1. DACHSER USA/Americas
2019 Benefits

2. Short Term Disability - LFG
60% of weekly earnings up to $300 weekly based upon employee status
Begins after the 8th day of illness/accident (non work related)
Benefit period is 13 weeks
Premiums paid by DACHSER

3. Long Term Disability - LFG
60% of earnings up to $6,000 of monthly salary
Begins at the cessation of the Short Term Disability
90 day waiting period
Benefits payable to age 65
Three month survivor benefit
Partial disability covered
Residual disability covered
Premiums paid by DACHSER

4. Group Term Life Insurance - LFG
One time annual earnings up to $200,000
Accidental death benefits of one time annual earnings up to $200,000
Premiums paid by DACHSER

5. Employee Voluntary Life Insurance - LFG
Benefit amounts available from $10,000 to $100,000
Spouse and dependent children benefits available
Coverage is portable after 12 months
Premiums paid by employee

6. Cost of Insurance – Meritain/Aetna
POS Plan
Annual Gross Income
Employee
Employee + Child(ren)
Employee + Spouse
Family
$40,000 - Under
$190.00
$230.00
$240.00
$260.00
$40,001 - $60,000
$195.00
$250.00
$280.00
$60,001 - Above
$215.00
$270.00
$300.00
Deductions are per pay period and include medical, dental & vision insurance.

7. Medical Benefits – Meritain/Aetna
POS Plan
In-Network Providers
Out-of-Network Providers
Calendar Year Deductible
Individual
$600.00
$2,400.00
Family (Up to 3 members)
$1,800.00
$7,200.00
Out of Pocket Maximum (includes Deductible)
$9,600.00
Family (Up to 3 members, All copays, coinsurance and benefit deductibles contribute towards your out-of-pocket maximum)
$28,800.00

8. Medical Benefits – Meritain/Aetna
POS Plan
In-Network Providers
Out-Of-Network Providers
Physician Office Visits
All Physician Office Visits
Primary Care Physician
$15 Co-Pay then 90%
Subject to deductible and
then 60%
Specialist
$30 Co-Pay then 90%
Urgent Care
$50 Co-Pay then 90%
Preventive/Routine Services
100% Covered
then 70%
Emergency Room visit
$ Co-Pay

9. Medical Benefits – Meritain/Aetna
POS Plan
In-Network Providers
Out-Of-Network Providers
Inpatient Mental/Chemical Dependency
90% after the deductible
60% after deductible
Hospice and Home Care
90% after the deductible.
Chiropractic, Occupational, Physical, and Speech therapy (limit 20 visits annually)
$15 Co-Pay Primary Physician
$30 Co-Pay Specialist

10. Medical Benefits – Meritain/Aetna
POS Plan
Retail
Mail Order (3 Months)
Prescription Drugs
Generic
$15 Co-Pay
$ 30 Co-Pay
Brand Name
$40 Co-Pay
$ 80 Co-Pay
Non-Preferred
$60 Co-Pay
$120 Co-Pay
No Annual Maximum Yearly or Lifetime

11. Cost of Insurance – Meritain/Aetna
Health Reimbursement Account
Annual Gross Income
Employee
Employee + Child(ren)
Employee + Spouse
Family
$40,000 - Under
$99.00
$180.00
$190.00
$210.00
$40,001 - $60,000
$145.00
$200.00
$230.00
$60,001 - Above
$165.00
$220.00
$250.00
Deductions are per pay period and include medical, dental & vision insurance.

12. Medical Benefits – Meritain/Aetna
Health Reimbursement Account: DACHSER will fund the first $1,000 (individual) and the first $2,000 (family) of the calendar year deductible. If not used during the year, the amount will carry over.
In-Network Providers
Out-of-Network Providers
Calendar Year Deductible
Individual
$2,000.00
$8,000.00
Family (Up to 3 members)
$4,000.00
$16,000.00
Out of Pocket Maximum (Includes deductible, copays and coinsurance)
Out of Pocket Maximum (includes Deductible)
Family
(One individual is $6,850 and second individual is $1,150 totaling $8,000 for your total out of pocket max or all individuals can collectively reach $8,000.)
$30,000.00

13. Medical Benefits – Meritain/Aetna
Health Reimbursement Account
In-Network Providers
Out-Of-Network Providers
All Physician Office Visits
90% After Deductible
60% After Deductible
Routine/Preventive Care
100% Covered
70% After Deductible
Emergency Room visit

14. Medical Benefits – Meritain/Aetna
Health Reimbursement Account
In-Network Providers
Out-Of-Network Providers
Inpatient Mental/Chemical Dependency
90% after Deductible
60% after deductible
Hospice and Home Care
90% after Deductible.
Chiropractic, Occupational, Physical, and Speech therapy (limit 20 visits annually)

15. Medical Benefits – Meritain/Aetna
Health Reimbursement Account
In-Network Providers
Out-Of-Network Providers
(MRI, MRA, CAT Scan, PET Scan, etc.) at Physician office
90% after Deductible
60% after Deductible
(MRI, MRA, CAT Scan, PET Scan, etc.) Inpatient/Outpatient at hospital
In-Patient Hospitalization

16. Medical Benefits – Meritain/Aetna
Health Reimbursement Account
Retail
Mail Order (3 Months)
Prescription Drugs
Generic
$15 Co-Pay
$30 Co-Pay
Brand Name
$40 Co-Pay
$80 Co-Pay
Non-Preferred
$60 Co-Pay
$120 Co-Pay
No Annual Maximum Yearly or Lifetime

17. Dental Benefits – Meritain/Aetna
POS Plan & Health Reimbursement Account Dental Benefits
Preventive Services
100% Deductible Waived
Calendar Year Deductible
Individual
$50.00
Family
$150.00

18. Dental Benefits – Meritain/Aetna
POS Plan & Health Reimbursement Account Dental Benefits
Basic Services
80%
Major Services
50%
Calendar Year Maximum
$1,500.00
Orthodontia coverage
50% After Deductible (Up to age 19)
Maximum coverage
$1,000.00

19. Vision Care – EyeMed
POS Plan & Health Reimbursement Account Vision Benefits
Routine Eye Exams (1 per calendar year)
$10 Co-pay
Eyeglass Lenses (1 per calendar year)
100% after $20 Co-pay
Frames (1 every 24 months)
100%, up to $120, 20% off balance over $120
Contacts (1 per calendar year)
Conventional
100%, up to $110, 15% off balance over $110
Disposable
100%, up to $110
Medically Necessary
100%
**Please see Vision Benefits Summary for more detailed information.

20. Vision Care - EyeMed
POS Plan & Health Reimbursement Account Vision Benefits
In-Network Providers
Out-Of-Network Providers
Routine Eye Exams (1 per calendar year)
$10 Co-pay
(MRI, MRA, CAT Scan, PET Scan, etc.) at Physician office
60% after Deductible
Eyeglass Lenses (1 per calendar year)
100% after $20 Co-pay
(MRI, MRA, CAT Scan, PET Scan, etc.) Inpatient/Outpatient at hospital
Frames (1 every 24 months)
100%, up to $120, 20% off balance over $120
In-Patient Hospitalization
Contacts (1 per calendar year)

21. Flexible Spending – Meritain/Aetna
The Flexible Benefit Plan is an employer-sponsored plan that allows you to pay for certain premiums, eligible medical expenses and dependent care expenses on a pre-tax basis. Paying for these expenses with pre-tax dollars saves you money by lowering your taxable income.
Health Care Reimbursement FSA: $2,650 maximum per calendar year. Dependent Care FSA: $5,000 per calendar year maximum, or $2,500 if you are married and filing separate tax returns.
You should only set aside amounts that you expect to incur during the plan year, January 1st – December 31st, Amounts can include expenses for yourself, your spouse or your dependents as long as you claim them as a dependent.
Any amounts left in your account at the end of the plan year will be forfeited; essentially use-it-or-lose-it. Therefore, please plan carefully when making your election. It cannot be changed during the plan year unless you have a qualified status change.