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2014 BENEFITS GUIDE 12/19/13 TABLE OF CONTENTS Mutual of Omaha Benefits Benefit Options………. . . . . . . . . . …………………………………………… Eligibility for Benefits. .……………………………………………………….. An Opportunity to Change My Benefit Elections During the Year………….... 1 1 3 Health Options and Coverage Details Waive Health Coverage….………………………………………………….. Health ………………………………………………………………………. Networks & Calendar Year Deductibles Comparison………………………… Premiums Per Pay Period…………………………………………………….. Schedule of Health Benefits….………………………………………………... Prescription Benefits…………………………………………………………... 4 4 5 5 6 11 Dental Options and Coverage Details Waive Dental Coverage……………………………………………………….. Dental . . . . . . . . . . . . .….……………………………………………………... Dental Deductibles…………………………………………………………….. Percentage Paid for Covered Services ………………………………………… Predetermination of Benefits. ………………………………………………… Premiums Per Pay Period ………………………………………………….. . . . 12 12 13 13 13 13 Vision Option and Coverage Detail VSP Vision Benefits.………………………………………………………….. Premiums Per Pay Period……………………………………………………… 14 14 Health Care Flexible Spending Account Advantages of a Health Care Flexible Spending Account ……………………. Contribution Amounts…………………………………………………………. Eligible Expenses.. ……………………………………………………………. Setting Up Your Health Care Flexible Spending Account……………………. Important Internal Revenue Service (IRS) Requirements…………………….. Reimbursement Methods………………………………………………………. Submitting the Claim…………………………………………………………… 14 14 15 15 15 15 16 Dependent Care Flexible Spending Account Advantages of a Dependent Care Flexible Spending Account………………… Contribution Amounts…………………………………………………………. Eligible Expenses……………………………………………………………… Eligible Dependents………………………………………………………….... Setting Up Your Dependent Care Flexible Spending Account……………….. Important Internal Revenue Service (IRS) Requirements…………………….. Reimbursement Method……………………………………………………….. Submitting the Claim………………………………………………………….. 16 16 17 17 17 17 17 17 12/19/13 Employee Life Insurance Basic Employee Life Benefits…………………………………………………. Employee Supplemental Life Options………………………………………… Employee Supplemental Life Costs…………………………………………… 18 18 18 Spouse Life Insurance Spouse Life Options…………………………………………………………… Spouse Life Costs……………………………………………………………… 19 19 Child Life Insurance Child Life Options…………………………………………………………….. Child Life Costs……………………………………………………………….. 19 19 Accidental Death & Dismemberment (AD&D) Basic AD&D Benefits. ………………………………………………………… Supplemental AD&D Options …………………………………………………. Supplemental AD&D Costs……….…………………………………………… 20 20 20 Long-Term Disability (LTD) Basic Long-Term Disability Benefits………………………………………….. Long-Term Disability Supplemental Options…………………………………. Long-Term Disability Supplemental Costs……………………………………. 21 21 21 Paid Time Off Paid Time Off Overview………………………………………………………. Short-Term Disability (STD) Plan.…………………………………………… Personal Time…………………………………………………………………. Vacation……………………………………………………………………….. Holidays……………………………………………………………………….. 21 22 23 24 26 401(k) Long-Term Savings Plan/Mutual of Omaha Bank 401(k) Plan……. 27 Definitions…………………………………………………………………….. 28 Appendix Benefits Enrollment Tips……………………………………………………….. Benefits FAQs…………………………………………………………………. 32 32 Web sites, Links and Contact Information References………………………. 34 12/19/13 NOTE: This packet is only a summary of the Employee Benefit’s program. A more complete description of the program’s provisions and benefits can be found in the Summary Plan Description, Plan documents and underlying contracts. In the event of a discrepancy between the Summary Plan Description and the Plan documents, the plan documents and underlying contracts will rule. The Company reserves the right to make final decisions concerning the interpretation and application of the Employee Benefit’s program and the benefit plans. Mutual of Omaha Benefits Benefit Options As part of Mutual of Omaha’s total compensation package, we offer employees a variety of benefit options. Review the information in this Benefits Guide to help you make the most of your benefit options and to prepare you to make your benefit choices. You may use HR@Home through the Internet to find benefit information when you are at home, if needed. The Web site is referenced on the last page of this Benefits Guide. Level of Coverage Options Your level of coverage is based on the following categories:  Employee Only (You are the only person covered)  Employee + One (You and one eligible dependent is covered)  Employee + Family (You and two or more eligible dependents are covered) NOTE: If you are enrolling a spouse in any of your coverages, you must provide Corporate Benefits and Services Department a copy of your certified marriage license, in order to have your spouse covered on your benefit effective date. A copy of your certified marriage license can be faxed to (402) 351-6192. Eligibility for Benefits Eligible Dependents For all applicable benefit plans, eligible dependents include:  Your spouse  Your same sex domestic partner  Your child up to age 26, unless the Child meets the requirements as an Incapacitated Child Please see the Definition Section of this Benefits Guide for the definition of Child, Foster Child, Same Sex Domestic Partner and Spouse. If you have a parent who works at Mutual, you cannot be enrolled as a dependent under their health, dental and/or vision coverage. You must be enrolled as an employee. If both you and your spouse work for Mutual of Omaha, you may each enroll separately in a health, dental and/or vision plan. Or, one of you may elect coverage in which the other is enrolled as a dependent. The employee who elects coverage is the primary covered person. 1 12/19/13 Mutual of Omaha Benefits Eligibility for Benefits, continued Benefits Eligibility Based on Scheduled Hours Worked and Hire Dates The following benefit plans are available according to your employment status, if you enroll during your designated enrollment period: Benefit Plan (Scheduled Hours Per Week) Basic Employee Life & Basic Long-Term Disability Health, Dental, Vision Supplemental Life, Spouse Life, Child Life, Basic Accidental Death & Dismemberment, Supplemental Accidental Death & Dismemberment Supplemental Long-Term Disability Health Care Flexible Spending Account Dependent Care Flexible Spending Account Legal Services 401(k) Plan Coverage Effective Date Date of Hire (30 hrs or more) X Benefits Effective Date X (20 – 30 hrs) (< 20 hrs) X X X X X X X X X Temporary (40 hrs or less) X Benefits Effective Date Benefits Effective Date Benefits Effective Date Benefits Effective Date Benefits Effective Date Benefits Effective Date X X X As an eligible employee, you have the opportunity to enroll in the benefits program each year. Once you have made your benefit elections, they remain in effect throughout the year, unless you have a qualified Life Event as defined in the Definitions Section of this Benefits Guide. Your benefit effective date is based on your hire date with the company as referenced in the below table. Hire Dates 1/1/14 - 1/18/14 1/19/14 - 2/15/14 2/16/14 - 3/18/14 3/19/14 - 4/17/14 4/18/14 - 5/18/14 5/19/14 - 6/17/14 6/18/14 - 7/18/14 7/19/14 - 8/18/14 8/19/14 - 9/17/14 9/18/14 - 10/18/14 10/19/14 - 11/17/14 11/18/14 - 12/18/14 12/19/14 - 12/31/14 Benefit Effective Date 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/14 10/1/14 11/1/14 12/1/14 1/1/15 2/1/15 If you are not Actively at Work on the date coverage would normally begin, your effective date is delayed until you return to work. 2 12/19/13 Mutual of Omaha Benefits An Opportunity to Change Your Benefit Elections During the Year Life Event IRS regulations determine when you can make changes to your benefit elections depending on changes in your status. Following are some examples of what may qualify:       You become married or divorced You acquire an eligible dependent Your spouse loses health coverage under an employer’s group plan because of a change in your spouse’s job status or because the spouse’s employer terminates its group plan Your dependent loses his or her eligibility under this Plan or another employer’s group plan Your spouse or dependent obtains coverage under an employer’s group plan because of a change in his or her job status or because his or her employer begins offering a group plan Your spouse makes a change during his or her employer’s annual enrollment, with an effective date other than January 1. In most situations, you may only add or delete dependents from your current coverage as the result of a Life Event change in status with the proper documentation, if required. Changes to your plan options must be consistent with the Life Event. If you increase the payroll deduction amount for Your Health Care Flexible Spending Account with an eligible Life Event, the increased dollar amount must be used for expenses incurred after the Life Event for services to be consistent with the Life Event. See the Definitions Section of this Benefits Guide for examples of Life Event changes. To make a change in coverage due to a Life Event change in status, you must report the change in status to Corporate Benefits and Services Department within 31 days of the event. If you do not contact the Corporate Benefits and Service Department within 31 days of the Life Event and you are electing to add a dependent, you will need to wait until the next annual enrollment. If you are removing a dependent and did not contact the Corporate Benefits Service Department, you will be required to pay the premium for that dependent for the remainder of the Benefit Year, but the dependent will be removed from your coverages, if ineligible. Contact the Corporate Benefits and Services Department by calling the HR Hotline at 402-351-3300 or toll free 1-800-365-1405 and select “1” for Benefits. You may also e-mail the Benefits Hotline for any questions you have regarding qualified Life Event changes. 3 12/19/13 Health Options and Coverage Details Waive Health Coverage Waive health coverage means that you are electing not to have health coverage through Mutual of Omaha as your employer. If you waive coverage, you should have health coverage through another plan. For instance, you may prefer to be covered under a spouse’s health plan. Compare your options, look at physicians in the network, premiums or differences in coverage in order to find the best option for you and your family. When deciding whether to be covered by two plans, look at whether the benefit of double coverage is worth the cost. With Coordination of Benefits plan provisions, one plan will pay its full benefits first, then the other plan may only pay the amount it would have paid had it been the primary plan. You will have the option to change your waive election every year at annual enrollment or if you experience a Life Event, as long as the benefit change requested is consistent with the Life Event. Health PPO through Coventry Health Care The health plan allows you complete freedom to go to any Preferred Provider Option (PPO) (in-network) and/or Non PPO (out-of-network) health care provider. This includes direct access to specialists without prior approval from the plan. When using in-network providers, you reduce the cost of health care expenses because the plan pays a larger percentage of the expenses and deductibles are lower. On the other hand, if you choose out-of-network providers, you will have higher out of pocket costs because the plan pays a lower percentage of expenses, the deductibles are higher and coinsurance percentages are higher. How to locate a preferred in-network provider is referenced on the last page of this Benefits Guide. Grandfathered Health Plan Mutual of Omaha Group believes that the Mutual of Omaha Group Health Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the “Affordable Care Act”). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that this Plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Benefits Hotline at 402-351-3300 and select “1” for Benefits. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans. 4 12/19/13 Health Options and Coverage Details In-Network Deductible Options Your health plan has two deductible options and you should choose the level of deductible best suited to you. A deductible is the amount of covered expenses that you must pay before the plan will start paying benefits. The $1,250/$2,500 deductible level is NOT qualified for HSA account set ups. Below are your calendar year deductible options: Individual Family $750 $1,500 $1,250 $2,500 We will recognize your health deductibles met with other coverage only during the first plan year (Jan. 1 – Dec. 31) of service. Explanation of Benefits (EOB’s) should be sent either by mail to Coventry Healthcare; Aberdeen Service Center; Attn: Katie Pearce; P.O. Box 2778; Bismarck, ND 58504 or by e-mail at KMPearce1@cvty.com or by toll-free fax at 855-985-2902. Networks and Calendar Year Deductibles Comparison Plan Type Plan Payments* Hospitalization Physician Services Surgery Prescription Drugs Calendar Year Deductible Low Deductible High Deductible Out of Pocket Maximum Low Deductible High Deductible In-Network Providers Out-of-Network Providers 85% 85% 85% RX Drug Program 75% 75% 75% 50% Per Person/Per Family $750/$1,500 $1,250/$2,500 Per Person/Per Family $1,000/$2,000 $1,750/$3,500 Per Person/Per Family Excluding RX and Medical Deductible $2,500/$5,000 $2,500/$5,000 Per Person/Per Family Excluding RX and Medical Deductible $5,000/$10,000 $5,000/$10,000 There is no Lifetime Maximum Amount for the Health Plan * The figures provided refer to the percentage paid after the calendar year deductible has been met. Health Premiums Per Pay Period (Before Tax) You Pay Health Coverage (Per Pay Period) $750 Individual/$1,500 Family Deductible PPO Health Option Employee Only Employee + One Employee + Family $60.00 $117.00 $176.00 $1,250 Individual/$2,500 Family Deductible PPO Health Option Employee Only Employee + One Employee + Family $29.00 $63.00 $103.00 5 12/19/13 Health Options and Coverage Details Schedule of Health Benefits Benefits Schedule of (PPO) Benefits for Active Covered Persons: In-Network Providers Out-of-Network Providers Choice of Physician You choose any licensed Physician or You choose any licensed Physician or Hospital that is participating in the Hospital that is not participating in the network. network. “Benefit Year” means a Calendar Year, which is the period of 12 consecutive months commencing on January 1 st and continuing through December 31st of that year Deductible (Per Benefit Year) Individual $750/Family $1,500 Individual $1,000/Family $2,000 Individual/Family Individual $1,250/Family $2,500 Individual $1,750/Family $3,500 Out-of-Pocket Maximums: Individual $2,500/Family $5,000 Individual: $5,000/Family $10,000 (Deductibles and Copayments for Prescription and medical are Individual $2,500/Family $5,000 Individual: $5,000/Family $10,000 not included) There is no Lifetime Maximum Limit for the Health Plan Note: In-Network and Out-of-Network Deductible and Out-of-Pocket Maximums are combined. Visit limits and Maximum Benefits are combined for both In-Network and Out-of-Network. Preventive Care Covered Charges Preventive Health CareNewborn through Age 6 Childhood Immunizations recommended by the American Academy of Pediatrics – Newborn through Age 6 diphtheria, tetanus, pertussis, measles, mumps and rubella; haemophilus influenza type B (HIB); hepatitis A; hepatitis B; pneumococcal; inactivated poliovirus; varicella; meningococcal; rotavirus; and influenza vaccinations, which includes the spray mist under the medical plan only. The coverage for influenza vaccinations listed at the end of this schedule under the Prescription Benefits, excludes the spray mists, and also excludes any form of influenza vaccination administered in an office visit setting. In-Network Providers Deductible is waived. Health Plan pays 100%. Deductible is waived. Health Plan pays 100%. Out-of-Network Providers Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. 6 12/19/13 Health Options and Coverage Details Schedule of Health Benefits, continued Preventive Care Physical Exam Benefits-Age 7 and older Routine vaccines for age 7 and older includes: Tetanus, Diphtheria & Pertussis (Tdap) ; meningococcal; pneumococcal; hepatitis A; hepatitis B; hepatits C; inactivated poliovirus; measles, mumps, rubella; Varicella (Chickenpox) ; Gardasil Vaccine (cervical cancer and HPV). Influenza vaccinations are excluded from the Preventive Care services under the medical plan only. There are influenza vaccination benefits listed under the Prescription Benefits at the end of this Schedule of Benefits. Zostavax Vaccine (shingles) Deductible is waived. Health Plan pays 100%. Deductible is waived. Health Plan pays 100%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Deductible is waived. Health Plan pays 100%. Routine Mammography – (limited Deductible is waived. Health Plan to one per Benefit Year) pays 100%. Colonoscopy-- one test every 5 Deductible is waived. Health Plan years for either a routine or a pays 100%. miscellaneous reason – Polyp removal while undergoing a colonoscopy once every 5 years is covered at 100% (In-network only) Colorectal Cancer Screening Deductible is waived. Health Plan limited to: pays 100%. Fecal occult blood test (once annually for age 40 and over); Sigmoidoscopy, screening (one every 5 years for age 50 and over); and Double Contrast Barium Enema (DCBE) (one every 5 years for age 50 and over) Prostate Cancer Screening Deductible is waived. Health Plan Prostate Specific Antigen (PSA) pays 100%. (one annually for men age 40 and over) Deductible is waived. Health Plan pays 100% for Zostavax vaccine. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. In-Hospital Confinement and Services Covered Charges In-Network Providers Room and Board, X-ray, Lab $120 Copayment per Hospital and other covered Hospital admission. Services covered at 85% charges after Deductible. Coinsurance 15%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Out-of-Network Providers $120 Copayment per Hospital admission. Services covered at 75% after Deductible. Coinsurance is 25%. 7 12/19/13 Health Options and Coverage Details Schedule of Health Benefits, continued In-Hospital Confinement and Services Covered Charges In-Network Providers Mental and Nervous Disorders $120 Copayment per Hospital admission. Health Plan pays 85% after the Deductible, Coinsurance is 15%. Substance $120 Copayment per Hospital Abuse Treatment admission. Health Plan pays 85% after the Deductible, Coinsurance is 15%. Emergency Room (Copayment $60 Copayment each visit. Services waived if Hospitalized) covered at 85% after Deductible, Coinsurance is 15%. Organ Transplant Benefits Coventry Transplant Network: Health Plan pays 85% after Deductible. Recipient must be a Covered Person. Coinsurance is 15%. Other Network Providers: Health Plan pays 85% after Deductible. Recipient must be a Covered Person. Coinsurance is 15%. Inpatient Rehabilitation Therapy Health Plan pays 85% after the Services Deductible, Coinsurance is 15%. (Maximum combined InNetwork and Out-of-Network Providers is limited to 60 days per Benefit Year) Outpatient Facility Services Covered Charges Hospitals, Outpatient Surgery Facility Urgent Care Facility Physician Services Covered Charges Hospital, Office and Home Visits Maternity Care Physician Surgical Services Outpatient Mental and Nervous Disorders Outpatient Substance Abuse Treatment Out-of-Network Providers $120 Copayment per Hospital admission. Health Plan pays 75% after the Deductible, Coinsurance is 25%. $120 Copayment per Hospital admission. Health Plan pays 75% after the Deductible, Coinsurance is 25%. $60 Copayment each visit. Services covered at 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible. Recipient must be a Covered Person. Coinsurance is 25%. Coinsurance for out of network Organ Transplants will not be applied to the Out-of-Pocket Maximum. Health Plan pays 75% after the Deductible, Coinsurance is 25%. In-Network Providers Health Plan pays 85% after the Deductible, Coinsurance is 15%. Health Plan pays 85% after the Deductible, Coinsurance is 15%. Out-of-Network Providers Health Plan pays 75% after the Deductible, Coinsurance is 25%. Health Plan pays 75% after the Deductible, Coinsurance is 25%. In-Network Providers Health Plan pays 85% after Deductible, Coinsurance is 15%. Health Plan pays 85% after Deductible, Coinsurance is 15%. Health Plan pays 85% after Deductible, Coinsurance is 15%. Health Plan pays 85% after Deductible, Coinsurance is 15%. Health Plan pays 85% after Deductible, Coinsurance is 15%. Out-of-Network Providers Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 75% after Deductible, Coinsurance is 25%. 8 12/19/13 Health Options and Coverage Details Schedule of Health Benefits, continued Physician Services Covered Charges Outpatient Therapy Services Acupuncture Treatment Non Surgical Spinal Treatment (example – Chiropractic Care) E.R. physician, radiologist, anesthesiologist, pathologist (ERAP) When service is rendered in a Network Facility In-Network Providers Health Plan pays 85% after Deductible not to exceed 60 visits per Benefit Year for Occupational and Physical therapy combined; and 30 visits per Benefit Year for Speech therapy. Coinsurance is 15%. Health Plan pays 85% of a maximum allowable of $50 per visit, after Deductible, not to exceed 18 visits per Benefit Year. Coinsurance is 15%. Health Plan pays 85% of a maximum allowable of $35 per visit, after Deductible, not to exceed one visit each day and 30 visits per Benefit Year. Coinsurance is 15%. Health Plan pays 85% after Deductible, Coinsurance is 15%. Out-of-Network Providers Health Plan pays 75% after Deductible not to exceed 60 visits per Benefit Year for Occupational and Physical therapy combined; and 30 visits per Benefit Year for Speech therapy. Coinsurance is 25%. Health Plan pays 75% of a maximum allowable of $50 per visit, after Deductible, not to exceed 18 visits per Benefit Year. Coinsurance is 25%. Health Plan pays 75% of a maximum allowable of $35 per visit, after Deductible, not to exceed one visit each day and 30 visits per Benefit Year. Coinsurance is 25%. If the ERAP provider is not participating in the network, but the facility is an In-Network Provider, the Health Plan pays 85% after the PPO Deductible, Coinsurance is 15%. For services rendered in an out-of-network facility, the Health Plan pays 75% after the out of network Deductible, Coinsurance is 25%. In-Network Providers Health Plan pays 85% after Deductible, Coinsurance is 15%. Out-of-Network Providers Health Plan pays 75% after Deductible, Coinsurance is 25%. Deductible is waived. Health Plan pays 100%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Deductible is waived. Health Plan pays 100%. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 85% after Deductible up to one visit for the same type of visit per day and 100 visits per Benefit Year. Coinsurance is 15%. Health Plan pays 75% after Deductible not to exceed 100 visits per Benefit Year and no more than one visit for the same type of service per day. Coinsurance is 25%. Miscellaneous Covered Charges Independent Radiology and Pathology (Lab, X-ray and High End Radiology (MRI, CT, PET, SPECT scans)) Colonoscopy-- one test every 5 years for either a routine or a miscellaneous reason – Polyp removal while undergoing a colonoscopy once every 5 years is covered at 100% (In-network only) Mammography – If not used for preventive care, limited to one per Benefit Year. Home Health Care 9 12/19/13 Health Options and Coverage Details Schedule of Health Benefits, continued Miscellaneous Covered Charges Hospice Care Inpatient: Outpatient: (Maximum combined Inpatient and Outpatient benefit is limited to 185 days/visits) Skilled Nursing Facility (Maximum combined InNetwork and Out-of-Network benefit is limited to 100 days per Benefit Year) Ambulance Infertility Smoking Cessation All Other Covered Charges Covered Charges Durable Medical Equipment and Prosthetics VSP Free Vision Discounts In-Network Providers Health Plan pays 85% after Deductible, Coinsurance is 15%. Out-of-Network Providers Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 85% after Deductible, Coinsurance is 15%. Health Plan pays 75% after Deductible, Coinsurance is 25%. $120 Copayment per Hospital admission. Health Plan pays 85% after the Deductible. Coinsurance is 15%. $120 Copayment per Hospital admission. Health Plan pays 75% after Deductible, Coinsurance is 25%. Health Plan pays 80% of charges, Coinsurance is 20%. Deductible waived. Health Plan pays up to a maximum of $2,500 while covered under the Health Plan. $50 Copayment for Chantix and other smoking cessation drugs. Health Plan pays 80% of charges, Coinsurance is 20%. Deductible waived. Health Plan pays up to a maximum of $2,500 while covered under the Health Plan. Reimbursement for Covered Drugs and medicines will be limited to 50% for nonparticipating providers. In-Network Providers Health Plan pays 85% after the Deductible, and Coinsurance is 15%. If You are enrolled in Mutual of Omaha’s health plan and not enrolled in the Voluntary VSP vision coverage, You are entitled to discounts on eye exams and eyewear from VSP participating vendors. Out-of-Network Providers Health Plan pays 75% after Deductible, Coinsurance is 25%. If You are enrolled in Mutual of Omaha’s health plans and not enrolled in the Voluntary VSP vision coverage, You are entitled to discounts on eye exams and eyewear from VSP participating vendors. Prescription Benefits Prescription Drug Card Deductible: $50 per person per Benefit Year before Copayment applies Generic Brand Brand NonFormulary Formulary Retail Pharmacy $13 $35 $60 (30-day supply) Retail Pharmacy $39 $105 $180 (90-day supply) Mail Order (90-day $39 $105 $180 supply) Reimbursement for Covered Drugs and medicines will be limited to 50% for nonparticipating providers. 10 12/19/13 Health Options and Coverage Details Schedule of Health Benefits, continued Prescription Benefits Covered Charges In-Network Providers Out-of-Network Providers Diabetic Supplies$5 $5 $50 Retail Diabetic Supplies$15 $15 $150 Mail Order Diabetic Supplies include needles, syringes, test tablets, sticks, strips and lancets. Specialty Pharmacy $120 Copayment for a 30 day supply after Drugs (for rare or prescription Deductible has been met. complex diseases) Zostavax Vaccine (shingles) Influenza Intramuscular Vaccination Deductible is waived. Prescription Plan pays Deductible is waived. Prescription 100%. Plan pays 100%. $15 Copay at a participating pharmacy location. The Influenza Vaccination does not apply towards the RX deductible. This benefit excludes influenza spray mists, and also excludes any form of influenza vaccination administered in an office visit setting, except as provided under Preventive Care benefits for the medical plan only for newborns through age 6. Contraceptives, which require a physician’s written prescription are included. Precertification - You must precertify any hospital confinement, outpatient surgery and certain other services in order to receive maximum benefits payable under the plan. Refer to the Employee Benefits Handbook for a complete explanation of all of your group benefits including your medical coverages. You may also call the Customer Service number on the back of your ID card for more preauthorization information. Prescription Benefits Prescription Drug Benefits are available to you and your eligible dependents if you are covered under one of the health deductible plans. Prescription Drug Deductibles  A $50 per person per calendar year deductible must be paid before copayments apply. When purchasing prescription drugs, the calendar year deductible for each covered person on the plan must be paid first. Then on the remaining balance, the appropriate copay will follow on a claim over the deductible amount. The total of the prescription drug deductible and the copayment will not exceed the cost of the prescription. The prescription drug deductible is separate from the calendar year deductible on your health and dental plans. Reimbursement for out-of-network benefits for prescription drugs will be limited to 50%. Prescription Drug Copayments Retail Program (30-day supply) Generic $13 Brand Formulary $35 Brand Non-formulary $60 Retail Program (90-day supply) Generic $39 Brand Formulary $105 Brand Non-formulary $180 Mail Order Program (90-day supply) Generic $39 Brand Formulary $105 Brand Non-formulary $180 11 12/19/13 Health Options and Coverage Details Prescription Benefits, continued Utilize formulary prescription drugs to keep your prescription drug costs down for you and your eligible dependents. A formulary is a preferred list of drugs. If your prescription is on the formulary you will pay a lower copayment. If your prescription is not on the formulary you still have coverage but you will pay a higher copayment. To view the formulary list or search for an in-network pharmacy, reference the Web site on the last page of this Benefits Guide. You may want to print out the formulary list and bring a copy with you when you visit your doctor. Specialty Pharmacy Drugs are most often an injectable medication for chronic diseases. When you receive a prescription for a specialty drug, you will pay a $120 copayment for a 30-day supply after the calendar year prescription deductible has been met. For more detailed information on Specialty Pharmacy Drugs, please see your Employee Benefits Handbook. Dental Options and Coverage Details Waive Dental Coverage Waive dental coverage means that you are electing not to have dental coverage through the Mutual of Omaha Dental Plan. Perhaps you prefer to be covered under a spouse’s dental plan. Compare your options, look at dentists in the network, premiums or differences in coverage in order to find the best option for you and your family. When deciding whether to be covered by two plans, look at whether the benefit of double coverage is worth the cost. With Coordination of Benefits plan provisions, one plan will pay its full benefits first, then the other plan may only pay the amount it would have paid had it been the primary plan. You will have the option to change your waive election every year at annual enrollment or if you experience a Life Event, as long as the benefit change requested is consistent with the Life Event. Dental Mutual of Omaha Dental balances savings, service and customer satisfaction by providing easy access to the DenteMax network. The DenteMax network is available nationwide. When using DenteMax network providers, you reduce the cost of dental care expenses because the plan pays a larger percentage of the expenses and deductibles are lower. If you choose out-of-network providers, you will have higher out of pocket costs because the plan pays a lower percentage of expenses, the deductibles are higher and coinsurance percentages are higher. To view the DenteMax network provider directory, reference the Web site on the last page of this Benefits Guide. All benefits are subject to your calendar year deductible. Our dental covers preventive, basic services, major services and orthodontics. Two dental cleanings are covered per calendar year for each covered person, unless You or Your eligible dependents are pregnant, have diabetes or heart disease, then four dental cleanings are covered per calendar year for each covered person. 12 12/19/13 Dental Options and Coverage Details Deductibles There is a calendar year deductible. A deductible is the amount of covered expenses that you must pay before the plan will start paying benefits. Below are the calendar year dental deductibles: In-network $25 per person, $50 per family Out-of-network $75 per person, $150 per family Percentage Paid for Covered Services After The Calendar Year Deductible Has Been Met Covered Services Examples In-Network Providers Out-of-Network Providers Class I Cleanings & X-rays 100% 100% of maximum allowance for out of network covered services Class II Prefabricated Crowns, Root Canals & Fillings 80% 60% of maximum allowance for out of network covered services Class III Cast Restoration Crowns, Dentures & Bridgework 60% 50% of maximum allowance for out of network covered services Orthodontics Braces 60% 50% of maximum allowance for out of network covered services Annual Maximum $1,500 per person $1,500 Orthodontics Lifetime Maximum $1,500 per person $1,200 For detailed information on covered services, see the Employee Benefits Handbook Web site referenced on the last page of this Benefits Guide. Predetermination of Benefits If your dental expense is going to be over $300, we recommend you submit a dental Predetermination of Benefits form (Dental Claim Form) to show you and your dentist, in advance, what benefits will be payable. If available, less expensive alternative treatment plans will be presented. To access the Dental Claim Form used for predetermination of benefits, reference the link on the last page of this Benefits Guide. Premiums Per Pay Period (Before Tax) Dental Coverage You Pay(Per Pay Period) Dental Employee Only Employee + One Employee + Family $4.50 $9.50 $16.50 13 12/19/13 Vision Option and Coverage Detail VSP Vision Benefits    You can purchase VSP vision coverage, even if you did not elect one of our health plans. By using a VSP participating vendor, you will have the following benefits:  Exam covered after a $25 copay every calendar year  Prescription glasses (after a $35 copay):  Lenses covered every calendar year  Single vision, lined bifocal, and lined trifocal lenses  Scratch resistant and anti-reflective coatings for in-network providers  Polycarbonate lenses for dependent children  Frames covered up to $150 every other calendar year  Contact Lens Care – up to $60 copay for your contact lens exam (fitting and evaluation). When you choose contacts instead of glasses, your $200 allowance applies to the cost of your contacts. The every calendar year exam is in addition to your vision exam to ensure proper fit of contacts. If you choose contact lenses, you will be eligible for a frame the next calendar year from the date the contact lenses were obtained.  Laser Vision Correction discounts To search for a VSP participating vendor and to find out more about your VSP vision benefits, reference the last page of this Benefits Guide. You Pay VSP Vision Coverage (Per Pay Period) VSP Vision Employee Only Employee + One Employee + Family $5.41 $7.75 $13.86 Health Care Flexible Spending Account Advantages of a Health Care Flexible Spending Account (FSA) The Health Care FSA allows you to set aside before-tax dollars to pay eligible health, prescription drug, dental, and vision expenses that other benefit plans don’t cover. Mutual of Omaha does not cover over the counter expenses, even if prescribed by a physician, which includes prescribed marijuana. The Health Care FSA reduces your taxable income because your contributions are deposited in the FSA on a pre-tax basis. On a pre-tax basis means that your contribution is deducted from your paycheck before taxes are withheld. Your FSA can help you pay for expenses that are predictable. For example, if your income was $30,000 and your out-of-pocket expenses totaled $540 and you had $45 a month deducted from your paycheck before taxes, you could save $122 in taxes over the course of the year, because your taxable income would be reduced. Contribution Amounts Minimum - $60 per year Maximum - $2,500 per year 14 12/19/13 Health Care Flexible Spending Account Eligible Expenses       Health/dental out of pocket expenses Copayments Deductibles Expenses not covered by the plans or over plan maximums Vision/hearing expenses Lasik surgery to correct vision (make certain you are a candidate before enrolling in the FSA) Setting Up Your Health Care Flexible Spending Account Estimate how much money you will need to cover your eligible expenses for the period from your benefit effective date to the end of the year to determine your annual contribution amount. Each year during annual enrollment period, as required by law, you will have the opportunity to re-enroll in the Health Care Flexible Spending Account. When you incur an eligible expense, you pay the expense, then you get reimbursed. Important Internal Revenue Service (IRS) Requirements  Money contributed to Flexible Spending Accounts must be used for eligible expenses incurred during the year that it is taken from your pay or it will be forfeited.  Eligible expenses must be incurred after the date your plan participation begins.  Money cannot be transferred between the Health Care Flexible Spending Account and the Dependent Care Flexible Spending Account.  The amount paid out will be equal to the annual pledge anytime during the calendar year.  If you or your dependents are enrolled in a health savings account, participation in the Health Care FSA could jeopardize the ability for you or your dependents to make contributions to the health savings account. Please contact your tax advisor for additional information. Reimbursement Methods To be reimbursed for you and your dependents’ incurred expenses for health care, you have two methods to submit your expenses:  Online  Paper Online Expense Reimbursement Eligible health, dental, prescription drug and vision expenses are submitted through Employee Self Service to the claim system, if you have elected one of our health, dental and/or vision plans. You will receive an email notifying you when these expenses are available for online submission for reimbursement. The e-mail will provide you with a link to view your account online. Paper Expense Reimbursement Eligible expenses that are not processed through our Employee Group Insurance Plan must be submitted on a paper claim form. These expenses include: 15 12/19/13 Health Care Flexible Spending Account Reimbursement Methods, continued     Vision, if not covered under VSP Lasik surgery Routine hearing exams and hearing aids Covered out-of-pocket health, dental, vision and prescription drug expenses incurred while you or your eligible dependents were covered under another health, dental or vision plan. Paper claim forms are submitted to the Payroll Department for reimbursement. To print a copy of the paper Health Care FSA Claim Form, reference the link on the last page of this Benefits Guide. Submitting the Claim Claim forms can be submitted weekly, bi-weekly, monthly or how often you wish. You can be reimbursed each week for eligible expenses from your Flexible Spending Account that you have submitted during the week. Reimbursement requests received by Monday at noon will be processed the same week. If Monday is a holiday, the reimbursement request must be received by 4:30 p.m., on the previous Friday. Reimbursement payments will be directly deposited into your existing payroll deposit account on Fridays after the claim has been processed. After December 31, 2014, you will have until March 31, 2015, to submit reimbursement claims for health care expenses incurred during 2014. Dependent Care Flexible Spending Account Advantages of a Dependent Care Flexible Spending Account (FSA) The Dependent Care FSA allows you to set aside before-tax dollars to pay eligible dependent care expenses. The Dependent Care FSA reduces your taxable income because your contributions are deposited in the FSA on a pre-tax basis. Pre-tax basis means that your contribution is deducted from your paycheck before taxes are withheld. Consult your tax advisor to determine if participating in the dependent care account would be to your advantage based on your combined household income and financial situation. Contribution Amounts If both you and your spouse work or you are a single parent, you can contribute to the dependent care account. The maximum listed is a combined amount for you and your spouse. This is an IRS limit so you need to make sure you don’t exceed it, if you have been contributing to a Dependent Care Flexible Spending Account through another employer. Minimum - $60 per year Maximum - $5,000 per year 16 12/19/13 Dependent Care Flexible Spending Account Eligible Expenses  Dependent Day Care expenses for an eligible dependent incurred while you are at work Eligible expenses cannot exceed your spouse’s earnings, unless your spouse is a full-time student or is disabled. If your spouse is a full-time student or disabled, their earnings are considered to be $200 a month or $400 a month if two or more dependents are receiving care. Eligible Dependents An eligible dependent is someone you claim as a dependent on your tax return. The dependent must be under age 13 or a mentally or physically disabled spouse or dependent who lives in your home and is unable to care for himself or herself. Setting Up Your Dependent Care Flexible Spending Account Estimate how much money you will need to cover your expenses for the rest of this year to determine your annual contribution amount. Remember vacation and school breaks (including the summer months). Each year during annual enrollment period, as required by law, you will have the opportunity to re-enroll in the Dependent Care Flexible Spending Account. When you incur an eligible expense, you pay the expense, and then you get reimbursed. Important Internal Revenue Service (IRS) Requirements  Money contributed to Flexible Spending Accounts must be used for eligible expenses incurred during the year that it is taken from your pay or it will be forfeited.  Eligible expenses must be incurred after the date your plan participation begins.  Money cannot be transferred between the Health Care Flexible Spending Account and the Dependent Care Flexible Spending Account.  Expenses paid out are limited by the amount you contribute anytime during the year. Reimbursement Method Once you incur and pay the expense, submit the expense to the Payroll Department. Use a reimbursement claim form and submit to PL – Payroll-Flexible Spending Accounts. If you are attaching a receipt with your claim form, remember a canceled check cannot be accepted as a receipt. To print a Dependent Care FSA Claim Form, reference the link on the last page of this Benefits Guide. Submitting the Claim Claim forms can be submitted weekly, bi-weekly, monthly or how often you wish. You can be reimbursed each week for eligible expenses from your Flexible Spending Account that you have submitted during the week. Reimbursement requests received by Monday at noon will be processed the same week. If Monday is a holiday, the reimbursement request must be received by 4:30 p.m., on the previous Friday. Reimbursement payments will be directly deposited into your existing payroll deposit account on Fridays after the claim has been processed. After December 31, 2014, you will have until March 31, 2015, to submit reimbursement claims for dependent care expenses incurred during 2014. 17 12/19/13 Employee Life Insurance The Employee, Spouse and Child Life options are term life products. The premiums are on an after-tax basis. Life restriction rules do apply to the Employee, Spouse and Child Life options. Life restriction rules apply after your new hire enrollment. You will only be able to move up one level at annual enrollment unless you experience a qualified Life Event, without proof of good health at your own expense. Basic Employee Life Benefits  The coverage is equal to one times your Annual Benefit Salary. Annual Benefit Salary is defined in the Definitions Section of this Benefits Guide  Provided by the company at no cost to you  Premiums for coverage exceeding $50,000 (basic benefit only) are considered taxable income Employee Supplemental Life Options  You may purchase an additional 1, 2, 3, 4 times your Annual Benefit Salary (Basic and Supplemental Life coverage cannot exceed a total of $750,000) without proof of good health at your own expense as a new employee  Includes waiver of premium for employees who become disabled Employee Supplemental Life Costs The premiums for Employee Supplemental Life Insurance are paid by you on an after tax basis. The after tax amount is based on your age as of the previous year of your new hire date and your smoking status. Thereafter, your after tax amount is based on your age as of August 31 in the current year and your smoking status. The amount of your coverage will not change during the year, even if your monthly pay changes. Below you can calculate your premiums per $1,000 of coverage per pay period based on your age and smoking status: Employee Age As of Benefits Start Date Under 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Over 70 Nonsmoker Monthly Rate per $1,000 of Coverage $ .05 $ .07 $ .09 $ .10 $ .15 $ .23 $ .43 $ .53 $ .93 $ .98 Smoker Monthly Rate per $1,000 of Coverage $ .14 $ .14 $ .14 $ .19 $ .30 $ .41 $ .62 $1.35 $3.05 $3.05 EXAMPLES: If you are under 30 and a nonsmoker you would multiply .05 x $25,000 (employees’ annual salary) /$1,000 = $1.25 per month or if you are 42 and a smoker you would multiply .19 x $35,000 (employees’ annual salary) /$1,000 = $6.65 per month. Divide by two to determine your after tax per pay period cost. 18 12/19/13 Spouse Life Insurance Spouse Life Options You may purchase the following amounts of life insurance:  $10,000  $25,000  $50,000  $75,000 The amount of life insurance for your spouse or same sex domestic partner cannot be greater than the amount of group life insurance carried on you, which includes your basic benefit plus any supplemental. Spouse Life Costs Spouse's Age Younger than 40 40-44 45-49 50-54 55-59 60-64 65 and older Per Pay Period Premium Based on Coverage Level Elected: $10,000 $25,000 $50,000 $75,000 $0.80 $2.00 $4.00 $6.00 $1.00 $2.00 $3.00 $4.50 $6.00 $13.50 $2.50 $5.00 $7.50 $11.25 $15.00 $33.75 $5.00 $10.00 $15.00 $22.50 $30.00 $67.50 $7.50 $15.00 $22.50 $33.75 $45.00 $101.25 Child Life Insurance Child Life Options You may purchase the following amounts of life insurance:  $10,000  $15,000  $20,000 Dependent children at least 14 days old can be covered as long as they are an eligible dependent. Child Life Costs One premium covers all eligible children. Below are your per pay period after tax premiums based on coverage level elected: $10,000 $15,000 $20,000 $0.35 $0.70 $1.40 19 12/19/13 Accidental Death & Dismemberment Insurance (AD&D) Accidental Death and Dismemberment benefits will be paid only if you die as a result of an accident or suffer certain losses in an accident. Benefits are also paid for paralysis as a result of an accident. Basic AD&D Benefits   You will receive $25,000 of employee AD&D coverage Provided by the company at no cost to you Supplemental AD&D Options   You may purchase additional Supplemental AD&D benefits for the employee and eligible dependents from $50,000 to $250,000 in $50,000 increments. If you enroll in family coverage, the benefit for your spouse or your same sex domestic partner is 40% of your benefit and the eligible child benefit is 10% of your benefit. Employee $50,000 $100,000 $150,000 $200,000 $250,000 Spouse (40%) $20,000 $40,000 $60,000 $80,000 $100,000 Children (10%) $5,000 $10,000 $15,000 $20,000 $25,000 Supplemental AD&D Costs Below are your per pay period after tax premiums for the following options you may purchase: $50,000 $100,000 $150,000 $200,000 $250,000 Employee Only Employee + One or Employee +Family $ .75 $1.50 $2.25 $3.00 $3.75 $1.00 $2.00 $3.00 $4.00 $5.00 20 12/19/13 Long-Term Disability (LTD) Basic Long-Term Disability Benefits Long-Term Disability benefits replace a portion of your pay if you become disabled and are unable to work.  At no cost to you, the company provides basic monthly pay replacement of 60% of your Annual Benefit Salary, not to exceed a maximum monthly benefit of $10,000. Annual Benefit Salary is defined in the Definitions Section of this Benefit Guide  There is a six-month period before benefits are payable Long-Term Disability Supplemental Options  You may purchase an additional 10% of supplemental LTD coverage for a total monthly pay replacement of 70% of your Annual Benefit Salary, not to exceed a maximum monthly benefit of $20,000. Long-Term Disability Supplemental Costs If you elect the additional 10% of coverage, your portion of the cost will be paid with before tax dollars from your pay. The cost is your monthly Annual Benefits Salary x .0030. Divide the monthly premium by two to get the per pay period premium. Paid Time Off Benefits Paid Time Off benefits available:  Short-Term Disability (STD) Plan  Personal Time  Vacation  Holidays Paid Time Off benefits navigation:  View the Paid Time Off benefits by visiting Associate Access under Human Resources and then under Pay, Time Reporting & Time Off or under HR Policies & Compliance Notices  Log on using your User ID and Password 21 12/19/13 Paid Time Off Benefits Short-Term Disability Plan The Short-Term Disability (“STD”) Plan provides short-term income replacement benefits for eligible employees who are determined by the Health Services Department to have an absence due to an illness and are unable to perform the duties of their assigned jobs. Eligibility - Employees scheduled to work 30 or more hours per week are eligible for STD coverage following 12 months of continuous Regular employment (Temporary employment excluded from the 12 months of continuous employment) working 30 or more hours per week. Amount of Benefit – In the event of an eligible absence (not considered to be Workers’ Compensation), the eligible employee will receive 70% of base pay after meeting the 5 day waiting period. For Production Sales employees who are going out on STD, the value of one's compensation for the first two months after meeting the Waiting Period is 70% of Base Salary plus 100% on incentive compensation earned in previous production months. For months three through six (or until the employee returns to work) the value of one's compensation will be 70% of Base Salary plus 70% of monthly average earned incentive compensation (monthly average incentive compensation is calculated as the average earned incentives from your most recent 12 full production months). Any monthly bonus paid to a new Production Sales employee in addition to earned incentive compensation during such 12-month period will be included in determining average earned incentive compensation. Upon return to work, the Production Sales employee will receive 70% of one's earned average incentive compensation for the first two months plus 100% of Base Salary. Starting with one's third month back to work from STD, they will receive 100% of Base Salary and 100% Incentive Compensation. Maximum Benefit Period – The maximum number of days an eligible employee who is scheduled to work Regular Full-time hours is up to 125 days in a rolling 12 month time period, which includes Holiday. The maximum number of hours an eligible employee who is working 30 hours, but less than scheduled Regular Full-time hours is 750 hours in a rolling 12 month time period, which includes Holidays. 22 12/19/13 Paid Time Off Benefits Personal Time Eligibility – Employees scheduled to work 20 or more hours per week (except for temporary employees) will receive a pro-rated amount of Personal Time (based on the month of hire) on the 10th of the month following the completion of three full consecutive calendar months of employment, according to the following schedule: Personal Time - New Hire Schedule for Mutual of Omaha Insurance Employees Employment Month Based on scheduled hours worked January, 2014 February, 2014 March, 2014 April, 2014 May, 2014 July, 2014 August, 2014 September, 2014 October, 2014 November, 2014 December, 2014 Hours Received Hours Received 40 (Regular Full-time) 30 up to Regular Full-time hours) 32.00 Hours 28.00 Hours 24.00 Hours 20.00 Hours 16.00 Hours 8.00 Hours 4.00 Hours 48.00 Hours 44.00 Hours 40.00 Hours 36.00 Hours 24.00 Hours 21.00 Hours 18.00 Hours 15.00 Hours 12.00 Hours 6.00 Hours 3.00 Hours 36.00 Hours 33.00 Hours 30.00 Hours 27.00 Hours Hours Received First Pay Advice with Viewable Personal Time 20 up to 30 10.75 Hours 9.50 Hours 8.00 Hours 6.75 Hours 5.50 Hours 2.75 Hours 1.50 Hours 16.00 Hours 14.75 Hours 13.50 Hours 12.00 Hours 05/10/2014 06/10/2014 07/10/2014 08/10/2014 09/10/2014 11/10/2014 12/10/2014 01/25/2015 02/10/2015 03/10/2015 04/10/2015 Due to how the holidays fall in 2014 for Insurance employees, the above chart reflects the additional prorated personal time granted, based upon the number of hours an employee is scheduled to work, in place of the second floating holiday. Employees will need to inform their managers or supervisors when they are absent due to their own illness. When Personal Time is used for any absence other than your own illness, the use of personal other time may be used at the employee's discretion, subject to manager's approval. Personal Time does not carryover to the next year. Personal Time - New Hire Schedule for Mutual of Omaha Bank Employees Employment Month Based on scheduled hours worked January, 2014 February, 2014 March, 2014 April, 2014 Hours Received Hours Received 40 (Regular Full-time) 30 up to Regular Full-time hours) 26.75 Hours 23.50 Hours 20.00 Hours 16.75 Hours 20 Hours 17.50 Hours 15 Hours 12.50 Hours Hours Received First Pay Advice with Viewable Personal Time 20 up to 30 8 Hours 7 Hours 6 Hours 5 Hours 05/10/2014 06/10/2014 07/10/2014 08/10/2014 23 12/19/13 Paid Time Off Benefits Personal Time, continued Personal Time - New Hire Schedule for Mutual of Omaha Bank Employees Employment Month Based on scheduled hours worked May, 2014 June, 2014 July, 2014 August, 2014 September, 2014 October, 2014 November, 2014 December, 2014 Hours Received Hours Received Hours Received 40 (Regular Full-time) 30 up to Regular Full-time hours) 13.50 Hours 10.00 Hours 6.75 Hours 3.50 Hours 40.00 Hours 36.75 Hours 33.50 Hours 30.00 Hours First Pay Advice with Viewable Personal Time 20 up to 30 10 Hours 7.50 Hours 5 Hours 2.50 Hours 30 Hours 27.50 Hours 25 Hours 22.50 Hours 4 Hours 3 Hours 2 Hours 1 Hour 12 Hours 11 Hours 10 Hours 9 Hours 09/10/2014 10/10/2014 11/10/2014 12/10/2014 01/25/2015 02/10/2015 03/10/2015 04/10/2015 Employees will need to inform their managers or supervisors when they are absent due to their own illness. When Personal Time is used for any absence other than your own illness, the use of personal other time may be used at the employee's discretion, subject to manager's approval. Personal Time does not carryover to the next year. Vacation Eligibility - Employees (except for a temporary employees) are eligible to earn Vacation based on eligible hours paid. The amount of Vacation granted is based on years of service. New employees will be able to use vacation time as it appears on the pay advice, subject to manager approval. Accrual – New employees will begin accruing vacation time upon their benefits effective date. The amount of Vacation accrued per pay period will vary based on the eligible hours paid in each pay period. Vacation Awarded to New Hires Hire Dates 1/1/14 - 1/18/14 1/19/14 - 1/31/14 2/1/14 - 2/15/14 2/16/14 - 2/29/14 3/1/14 - 3/18/14 3/19/14 - 3/31/14 4/1/14 - 4/17/14 4/18/14 - 4/30/14 5/1/14 - 5/18/14 5/19/14 - 5/31/14 6/1/14 - 6/17/14 6/18/14 - 6/30/14 7/1/14 - 7/18/14 7/19/14 - 7/31/14 Vacation Accrual Start Date Pay Advice w/ 1st Award of Vacation 02/01/2014 03/01/2014 03/01/2014 04/01/2014 04/01/2014 05/01/2014 05/01/2014 06/01/2014 06/01/2014 07/01/2014 07/01/2014 08/01/2014 08/01/2014 09/01/2014 02/25/2014 03/25/2014 03/25/2014 04/25/2014 04/25/2014 05/25/2014 05/25/2014 06/25/2014 06/25/2014 07/25/2014 07/25/2014 08/25/2014 08/25/2014 09/25/2014 24 12/19/13 Paid Time Off Benefits Vacation, continued Vacation Awarded to New Hires Hire Dates Vacation Accrual Start Date Pay Advice w/ 1st Award of Vacation 09/01/2014 10/01/2014 10/01/2014 11/01/2014 11/01/2014 12/01/2014 12/01/2014 01/01/2015 01/01/2015 02/01/2015 09/25/2014 10/25/2014 10/25/2014 11/25/2014 11/25/2014 12/25/2014 12/25/2014 01/25/2015 01/25/2015 02/25/2015 8/1/14 - 8/18/14 8/19/14 - 8/31/14 9/1/14 - 9/17/14 9/18/14- 9/30/14 10/1/14 - 10/18/14 10/19/14 - 10/31/14 11/1/14 - 11/17/14 11/18/14 - 11/30/14 12/1/14 - 12/18/14 12/19/14 - 12/31/14 Maximum Vacation Earned per Twelve Month Period Accumulated Service Up to 5 yrs of service 5 yrs of service 10 yrs of service 15 yrs of service *25 yrs of service Months of Service 0-60 61-120 121-180 180 - 299 300 + In Days 10 days per year 15 days per year 17.5 days per year 20 days per year 25 days per year In Hours 80.00 120.00 140.00 160.00 200.00 *Not available for Bank Employees. Eligible employees will earn Vacation at the hourly accrual rate based on service and eligible hours paid in each pay period according to the following schedule: Vacation Calculation Accrual Schedule for Full-Time Employees Months of Service Average Pay Period Vacation Accrual Rate 0 to 59 60 to 119 120 to 179 180 to 299 300 plus .038461 .057692 .067307 .076923 .096153 Average Vacation Accrual for 9 day/72.00 hrs pay period 2.77 hrs 4.15 hrs 4.85 hrs 5.54 hrs 6.92 hrs Average Vacation Accrual for 10 day/80.00 hrs pay period 3.08 hrs 4.62 hrs 5.38 hrs 6.15 hrs 7.69 hrs Average Vacation Accrual for 11 day/88.00 hrs pay period 3.38 hrs 5.08 hrs 5.92 hrs 6.77 hrs 8.46 hrs Average Vacation Accrual for 12 day/96.00 hrs pay period 3.69 hrs 5.54 hrs 6.46 hrs 7.38 hrs 9.23 hrs Maximum Vacation Allowed in Vacation Balance 120.00 hrs 160.00 hrs 180.00 hrs 200.00 hrs 240.00 hrs Vacation is accrued twice monthly on the 15th and the last day of the month. To calculate your accrual each pay period, count the workdays only between the 1st and the 15th or between the 16th and the last day of the month. The number of workdays in that pay period will determine your accrual. 25 12/19/13 Paid Time Off Benefits Vacation, continued For example, an employee who has 0 to 59 months of service would receive the following accrual amounts using the calculation below: If the count is 9 workdays, the accrual for that pay period would be: If the count is 10 workdays, the accrual for that pay period would be: If the count is 11 workdays, the accrual for that pay period would be: If the count is 12 workdays, the accrual for that pay period would be: 2.77 hours 3.08 hours 3.38 hours 3.69 hours Employees working less than 40.00 hours per week will need to use the chart above to calculate the Vacation Accrual based on Months of Service and then take the appropriate Average Pay Period Vacation Accrual Rate and multiply it by eligible hours paid in the pay period. Holidays Holidays – For all Mutual of Omaha Insurance Employees Eligibility – All employees normally scheduled to work on the observed Holiday. Seven of the nine Holidays are scheduled Holidays and one is a Floating Holiday. Listed below are the Holidays observed for 2014: New Year’s Day Memorial Day Independence Day Labor Day Thanksgiving Day Day After Thanksgiving Day Christmas Day Day After Christmas Day* *Denotes Floating Holiday Special Notice Regarding the 2014 Holiday Schedule Due to how the holidays fall in 2014 for Insurance employees, one additional day of personal time will be granted, based upon the number of hours an employee is scheduled to work, in place of the second floating holiday. Because employees scheduled to work less than 20 hours per week are not eligible for personal time, managers/timekeepers will use the "RTO" time reporting code to record the use of the 3 hours of time off granted to this group of employees. 26 12/19/13 Holidays – For all Mutual of Omaha Bank employees Eligibility – All employees are eligible for ten Holidays as observed by the Federal Reserve, if you are normally scheduled to work on the observed Holiday. Listed below are the Holidays observed for 2014: New Year’s Day Martin Luther King Day President’s Day Memorial Day Independence Day Labor Day Columbus Day Veterans’ Day Thanksgiving Day Christmas Day 401(k) Long-Term Savings Plan/ Mutual of Omaha Bank 401(k) Plan Our 401(k) plans are long term savings plans set up to assist you for saving for retirement, and we encourage you to save appropriately. All Insurance employees are eligible to participate in the 401(k) Long-Term Saving Plan and all Bank employees are eligible to participate in the Mutual of Omaha Bank 401(k) Plan. You are eligible to participate upon your benefits effective date. You may contribute a total of 0-75% of your earnings on a Pre-Tax or After-Tax basis each pay period. Elective deferrals in partial fractional percentages are allowed. The Company will match $1 for $1 on the first 6% you contribute. The company matching contributions are deposited at the same time as your contributions. You are always 100% vested in your contributions and are immediately 100% vested in company matching contributions (subject to gains and losses). Elective Deferral Changes: You may make changes in your elective deferral percentage after your initial enrollment by going to Associate Access. Select Employee Self Service from the featured Quick Links and click on Review/ Update your 401(k