HCL Benefits 2012
Important Enrollment Information
Key Items to know:

You must enroll in benefits within 30 days of your date of hire or you will void your
opportunity to enroll for the year unless you have a life changing event.

A life changing event is Marriage/Divorce/Birth/DeathSpouse employed/terminated/changes jobs/leave of absence

It will take approximately 7 business days for CIGNA to receive your data. Once
received you can go to mycigna.com & print our a temporary ID Card. Your
permanent card will be mailed to your home address within 3 weeks.

FSA Flexible Spending Account must also be selected within 30 days of
employment or you will void your opportunity to enroll for the year unless you have
a life changing event.

Annual Open Enrollment: Each year you are eligible to enroll and change
plans. This occurs in November for each year
2
3 PPO Plans – Detail Explanation
Cigna Open Access Network of Providers
Premier Plan
Gold Plan
Standard Plan
Co-pay Office
Primary / Specialist
You pay $15 / $30
Cigna pays the rest
You Pay $15 / $30
Cigna pays the rest
You pay $20 / $40
Cigna pay the rest
Annual Exams
No Co-pay Cigna pays
100%
You pay No Deductible or CoInsurance
No Co-pay Cigna pays
100%
You pay No Deductible or CoInsurance
No Co-pay Cigna pays
100%
You pay No Deductible or
Co-Insurance
Emergency Room
Hospital Admit
$100 per visit
$200 per admission
$125 per visit
$250 per admission
$150 per visit
$300 per Admission
Annual Deductible
Paid 1x per Year
$125 (3 max per family)
For Hospital & Out patient
$250 (3 max per family)
For Hospital & Out Patient
$500 (3 max per family)
For Hospital & Out Patient
You pay 0% of Bills after
Deductible
You pay 10% of Bills after
Deductible
You pay 20% of Bills after
Deductible
Maximum % you
pay after Deductible
Plan pays 100% after
Deductible
When you have paid $2,000
Plan pays 100% thereafter
When you have paid $4,000
Plan pays 100% thereafter
Prescriptions
Generic
Brand
Non-Brand
Annual Ded. $100 (3 max)
$10
$20
$40
Annual Ded. $100 (3 max)
$15
$30
$50
Annual Ded. $100 (3 max)
$20
$30
$50
Mail Order (90 day)
$20 / $40 / $80
$30 / $60 / $100
$40 / $60 / $100
Contributions (per
Month)
E- $175
E+1- $ 350
E+ Family - $ 475
E- $ 90
E+1- $ 180
E+ Family - $ 250
E- $ 65
E+1- $ 120
E+ Family - $ 180
Co-Insurance
% you pay after
Deductible
3
What are Co-pays Deductible & Co-Insurance?
Co-pays
Additional Fees*
Deductible then Co-Insurance*
Paid Per Visit
Paid Per Visit
In Addition to Deductible
Deductible is an Annual Payment
Co-Insurance is a % of bill you pay after Deductible
NO Deductibles No Co-Insurance
100% No Co-pay for Annual
Wellness Exams
Office Primary Visit
Urgent Care Facility
Immunization
Lab and X-Ray
Ob/Gyn
Acupuncture
Allergy Treatment
Physical Therapy
Speech Therapy
Occupational Therapy
Acupuncture
Family Planning
Chiropractic to $3K Annually
Nutritional Evaluation (3 visits)
Hospital Admission
(per admission)
Emergency Room
(Waived if admitted)
RX Annual Deductible
Specialist Visit 2x Primary Visit
Infertility Treatment Not Covered
In-patient/Out-patient Facility and Professional Charges:
Hospital Room
Operating Room
Procedure Room
Treatment Room
Recovery Room
Physician/Surgeon
Anesthesiologist
Radiologist
Pathologist
Ambulance
Maternity Delivery and Prenatal Visits
MRI and CAT Scans
Substance Abuse
Mental and Nervous Disorder
Prosthetic Appliance
Durable Medical Equipment
Organ Transplant
Home Health Care/Hospice
Skilled Nursing Facility (120 days max)
Bereavement Counseling
*NOTE: SPD for each plan is the final authority of plan
4
When are Deductible & Co-Insurance Applied?
Premier Plan
Gold Plan
Standard Plan
Deductible & Co-insurance are paid
when these services are used
Cigna Pays 100% of Bills
after you have paid $4,000
In-patient/Out-patient Facility and
Professional Charges:
Hospital Room
Operating Room
Treatment Room
Recovery Room
Physician/Surgeon
Anesthesiologist
Radiologist
Pathologist
Ambulance
Maternity Delivery and Prenatal Visits
MRI and CAT Scans
Cigna Pays 100% of Bills
after you have paid $2,000
Co-Insurance:
You pay 20% of the next
$20,000 in bills after you have
paid the deductible.
The maximum you will pay
i$4,000
Cigna Pays 100% of Bills
after you have paid the
Deductible
Substance Abuse
Mental and Nervous Disorder
Prosthetic Appliance
Durable Medical Equipment
Co-Insurance:
You pay 10 % of the
next$20,000 in bills after you
have paid the deductible
The maximum you will pays is
$2,000
Organ Transplant
Home Health Care/Hospice
Skilled Nursing Facility (120 days max)
Annual Deductible $500
Bereavement Counseling
Annual Deductible $125
Annual Deductible $250
5
When are Office Visits and Fees Applied?
Premier Plan
Gold Plan
Standard Plan
Office Visit $15 / $30
100% paid by Cigna
NO Deductible or Coiinsurance
Office Visit $15 / $30
100% paid by Cigna
NO Deductible or Coiinsurance
Office Visit $20 / $40
100% paid by Cigna
NO Deductible or Coiinsurance
Office Primary Visit
Urgent Care Facility
Office Primary Visit
Urgent Care Facility
Office Primary Visit
Urgent Care Facility
All proceedures are covered
at 100% after Co-Pay.
Immunization
Lab and X-Ray
Ob/Gyn
Acupuncture
Immunization
Lab and X-Ray
Ob/Gyn
Acupuncture
Immunization
Lab and X-Ray
Ob/Gyn
Acupuncture
100% No Co-pay
for Annual Wellness Exams
Allergy Treatment
Physical Therapy
Speech Therapy
Occupational Therapy
Allergy Treatment
Physical Therapy
Speech Therapy
Occupational Therapy
Allergy Treatment
Physical Therapy
Speech Therapy
Occupational Therapy
Acupuncture
Acupuncture
Acupuncture
Family Planning
Family Planning
Family Planning
100% No Co-pay for Annual
Wellness Exams
100% No Co-pay for Annual
Wellness Exams
100% No Co-pay for Annual
Wellness Exams
Office & Urgent Care Visits:
NO Deductible or Co-Insurance
Premier
Fees Paid Each time You go
to a Hospital or Emergency Room
No Deductible or Co-Insurance
unless admitted to Hospital
Gold
Standard
Hospital Admit $300
Hospital Admit $250
Hospital Admit $200
Emergency Room $100
6
Emergency Room $125
Emergency Room $150
Example of ‘Co-Pay’ Costs with 3 Preferred Provider
Organization (PPO) Medical Plans: (In Network Comparison)
Premier Plan
Gold Plan
Standard Plan
$120 ($15 each)
$120 ($15 each)
$160 ($20 each)
$120 ($30 each)
$120 ($30 each)
$160 ($40 each)
2 Emergency
Rooms
$200 ($100 each)
$250 ($125 each)
$300 ($150 each)
12 Generic RX
$220 $100 (ded + $10 each)
$280 (ded + $15 each)
$340 (ded + $20 each)
$660
$770
$110 more than Premier
$960
$300 more than Premier
$190 more than Standard
Co-pays
8 Office Visits
(0ther than exams)
4 Specialist Visits
Your Co-Pay Costs
Your Annual Contribution for Each Plan vs. Saving by Switching to a Lower Cost Plan
Ann. Cost
Annual Cost
Pemier to Gold
Annual Cost
Gold to Standard
Premier to Standard
Premier
Gold
Annual Savings
Standard
Annual Savings
Annual Savings
Employee
$2,100
$1,080
-$1,020
$780
-$300
-$1,320
Plus 1
$4,200
$2,160
-$2,040
$1,440
-$720
-$2,760
Family
$5,700
$3,000
-$2,700
$2,160
-$840
-$3,540
7
Example of ‘Deductible’ and ‘Co-insurance’
$5,000 3 PPO Plans
(In Network Comparison)
Premier Plan
Gold Plan
Standard Plan
$200
$250
$300
(Does not count toward Max Out of
Pocket Expense)
$125
$250
$500
Co-Insurance-After Deductible
None
10% of next $4.5K = $450
20% of $4.2K = $840
$325
$950
$625 more than Premier
$1,640
$1,315 more than Premier
$690 more than Standard
Plan pays 100%
After you pay $2,000 Excluding:
Co-pays / Fees / Ded.
Plan pays 100%
After you pay $4,000 Excluding: Copays/Fees/Ded.
1 Hospital Admit Fee
(Does not count toward Max Out of
Pocket Expense)
Annual Deductible
Your Co-Ins. Out of Pocket
Fees/Deductibles/CoInsurance.
Co-Insurance- After Deductible
(that count towards your out of
None
pocket Maximum)
Your Annual Contribution for Each Plan vs. Saving by Switching to a Lower Cost Plan
Ann. Cost
Annual Cost Premier to Gold
Annual Cost
Gold to Standard
Premier to Standard
Premier
Gold
Annual Savings
Standard
Annual Savings
Annual Savings
Employee
$2,100
$1,080
-$1,020
$780
-$300
-$1,320
Plus 1
$4,200
$2,160
-$2,040
$1,440
-$720
-$2,760
Family
$5,700
$3,000
-$2,700
$2,160
-$840
-$3,540
8
Dental Plan: CIGNA Core
Detailed SPD on to be up on HCLBenefits.Com shortly
In- Network
Out of Paid at 80% of
Usual Customary
Charges Network
Waived for Preventative Care
$25
$75
Waived for Preventative Care
$75
$225
$1,500
$1,500
100%
100%
Basic Restorative Care –
Class II
90%
70%
Major Restorative Care –
Class III
60%
50%
50%
$1,000
50%
$1,000
Annual Deductible
Employee
Family
Annual Maximum Benefit
per person
Preventive and
Diagnostic Care – Class I
Orthodontia
Life time Max
Children Only
CIGNA Vision Plan
Detailed SPD to be up on HCLBenefits.Com shortly
VSP's choice network + CIGNA's networks and Retail chains
Please visit www.mycigna.com to search for providers
Exam Co-pay
Lenses & Frames Co-pay
CIGNA/VSP Network
Non Network
$10
$10
Up to $45
100%
Up to $32
100%
Up to $55
Up to $65
Elective: 100% Up to $130
Therapeutic: 100%
Elective: Up to $105
Therapeutic: Up to $210
100% Up to $120
Up to $66
(Does not apply to contact lenses)
Single Lens Co-pay
One pair every year
Bi-focal
Tri-focal
One pair every year
Contact Lens
(choice of contact lenses or frames)
One pair every year
Frames
(choice of contact lenses or frames)
One Pair every 2 years
Employee Assistance Plan - CIGNA
24/7 Assistance: 800-538-3543 (100% Company Paid)
Our Employee Assistance Plan offers you professional counseling with licensed
doctors on a variety of matters to foster healthier living and well-being:


Marital/Family Problems

Abuse (verbal & physical)

Gambling

Maintaining Work-Life Balance

Financial Difficulties and Work-
Stress and Anxiety

Depression

Alcohol/Substance Abuse

Legal Concerns

Mental Health Concerns

Relationship Concerns
Related concerns
For more, please log on to www.cignabehavioral.com/CGI
Click on the Healthy Rewards link to access discount information:
User name: rewards
Password: savings
Group Life Insurance Plan:
CIGNA Life Insurance and Voluntary coverage
Company Paid Group Life
Group Base Coverage
2x Base Salary up to a Maximum $500K
for your Beneficiary upon Death
(Guaranteed issue $500K)
Group Accidental Death &
Dismemberment
2x Base Salary up to a Maximum $500K
for your Beneficiary upon Death
Employee Paid Voluntary Life
Employee Coverage
Voluntary Spouse Coverage
Select up to 1 – 5x Base Salary
(Guaranteed issue $200K)
Select up to $10k - $150K
(Guaranteed issue $20K)
(50% of employee coverage)
Voluntary Child Coverage
$10k per child
(Maximum $10K )
Group Short Term Disability Plan: CIGNA
(100% Company Paid)
Short Term Disability
In the event of an accident or illness
benefits begin from the
Maximum Weekly Benefit to replace
your income up to
% of Weekly Earnings Covered
Benefit is payable for
8th Day
(applicable if the patient is under doctor’s care
and unable to work)
$2,300 weekly
(integrated with all sources of income)
70%
90 Days
HCL does not have a paid maternity leave benefit.
This plan provides benefits during maternity as long as you meet the criteria mentioned under
the policy.
To file a claim, please call 1-800-362-4462
Group Long Term Disability Plan: CIGNA
(100% Company Paid)
LTD
In the event of an accident or
illness benefits begin after
90 Days
(applicable if the patient is under doctor’s care
and unable to work)
Maximum Monthly Benefit to
replace your income up to
$9,000 monthly
(integrated with all sources of income)
% of Monthly Earnings Covered
70%
Benefit is payable to
Age 65
FSA Cafeteria Plan
All Contributions taken out of Gross Wages
Contribution for Plans
(taken out of your salary)
Health Care Benefit
To pay for expenses not covered by your plan
Dependent Child Care Expenses
Pre tax Benefit
CIGNA FSA
100% of your contribution
$5,000 Maximum Contribution Annually
$5,000 Maximum Contribution Annually
Considerations before you Enroll:
Unused dollars are forfeited Health and dependent care accounts
are separate Tax implications
All elections need to be made during Open Enrollment and cannot be changed unless there is
a life changing event i.e. Death, Divorce, Loss of Employment
Effective January 1, 2011, distributions from health FSAs will be allowed to reimburse the cost of
over-the-counter medicines or drugs “only” if they are purchased with a prescription.
Example: FSA Expenses
Reimburses expenses not covered by your medical,
dental or vision plan
Co-pays

Deductibles

Co-Insurance

Hospital Admit Fee

Emergency Room Fee

Prescription drugs Co-pay

Dental Deductible & Orthodontia

Vision Co-pays
See a complete list at:
http://www.irs.gov/publications/p502/index.html


\
Thank You!