2021 BENEFITS OPEN ENROLLMENT GUIDE

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2021 BENEFITS OPEN

ENROLLMENT GUIDE

ENROLL BY PHONE OR ONLINE

Monday, November 30th

to Friday, December 4th

1-866-833-8915

www.elmetbenefits.com

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1 | 2021 Elmet Benefits Guide Questions? Call the Elmet Benefits Service Center at 1-866-833-8915.

I N T RO D U C T I O N

This guide provides an overview of your Elmet Technologies benefits and the Open Enrollment process. You’ll also find important benefit resources and contact information. Additional benefits information is available on www.elmetbenefits.com.

OPEN ENROLLMENT FOR 2021 BENEFITS

Monday, November 30th - Friday, December 4th

KEY 2021 Benefit Changes

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2021 Elmet Benefits Guide | 2 Questions? Call the Elmet Benefits Service Center at 1-866-833-8915.

Call 866-833-8915

Monday - Thursday: 8am to 6pm

Friday: 8am to 5pm

[email protected]

If you do not actively enroll, all of your

current benefits will rollover into 2021;

EXCEPT Flexible Spending (FSA) must

be re-elected each year.

How to Enroll

Benefits Enrollment – Online or By Phone

Enrollment Online

Step 1: Access www.elmetbenefits.com and click “Enroll Now!”. Step 2: Click on “Get Started Now” and enter your personal information to create your account.

Step 3: Once you’ve logged in, you’ll be able to complete your enrollment. Complete your benefit elections by clicking “Begin Enrollment” and following the prompts.

Enrollment by Phone

Call the Elmet Benefits Service Center at 1-866-833-8915 to complete your options by phone. You’ll speak with a trained Benefits Specialist who will confirm your personal information, review your plan options, and complete your elections for 2021. For online and phone enrollment, you will receive a Confirmation Statement via email at the end of your enrollment.

Benefits Website

Access plan documents, benefit summaries, forms, premium information, benefits presentations and guides, links to insurance company and vendor websites, and more.

www.elmetbenefits.com

Contact the Elmet Benefits Service Center

for enrollment and service for all of your benefits. The trained Benefits Specialists can assist with:

• Benefits questions & claims inquiries

• Life insurance beneficiary updates

• Qualifying life event benefits changes

• _Enrollment

E N RO L L M E N T

2021 Benefit Elections

Now is your opportunity to make benefit elections, and these elections are effective for the entire 2021 plan year. Please remember no benefits changes are allowed during the year unless you have a qualifying life event or change in family status (supporting documentation required). Common qualifying life events that could result in changes to your benefit coverage include the following:

• Marriage or divorce

• Birth or adoption of a child

• Loss of a dependent

• Medicare entitlement

• Gain or loss of coverage

Qualifying Life Events During the Year

Should you have a qualifying event during the year, please notify the Benefits Service Center at 866-833- 8915. You must submit necessary documentation to the Benefits Service Center within 30 days of your event for the change to be completed.

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NEW FOR 2021

Telemedicine

Welcome to MDLIVE! Your anytime, anywhere doctor’s office. MDLIVE telemedicine allows you to “visit” a doctor from the comfort of your home (or work) over-the-phone, through secure video, or through the MDLIVE App - for FREE.

Both employees and family members are eligible to use this FREE benefit 24 hours a day, 7 days a week. Pediatricians are also available 24/7. Consultations are convenient, private, and secure. This benefit is for Patient Advocates medical plan participants only.

Prescriptions can be sent to your nearest pharmacy, if medically necessary.

Visit www.247mdaccess.com or call MDLIVE at 1-888-674-2490. Identify yourself with Group ID: 247Doctor.

A digital

health program

for tobacco addiction

With more individuals working remotely and experiencing non-traditional routines, digital health is more important than ever to give your population easy access to support.

7KH(;3URJUDPLVWKHRQO\TXLWWREDFFRSURJUDPWKDWFRPELQHVWKHVFLHQWLȴFOHDGHUVKLSLQGLJLWDO tobacco solutions from Truth Initiative^® with a proven treatment model from Mayo Clinic.

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What makes us GL΍HUHQW:

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Our new Tobacco Cessation Partner, Truth Initiative, provides FREE personalized support to quit smoking. If you are interested in quitting and having your tobacco surcharge removed, this program offers expert coaching, interactive exercises, educational videos, nicotine patches, gum, or lozenges delivered to your home. To get started, call the Elmet Benefits Service Center: 1-866-833-8915.

Tobacco Cessation

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2021 Elmet Benefits Guide | 4 Questions? Call the Elmet Benefits Service Center at 1-866-833-8915.

Elmet Technologies offers three Patient Advocates medical plans to its eligible employees. You may choose between the HSA Plan, PPO Plan, and PPO Gold Plan, unless you are a Union member hired before April 15th, 2013. If you are enrolled in the union-contracted Allegiant Care plan, you are not eligible to elect any of the Patient Advocates plans.

The Patient Advocates HSA plan is a High Deductible Health Plan (HDHP) which qualifies participants to contribute to a Health Savings Account (HSA). If you elect the HSA plan, you are not required to open or contribute to a Health Savings Account (HSA), however, those who do contribute to an HSA will reduce their taxable income and be able to pay for medical, dental, vision, and prescription expenses Federal income-tax-free. See the Health Savings Account (HSA) page for more information. This plan has the lowest premiums, highest deductible, and highest maximum out-of-pocket costs. All services, including pharmacy, are subject to the deductible and coinsurance, and there are no copays with this plan. Once you meet your deductible, you pay coinsurance until you satisfy the out-of-pocket maximum.

The Patient Advocates PPO plan offers copays for services like office visits, ER visits, and prescription drugs. For most other services, you are responsible for a deductible and coinsurance until you meet your out-of-pocket maximum. Please be aware that copays do not count towards your deductible, only your out-of-pocket maximum. Preventive care is always covered at 100% before the deductible.

The Patient Advocates PPO Gold plan option has the lowest deductible out of all plans, but has the highest premiums. Services are covered at 100% after a copay, as long as you stay in-network and coordinate care through the Patient Advocates Nurseline. Otherwise, you are responsible for an out- of-network deductible and coinsurance until you meet your out-of-pocket maximum.

M E D I CA L

Medical

The Patient Advocates Nurseline will function as your first point of contact to help direct you to a Nurse Care Manager if needed. The Nurseline is unique in the respect that it will not deny or limit your healthcare. People will almost always make the best choices when they have the correct information and are aware of their options. Like most employee health plans, your plan requires members to call a toll- free number prior to obtaining certain healthcare services.

Patient Advocates Nurseline: 1-800-290-8559

• When you have ANY questions about your healthcare

• When you want information about treatments and alternatives

• When you want to know what you should expect from your doctor or treatment

• If you confirm you are pregnant

• One week prior to any hospital admission

• The next working day after an emergency admission

• One week before any surgery

• Prior to any visit to a recommended Center of Excellence

• Prior to the purchase of Durable Medical Equipment in excess of $2,500

You are REQUIRED to call the Nurseline:

You are ENCOURAGED to call the Nurseline:

IMPORTANT

If you believe that you need one of the following procedures, you must first call Patient

Advocates. Additional costs will apply if you fail to call the Patient Advocates Cost Department. Cost Department: 1-800-290-8559 | [email protected]

Prostate Surgery, Arthroscopy, Infusion/IV Therapies, Sleep Studies, Non-Emergent Invasive Cardiac Surgery, Joint Replacements, Oncology Treatments

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Plan PPO Gold ^PPO

Provider In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Deductible ^{Single: $0}_{Family: $0} Single: $250

Family: $500 Single: $1,000

Family: $2,000 Single: $2,000 Family: $4,000

Coinsurance (Plan Pays) ^100% ^70% ^80% ^60%

Out-of-Pocket Limit Single: $2,100

Family: $4,200 Single: $4,000

Preventive Care Covered at 100% Not Covered Covered at 100% Deductible, then

20% coinsurance Routine Eye Exams (1 per 12 mo) Covered at 100% Not Covered Covered at 100% Deductible, then 20% coinsurance Emergency / Hospital Services In-Network Out-of-Network In-Network Out-of-Network

Emergency Room $100 Copay, Waived if Admitted $150 Copay, Waived if Admitted

Ambulance Covered at 100% Deductible, then

20% coinsurance Deductible, then 20% coinsurance Inpatient Surgery per Admission^{$500 Copay} Deductible, then

30% coinsurance Deductible, then

20% coinsurance Deductible, then 40% coinsurance

Urgent Care - Tier 1 $25 Copay $35 Copay $35 Copay, then

20% coinsurance

Urgent Care - Tier 2 $0 Convenient MD Only $0 Convenient MD Only

Medical Services In-Network Out-of-Network In-Network Out-of-Network

Primary Care Office Visit $20 Copay Deductible, then

30% coinsurance ^{$25 Copay} $25 Copay, then

20% coinsurance

Specialist Office Visit $25 Copay Deductible, then

30% coinsurance ^{$35 Copay} $35 Copay, then

20% coinsurance Chiropractic Care (40 visits) $25 Copay Reimbursement

up to $30 ^{$25 Copay} $25 Copay, then

20% coinsurance Maternity: Pre & Post-Natal Care Covered at 100%

Deductible, then 30% coinsurance

Deductible, then

20% coinsurance Deductible, then 40% coinsurance Outpatient Therapies

PT, OT, ST (60 visit limit combined) ^{$25 Copay}

Deductible, then

20% coinsurance Deductible, then 40% coinsurance Mental Health / Substance Abuse

Office Visit ^{$20 Copay} ^{$25 Copay} $25 Copay, then

20% coinsurance Hospice Care

Covered at 100% Deductible, then

20% coinsurance Deductible, then 40% coinsurance Skilled Nursing Care

Diagnostic Labwork In-Network Out-of-Network In-Network Out-of-Network

Diagnostic Lab Test / X-ray Covered at 100%

Deductible, then

Allergy Testing $100 Copay

Advanced Imaging

MRI, MRA, CAT & PET Scans ^{$100 Copay}

Surgical Procedures In-Network Out-of-Network In-Network Out-of-Network

Outpatient Surgery $150 Copay

Deductible, then

20% coinsurance Deductible, then 40% coinsurance Physician Fees & Anesthesia Covered at 100%

Maternity: Hospital Delivery $500 per Admission

Durable Medical Equipment Covered at 100% Deductible, then

M E D I CA L

*Please refer to the Benefit Summary for complete plan details.

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Plan ^HSA Allegiant Care OAP

Provider In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Deductible Single: $2,600

Family Plan: $2,800 Individual, $5,600 Family ^{Single: $0}Family: $0 Single: $250 Family: $500

Coinsurance (Plan Pays) ^80% ^60% ^70%

Out-of-Pocket Limit Single: $5,000

Family: $10,000 Single: $10,000

Preventive Care Covered at 100% Deductible, then

40% coinsurance Covered at 100% No Coverage Routine Eye Exams (1 per 12 mo) Deductible Waived,

$20 Copay Deductible, then

20% coinsurance Not Covered

Emergency / Hospital Services In-Network Out-of-Network In-Network Out-of-Network Emergency Room

Deductible, then 20% coinsurance Care: $100 Copay | Room: $500 Copay/Admission

Ambulance No Charge

Inpatient Surgery

Deductible, then

Care: No Charge

Room: $500 Copay Deductible, then 30% coinsurance Urgent Care - Tier 1

$25 Copay $25 Copay, deductible does not apply Urgent Care - Tier 2

Medical Services In-Network Out-of-Network In-Network Out-of-Network

Primary Care Office Visit

Deductible, then

$20 Copay

Specialist Office Visit $25 Copay

Chiropractic Care (40 visits) 34 visits

Maternity: Pre & Post-Natal Care No Charge

Outpatient Therapies

PT, OT, ST (60 visit limit combined)

Deductible, then 20% coinsurance Mental Health / Substance Abuse

Office Visit ^{$20 Copay}

Hospice Care

No Charge Skilled Nursing Care

Diagnostic Labwork In-Network Out-of-Network In-Network Out-of-Network

Diagnostic Lab Test / X-ray

Deductible, then

Covered at 100% X-ray: 30% coinsurance Blood work: Not covered Allergy Testing

Advanced Imaging

MRI, MRA, CAT & PET Scans $100 Copay per type

of scan per day $250 penalty for no precertification

Surgical Procedures In-Network Out-of-Network In-Network Out-of-Network

Outpatient Surgery

Deductible, then

Facility fee:

$150 Copay/visit

Physician Fees & Anesthesia No Charge

Maternity: Hospital Delivery $500 Copay

Durable Medical Equipment Deductible, then

40% coinsurance ^{No Charge} Deductible, then 30% coinsurance

M E D I CA L

*Please refer to the Benefit Summary for complete plan details.

Union Employees Only

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Prescription Drug Coverage

Plan PPO Gold ^PPO ^HSA Allegiant Care

In- & Out-of-Network In- & Out-of-Network In- & Out-of-Network In-Network Only

Tier 1 - Generic Drugs $15 Copay $10 Copay

Deductible, then 20% coinsurance Preventative Rx covered at 100%

$15 Copay Retail or Mail Order

Tier 2 - Preferred Brand $25 Copay $30 Copay Retail or Mail Order^{$25 Copay}

Tier 3 - Non-Preferred Brand $25 Copay $50 Copay ^{$25 Copay}_{Mail Order}

Specialty Drugs - 30 day supply

Mail Order Only (WellDyne Rx) ^{$50 Copay} 20% coinsurance to a max of $300

N/A

WellDyne Rx Mail Order

90 day supply 2 x Copay above 2 x Copay above N/A

WellDyne Rx Preventative Meds Covered at 100% Covered at 100% Covered at 100% N/A

CanaRx & ElectRx (Mail Order) Covered at 100% Covered at 100% Covered at 100% N/A

PHARMACY & EMPLOYEE ASSISTANCE

Prescription Drug Savings

CanaRx is a voluntary prescription drug program that offers $0 copays for members and dependents enrolled in Elmet’s employee health benefit plans. Enrolling in this program allows you access to FREE brand name prescriptions, delivered to your home. To get started, call 1-866-893- (MEDS) 6337.

ElectRx offers specialty and diabetic medications at a $0 copay. This program is also voluntary

and is limited to members and dependents enrolled in Elmet’s employee health benefit plans. Enroll by calling 1-855-353-2879 with a list of prescription drugs you are taking.

Anthem Resource Advisor

You and your family members are eligible for up to three counselor visits for each issue or concern, at no cost to you. Counselors can help with: stress, parenting, anxiety, depression, dealing with illness, relationship or family issues, finding child care, elder care issues and resources, and any issue that affects your wellbeing. Talk with a licensed counselor any time, 24/7:

By phone: Call 1-888-209-7840

In-person: Call to set up face-to-face sessions and then schedule with your counselor

Video chat: Call Resource Advisor and we’ll give your the details about how to schedule a visit.

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HSA & FSA

Healthcare Flexible Spending Account

You can contribute up to $2,750 during 2021 into a Healthcare FSA. Eligible Healthcare FSA expenses include deductibles, copays, coinsurance, prescription drugs, over-the-counter drugs (no prescription required), dental, and vision expenses. Participants in the FSA receive a debit card so that many expenses can be paid at the time of service.

Use It or Lose It

Claims must be incurred by December 31, 2021 to be eligible for reimbursement for the 2021 plan year. The IRS requires that any unused money in your account at the end of the plan year is retained by your employer and forfeited by the employee. However, the IRS allows Healthcare FSA plan members to roll over up to $550 of unused funds for future use.

Flexible Spending Account (FSA)

A Healthcare Flexible Spending Account allows you to pay for out-of-pocket costs with pre-tax dollars, saving you money. Medcom is the FSA Administrator. Your prior FSA election will not automatically continue in 2021. You must actively elect to participate in 2021 by completing your benefits enrollment.

Health Savings Account (HSA)

If you have signed up for the company HSA health plan, you are eligible for a free Health Savings Account (HSA). This savings account stays with you even after leaving the company, and Elmet will contribute $500 per year to the account as long as you contribute each year. The money from this HSA is tax-free and can be spent on qualified medical-related costs, such as over-the-counter medications, prescriptions, vision, or medical expenses. You receive a free debit card with this account and also can reimburse yourself for any costs you pay out of pocket. Once you reach 65 years of age, the money in the account can be spent for any purpose. You can contribute up to the below maximum amounts per year to your account:

Employee Maximum Contributions

Plan Year Individual Coverage Family Coverage Over 55 Catch Up

2021 _$3,100 _$6,700 _$1,000

*Maximums have factored in Elmet’s $500 annual contribution

To get started, enroll by seeing HR for a form, or call KeyBank at 207-262-5712. There is no minimum balance, and the account also includes ATM access and free online transfers and bill pay. Eligibility does require that you are not a dependent on someone else’s tax return and that you’re not covered by Medicare, Tri-Care, or another health insurance plan (other than as permitted in IRS Publication 969).

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D E N TA L

Dental

With Northeast Delta Dental, you can see any dentist of your choosing. If you choose a dentist in the Premier network, you will ensure lower out-of-pocket costs. You can locate in-network providers by visiting www.nedelta.com and selecting “Find a Dentist” – You can select either Delta Dental PPO or Delta Dental Premier as the network.

Delta Dental PPO + Premier Network

Calendar Year Deductible $50 Individual / $150 Family

Calendar Year Maximum $1,500

Orthodontia Lifetime Maximum $1,500

Coverage Type A Services (Preventive)

100%, no deductible

Exams - Two in a 12 month period Cleanings - Two in a 12 month period** Bitewing x-rays - Once in a 12 month period X-rays of individual teeth as necessary

Flouride - Once in a 12 month period for children to age 19

Sealant - Once in a 3 year period per permanent molar for children to age 19

Type B Services (Basic Restorative)

80%, after deductible

Amalgam fillings (silver) Composite fillings (white) Endodontics (root canal therapy)

Periodontal maintenance (cleaning) – Two in a 12 month period** Denture repair (removable denture repaired to original condition) Emergency palliative treatment

Oral surgery (surgical and routine extractions)

Type C Services (Major Restorative)

50%, after deductible

Crowns Onlays Implants

Removable and fixed partial dentures (bridge) Dentures

Dentures – rebases and relines

*Please refer to the Benefit Summary for complete plan details.

** Cleanings are limited to two in a 12-month period; these may be routine (Coverage A) or periodontal (Coverage B), or a combination of both.

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VISION

Vision

Vision Summary of Benefits In-Network Out-of-Network

Frequency of Services Exam and Lenses – once per 12 months

Eye Exam $10 copay $48 allowance

Lenses Single

Covered in full after $25 copay

$36 allowance

Bifocal $54 allowance

Trifocal $69 allowance

Options

Standard Progressive $65 copay

No allowance on lens enhacements when obtained out-of-network

Premium Progressive (Tier 1) $85 copay

Standard polycarbonate (to age 19) Covered in full

Frames $130 allowance

then 20%off remaining balance $64 allowance

Costco, Wal-Mart, Sam’s Club $70 allowance $70 allowance

Contacts(in lieu of eyeglass lenses)

Conventional or Disposable $130 allowance $105 allowance

Non-elective contact lenses Covered in full $210 allowance

Additional Savings

Glasses and Sunglasses Get 20% off the cost of additional pairs

Laser Vision Correction Saving on average 15% off regular price or 5% off a promotional offer including PRK, LASIK, Custom LASIK.

Available at participating MetLife locations only. Elmet offers Vision insurance through Anthem, which allows you to visit any vision provider you choose. Using

participating Anthem providers will help you to maximize your benefits. You can find participating providers by going to: www.anthem.com/find-care, following the instructions, and selecting “Blue View Vision” network.

Frequency Limitations: The plan limits each participant to 1 covered contact lens or eyeglass lens benefit in a 12-month period, and 1 set of frames every 24 months.

*Please refer to the Benefit Summary for complete plan details.

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LIFE & DISABILITY

Life Insurance

Voluntary Life and AD&D Insurance

You may elect voluntary life insurance for yourself and your dependents to supplement the basic life benefit. Employee coverage is available up to the lesser of 5 times your annual salary or $500,000. Spouse life coverage is available up to 100% of the employee election. You must insure yourself for at least as much coverage as you select for your spouse. Spouse voluntary life rates are based on employee age. Child life insurance is available for children below the age of 26 regardless of student status.

All plans also include Accidental Death and Dismemberment (AD&D) which pays in the event of death or loss of limbs, speech, hearing and more caused by an accident. (Refer to the Certificate of Coverage for details.)

Beneficiary Information: You must elect a beneficiary or beneficiaries who will receive your life insurance payout at the time of your death. You can update your life insurance beneficiaries any day of the year by calling the Elmet Benefits Service Center at 1-866-833-8915.

Employer-Paid Basic Life Insurance

Elmet Technologies provides employer-paid basic life insurance at no employee cost.

•

Hourly employees receive $40,000.

•

Salaried employees receive 1x annual earnings to a maximum of $500,000.

Voluntary Life & AD&D Options

Employee $10,000 increments to a maximum of the lesser of 5 times annual earnings or $500,000

Spouse $5,000 increments up to a maximum of $250,000 (based on employee age)

Child(ren) $5,000 or $10,000

Disability Insurance

Elmet Technologies pays for the full cost of both Short Term Disability and Long Term Disability coverage for all employees. Disability coverage provides an income replacement benefit in the event that you are unable to work due to a non-job-related illness or accident.

Long Term Disability

Monthly Benefit Amount 60%

Maximum Weekly Benefit $10,000

Waiting Period 180 days - Benefits begin upon exhaustion of Short Term Disability for accident and sickness

Benefit Duration ^To Social Security Normal Retirement Age

Pre-existing Condition Limitation

A pre-existing condition is an illness or injury for which you received treatment or where symptoms were present within 3 months prior to your effective date of coverage. A disability that begins in the first 12

months after your effective date will not be covered if it results from a pre-existing condition.

Short Term Disability

Weekly Benefit Amount Hourly: $375/week | Salaried: 60% Maximum Weekly Benefit Hourly: $375/week | Salaried: $2,500/week Waiting Period Benefits begin on day 8 of accident and sickness^{7 days}

Benefit Duration 25 weeks

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RETIREMENT

Empower 401k

Starts on date of hire:

•

Enroll at www.empowermyretirement.com

•

Choose which funds you will invest in Matching contributions

•

100% match on first 4% of wages earned

•

50% match on next 2% IRS Limits for 2021

•

Under 50: $19,500

•

50 or over: $26,000 Applies to all salaried employees

Applies to Union employees for 1st 18 months

Union employees can still put in contributions after 18 months but with no match

401(k)

Elmet pays $2.57 per hour worked, up to 40 hours a week, toward the Teamsters Union pension fund once you have completed 18 months of service. You become fully vested after 5 years of pension contributions (6 ½ years of employment), as long as at least 750 hours have been worked in each of those years. For a full year of pension payment credit to be granted, you must work at least 1,800 hours. Otherwise, pension payment amounts will be prorated. The monthly credit amount from 2005 forward is

$171.20 for each year of pension credit obtained.

For questions:

• Visit the New England Teamsters & Trucking Industry Pension Fund at www.nettipf.com

• Call 800-447-7709

The website above allows you to put in your information and view what you’ve earned toward your pension and what your projected monthly payment would be based on different retirement ages. Your pension can also have different modifiers to guarantee payment to beneficiaries with certain terms, such as a surviving spouse annuity. An employee retiring at age 62 or beyond will receive their medical insurance paid for until they reach Medicare age at 65. There are additional supplements and premiums employees can receive depending on the specific retirement age they choose.

Teamsters Union Pension Plan

• To receive the regular pension, you must be at least 64 years old and have at least 15 years of pension credit.

• You can elect to retire earlier, as long as you are fully vested. If you do so, you will receive a smaller portion of your pension credits, based on the below grid:

Age at Retirement Early Retirement Pension

64 and Older 100%

63 95%

62 90%

61 85%

60 80%

59 72%

58 64%

57 56%

56 48%

55 40%

All information contained in this section is excerpted from the Teamsters Pension Plan document located at www.nettipf.com and the full document or website

should be referenced for all official plan specifics.

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2 0 21 R AT ES

WEEKLY RATES

Tier PPO Gold PPO $1,000 HSA $2,800 Allegiant Care OAP

Employee Only $98.44 $45.79 $22.37 $138.75

Employee + Spouse $225.81 $93.42 $45.64

Employee +1: $299.50

Employee + Child(ren) $188.40 $76.02 $37.14

Family $285.48 $132.80 $64.88 $345.84

BI-WEEKLY RATES

Tier PPO Gold PPO $1,000 HSA $2,800

Employee Only $196.89 $91.59 $44.74

Employee + Spouse $451.62 $186.85 $91.28

Employee + Child(ren) $376.81 $152.04 $74.27

Family $570.97 $265.61 $129.76

Medical Plan Rates

Coverage Level Weekly Payroll

Deduction Bi-Weekly Payroll Deduction

Employee Only $3.27 $6.54

Employee + 1 $6.12 $12.23

Family $11.00 $21.99

Coverage Level Weekly Payroll

Deduction Bi-Weekly Payroll Deduction

Employee Only $1.27 $2.53

Employee + 1 $2.00 $3.99

Family $3.55 $7.09

Dental Plan Rates

Voluntary Life + AD&D Rates

Age Per $1,000 / Month

0 - 24 $0.107

25 - 29 $0.107

30 - 34 $0.107

35 - 39 $0.132

40 - 44 $0.145

45 - 49 $0.157

50 - 54 $0.221

55 - 59 $0.323

60 - 64 $0.573

65 - 69 $0.871

70 - 74 $2.654

75 - 120 $2.654

Voluntary Life Insurance Rates

Vision Plan Rates

Child Voluntary Life Deductions To Age 26 $5,000 $10,000

Weekly $0.22 $0.44

Bi-Weekly $0.44 $0.88

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CO N TAC T S

For benefits questions and enrollment assistance,

call 1-866-833-8915 or visit www.elmetbenefits.com.

Benefits & Enrollment Questions

Elmet Benefits Service Center 1-866-833-8915

www.elmetbenefits.com

Medical

Patient Advocates 1-800-290-8559

www.PatientAdvocatesLLC.com

Prescription Savings

CanaRx 1-866-893-6337 ElectRx 1-855-353-2879

Telemedicine

MDLIVE 1-888-674-2490 Group ID: 247Doctor www.247mdaccess.com

Flexible Spending Accounts

Medcom

1-800-523-7542, Option 1 www.medcombenefits.com

[email protected]

Health Savings Account

KeyBank 207-262-5712 www.key.com/hsa

Dental

Northeast Delta Dental 1-800-832-5700 www.nedelta.com

[email protected]

Vision

Anthem

www.anthem.com/find-care 1-866-723-0515

Life Insurance & Disability

Anthem - Life 1-800-552-2137

[email protected] Anthem - Disability

1-800-232-0113

[email protected]

Tobacco Cessation

Truth Initiative - EX Program 1-866-833-8915

www.theexprogram.com

Employee Assistance Program (EAP)

Anthem Resource Advisor 1-888-209-7840

www.ResourceAdvisor.Anthem.com Login with program name:

AnthemResourceAdvisor

401(k) Retirement Plan

Empower Retirement 1-800-338-4015

www.empowerretirement.com

Union Pension

Teamsters Union Pension 1-800-447-7709

www.empowerretirement.com

Elmet

Benefits Service Center

1-866-833-8915

Mon-Thurs 8am-6pm, Fri 8am-5pm [email protected]

Important Contact Information

Carrier Contact Information

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This guide is a general summary of your benefit options. For specific details, you may refer to each plan’s Summary Plan Description (SPD). SPDs for health insurance plans can be found on the Elmet Benefits website: www.elmetbenefitscom. Every effort has been made to ensure that this document accurately represents the benefits being offered. However, if there are any discrepancies between the terms in this document and the terms in the SPD, the SPD will prevail.

2021 BENEFITS OPEN ENROLLMENT GUIDE