withdrawals Employees can withdraw from their VESC 401(k) plans for certain hardships,as long two conditions are met such as: 1. In order to withdraw from the 401(k) plan it must be a necessary and severe financial hardship such as: -Medical expenses incurred by the participant or the participant's spouse or dependents -Funeral or burial expenses for certain family members -Preventing an eviction or foreclosure from a primary residence -Expenses for repair of damage to an employee's principal residence -Costs relating to the purchase of a principal residence -Tuition and related educational fees and expenses 2. Funds from the VESC 401(k) plan are not available from any other resources. The requirements will be deemed met from the following circumstances: -Employee has obtain all distributions other than hardship distributions and non taxable loans are available -Distribution does not go over the amount that is needed for the hardship -Contributions will be suspended for12 months after the distribution and the maximum contribution in the year following the suspension will be reduced by the amount contributed in the prior year. Loans under the VESC 401(k)Plan Loans taken from a VESC 401(k) plan has a minimum loan amount of $1,000 and maximum loan amount is either $50,000 or 50 percent whichever is less of the vesting balance. There are two different option of loans an employee can choose from: -General Purpose: 6 to 60 months to repay back the loan -Primary Residence: 61 to 180 months to repay back the loan. House, condominium, co-op, mobile home, new home construction are eligible residence. Investment Employee bears all risk of investments associated with VESC 401(k) Savings Accounts. You as the employee have several investment funds with Wells Fargo Bank, which you can select your own level of risk. -Virginia Energy Savings Company Stock Fund -Wells Fargo Mutual Fund Center -Invest Independently with WellsTrade For more information contact a Wells Fargo Advisor, who can offer you the helpful support of an investment professional Termination The VESC 401(k) plan will cease to exist when employment terminates. Hypothetical Losses The first loss/benefit payment scenario comes from the Life Insurance:
  • 19. 19 Mr. Smith, a 35-year-old full-time employee who makes an annual base salary of $42,250 dies in an automobile accident on May 10, 2015 while leave church. The accident was not Mr. Smith fault. Claim was reported on three days after the investigation on May 13, 2015. Mr. Smith is covered though VESC Basic Life Insurance plan and Accidental Death & Dismemberment (AD&D). The Beneficiary will receive the following benefits:  1 ½ times pay of base salary or $63,375 from Prudential Insurance for basic life  1 ½ times pay of base salary or $63,375 from Prudential Insurance for AD&D Total amount of benefits received is $126,750.00 The second loss/benefit payment scenario comes from the Health Insurance: Ms. Jane, a 30-year-old full time employee who has an emergency where she has to stay in the hospital for four days with a cost of $300 per day for inpatient care. She also has to have 3 x-rays which cost $50 each. Ms. Jane has health insurance from VESC, her coverage is a PPO plan with a low deductible. Her coinsurance is 80/20, so she is responsible for 20 percent.  Inpatient Hospital Services is $300 per stay  $300 times 4 days equals a total of $1,200  Her deductible is $650  $1,200 minus the deductible $650 equals $550  $550 * 20 percent equals $110  $650 deductible plus $110 equals $760  3 x-rays each cost $50 equals $150  Total expense $760 plus $150 equals $910  So Ms. Jane has to pay a total of $910.00 Conclusion The management of VESC hopes that the benefits we offer are clear to you. Our studies indicate that our benefits package far exceeds the norms of our industry. We are very interested in your well-being, and this has motivated us to provide you with the best care possible. Should you have questions, please contact our HR department at 11-800-SAVINGS (728-4647) or email us at virginiaenergycorporate@vesc.com
  • 20. 20 References Page Employee Benefit and Retirement Planning Textbook by Leimberg and McFadden Enterprise and Individual Risk Management by Baranoff Internal Revenue Service website Dominion Resources website Pension Benefit Guaranty Corporation website Notes from class “Spotlight on your benefits” published by Department of Human Resources Management – Commonwealth of Virginia
  • 21. 21 This is a comparison of someone at Dominion Resources: Dominion Medical Plan Summary of Benefits and Coverage Details: Anthem** Option C Website: anthem.com 1-800-348-1966; Cost Sharing Annual Individual Deductible $476 (in-network & out of network services combined to satisfy deductible Annual Family Deductible $952 (in-network & out of network services combined to satisfy deductible Out of Network Annual: Individual $476; Family $952; in-network & out of network services combined to satisfy deductible Lifetime Maximum: In network and Out of Net Work – No limit Coinsurance Percentage: In Network: 80% covered; after the deductible is met Coinsurance Percentage: Out of Network: 60% covered; after the deductible is met Annual Individual Out of Pocket Maximum $1912; includes deductible (in- network) Annual Family Out of Pocket Maximum $3824; includes deductible (in-network) Out of Network Annual Individual Out of Pocket Maximum $3,346 Out of Network Annual Family Out of Pocket Maximum $6,692 Outpatient Services Option C Primary Care (PCP) Office Copay: In Network: 80% covered; after the deductible is met Out of Network: 60% covered; after the deductible is met Specialist Copay: In Network: 80% covered; after the deductible is met Out of Network: 60% covered; after the deductible is met Preventive Care Option C Routine Exams In Network 100% Covered; Out of Network Not covered
  • 22. 22 Other Preventive Services In Network 100% Covered; Out of Network Not covered Well woman exam (includes pap) In Network 100% Covered; Out of Network Not covered Mammogram In Network 100% Covered; Out of Network Not covered Immunizations In Network 100% Covered; Out of Network Not covered Pediatric Exams In Network 100% Covered; Out of Network Not covered Immunizations (child) In Network 100% Covered; Out of Network Not covered Outpatient Care Outpatient lab/x-ray services In Network 80% Covered after deductible is met; Out of Network: 60% Covered after the deductible is met Outpatient X-ray In Network 80% Covered after deductible is met; Out of Network: 60% Covered after the deductible is met Outpatient surgery In Network 80% Covered after deductible is met; Out of Network: 60% Covered after the deductible is met Physical/Occupational therapy surgery In Network 80% Covered after deductible is met; Out of Network: 60% Covered after the deductible is met Family Planning/Maternity Care Office Visit: Pre/postnatal In Network 80% Covered after deductible is met; Out of Network: 60% Covered after the deductible is met Hearing Hearing Exams In Network: Not Covered Out of Network: Not Covered Hearing Aids In Network: Not Covered Out of Network: Not Covered Vision
  • 23. 23 Routine Vision Exams In Network: Not Covered Out of Network: Not Covered Glasses/contact lenses In Network: Not Covered Out of Network: Not Covered Inpatient Services Inpatient Care Inpatient lab and X-ray In Network: 80% covered; after deductible is met Out of Network: 60% covered; after deductible is met; subject to network allowance Inpatient physician and surgeon services In Network: 80% covered; after deductible is met Out of Network: 60% covered; after deductible is met; subject to network allowance Inpatient Room and Board Hospital Copay In Network: Not applicable; Out of Network: Not applicable Inpatient Hospital In Network: 80% covered after deductible is met; preauthorization required; Out of Network: 60% covered after deductible is met; preauthorization required Emergency Care Emergency Room (not followed by admission) In Network $100 copay (copay waived if admitted) then 80% covered after deductible is met; Out of Network $100 copay (copay waived if admitted) then 80% covered after deductible is met Urgent Care Clinic Visit In Network: 80% covered after deductible is met Out of Network: 60% covered after deductible is met Ambulance Services 80% covered after deductible is met **Anthem; P. O. Box 105187 Atlanta GA 30348-5187
  • 24. 24
  • 25. 25 Basic Services Continued: Routine Extractions, Endodontics (root canal therapy),Periodontics, Gingivoplasty or gingivectomy: In Network 90% covered; Out of Network: 80% Covered Emergency Treatment for dental plan In Network: 100% covered; Out of Network: 100% Covered
  • 26. 26
  • 27. 27 Tints In Network Covered in full; Out of Network: Not Covered Frame Benefits In Network $0 copay; $80 retail allowance; 20% discount off balance over $80; limited to one pair every other calendar year Out of Network Up to $65 reimbursement; limited to one pair every other calendar year Contact Lenses Medically Necessary lenses In Network covered in full; Out of Network up to $100 reimbursement Elective Lenses In Network $0 copay; Up to $110 retail allowance; 15% discount off balance over $110; limited to one pair every calendar year; in lieu of spectable lenses.
  • 28. 28 Out of Network Up to $100 reimbursement EyeMed Vision Care 4000 Luxottica Place Mason, Ohio 45040
  • 29. 29