New Employee Benefits Enrollment - Dow Corning

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MEDICAL Annual Employee Contribution for 2008 PPO CDHP Option HealthPlus Anthem BPP United Healthcare Employee Only Employee + One Employee + Two or More $820 $1,540 $2,260 $0 $0 $0 $760 $1,420 $2,080 $1,000 $1,900 $2,800 $940 $1,780 $2,620 Waiver without credits* $0 $0 $0 Waiver with credits $500 credit $500 credit $500 credit * If you are the spouse of a Dow Corning employee, you are not eligible for benefit credits and will need to select the “Waiver without credits” option if you wish to waive coverage. You should know….. � Refer to the Cost and Coverage Comparison Chart for details. � The CDHP option provides 100% coverage for certain prescriptions including blood pressure and cholesterol lowering medications. � The CDHP option will have a zero premium in 2008. � The CDHP option includes a Health Savings Account (HSA). � An HSA is a tax-advantaged account to help you save for medical costs. � Dow Corning will contribute to your HSA in 2008. See the HSA section for further details. 9
Cost and Coverage Comparison Chart This chart provides a comparison of the most frequently utilized services and their associated cost and coverage under each of the Medical Plans. NOTE: CDHP out-of-pocket maximum includes all co-pays and co-insurances – including prescription drug co-pays. Once the CDHP out-of-pocket maximum is met, all expenses are covered at 100% including prescription drugs. Geographic Eligibility All Locations Mid-Michigan Carrollton/ Elizabethtown Annual Deductible HSA Dow Corning Contribution HSA Employee Contribution Out-of-Pocket Limit BCBS PPO CDHP Option In Network Out of Network In-Network Out-of- Network $ 250 EE only $ 500 EE + 1 $ 750 EE + 2/more $ 1,250 EE only $ 2,500 EE + 1 $ 3,750 EE + 2/more $ 500 EE only $ 1,000 EE + 1 $ 1,500 EE + 2/more $ 2,500 EE only $ 5,000 EE + 1 $ 7,500 EE + 2/more $1,200 Single $2,400 Family $500 Single $1,100 Family $0 - $2,300 Single $0 - $4,600 Family $900 - age 55 catch up $1,200 Single $2,400 Family (see note below) HealthPlus Anthem BPP Greensboro United Healthcare $ 0 $ 0 $0 Not Applicable $ 1,500 EE only $ 3,000 Family $ 1,500 EE only $ 3,000 Family Lifetime Maximum $ 2,000,000 $ 2,000,000 $2,000,000 $ 2,000,000 $ 5,000,000 Unlimited Office Visits $ 15 co-pay 70% 90% 70% $ 15 co-pay $ 15 co-pay $ 15 co-pay Urgent Care Facility $ 35 co-pay 70% 90% 70% $ 25 co-pay $ 25 co-pay $ 50 co-pay X-Ray & Lab 90% 70% 90% 70% 100% 80% 80% Outpatient Surgery 90% 70% 90% 70% 100% $ 75 co-pay 80% Inpatient Hospital Services (including surgery) 90% 70% 90% 70% $ 250 co-pay/ admission $ 250 co-pay/ admission Note: CDHP out-of-pocket maximum includes all co-pays and co-insurances - including prescription drug co-pays. Once the CDHP out-of-pocket maximum is met, all expenses are covered at 100% including prescription drugs. 80% 10
Page 1 and 2: Dow Corning Corporation - Multibase
Page 3 and 4: INTRODUCTION Dear Fellow Employee:
Page 5 and 6: BENEFIT ENROLLMENT INFORMATION Dow
Page 7 and 8: DENTAL Coverage is effective on you
Page 9: MEDICAL Coverage is effective on yo
Page 13 and 14: VISION Coverage is effective on you
Page 15 and 16: DEPENDENT LIFE Coverage is effectiv
Page 17 and 18: BASIC & OPTIONAL LIFE Coverage is e
Page 19 and 20: ACCIDENTAL DEATH & DISMEMBERMENT (A
Page 21 and 22: HEALTH SAVINGS ACCOUNT (HSA) The fe
Page 23 and 24: FLEXIBLE SPENDING ACCOUNTS (FSA) Do
Page 25 and 26: LONG TERM DISABILITY (LTD) Coverage
Page 27 and 28: BUSINESS TRAVEL ACCIDENT LIFE Busin
Page 29: BENEFIT ENROLLMENT WORKSHEET After

New Employee Benefits Enrollment - Dow Corning

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