2011 Benefits Enrollment

This is only a summary of benefits. Refer to the Summary Plan Description or Plan Contract for complete descriptions of coverages, exclusions and limitations

2011 Benefits Enrollment

This is only a summary of benefits. Refer to the Summary Plan Description or Plan Contract for complete descriptions of coverages, exclusions and limitations Hays Companies

April 20, 2023

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2011 Open Enrollment – Introduction

The year 2011 brings change to all Old Republic Companies regarding our benefits

program. Beginning on January 1, 2011, all Old Republic Companies will offer the same

benefits package. All premium contributions will be the same regardless of where you are

employed in the Old Republic enterprise of companies.

The following presentation will summarize the benefit programs that are available

to you. Additional information is also available in the following formats:

Paper – 2011 Benefits Guide

Online – www.oldrepublic2011benefits.com

You must complete an enrollment form even if you do not elect coverage(s).

All enrollment forms should be returned to your local HR representative.


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Medical Plan

Blue Cross Blue Shield of MinnesotaContributory Plan – Contribution based on salary

Eligibility – Regular full-time and regular part-time employees working 30 hours or more per week

Please refer to pages 4 - 7 of the 2011 Benefits Guide

Choose between two medical plans:

– $500 Deductible PPO Plan

– $3,000 Deductible High Deductible Health Plan (HDHP/Options Blue) – with Optional HSA

• Both options use the same network of providers

– Online “Find a Doctor” tool

• Visit bluecrossmn.com and use “Find a Doctor”

• For MN providers, click on Blue Cross Aware – Search the network

• For National providers, click on National BlueCard – Search the network

– Click on “Guest”

– Click on “FIND PROVIDERS”

– Call 1-800-810-BLUE (2583)

– Call Customer Service: 651-662-5004 or toll free at 1-866-870-0348

– Specify PPO network


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BCBSMN - $500 Deductible PPO Plan


UnlimitedUnlimitedLifetime Maximum

$150 Copay$150 copayEmergency Room Care*

*Waived if admitted

60% after deductible80% after deductibleHospital Care

60% after deductible Plan pays 100%Preventive and Well Baby Care

$4,000 Single

$8,000 Family

$2,500 Single

$5,000 FamilyOut-of-Pocket Maximum

Plan pays 60%Plan pays 80%Medical Coinsurance

N/A$20 copayOffice Visit Copay

$1,000 Single

$3,000 Family

$500 Single

$1,500 FamilyDeductible

Out of NetworkIn Network

$500 Deductible PPO PlanPlan


$150 Copay$150 CopayEmergency Room Care*

*Waived if admitted

60% after Deductible80% after DeductibleHospital Care

60% after Deductible Plan pays 100%Preventive and Well Baby Care

$4,000 Single

$8,000 Family

$2,500 Single


Plan Pays 60%Plan Pays 80%Medical Coinsurance

N/A$20 CopayOffice Visit Copay

$1,000 Single

$3,000 Family

$500 Single


Out-of-NetworkIn-Network

$500 Deductible PPO PlanPlan


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BCBSMN - $500 Deductible PPO Plan Rx Program

*For eligible drugs available at participating 90dayRx pharmacies.


$135 copay$60 copayBrand Name with Generic Equivalent

90 days31 daysDays Supply

90dayRx*Retail Pick-up or Home Delivery

RetailPharmacy

$95 copay$40 copayBrand Name with No Generic Equivalent

$25 copay$10 copayGeneric

$135 Copay$60 CopayBrand Name with Generic Equivalent

90 days31 daysDays’ Supply


RetailPharmacy

$95 Copay$40 CopayBrand Name with No Generic Equivalent

$25 Copay$10 CopayGeneric


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BCBSMN - $3,000 Deductible High Deductible Health Plan (HDHP/Options Blue)


60% after deductible100% after deductibleEmergency Room Care


60% after deductible 100%Preventive and Well Baby Care

$6,000 Single

$8,000 Family

$3,000 Single



N/AN/AOffice Visit Copay

$4,000 Single

$6,000 Family

$3,000 Single


Out of NetworkIn Network

$3,000 Deductible HDHP PlanPlan


60% after deductible100% after deductibleEmergency Room Care


60% after deductible 100%Preventive and Well Baby Care

$6,000 Single

$8,000 Family

$3,000 Single



N/AN/AOffice Visit Copay

$4,000 Single

$6,000 Family

$3,000 Single

$5,000 FamilyDeductible *

Out-of-NetworkIn-Network

$3,000 Deductible HDHP PlanPlan

*Deductibles are based on a per contract basis. For example: If single coverage is elected, a $3,000 deductible must be satisfied before

the plan pays 100%. If family coverage is elected, the entire $5,000 deductible must be satisfied before the plan pays 100%.


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BCBSMN - $3,000 Deductible High Deductible Health Plan (HDHP/Options Blue)

*For eligible drugs available at participating 90dayRx pharmacies.


• Please refer to the 2011 Open Enrollment Website for rates and enrollment forms

100% after deductible100% after deductibleBrand Name with Generic Equivalent

90 days31 daysDays Supply


RetailPharmacy

100% after deductible100% after deductibleBrand Name with No Generic Equivalent

100% after deductible100% after deductibleGeneric

100% after deductible100% after deductibleBrand Name with Generic Equivalent

90 days31 daysDays’ Supply


RetailPharmacy

100% after deductible100% after deductibleBrand Name with No Generic Equivalent

100% after deductible100% after deductibleGeneric


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Health Savings Account (HSA) – Optional, if HDHP is chosen

SelectAccountEligibility – Regular full-time and regular part-time employees working 30 hours or more per weekPlease refer to page 7 of the 2011 Benefits Guide

What is a Health Savings Account?• HSA is a financial account owned by the individual• Contributions to the account are used to pay for current medical expenses or saved for future medical expenses -

all IRS Section 213(d) eligible expenses• No “use it or lose it” - unused funds roll over• Tax advantages

– Contributions are pretax– Interest earned or investment gains are tax free– Distributions are not taxed, if used for qualified medical expenses

• Investment opportunities• Portable

What expenses are eligible?• All health plan eligible expenses (including deductible)• IRS Section 213(d) • Some insurance premiums

– Continuation/COBRA Premiums– Medicare Premiums (in retirement)– Long Term Care Insurance (excludes employer-sponsored plan)


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Who is Eligible? • Is covered by a qualified HDHP• Is not covered by any other health insurance (including spouse’s medical FSA) • Is not enrolled in Medicare• Can’t be claimed as a dependent on someone else’s tax return (i.e., children)

Contributions• Employee pretax contributions through a cafeteria plan can be changed at the end of any pay

period• Post-tax contributions are an “above the line” deduction• Contributions can be made any time during the year up to the date the member’s tax return is

due (April 15th)• Maximum employee contribution in 2011:

– $3,050 (employee) – $6,150 (employee + 1 or more dependents)

• Catch-up contributions:– Individuals 55 years of age and older may make additional contributions– Contribution amount: $1,000


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Withdrawals

• As you use health care services, your portion of the expenses can be reimbursed out of your Health Savings Account

– Debit Card

– Direct Deposit (online withdrawal requests)

• Withdrawals are tax-free, if used for qualified medical expenses of the HDHP member, his/her spouse or tax-dependents (even if not covered by the HDHP)

• Expenses must be incurred after the HSA is established

• Expenses are reimbursed up to the HSA balance

• There is no time limit on when expenses can be reimbursed

• Individuals must retain documents to support reimbursement

• Withdrawals for non-qualified medical expenses

– Withdrawal amount is counted as income

– Subject to 20% excise tax

• Non-qualified withdrawals for those 65+ years of age

– Withdrawal amount is counted as income

– No excise tax applies



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Flexible Spending Account – Plan Year 1/1/2011 - 12/31/2011

SelectAccountEligibility – Regular full-time and regular part-time employees working 30 hours or more per week

Please refer to page 10 of the 2011 Benefits Guide

• There are two separate components

– Medical Flexible Spending Account

• Minimum Election: $10 per month ($120 per year)

• Maximum Election: $2,500 per year

• You may use funds immediately for eligible expenses incurred during the plan year

– Dependent Care Reimbursement Account

• Minimum Election: $10 per month ($120 per year)

• Maximum Election: $5,000 per year (Determined by IRS)

• Funds must be in the account prior to reimbursement

– For every dollar you set aside, you do not pay Federal, State or FICA taxes

– “Use it or lose it” – all expenses must be incurred by December 31st or they will be forfeited

– Funds will be deducted semi-monthly through a payroll deduction

• If participating in an HSA, participation is limited to dental and vision expenses.


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Additional Information

• If you would like additional information on the Health Savings Account or Flexible Spending Accounts offered through SelectAccount, please go to one of the following resources.

– Webinar: Located on www.oldrepublic2011benefits.com

– Call Customer Service:1-800-859-2144

– Online: www.selectaccount.com

• A Benefits Cost Calculator is available in the 2011 Benefits Guide or on the 2011 Open Enrollment Website. The Benefits Cost Calculator will assist you in determining how much you should set aside for the 2011 plan year.


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Voluntary Vision Program

VSPEligibility – Regular full-time and regular part-time employees working 30 hours or more per week


• Must use a VSP provider to get highest level of coverage

• Visit www.vsp.com for more information

• Basic Plan Summary:

– Eye Examinations: $10 Copay

– Standard Lenses: $20 Copay

– Additional Lens Options: 20% Discount

– Contact Lens or Frame Allowance:$150

– Contacts or Frames over $150: 20% Discount

– Frequency Limitations:

• Examination: 1 – Every 12 months

• Frames: 1 – Every 24 months

– Premiums will be deducted semi-monthly through a payroll deduction

– Please refer to the 2011 Open Enrollment Website for rates and enrollment forms


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Dental Plan

Delta Dental of Minnesota

Contributory PlanEligibility – Regular full-time and regular part-time employees working 30 hours or more per week


Category of Service Network Out-of-NetworkDiagnostic & Preventive 100% 80%

Deductible (does not apply to Diagnostic & Preventive) $75 per Covered Person

after deductibleBasic Services 80% 60%Oral Surgery 80% 60%Periodontics 50% 40%Endodontics 50% 40%Major Restorative Services 50% 40%Prosthetics 50% 40%Annual Maximum - Per Covered Person $1,500 $1,000

Orthodontics 50% 50% Lifetime Maximum - Per Covered Person $1,500 $1,500 (Separate from Dental Maximum)


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Dental Plan

• Networks – Delta Premier or Delta PPO

– Online “Find a Dentist” tool

• Visit deltadentalmn.org and use “Find a Dentist”

• For providers, click on Delta Dental PPO or Delta Premier – Search the network

– Call Customer Service toll free at 1-800-448-3815

– Delta Premier is Delta’s largest National Network

– Delta PPO is a smaller National Network, but offers deeper discounts

• Premiums will be deducted semi-monthly through a payroll deduction.

• Please refer to the 2011 Open Enrollment Website for rates and enrollment forms.


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Basic Life and Accidental Death & Dismemberment

UNUM

Company-PaidEligibility – Regular full-time and regular part-time employees working 30 hours or more per week

Please refer to pages 12 and 13 of the 2011 Benefits Guide

• Basic Life and Accidental Death & Dismemberment Benefit

– Two times annual base earnings plus commissions/performance bonuses

– $500,000 maximum

– Accidental Death & Dismemberment matches the Basic Life

– The benefit will reduce at age 70 to 65% of the original benefit and to 50% of the original benefit at age 75

• Additional Features

– Worldwide Travel Emergency Assistance utilizing Assist America

– Employee Assistance Program utilizing Ceridian

• Master-level consultants available for you or your family members – Locate childcare or eldercare– Financial experts– Depression or substance abuse– 30 minute legal consultation– Website access to www.lifebalance.net


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Supplemental Life Insurance - Employee

UNUM

Employee-PaidEligibility – Regular full-time and regular part-time employees working 30 hours or more per week


• Employee Life Insurance

– May purchase additional life insurance in increments of $10,000

– Maximum – the lesser of 5 times annual base salary or $500,000

– Guarantee Issue Limit - $200,000

• Amounts purchased up to $200,000 during the open enrollment period do not require evidence of insurability.

• If life insurance is declined during open enrollment, future enrollment will require evidence of insurability. You may be declined.

– Rates are based on employees age as of January 1, 2011.

– Premiums will be deducted semi-monthly through a payroll deduction.

– Please refer to the 2011 Open Enrollment Website for rates and enrollment forms.


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Supplemental Life Insurance – Spouse

UNUM



• You must purchase Supplemental Life Insurance on yourself in order to purchase Supplemental Life Insurance on your spouse and child(ren).

• Spouse Life Insurance

– May purchase additional life insurance in increments of $10,000

– Maximum – Lesser of employee purchased benefit or $500,000

– Guarantee Issue Limit - $30,000

• If life insurance is declined during open enrollment, future enrollment will require evidence of insurability. You may be declined.

– Rates are based on the spouses age as of January 1, 2011.




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Supplemental Life Insurance – Dependent Child(ren)

UNUM


Please refer to Pages 12 and 13 of the 2011 Benefits Guide

• You must purchase Supplemental Life Insurance on yourself in order to purchase Supplemental Life Insurance on your spouse and child(ren).

• Dependent Child(ren)

– Dependents include children ages six months to 19 years, or up to age 26, if a full-time student.

– May purchase one of three options - Evidence of insurability is not required

• Option 1: $5,000

• Option 2: $10,000

• Option 3: $15,000

– Each child is insured for the amount chosen, rate is the same regardless of the number of children in each family.




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Voluntary Long Term Disability

UNUMEmployee PaidEligibility – Regular full-time and regular part-time employees working 30 hours or more per week. Please refer to page 14 of the 2011 Benefits Guide

• Basic Plan Summary– Monthly Benefit: 60% of base salary, plus commissions/performance bonuses– Monthly Maximum: $10,000– Elimination Period: 90 Days – Zero Day Residual– Benefit Duration:

*Social Security Normal Retirement Age

Age at DisabilityMaximum Period of PaymentLess than age 62 To SSNRA*Age 62 60 MonthsAge 63 48 MonthsAge 64 42 MonthsAge 65 36 MonthsAge 66 30 MonthsAge 67 24 MonthsAge 68 18 MonthsAge 69 or Older 12 Months


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Voluntary Long Term Disability - Continued

• Basic Plan Summary, continued

– Survivor Benefit: 3 Months

– Pre-existing Conditions Limitation: 3/3/12

• Conditions that existed 3 months prior to the insured's effective date of coverage will not be covered if the disability began during the first 12 months of coverage, unless the insured was treatment-free for 3 consecutive months starting on or after the effective date of coverage.

• The Pre-existing Conditions Limitation will be waived if currently enrolled in a Long Term Disability Plan at their respective SOC.

– Mental Illness Limitation: 24 Months

– Enrollment is guaranteed if benefit is purchased during the open enrollment period.




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Questions???

Please contact your local HR representative or one of the following:

Carrier Phone Website

Blue Cross Blue Shield of MN 866-870-0348 www.bluecrossmn.com

Delta Dental of MN 800-448-3815 www.deltadentalmn.org

Select Account (HSA or FSA) 800-859-2144 www.selectaccount.com

UNUM 800-421-0344 www.unum.com

Vision Service Plan (VSP) 800-877-7195 www.vsp.com

Documents

2011 Benefits Enrollment