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EmployeeBENEFITSGuide2022NON-UNION TEAM MEMBERS
EmployeeBenefits Guide2022General Information1.Take a Fresh Look4.Eligibility2.2022 Benefits Overview5.Benefits Enrollment WebsiteCore Benefits7.Medical – Providers12.Non-Union Team Member Cost Sharing9.Medical Plans14.Dental10.Find a Provider15.Vision11.Medical Plans: SupplementOther Benefits17.Well-Being24.Retirement Benefits – 401(k)20.Employee Assistance Program25.Company Paid Benefits22.Flexible Spending Accounts (FSA)27.Voluntary Benefits30.Important NoticesMiscellaneous29.Contact InformationIf you (and/or your dependents) have Medicare or you will become eligible for Medicarein the next 12 months, a Federal law gives you more choices about your prescription drug coverage.See the Important Notices included in this guide for additional details.The information in this brochure is a general outline of the benefits offered under Save Mart’s benefits program. Specific details and plan limitationsare provided in the Summary Plan Descriptions (SPD), which is based on the official Plan Documents that may include policies, contracts and planprocedures. The SPD and Plan Documents contain all the specific provisions of the plans. In the event that the information in this brochure differs fromthe Plan Documents, the Plan Documents will prevail.The Save Mart Companies Non-Unioni
Take a Fresh LookA new year is approaching and now more than ever, access to affordable quality health care is an importantpart of you and your family’s well-being. We are proud that The Save Mart Companies continues to be aleader in our community and our industry in providing a quality benefits package to our team members.Different from previous years, this year is an “active” enrollment, meaning you must actively enroll forthe medical, dental, vision and FSA (if applicable) benefits that you want for the plan year beginningJanuary 1, 2022. Your current 2021 medical, dental, vision and FSA (if applicable) benefit elections WILLNOT roll over to 2022.This guide is designed to help you navigate through all the offerings available to you as a Save MartTeam Member. Please read it carefully to find out how you can make our benefits work for you and yourloved ones.Open Enrollment for the 2022 Benefits Plan year will take place Monday, October 11 throughSunday, October 24, 2021.The Save Mart Companies Non-Union1
2022 Benefits OverviewAction Required for 2022 BenefitsFor 2022, changes have been made to the benefits program. In order to ensure yourreview and understanding of the new benefit and contribution changes, we will behaving an Active Enrollment. An Active Enrollment means all Team Members must login (page 5) during the open enrollment period (10/11-10/24) and elect medical,dental, vision and FSA (if applicable) benefit coverages for 2022. Team Memberswill not be re-enrolled in current benefits. A non-action will result in termination ofcurrent medical, dental, vision and FSA (if applicable) benefits effective 1/1/2022.Exception: Your current 2021 voluntary benefit elections willroll over to 2022. See page 27 for details.Team Member ContributionsCall CenterAs healthcare costs rise, we continue to offer comprehensivebenefits. Over the past six years, despite continuous andsignificant increases in health care costs year after year,The Save Mart Companies has not increased employeecontributions for benefits. For the benefits plan yearbeginning January 1, 2022, we are simplifying and makingchanges to our benefits offerings to be more in line with thenational standard for our industry, while staying competitiveand comprehensive. These changes include both plandesign and employee contributions. We will continue toprovide wellness discount opportunities, including theannual biometric screening.The Save Mart call center is available to provide assistancein understanding your benefits, answering claims questionsand providing resources for all your benefit needs. You canreach the call center at 1-87SAVEMART (1-877-283-6278).The call center is available to assist you Monday - Fridayfrom 8 a.m. to 5 p.m. PST.See page 9 for plan comparisons and coveragelevels. Remember, you can elect medical, dental or visionseparately: they do not have to be bundled together. TeamMembers married to team members of The Save MartCompanies cannot cover each other as dependents.How do I enroll?Quick Tip!After choosing your benefits, you cannot change themduring the year unless you have had a qualifying lifeevent (marriage, a new child, etc.). Go to page 4 tolearn more.Visit www.mysavemartbenefits.com on a computer,smartphone, or tablet and make your benefit choices. Fordetailed directions, go page to 5.REMINDER: You must complete your biometric screeningANNUALLY in order to receive the discounted medicalpremium rate; biometric screenings from previousyears do not qualify you for the 2022 credit. Spousesare no longer required to complete in order to satisfyrequirement. See page 18 for more details.2The Save Mart Companies Non-Union
2022 Benefits Overview (continued)Your Open Enrollment Checklist Review your benefit options and product brochures. Need to make changes or enroll in FlexibleSpending Accounts (FSAs)? You will need to gothrough the enrollment process. See FSA section ofthe Guide to learn more. Enrolling Dependents? Be prepared with yourdependents’ dates of birth and Social Securitynumbers. You will not be able to enroll themwithout this information. Effective January 1, 2022,a Working Spouse Rule Applies. See Eligibilitysection of the Guide to learn more. Dependenteligibility verification documents (copies ofmarriage and/or birth certificates) can be uploadedduring open enrollment to BenefitSolver byOctober 24, 2021. Confirm your dependents’ Social Security numbersand birthdates even if you aren’t making changes. Review/update your beneficiary designations.When Do I Get My ID Cards?For the benefits year beginning January 1, 2022, we areswitching from Blue Shield to Anthem.All Anthem Members: After you enroll, Anthem memberswill receive a new ID card from the medical plan youselected. When you get your medical benefits ID card,check to make sure the information is accurate. If not,contact our Customer Service call center at 1-87SAVEMART(1-877-283-6278).Note: Effective January 1, 2022, your current Blue Shieldcards will be invalid.Kaiser Members: New members will receive ID cards. Ifyou are an existing Kaiser member, new ID cards will notbe issued. All members will have access to their a digitalID card, which will be available on the Kaiser Permanentemobile app or ordered at kp.org.You will not receive an ID card for dental or vision coverage.Please contact the Customer Service Centerat 1-87SAVEMART (1-877-283-6278).The Save Mart Companies Non-Union3
EligibilityWho’s Eligible Team Members who work full-time with 130 hours or more per month on the clock and have been with the company forat least 60 days of continuous employment. Team Members working less than 130 hours per month are subject to a 12-month measurement period before they mayenroll in benefits, in accordance with the Affordable Care Act (ACA). The measurement period begins October 3rd andends October 2nd of the following year.Eligible employees may enroll dependents as follows: Legally married spouse and registered domestic partner– Working Spouse Rule: Effective January 1, 2022, if your legally married spouse or registered domestic partner worksand is eligible for their employer’s group health plan, they may not be covered on the Save Mart medical plans. Yourworking legally married spouse or registered domestic partner will remain eligible for all other Save Mart benefits(dental, vision, life, etc.).Children–An employee’s, married spouse’s or domestic partner’s natural child, stepchild, legally adopted child or a child forwhom the employee, married spouse or domestic partner has legal custody or has been appointed legal guardianby a court of law.–The employee, married spouse or domestic partner is legally required to provide group health coverage for the childpursuant to an administrative or court order.–A child who is incapable of self-sustaining employment due to a physical or mental condition. If such dependent isage 26 or older, you must provide proof of continuous health coverage for this dependent since the age of 26.–Adult children up to the age of 26 (does not include the adult child’s spouse or children).Child does not include: any person who is in active service in the armed forces.Making ChangesYou can only change your benefits elections during Open Enrollment unless you experience a qualifying life event that enablesyou to make mid-year changes. Make sure to notify the Human Resources Benefits Department within 31 days of the event ifyou have a qualifying life event and need to make a change (add or drop) to your coverage elections.Life events include (but are not limited to): Birth or adoption of a baby or child Marriage Loss of other group healthcare coverage Divorce Eligibility for new group healthcare coverageQuestions?Call 1-87SAVEMART(1-877-283-6278)4The Save Mart Companies Non-Union
Benefits Enrollment WebsiteHow to enrollin your benefitsYour Logo HereREGISTER AND LOGIN1. Visit www.MySaveMartBenefits.com andclick the Register button to get started. Thecase-sensitive company key is savemart.2. Create your user name and password, verifyyour personal information, and answer a fewsecurity questions.3. Log in using your new user name andpassword.RETURNING USERS: Click on the Forgot yourusername or password? link to reset your login details.EXPLORE YOUR OPTIONSExplore the site to learn about your benefits.You’ll find lots of helpful information in theReference Center.The calendar at the top of the Home page letsyou know how many days you have to enroll.START YOUR ENROLLMENTClick the Start Here button to review yourpersonal information and add or edit anydependents you wish to cover.You will need to provide each dependent’s legalname, Social Security Number, and birth date toadd them to your coverage.*Sofia, your personal benefits assistant, cananswer questions and guide you as you enroll.*You may be required to provide documentation to prove yourrelationship to each dependent.Questions? 877-283-6278www.MySaveMartBenefits.comCompany Key: savemartThe Save Mart Companies Non-Union5
Benefits Enrollment Website (continued)2 WAYS TO ENROLL IN COVERAGE MyChoice Recommendation EngineAnswer a few simple questions to receive apersonalized benefits recommendation. Youranswers are never shared. Explore on your ownUse the Next and Back buttons to review andelect options available to you. Choose ordecline coverage for each option, and selectwhich family members you want to cover.REVIEW AND FINALIZE YOUR ELECTIONSMake sure your personal information, elections,dependents, and beneficiaries are accurate, thenapprove your elections.To finish, click I Agree. When your enrollment iscomplete, you will receive a confirmationnumber and can print your Benefit Summaryfor your records.AFTER YOU ENROLLReturn to the Home page to check for anyadditional tasks needed to complete yourenrollment, view or download your BenefitSummary, and download the MyChoiceTMMobile App.Questions? 877-283-6278www.MySaveMartBenefits.comCompany Key: savemart6Visit this site anytime you want to learn moreabout your benefits or make a change toyour coverage (if you experience a qualifyinglife event).The Save Mart Companies Non-Union
Medical – ProvidersChoose The Medical Plan That Fits Your LifeLearn about Save Mart’s medical plans here to find a plan that best meets your needs. The descriptions below will introduce youto them, then check the medical plan tables beginning on page 9 for specific coverage and cost details.ACTION REQUIRED: 2022 is an Active Enrollment.All team members must actively enroll for 2022 medical benefits. Current 2021medical benefit elections WILL NOT roll over to 2022. A non-action will resultin termination of current medical benefits effective January 1, 2022.AnthemFor the benefits year beginning January 1, 2022, we areswitching from Blue Shield to Anthem. All Anthem Planshave these features: Cost of in-network preventive exams and screeningsare 100% covered Copays and coinsurance, including pharmacy, counttoward the deductible and out-of-pocket maximum Coverage through the Anthem network with norequirement to select a primary care physician or geta referral for specialist careYou have two Anthem Plan Options:1. Anthem PPO provides comprehensive coverage foryou and your enrolled dependents. You will pay lesswhen using Anthem network providers and facilities.2. Anthem Minimum Value PPO has lesser coveragethan the alternative plans at a lower cost, so it maybe the best choice for Team Members with very fewhealth problems.What are the differences between these plans? The cost you pay out of your paycheck for the planyou choose The costs you pay for healthcare services you receiveIt’s important to pay special attentionto the annual deductible amount.It’s the amount you pay each year for most eligible medicalservices or medications before your health plan begins toshare in the cost of covered services.You’ll also want to consider the annualout-of-pocket maximum.It’s the most you could pay for covered medical expensesin a year. Once you reach your annual out-of-pocketmaximum, your health plan will pay all of your coveredmedical and prescription costs for the rest of the year.Note: The out-of-pocket maximum is for in-networkcoverage only, excluding the Anthem Minimum Value PPOmedical plan.ANTHEM’S CARE & COST FINDERLog in to www.anthem.com to use the tool to researchthe difference in the estimated cost of a particular servicebased on the facility where the service is provided, such asa doctor’s office, hospital, imaging center or ambulatorysurgery center.All Anthem members will receive a new ID card. Effective January 1, 2022, current Blue Shield cards will become invalid.Anthem members will receive new ID cards with new member numbers mid-December. Anthem members will need to give thenew ID card information to their medical and pharmacy providers. Team Members currently enrolled in Blue Shield will needto check if their current doctors accept Anthem and are considered in-network. Otherwise, team members may have tochange doctors or pay for out-of-network service costs.Find an Anthem Providerhttps://www.anthem.com/ca/find-care/The Save Mart Companies Non-Union7
Medical – Providers (continued)Kaiser HMO PlanKaiser is a health maintenance organization (HMO).This plan only covers care received at Kaiser health carefacilities so it is important to have a Kaiser location nearby.Kaiser is a “one stop shop” for check-ups with physicians,surgery, pharmacy and vision needs, which many peoplelike. If you’re unfamiliar with Kaiser, you can learn moreby visiting their website at kp.org or by calling Kaiserat 1-800-464-4000.Key Features: Available to all Team Members residing in California Fixed copays and low deductible Requires a referral for specialist care but does notrequire designation of a Primary Care Physician (PCP) Kaiser network only. No out-of-network benefits(other than medical emergencies)Manage Health Care on the GoDownload the Kaiser Permanente app today at no costfrom the Apple App Store or Google Play store.This app allows you to: Email yourdoctor’s office View mostlab test results Refill mostprescriptions Schedule or cancelroutine appointments Access your ID cardKaiser ResourcesVideo VisitsKaiser Members can video chat with a doctor from thecomfort of their own homes, without an appointment. Formore information, visit: mydoctor.kp.org/ncal/videovisitKaiser PharmacyKaiser Permanente has many medical offices that providepharmacy services. They also offer a low-cost mail orderservice with free shipping. Register or login on kp.org tofind a location closest to you.Save Mart/Express ScriptsPharmacy BenefitPharmacy benefits for Anthem MembersAs a reminder, The Save Mart Companies Team Membersmust fill prescriptions at a Save Mart Companies Pharmacy.Express Scripts manages your pharmacy benefit and willhelp you with your prescriptions.Save Mart Mail-Order: If you take ongoing maintenancemedications, you can obtain a 90-day supply through themail-order program. Please refer to the mail order form forfull instructions located on Cornerstone Connections Benefits Connection Pharmacy or call 1-209-863-1483.For Specialty Medications please see your Save MartPharmacist. If the Save Mart Pharmacy is unable to provideyour medication, contact Express Scripts for assistance. Formore information about this service, please contact ExpressScripts at 1-877-849-5523.FAQsWhat if I have an emergency or don’t live near a SaveMart Pharmacy?Your first fill is allowed at any retail pharmacy (CVS,Walgreens, etc.), second fills and maintenance drugs willhave to be filled at a Save Mart Pharmacy or through theSave Mart mail-order program.What if I want to continue to use a non-Save MartPharmacy after the first fill?You can have your prescription filled at a retail pharmacy,but you will be subject to the full price of the drug.Can prescriptions be filled at Save Mart and LuckyPharmacies?Yes! You can utilize any Save Mart or Lucky pharmacy.What if Save Mart does not carry the drug that I need?If Save Mart is unable to fill your prescription, ExpressScripts will ensure that you receive your medications in atimely manner.Find a ns8The Save Mart Companies Non-Union
Medical PlansACTION REQUIRED: 2022 is an Active Enrollment.All team members must actively enroll for 2022 medical benefits. Current 2021 medical benefit elections WILL NOTroll over to 2022. A non-action will result in termination of current medical benefits effective January 1, 2022.Plan Highlights1Anthem PPOMedical PlanKaiser HMOMedical PlanAnthem Minimum Value PPOMedical PlanEmployee Cost ShareEmployee CostShareEmployee Cost ShareIn-Network2Out-of-Network3Kaiser s to all servicesunless otherwise indicated) 1,000/person; 2,000 family max 3,000/person; 6,000/family max 1,000/person; 2,000 family max 2,500/person 5,000/family maxCalendar YearOut-of- Pocket Maximum 3,000/person; 6,000/family maxNone 3,000/person; 6,000/family max 5,500/person 11,000/family maxDoctor’s Office Visits 30450% 304Specialist Office Visits30%50% 6050% 3030%50%Preventive CareNo charge450%No charge4No charge450%Diagnostic X-Rayand Lab Tests30%50% 1030%50%4Chiropractic Care 304,550%5 154,530%550%5Inpatient HospitalServices/Surgeon’s Fees30%50%30%30%50%4Emergency Room430%Mental Health/Substance AbuseOutpatient Services 25430%650%30%Individualtherapy: 304;Group therapy: 154/Mental Health;4 5 /Substance AbusePrescription DrugBenefits2,7,830%50%Minimum Value PPO:All prescriptions subject to deductibleSave Mart Pharmacies(Up to 30 Day Supply)Generic: 15Brand Formulary: 25Non-Formulary: 35Generic: 30Brand: 55Non-Formulary: 90Save Mart Retail/MailOrder Pharmacies(Up to 90 Day Supply)Generic: 30Brand Formulary: 50Non-Formulary: 70Not coveredGeneric: 15Generic: 30Generic: 10Brand Formulary: 30 Brand Formulary: 25 Brand Formulary: 55(Kaiser pharmacies only)Non-Formulary: 35 Non-formulary: 90Generic: 30Generic: 20Brand Formulary: 60 Brand Formulary: 50(Kaiser pharmacies only)Non-Formulary: 70Not covered1.This is a summary only; for more detailed information, please refer to the Summary Plan Description or Plan Summary for each plan.2.Subject to the deductible and paid at in-network, negotiated rates.3.Members pays applicable coinsurance and any amount above Anthem’s negotiated rates.4.Deductible waived.5.See Summary Plan Description for number of visits covered per year and out-of-network plan payment maximums.6.If you are admitted directly to the hospital as an inpatient for Services, you will pay the per admission inpatient cost share instead of the Emergency Room CostShare.7.Anthem members: Out-of-network prescription drug coverage under the Anthem plans is limited to a 30-day supply for first-time fills only.8.Kaiser members: Prescriptions obtained from non-Kaiser pharmacies are not covered.The information described on this page is only intended to be a summary of benefits. It does not describe or include all benefit provisions, limitations, exclusions, orqualifications for coverage. Please review plan documents for full details. If there are any conflicts with information provided on this page, the plan documents will prevail.The Save Mart Companies Non-Union9
Find a ProviderAre you looking for a doctor?It’s easy to find one onlineThe right doctor can have a positive impact on your health and well-being. Choosing one inyour plan can save you money as well. The Find Care tool helps you locate doctors,dentists, eye care professionals, hospitals, labs, and other health care providers in yourplan. If you decide to see a doctor outside your plan, your costs will be higher and yourcare may not be covered. Therefore, it is a good idea to learn how this convenient tool canhelp you find care.How to find a doctor near you:1Go to anthem.com/ca/find-care2You can look for a doctor by using either: Search as a member: Log in with a username and password or with the membernumber on your ID card. Search as guest: Select a plan or network,* or search by all plans and networks3Once you log in, select the Find Care option on the welcome menu.4Next, choose who you would like to see. You can search for adoctor nearby or use the doctor’s name.5Select a provider to see more details, such as: Specialties Training Gender A map of their office location Languages spoken Phone numberHealth information that goes where you goThe Sydney Health app makes it easy to find information about your plan benefits wherever you are. Theapp keeps everything you need to know about your plan personalized and in one place. Download theapp today.* If you don’t know the name of the plan or network, check with your human resources department or benefits administrator.Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.00734CAMENABC VPOD Rev. 06/2010The Save Mart Companies Non-Union
Medical Plans: SupplementTelehealth Services through Anthem’s Live Health OnlineAvailable to Anthem members only. Whether you’re sick or don’t have time to wait for a doctor’s appointment, you canstill access care for non-life-threatening conditions through our integrated virtual care service program. This program givesyou 24/7/365 access to clinical support and expertise through the convenience of phone or video consults. Take control of yourhealth when, where and how it best works for you, and get the care you need at your convenience.Telehealth can treat many general medical conditions, including: Cold and flu symptoms Respiratory infection Allergies Rashes/Skin infections Asthma Sore throat Bronchitis Sinus problems Fever Urinary tract infections Nausea And more!Virtual Behavioral Health Care through Anthem’s Live Health OnlineAvailable to Anthem members only. Team Members have access to the quality care they need without the obstacles ofconventional in-office options. Members speak with board certified psychiatrists, licensed psychologist, or therapists convenientlyby video and phone from wherever they feel most comfortable. Members can book appointments with ease seven days a weekand build ongoing relationships with mental health professionals of their choice - all without having to travel to or wait at thedoctor’s office.Telehealth and Virtual Behavioral Health Care through Anthem’s Live HealthOnline is available to eligible Team Members enrolled in Anthem plans. A 5 copay pervirtual visit applies. To access your telehealth and virtual behavioral health care or haveany questions, please contact 1.844.784.8409 or visit www.livehealthonline.com.The Save Mart Companies Non-Union11
Non-Union Team Member Cost Sharing2022 Cost Sharing for Team MembersThe Save Mart Companies pays the majority of the cost for health plan coverage. Team Members pay a portion of the cost ofcoverage as outlined below. All employee contributions are deducted on a pre-tax basis.Effective January 1, 2022, Team Members who indicate they are tobacco users during benefit enrollment will pay an additional 15 per week for medical coverage for the 2022 benefit year. Tobacco users can earn the tobacco-free discount by completingsix sessions of a tobacco cessation program or other alternative by March 31, 2022. For more information, please see theWell-Being section of the Guide.Effective January 1, 2022, Team Members who do not complete their biometric screenings will pay an additional 20 per weekfor medical coverage for the 2022 benefit year. Biometric screenings from previous years do not qualify you for the 2022 discount.Screening requirement applies to Save Mart team members only; spouse screening is not required. For more information, pleasesee the Well-Being section of the Guide.Medical PlansEmployeesParticipating inScreening*EmployeesNot Participating inScreening*Additional Premiumfor Tobacco Users**(Pre- Tax)2022 Weekly2022 Weekly2022 Weekly Employee Only 29.00 49.00 15.00 Employee Spouse/Domestic Partner 60.00 80.00 15.00 Employee Child(ren) 53.00 73.00 15.00 Employee Family 82.00 102.00 15.00 Employee Only 22.00 42.00 15.00 Employee Spouse/Domestic Partner 43.00 63.00 15.00 Employee Child(ren) 39.00 59.00 15.00 Employee Family 59.00 79.00 15.00 Employee Only 29.00 49.00 15.00 Employee Spouse/Domestic Partner 60.00 80.00 15.00 Employee Child(ren) 53.00 73.00 15.00 Employee Family 82.00 102.00 15.00Anthem PPO Medical PlansPPO PlanMinimum Value PPO PlanKaiser HMO Plan*You must complete your biometric screening annually in order to receive a 20 per week discount on your medical premium. For more information, pleasesee the Well-Being section of the Guide.**If you use tobacco products you will pay an additional 15 per week.The information described on this page is only intended to be a summary of benefits. It does not describe or include all benefit provisions, limitations, exclusions, orqualifications for coverage. Please review plan documents for full details. If there are any conflicts with information provided on this page, the plan documents will prevail.12The Save Mart Companies Non-Union
Non-Union Team Member Cost Sharing (continued)Dental and Vision PlansEffective January 1, 2022, screening discounts no longer apply to dental and vision.Employees2022 WeeklyMetLife Dental Plan (Select Dental) Employee Only 6.00 Employee Spouse/Domestic Partner 10.00 Employee Child(ren) 9.00 Employee Family 12.00Vision Service Plan (Select Vision) Employee Only 3.00 Employee Spouse/Domestic Partner 5.00 Employee Child(ren) 4.00 Employee Family 6.00The information described on this page is only intended to be a summary of benefits. It does not describe or include all benefit provisions, limitations, exclusions, orqualifications for coverage. Please review plan documents for full details. If there are any conflicts with information provided on this page, the plan documents will prevail.The Save Mart Companies Non-Union13
DentalMetLife DentalYou can choose your own dentist with the Dental PPO plan from MetLife. However, you can save money if you pick a dentistfrom the MetLife PDP Plus network because they have agreed to charge discounted fees. The table below explains what portionof the fees the plan will cover.ACTION REQUIRED: 2022 is an Active Enrollment.All team members must actively enroll for 2022 dental benefits. Current 2021 dental benefit elections WILL NOTroll over to 2022. A non-action will result in termination of current medical benefits effective January 1, 2022.Please see Contact Information section in the Guide for group number and contact information.MetLife Dental PPO PlanPlan BenefitsIn-Network1 Employee Cost Share 50/person 150/family maximumDeductible2Benefit Maximum 1,500/personPreventive Care Benefits X-Rays, Routine Exams and Two Semi-Annual Teeth CleaningsNo ChargeBasic Care Benefits Fillings, Extractions, Endodontics, Periodontics, and Oral Surgery20%Major Care Benefits Crowns, Inlays, Onlays, Bridges, Dentures, and Restorations50%Orthodontia Benefits50% 1,500 Lifetime Maximum Benefit Adults and Children1.Paid at negotiated rates.2.All services are subject to the deductible except in-network preventive care.ID cards are not required to obtain dental careFind a dentistmetlife.com/insurance/dental-insurance/The information described on this page is only intended to be a summary of benefits. It does not describe or include all benefit provisions, limitations, exclusions, orqualifications for coverage. Please review plan documents for full details. If there are any conflicts with information provided on this page, the plan documents will prevail.14The Save Mart Companies Non-Union
VisionKaiser VisionWhen you enroll in the Kaiser HMO medical plan option, Kaiser Vision coverage is included. You must be enrolled in the Kaisermedical plan to be eligible for Kaiser Vision coverage. You may only use your optical benefit when you visit a Kaiser OpticalCenter for service; there is no out-of-network coverage.ACTION REQUIRED: 2022 is an Active Enrollment.All team members must actively enroll for 2022 Kaiser medical and vision benefits. Current 2021 medical benefitelections WILL NOT roll over to 2022. A non-action will result in termination of current medical benefits effectiveJanuary 1, 2022.Kaiser VisionPlan BenefitsBenefit AmountFrequencyCovered by yourKaise
Employee Benefits Guide The Save Mart Companies Non-Union i If you (and/or your dependents) have Medicare or you will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. See the Important Notices included in this guide for additional details.
