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Employee Benefits HIGHLIHGTS

YOUR BENEFITS | PLAN EFFECTIVE DATE: August 1, 2011July 31, 2012

Your benefits package is an important part of your total compensation and we are proud to provide a comprehensive benefits package to fit the needs of you and your family members. This brochure explains some of the great benefits that are available to you as a new team member. You can opt out of medical coverage as long as you can provide proof of other medical coverage. Opt out benefits pay $75 / month

The choices that you make now remain in effect until our next annual Enrollment, unless you experience a Change in Status Examples of Status Changes are:

Marriage, divorce, or legal separation Birth or adoption of a child Death of a spouse or dependent

Spouse becomes employed or unemployed Physically move outside the coverage area Receipt of a Qualified Medical Child Support Order (QMCSO) that requires you to cover a child under your medical plan

When you need to make a change due to a Status Change, please contact Human Resources within 30 days of the event. If you do not make your changes within 30 days, you will have to wait until the next Open Enrollment to make changes.

Remember to complete your online enrollment within 30 days of your hire date!
Failure to enroll within the given time frame will result in an automatic enrollment in the Kaiser HMO plan and declination of dental and vision coverage. How do I log into Ceridian Self-Service?
1. 2. To access Ceridian Self-Service, log on to: You will be prompted to enter your User Name and Password on the login page: User Name: Full first name dot full last namesimilar to your Green Dot e-mail address (e.g. jane.doe) Password: Your Social Security Numberno dashes (e.g. 123456789) If you have any login problems, please send an email to

Medical Plan Benefits

100% Employer Paid!

Benefits and Services Annual deductible: Individual/Family Out-of-Pocket Max: Individual / Family Lifetime benefit maximum Office visits Preventive Care In-patient hospitalization Out-patient surgery Emergency room services *waived if admitted Chiropractic Care

Kaiser HMO
None $1,500 / $3,000 Unlimited $10 copay No Charge Covered 100% $10 per procedure $50 copay* Not Covered

Health Net EOA

None $1,500 / $4,500 Unlimited $10 copay ($30 copay if selfreferred to a PPO provider) No Charge Covered 100% Covered 100% $50 copay* $10 copay D R U G S

Health Net PPO In-Network Out-of-Network

$250 / $750 $2,000 / $6,000 $6,000 / $18,000 Unlimited 10% $20 copay 10% 10% 10% after $100 deductible* $10 copay 30% Not Covered 30% after $500 deductible 30% after $500 deductible 30% after $100 deductible* 30% to a max of $25


Generic Brand Formulary Brand Non-formulary Mail Order

$10 copay $20 copay Not covered 3 copays for 100-day supply

$10 copay $20 copay $35 copay 2 copays for 90-day supply

$10 copay $20 copay $35 copay 2 copays for 90-day supply

VSP Vision Plan Benefits

Benefits & Services
Copayment Lenses (every 12 months) Single Vision Bifocal Trifocal Lenticular Frames (every 12 months) Contact Lenses* Medically Necessary (every 12 months) Contact Lenses* Elective (every 12 months) *contact lenses are in lieu of frames and lenses

100% Employer Paid!


$10 Exam Copay / $25 Materials Copay

Covered after copay Covered after copay Covered after copay Covered after copay Up to $120 allowance (retail) Covered after copay Up to $120 allowance

Reimbursement up to $45 Reimbursement up to $65 Reimbursement up to $85 Reimbursement up to $125 Reimbursement up to $47 Reimbursement up to $210 Reimbursement up to $105

Delta Dental Plan Benefits

Good dental care is important for your overall good health. Regular check-ups and teeth cleanings help you stop small problems before they become expensive procedures.
100% Employer Paid!

Benefits & Services

Annual Maximum Benefit: Annual Deductible: Waived for Preventative Services? Annual Deductible: Individual / Family Diagnostic & Preventive Services: (Routine oral exams, X-rays, cleanings every 6 months) Basic Services (oral surgery, restorative dentistry) Major Services (crowns, prosthetics, inlays, onlays, posts, & crowns) Orthodontic Services:

Delta Dental PPO In-Network

$1,500 Yes $25 / $75 $50 / $150

DeltaCare PMI
Unlimited N/A None No copay Various copays (see schedule) Various copays (see schedule) $1,700 child / $1,900 adult


No cost, deductible waived 20% 50% 40% / $2,500 lifetime maximum

So, what are my costs to Participate? (Your costs per pay period)
Kaiser HMO* Employee Only Employee + 1 Dependent Employee + Family $0 $0 $0 Health Net EOA $14.95 $32.16 $44.13 Health Net PPO $183.53 $394.59 $541.42 Vision* $0 $0 $0 Dental PMI* $0 $0 $0 Dental PPO $22.88 $40.89 $75.47

* Green Dot Pays 100% of premium

Protect your own personal finances and standard of living in the event of a covered illness or injury with the best supplemental plans available. All plans pay CASH benefits directly to the employee. Enrollment options for you and your family include: Short Term Disability Supplement Personal Accident Indemnity + Wellness Benefits Hospital Indemnity Plan + Wellness Benefits Personal Cancer Plan + Wellness Benefits + Annual Building Benefit Specified Health Event (Critical Illness / Injury and Intensive Care) + Wellness Benefits + Annual Building Benefit

Contact Dawn Christensen at (661) 904-6542 or email:

Employee Assistance Program

100% Employer Paid!

The Employee Assistance Program (EAP) is a free, confidential service provided by Empathia, Inc., to all Green Dot employees and their dependents. It offers confidential assessment and referral services for any stress-related issue, including marriage, family, mental health, substance abuse, or workrelated problems. EAP counselors are available 24 hours a day, 7 days a week. To schedule an appointment, employees and eligible family members may call 1-800-3677474. We encourage you to use this company benefit when needed.

Company Paid Life / AD&D Insurance

100% Employer Paid!

Green Dot provides you with Life and Accidental Death & Dismemberment (AD&D) coverage equal to 1 times your annual earnings, up to a maximum of $200,000 at no cost to you.

Optional Term Life / AD&D Insurance

You have the option to purchase optional term life insurance for you and your family. You can obtain up to $150,000 without any medical questions, or up to $500,000 with a statement of health (subject to approval). For further information, please contact Human Resources.

Remember to Designate a Beneficiary!

Short Term and Long Term Disability Insurance
100% Employer Paid!

Disability coverage is also provided by Green Dot for every eligible employee. This important benefit provides valuable income protection if you are unable to work due to sickness or injury. Disability insurance covers up to 60% of your salary to a maximum of $1,500 per week for short-term coverage, and $10,000 a month for long-term coverage on a tax-free basis. For further information, please contact Human Resources.

Flexible Spending Accounts

A flexible spending account (FSA) lets you save on everyday health and dependent care expenses using pre-tax dollars. The Medical Care Reimbursement Plan will allow you to be reimbursed for medical expenses not covered or reimbursed by insurance, including copays for office visits and prescriptions, deductibles, and co-insurance. The Dependent Care Reimbursement Account is a vehicle through which you can accumulate pre-tax funds to reimburse yourself for childcare expenses, or day care expenses for a disabled dependent while you are employed. If you are married, you generally will not be able to receive benefits unless your spouse is employed, a full-time student, or disabled. Typically, your healthcare FSA covers: Co-payments Vision care Dental care Eye surgery Orthodontia Counseling Your Dependent care account typically covers these work-related expenses: Before and after-school programs Day care and nursery schools Pre-school programs Elder care services


CARRIER HealthNet Kaiser Permanente Delta Dental VSP Prudential Empathia IGOE Aflac HUMAN RESOURCES Christine Sowers Lidia Larrazabal
Arranged by

BENEFIT Medical EOA or PPO Medical HMO Dental PMI Dental PPO Vision Basic Life/AD&D, Disability, Optional Term Life/AD&D, Disability Employee Assistance Program Flexible Spending Accounts Voluntary Benefits EMAIL

TELEPHONE (800) 676-6976 (800) 646-4000 (888) 422-4234 (888) 335-8227 (800) 877-7195 (800) 346-3778 (800) 367-7474 (800) 633-8818 (661) 904-6542 (323) 565-1654 (323) 565-1658


This newsletter highlights the main features of Green Dot Public Schools benefit plan. It is intended to help you choose the benefits that are best for you. This newsletter does not include all plan rules and details. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this newsletter and the legal plan documents, the plan documents are the final authority. Green Dot reserves the right to change or discontinue its benefit plans at any time.