Medical Plan Details:

Plan Name	BasicAdvantage Plan
Doctor Visit Benefits	$50/day \| 10 per year
Ambulance Benefits	$100/day \| 1 per year
Outpatient Benefits	$100/day \| 1 per year
Emergency Due to Accidental Injury	$500/day \| 1 per year
Urgent Care Benefits	$100/day \| 2 per year
Surgery Benefit	$100/day \| 1 per year
Prescription Drug Benefits	Generic: $25/day \| 8/year Brand Name: Discount Only

Plan Name	Essential Care Plan
Deductible	$0
Copays	$0 / $50 copay for brand name contraceptives
Benefit % Payable by Plan	100% for covered expenses
Preventive Care	Included
Plan Annual Maximum	Unlimited
Plan Lifetime Maximum	Unlimited

Summary of Benefits and Coverage

Plan Booklets

Benefit Summaries

with

800-351-7500

Cigna Prescription Drug

HDHP $1750

Preventive

Covered at 100%
Generic (Retail)

$15 copay after deductible
Preferred Brand (Retail)

$45 copay after deductible
Non-Formulary Brand (Retail)

$75 copay after deductible
Specialty (Retail)

$150 copay after deductible

Generic (Mail Order | 90-day supply)

$30 copay after deductible
Preferred Brand (Mail Order | 90-day supply)

$90 copay after deductible
Non-Formulary Brand (Mail Order | 90-day supply)

$150 copay after deductible
Specialty (Mail Order | 90-day supply)

$150 copay after deductible

HDHP $3500

Preventive

Covered at 100%
Generic (Retail)

$10 copay after deductible
Preferred Brand (Retail)

$40 copay after deductible
Non-Formulary Brand (Retail)

$70 copay after deductible
Specialty (Retail)

$150 copay after deductible

Generic (Mail Order | 90-day supply)

$20 copay after deductible
Preferred Brand (Mail Order | 90-day supply)

$80 copay after deductible
Non-Formulary Brand (Mail Order | 90-day supply)

$140 copay after deductible
Specialty (Mail Order | 90-day supply)

$150 copay after deductible

EPO $800

Preventive

Covered at 100%
Generic (Retail)

$10 copay
Preferred Brand (Retail)

$40 copay
Non-Formulary Brand (Retail)

$70 copay
Specialty (Retail)

$150 copay

Generic (Mail Order | 90-day supply)

$20 copay
Preferred Brand (Mail Order | 90-day supply)

$80 copay
Non-Formulary Brand (Mail Order | 90-day supply)

$140 copay
Specialty (Mail Order | 90-day supply)

$150 copay

Covered Drug Lists

Value 4-Tier Formulary →
Value 4-Tier Formulary (Spanish) →
Value 4-Tier Formulary (Latest changes) →
Specialty Pharmacy Customer Prescription Drug List →
Value 4-Tier Formulary (Spanish) →
HDHP Preventive Generic Only Formulary →
PPACA No Cost-Share Preventive Formulary →
Drug List FAQs (English) →
Drug List FAQs (Spanish) →

Program Information

Informational Video →
Home Delivery Information →
Cigna 90 Now Mandatory Flyer →
How to Price a Medication →
myCigna Medication Pricing →

with

800-244-6224

Plan Booklets

Summary of Benefits

Summary of Benefits (Spanish)

Brochures

Program Information

Find a Dentist

Summary of Dental Benefits and Coverage (CA)

Dental Plan Details

Dental HMO

Deductible

$0
State Availability

We are not able to offer DHMO in the following states/locations: AK, ID, ME , MT, ND, NH, NM, PR, SD, VI, VT WV, and WY
Calendar Year Maximum

N/A

Dental Low PPO

Deductible

$50 (I) / $150 (F)
State Availability

All states
Calendar Year Maximum

$1,000

Dental HMO

Diagnostic & Preventive

$5 office copay, then 100%
Basic Services

$5 office copay
Major Services

$5 office copay, then 50%

Dental Low PPO

Diagnostic & Preventive

100% covered
Basic Services

50% after deductible
Major Services

No coverage

Dental HMO

Orthodontic Services

$5 office copay, then 50%
Orthodontia Lifetime Max

N/A

Dental Low PPO

Orthodontic Services

No coverage
Orthodontia Lifetime Max

N/A

with

800-244-6224

Vision Plan Details

Base Plan

Annual eye exam

$10 copay
Frames

$130 allowance
Featured Frame Brands

$180 allowance
Contacts (instead of glasses)

$130 allowance
Materials Copay
(frames and lenses)

$30 copay

Buy-up Plan

Annual eye exam

$10 copay
Frames

$200 allowance
Featured Frame Brands

$250 allowance
Contacts (instead of glasses)

$200 allowance
Materials Copay
(frames and lenses)

$10 copay

Summary of Benefits

Plan Brochures

Accident

Hospital Indemnity

Critical Illness

Group Term Life

ID Watchdog

Total Pet Program

MetLaw Legal

Home & Auto

Travel Assistance

with

800-877-7195

Life/AD&D - The Hartford

860-547-5000

Login now →

Long-Term Disability - Unum

866-679-3054

Login now →

HSA/FSA Plan Details

Health Savings Account

A health savings account (HSA) is a medical savings account that allows you to use pre-tax contributions from your paycheck to cover eligible health care expenses, tax-free.

You’ll earn a $0.50 Niagara HSA match on every $1 you set aside in your HSA up to a maximum match of $250 individual/$500 family.

Five Below Matching Contributions

Individual: Up to $500 for the plan year
Family: Up to $1,000 for the plan year
2021 Contribution Limit

Individual: $3,600 | Family: $7,200
Catch-up Contributions

$1,000

Flexible Spending Accounts

A flexible spending account (FSA) is a tax-free reimbursement account funded by pre-tax contributions from your paycheck. You can use FSA funds to pay for qualified medical or dependent care expenses. Your eligibility for a healthcare FSA depends upon which medical plan you elect.

Health Care FSA Eligibility:
EPO $800 plan or no medical coverage

Dependent Care FSA and Commuter Reimbursement Eligibility:
All benefit-eligible employees

Health Care FSA Contribution Limit

$2,850
Commuter FSA Contribution Limit

$280/month
Dependent Care FSA Contribution Limit

$5,000

HSA - PayFlex

888-678-8242

Login now →

FSA - Discovery Benefits

866-451-3399

Login now →

Life & Disability Plan Details

Basic Life

The company provides a benefit of 2x base salary up to $10,000, $50,000 or $500,000 - depending on your eligibility class - of basic employee life insurance for all eligible employees. Be sure to have an updated beneficiary form on file.

Product Highlights

✓ You are automatically enrolled.

✓ Benefit reduces to 65% at age 65 and 50% at age 70.

Summary of Benefits: Group 1 →
Summary of Benefits: Groups 2 and 3 →
Certificate →

Short-Term Disability

If you’re suddenly unable to earn a paycheck due to illness or an accident, short-term disability insurance through your employer can replace a portion of your income during the initial weeks of your disability.

Product Highlights

✓ You are automatically enrolled.

✓ Receive 60% of your pre-disability weekly earnings.

✓ Receive coverage for up to 26 weeks of disability.

✓ Your coverage begins after seven days of disability, known as the “elimination period” (elimination period waived in the case of an accidental injury).

Summary of Benefits →
Certificate →

Long-Term Disability

Long term disability insurance through your employer can provide a steady stream of income to help cover essential expenses during an extended illness or after a disabling accident.

Product Highlights

✓ You are automatically enrolled.

✓ Receive 60% of your pre-disability monthly earnings.

✓ Coverage begins after 180 days of disability.

Summary of Benefits: Group 1 →
Summary of Benefits: Groups 2 and 3 →
Certificate →

Supplemental Life Insurance

If you want additional protection for yourself and your family, you have the option to purchase supplemental life insurance up to the limits shown below. You must elect supplemental life insurance for yourself in order to purchase coverage for your dependents.

Product Highlights

✓ Employee Life: increments of $10,000 up to $500,000.

✓ Spouse Life: increments of $5,000 up to $100,000.

✓ Child(ren) Life: $1,000, $2,000, $4,000, $5,000 or $10,000 coverage amounts available.

✓ Guaranteed Issue $150,000 employee; $25,000 spouse; N/A child(ren) (EOI not required)

Summary of Benefits →
Certificate →

Employee Stock Purchase Plan (ESPP)

We offer the chance to build your investment portfolio by purchasing Five Below stock at a discounted rate.

Eligibility
You are eligible to purchase company stock during the first offering period after six months of employment. Offerings happen twice a year in January and July.

Enrollment
You may enroll at any point after becoming eligible.

Shopping & Travel Discount from PerkSpot

As a Five Below employee you receive perks and discounts on more than 900 local and national merchants like Apple, Samsung, Sprint, Six Flags, and Disney.

Whether it’s greater discount percentages or benefits like free shipping, this exlusive benefit can help you get more for your money! Plus, PerkSpot includes a newly released travel feature with exclusive discounts up to 60% on hotels in hundreds of destinations worldwide.

NIAGARA WATER permits INSURERS to offer Team Members of NIAGARA WATER certain voluntary insurance programs. Whether you choose to enroll in any of these programs is completely optional and voluntary. NIAGARA WATER does not make a contribution towards the cost of these programs and Team Members pay the full cost of premiums on an after-tax basis. NIAGARA WATER does not sponsor, maintain, endorse, recommend, or promote these voluntary programs. NIAGARA WATER'S involvement regarding these voluntary insurance programs is strictly limited to allowing the insurer access to Team Members to publicize these programs and NIAGARA WATER may perform certain ministerial functions such as payroll deduction and forwarding Team Member premium payments to the insurer. NIAGARA WATER does not receive any consideration in the form of cash or otherwise in connection with the program, other than reasonable compensation, excluding any profit, for administrative services actually rendered in connection with payroll deductions. Accordingly, these voluntary insurance programs are not subject to ERISA and related regulations. All questions or claims regarding these programs should be directed to the insurer.

Wellness

GlobalFit

Optimal health isn't just about being healthy physically. It's about a balanced approach that includes components designed to improve the health of the mind, body, and spirit. GlobalFit's Gym Network 360 delivers an extensive wellness network that focuses on 5 key components: exercise, eating, energize, explore, and education.

Activate your membership now

A Summary of Benefits and Coverage (SBC) has been designed to assist you with better understanding the coverage being offered to you, and to allow you to compare coverage options. The SBC is available on www.fivebelowbenefits.com. A paper copy is also available, free of charge, by calling 855-219-4530.

Five Below permits INSURERS to offer employees of Five Below certain voluntary insurance programs. Whether you choose to enroll in any of these programs is completely optional and voluntary. Five Below does not make a contribution towards the cost of these programs and employees pay the full cost of premiums on an after-tax basis. Five Below does not sponsor, maintain, endorse, recommend, or promote these voluntary programs. Five Below'S involvement regarding these voluntary insurance programs is strictly limited to allowing the insurer access to employees to publicize these programs and Five Below may perform certain ministerial functions such as payroll deduction and forwarding employee premium payments to the insurer. Five Below does not receive any consideration in the form of cash or otherwise in connection with the program, other than reasonable compensation, excluding any profit, for administrative services actually rendered in connection with payroll deductions. Accordingly, these voluntary insurance programs are not subject to ERISA and related regulations. All questions or claims regarding these programs should be directed to the insurer.

All benefit plans are governed by master policies, contracts, and plan documents. In the event of any inconsistency between the information contained herein and the applicable plan documents, the provisions of the plan documents shall prevail. Five Below reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.

Perks Details

Shopping & Travel Discount from PerkSpot

As a Five Below employee you receive perks and discounts on more than 900 local and national merchants like Apple, Samsung, Sprint, Six Flags, and Disney.

Whether it’s greater discount percentages or benefits like free shipping, this exlusive benefit can help you get more for your money! Plus, PerkSpot includes a newly released travel feature with exclusive discounts up to 60% on hotels in hundreds of destinations worldwide.

HP Discounts

Five Below has teamed up with HP Inc. to offer you the benefit of purchasing high-quality HP Inc. products at discounted prices. Save on HP offerings like laptops, desktops, printers, accessories and more.

The HP Employee Purchase Program offers:
✔ Discounts up to 35%
✔Free shipping and easy returns
✔Dedicated support for premium products

Subaru Discounts

All regular (non-temporary) full-time and part-time crew located in the US (except Hawaii) are eligible to participate in the Subaru of America, Inc. (SOA) VIP Program. You can now purchase or lease a new Subaru with no haggling, no negotiation, and no pressure – just a great deal on a new Subaru!

Learn more about Subaru →

UpWise Financial Wellness

A financial wellness app for all Full-time and Part-time crew! Keep track of your money easily and holistically in one place with UpWise! See your spending patterns and habits to learn what you can change. The more you use the app, the better it understands your needs – continuously learning to deliver an experience customized for you!

Blue Mountain Resort

Looking for some winter fun? Check out Blue Mountain Resort in the Poconos! Your exclusive Five Below discount saves you 25% on off-peak days (Monday – Friday and non-holidays) and 10% on peak days (Saturdays, Sundays, and Holidays). Crew can purchase up to 4 passes per visit at the special rate! Get details under the Documents section.

Learning Care Group Childcare Discounts

A brand new partnership to help you and your family tackle child care challenges – check out the Learning Care Group (LCG)! LCG offers infant care to school-age programs and flexible enrollment options to fit your schedule. Through our partnership, crew will receive a 10% tuition discount on child care expenses for children ages 0-12 years. This includes a free initial registration fee, valued at $150-$175.

Flexible Spending Account

An FSA saves you money by reducing your income taxes. You must choose how much to contribute each year, up to the stated limit. Your FSA contributions are automatically deducted from your pay BEFORE any taxes are calculated, and are not reported as income to the IRS. The FSA plan is effective January 1 to December 31 (calendar year).

Existing Team Members may enroll during Open Enrollment. New Hires must fulfill their eligibility requirements prior to enrolling.

Product Highlights

✓ Contributions are pre-tax and are automatically deducted

✓ Funds do not rollover from year-to-year

Health Savings Account

Choice Fund HSA FAQ →
Choice Fund HSA General Brochure →
Make the Most of Your HSA Flyer →
Employer HSA Contribution Information →

Flexible Spending Accounts

All About Spending Accounts →
Comparing Account 2021 Limits →
Get to Know Your Spending Account →
Manage your Dependent Care Claims →
Dependent Care FSA Provider Certification →
Over-the-Counter Medicine Health Care FSA →

Shopping & Travel Discounts from PerkSpot

HP Discounts

Subaru Discounts

UpWise Financial Wellness

Learning Care Group Childcare Discounts

Blue Mountain Discounts

with

855-952-3569

Life and Accidental Death & Personal Loss

With this coverage, you can deliver peace of mind to your family in the event of your unexpected death.

Product Highlights

✓ Receive up to 2x your annual salary up to a maximum of $250,000

✓ Living Benefit allows you to collect 80% of your policy while living in the event you are diagnosed with a terminal illness

✓ You may be able to keep coverage if you leave the company, retire or change the amount of hours you work

Short-Term Disability

If you’re suddenly unable to earn a paycheck due to illness or an accident, short term disability insurance through your employer can replace a portion of your income during the initial weeks of your disability.

Product Highlights

✓ Receive a portion of your salary for 25 weeks

✓ Off-the-job coverage

Long-Term Disability

Long term disability insurance through your employer can provide a steady stream of income to help cover essential expenses during an extended illness or after a disabling accident.

Product Highlights

✓ Offers additional coverage beyond your initial Short-Term disability coverage

MetLife

Supplemental Benefit Details

ID Watchdog

Your identity is important – it’s what makes you, you! ID Watchdog helps you better protect the name and financial reputation you’ve spent a lifetime building. And, we’ll even go one step further and help you better protect the identities of your family members as well.

Credit Lock

Online or through the mobile app, lock your Equifax® credit report – and your child’s credit report – to help provide additional protection against unauthorized use of your credit information.

More for Families:

The family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.

Dedicated Resolution Specialists:

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

Total Pet Program

Five Below is offering you access to one of the nation’s best pet benefit plans. Total Pet Program gives you access to savings on everything your pet needs!

You get:

✓ PetAssure

✓ PetPlus

✓ PetTag

✓ WhiskerDocs

✓ BarkBox

✓ Rover

MetLaw Legal

From exciting moments like buying a home, to less exciting ones like getting a speeding ticket, we make legal help for life’s big moments affordable, accessible, and easy.

Product Highlights

✓ Conveniently access a network of attorneys whenever you need legal help.

✓ Get assistance with things like marriage licenses, identity theft, caring for aging parents, and more!

Group Term Life

Get up to $100,000 of guaranteed financial protection in the event of your death to help cover costs such as funeral and daily expenses. If you elect coverage for yourself, you may also enroll your spouse and/or child(ren).

Product Highlights

✓ Waiver of premium benefit if laid off from work.

✓ Spouse and dependent benefits available.

✓ Option to continue coverage if you change employers or retire.

✓ No medical history required to renew after initial term.

Accident

This coverage provides cash payments directly to you in the event of an accident.

Product Highlights

✓ Pays benefits directly to you.

✓ Family options available.

✓ Payroll-deducted premiums.

Hospital Indemnity

If you are hospitalized for a covered reason, this plan provides a one-time cash payment of $100 (once per calendar year) along with $100 per day for up to 30 days per hospital stay.

Product Highlights

✓ No lifetime maximum.

✓ No waiting period.

✓ Benefits paid directly to you.

Critical Illness

Critical illness coverage pays a tax-free lump sum if you’re diagnosed with a covered critical illness – regardless of any other coverage you may have. Choose a benefit amount up to $30,000.

Product Highlights

✓ No lifetime maximum.

✓ No waiting period.

✓ Benefits paid directly to you.

Home & Auto

We’re proud to offer Home and Auto coverage through Farmers Insurance to help you and your family protect your most prized and expensive assets. As a Five Below crew member, you have access to auto and home insurance through Farmers GroupSelect.

This program provides you with special savings, outstanding customer service, and a full suite of products.

In addition to auto and homeowners insurance, we offer a variety of other policies including:

✓ Condo

✓ Renter's

✓ Motorcycle

✓ Personal Excess Liability

This benefit is a self-pay benefit (not through payroll deductions). Get a quote by calling 800-438-6381 or visit www.farmers.com/groupselect.

Progyny

888-597-5065

Login now →

Fidelity

800-835-5097

Login now →

Accident - The Hartford

860-547-5000

Login now →

Legal/Identity Theft - LegalShield

800-654-7757

Login now →

Pet Discount

888-789-7387

Login now →

Employee Discounts

800-565-3712

Login now →

Critical Illness - Chubb

833-542-2013

Login now →

Family-Friendly Benefits Details

Paid Parental Leave

We are proud to offer you paid parental leave. From our family to yours, time to bond with your bundle!

For birth mothers:

Up to 12 weeks of paid leave at 100% of your base pay

For all other parents:

Four weeks of paid leave at 100% of your base pay

Useful Forms:

✓ Paid Parental Leave Policy →

Cigna's Healthy Pregnancy, Healthy Babies Program

Enrolling in this program is an important first step toward a healthy future for you and your baby. All Cigna Healthy Pregnancies, Healthy Babies services are confidential, and your private information will not be shared with Five Below.

Plan for a Healthy Pregnancy:

When you enroll before becoming pregnant, we can help you be as healthy as possible. You’ll have access to preconception planning tools and resources, including information from the March of Dimes on eating right, maintaining a healthy weight, taking prenatal vitamins, stopping alcohol and tobacco use, and controlling any medical conditions you may have.

Support During Your Pregnancy:

Tell Cigna about your pregnancy so they can meet your needs. You can ask them anything – your coach, who has a nursing background, is there to support you during your whole pregnancy. You’ll even get a pregnancy journal with information, charts, and tools to help you have a happy nine months.

Start Now:

Cigna can help you stay healthy before and during your pregnancy and in the days and weeks following your baby’s birth. Call 800-615-2906 to enroll today. Download the new app by searching for “Cigna Healthy Pregnancies” in the App Store to get support through your entire pregnancy with tips and tools.

Useful Forms:

✓ Healthy Babies Pregnancy App →

✓ Healthy Babies Free Breast Pump →

✓ Healthy Babies MotivateMe →

Ovia

Manage your parenthood journey with Ovia Health! From preconception to returning to work and navigating life as a new parent, Ovia offers three apps to guide you on your journey.

Fertility:

Track your period, symptoms, moods and more! Receive accurate predictions for period and ovulation, connect with an anonymous community of women and read personalized summaries of your health and fertility.

Pregnancy:

Follow your baby's growth by tracking pregnancy, symptoms moods and more. Connect with other moms-to-be for support, check food and medication with safety lookups, and more.

Parenting:

Celebrate memories and milestones by inviting friends and family to follow along, upload photos and videos of precious moments, and track your child's growth and development.

Download apps now

Wellness Program Details

Hydrate your Health

Team Members and participating Spouse/Domestic Partners covered by a Niagara medical plan as of 1/1/2021 may voluntarily participate in the Hydrate Your Health Program. For Team Members, your participation helps you avoid paying the Wellness Surcharge, an additional medical premium beginning in May 2021. The surcharge is $40 per paycheck for team members. There will not be a surcharge for spouses in 2021, but spouses are encouraged to participate.

A wellness surcharge of $40/pay period will apply to Team Members if the following actions are not taken by the deadlines:

Complete a Personal Health Questionnaire (PHQ) an online, confidential questionnaire through Virgin Pulse (between 12/15/20-2/28/21).
Participate in a Biometric Health Screening at a participating Quest Diagnostics Lab or an At Home Self Collection test kit (between 12/15/20-2/28/21).
During the Biometric Screening, participate in a Nicotine Test and test negative for nicotine use.

OR you may choose NOT to participate in the Biometric Screening and instead choose to complete 4 Wellness Coaching sessionsthrough Virgin Pulse.

Get started →

Wellness Update Video →
Biometric Screening Announcement →
FAQs →

	Activity #1: PHQ	Activity #2: Biometric Screening OR Coaching
Activity	PHQ Online Questionnaire	Option 1: Quest Patient Service Center Lab	Option 2: At Home Self-Collection Test Kit	Option 3: Complete 4 Wellness Coaching Sessions
Deadline	Complete between 12/15/2020 - 2/28/2021	Complete between 12/15/20 - 2/28/2021		Complete between 12/15/2020 - 5/4/2021 to avoid surcharges; complete by 9/30 to earn a refund

Rewards for participating in a wellness program are available to all eligible Team Members/spouses. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by a different means. Contact the Benefits Department. We will work with you (and, if you wish, with your doctor) to develop another way to qualify for the reward.

LifeWorks Team Member Assistance Program

Get immediate access to specialized professionals in counseling, social work, human services and psychology. You have access to the LifeWorks network of thousands of master’s level counselors and affiliates.

Benefit Features

✓ Get support with financial and legal issues

✓ Receive 5 free appointments included in your Niagara benefits

✓ Enjoy hassle-free scheduling with LifeWork's easy-to-use app

Get started

New Hire Wellness Steps

The Hydrate Your Health Wellness Program is designed to maintain a high level of well-being through nutrition, activity, stress management, and illness prevention & management.

For your first year at Niagara, you may voluntarily choose to participate in our wellness challenges and other wellness programs through Virgin Pulse, a global leader in health and wellness. After your benefit effective date, you will have access to this web and app-based program, where you can track your healthy habit development!

For Team members enrolled in a Niagara medical plan, your voluntary participation can earn you Pulse Cash! You and your spouse can earn up to $100 each by completing various activities, such as: Niagara sponsored wellness challenges, healthy habit trackers, goal setting, daily wellbeing tips, sleep guide, nutrition guide, & digital coaching.

If you choose not to enroll in a Niagara medical plan, that’s okay. You can still join your team and colleagues on our wellness adventures and take advantage of all of the same tools and resources. But no Pulse Cash for you.

Do you ever wish you had accountability for fitness or healthy eating?
Partner with a FREE coach to work on areas you wish to improve. Topics include: Get Active, Eat Healthy, Reduce Stress, Manage Weight, Navigate Health Situations, Tobacco Cessation, and Sleep Well.

What about Biometric Screenings?
You may have heard that Niagara offers Biometric Screenings to team members and covered partners. That is true! The biometric screening program is offered to those covered team members and partners enrolled as of January 1st. If you continue to enroll in a Niagara medical plan next year, you will be included in our 2022 program. For this year, focus on improving or maintaining your good health and joining your colleagues on some fun wellness adventures!

Get started →

LifeWorks

Compliance Notices

Compliance Document (English) →
Compliance Document (Spanish) →
Illinois Health Coverage Disclosure →
SAR 08/01/2019 through 07/31/2020 →
SAR 08/01/2020 through 10/31/2020 →
SAR 11/01/2020 through 10/31/2021 →

Privacy

Website Privacy Statement →

Medicare Part D Notice

Wrap Summary Plan Document

Cafeteria Plan

Summary Annual Report

2023

Benefits Hub

Ready to enroll or review your benefits?

Medical Plans

BasicAdvantage Plan

Essential Care Plan

Dental Plans

Dental HMO

Dental Low PPO

Vision Plans

Supplemental Benefits

Included Benefits:

Perks

Wellness

Compliance

Medical Plan Details:

Cigna Prescription Drug

Plan Details

HDHP $1750

Preventive

Generic (Retail)

Preferred Brand (Retail)

Non-Formulary Brand (Retail)

Specialty (Retail)

Generic (Mail Order | 90-day supply)

Preferred Brand (Mail Order | 90-day supply)

Non-Formulary Brand (Mail Order | 90-day supply)

Specialty (Mail Order | 90-day supply)

HDHP $3500

Preventive

Generic (Retail)

Preferred Brand (Retail)

Non-Formulary Brand (Retail)

Specialty (Retail)

Generic (Mail Order | 90-day supply)

Preferred Brand (Mail Order | 90-day supply)

Non-Formulary Brand (Mail Order | 90-day supply)

Specialty (Mail Order | 90-day supply)

EPO $800

Preventive

Generic (Retail)

Preferred Brand (Retail)

Non-Formulary Brand (Retail)

Specialty (Retail)

Generic (Mail Order | 90-day supply)

Preferred Brand (Mail Order | 90-day supply)

Non-Formulary Brand (Mail Order | 90-day supply)

Specialty (Mail Order | 90-day supply)

Dental Plan Details

Plan Details

Dental HMO

Deductible

State Availability

Calendar Year Maximum

Dental Low PPO

Deductible

State Availability

Calendar Year Maximum

Cost of Services

Dental HMO

Diagnostic & Preventive

Basic Services

Major Services

Dental Low PPO

Diagnostic & Preventive

Basic Services

Major Services

Orthodontic

Dental HMO

Orthodontic Services

Orthodontia Lifetime Max

Dental Low PPO

Orthodontic Services

Orthodontia Lifetime Max

Vision Plan Details

Plan Details

Base Plan

Annual eye exam

Frames

Featured Frame Brands

Materials Copay
(frames and lenses)

Materials Copay
(frames and lenses)