Benefits at a Glance

For employees working 30 hours or more, on average, per week are eligible for benefits.
You must enroll within 30 days of your hire date, however, benefits do not start until the first
day of the month following 30 days.
Please note: If you do not enroll yourself or your eligible dependents for most benefits at the time of
initial eligibility (within 30 days of your start date), you will not be able to enroll them until the next
annual open enrollment unless there is a qualifying event which allows a change to your election.

PMG Cost

Employee Cost

(PMG pays on your

behalf per pay
period)

(costs indicated are per pay period)

Eligibility is 30-day waiting period, then coverage

st
begins on the 1 day of the following month.

Medical
Employee Only
Employee & Spouse
Employee & Child/Children
Family

$164.85
$164.50
$164.71
$164.18

Eligibility is 30-day waiting period, then coverage

st
begins on the 1 day of the following month.

Dental
Employee Only
Employee & Spouse
Employee & Child/Children
Family
Basic Life/Accidental Death
& Dismemberment Insurance
Employee Only

$44.35
$229.60
$127.89
$405.22

$18.79
$18.79
$18.79
$18.79

FREE
$16.97
$33.92
$58.21

Eligibility is 30-day waiting period, then coverage begins on

st
the 1 day of the following month.

FREE
1 x your annual earnings to a maximum of $50,000

Short-Term Disability
Employee Only

*Recommend joining at initial eligibility to avoid possible denial

at a later date.

Based on monthly earnings

Maximum benefit $500/week

Long-Term Disability
Employee Only

FREE
Pays 60% of your monthly salary up to $6,000 per month

Flexible Spending Account

(FSA)
Dependent Care Only

Maximum deduction for Dependent Care is

$5,000 per plan year
Plan administered through a third party
Deductions are made on a pre-tax basis

Accumulated Time Off (ATO)

For Full-Time Employees
First year of employment
Hired January 1 March 31
Hired April 1 June 30
Hired July 1 September 30
Hired October 1 October 31
Hired October 31 December 31
After January following start date
1st 5th calendar year of
employment
6th 10h calendar year of
employment
11th 15th calendar year of
employment
16th & higher
Accumulated Time Off (ATO)
For Part-Time Employees

To be used for vacation time, sick time and personal time.

At year-end, employees may sell back or rollover up to 40
hours of ATO to be paid in November. ATO may vary
depending on employment terms.

Pro-rated based on start date

80 hours
60 hours
40 hours
20 hours
No hours for current year
120 hours
160 hours
200 hours
240 hours
To be used for vacation time, sick time and personal time.
At year-end, employees may sell back or rollover up to 40
hours of ATO to be paid in November.

Based on a schedule of working 30-39 hours per week, ATO is calculated at

75% of the full allotment noted above.
Holidays
Paid-time off for Holidays are set annually by the CEO based on the calendar.
Floating Holiday
If hired prior to July 1st of current year, full-time employees are entitled to eight
(8) hours of Floating Holiday.

Additional Benefits Information

This is intended to be only a very brief summary of the HSA-qualified Group Medical Plan.
Benefit limitations and/or exclusions may apply. For specific benefit questions please visit
www.bcbsnc.com/members/public/ or contact BCBS of NC Member Services at
(877) 258-3334. For HSA account information, visit www.hsamember.com.

HSA-qualified Plan Features

In-network Benefits

Individual Plan Year Deductible

Family Plan Year Deductible
Individual Plan Year Out-of-Pocket Maximum
Family Plan Year Out-of-Pocket Maximum

$3,000
$6,000 (Aggregate)
$6,350 (includes Deductible)
$12,700 (Aggregate, includes Deductible)

Wellness & Preventive Care

Routine Annual Wellness Exams
100%, no Deductible
Pap tests, Mammograms, PSA tests, and
100%, no Deductible
other Wellness Screening Services
Well-child Care and Immunizations
100%, no Deductible
Routine Eye Exams
100%, no Deductible
Physician Services
Primary Care Office-based Services
Specialists Office-based Services

Inpatient Hospital Services

Inpatient Physician Services

60% after Deductible

60% after Deductible

Inpatient Hospital Services

60% after Deductible
60% after Deductible
Outpatient Services

Outpatient Physician Services

Outpatient Hospital Services
CT Scans, MRIs, and PET Scans
Ambulatory Surgical Center Services
Outpatient Therapies
Emergency Room Visits
Urgent Care Center Services
Comprehensive Eye Exam

60% after Deductible

60% after Deductible
60% after Deductible
60% after Deductible
60% after Deductible
60% after Deductible
60% after Deductible
60% after Deductible

Prescription Drugs
All Covered Prescription Drugs

60% after Deductible

HSA Contribution Limits for 2014

Individual
Family
Catch-up Contribution (age 55+)
PMG Contribution Amount

$3,350
$6,650
$1,000
$600

Additional Benefits Information, Contd.

This is intended to be only a very brief summary of your employer-sponsored ancillary benefit
plans. For specific benefit questions please contact the insurance carriers listed below.

Basic Life and AD&D USAble Life (800) 370-5856

All Eligible Employees
Eligible Dependent Spouses and Child(ren)

1X Annual Salary ($50,000 Maximum)

$10,000

Short Term Disability Principal Life (800) 245-1522 www.principal.com

Weekly Benefit

60% of Weekly Earnings to $500 Maximum

per week
14 days Accident/ 14 days Sickness or Injury
11 weeks

Elimination Period
Maximum Benefit Period

Long Term Disability Principal Life (800) 245-1522 www.principal.com

Monthly Benefit
Elimination Period
Benefit Period

60% of Monthly Earnings to $6,000 Maximum

90 days
To Social Security Normal Retirement Age

Dental Delta Dental of NC (800) 524-0149 www.toolkitsonline.com

Annual Deductible
Annual Maximum Benefit

$50 Individual/ $150 Family

$1,500
Preventive Services

Exams, Cleanings, and X-Rays

Fluoride Treatments, Sealants

100%, no Deductible
100%, no Deductible
Basic Services

Fillings and Extractions

Endodontic Services
Oral Surgery and Anesthesia
Repairs of Crowns, Bridges, and Dentures

80% after Deductible

80% after Deductible
80% after Deductible
80% after Deductible

Major Services
Periodontic Services
Crowns, Bridges, Dentures, and Implants

50% after Deductible

50% after Deductible

Orthodontia Services
Adults and Children

50%, no Deductible
$1,500 Lifetime Maximum

Additional Benefits Information, Contd.

This is intended to be only a very brief summary of your voluntary ancillary benefit plans. For
specific benefit questions please contact the vendors listed below.

Voluntary Term Life and AD&D Principal Life (800) 245-1522

www.principal.com
*Recommend joining at initial eligibility to avoid possible denial at a later date.

Employee
Spouse
Child(ren) to age 19
(full-time students to age 26)
Guarantee Issue Amounts

$25,000 increments,
up to $100,000
$5,000 increments,
up to 50% of the employee amount/$25,000
$5,000 increments,
up to $10,000/50% of the employee amount
(birth to 6 months $1,000)
$100,000 for Employees
$25,000 for Spouses
$10,000 for Child(ren)

Retirement Benefits
This is intended to be only a very brief summary of your employer-sponsored plan. For
specific benefit questions please contact the vendor listed below.

401(k) Retirement Plan Plybon and Associates, Inc. (336) 292-9050

www.plybon.com
Plan Eligibility Requirement
Employee Contributions

Entrance Date for Plan Eligibility

Employer Matching Contributions
Entrance Date for Matching Contributions

Vesting Schedule

6 Months of Service and at least 21 years of age

Participants may contribute between 2% and 75%
of compensation, up to $18,000; Participants over
the age of 50 can contribute an additional $6,000.
1st day of the month coincident with or next
following eligibility date
Employer matches 25% of employee contribution,
up to 6%
1st day of the first quarter coincident with or next
following 12 months of Service (1,000 hours
worked/minimum)
100% immediate