New Employee Benefits Enrollment - Dow Corning

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DENTAL Level of Coverage Plan Features DeltaPreferred DeltaPremier Non-Participating* Annual maximum benefit/person Diagnostic & preventive services, $1,500 $1,500 $1,500 and radiographs Sealants, oral surgery, minor 100% 100% 100% restorative services, periodontics and endodontics Major restorative services and 90% 75% 75% prosthodontics 70% 60% 60% Dental Implants Orthodontics - $1,500 lifetime 50%, up to a $500 benefit per implant maximum applies 60% 50% 50% *A non-participating dentist can bill you for the difference between the Delta Dental fee schedule and the dentist’s fee. Annual Employee Contribution for 2008 Full-time employee pays Part-time employee pays** Waiver without credits*** Waiver with credits Employee Only Employee + One* Employee + Two or More* $ 84 $ 460 $ 0 $ 150 Credit $ 168 $ 920 $ 0 $ 150 Credit $ 252 $ 1,380 $ 0 $ 150 Credit * Per IRS regulations, Dow Corning cannot withhold benefit premiums for a domestic partner on a pre-tax basis. ** Part-time employees do not receive Flex credits for dental coverage and are responsible for the full cost of coverage. *** 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. 7
MEDICAL Coverage is effective on your first day of work. See Benefit Enrollment Information page for details on how to enroll for benefit coverage. After two months from your start date, if you fail to enroll in a medical plan, you will automatically be enrolled in the default plan CDHP for Employee Only. Plan Highlights Under a Preferred Provider Organization (PPO) plan, you have a network of doctors that you can use. If you use a doctor in the network, the doctor accepts a discounted rate and you cannot be billed the difference. The amount is paid at the in-network rate. If you go out-of-network, the charges are paid at the out-of-network rate. You can be billed the difference between the doctor’s charge and the plan’s allowed amount. Two Blue Cross Blue Shield (BCBS) PPO health plans are available to all active employees. � PPO – this plan generally provides 90 percent coverage when services are received in-network and 70 percent coverage when services are received out-of-network. � Consumer Driven Health Plan (CDHP) – this plan generally provides 90 percent coverage when services are received in-network and 70 percent coverage when services are received outof-network. This plan is a high deductible plan that offers a Health Savings Account (HSA) to help save for health care expenses. For more information, call BCBS at 1-866-491-3083 or visit www.bcbs.com. Under a Health Maintenance Organization (HMO), you select a primary care physician (PCP) who will manage your care and refer you to a specialist in the network. Except in an emergency or if directly referred by the PCP, you will be responsible for 100 percent of the cost if you receive care outside of the network. Coverage through the following HMOs is also available: � HealthPlus – Mid-Michigan area including Bay City/Saginaw/Flint (visit www.healthplus.com for participating providers) � Anthem BCBS – Carrollton/Elizabethtown (visit www.anthem.com for participating providers) � United Healthcare – Greensboro (visit www.uhc.com for participating providers) 8
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: DENTAL Coverage is effective on you
Page 11 and 12: Cost and Coverage Comparison Chart
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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