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Force10 Networks Employee Benefit Summary

 

ELIGIBILITY

  • Date of hire
  • All active full-time employees working 30 hours per week

MEDICAL BENEFITS

 

BLUE SHIELD – PPO PLAN
 

In Network

Out of Network
Ind. Lifetime Maximum
$6,000,000
Deductible (*Applies)

$250 (Individual)
$500 (Family)
Out-of-Pocket Maximum

$1,000 (Individual)

$2,000 (Family)

$3,000 (Individual)

$6,000 (Family)
Office Visits
$10 copay
70%
Ambulance Services
90%*
90%*
Hospital Services
90%*
70%
Lab & X-Ray
$10 copay
70%
Maternity Care
$10 copay
70%
Well-baby care
$10 copay
Not covered
Immunizations
$10 copay
Not covered
Routine/Preventative Care
$10 copay
Not covered
Emergency Room Co-pay
$75 copay (waived if admitted)
Chiropractic Care
$25 visits
70%
12 visits per calendar year
Prescriptions (30 days)
 
25% allowable amount then copay
- Generic
$5
$5
- Brand (Formulary)
$10
$10
- Brand (Non-Form.)
$25
$25
Mail Order Drug Program
$10/$20/$50
(30-90 day supply)
N/A
 
HMO PLANS (California Employees Only)
 

Blue Shield

Kaiser
Office Visits
$10 copay
$15 copay
Hospital Services
$100 per day up to
7 days max.
100%
Lab & X-Ray
100%
100%
Emergency Room
$100 copay
$50 copay
Prescriptions
30 days
100 day supply
- Generic
$5
$10
- Brand
$10
$10
Mail Order Drug Program
$10/$20
(30-90 day supply)
$10 (100 day supply)
 
DENTAL – Aetna PPO
 

In-Network

Out-of-Network
*Deductible – Individual
$50
*Deductible – Family
$150
Preventive
100%
100%
Basic
80%
80%
Major
50%
50%
Dental Calendar Year Max
$1,500
$1,500
Orthdontic Deductible
None
None
Orthodontic Lifetime Max
$1,000
$1,000
Orthodontic Coinsurance
50%
50%
 
DENTAL – Aetna DMO
Deductible
None
Office Visit Copay
$5
Preventive
100%
Basic
100%
Major
60%
Dental Calendar Year Max
Unlimited
Orthodontic Lifetime Max
Unlimited
Orthodontic Coinsurance
$2,000
 
VISION - VSP
 

VSP

Non-VSP
Copay (*Applies)
$0 copay for exam
$20 copay for materials
Frequency
12 months
Examination
100%
Up to $45.00
Materials
100%
Varies*
Lenses
100%
Varies*
Frames
Up to $120
every 24-months*
Up to $47
every 24-months*
Elective Contacts
Up to $105
every 12-months*
Up to $105
every 12-months*
 
LIFE INSURANCE – UNUMProvident
  • Basic Life and Accidental Death & Dismemberment Insurance:
    2 x salary up to $500,000 maximum (Employer Paid)
  • You can purchase additional Life coverage for you and your dependents through the Supplemental Life plan.
 
DISABILITY INSURANCE – UNUMProvident

STD (For Non-CA employees; CA employees have SDI benefits)

  • 55 % of an employee’s weekly earnings to a maximum of $882.
  • 7 day waiting period.

LTD

  • 66.67% of an employee’s monthly earnings to a maximum of $10,000.
  • 90 day waiting period.
 
EMPLOYEE ASSISTANCE PROGRAM – UnumProvident
  • Personal Assistance 24/7, for counseling needs with Family, Financial, Legal, Emotional and Work issues through Work Life Balance EAP
  • www.lifebalance.net ID is lifebalance and Password is lifebalance
 
FLEXIBLE SPENDING ACCOUNTS (FSA) – Flex-Plan Services
  • Health Care Reimbursement Account:           $5,000 maximum
  • Dependent Care Reimbursement Account:    $5,000 maximum
  • Pre-Tax Premium Plan:  Pre-tax deductions for medical and dental healthcare contributions.
 
PLAN CONTACT INFORMATION

PLAN

GROUP#

CUSTOMER SERVICE
Kaiser HMO
39011
(800) 464-4000
Blue Shield HMO
H19005
(800) 424-6521
Blue Shield PPO
939005
(800) 200-3242
Aetna Dental
622950
(800) 240-2386
VSP Vision
12135714
(800) 877-7195
Unum Life and Disability
560678
(800) 421-0344
FlexPlan FSA
Force10
(800) 669-3539
 

 

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Last updated: 2/1/2008 3:15:49 PM