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2017 Benefits-at-a-GlanceThis document provides a general overview of the benefits package provided to eligibleemployees at Sodexo. These benefits are provided on a company-wide basis to salariedexempt employees. Employees in the state of Hawaii are not eligible for most standard company medicalplans but may be eligible for state-specific medical plans.Some benefits listed here may not apply to employees in Puerto Rico and Guam.The benefits, terms and conditions described above are not subject to change without theprior approval of the Benefits Department. Certain benefits are described in greater detail intheir respective Summary Plan Descriptions.Always refer to the appropriate Summary Plan Description (SPD) and any applicableSummary of Material Modification (SMM) for details on the services and supplies that arecovered or excluded for each plan. If there is a difference between the information in thisdocument, the SPD, the plan document or the carrier’s policy or service contract, theinformation in the plan document or contract governs. The Plan Administrator reserves theright to resolve any ambiguity in this document.1 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Your Choices.Your Health. MedicalDentalVisionDisabilityFlexible SpendingAccountso HealthcareSavings Accounto Family CareSavings AccountYour Choices.Your Future. Life Insurance401(k) RetirementSavings PlanCredit UnionsTuitionReimbursementPayroll Optionso Direct Deposito Money NetworkServicesTotal RewardsSodexo team members make significant contributionsthat improve the quality of daily life for our clients,customers and in the communities we serve. In return,Sodexo is committed to caring for our employees inthe same way that we care about our customers.One way we care about our employees is providing aTotal Rewards package that meets or exceedsstandards for our industry and attracts, retains andrewards the people responsible for our growth andsuccess—you.Total Rewards represents a broad spectrum of plansand programs designed to reward and motivate youthroughout your career.It includes benefits programs to support you indifferent stages of your life. Whether you are single orsupporting several dependents, saving for your future,or going back to school, Sodexo provides a range ofbenefits options.This At-a-Glance document provides an overview ofthe Total Rewards package Sodexo offers to you—tohelp you meet your needs now and in the future.Your Choices.Your Life. VacationSick LeaveOther Time OffLifeWorksEmployee Discounts2 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Benefits Eligibility You are eligible to participate in Sodexo Benefits if you are a non-temporary, exempt salariedemployee.After You EnrollAfter you enroll, your Confirmation of Enrollment, will be sent to you which lists the specific date on whichyour benefits will begin. Check your paycheck after the effective date of coverage to review your benefitdeductions to be sure they are correct.When Your Benefits BeginEmployees Who Live in the U.S. (except Hawaii)New Hires Salaried exempt employees are eligible forthcoverage on the 90 day after their hire date. Youmust enroll in benefits coverage within your first89 days of employment. If you do not enroll withinyour enrollment period, you will have to wait untilthe next Annual Enrollment period to enroll.When you become eligible, you will automaticallybe enrolled in the Free Basic Life Insurance Planand Business Travel Accident plans at no cost toyou. These plans pay a monetary benefit to yourdesignated beneficiary in the event of your death.Vacation and sick leave will begin to accrueimmediately when you become eligible.Employees classified as part-time are not eligibleto accrue vacation or sick leave.You are automatically enrolled in the companysponsored LifeWorks Plan on your first day ofemployment. LifeWorks is a free, confidentialprogram that can help with almost anything – fromhandling stress, relationships, challenges at work,parenting or caring for an older relative to healthissues like losing weight or quitting smoking.Newly Eligible Employees who become eligible due to aclass change (for example, your positionchanges from part-time to full-time) will beeligible for benefits on the 90th day after theclass changes in the payroll system. Youmust enroll for benefits coverage within thefirst 89 days from this date. If you miss thisenrollment window, you will have to wait untilthe next Annual Enrollment period to enroll.Eligibility for vacation, sick, and other paidleave, Tuition Reimbursement and LifeWorksis based on your status of part-time or fulltime. If your status changes from part-time tofull-time, you will immediately becomeeligible for these benefits except TuitionReimbursement. You must have one year ofservice to be eligible for the TuitionReimbursement Program. If the status ischanged to part-time, you will no longer beeligible for vacation, sick, personal leave,Tuition Reimbursement and LifeWorks, as ofthe date your status changes.3 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
When Your Benefits BeginEmployees Who Live in HawaiiNew Hires All full-time employees, are eligible for benefitson the 24th day after being hired.New hires must enroll for benefits coveragewithin the first 23 days of employment. If you donot enroll within this enrollment window, you willhave to wait until the next Annual Enrollmentperiod.Vacation and sick leave will begin to accrueimmediately upon becoming eligible. There isno waiting period to use LifeWorks, theemployee resource program.Newly Eligible Employees who become eligible due to a classchange (for example, your position changesfrom part-time to full-time) must enroll forcoverage within 31 days from the date theirclass changed, which is their eligibility date. Ifyou do not enroll within the 31 day timeframe,you will have to wait until the next AnnualEnrollment period to enroll for coverage.Eligibility for vacation, sick, and other paid leave,Tuition Reimbursement and LifeWorks is basedon your status. If your status changes from parttime to full-time, you will immediately becomeeligible. You must have one year of servicebefore you become eligible for the TuitionReimbursement Program. If the status ischanged to part-time, you will no longer beeligible for vacation, sick leave, personal leave,Tuition Reimbursement and LifeWorks, as of thedate of the status change.NOTE: If you live and work in Hawaii and you donot enroll, you must submit a Hawaii State WaiverForm to the Sodexo Benefits Center or you willautomatically be enrolled in the Kaiser PermanenteHMO Plan.4 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Your Choices. Your Health.Good health is essential to a good life. Sodexo’s health plans are designed to keep you and your familyfeeling good while helping you manage the costs of medical care. One of the best ways to stay healthy andsave money is to take advantage of preventive healthcare which is free to you. Getting recommendedscreenings, annual check-ups and immunizations is important for staying healthy.Medical BenefitsMedical - PPO Plan (CIGNA)www.cigna.com/sodexo800 909 2227Available to employees in the continental United States, Alaska and Guam.Not available to employees in Puerto Rico or Hawaii.In-NetworkCoverageAnnual Deductible 1,000 individual; 2,000 familyAnnual Out-Of-Pocket Maximum 5,000/individual, 12,700/familyPreventive Care (routine physicalexams, well-baby care, gyn exams,immunizations)Plan pays 100%Out-of-Network 2,000 individual; 4,000family 10,000/individual, 30,000/familyPlan pays100%Tobacco cessation program andHealth Coaching services availableat no cost to youDoctor Office Visit (primary and 30 primary/ 50 specialist copay per visitPlan pays 50% afterspecialist)deductibleTelemedicine – MDLIVE 25 per visitNot coveredMDLIVE is a convenient way to see a doctor without going to the doctor’s office for such non-life threateningconditions which would include urinary tract infections, colds/flu, fever, pink eye, migraines, bronchitis.Log in to myCigna.com and click on MDLIVE or mdlive.com/Sodexoor call 888 726 3171Note Limitations by State: AR – Not available, IA, LA, TX – Phone Consultations Only, ID – Video consultations only, CA – 72hour supply of prescriptions by phone (no restrictions for video consultation)5 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Medical BenefitsMedical - PPO Plan (CIGNA)CoverageUrgent CareHospital -Inpatient (includesmaternity admissions)Prior authorization required for allinpatient and outpatient hospitalservicesHospital- Outpatient SurgeryPrior authorization required for allinpatient and outpatient hospitalservicesMaternity(pre- and postnatal office visits)Emergency Care(when not followed by admission)Mental Health – InpatientPrior authorization requiredMental Health – OutpatientSubstance Abuse – InpatientPrior authorization requiredSubstance Abuse – OutpatientIn-Network 30 copay per visit 250 copay then you pay 30% andplan pays 70% after deductibleOut-of-Network 30 copay per visit 250 copay then you pay 50% andplan pays 50% after deductibleYou pay 30% and plan pays 70%after deductibleYou pay 50% and plan pays 50%after deductible 30 Primary Care Physician or 50Specialist copay for initial visit, then100% 150 copay per Emergency Roomvisit waived if admitted, then you pay30% and plan pays 70% afterdeductible 250 copay then you pay 30% and planpays 70% covered after deductible.FacilityYou pay 30% and plan pays 70%after deductibleYou pay 50% and plan pays 50%after deductibleOffice Visit 50 per visitOffice VisitYou pay 50% and plan pays 50%covered after deductible 250 copay then you pay 50% andplan pays 50% after deductible.Prior authorization requiredFacilityYou pay 50% and plan pays 50%after deductible. 250 copay then you pay 30% andplan pays 70% after deductible. Priorauthorization requiredFacilityYou pay 30% and plan pays 70%after deductibleOffice Visit 50 per visit 150 copay per Emergency Roomvisit waived if admitted, then youpay 30% and plan pays 70% afterdeductible 250 copay then you pay 50% andplan pays 50% after deductible.FacilityYou pay 50% and plan pays 50%after deductible.Office VisitYou pay 50% and plan pays 50%after deductible6 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Medical BenefitsMedical - PPO Prescription Drug Benefit – (ExpressScripts)www.expressscripts.com800 903 7968Mandatory Generic Drugs - If you purchase brand-name drugs when a generic isavailable, you pay more.CoverageTypeRetail (30-daysupply)Generic 10 copayBrand Name10% coinsurance- 35 minimum/ 100 maximumNon-Formulary Brand Name30% coinsurance - 50 minimum/ 150 maximumGeneric 20 copayBrand Name10% coinsurance- 87.50 minimum/ 200 maximumNon-Formulary Brand Name30% coinsurance - 125 minimum/ 300 maximumIf you don’t use mail order for your non-specialty long-term medications, you will pay100% of the cost of the medication after you fill your initial prescription and two refills ofthe drug at a retail pharmacy.Mail Order (90-daysupply)Retail RefillAllowanceCopay/CoinsuranceSome long-term specialty drugs, including but not limited to, Copaxone, Enbrel, Humiraand Sovaldi are required to be filled through Accredo, Express Script’s mail orderpharmacy, on the first fill.WELLNESS INCENTIVEEarn 100 Toward Your Medical ExpensesTo participate, each plan year you take an online Health Assessment. If youcomplete a Health Assessment, you will earn a 100 credit. If you are a PPOPlan member, you will have the credit held in an account for you at Cigna touse toward paying medical expenses for yourself and your dependents.To take your Health Assessment and for more details on this incentiveprogram, visit www.mycigna.com7 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Medical BenefitsMedical - UnitedHealthcare Health ReimbursementAccount (HRA)https://www.myuhc.com800 784 2023Available to employees in the continental United States and Alaska.Not available to employees in Guam, Puerto Rico and Hawaii.CoverageYou OnlyHRA 750You Spouse/DomesticPartner 1,175You Child(ren)You Family 1,175 1,500CoverageIn-NetworkOut-of-NetworkAnnual Deductible 1,750 per member; 3,500 member spouse/DP or child; 4,175 member Children; 4,500 family 2,750 per member; 5,500 member spouse/DP orchild; 7,175 member Children; 7,500 family 6,350 per member; 12,700 member spouse/DP orchild; 12,700 member children; 12,700 family 12,750 per member; 25,500 member spouse/DP orchild; 37,175 member child; 37,500 familyYou pay 20% and plan pays 80% afterdeductibleYou pay 0% and plan pays 100%You pay 40% and plan pays 60%after deductibleYou pay 0% and plan pays100%(HRA Annual Funding MemberResponsibility)Annual Out of Pocket MaximumMember Responsibility and Medicaland Pharmacy Copays andCoinsurance applied to out ofpocket maximumDoctor Office Visit (primary andspecialist)Preventive Care (routine physicalexams, well-baby care, gyn exams,immunizations)Tobacco cessation program andHealth Coaching services availableat no cost to youVirtual VisitsApproximate cost is 40 - 50Not CoveredVirtual Visits – See your doctor anytime, anywhere through video, phone or e-mail. Common conditions thatwould be treated during a virtual doctor visit would include urinary tract infections, colds/flu, fever, pink eye,migraines, bronchitis.Go tomyuhc.com, click on Physician & Facilities tab at the top of the pageor call Advocate4Me 800 784 20238 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Medical BenefitsMedical - UnitedHealthcare Health Reimbursement Account (HRA)CoverageIn-NetworkOut-of-NetworkUrgent CareYou pay 20% and plan pays 80% afterdeductibleYou pay 20% and plan pays 80%after deductibleHospital –Inpatient (includesmaternity admissions)You pay 20% and plan pays 80% afterdeductibleYou pay 40% and plan pays 60%after deductibleHospital- Outpatient SurgeryYou pay 20% and plan pays 80% afterdeductibleYou pay 40% and plan pays 60%after deductibleMaternity(pre- and postnatal office visits)You pay 20% and plan pays 80% afterdeductibleYou pay 40% and plan pays 60%after deductibleEmergency Care(when not followed byadmission)Mental Health – Inpatient andOutpatientYou pay 20% and plan pays 80% afterdeductibleYou pay 20% and plan pays 80%after deductibleYou pay 20% and plan pays 80% afterdeductibleYou pay 40% and plan pays 60%after deductibleSubstance Abuse – Inpatientand OutpatientYou pay 20% and plan pays 80% afterdeductibleYou pay 40% and plan pays 60%after deductible9 P ageBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Medical BenefitsMedical - UnitedHealthcare HRA Prescription Drug BenefitCoverageTypeCopay/CoinsuranceRetail (30-day supply)GenericBrand NameNon-Formulary Brand NameGenericBrand NameNon-Formulary Brand NameSame as brand, as applicable 10 copay10% coinsurance- 35 minimum/ 100 maximum30% coinsurance - 50 minimum/ 150 maximum 20 copay10% coinsurance- 87.50 minimum/ 200 maximum30% coinsurance - 125 minimum/ 300 maximumNot CoveredMail Order (90-daysupply)Specialty DrugsMandatory Mail OrderIf you don’t use mail order for your long-term medications, you will pay 100% of the cost of the medication after youfill your initial prescription and two refills of the drug at a retail pharmacy.Specialty drugs must be purchased through UnitedHealthcare’s mail order pharmacy, OptumRX Mail ServicePharmacy on the first fill.WELLNESS INCENTIVEEarn 100 Toward Your Medical ExpensesSodexo partners with UnitedHealthcare to provide a wellness incentive foremployees enrolled in the Health Reimbursement Account Plans. To participate,each plan year and get your 100 credit, you must take an online HealthAssessment. The credit will be deposited into your Health Reimbursement Accountand can be used toward paying medical expenses for yourself and yourdependents.To take your Health Assessment and for more details on this incentive program,visit www.myuhc.com.10 P a g eBenefits-at-a-Glance – Standard Salaried 1/17If there is a difference between the information in this document, the Summary Plan Description, the plan document or the carrier’sservice contract, the information in the plan document or contract governs. The Plan Administrator reserves the right to resolve anyambiguity in this document.
Medical BenefitsMedical - Regional PlansPlanKaiser alifornia800 464 4000Colorado800 632 9700D.C. Metro/MD/VA800 777 7902Georgia888 865 5813Hawaii808-432-5955HMSA – HawaiiOnlyThese options are onlyavailable to employeesin Hawaii.www.kp.orgHMSA PPP808 948 6111HMSA HPH Plus HMO808 948 6372Coverage Must choose and see a Kaiser Primary Care Physician(PCP)No out-of-network coverageObtain a referral from a PCP to see a specialistReceive preventive care coverage at 100%Do not need to file claim formsFor Kaiser Permanente Health Maintenance Organization(HMO) information, call Member Services in your region(numbers listed on the left). HMO eligibility is based, in part,on your home ZIP code. Plan designs and benefits vary bygeographic location.PPP: See the doctor of your choice (in- or out-of-network) Receive a higher level of benefits by seeing aparticipating in-network provider Go to a specialist without a referral Generally, file claim forms only if out-of-networkproviders are used Receive preventive care coverage at 100%HMO: Must c
the Total Rewards package Sodexo offers to you—to help you meet your needs now and in the future. Medical Dental Vision Disability Flexible Spending Accounts o Healthcare Savings Account o Family Care Savings Account Your Choices. Your Future. Life Insurance 401(k)
