Benefits That Empower. - Schneider Electric

Benefits that empower.5Who’s eligible?Employee eligibilityEligible 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.NOTE: Temporary workers and contracted or leasedemployees are excluded from Schneider Electric benefits.DependentDefinitionRequired documents*SpouseA 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 SPD*)Child(ren)A dependent child** (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 listed* 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.** 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.

Benefits that empower.6Your health advocate:Health Advocacy SolutionsAs of January 1, 2020, your Schneider Electric medical coverage includesHealth Advocacy Solutions, a new Blue Cross and Blue Shield of Illinois(BCBSIL) concierge service, to help you navigate health care decisions whilesaving you time and money.What does this mean?The first notable change is you now have one phone number, 877-557-3417(as shown on your new medical ID card), to connect with skilled healthadvocates dedicated to our Schneider Electric medical plans. Whether youare searching for a doctor, have a medical question in the middle of the nightor have claims questions, this is the one phone number to call.Health 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 features of Health Advocacy Solutions include: Digital Member Health Hub. Log in to myhealth.myevive.com or use the MyEvive appas a one-stop resource for everything related to your health:– Review medical, prescription drug and dental benefits.– View claims and benefit coverage details, and receive personalized health reminders.– Find information about resources like Naturally Slim. Virtual physical therapy (PT). If you suffer from chronic back, hip or knee pain, takeadvantage of this virtual physical therapy program with a live coach from Hinge Health.Get started at hingehealth.com/schneider20. Oncology Navigator. If you or a family member is facing cancer, trained navigators will helpguide you to the right care and support. Special Beginnings. Get support for high-risk pregnancies.

7Benefits that empower. BCBSIL Cost Estimator Tool. This tool lets you compare charges for more than 1,500procedures, treatments and tests — and estimate your out-of-pocket expenses based on yourmedical plan option. Log in at bcbsil.com Provider Finder. ConsumerMedical. Whether you need help finding a specialist, getting a secondopinion or understanding your diagnosis and treatment options, ConsumerMedicalcan help make sure you get the best care — all at no extra cost to you. Go tomyconsumermedical.com company code: Schneider or the ConsumerMedicalapp: MyMedicalAlly, or call 877-557-3417. MDLIVE. If you enroll in medical coverage, consider using MDLIVE for virtual officevisits. These can save you money when you’re in need of care for non-emergencymedical conditions and pediatric care, especially if you have CDHP coverage. Connectwith a board-certified doctor for non-emergency medical conditions or pediatric care bysecure video, phone or email. Go to www.mdlive.com/bcbsil or the MDLIVE mobile appor call 877-557-3417.

Benefits that empower.8MedicalMedical 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 11), 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.

Benefits that empower.9Meeting the deductibleThe way you meet your deductible varies by plan option.In the Core CDHP HSA and Core PPO Once one person’s claims reach the single deductible amount, that person can then beginreceiving benefits and just pay the coinsurance amount. Once one person reaches the single out-of-pocket maximum, the plan will pay 100% for thatperson 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 the remainder of thatcalendar 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 Click the search in-network provider link Answer the questions – Select the Participating Provider Organization (PPO) network.– For Georgia, Florida, New Hampshire, St. Louis area, Kansas City area and the WashingtonD.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 andsubject to a separate out-of-network deductible 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.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 se-benefitslink.com.You may also request a paper copy of any SBC by calling PeopleLink at 877-248-2998.

Benefits that empower.10Comparing 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 (30 day supply)3Generic20% (after youmeet the annualdeductible)Preferred brandBrandMail order (90 day supply)GenericPreferred brandBrand40% (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)420% (after youmeet the annualdeductible) 25 copaymentNo coverage20% coinsurance ( 75 min / 150 max)40% coinsurance ( 150 min / 300 max)1. The out-of-pocket maximum includes expenses paid toward your deductible, as well asmedical and prescription drug copayments and coinsurance amounts.3. For preventive drugs in the CDHP HSA options, the deductible does not apply. You pay20% coinsurance for preferred brand and brand name drugs, nothing for generics.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 or certain organ transplants is 10%if treatment received at a BCBSIL Blue Distinction Centers Plus facility.4. Specialty drugs under the Core PPO will be 75 min/ 150 max for preferred brand and 150 min/ 300 max for brand for up to a 90-day supply.

Benefits that empower.11Health Savings Account (HSA)Schneider Electric opens an HSA for you and contributes to your account in January and July eachyear you participate in a Schneider Electric CDHP medical option. You can also make contributionsto the HSA, up to IRS limits, as shown below.2020 HSA contribution limitsWho is coveredSchneider Electriccontribution* Your maximumcontribution** 2020 IRS maximumcontribution 700 2,850 3,550 1,400 5,700 7,100Employee 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, 2020, you can contribute an additional 1,000.Getting startedAre you eligible?If 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.To be eligible for an HSA: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. Decide if you want to contribute: You can start, change or stop 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;your contributions anytime during the year at se-benefitslink.com. Money is always yours: Because any unused money in your HSAYou must be enrolled in a CDHPmedical option; and Covered under a generalFSA through your spouse’s ordomestic partner’s plan (however,you may participate in a Limiteduse Health Care FSA specificallyfor dental and vision expenses);Claimed as a dependent onsomeone else’s taxes;Enrolled in Medicare (includingretroactive Medicare coverage);Covered by TriCare or Medicaid;or The recipient of VA benefits withinthe last three months.

Benefits that empower.12DentalDental 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 deltadentalil.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 higher calendar year maximum —that is, the amount the plan will pay in one year — and covers orthodontia services. The following chartprovides a summary of your dental coverage.Plan provisionCoreBuy-up 1,500 per person 2,000 per personNo benefit 2,000 per personIndividual 50 per person 50 per personFamily 150 per family 150 per familyPreventive and diagnostic care (exams, cleanings, x-rays, etc.) 0 (100% covered) 0 (100% covered)Basic restorative care (fillings, endodontics, periodontics, oralsurgery, etc.)20%20%Major restorative care (crown, bridge, denture, implant, etc.)50%50%No benefit50% (PPO provider)50% of Maximum PlanAllowance (Premier provideror out-of-network)Calendar year maximum (excludes orthodontia)Orthodontia lifetime maximumAnnual deductible you payCoinsurance you payOrthodontia care — for adults and childrenDelta Dental NetworksWhile you can visit any general or specialty dentist, you pay less for carewhen you use a provider in one of the Delta Dental networks — DeltaDental PPO and Delta Dental Premier — with deeper discounts when youuse a Delta Dental PPO network dentist. Average discounts range from15% to 35% for the Delta Dental PPO network and 5% to 10% for theDelta Dental Premier network.* If you live in Puerto Rico, your dental c

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.