2024-BenefitsGuide-V14-Final

Dental Benefits

Flexible Spending Accounts

Reliance Rewards offers a PPO dental plan administered by Delta Dental of California. It covers preventive, basic, and major dental services on an in-network and out-of-network basis. You may use any dental provider you choose, but you will save the most when you use a dentist who participates in the Delta Dental PPO network. To view dentists in the Delta Dental PPO and Premier networks, go to www.deltadentalins.com/reliancerewards.

A Flexible Spending Account (FSA) is an individual account that allows you to set aside part of your pre-tax earnings each pay period. This plan is administered by Anthem Blue Cross. You can use the Healthcare FSA funds to pay for qualified healthcare expenses for you (and your eligible dependents) that are not covered under your medical, dental, or vision plans. Dependent Day Care FSA funds can be used to pay for child and dependent care expenses that qualify as a credit or deduction on your tax return.

IN-NETWORK

OUT-OF-NETWORK

Neither you nor your dependents have to be enrolled in a Reliance Rewards medical plan for eligible expenses to be reimbursable under the FSA.

Delta Dental PPO Lower deductible and coinsurance, lowest negotiated rates, no claim forms

Delta Dental Premier Higher deductible and coinsurance, negotiated rates

Non-Delta Dental Higher deductible and coinsurance

LIMITED PURPOSE (for Saver Plan Enrollees)

HEALTHCARE

DEPENDENT DAY CARE

Annual Deductible Individual Family

$50 $100

$100 $200

$100 $200

Youmay contribute from$130 to $5,000 per year per household. Eligible day care expenses for dependents under age 13, or for your spouse, your parents, or your parent(s) in-law who are mentally or physically incapable of caring for themselves and declared as a dependent on your federal income tax return. Qualified dependent day care expenses include day care or elder care and are the same as those you are allowed to take as a credit or deduction on your federal income tax return. To qualify for reimbursement, these expenses must be necessary to allow you and your spouse (if applicable) to work outside the home.

Annual Contribution Limits

You may contribute from $130 to $3,050 per year. You may be reimbursed for certain healthcare expenses, provided they are not reimbursed by any health plan, and qualify as a medical deduction on your federal

You may contribute from $130 to $3,050 per year. If you enroll in the Saver Plan, you can enroll into a “Limited Purpose” Healthcare FSA. As noted, you may be reimbursed for certain healthcare expenses that are not covered by your HSA, provided they are not reimbursed by any health plan, and qualify as a medical deduction on your federal income tax return. Examples include: • Dental/Vision plan copays, deductibles, and coinsurances • Acupuncture • Contact lens solution • Hearing aids and exams

Annual Benefit Maximum – per Individual

$1,500

$1,500

$1,500

Diagnostic & Preventive Services Exams, x-rays, cleanings, fluoride treatments Basic Services Fillings, extractions, sealants, root canals, gum treatment, and oral surgery Major Services Crowns, inlays, onlays, implants, cast restorations, bridges, dentures

No Cost to You, However May be Subject to Balance Billing

No Cost to You

No Cost to You

You Pay 30% after Deductible

You Pay 30% after Deductible

You Pay 10%

income tax return. Examples include: • Medical and dental plan deductibles • Copays and coinsurance • Prescription drug copays • Acupuncture • Contact lens solution • Hearing aids and exams

You Pay 40% after Deductible

You Pay 50% after Deductible

You Pay 50% after Deductible

Eligible Expenses

Member Responsible for Balance Billing? Orthodontic Services for Children under 26

NO

YES

• Expenses not covered/partially covered by the medical, dental, and vision plans

$750 LifetimeMaximum

Vision Benefits

Reimbursements can be made by: • Use your Anthem Blue Cross FSA Debit Card or • Submit a paper or online claim to Anthem Blue Cross FSA

Vision benefits offered under Reliance Rewards are provided by VSP. The vision plan helps cover the cost of annual eye exams and prescription glasses or contact lenses. Youmay use any eye care provider you choose, but you will save themost when you use a VSP Preferred Provider. VSP also has special offers, including discounts on hearing aids. Visit www.VSP.com for details.

Getting Reimbursed

2024 Healthcare FSA and Dependent Day Care FSA dollars can be used to reimburse expenses incurred beginning January 1, 2024, through March 15, 2025

Eligible Expenses

IN-NETWORK

OUT-OF-NETWORK

Eye Exam Once every calendar year

$10 Copay

Up to $45 allowance after $10 Copay

You have through March 30, 2025, to submit claims for reimbursement against the 2024 plan year FSA dollars. Anthem Blue Cross FSA may request verification of expenses before they process your claim. Keep your receipts!

Claim Deadline

Prescription Glasses

$25 Copay*

$25 Copay*

Covered up to $175 allowance after Copay; 20% off the amount over the allowance

Frames Every other calendar year

Up to $70 allowance after Copay

IMPORTANT RULES FOR FLEXIBLE SPENDING ACCOUNTS • As required by the IRS, any money in your FSA accounts that is not used for expenses incurred from January 1, 2024, through March 15, 2025, will be forfeited. This is called the “use it or lose it” rule. • Your payroll contributions will stay the same for the entire plan year. You cannot change your contribution level during the plan year unless you have a Qualifying Life Event – for example, marriage, the birth of a child, or a change in employment. • You cannot use money in your Healthcare FSA to pay for Dependent Day Care expenses or vice versa.

Single Vision – Up to $45 allowance after Copay Lined Bifocal Vision – Up to $65 allowance after Copay Lined Trifocal Vision – Up to $85 allowance after Copay Covered up to $150 allowance; allowance applies to contact lenses and contact lens exam, fitting, and evaluation

Lenses Once every calendar year

$25 Copay*

Contact Lenses Once every calendar year (Instead of lenses and frames)

Covered up to $175 allowance. Allowance applies to contact lenses and contact lens exam, fitting, and evaluation

*Only one $25 copy applies when receiving frames and lenses

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