January 1 2025 December 31 2025 Open Enrollment Guide This guide offers an overview of the benefit program provided by Konec USA LLC designed to support the well being and financial security of you and your family Prepared by Hipson Benefits
Welcome Benefits for January 1 2025 December 31 2025 OUR EMPLOYEES ARE OUR MOST VALUABLE ASSET That is why Konec USA LLC strives to provide you and your family with a comprehensive benefits package Please select the benefit options that best fit the needs of you and your family We have put together this Benefit Guide for open enrollment and new hires throughout the plan year Open enrollment is an important time it is a short period each year when you can make changes to your benefits The IRS allows employees to select certain benefits through pre tax salary reductions lowering your taxes and saving you money Because of these tax savings after initial eligibility the IRS allows you to make changes only during an open enrollment period unless you experience a qualified life event or status change marriage divorce death birth adoption etc Since this is your one opportunity to enroll in coverage or make changes to your benefits please carefully consider your anticipated needs for the upcoming plan year Elections you make during open enrollment will be effective on January 1 2025 This Benefit Guide includes summaries of benefit plans If there is a discrepancy between these summaries and the written legal plan documents the plan documents shall prevail This Guide and plan summaries do not constitute a contract of employment and benefits described in this Guide may be changed by the employer
Eligibility and Enrollment Benefits for January 1 2025 December 31 2025 Who Is Eligible If you re an eligible employee at Konec USA LLC you can enroll in the benefits outlined in this Guide As an eligible employee the following family members are also eligible for Medical Dental Vision Life and Voluntary Products Spouse Dependent child under the age of 26 regardless of that child s marital status Disabled dependent child regardless of age The minimum required hours you must work in order to be eligible are 30 hours per week The waiting period before you can enroll is the first day of the month following your date of hire eligibility Open Enrollment Are you ready to enroll The first step is to login to your Employee Navigator profile If you do not yet have a profile please reach out to Human Resources for more information Review personal profile and your current benefits Did you move recently or get married Make any necessary updates to address beneficiaries etc Once all your information is up to date it s time to make your benefit elections in Employee Navigator The decisions you make during open enrollment can have a significant impact on your life and finances so it is important to weigh your options carefully The benefits you choose during Open Enrollment will become effective on January 1 2025 For newly hired or newly eligible employees who are enrolling coverage will begin on the first day of the month following your date of hire or eligibility How to Make Changes Unless you experience a life changing Qualifying Event you cannot make changes to your benefits until the next Open Enrollment Period Qualifying events include things like Marriage divorce or legal separation Birth or adoption of a child Change in residence in certain instances Death of a spouse child or other qualified dependent Change in child s dependent status Change in employment status or a change in coverage under another employer sponsored plan If you have a qualifying life event changes must be made within 30 days of the event or you will need to wait until the next Open Enrollment Contact your HR representative for support immediately if you have a qualifying life event
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Medical Benefits for January 1 2025 December 31 2025 Value Care MEC 1 This is a limited summary please see official carrier document for more information Any discrepancy between this summary and the official policy documents the policy documents will prevail Benefits Schedule Network Deductible calendar year Coinsurance Out of Pocket Max Preventative Care Office Visits Primary Specialist Visits Urgent Care Visits Emergency Room Outpatient Testing diagnostic lab x ray advanced e g MRI CAT PET Outpatient Care e g surgery Inpatient Care Prescription Drugs In Network MultiPlan PHCS N A N A N A 100 15 copay 3 per year Network Discount 50 copay 3 per year Not Covered Network Discount Not Covered Not Covered 15 30 50 75 Rates are based on years of service For more information see page 10
Medical Benefits for January 1 2025 December 31 2025 Optima Care MEC 2 This is a limited summary please see official carrier document for more information Any discrepancy between this summary and the official policy documents the policy documents will prevail Benefits Schedule Network Deductible calendar year Coinsurance Out of Pocket Max Preventative Care Office Visits Primary Specialist Visits Virtual Care Virtual Behavioral Health Urgent Care Visits Emergency Room Outpatient Testing diagnostic lab x ray advanced e g MRI CAT PET Outpatient Care e g surgery Inpatient Care Prescription Drugs In Network MultiPlan PHCS N A N A N A 100 15 copay unlimited Network Discount 0 copay unlimited 50 copay first 3 85 after 50 copay unlimited Not Covered Network Discount Not Covered Not Covered 15 30 50 75 Rates are based on years of service For more information see page 10
Medical Benefits for January 1 2025 December 31 2025 Elite Care MEC 3 This is a limited summary please see official carrier document for more information Any discrepancy between this summary and the official policy documents the policy documents will prevail Benefits Schedule Network Deductible calendar year Coinsurance Out of Pocket Max Preventative Care Office Visits Primary Specialist Visits Virtual Care Virtual Behavioral Health Urgent Care Visits Emergency Room Outpatient Testing diagnostic lab x ray advanced e g MRI CAT PET Outpatient Care e g surgery Inpatient Care Prescription Drugs In Network MultiPlan PHCS N A N A N A 100 15 copay unlimited Network Discount 0 copay unlimited 50 copay first 3 85 after 50 copay unlimited Not Covered 50 copay for lab xray advanced not covered Not Covered Not Covered 15 30 50 75 Rates are based on years of service For more information see page 10
Medical Benefits for January 1 2025 December 31 2025 Premium MVP This is a limited summary please see official carrier document for more information Any discrepancy between this summary and the official policy documents the policy documents will prevail Benefits Schedule Network Deductible calendar year Coinsurance Out of Pocket Max Preventative Care Office Visits Primary Specialist Visits Virtual Care Virtual Behavioral Health Urgent Care Visits Emergency Room Outpatient Testing diagnostic lab x ray advanced e g MRI CAT PET Outpatient Care e g surgery Inpatient Care Prescription Drugs In Network MultiPlan PHCS 0 N A 9 100 100 15 copay unlimited Network Discount 0 copay unlimited 50 copay first 3 85 after 50 copay unlimited 500 copay 1 per year 50 copay for lab xray 350 copay for advanced imaging limit 2 per year 350 copay limit 1 per year 500 copay limit 7 days 3 surgeries 10 copay tier 1 generics Discount only for higher cost Rx Rates are based on years of service For more information see page 10
Medical Benefits for January 1 2025 December 31 2025 Max MV Plan This is a limited summary please see official carrier document for more information Any discrepancy between this summary and the official policy documents the policy documents will prevail Benefits Schedule Network Deductible calendar year Coinsurance Out of Pocket Max Preventative Care Office Visits Primary Specialist Visits Virtual Care Virtual Behavioral Health Urgent Care Visits Emergency Room Outpatient Testing diagnostic lab x ray advanced e g MRI CAT PET Outpatient Care e g surgery Inpatient Care Prescription Drugs In Network MultiPlan PHCS 0 N A 9 100 100 15 copay unlimited Network Discount 0 copay unlimited 50 copay first 3 85 after 50 copay unlimited 500 copay 1 per year 50 copay for lab xray 350 copay for advanced imaging limit 3 per year 350 copay limit 2 per year 500 copay limit 14 days 4 surgeries 10 copay tier 1 generics 50 75 for higher cost Discount only for specialty drugs Rates are based on years of service For more information see page 10
Medical Benefits for January 1 2025 December 31 2025 Max MV Plan This is a limited summary please see official carrier document for more information Any discrepancy between this summary and the official policy documents the policy documents will prevail Benefits Schedule Hospital Admission requires 30 day claim separation Hospital Confinement Inpatient Surgery In Patient Anesthesia Outpatient Surgery Hospital of Ambulatory Surgical Center Care Outpatient Surgery Physician Office Outpatient Anesthesia In Network 2 000 up to 3 admissions per year 50 per day up to 30 days per year 1 000 1 time per year 300 250 1 time per year 75 1 time per year 20 of outpatient surgery benefit Rates are based on years of service and available to view in Employee Navigator This is a supplemental plan and cannot be enrolled in by itself
Medical Rates Benefits for January 1 2025 December 31 2025 Medical rates are based on years of service Please see below grid for your rate per pay period Semi Monthly Employee Rates 24 Pay Periods 0 3 years 50 of EO cost ValueCare OptimaCare EliteCare Advantage MV Plan Premium MV Plan Employee Only 21 25 27 25 34 75 99 75 117 25 Employee Spouse 63 75 81 75 104 25 292 75 307 25 Employee Children 63 75 81 75 104 25 269 75 265 25 Employee Family 106 25 136 25 173 75 397 75 457 25 3 5 years 70 of EO cost ValueCare OptimaCare EliteCare Advantage MV Plan Premium MV Plan Employee Only 12 75 16 35 20 85 59 85 70 35 Employee Spouse 55 25 70 85 90 35 252 85 260 35 Employee Children 55 25 70 85 90 35 229 85 218 35 Employee Family 97 75 125 35 159 85 357 85 410 35 5 7 years 80 of EO cost ValueCare OptimaCare EliteCare Advantage MV Plan Premium MV Plan Employee Only 8 50 10 90 13 90 39 90 46 90 Employee Spouse 51 00 65 40 83 40 232 90 236 90 Employee Children 51 00 65 40 83 40 209 90 194 90 Employee Family 93 50 119 90 152 90 337 90 386 90 8 years 100 of EO cost ValueCare OptimaCare EliteCare Advantage MV Plan Premium MV Plan Employee Only 0 0 0 0 0 Employee Spouse 42 50 54 50 69 50 193 00 190 00 Employee Children 42 50 54 50 69 50 170 00 148 00 Employee Family 85 00 109 00 139 00 298 00 340 00
Dental Benefits for January 1 2025 December 31 2025 This is a limited summary please see official carrier document for more information If there is a discrepancy between this summary and the official policy documents the policy documents will prevail Benefits In Network Network Benefit Schedule Unum Dental Calendar Year Deductible Ind Fam 50 150 Annual Benefit Max per member Preventive Services includes routine exams cleanings x rays fluoride sealants space maintainers and minor restorative fillings Basic Services includes emergency palliative treatments simple extractions endodontics and periodontics Major Services includes complex extractions dental surgery crowns veneers bridges dentures and implants Out of Network Fee Basis 2 000 Plan pays 100 Ded 20 Ded 50 UCR 90th Refer to your plan certificate and the enrollment portal for more details
Dental Rates Benefits for January 1 2025 December 31 2025 Semi Monthly Employee Rates 24 Pay Periods 0 3 years 50 of EO cost Unum Dental Plan Employee Only Employee Spouse Employee Children Employee Family Employee Only Employee Spouse Employee Children Employee Family Employee Only Employee Spouse Employee Children Employee Family Employee Only Employee Spouse Employee Children Employee Family 3 5 years 70 of EO cost 5 7 years 80 of EO cost 8 years 100 of EO cost 8 50 25 14 36 02 57 75 Unum Dental Plan 5 10 21 74 32 62 54 35 Unum Dental Plan 3 40 20 04 30 92 52 65 Unum Dental Plan 0 16 64 27 52 49 25
Vision Benefits for January 1 2025 December 31 2025 This is a limited summary please see official carrier document for more information If there is a discrepancy between this summary and the official policy documents the policy documents will prevail Benefits In Network Benefit Schedule Network EyeMed Vision Exam available every 12 months Frames materials Frames Allowance available every 24 months Contacts in lieu of glasses available every 12 months 10 copay 10 copay 130 allowance 130 allowance Materials copay covers basic lenses Upgrades available at additional charge Discounts available for items not covered by the plan or in overage of the annual allowance at network providers Members may also receive 15 off retail price or 5 off promotional price for Lasik PRK from the US Laser Network owned and operated by LCA Vision Refer to your Vision plan documentation for more information
Vision Rates Benefits for January 1 2025 December 31 2025 Semi Monthly Employee Rates 24 Pay Periods 0 3 years 50 of EO cost Unum Vision Plan Employee Only 1 37 Employee Spouse 4 12 Employee Children 4 81 Employee Family 8 28 3 5 years 70 of EO cost Unum Vision Plan Employee Only 82 Employee Spouse 3 57 Employee Children 4 26 Employee Family 7 73 5 7 years 80 of EO cost Unum Vision Plan Employee Only 55 Employee Spouse 3 29 Employee Children 3 99 Employee Family 7 45 8 years 100 of EO cost Unum Vision Plan Employee Only 0 Employee Spouse 2 75 Employee Children 3 44 Employee Family 6 91
Life AD D Insurance Basic Benefits for January 1 2025 December 31 2025 Who is Eligible and When Benefits are available to employees working 30 or more hours per week New employees are eligible for benefits on the first day of the month following date of hire Benefits You Receive At no cost to you Konec USA LLC offers you employer sponsored Group Life and Accidental Death and Dismemberment AD D insurance from Unum Life As long as you are eligible you are automatically enrolled and receive a flat 20 000 benefit with matching AD D coverage This insurance can help provide for your family if something happens to you as the result of an accident or disability You must choose a beneficiary or beneficiaries the person s or entity you name who will receive the proceeds from your life or AD D insurance in the event of your death or injury Summary of Coverage Plan Features Employee Benefit Amount AD D Benefit Amount Basic Life AD D 20 000 Matches life amount Refer to your Life and AD D plan documentation for more information
Additional Voluntary Benefits Benefits for January 1 2025 December 31 2025 Voluntary Benefits are a cost effective way to help employees offset out of pocket medical expenses and provide financial stability As an employee of Konec USA LLC you have the opportunity to apply for personal insurance products offered by Colonial Life These benefits can enhance your benefits portfolio and customized to fit your individual needs These programs and insurance products have advantages including Any benefits are paid directly to you You can take the coverage with you if you change jobs or retire and Any premiums are payroll deducted Colonial Life Accident Insurance Colonial Life s accident coverage offsets unexpected medical expenses such as deductibles and copayments that result from an injury due to a covered accident The severity of the accident injury determines the level of payment expected under this plan The benefits are available once per covered person for each covered accident unless otherwise noted in your policy documents This benefit also has an accidental death rider in the event you or a covered family dies as the result of a covered accident This is great coverage for families with children in sports Colonial Life Critical Illness Insurance Colonial Life s individual Specified Critical Illness insurance helps maintain financial security during the lengthy expensive recovery period of a critical illness It provides a lump sum benefit to help with the out of pocket medical and nonmedical expenses of employees who suffer a critical illness Covered Specified illnesses include heart attack stroke major organ failure end stage renal disease cancer permanent paralysis if due to covered accident coma blindness occupational infectious diseases Partial coverage for coronary artery bypass graft surgery and carcinoma in situ Colonial Life Medical Bridge Insurance Colonial Life s Individual Medical Bridge coverage can offer a solution to the financial burden of paying for medical care and other non medical costs associated with an illness or injury This coverage provides a benefit that offsets deductibles copays and out of pocket medical and non medical expenses related to events such as hospital confinement outpatient surgery diagnostic testing and more This coverage pays out in a lump sum benefit based on the covered services There are no deductibles or lifetime maximums
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