Schneider Electric 2021 Benefits Guide

Your 2021 Benefits Guide6Who’s eligible?Employee eligibility1Eligible dependentsYou are eligible for Schneider Electric benefitsif you are a:At Schneider Electric, we recognize theimportance of benefits coverage for your family.If you are eligible for benefits, you may coveryour spouse or domestic partner and yourchildren, as defined below. Also see below forthe information you need to submit to ensurethey can be covered. Salaried or hourly full-time employee; Regular part-time employee, scheduled towork at least 17.5 hours per week; or Union employee covered by a collectivebargaining agreement providing coverageby this program.DependentDefinitionRequired documents2SpouseA person to whom you are legally married,including common law spouses and same-sexspouses legally married in states where suchmarriages are recognized. Copy of the front page of the employee’s most recent federal tax return thatincludes the employee’s spouseOR Photocopy of marriage certificate AND Proof of joint debt/ownership dated within the past 90 days (must haveemployee and spouse name) such as:– Monthly statement from a joint checking or savings account– Mortgage payment or lease agreementDomesticpartnerSame- or opposite-sex partner (no age limit)with whom you are registered with an authorizedgovernment agency or, if not registered,with whom you are involved in an ongoingand committed relationship and who hasbeen residing with you for the last sixconsecutive months. Domestic Partner Registration as legally recognized OR Two of the following that show both the employee’s and domestic partner’sname and address:– Mortgage payment or lease agreement– Joint ownership of a motor vehicle– A current joint bank account or a joint credit account (dated within the last90 days) AND Certification of Tax Dependency and Declaration of Domestic Partnership(refer to the General Information section of the SPD2)Child(ren)A dependent child3 (younger than age 26regardless of student or marital status) who is/are: Your natural child(ren) Stepchild(ren), foster child(ren), andchild(ren) for whom you are the courtappointed legal guardian Adopted child(ren) once they are placed withyou for adoption Child(ren) entitled to coverage under a qualifiedmedical child support order Disabled child(ren) over age 26 Child(ren) of domestic partners Unmarried child(ren) up to age 19 — but lessthan age 25 — who are full-time students (lifeinsurance only) For natural child(ren): Photocopy of birth certificate showing employee’sname OR a copy of the employee’s most recent federal tax return showingthe dependent listed For stepchild(ren): Photocopy of birth certificate showing employee’sspouse’s name and a copy of the marriage certificate showing theemployee’s and parent’s name OR a copy of the employee’s most recentfederal tax return showing the dependent listed For domestic partner’s child(ren): Photocopy of birth certificate showingdomestic partner’s name OR a copy of the employee’s or domesticpartner’s most recent federal tax return showing the dependent listed For legal guardian, adoption or foster child(ren): Photocopy of final courtorder with presiding judge’s signature, final adoption decree or qualifiedmedical child support order, OR a copy of the employee’s most recentfederal tax return showing the dependent listed1. Temporary workers and contracted or leased employees are excluded from Schneider Electric benefits.2. You can find a complete list of acceptable documents as well as the Certification of Tax Dependency and Declaration of Domestic Partnership atse-benefitslink.com (Tools & Resources Forms) or by contacting PeopleLink at 877-248-2998.3. This also includes your adult child(ren) to the end of the month in which they turn age 26 even if they are eligible for medical, dental or vision coveragethrough their own employer plans.

Your 2021 Benefits Guide7Your health advocate:Health Advocacy SolutionsYour Schneider Electric medical coverage includes Health Advocacy Solutions,a Blue Cross and Blue Shield of Illinois (BCBSIL) concierge service, to help younavigate health care decisions while saving you time and money.Connect with a health advocateIt’s easy to connect with skilled health advocates dedicated to our SchneiderElectric medical plans. Call 877-557-3417 (as shown on your medical ID card)whether you are searching for a doctor, have a medical question in the middleof the night or have claims h advocates will: Facilitate prior authorizations for services under the medical plan. If you require anauthorization for certain services (MRIs, CT scans, surgeries, etc.), a health advocate canfacilitate the authorization for you. IMPORTANT: Typically your provider will take care of thisfor you, but it is your responsibility to connect with a health advocate before receiving care.If this step is not completed, your procedure may not be covered. Help you compare costs and find high-quality, low-cost providers for medical tests andprocedures, giving you the potential to earn a cash reward (called member rewards). Help coordinate your behavioral health care and benefits for outpatient care to treat issueslike anxiety, depression or addiction.Other programs and featuresMDLIVEIf you enroll in medical coverage, consider using MDLIVE for virtual office visits. These can saveyou money when you’re in need of care for non-emergency medical conditions and pediatriccare, especially if you have CDHP coverage. Connect with a board-certified doctor 24/7 includingnights, weekends and holidays by secure video, phone or email.Go to mdlive.com/bcbsil or the MDLIVE mobile app or call 877-557-3417.GET PAID FOR SMART SHOPPING: MEMBER REWARDSYou may be able to save on out-of-pocket health care costs and earn a cash reward —called Member Rewards — when you shop around for health care services and proceduresand choose a more cost-effective provider and/or location for your care. The potentialcash reward depends on the procedure and which provider you use. After your doctorrecommends a procedure or test, you can search Provider Finder on bcbsil.com to find outif those services are eligible for Member Rewards. You can also call your health advocate tohelp you compare costs and find high-quality, low-cost facilities for medical tests andprocedures. You must have the procedure or test verified by a health advocate to receiveyour cash reward.

Your 2021 Benefits Guide8ConsumerMedicalWhether you need help finding a specialist, getting a second opinion or understanding yourdiagnosis and treatment options, ConsumerMedical can help make sure you get the bestcare — all at no extra cost to you. Go to myconsumermedical.com company code: Schneideror the ConsumerMedical app: MyMedicalAlly, or call 877-557-3417.Digital exercise therapyIf you suffer from chronic neck, shoulder, back, hip or knee pain, you have free access to adigital exercise therapy program with a live coach from Hinge Health.Apply at hingehealth.com/schneider20.Oncology NavigatorThrough Oncology Navigator, if you or a family member is facing cancer, trained navigators willhelp guide you to the right care and support.High-risk maternity managementGet support for high-risk pregnancies through high-risk maternity management.!Learn more: Get details on all of these programs and more on Rewards@Schneider.

Your 2021 Benefits Guide9MedicalMedical coverage helps you and your family with the costs of maintaining good healthand treating illness or injury. Schneider Electric offers you three options to choose from,or you can decline medical coverage: Core Consumer-Directed Health Plan (CDHP) HSA Buy-up Consumer-Directed Health Plan (CDHP) HSA* Core Preferred Provider Organization (PPO)Learn about your plan options.All options cover the same features, including: Free, in-network preventive care such as annual physicals, wellness exams, cancer screeningsand immunizations; The same BCBSIL network of providers; and Prescription drug coverage through Express Scripts.**Below are some key differences for you to consider.CDHP HSA Options: best value at any ageYoung and healthy? Nearing retirement? Or somewhere in between? No matter where you are inyour health journey, the CDHP HSA options can save you money on health care. Though theyhave higher deductibles, you get: Health Savings Account (HSA), which lets you pay for eligible health care expenses withtax-free money. Schneider Electric contributes to your HSA to help offset the deductible —that’s free money for you. Lower costs from your paycheck. Consider contributing to your HSA the difference in yourcost for medical coverage between the Core PPO and a CDHP option to use toward the higherdeductible or to save and invest in your HSA. Choice. The HSA empowers you to decide when to use your money: now or save it for later.PPO OptionThe Core PPO option has higher employee contributions per pay period but a lower annualdeductible than the CDHP HSA options. And since this option doesn’t include an HSA,you will not receive a Company HSA contribution.* If you are not eligible for an HSA (see page 12), you can enroll in the Buy-up CDHP option with NO HSA.** If you live in Puerto Rico, your medical and prescription drug coverage is administered by Triple S (Blue Cross and Blue Shield of PuertoRico). You will receive a separate insert regarding coverage details and cost.

Your 2021 Benefits Guide10Meeting the deductibleIn the Core CDHP HSA and Core PPO Once one person’s claims reach the single deductible amount, that personcan then begin receiving benefits and just pay the coinsurance amount. Once one person reaches the single out-of-pocket maximum, the planwill pay 100% for that person for the remainder of that calendar year.In the Buy-up CDHP HSA All of the family’s eligible expenses added together must reach the family deductible amountbefore paying coinsurance for any family member. The family deductible can be met by one family member or a combination of family members. All of the family’s eligible expenses added together must reach the family out-of-pocketmaximum before the plan will pay 100% for any family member for that calendar year.Is your provider/pharmacy in the network?BCBSIL provider networkTo see if your provider is in the network, or to find a new provider, go to bcbsil.com and click onthe Find a Doctor or Hospital link. Search as a guest enter the location where you would like tosearch for care and then: Select the Participating Provider Organization (PPO) network. For Florida, Georgia, Kansas City area, New Hampshire, New Jersey, St. Louis area,Tennessee and the Washington D.C./Maryland/Virginia area, select the appropriate network.For help finding a network provider, call BCBSIL. Your health advocate will help you find skilledproviders who are proven to be high performers. If you use a provider outside of your network,your claim will be processed as out-of-network and subject to a separate out-of-networkdeductible and out-of-pocket maximum.Pharmacy networkTo find an in-network pharmacy near you, sign in at Express-Scripts.com Locate a Pharmacy. Ifyou are a first-time visitor to Express-Scripts.com, first register, using your member ID number.Brand-name drug cost when generic is availableIf you or your doctor requests a brand-name medication and indicates “dispense as written” whena generic equivalent is available, you will pay the generic copay plus the cost difference betweenthe brand and the generic. You or your doctor may request a coverage review to waive the costdifference between the brand and generic medication by contacting Express Scripts.Get more information Find more plan details in the Summary of Benefits and Coverage (SBC) for each medicaloption, along with a Glossary of Health Coverage and Medical terms, at Rewards@Schneider.You may also request a paper copy of any SBC by calling PeopleLink at 877-248-2998.

Your 2021 Benefits Guide11Comparing medical plan optionsCore CDHP HSAPlan provisionBuy-up CDHP HSACore PPOYou payin-networkYou payout-of-networkYou payin-networkYou payout-of-networkYou payin-networkYou payout-of-networkSingle 2,800 5,600 1,450 2,900 600 1,200Family 5,600 11,200 2,900 5,800 1,200 2,400DeductibleHealth Savings AccountSingleFamilyCompany contributes 700NACompany contributes 1,400NAOut-of-pocket maximum1SingleFamily 5,600 11,200 4,450 8,900 3,700 7,400 11,200 22,400 7,150 17,800 7,400 14,80020%40%20%40%20%40%FreeNot coveredFreeNot coveredFreeNot coveredCoinsurance2Office visitPreventive carePrimary care physicianSubject to deductible and coinsurance 30 copaymentSubject todeductible andcoinsuranceSpecialistSubject to deductible and coinsurance 50 copaymentSubject todeductible andcoinsurance 30 copaymentNo coverageTelehealth throughMDLIVE 44; subject todeductible andcoinsuranceUrgent careNo coverage 44; subject todeductible andcoinsuranceNo coverageSubject to deductible and coinsuranceEmergency room 50 copaymentSubject to deductible and coinsuranceHospital admissionSubject to deductible and coinsurancePrescription drugsRetail (up to 30-day supply)3GenericPreferred brandBrand20% (after youmeet the annualdeductible)40% (after youmeet the annualdeductible)20% (after youmeet the annualdeductible)No coverage20% (after youmeet the annualdeductible)40% (after youmeet the annualdeductible) 10 copayment20% coinsurance ( 30 min / 60 max)40% coinsurance ( 60 min / 120 max)Mail order (90-day supply)GenericPreferred brandBrand20% (after youmeet the annualdeductible)1. The out-of-pocket maximum includes expenses paid toward your deductible, as well asmedical and prescription drug copayments and coinsurance amounts.2. The coinsurance is calculated based on the allowed amount under the medical plan.For out-of-network care, you may be responsible for any amount billed in excess of theallowed amount. The coinsurance for bariatric surgery and certain organ transplants, aswell as cardiac, knee, hip, maternity and spine services is 10% if treatment received at aBCBSIL Blue Distinction Centers facility. 25 copaymentNo coverage20% coinsurance ( 75 min / 150 max)40% coinsurance ( 150 min / 300 max)3. For prescription drug coverage: F or preventive drugs in the CDHP HSA options, the deductible does not apply.You pay 20% coinsurance for preferred brand and brand name drugs, nothing for generics.Go to express-scripts.com/schneiderelectric to check how medications are classified. S pecialty drugs under the Core PPO: Certain specialty drugs may be at no cost to youthrough SaveonSP, which helps coordinate manufacturer-sponsored copay assistance.

Your 2021 Benefits Guide12Health Savings Account (HSA)Schneider Electric opens an HSA for you and contributes to your account in late January each yearyou participate in a Schneider Electric CDHP medical option. You can also make contributions tothe HSA, up to IRS limits, as shown below.2021 HSA contribution limitsWho is coveredSchneider Electriccontribution* Your maximumcontribution** 2021 IRS limit 700 2,900 3,600 1,400 5,800 7,200Employee onlyFamily* Contributions for new hires will be prorated and deposited based on your effective date for medical coverage.** If you turn age 55 by December 31, 2021, you can contribute an additional 1,000.Getting startedIf you enroll in a CDHP option, you will be prompted to review andaccept the terms and conditions associated with the HSA. PayFlex,the HSA administrator, will reach out to you if they need additionalinformation to set up your account.Key features of an HSA Get triple tax savings:1. Contributions are tax-free: both Schneider Electric’s and yours.2. Money grows tax-free with interest.3. Withdrawals are tax-free for eligible expenses.Are you eligible?To be eligible for an HSA: your contributions anytime during the year at se-benefitslink.com. Use now or save: When you incur eligible expenses, you decide – If you want to use HSA dollars to pay the expense (funds areavailable when they’re posted to your account), or – Pay out of your own pocket and save your HSA dollars forfuture expenses. rolls over from year to year, you can save the money in your HSAto use in the future, even if you leave the Company or retire. Invest your money: If you have at least 1,000 in your account,you can invest the additional money in a variety of mutual fundoptions. To access your account and for more information, visitpayflex.com.Use your HSA dollars for larger expenses and pay for smallerexpenses out of your own pocket to help build up your account.You must be a U.S. citizen, GreenCard holder, or H1-B visa holderwith a U.S. residential address.You cannot be: Covered by any medical plan thatis not a consumer-directed healthplan, including your spouse’s ordomestic partner’s plan; Decide if you want to contribute: You can start, change or stop Money is always yours: Because any unused money in your HSAYou must be enrolled in a CDHPmedical option; and Covered under a general FSAthrough your spouse’s or domesticpartner’s plan (however, you mayparticipate in a Limited-use HealthCare FSA specifically for dentaland vision expenses);Claimed as a dependent onsomeone else’s taxes;Enrolled in Medicare (includingretroactive Medicare coverage);Covered by TriCare, TriCare forLife, or Medicaid;or The recipient of VA benefits withinthe last 3 months unless you havea disability rating from the VA.

Your 2021 Benefits Guide13DentalDental coverage provides benefits for preventive care like examsand cleanings. It also covers basic and major restorative care.Is your dentist inthe network?The Company offers you two dental options administeredby Delta Dental of Illinois*, or you can decline coverage:Visit deltadental.com to see if yourdentist is in the Delta Dental network,or ask the dentist’s office when youmake your appointment. Core Buy-upBoth options cover the same services, but the Buy-up option has a high

a Schneider Electric employee eligible under the Schneider Electric Benefits Program for U.S. Employees, you may each want to enroll in single coverage (or one enrolls in single coverage and the other in employee plus children coverage if you have children who need medical coverage) to avoid the 75 per month working spouse/domestic partner fee.