employee benefits guide · prescription drug coverage with rxbenefits ca times is pleased to...

EMPLOYEE BENEFITS GUIDEJanuary 1, 2021 – December 31, 2021

BENEFIT OPTIONS THAT FIT YOUR LIFE!

Benefits Portal SearchableQuickly find service

contact information and

online resources

Benefit PlansReview benefit plan

design information and

find online provider

directories

Group InformationAccess and print

generic ID cards with

group information

How to EnrollFind information on who

is eligible and how to

enroll

iPhoneQR CodeTake Picture

Tap the Share Icon

Add to Home Screen

Android

Tap the Icon in Menu

Select: Add to Home Screen

Nothing to install! Access from a computer, tablet or smartphone.

1) Visit catimes.mybenefitsapp.com

2) Or, scan QR Code to launch app

Benefits at your Fingertips

anaheimarena.mybenefitsapp.com

Our employees are our most valuable resource, and your health and welfare will always be a main

priority of ours. As part of our ongoing commitment to your good health and financial security, we

are pleased to offer flexible benefits to our eligible employees and their family members to help

address their health and welfare needs. Please take time to review this guide and share with your

dependents; we want you to make the right choice for you and your family.

We understand that electing benefits is an important process, we hope you will leverage the

available resources to make the plan selection that best suits the needs of you and your family.

For more information, please contact Empyrean, the CA Times Benefits Department, or visit your

Employee Benefits Portal at catimes.mybenefitsapp.com

2

Welcome

anaheimarena.mybenefitsapp.c

om3

Employee Eligibility / Dependent Eligibility

If you are a regular full-time or part-time employee

regularly scheduled to work at least 30 hours per week, you

and your eligible dependents may participate in the

benefits program. Your eligible dependents include:

• Legally married spouse or domestic partner;

• A natural child, step-child, adopted child, legal

guardianship, children of your spouse or domestic

partner up to age 26;

• A child over the age of 26 that has a severe physical or

mental condition that makes them indefinitely

dependent on you for primary support.

Qualifying Events

If you fail to enroll or make changes during your first 31

days of employment or during open enrollment, you can

only make certain changes to your benefits if you

experience a qualified life event pursuant to the IRS

Section 125 rules. You must report any qualifying life event

to Empyrean within 31 days of the occurrence of the event

to be allowed to make a change. Examples of qualified

life events include:

• Marriage or divorce;

• Spouse or dependent child terminates employment

or becomes employed;

• Birth or adoption of a child;

• Death of a spouse or child;

• Become eligible for assistance under a Medicaid

plan, State Exchange Plan or Medicare

Required Documentation for Dependent Verification

If you are adding a dependent to any CA Times benefit plans, you will be required to submit

dependent eligibility documentation no later than December 31, 2020 directly to Empyrean. Your

dependents will not be enrolled into the plans if required documentation is failed to be to be submitted

within the required deadline and will have to wait until the next open enrollment to enroll into the plans.

All required documents must indicate the date, your name, your Employee ID and your dependent’s

name. This documentation allows us to ensure that only eligible dependents are added to the CA

Times benefit plans.

If you have any questions, you may contact the CA Times Benefits Service Center at (833) 269-2137

from 8am to 5pm PST, Monday through Friday or find Required Dependent Documentation details by

visiting catimes.mybenefitsapp.com, under Eligibility tile.

anaheimarena.mybenefitsapp.com4

You can enroll, waive or make changes to your benefits via Empyrean site starting Monday,

October 26 through Friday, November 6, 2020. The elections you make will stay in effect from January 1, 2021 through December 31, 2021. Dependent verification documents are due to

Empyrean no later than December 31, 2020 for any new dependent(s) being added to the

benefit plans. If no action is taken during this upcoming open enrollment, your current benefits

will rollover into 2021 Plan Year, except for the FSA plans and HSA. Reminder, you must actively

re-enroll yearly into the Health Care FSA, Dependent Care FSA, Health Savings Account (HSA) and Parking / Transit benefit, failing to re-enroll will waive your coverage for 2021.

How to Enroll

Login starting

October 26th

https://compass.empyreanbenefits.com/CATimes

If you are a new user, you must register first. User ID is your company email address.

If you are a returning employee login using your previous

password.

If you experience technical issues, reach out to Empyrean

directly at: (833) 269-2137

Review and confirm all your election no later than November 6th. Make sure

to finish your enrollment until you receive a confirmation. Elections are NOT recorded if you fail to complete

the enrollment in its entirety.

Remember to Submit Dependent Verification by 12/31/2020.

Evidence of Insurability (EOI) must be submitted for new Life or Long Term

Disability enrollments. Coverage is not effective until after the date the

required documents are submitted and approved by the carriers.

You also have the option to make your elections or changes

over the phone by calling CA Times Benefits Service Center administered by Empyrean at

1(833) 269-2137

They are available from 8am to 5pm PST

Monday to Friday



om5

Contacts

Refer to this list when you need to contact one of your benefit vendors. For general information,

contact your CA Times Benefits Department.

Your Employee Benefits Portal catimes.mybenefitsapp.com

Carrier / Vendor Group # Phone # Website

CA Times Benefits Department N/A (213) 237-2165 Email: [email protected]

Empyrean –Enrollment Administrator

N/A (833) 269-2137 https://compass.empyreanbenefits.com/CATimes

Collective Health Medical PPO / HDHP

282016 (833) 440-4367New Member: join.collectivehealth.com/catimes

Members: join.collectivehealth.com/catimes

Delta Dental

19876-00001

Standard(800) 765-6003 www.deltadentalins.com

19876-00002

Enhanced

Discovery Benefits - FSA 33535 (866) 451-3399www.discoverybenefits.com

[email protected]

Employee Discounts EHJ6XN (866) 664-4621catimes.benefithub.com

Referral Code: EHJ6XN

EyeMed - Vision

1019531-1001

Standard(866) 299-1358 www.eyemed.com

1019531-1002

Enhanced

Health Equity - HSA N/A (866) 346-5800www.healthequity.com

[email protected]

Kaiser PermanenteMedica HMO

Northern CA

Region: 606131(800) 464-4000 www.kp.org

Southern CA

Region: 234268

LegalZoom - LifePlan N/A (855) 787-1909www.lifeplan.legalzoom.com

[email protected]

LifeLock - Identity Theft Protection YIG480 (800) 607-9174 www.lifelock.com

Lincoln Financial GroupShort Term Disability

Long Term Disability

000010247437

STD(800) 423-2765 www.lfg.com

000010247436

LTD

ComPsych Employee Assistance Program

California Times (855) 327-4463www.GuidanceResources.com

Web ID: Lincoln

MetLife Legal Plan 217517 (800) 821-6400 www.legalplans.com

MetLife - Voluntary Products 217517 (800) 438-6388 www.metlife.com

Nationwide - Pet Insurance N/A (877) 738-7874 www.petinsurance.com/catimes

Telemedicine N/A(888) 548-3432 www.livehealthonline.com

(866) 454-8855 www.kp.org

Vanguard - 401(k) / DCRP 094880 / 094625 (800) 523-1188 www.vanguard.com/actnow

WageWorks - Commuter Benefit CA Times (877) 924-3967 www.wageworks.com

tel:213-237-2165tel:833-269-2137https://compass.empyreanbenefits.com/CATimestel:833-440-4367http://join.collectivehealth.com/catimeshttp://join.collectivehealth.com/catimestel:800-765-6003http://www.deltadentalins.com/http://www.discoverybenefits.com/mailto:[email protected]:866-664-4621https://catimes.benefithub.com/tel:866-229-1358http://www.eyemed.com/tel:866-346-5800http://www.healthequity.com/https://catimes.mybenefitsapp.com/contacts/[email protected]:800-464-4000http://www.kp.org/tel:855-787-1909http://www.legalplans.com/mailto:[email protected]:800-607-9174http://www.lifelock.com/tel:800-423-2765https://www.lfg.com/tel:833-306-0099http://www.guidanceresources.com/tel:800-821-6400http://www.legalplans.com/tel:800-438-6388https://mybenefits.metlife.com/getGroupByIdForHP.htm?group=217517&aURL=http://zzztel:877-738-7874http://www.petinsurance.com/tel:888-548-3432http://www.livehealthonline.com/tel:866-454-8855http://www.kp.org/tel:800-523-1188http://www.vanguard.com/tel:877-924-3967


om6

Medical Plans with Collective Health (Anthem Blue Cross Network)

You have the option of two plans through Collective Health, a PPO and HDHP. Employees may seek services

from in-network and out-of-network providers. Utilizing an in-network provider offers an enriched benefit; a

lower deductible, a lower co-insurance charge, and expenses over the usual and customary limit are waived.

If an out-of-network provider is selected, the employee may be responsible for charges above the usual and

customary limit. Benefits are paid on covered charges after the deductible is satisfied on certain services under

the PPO plan. Under the HDHP the full deductible must be satisfied first for all services before benefits are paid.

Coverage out of the country are only covered in emergency situations.

Please take time to review the chart below; we want you to make the right choice for you and your family. This

chart is a brief summary only. In the event of discrepancy, plan documents will prevail. Certain limitations and

exclusions apply. For exact terms and conditions, please refer to the summary plan description located within

catimes.mybenefitsapp.com.


Get to know your plan options at join.collectivehealth.com/catimes

MEDICAL

Collective Health – PPO

(Anthem Blue Cross Network)

Collective Health – HDHP

(Anthem Blue Cross Network)

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

Calendar Year Maximum

Out Of Pocket

(Individual/Family)

$3,000 / $6,000 $6,000 / $12,000 $6,750 / $13,500 $11,400 / $22,800

Calendar Year Deductible

(Individual/Family)$1,000 / $2,000 $3,000 / $6,000 $3,375 / $6,750 $6,750 / $13,500

Preventive Care No Charge* 40% coinsurance No Charge* 40% coinsurance

Primary Care

Specialist Visit

$25 copay*

$40 copay*

40% coinsurance

40% coinsurance

20% coinsurance

20% coinsurance

40% coinsurance

40% coinsurance

Urgent Care 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance

Diagnostic Lab & X-Rays

Complex Imaging (CT/Pet Scans, MRI’s)

20% coinsurance

20% coinsurance

40% coinsurance

40% coinsurance20% coinsurance 40% coinsurance

Chiropractic

(limit 30 visits/year)20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance

Acupuncture

(limit 12 visits/year)20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance

Emergency Room Care $150 copay/visit* $150 copay/visit* 20% coinsurance 20% coinsurance

Inpatient Hospital 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance

Outpatient Surgery 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance

Mental Health &

Substance Abuse

$25 copay office

visit*

40% coinsurance 20% coinsurance 40% coinsurance

*Deductible Waived

7

We partner with Collective Health for the

Medical PPO and HDHP plan to empower our

health benefits. They’re here to make using your

benefits easier and more transparent than ever.

Collective Health can help you monitor your

claims, find local doctors, and simply understand

how your benefits work.

Collective Health is here to

help!GIVE THEM A CALL OR EMAIL THEM(833) 440-4367 / [email protected] – Friday 4am to 6pm PST

Saturday 7am to 11am PST

FOR MORE INFORMATION

More information about these and other important tools to help you

manage your health are available

on the Collective Health website:

join.collectivehealth.com/catimes

Benefits info, handled• Easily review your

medical plan

• Get a detailed breakdown

of your benefits

• Find an in-network doctor

Pocket-sized ID cards• Your insurance card

and health benefit info fits

right into your pocket. Just

download the mobile app

Ditch the jargon• They’ve translated the

medical speak into

understandable

language so you can

choose and use your

health benefits with total

clarity

Answers to your questions!• Their help center can

help you navigate your

account, better

understand billing, and

decode complicated

insurance terms

8

Prescription Drug Coverage with RxBenefits

CA Times is pleased to announce effective January 1, 2021, your pharmacy benefits for the PPO and HDHP

plan will be administered by RxBenefits in partnership with Express Scripts. All members enrolled in the Collective

Health PPO or HDHP will receive a New member ID with the New Pharmacy Information. You must present the

new card beginning January 1, 2021 when filing a prescription. The RxBenefits service model delivers enhanced

safety, better cost savings, and top-notch customer service. You will continue to have access to a massive

network of more than 60,000 pharmacies nationwide.

Your prescription benefit coverage includes:

Member Services: Dedicated to meeting your prescription benefits needs, RxBenefits can be reached at (800) 334-8134 or [email protected] Monday through Friday from 7am to 8pm CT. After hours you may choose to transfer directly to Express Scripts.

Digital Tools: January 1, 2021 register at express-scripts.com and download the Express Scripts mobile app to manage your profile, request refills, locate pharmacies, and more!

Drug Exclusions: Review the Formulary Exclusions List at express-scripts.com and the Exclusions section in the Prescription Benefit Coverage document. Speak with your doctor about moving to a covered alternative if you are prescribed an excluded medication.

Prior Authorization: Certain medications require Prior Authorization (PA) before the prescription can be filled. The PA review process helps ensure FDA prescribing guidelines are met and that you receive the safest and most appropriate drug therapy.

Maintenance Medications: Treat ongoing conditions like diabetes, high blood pressure, and asthma. In addition to local retail pharmacy access, your benefit coverage allows medications to be filled by mail.

Pharmacy

RxBenefits – PPO

(Express Scripts Network)

RxBenefits - HDHP

(Express Scripts Network)

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

Retail Pharmacy

(30-Day Supply)

Generic Drugs$10 copay $10 copay 20% coinsurance Not Covered

Preferred Brand Drugs

(Min. $25, Max $50 copay)30% coinsurance 30% coinsurance 20% coinsurance Not Covered

Non-Preferred Brand Drugs

(Min. $40, Max $80 copay)45% coinsurance 45% coinsurance 20% coinsurance Not Covered

Specialty Drugs$125 copay Not Covered 50% coinsurance Not Covered

Mail Order Pharmacy

(90-Day Supply)

Generic Drugs$10 copay Not Covered 20% coinsurance Not Covered

Preferred Brand Drugs$100 copay Not Covered 20% coinsurance Not Covered

Non-Preferred Brand Drugs$160 copay Not Covered 20% coinsurance Not Covered

Specialty Drugs$125 copay Not Covered 50% coinsurance Not Covered

mailto:[email protected]


om10

Medical Plans with Kaiser

You have the option of two plans through Kaiser Permanente, Traditional HMO and Signature (Deductible)

HMO plans. Kaiser is an HMO plan with a closed network of providers. The HMO plan is designed for you to

choose a primary care physician from Kaiser’s network.

The Traditional HMO plan covers the cost of services only when authorized with simple copays and

coinsurance and no annual deductible applies. Through the Signature (Deductible) HMO plan, you

receive the quality care and service you expect from Kaiser Permanente. You will pay the full charges for

some services until you reach your deductible. After you reach your deductible you’ll start paying less – a

copay or a percentage of the charges (coinsurance) for the rest of the plan year.

Please take time to review the chart below; we want you to make the right choice for you and your

family. This chart is a brief summary only. In the event of discrepancy, plan documents will prevail. Certain

limitations and exclusions apply. For exact terms and conditions, please refer to the summary plan

description located within catimes.mybenefitsapp.com.


MEDICAL

Kaiser Permanente

Traditional HMO

Kaiser Permanente

Signature (Deductible) HMO

In-Network* In-Network

Calendar Year Maximum Out

Of Pocket (Individual/Family)$500 / $1,000 $3,000 / $6,000


(Individual/Family)None $1,000 / $2,000

Preventive Care No Charge No Charge

Primary Care

Specialist Visit

$15 copay

$25 copay

$25 copay*

$40 copay *

Urgent Care $15 copay $25 copay*

Diagnostic Lab & X-Rays

Complex Imaging (CT/Pet Scans, MRI’s)

No Charge

No Charge20% coinsurance

20% coinsurance

Chiropractic

(limit 30 visits/year)$15 copay $15 copay*

Acupuncture

(limit 30 visits/year)$15 copay $15 copay*

Emergency Room Services $50 copay $150 copay

Inpatient Hospital $125 copay 20% coinsurance

Outpatient Surgery $50 copay 20% coinsurance

Mental Health &

Substance Abuse$15 copay $25 copay*

Pharmacy

Generic Drugs

Retail (up to 30-day supply)

Mail Order (up to 100-day supply)

$5 copay

$10 copay

$10 copay*

$10 copay*

Brand Drugs

Retail (up to 30-day supply)

Mail Order (up to 100-day supply)

$10 copay

$20 copay

30% coinsurance (up to $50)*

30% coinsurance (up to $50)*

Specialty Drugs

Retail (up to 30-day supply) $10 copay $125 copay*

*Deductible Waived


om11


om12

2021 Plan Year - Virtual Medical Visits and Mental Health Benefits

Do you have an ear infection, pink eye, suffering from anxiety, depression or another health issue that needs to

be addressed? If you need non-emergency medical attention, virtual medical visits might be a solution. You

can have a doctor’s appointment from the comfort of your home.

24/7 Nurse

Nurseline gives you access to a registered nurse 24 hours a day, seven days a week. Use this free service to have your

non-emergency questions answered.

Collective Health PPO and HDHP Plan Members Call (800) 700-9186 to receive assistance with any health-related questions or concerns.

Kaiser HMO Plan Members Call (833) 574-2273 to receive assistance with any health-related questions or concerns.

Collective

Health PPO

Members

(In-Network)

Telemedicine Visits With Your Own Provider

• Primary Care Doctor - $25 copay

• Specialist - $40 copay

• Mental Health Visits - $25 copay

LiveHealth Online – livehealthonline.com

You have access 24/7 by web, phone or mobile

app to medical providers and licensed therapist

$10 copay

Collective Health

HDHP Members

(In-Network Only)Deductible Applies

Telemedicine Visits With Your Own Provider

• Primary Care Doctor - 20% after deductible

• Specialist - $20% after deductible• Mental Health Visits - 20% after deductible

LiveHealth Online – livehealthonline.com

You have access 24/7 by web, phone or mobile

app to medical providers and licensed therapist 20% after deductible

Kaiser HMO

MembersSee plan document

for coverage level

See physicians and providers for urgent health

concerns by video visit. Register at kp.org today

to schedule a video visit. You can use the

telemedicine service available through kp.org or

by calling (866) 454-8855.

See physicians and providers for urgent health

concerns by video visit. Register at kp.org today

to schedule a video visit. You can use the

telemedicine service available through kp.org

or by calling (866) 454-8855.

13

This plan allows you to select the dentist of your choice. Both you and Delta Dental have a shared responsibility of

paying the dentist for services rendered. If you choose a dentist who participates in the Delta Dental PPO network

claims will be filed on your behalf. Please note: If you select a dentist from the Delta Dental PPO Network, you will

pay less in out-of-pocket expenses.

Dental Plans with Delta Dental

Delta Dental Dental PPO – Standard Plan Dental PPO – Enhanced Plan

Plan Feature In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Maximum

Per Person $1,500 $1,500 $2,000 $2,000


Per Individual

Per Family

$50 copay

$150 copay$50 copay

$150 copay

Preventive Services

(Exams and cleanings, x-rays)You pay 0% You pay 0%

Basic Services You pay 20% after plan deductible You pay 20% after plan deductible

Major Services You pay 50% after plan deductible You pay 50% after plan deductible

Orthodontic Not Covered You pay 50%

Orthodontic Lifetime Max N/A $2,500 per person

Orthodontic Eligibility N/A Children Only (up to age 19)



om14

Vision Plan with EyeMed

EyeMed offers a large network of contracting providers, including optometrists and ophthalmologists. When a

contracting network provider is used, the care is considered “in-network” and the out-of-pocket costs will be

less, and the highest level of benefits is received. If a provider outside the network is used, the care is

considered “out-of-network” coverage is still provided, but the out-of-pocket costs will be significantly higher.


Plan Feature

EyeMed Vision Plan

Standard Plan Enhanced Plan

In-NetworkOut-of-Network

ReimbursementIn-Network

Out-of-Network

Reimbursement

Copay

• Examination (Every 12 Months)

• Materials

$10 copay

$25 copay

Up to $40

Up to $40-$60

$10 copay

$10 copay

Up to $40

Up to $40-$60

Frames Standard Plan (Every 24 Months)

Enhanced Plan (Every 12 Months)

$130 allowance

+ 20% off

balance

Up to $45

$175

allowance

+ 20% off

balance

Up to $45

Elective Contact Lenses

(Every 12 Months)

In-Lieu of Frames and Lenses

$130 allowance Up to $105 $175 allowance Up to $105


Life Plan – LegalZoom LifePlan

LegalZoomTM LifePlan is a different kind of support, based

around your life. When questions arise surrounding important

events—getting married, buying a home, having a baby—

reach out to LegalZoom LifePlan for advice and direction.

From planning for your future, to getting help with your taxes,

LifePlan is your go-to resource. This plan also includes Identity

Theft protection.

What You Get• Legal, Insurance, Financial

and Tax Advice Sessions

• Identity Theft Protection

(One-Bureau Credit

Monitoring, Full Service

Restoration, ID Theft

Insurance)

• Unlimited File Storage in Our

Digital Vault

• Attorney Consulted Legal

Library• Document Review

• 10% Off Over 40

Comprehensive Products &

Services

Ease of Use

• Advice sessions can be

scheduled through the

mobile app, website, or

with a call to a Membership

Advisor

• Members are able to see

real time attorney

availability, ratings, reviews,

and online bios

• Estate planning documents

can be completed through an easy to use online

platform

• Membership Advisors are

there for you M-F

5am - 5pm PST

16

Flexible Spending Accounts (FSAs) and Health Savings Account (HSA)

You are offered Flexible Spending Accounts (FSAs) through Discovery Benefits a Health Savings Account (HSA-

only available for HDHP members) through Health Equity, and a Commuter Benefit through WageWorks, these

plans allow you to contribute on a pre-tax basis to pay for qualified expenses. Please review the below for a

comparison of the different types of tax-advantages of these accounts.

Please refer to catimes.mybenefitsapp.com for a more detailed HSA and FSA Information Guide, qualified expenses list and claim forms.

Ful l Purpose

Health Care

FSA

You can contribute up to $2,750* each year

(minimum of $100*) to pay for eligible medical,

dental, and vision expenses incurred by you and your

family during the plan year.

As of this year you can carryover up to $550* of

unused healthcare FSA funds at the end of the plan

year to use for the following plan year. This will not

count against your 2021 IRS maximum contribution.

The funds you elect are available to you from the

start of the plan year.

Current 2020 health care FSA plan year members

have until 12/31/2020 to incur claims, any amounts

below $100 or over $550 leftover beginning 1/1/2021

will be forfeited. Claims for reimbursement must be

submitted by 3/31/2021 for qualified expenses

incurred prior to 12/31/2020.

Limited Purpose

Health Care FSA

When enrolled in the High Deductible Health Plan

(HDHP) and a Health Savings Account (HSA) you may

also elect a Limited Purpose FSA (LPFSA) concurrently,

allowing you to receive reimbursement for eligible

dental and vision expenses only.

If enrolled in the HDHP, but not an HSA, you may enroll

in the Full Purpose Healthcare FSA with access to all

eligible medical, dental, and vision reimbursements.

Same limits as above apply for LPFSA.*

The funds you elect are available to you from the

start of the plan year.

Current 2020 plan year members have until

12/31/2020 to incur claims, any amounts below $100

or over $550 leftover beginning 1/1/2021 will be

forfeited. Claims for reimbursement must be

submitted by 3/31/2021 for qualified expenses

incurred prior to 12/31/2020.

Dependent

Care FSA

You can contribute up to $5,000 each year on a pre-

tax basis to pay for day care expenses for your

eligible dependents. This limit will be reduced to

$2,500 if you are married and filing separate tax

returns. For spouses who both contribute to DFSA, the

max amount that can be contributed between both

accounts is $5,000.

The funds available in your account will be the

amount deducted from your paycheck at that point

in time, the full amount is not available from the start

of the plan year.

Qualified dependent care expenses must all be

incurred by 12/31 each year. Any remaining balances

will be forfeited. You will have until 3/31/2021 to

submit your claims for reimbursement for qualified

dependent care expenses incurred prior to

12/31/2020. There is no carryover of unused

Dependent Care FSA funds.

Health Savings

Account

(only available to

HDHP members)

If you enroll into the HDHP health plan you can

contribute up to $3,600 for a single and $7,200 for a

family* each year to pay for eligible qualified health

care expenses incurred by you and your family. If you

are age 55 and over you have an additional catch-

up contribution of up to $1,000 per year (until you

enroll in Medicare)

The funds available will be the amount deducted

from your paycheck at that point in time, the full

amount is not available from the start of the plan

year.

HSA funds are yours for life, you maintain ownership of

the account even after you leave the company or

retire.

Commuter

Benefit

A WageWorks Commuter program is a pre-tax benefit

that can save you on parking and public transit-that

includes train, subway, busy and eligible vanpool as

part of your daily commute to work.

You can contribute up to $270 pre-tax for public

transit per month and CA Times subsidizes up to $70

monthly. You can also contribute up to $270 pre-tax

for parking as part of your daily commute to work.


17

Flexible Spending Accounts (FSAs) and Health Savings Account (HSA)

Downloaded the free Benefits Mobile App by Discovery

Benefits yet?

If you have the Health Care FSA or Dependent Care FSA,

the Benefits Mobile App lets you:

•Easily log in with Touch ID

•Check your balance anytime, anywhere

•Take a photo of documentation to submit a claim

•Track expenses

•Get claim alerts

•And more!

Download the app today by searching for "Discovery

Benefits" in the Apple or Android app store and manage

your benefits information directly from your mobile device.

If you enrolled in the Collective Health HDHP and chose to fund an HSA

through Health Equity, download the free Benefits Mobile App.


om18

Life and Accidental Death & Dismemberment (AD&D)


Basic Life/AD&D - Company Paid

CA Times provides you with Basic Term Life and AD&D insurance coverage in the amount of 1 times

your base annual earnings to a maximum of $1,000,000.

Voluntary Life - Employee Paid

You may elect 1 to 8 times your basic annual earnings of Voluntary Life insurance for yourself, to a

maximum of $2,000,000. The guarantee issue is the lesser of 3 times your annual salary up to

$650,000.

For your spouse/ registered domestic partner you may elect Voluntary Life options of $10,000,

$25,000, $50,000, $100,000, $150,000 or $250,000, up to 100% of your coverage amount. The

guarantee issue is up to $25,000.

For your dependent child(ren) you may elect $5,000, $10,000 or $25,000. The guarantee issue is up

to $25,000.

Guarantee Issue amount is only available for new hires. Any new enrollments or increases to life

insurance will require an Evidence of Insurability(EOI).

Voluntary AD&D Plan – MetLife

Voluntary AD&D - Employee Paid

You may elect $25,000 to $2,000,000 of AD&D coverage in increments of $25,000. The maximum

amount of coverage you can receive is the lesser of 10 times your basic annual earnings or $2,000,000.

For spouse/registered domestic partner coverage only, you may elect 50% of your coverage amount,

not to exceed $1,000,000.

For child(ren) only, you may elect up to 15% of your coverage amount, not to exceed $300,000.

For your spouse/registered domestic partner and child(ren) coverage together, you may elect an

amount equal to 40% for your spouse/registered domestic partner only, and 10% for each child, of your

Voluntary AD&D coverage.


om19

Critical Illness, Accident and Hospital


Critical IllnessThe Critical Illness Insurance through MetLife will help pay

you a percentage of the maximum coverage you choose.

Diagnosed illnesses like heart attack, stroke, Alzheimer’s

disease and cancer are among those covered. Rates will

vary, as they are based on age, smoker status and family

size. Critical Illness insurance will compliment your medical

and disability income coverage, which can ease the

financial impact of certain critical illnesses.

AccidentWith MetLife Accident Insurance, you have a choice of two

comprehensive plans a Low Plan and High Plan,

which pays money based on the injury or treatment

you and/or your eligible dependents receive, whether it’s a

simple sprain or something more serious, like an injury from

a car accident. The Low and High Plans may pay you

and/or your dependents a benefit for an emergency room

treatment, stitches, crutches, injury-related surgery and

certain other accident-related expenses.

HospitalYou are offered two Voluntary Hospital Indemnity Insurance

Plans through MetLife for you and your eligible family

members. It can complement your medical coverage by

helping to ease the financial impact of a hospitalization. A

flat amount may be paid for hospital admission and a per

day amount may be paid for each day of a covered

hospital stay, from the very first day of your stay.

Supplemental

coverage:

You can elect

to purchase

these additional

benefits as a

new hire, or

during your

annual benefits

enrollment

period

What it is What it could provide

Additional Benefits – Please refer to catimes.mybenefitsapp.com for more details on each benefit listed.

20

Supplemental

coverage:

You can elect

to purchase

these additional

benefits as a

new hire, or

during your

annual benefits

enrollment

period

Core Coverage: The company

provides these

additional

insurance benefits

automatically at no

cost to you.

Lincoln

Financial Short-Term

Disability

Pays a percentage of your income for

up to 26 weeks due to injury, illness,

surgery or recovery from childbirth.

60% of weekly salary up to a weekly maximum of $2,308.

ComPsych

Employee

Assistance

Program

Assistance program that offers unlimited

free and confidential counseling

services to employees and their families

for personal and/or work-related

problems.

Support for navigating life issues

like stress, anxiety, depression,

financial, grief and so much more.

Call (855) 327-4463 or visit

guidanceresource.com

Web ID= Lincoln

Chubb

Business

Travel

Accident

All employees, volunteers and students

have access to the company’s

International Advantage® Executive

Assistance® Services through Chubb.

This plan offers trip planning, travel

assistance, emergency response

services, travel alerts, security

services and so much more.

To register visit:

www.chubbtravelapp.com

Policy #PHFD42232646 002

BenefitHub

Provides you with a wide variety of

consumer products and services at a

discounted rate.

Discounts on sporting events,

shopping, theme parks, movies,

travel and more.

Visit: catimes.benefitshub.com

Supplemental

Coverage:

You can elect to

purchase these

additional benefits as a

new hire, or during your

annual benefits

enrollment period.

Lincoln

Financial

Long-Term

Disability

Pays a percentage of your monthly

income up to age 65 or SSNRA for

illness or accident in which you are

unable to work for an extended period

of time.

60% of monthly up to a maximum

of $15,000.

MetLife

Legal Plan

Benefit provides support surrounding

legal matters.

Plan offers you convenient,

professional legal counsel,

which entitles you to receive legal

advice and representation

for covered personal legal

services.

LifeLock

Identity Theft

ProtectionThis plan monitors your identity.

When activity occurs involving

your information, you’re alerted

by email, text, or a phone call.

You can respond to confirm

whether the activity is

legitimate, and if it’s not, a U.S.

based LifeLock Identity

Restoration Specialist will help

you resolve the issue.

MetLife

Auto & Home

Home and auto insurance generous

discounts.

Policies for auto, home, renters

insurance, motorhome and

includes things like towing,

windshield repair and more.

Nationwide

Pet Insurance

Nationwide® provides coverage for

veterinary expenses related to

accidents and illnesses.

Policies are available for dogs,

cats, birds, reptiles and other exotic

pets.

http://www.chubbtravelapp.com/


om21

Employee Contributions for 2021 Plan Year

CA Times is proud to provide you with competitive benefits and the ability to choose the coverage that meets your

needs. Your cost for coverage will vary depending on the option and level of coverage you choose. The contributions

below are based on 26 pay periods. These are the amounts that will be deducted per paycheck for the plan year of

1/1/2021 – 12/31/2021.

If you are a commissioned employee, please note your medical premiums will adjust according to your Annual

Benefits Base Rate (“ABBR”). This is defined as your base salary + commissions earned in 2020 Fiscal Year (12/30/2019 –

12/27/2020). Medical premiums are based on salary bands, above $100,000 and below $100,000. Please note

deductions will adjust no later than the first paycheck in February 2021.

Medical Employees Making Less Than $100,000

Collective Health | PPO Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Bi-Weekly (26-Pay Periods) $70.00 $207.00 $183.00 $315.00

Collective Health | HDHP Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Kaiser Traditional | HMO (CA Only) Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Kaiser Signature | HMO (CA Only) Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Kaiser Signature | HMO (Mid-Atlantic Only) Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Medical Employees Making More Than $100,000

Collective Health | PPO Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Collective Health | HDHP Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Kaiser Traditional | HMO (CA Only) Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Kaiser Signature | HMO (CA Only) Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Kaiser Signature | HMO (Mid-Atlantic Only) Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Dental

Delta Dental | Standard PPO Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Delta Dental | Enhanced PPO Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


Vision

EyeMed | Standard Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family


EyeMed | Enhanced Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family



om22

Employee Contributions for 2021 Plan YearCA Times is proud to provide you with competitive benefits and the ability to choose the coverage that meets your needs. Your

cost for coverage will vary depending on the option and level of coverage you choose. The contributions below are illustrated

on a monthly basis, deductions are calculated and deducted on a bi-weekly basis.

If you are a commissioned employee, please note your Life Insurance Premiums and Long Term Disability Premiums will adjust

according to your Annual Benefits Base Rate (“ABBR”). This is defined as your base salary + commissions earned in 2020 Fiscal

Year (12/30/2019 – 12/27/2020). Please note deductions will adjust no later than the first paycheck in February 2021.

Disability

Lincoln Financial

Short Term DisabilitySTD

Monthly Rate Per $10 of Weekly

Covered Payroll$0.082

Voluntary Life/AD&D - Monthly Rates Per $1,000 of Coverage

MetLife | Voluntary Life Employee RateSpouse Rate

(based on their age)

Monthly Rate per $1,000 of Coverage

Age < 24 $0.036 $0.042

Age 25 - 29 $0.036 $0.042

Age 30 - 34 $0.040 $0.049

Age 35 - 39 $0.052 $0.067

Age 40 - 44 $0.072 $0.090

Age 45 - 49 $0.109 $0.132

Age 50 - 54 $0.176 $0.209

Age 55 - 59 $0.272 $0.378

Age 60 - 64 $0.474 $0.711

Age 65 - 69 $0.797 $1.216

Age 70+ $1.355 $2.265

Age 75+ $1.355 $2.265

Child(ren) Monthly Rate Per $1,000 of Coverage $0.153

MetLife | Voluntary AD&D Employee Rate Employee + Family

Monthly Rate per $1,000 of Coverage $0.021 $0.028

LegalZoom - Life Plan - Legal and Identity Theft Protection

LegalZoom | Life Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates $13.90 $13.90 $13.90 $13.90

Lincoln Financial

Long Term DisabilityLTD

Monthly Rate Per $100 of

Covered Payroll

Age


om23

Employee Contributions for 2021 Plan Year

CA Times is proud to provide you with competitive benefits and the ability to choose the coverage that meets your needs. Your

cost for coverage will vary depending on the option and level of coverage you choose. The contributions below are illustrated

on a monthly basis, deductions are calculated and deducted on a bi-weekly basis.

Voluntary Critical Illness Plans

MetLife | Voluntary Critical Illness Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rate Per $100

Age < 24 $0.34 $0.59 $0.55 $0.80

Age 25 – 29 $0.35 $0.59 $0.56 $0.80

Age 30 – 34 $0.49 $0.79 $0.70 $1.00

Age 35 - 39 $0.68 $1.06 $0.89 $1.27

Age 40 - 44 $0.98 $1.50 $1.19 $1.71

Age 45 - 49 $1.42 $2.14 $1.63 $2.35

Age 50 - 54 $2.08 $3.09 $2.29 $3.30

Age 55 - 59 $2.85 $4.20 $3.06 $4.41

Age 60 - 64 $3.89 $5.69 $4.10 $5.90

Age 65 - 69 $5.59 $8.14 $5.80 $8.35

Age 70+ $8.39 $12.26 $8.60 $12.47

Voluntary Accident Plans

MetLife | Accident Plan | Low Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates$7.90 $12.15 $14.30 $18.88

MetLife | Accident Plan | High Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates$15.04 $23.31 $27.16 $35.53

Hospital Indemnity Plans

MetLife | Hospital Plan | High Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates $9.45 $15.62 $15.62 $22.50

MetLife | Hospital Plan | Low Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates$11.93 $19.52 $19.52 $28.40

LifeLock - Identify Theft Protection

LifeLock | Identity Theft | Benefit Elite Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates $7.99 $15.98 $13.99 $21.98

LifeLock | Identity Theft | Advantage Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates$15.99 $31.98 $23.99 $39.98

MetLife Legal Plan

MetLife | Legal Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Monthly Rates $16.50 $16.50 $16.50 $16.50

Nationwide - Pet Insurance

Nationwide | Pet Insurance

Monthly rates vary by state and type of animal. Must call Nationwide directly for a quote, not payroll deducted.

DISCLAIMER

This 2021 Benefit Guide provides an overview of some of your benefit plan choices. It

is for informational purposes only. It is not intended to be an agreement for continued

employment. Neither is it a legal plan document. This highlights the key features of the

plan. It is intended to be only a summary of the benefits available to you and does

not include all plan rules and details; this is not to be considered a certificate of

coverage. Please refer to your plan documents for complete information and more

detailed explanations as to coverage. If there is a disagreement between this guide and the plan documents, the plan documents will govern.

Walk the Dog

Wash Hands

Get Flu Shot

Select 2021 Benefits

Login to Empyrean to Enroll or Make Changes

Starting 10/26 – 11/6


or Call CA Times Benefits Service Center at (833) 269-2137

8am to 5pm PST, Monday to Friday

24

employee benefits guide · prescription drug coverage with rxbenefits ca times is pleased to...

Documents