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2021 Benefits Guide
ENTERBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
Welcome to
Benefits!
At Activision Blizzard, our employees build immersive worlds that impact popular NOTE ON MEDICARE:
culture across the globe. We encourage you to take the same approach with your If you (and/or your dependents) have Medicare or
benefits. This guide will help you explore, learn and build the best benefits to enhance will become eligible for Medicare in the next 12
months, a federal law gives you more choices
your quality of life. Check out www.benefitsforeveryworld.com for more resources to help
about your prescription drug coverage. Please see
you find the right coverage and value for you and your family. Important Notices for more details.
HOW TO ENROLL HEALTHCARE BENEFITS@PLAY WEALTHCARE LIFE & DISABILITY ADDITIONAL HOW TO
Enrollment Steps Medical Options
> CDHP Plan
Programs
> Activity Tracking
Activision Blizzard INSURANCE BENEFITS GET HELP
Choose Carefully 401(k) Plan Life Insurance Legal Services Providers
> PPO 500 Plan > Food Tracking
Fidelity 529 College > Company Paid
Who is Eligible > In-Network Plan (not open > Sleep Tracking ID Theft Protection
> Dependent Eligibility Verification Savings Plan > Supplemental
to new enrollments) This enrollment guide
> Find Fair Prices Auto/Home/Renters Insurance
> Kaiser HMO (CA only) Financial Wellbeing Accident Insurance (AD&D) constitutes a Summary of
> Brain Health > Company Paid Pet Insurance Material Modifications (SMM)
> Waiving Medical Coverage
> Fertility and Pregnancy Tracking > Supplemental to the 2021 summary plan
Additional Care Support Travel Assistance description (SPD). It is meant
> Gympass Disability Insurance
> Additional Care available Care Providers to supplement and/or replace
to Collective Health Plans > Parenting Support > Core STD and LTD certain information in the SPD,
> Additional Care available > 7 Minute Workout > Buy-up STD and LTD 24 Hour Fitness so retain it for future reference
to All Plans along with your SPD. Please
> Personalized Health Coach Supplemental Life & Income Medical Benefits Abroad
share these materials with your
Medical Plan Comparison > Joyful Mind Protection Mothers at Work covered family members.
> Whole Life Insurance
Rx > Financial Wellbeing
> Accident Insurance Call of Duty Endowment This guide is intended as an
Dental Annual Incentive Maximums > Critical Illness overview of benefits available
Happiest Baby Snoo
Vision to regular full time employees
Employee Contributions Other Perks or part time employees who
Spending Accounts are benefit eligible. Temporary
> Health Savings Account employees who work more than
> Flexible Spending Accounts 30 hours per week should refer
to the Benefits Summary for
Employee Contributions Temporary Employees located on
> Medical Plan Surcharges www.benefitsforeveryworld.com
< 2 >BENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
How to Enroll
Enrollment Steps
Explore this guide and other tools
Choose Carefully STEP 1 at www.benefitsforeveryworld.com.
Who is Eligible DISCOVER Choose the benefits that best suit the Your Deadline to Enroll
> Dependent Eligibility needs of you and your family. • Current Employees: You must enroll October 28 - November 13, 2020.
Verification If you don't enroll, your current 2020 benefit elections will be carried into
2021, except for flexible spending accounts. You have to enroll in those
every year.
It's important to make sure your • New Employees: You must enroll within 30 days from your
STEP 2 providers are within the medical,
hire date. If you miss the deadline, you will be auto-enrolled
MAP dental and vision networks to receive
as described on page 5.
lower out-of-pocket costs.
Questions? Try www.benefitsforeveryworld.com first. If you still have
questions, email the Benefits team at benefits@activisionblizzard.com.
Build your benefits and enroll online
STEP 3
BUILD through Workday
Workday.ActivisionBlizzard.com
Watch for ID Cards
•M
edical: After open enrollment, you’ll receive a new medical ID card
from Collective Health or Kaiser, if you made changes to your elections.
STEP 4 Review your benefit selections and • Dental: If you enroll in the Dental DHMO plan, you will receive a new ID
REVIEW print your confirmation statement. card from Delta Dental with a new dentist selected for you according to
your zip code. You need to see your assigned Dental provider otherwise
you will be responsible for 100% of the cost. You will need to contact Delta
Dental to make a change to your dentist. If you enroll in the Dental PPO plan,
you will receive a new ID card from Collective Health, which will also include
your vision card as well.
STEP 5
Provide SSN/National IDs and
documentation for each eligible If you enroll outside of open enrollment, you can expect your ID cards
PROVIDE approximately two weeks after you've made your elections.
dependent you add to your coverage.
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
CHOOSE CAREFULLY
NEED TO MAKE
Your Choices Last for the Plan Year
A MID-YEAR
The benefit elections you make start on the first of the month following your date of hire, or immediately if
hired on the first of the month, and will be in effect for the rest of the plan year. BENEFIT CHANGE?
Remember, you must enroll within
You cannot make changes to your benefits during the year, unless: 30 days of a “qualified life event,” such
•Y
ou have a “qualified life event” (such as marriage, divorce, birth, death or employment as marriage, divorce, birth of a child, or
status change). special enrollment period.
Enrollment Steps •Y
ou qualify for a “special enrollment period” (such as if you waive medical, dental or
If you don’t enroll within 30 days,
Choose Carefully vision coverage to participate in a spouse’s plan and your coverage under that plan ends).
you’ll have to wait until the next
Who is Eligible If you are eligible to make mid-year changes, you must enroll within 30 days of the event. Otherwise, you open enrollment to change your
> Dependent Eligibility will have to wait until the next enrollment period to make changes to your benefit elections. benefit elections.
Verification
For more information, please contact the Benefits Department at benefits@activisionblizzard.com.
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WHO IS ELIGIBLE
You’re eligible for benefits if you’re:
• A full-time or part-time, regular U.S. employee of Activision Blizzard, Activision Publishing, Blizzard
Entertainment, or King, and
• Regularly scheduled to work at least 30 hours a week.
You can also cover your eligible dependents:
Your Spouse/Domestic Partner
Enrollment Steps • Your legal spouse
Choose Carefully • Your same-gender or opposite-gender domestic partner
Who is Eligible Your Children
> Dependent Eligibility • Children up to age 26. That means you may enroll your adult child even if they:
Verification
— No longer live with you
— Are not a dependent on your tax return
— Are no longer a student
— Are married (although, your child’s spouse and children are not eligible for coverage)
• Dependent children of any age who are mentally or physically disabled
Keep in mind, enrolling your domestic partner (or your domestic partner's children) for medical, dental and vision
coverage could affect your taxes.
New Hires Must Enroll Within 30 Days
You must enroll for benefits within 30 days of your hire date. Otherwise, you’ll receive the following benefits (and
will not be able to make changes until the next open enrollment unless you experience a qualified life event):
IF YOU DO NOT ELECT… YOU WILL…
Medical …be auto-enrolled in the CDHP Plan for yourself only
Dental and Vision … have no dental or vision coverage
Life Insurance and AD&D …be enrolled for two times your annual salary
Short-Term Disability … be enrolled for 60% of your weekly salary
Long-Term Disability … be enrolled for 40% of your monthly salary
Benefits start on the first of the month following your date of hire or immediately if you are hired on the first day of the month.
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
Dependent Eligibility Certification
If you’re enrolling dependents for medical, dental and vision coverage during enrollment, you must add your dependents’
SSN/National IDs in Workday and upload appropriate documentation within 30 days to support the enrolled dependent.
If you want your dependent to receive important benefits related emails from the company, please add their email to
Workday under their dependent information. Below is a list of acceptable documents.
Dependent verification will also be required during the year if you make mid-year changes due to a qualified life event, such as
adding a newborn baby, adopting a child, or acquiring a new dependent through marriage or by entering into a domestic
partnership.
Enrollment Steps To enroll a domestic partner outside of open enrollment, you must do so within 30 days of meeting the initial 6-month
Choose Carefully minimum period of living together as defined in the Domestic Partner Affidavit form.
Who is Eligible
DEPENDENT REQUIRED DOCUMENTATION
> Dependent Eligibility
Verification Spouse • Copy of marriage license/certificate
Domestic Partner • A state-issued Domestic Partner Declaration, or
• An Activision Blizzard Affidavit of Domestic Partnership
Dependent Children • Birth certificate
• Document from hospital with name and date of birth
• Adoption certificate/documentation
• Proof of legal guardianship
• Qualified medical child support order
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Healthcare
Medical Options
> CDHP Plan BENEFITS TO HELP YOU STAY
NEED DETAILS ABOUT
> PPO 500 Plan
> In-Network Plan HEALTHY AND PREPARED OUR PROVIDERS?
> Kaiser HMO (CA only) Your benefit options include medical, dental and vision coverage for you and your eligible family members to
> Waiving Medical Coverage Collective Health
help you stay healthy, avoid serious conditions and deal with unexpected illness or accidents.
Use the Collective Health Open
Additional Care Enrollment Portal
Support Medical Options
( http://join.collectivehealth.com/
> Additional Care available You have a choice of medical plans so you can choose the coverage that works best for you and your
to Collective Health Plans activisionblizzard ) to view details of
family. The plan comparison charts on pages 14-20 show you how all the plans compare and the cost
> Additional Care available Collective Health, our medical
saving features each offer. If you prefer, you can waive coverage. Your options include:
to All Plans provider. You can also view dental
• CDHP Plan and vision.
Medical Plan
Comparison • PPO 500 Plan
Rx • In-Network Plan (not open to new enrollments)
• Kaiser HMO (CA only)
Dental
Each medical plan option provides coverage for a full range of medical services, including office visits,
Vision
preventive care, inpatient care, prescription drugs and mental healthcare. Choose carefully.
Spending Accounts
> Health Savings Account
> Flexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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Consumer Directed Health Plan (CDHP) Option
If you enroll in the CDHP Plan administered by Collective Health, you must meet key requirements to open a Health Savings
Account (HSA). See page 26 for more information or you can go to www.benefitsforeveryworld.com. The per pay period
cost of this plan has not changed in over seven years and is less than the PPO 500 Plan, Kaiser HMO and In-Network Plan,
but it has a higher annual deductible and it operates very differently. The CDHP Plan offers you the ability to choose your own
providers and encourages greater control over your healthcare spending, but you should only enroll in it if you understand all
of its features.
The CDHP Plan works in two ways:
Medical Options 1. Cost protection: Offered at no cost to you for employee-only coverage and at much
> CDHP Plan lower rates for family coverage.
> PPO 500 Plan 2. T
ax protection: Save and pay for current and future healthcare expenses in a tax-advantaged
> In-Network Plan way with the HSA.
> Kaiser HMO (CA only)
> Waiving Medical Coverage
Additional Care Cost protection
Support • Affordable (no-cost single/low-cost family)
> Additional Care available • Your choice of in-network or out-of-network providers
High
to Collective Health Plans
Deductible • Protection from catastrophic medical expenses
> Additional Care available Health
to All Plans • 100% coverage for in-network preventive care with
Plan
no deductible
Medical Plan
Comparison
Rx CDHP
Dental
Health Tax protection
Vision Savings
Account • In addition to your own pre-tax contributions, the company
Spending Accounts (HSA)
> Health Savings Account will contribute the following pre-tax amounts: up to $1,250
> Flexible Spending employee only coverage and $2,250 employee + dependent(s)
Accounts • Tax-free reimbursements
Employee • Tax-free account growth
Contributions • Take it with you if you leave the company
> Medical Plan Surcharges
• Long-term savings vehicle
• IRS limits apply: $3,600 maximum for employee only coverage
and $7,200 maximum for employee + dependent(s)
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Here’s a brief summary of how the CDHP Plan works
HEALTH SAVINGS ACCOUNT (HSA) PREVENTIVE CARE
If you enroll in the CDHP Plan, an HSA will be set up Preventive care (including generic preventive
Is the CDHP Plan right
in your name. It’s a lot like a checking account that prescription drugs) is covered at 100% with no for you?
you can use to pay for qualified medical expenses. If deductible, as long as you use in-network Whether this plan is right for you
you don’t use your entire HSA balance during the providers. You can get your annual check-up, depends on many factors, including:
year, you can roll it over to next year, and even take health screenings, and generic preventive
your balance with you if you leave the company. prescription drugs at no cost to you. Make sure • Your comfort with a high deductible
Your HSA is made up of three types of contributions: your provider bills your preventive services as and out-of-pocket limit (remember the
automatic company contributions, earned company preventive or routine instead of diagnostic. company helps fund more than half of
Medical Options contributions, and your own contributions. the deductible by contributing up to
> CDHP Plan $1,250 for employee-only coverage and
NON-PREVENTIVE CARE
> PPO 500 Plan $2,250 for employee + dependent(s)).
ACTIVISION BLIZZARD CONTRIBUTION For other types of healthcare services, including
> In-Network Plan
The annual deductible is higher than our other doctor visits for illness and non-preventive
> Kaiser HMO (CA only)
plans. To help fund it, Activision Blizzard will make prescription drugs, you can go to the provider of •If you have the resources to contribute
> Waiving Medical Coverage
a $250 contribution to each enrolled employee's your choice and pay for your care using your HSA. to the HSA and gain the tax advantages
Additional Care HSA in January of each year. You may also choose to pay for your care out of (consider depositing the savings in
Support your own pocket if you want to save your HSA premiums you would pay for another
> Additional Care available BENEFITS@PLAY CONTRIBUTIONS funds for future use. To maximize your benefit, we more expensive plan).
to Collective Health Plans
If you are enrolled in the CDHP Plan with an HSA encourage you to use Collective Health in-network
> Additional Care available
you can earn an additional $1,000 for employee-only providers. A list of Collective Health network • The amount of non-preventive services
to All Plans
coverage and $2,000 for employee + dependent(s) providers can be found here. you expect to use, like ER visits,
Medical Plan physician and hospital services you
coverage by engaging in healthy activities in the
Comparison might receive if you are ill.
Benefits@Play program (see more information on HSA DOLLARS ROLL OVER
Rx page 31). If you don’t use all of your HSA dollars, they roll over
Dental to the next year, and if you leave the company, your • Whether you plan to engage in the
YOUR OWN CONTRIBUTIONS HSA is yours to take with you. Benefits@Play healthy activities to earn
Vision You can also deposit your own funds, tax-free, to incentive payments to help offset the
Spending Accounts your HSA up to the IRS limits listed in the table on IF YOU HAVE AN HSA—NO FSA OR HRA deductible.
> Health Savings Account page 26. Please keep in mind that employer Because the HSA is a tax-advantaged account, the
> Flexible Spending It is important to understand that all eligible
contributions (automatic and earned) are subject IRS will not allow you to have both an FSA or HRA
Accounts non-preventive services and prescriptions
to the annual IRS limits. and an HSA. If you are covered by any other health
you receive are applied toward your
Employee plan that does not have a qualifying high deductible, deductible until it is met and then the plan
Contributions COINSURANCE you are also not eligible to participate in the HSA. pays 80% of in-network charges. You can
> Medical Plan Surcharges Once you satisfy the annual deductible, the plan use your HSA account to pay for these
begins paying a percentage of your costs for eligible eligible out-of-pocket medical expenses.
healthcare and prescription drug benefits. Keep in
mind that your costs will be lower if you use in-
network providers.
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PPO 500 Plan Option Waiving Medical Coverage
Like the CDHP Plan, the PPO 500 Plan is You may waive medical coverage if you have WANT MORE
administered by Collective Health and offers you a healthcare coverage through another source (for
INFORMATION?
choice every time you need care. You can receive example, your spouse’s employer’s health plan).
You'll find it all at:
care from an in-network provider or an out-of-
network provider without a referral. The plan Note: If your circumstances change and you (or if applicable,
your spouse and/or dependent child(ren) are no longer
www.benefitsforeveryworld.com or just click
includes a national network of doctors, hospitals
enrolled in an employer-sponsored group health plan, you will the direct links below:
and other healthcare providers that provide
not be eligible to participate in, or have access to, your HRA.
services at contracted rates. The PPO 500 Plan
Please notify Benefits@activisionblizzard.com in the event that Collective Health website
Medical Options also includes the Blue Shield network (Blue Card you, or your spouse and dependent children, are no longer https://join.collectivehealth.com/
> CDHP Plan nationwide) which is a broad network of doctors enrolled in an employer-sponsored group health plan. activisionblizzard
> PPO 500 Plan and facilities.
> In-Network Plan CVS/Caremark Pharmacy website
> Kaiser HMO (CA only) When you receive care from an
https://www.caremark.com/wps/portal
> Waiving Medical Coverage in-network provider:
Additional Care • You have a lower annual deductible Kaiser website
Support • You have a lower out-of-pocket maximum https://healthy.kaiserpermanente.org/
> Additional Care available
to Collective Health Plans • Your copay/coinsurance is less
Delta Dental website
> Additional Care available
https://www.deltadentalins.com/
to All Plans
In-Network Plan Options activisionblizzard/
Medical Plan
Depending on your location, choose from:
Comparison Vision Service Provider (VSP) website
• Kaiser HMO (CA only)
Rx https://www.vsp.com/
• In-Network Plan (not open to new enrollments)
Dental
Network-only plans generally cover only those EAP website
Vision services provided by in-network providers, except http://www.magellanascend.com
Spending Accounts for certain emergency situations. In the HMO,
> Health Savings Account you choose a primary care physician (PCP) who
> Flexible Spending coordinates your care and makes referrals to
Accounts in-network specialists. Each family member may
Employee select a different PCP. (The In-Network Plan is
Contributions administered by Collective Health and does not
> Medical Plan Surcharges require coordination through a PCP.) Most services
are covered in full after you pay a copay.
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ADDITIONAL CARE SUPPORT DOCTOR ON DEMAND
Additional Medical Programs available on Collective Health plans ADVANTAGES
Convenient. Now get care 24/7 no matter where
Healthcare Cost Transparency Tool Expert Second Opinions from you are in the U.S.
from Healthcare Bluebook Grand Rounds
Healthcare Bluebook helps you see which providers Grand Rounds gives you and your immediate or Fast. No waiting for an appointment. Get
are most cost-effective per procedure- prices for the extended family members (includes spouse/DP, an immediate diagnosis and, if needed, a
same in-network procedure can vary by up to 500%. children, legal dependents, parents, siblings and prescription, and start treating your condition
Healthcare Bluebook can help you easily compare in-laws) fast access to the world's top medical right away.
Medical Options prices to know if you're paying more than necessary, experts- Grand Rounds allows you to connect with
> CDHP Plan Save money. It’s a cost-effective alternative to
for free. To access the HCBB website or app login to nationally recognized experts for a second opinion, urgent care or the emergency room.
> PPO 500 Plan your Benefits@Play Castlight account. either on the phone, over the web, or through the
> In-Network Plan Superior care. You’ll be talking face-to-face over
Grand Rounds mobile app. If you're not sure where to
> Kaiser HMO (CA only) video with a network board-certified physician
Bonus: you can earn points in Benefits@Play and cash start with doctors, Grand Rounds can also schedule
> Waiving Medical Coverage who will share a report with your regular doctor.
rewards for using Healthcare Bluebook. you in-person office visits with in-network experts.
Additional Care Get started on the right treatment path from day one To get started, go to www.DoctorOnDemand.
Support Televideo Medicine from Doctor so you can get better, faster. com/ab or call 800-997-6196.
> Additional Care available on Demand
to Collective Health Plans
Doctor on Demand allows you to see a doctor from To get started call 1-800-929-0926, visit the Grand DOCTOR HOUSE CALLS
> Additional Care available
home via live video chat- Doctor on Demand's medical Rounds website, or open the app.
to All Plans FROM HEAL
doctors can diagnose, treat, and write prescriptions
Medical Plan Heal brings highly trained doctors right to your
to your local pharmacy for most non-emergency Note: Grand Rounds expert opinion services are
Comparison conditions. Meet with a board-certified doctor or covered at no cost to you, however any follow up
door- whether you're sick, in need of a physical,
or just looking for a new doctor, Heal makes it
Rx licensed psychologist or psychiatrist through live video treatment or doctor visits may have associated costs. convenient to get care. See a high-quality doctor
with the Doctor on Demand app. on your schedule and in a location that's
Dental convenient for you, at the same cost as an
Vision Acute telemedicine visits for PPO 500 and In-Network
office visit.
Spending Accounts are $0 copay and $49 for users on the Collective To get started visit the Heal website or open the
> Health Savings Account Health CDHP if they have not met the deductible (the app! Be sure to add Activision Blizzard as your
> Flexible Spending plan covers 80% of the cost after the deductible has employer and include your medical information
Accounts been met). so you are charged correctly.
Employee Heal is $99 for users on the Collective Health
Contributions Behavioral health telemedicine visits for PPO 500 CDHP and $20 copay for users on the Collective
> Medical Plan Surcharges and In-Network are $20 copay and the costs varies Health PPO 500 and In-Network plans. Annual
for visits in the CDHP plan if they have not met the physicals are free!
deductible (the plan covers 80% of the cost after the
Note: Heal is only available in certain zip codes,
deductible has been met). check the Heal website or app to find out if their
services are available in your area.
To use the program, simply download the app and
create an account with your insurance information.
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Fertility Treatment from Progyny Pre-diabetes and Type 2 Diabetes
Progyny gives you access to high-quality doctors Reversal from Virta
and patient advocates to guide you through your Virta is a clinically-proven treatment that reverses
fertility treatment plan. Through Progyny, you pre-diabetes and type 2 diabetes. The published
have access to a SMART Cycle, which includes a results of Virta’s clinical trial show that their
fast track to treatments with the highest chance patients reduce their blood sugar and A1c, all while
of success (like in vitro fertilization with advanced removing diabetes medications, losing weight, and
screening). Your SMART Cycle plan covers today’s reducing inflammation. Virta uses nutritional ketosis
best treatment course, so you no longer need to to treat the root causes of type 2 diabetes - insulin
let your decisions be dictated by cost. resistance and carbohydrate intolerance. There is
Medical Options NO calorie counting, starvation, new medications,
> CDHP Plan Your coverage offers 1 SMART Cycle per lifetime or required exercise. Virta offers continuous
> PPO 500 Plan subject to all applicable plan copays, coinsurance, medical supervision from a doctor, personal
> In-Network Plan and deductible requirements on your Collective one-on-one health coaching from nutrition and
> Kaiser HMO (CA only)
Health medical plan. Should your first and second behavior experts, biomarker testing supplies (scale,
> Waiving Medical Coverage
SMART Cycle be unsuccessful a 3rd SMART Cycle meter, blood glucose and blood ketone strips, and
Additional Care will be available. more), access to a private patient community, and
Support exclusive library of resources, including how-to
> Additional Care available Call Progyny at 1-888-203-4914 to be connected videos, meal plans, recipes, and guides.
to Collective Health Plans
with a Progyny Patient Care Advocate.
> Additional Care available
to All Plans
Diabetes Support from mySugr
Medical Plan It takes a lot of time and energy to live well with
Comparison diabetes but mySugr can help make diabetes suck
Rx less! mySugr is an app-based diabetes solution
Dental that brings together smart diabetes technology,
unlimited testing supplies, and personalized
Vision coaching from Certified Diabetes Educators to help
Spending Accounts you reach your health goals.
> Health Savings Account
> Flexible Spending Feel supported between visits, spot issues before
Accounts they escalate, and be prepared with unlimited
Employee supplies shipped right to your door. mySugr’s
Contributions easy-to-use app with automatic data syncing
> Medical Plan Surcharges will help you track all your health metrics and
hack your diabetes! To get started visit
www.mysugr.com/ActivisionBlizzard or call
1-855-337-7847.
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Additional Medical Programs available to all Plans
Family Support from Rethink VIRTUAL PHYSICAL THERAPY
Raising kids is tough. Rethink provides family support match your needs. Your Care Coordinator will then FROM PHYSERA
when you need it. create a personalized plan for you and get to work Back, shoulder, neck, or knee aches? With
researching, calling, and getting things done, so Physera, you’ll be able to quickly connect with
Through Rethink, you gain 24/7 access to you can focus on taking care of yourself or your an expert physical therapist from home, work,
consultations with a dedicated behavior expert and loved one. that nice shady spot in the park, or wherever. No
referral is necessary to start. After an initial live
unlimited use of the website filled with step-by-step
video visit, you'll be prescribed a personalized
videos, resources, and exclusive content developed to Wellthy is available at no additional cost to you. To treatment plan. But don’t worry, you won’t be
Medical Options help families raising children with learning, social or get started visit the Wellthy website and register left hanging. The app makes it easy to stay
> CDHP Plan behavioral challenges, or developmental disabilities. or call 1-877-588-3917. connected with your physical therapist, who’ll
The program has no age restriction, requires no monitor your progress, adjust your exercises
> PPO 500 Plan
as needed, and provide support throughout
> In-Network Plan diagnosis, and is completely confidential. Employee Assistance Program (EAP) treatment – all at no cost to you. Don’t you feel
> Kaiser HMO (CA only) from Magellan better already?
> Waiving Medical Coverage Employees have access to 3 hours of 1-on-1 virtual Magellan’s Employee Assistance Program (EAP)
consultations with a Rethink behavioral therapist or provides helpful tools, resources, and services to To get started, visit the Physera website and sign
Additional Care up for a personalized version of the Physera app.
special educator. help you live well. From counseling and coaching
Support
> Additional Care available support for challenges from stress, anxiety, grief,
to Collective Health Plans To get started simply visit the Rethink website/app relationship concerns and more. Magellan is there to
> Additional Care available and enroll. support you with resources when you need it most.
to All Plans You're offered up to six free sessions per incident,
Medical Plan Chronic Disease Prevention per year.
Comparison from Newtopia
Newtopia is designed to help people who are at The Magellan EAP is available 24/7 by calling
Rx
risk of developing diseases related to obesity (this 1-800-327-2593.
Dental can include type 2 diabetes, heart disease, and
Vision stroke). Newtopia is available at no cost to eligible Cancer Care Support from
employees. Login to your Castlight account to take Robin Care
Spending Accounts
> Health Savings Account their quick eligibility test to see if you are eligible. Robin Care offers patients and caregivers
> Flexible Spending comprehensive cancer care support.
Accounts Bonus: you can earn points in Benefits@Play and
for participating in Newtopia’s coaching plans. With Robin Care, each patient has 24/7 access
Employee to a team of coaches and nurses to help them
Contributions Family Care Coordination navigate their journey. The web and mobile
> Medical Plan Surcharges
from Wellthy apps provide education, tools, and resources to
Wellthy helps individuals and families manage empower patients every step of the way.
and coordinate care for a chronically ill, aging, or
disabled loved one. Robin Care is available at no additional cost to you.
To get started call 1-650-413-7502.
With Wellthy, you’ll get connected with a Care
Coordinator who has skills and experience that
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
MEDICAL PLAN COMPARISON
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
Activision Blizzard
$250 N/A N/A N/A
HSA Contribution
Medical Options
> CDHP Plan
> PPO 500 Plan Incentive Earnings up to $2,000 up to $1,000
> In-Network Plan
> Kaiser HMO (CA only)
> Waiving Medical Coverage
Annual Deductible
Additional Care $1,500/$3,000 $4,000/$8,000 $500/$1,000 $1,000/$2,000
Individual/Family
Support
> Additional Care available
to Collective Health Plans Coinsurance Employer/Indi-
> Additional Care available 80/20 50/50 90/10 70/30
vidual
to All Plans
Medical Plan
Comparison Annual Out-of-Pocket Max-
imum $4,500/$9,000 $6,350/$12,700 $3,000/$6,000 $4,000/$8,000
Rx Individual/Family
Dental COVERED EXPENSES
Vision What You Pay
Spending Accounts
> Health Savings Account Primary Care Physician
> Flexible Spending 20% after deductible 50% after deductible $20 copay 30% after deductible
Office Visits
Accounts
Employee
Contributions Specialist Office Visits 20% after deductible 50% after deductible $45 copay 30% after deductible
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
Preventive Care
• Adult and children from age 17
• Well-child care through age 16
No charge 50% after deductible $0 copay 30% after deductible
• Gender neutral services
Medical Options Lab and X-ray
pre-certification required for non-
> CDHP Plan emergent advanced radiology
20% after deductible 50% after deductible 10% after deductible 30% after deductible
> PPO 500 Plan services (MRI, PET, etc.)
> In-Network Plan
> Kaiser HMO (CA only) Initial visit: $20 copay
> Waiving Medical Coverage for primary care
physician
Additional Care
Support Maternity Care 20% after deductible 50% after deductible $45 copay for specialist 30% after deductible
> Additional Care available
to Collective Health Plans 10% after deductible
> Additional Care available for postnatal and physician’s
to All Plans charges
Medical Plan
Comparison
Inpatient Care 20% after deductible 50% after deductible 10% after deductible 30% after deductible
Rx
Dental
Vision
Outpatient Care 20% after deductible 50% after deductible 10% after deductible 30% after deductible
Spending Accounts
> Health Savings Account
> Flexible Spending
Accounts
No charge after No charge after
Employee Ambulance
deductible deductible
$0 copay $0 copay
Contributions
> Medical Plan Surcharges
20% 20% $50 copay; $50 copay:
Urgent Care
after deductible after deductible no deductible no deductible
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
TELEMEDICINE IN-NETWORK PROVIDER
PCP/Specialist Virtual
Ded/coinsurance Ded/coinsurance $20 / $45 copay 30% after deductible
Office Visit
Medical Options Network Behavioral Health
Ded/coinsurance Ded/coinsurance $20 copay 30% after deductible
> CDHP Plan Virtual Visit
> PPO 500 Plan
> In-Network Plan
> Kaiser HMO (CA only) PCP/Specialist Virtual Visit Ded/coinsurance Ded/coinsurance $20 / $45 copay 30% after deductible
> Waiving Medical Coverage
Additional Care Behavioral Health
Ded/coinsurance Ded/coinsurance $20 copay 30% after deductible
Support Virtual Visit
> Additional Care available
to Collective Health Plans TELEMEDICINE - DOCTOR ON DEMAND
> Additional Care available
to All Plans
Acute Telemed Visit $0 after ded/coin met Not available $0 copay Not available
Medical Plan
Comparison
Rx Behavioral Health
Ded/coinsurance Not available $20 copay Not available
Telemed Visit
Dental
HEAL
Vision
Spending Accounts
> Health Savings Account Home Visit Ded/coinsurance Not available $20 copay Not available
> Flexible Spending
Accounts
Telemed Visit Ded/coinsurance Not available $0 copay Not available
Employee
Contributions
> Medical Plan Surcharges Behavioral Health
Ded/coinsurance Not available $20 copay Not available
Telemed Visit
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
$200 copay; $200 copay;
20% 20%
Emergency Room Visits no deductible no deductible
after deductible after deductible
(waived if admitted) (waived if admitted)
Durable Medical No charge 50%
$0 copay 30% after deductible
Medical Options Equipment after deductible after deductible
> CDHP Plan
> PPO 500 Plan
Short-Term
> In-Network Plan Rehabilitative Therapy and
> Kaiser HMO (CA only) Chiropractic Care $20 copay for primary care
includes 90 total visits, combined 20% 50% 30%
> Waiving Medical Coverage physician;
between physical, occupational, after deductible after deductible after deductible
$45 copay for specialist
Additional Care and speech therapy, 60 visits of
chiropractor care per year, and
Support unlimited access to Physera
> Additional Care available
to Collective Health Plans
Treatment of Autism
> Additional Care available Includes office visits; speech,
to All Plans occupational and physical therapy;
psychotherapy; and ABA therapy to $20 copay could apply
Medical Plan 20% 50% 30%
manage behavioral issues related to for certain services or $45
after deductible after deductible after deductible
Comparison autism. Includes unlimited therapy copay for specialist
sessions and unlimited access to
Rx ReThink with
3 hours of tele-consultation.
Dental
Vision Treatment of Gender Charge based on Charge based on Charge based on Charge based on
Identity Disorder site of service site of service site of service site of service
Spending Accounts
> Health Savings Account
> Flexible Spending Charge based on Charge based on
Treatment of Infertility Not covered Not covered
Accounts provided by Progyny site of service site of service
Employee
Contributions Inpatient Mental Health/ 20% 50% 10% 30%
> Medical Plan Surcharges Substance Abuse after deductible after deductible after deductible after deductible
Outpatient Mental Health/ 20% 50% 30%
$20 copay
Substance Abuse after deductible after deductible after deductible
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
Incentive Earnings up to $1,000
Annual Deductible
None None
Individual/Family
Medical Options
> CDHP Plan Annual Out-of-Pocket Maximum
> PPO 500 Plan $1,500/$3,000 $1,500/$3,000
Individual/Family
> In-Network Plan
> Kaiser HMO (CA only) COVERED EXPENSES
> Waiving Medical Coverage What You Pay
Additional Care
Support Primary Care Physician Office Visits $20 copay $20 copay
> Additional Care available
to Collective Health Plans
Specialist Office Visits $35 copay $35 copay
> Additional Care available
to All Plans
Preventive Care
Medical Plan • Adult and children from age 17
$0 copay $0 copay
Comparison • Well-child care through age 16
• Gender neutral services
Rx
Lab and X-ray
Dental In-Network plan only. Pre-certification required for $0 copay $0 copay
non-emergent advanced radiology (MRI, PET, etc.)
Vision
Initial visit: $20 copay for
Spending Accounts primary care physician
> Health Savings Account $0 copay for office visits
Maternity Care $35 copay for specialist
> Flexible Spending $250 copay for delivery
$0 for subsequent visits
Accounts
$300 copay for delivery
Employee
Contributions
Inpatient Care $250 copay $300 copay
> Medical Plan Surcharges
Outpatient Care $100 copay $100 copay
Ambulance $0 copay $0 copay
*Not open to new enrollments
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
TELEMEDICINE IN-NETWORK PROVIDER
PCP/Specialist Office Virtual Visit Not available $20 / $35 copay
Medical Options
> CDHP Plan Network Behavioral Health Virtual Visit Not available $20 copay
> PPO 500 Plan
> In-Network Plan
> Kaiser HMO (CA only) PCP/Specialist Virtual Visit Not available $20 / $35 copay
> Waiving Medical Coverage
Additional Care
Support Behavioral Health Virtual Visit Not available $20 copay
> Additional Care available
to Collective Health Plans
TELEMEDICINE - DOCTOR ON DEMAND
> Additional Care available
to All Plans
Medical Plan Acute Telemed Visit Not available $0 copay
Comparison
Rx
Behavioral Health Telemed Visit Not available $20 copay
Dental
Vision HEAL
Spending Accounts
> Health Savings Account Home Visit Not available $20 copay
> Flexible Spending
Accounts
Employee Telemed Visit Not available $0 copay
Contributions
> Medical Plan Surcharges
Behavioral Health Telemed Visit Not available $20 copay
*Not open to new enrollments
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
$100 copay $200 copay
Emergency Room Visits
(waived if admitted) (waived if admitted)
Urgent Care $20 copay $50 copay
Medical Options
> CDHP Plan Durable Medical Equipment $0 copay $0 copay
> PPO 500 Plan
> In-Network Plan $20 copay per office visit for physical
> Kaiser HMO (CA only) Short-Term Chiropractic Care $20 copay for primary care physician
Includes physical, speech, occupational, chiropractic,
occupational and speech therapy
> Waiving Medical Coverage pulmonary rehabilitation, and cognitive therapy $35 copay for specialist; unlimited visits
$10 copay (30 visits/year)
Additional Care
Support Short-Term Rehabilitative Therapy $20 copay per office visit for physical
> Additional Care available Includes physical, speech, occupational, chiropractic, $20 copay for primary care physician
pulmonary rehabilitation, and cognitive therapy
occupational and speech therapy
to Collective Health Plans $35 copay for specialist; unlimited visits
> Additional Care available Collective Health members also have unlimited access to Physera $10 copay for a group session
to All Plans
Treatment of Autism
Medical Plan Includes office visits; speech, occupational and physical Covered the same as other illness/Rx
Comparison therapy; psychotherapy; and ABA therapy to manage Covered the same as other illness/Rx (subject to applicable specialist copay)
behavioral issues related to autism. Includes unlimited therapy (subject to applicable specialist copay)
Rx sessions and unlimited access to ReThink with Unlimited maximum per calendar year
3 hours of tele-consultation.
Dental
Charge based on site Charge based on site
Vision Treatment of Gender Identity Disorder
of service of service
Spending Accounts
> Health Savings Account Coverage is through Progyny, a concierge fertility
Coverage includes services for the benefit. It provides members with one smart
> Flexible Spending Treatment of Infertility
provided by Progyny for Collective Health members
diagnosis and treatment of involuntary cycle per lifetime and a full suite of fertility
Accounts infertility; 50% coinsurance treatment options. Additional smart cycles apply
Employee if 1st/2nd fail.
Contributions
> Medical Plan Surcharges Inpatient Mental Health/Substance Abuse $250 copay $300 copay
$20 copay
Outpatient Mental Health/Substance Abuse $20 copay
(individual visit)
*Not open to new enrollments
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
PRESCRIPTION DRUGS
Under each medical plan, generic preventive drugs are covered at 100%. You’ll also pay Collective Health CDHP Plan
less when you buy regular generic drugs or use mail-order for ongoing medications. But, With the exception of generic preventive medications which are always covered at 100%,
prescription benefits work much differently under the Collective Health CDHP Plan than the you pay the full cost of prescriptions until you meet the annual deductible. Your initial
traditional medical plans (i.e., Collective Health PPO 500 and In-Network plans and HMO). visits to the pharmacy may be more expensive at first, but that’s why the company
contributes money to your HSA. You can use your HSA debit card at the pharmacy to
CVS will be enforcing a Dispense as Written (DAW) rule meaning a penalty will be help cover those higher costs. After you meet the deductible, you pay copays for generic
imposed when a brand name drug is chosen over an equivalent generic drug, unless drugs and coinsurance for brand names.
overridden by an independent medical review.
Collective Health PPO 500 and In-Network plans and HMO
Medical Options Rx Savings Solutions is the most comprehensive online prescription tool that shows Under these traditional medical plans, you pay copays for generic and brand-name
> CDHP Plan
you all the opportunities to save money on your prescriptions. drugs, even if you haven’t met the deductible. Generally, copays are lower for generics
> PPO 500 Plan
and higher for preferred and non-preferred brand names.
> In-Network Plan It will automatically alert you if you are paying too much for your prescription as it
> Kaiser HMO (CA only) finds you other ways to get the same treatment for less money. Fertility treatment
> Waiving Medical Coverage medications are provided through Progyny Rx.
Additional Care
Support MEDICAL — CDHP AND PPO 500 OPTIONS
> Additional Care available CDHP PPO 500
to Collective Health Plans
> Additional Care available Features In-Network Out-of-Network In-Network Out-of-Network
to All Plans PRESCRIPTION DRUGS (generic/preferred brand/non-preferred brand)
Medical Plan Retail Pharmacy Preventive generics: 100% covered Deductible and 50% coinsurance Preventive generics: 100% covered 40% after deductible
Comparison 30-day supply
(You are not Generic: $4 copay after deductible Generic: $10 copay
Rx required to use Preferred Brand: 20% ($20 min/$45 Preferred Brand: $30 copay
Dental a CVS pharmacy) max) after deductible
Non-Preferred Brand: $60 copay
Vision Non-Preferred Brand: 35%
($40 min/$100 max) after deductible Copay increases by $10 for
Spending Accounts select maintenance drugs after
Copay increases by $10 for select the second refill
> Health Savings Account maintenance drugs after the second refill
> Flexible Spending
Accounts Home Delivery Preventive generics: 100% covered Not covered Preventive generics:100% covered Not covered
90-day supply
Employee (Available at CVS Generic: $10 copay after deductible Generic: $20 copay
Contributions retail at home Preferred Brand: 20% ($50 min/$125 Preferred Brand: $60 copay
> Medical Plan Surcharges delivery pricing) max) after deductible
Non-Preferred Brand: $120 copay
Non-Preferred Brand: 35% ($70
min/$175 max) after deductible
Specialty Pharmacy All Specialty medications need to be Not covered All Specialty medications need to be Not covered
filled by CVS Specialty. Questions can filled by CVS Specialty. Questions can
be directed to 1-800-237-2767 be directed to 1-800-237-2767
Note: This enrollment guide constitutes a summary of material modifications (SMM) to the 2021 summary plan description (SPD). It is meant to supplement and/or replace certain information in the SPD, so retain it for future
reference along with your SPD. Please share these materials with your covered family members.
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MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
PRESCRIPTION DRUGS - CVS/CAREMARK
Retail Pharmacy Generic: $10 copay Preventive generics: 100% covered
Up to 30-day supply
(You are not required to use a CVS Brand: $30 copay Generic: $10 copay
Medical Options pharmacy for the In-Network Plan)
Non-Preferred Brand: covered with exceptions Preferred Brand: $30 copay
> CDHP Plan
> PPO 500 Plan Non-Preferred Brand: $60 copay; copay
> In-Network Plan increases by $10 for select maintenance drugs after the
> Kaiser HMO (CA only) second refill
> Waiving Medical Coverage
Home Delivery Generic: $20 copay Preventive generics: 100% covered
Additional Care Up to a 90-day supply**
Brand: $60 copay Generic: $20 copay
Support (Available at CVS retail at home delivery
> Additional Care available pricing for the In-Network Plan)
Preferred Brand: $60 copay
to Collective Health Plans
> Additional Care available
Non-Preferred Brand: $120 copay
to All Plans
Medical Plan Specialty Pharmacy $30 copay All Specialty medications need to be filled by CVS
Comparison Specialty. Questions can be directed to 1-800-237-2767
Rx
*Not open to new enrollments
Dental **100-day supply applies to Kaiser HMO in CA
Vision
Spending Accounts
> Health Savings Account
> Flexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
DENTAL
To keep those pearly whites healthy, Activision Blizzard offers the flexibility to choose a dental plan that fits SOMETHING TO SMILE ABOUT
your and your family’s needs. You can choose from two Delta Dental plans or waive coverage.
Both dental plans offer orthodontic,
•D
elta Dental PPO. This plan pays benefits for covered services provided by any in- or out-of-network preventive care exams, basic services and
dentist. However, you can save money by using a dentist who participates in the Delta Dental PPO network. major services. The difference is in who you
That’s because in-network dentists have agreed to provide services at lower, contracted rates. For out-of- can see and how much you pay.
network services, you’ll pay a percentage of the covered expenses, plus any amounts above reasonable and
customary (R&C) charges. The DHMO requires a referral to see another
dentist and has no plan max as long as you
Medical Options To verify coverage, just give your dental provider your plan’s group number: 17915 continue to pay copays.
> CDHP Plan • DeltaCare USA DHMO. This plan generally covers only those services provided by an in-network dentist. This
> PPO 500 Plan cost-effective plan pays 100% of most services after you pay a copay. For each family member, you must use an If you need more info, visit
> In-Network Plan https://www.deltadentalins.com/
in-network Primary Care Dentist who will coordinate any treatments by in-network specialists. To verify
> Kaiser HMO (CA only) activisionblizzard/ or call:
coverage, just give your dental provider your plan’s group number: 78613
> Waiving Medical Coverage • HMO: 800-422-4234, or
You will receive a Delta Dental DHMO ID card with an auto-generated dentist based on your zip code in the
Additional Care • PPO: 800-765-6003.
mail to present to your dental provider at the time of service. If you need to change your dentist, call Delta
Support Dental at 800-422-4234.
> Additional Care available
to Collective Health Plans
> Additional Care available DENTAL OPTIONS
to All Plans
DELTA DENTAL PPO DELTACARE USA DHMO (NOT IN MN)
Medical Plan
Comparison Features In-Network Out-Of-Network In-Network
Rx Annual Deductible Individual/Family $50/$150 None
Dental
Annual Dental Maximum $2,000 N/A
Vision
Lifetime Orthodontic Maximum $2,000 N/A
Spending Accounts
> Health Savings Account COVERED SERVICES What You Pay
> Flexible Spending
Preventive Services $0 except amounts above
Accounts $0 copay Copays vary
Exams, cleanings, X-rays contract allowance*
Employee Basic Services Fillings, root canal 20% after deductible, plus amounts
20% after deductible Copays vary
Contributions therapy above contract allowance*
> Medical Plan Surcharges
Major Services Crowns, bridges, 50% after deductible, plus amounts
50% after deductible Copays vary
dentures and implants above contract allowance*
50% after deductible, plus amounts
Orthodontics Children and adults 50% after deductible Copays vary
above contract allowance*
*Contract allowance — PPO contracted fees for PPO Dentists, Delta Dental Premier® contracted fees for Premier Dentists and the program allowance for non-Delta Dental Dentists.
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
VISION
Are you squinting? Well, don’t worry. Good vision is on the horizon with Activision Blizzard vision coverage. You always
have a choice of eye care providers. When you receive care from an:
• I n-network provider (VSP Signature Network), your costs will be lower. You don’t have to fill out any forms or
file any claims.
•O
ut-of-network provider (Non-VSP provider), you will typically pay more out of pocket. You pay the provider in full
and submit a claim to VSP for reimbursement. The plan has a set reimbursement amount for each service.
Medical Options Just give your SSN/National ID to the VSP provider and they will be able to verify your coverage. Questions?
> CDHP Plan
Go to https://www.vsp.com or call 800-877-7195.
> PPO 500 Plan
> In-Network Plan
> Kaiser HMO (CA only)
> Waiving Medical Coverage
VISION
Additional Care VSP
Support In-Network Out-Of-Network
> Additional Care available Features
(VSP Network Provider) (Non-VSP Provider)
to Collective Health Plans
> Additional Care available Copay $15 N/A
to All Plans
Medical Plan
Comparison
Rx COVERED SERVICES What You Pay
Dental Exam $0 after copay You receive up to $50 allowance
Once every 12 months
Vision
Spending Accounts
> Health Savings Account
> Flexible Spending Frames After copay, you receive up to $150 You receive up to $70 allowance
Accounts Once every 24 months allowance plus 20% off any out-of
pocket costs
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2021 BENEFITS GUIDE
VISION
VSP
In-Network Out-Of-Network
Features
(VSP Network Provider) (Non-VSP Provider)
Lenses $0 after copay You receive an allowance of:
Once every 12 months
• Single vision • Up to $50
• Lined bifocal • Up to $75
Medical Options • Lined trifocal • Up to $100
> CDHP Plan • Standard progressive
> PPO 500 Plan If you choose contact lenses, you will be eligible
> In-Network Plan for a frame 12 months from the date the contact
> Kaiser HMO (CA only) lenses were obtained
> Waiving Medical Coverage Lens Options You receive an allowance of: You receive an allowance of:
• Premium progressive lenses • Up to $50 • Up to $75
Additional Care
• Custom progressive lenses • $80 - $90
Support
• Anti-reflective coating: $30 copay • $120 - $160
> Additional Care available
to Collective Health Plans
> Additional Care available
to All Plans Contact Lenses Up to $60 copay for contact lens exam (fitting You receive up to $105 allowance
Once every 12 months instead of frames and evaluation) and $130 allowance for cost of
Medical Plan and lenses contact lenses
Comparison
Rx
Dental
Laser Vision Correction LASIK vision correction, up to $1,000 per eye; once per lifetime
Vision Average of 15% off the regular price or 5% off the promotional price from
contracted facilities
Spending Accounts
> Health Savings Account
> Flexible Spending
Accounts
KidsCare Two (2) exams every 12 months; Frames every 12 months
Employee Covered dependent children
Contributions
> Medical Plan Surcharges
Note: If you purchase vision services/products through the plan at Costco or any other VSP Affiliate Provider, no claim form is needed.
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INSURANCEYou can also read
