2020 benefits snapshot - amazon web services€¦ · this benefits snapshot provides you with an...

Welcome to Your Penumbra Benefits!This benefits snapshot provides you with an overview of the benefits available to you at Penumbra. For more information, listen to the recorded education presentations and review the annual notices, benefit summaries, Summary Plan Descriptions, or Evidences of Coverage at www.mybenefitsnow.com/penumbra or email [email protected].

EligibilityU.S. employees at Penumbra and its subsidiaries are eligible for benefits if you are scheduled to work an average of 30 hours per week over the course of a 12-month measurement period that takes place before the plan year begins. Eligible dependents include your spouse or domestic partner and your or your domestic partner's children up to age 26.

How to EnrollEnroll in or make changes to your benefits by logging onto UltiPro via PenHub or https://penumbrainc.ultipro.com.

2020 Benefits Snapshot

UltiProLog on to UltiPro via PenHub to enroll online.

Website: https://penumbrainc.ultipro.comUser Name: Your Penumbra email address

Password: Your network passwordFor login assistance, email [email protected].

Penumbra Benefits PortalAccess Penumbra’s benefits information 24/7 from any device.

Carrier phone numbers, group numbers, claim forms, and other benefits materials are available.

Website: www.mybenefitsnow.com/penumbra

Benefits Portal: www.mybenefitsnow.com/penumbra Email: [email protected] 1

http://www.benefitstream.nethttps://penumbrainc.ultipro.com

Benefits Portal: www.mybenefitsnow.com/penumbra Email: [email protected]

Medical Plan Comparison Plan Features

Blue Shield CA HDHP/HSA Blue Shield CA PPO

In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Deductible1Individual/Family $2,800 / $5,200 $5,000 / $10,000 $500 / $1,000 $1,000 / $2,000

Calendar Year Out-of-Pocket Maximum1Individual/Family

$5,000 / $10,000 $10,000 / $20,000 $3,000 / $6,000 $6,000 / $12,000

Penumbra Annual HSA ContributionIndividual/Family

$1,400 / $2,600 N/A

You pay:

Preventive Care Visit Covered in full Not covered Covered in full Not covered

Primary Care Visit 10% after deductible 30% after deductible $20 copay 30% after deductibleSpecialist Visit 10% after deductible 30% after deductible $40 copay 30% after deductibleTelemedicine Visit $5 copay after deductible Not covered $5 copay Not coveredUrgent Care 10% after deductible 30% after deductible $20 copay 30% after deductibleEmergency Room 10% after deductible $150 copay (waived if admitted)

Outpatient Facility Services 10% after deductible30% up to $350/day

plus 100% of additional charges, after deductible

10% after deductible30% up to $350/day


Inpatient Facility Services 10% after deductible30% up to $600/day


10% after deductible30% up to $600/day


Chiropractic Services 10% after deductible(24 visits per year)30% after deductible(24 visits per year)

$20 copay(24 visits per year)

30% after deductible(24 visits per year)

Acupuncture 10% after deductible(20 visits per year)30% after deductible(20 visits per year)



Prescription Drugs: Retail (up to a 30-day supply)

Tier 1 $10 copay after deductible

25% of purchase price + $10 per prescription,

after deductible$10 copay 25% of purchase price + $10 per prescription







Tier 4 (excluding specialty drugs)

30% up to $200 per prescription, after

deductible

25% of purchase price + 30% up to $200

per prescription, after deductible

30% up to $200 per prescription

25% of purchase price + 30% up to $200 per

prescription

Tier 4 (specialty drugs)30% up to $200 per prescription, after

deductibleNot covered 30% up to $200 per prescription Not covered

Prescription Drugs: Mail Order for 2x retail copay (up to a 90-day supply)1If you cover dependents, the Blue Shield plans have individual limits (deductible and out-of-pocket maximum) within the family limits (deductible and out-of-pocket maximum). This means that these limits will be met for an individual who meets the individual limit prior to the family limit being satisfied within a calendar year. For example, one member can satisfy his/her individual deductible in order for the coinsurance to apply for that individual.

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Medical Plan Comparison (continued) Plan Features

Blue Shield CA EPO Kaiser HMOIn-Network Out-of-Network In-Network Only

Calendar Year Deductible1Individual/Family $0 / $0 $3,000 / $6,000 None

Calendar Year Out-of-Pocket Maximum1Individual/Family

$2,500 / $5,000 $9,000 / $18,000 $2,500 / $5,000

Penumbra Annual HSA Contribution Individual/Family

N/A N/A

You pay: You pay:Preventive Care Visit Covered in full Not covered Covered in full

Primary Care Visit $20 copay 50% after deductible $20 copaySpecialist Visit $40 copay 50% after deductible $40 copayTelemedicine Visit $5 copay Not covered No chargeUrgent Care $20 copay 50% after deductible $20 copay

Emergency Room $150 copay (waived if admitted) $150 copay (waived if admitted)

Outpatient Facility Services $0 copay50% up to $350/day plus 100%

of additional charges, after deductible

$35 copay per procedure

Inpatient Facility Services $250 copay per admission50% up to $600/day plus 100%

of additional charges, after deductible

$250 copay per admission

Chiropractic Services $20 copay(24 visits per year)50% after deductible(24 visits per year)

$15 copay (20 visits per year)

Acupuncture $0 copay(20 visits per year)50% after deductible(20 visits per year) Not covered

Prescription Drugs: Retail (up to a 30-day supply)

Tier 1 $10 copay 25% of purchase price + $10 per prescription Generic - $10 copay

Tier 2 $30 copay 25% of purchase price + $30 per prescription Brand - $35 copay

Tier 3 $50 copay 25% of purchase price + $50 per prescription N/A

Tier 4 (excluding specialty drugs) 30% up to $200 per prescription25% of purchase price + 30%

up to $200 per prescription N/A

Tier 4 (specialty drugs) 30% up to $200 per prescription Not coveredSpecialty - 20% not to

exceed $150Prescription Drugs: Mail Order for 2x retail copay (up to a 90-day supply); Kaiser for 2x retail copay (up to a 100-day supply)

1If you cover dependents, the Blue Shield plans have individual limits (deductible and out-of-pocket maximum) within the family limits (deductible and out-of-pocket maximum). This means that these limits will be met for an individual who meets the individual limit prior to the family limit being satisfied within a calendar year. For example, one member can satisfy his/her individual deductible in order for the coinsurance to apply for that individual.

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Dental Coverage

Plan FeaturesMetLife High PPO MetLife Low PPO

In-Network Out-Of-Network In-Network Out-Of-Network

Calendar Year Deductible (Individual/Family) $50 / $150 $100 / $300 $50 / $150 $100 / $300Calendar Year Benefit Maximum $2,000 per person $1,000 per personDiagnostic and Preventive Services Covered at 100% (deductible waived) Covered at 100% (deductible waived)

Basic and Restorative Services Covered at 90% after deductibleCovered at 80% after deductible

Covered at 80% after deductible


Major Services Covered at 65% after deductibleCovered at 50% after deductible



Orthodontia (children to age 26, adults) Covered at 50% after deductible Not covered

Orthodontia Lifetime Maximum $2,000 per person

Vision Coverage

Plan FeaturesVSP

In-Network Out-of-NetworkYou pay: Plan reimburses you:

Exam every 12 months $10 copay Up to $45

Frames every 12 months $200 allowance after $25 copay; 20% off balance over $200 Up to $70

Lenses every 12 months Included in Prescription Glasses Up to $30-$65 depending on lensesContacts (instead of glasses) every 12 months

$200 allowance for contacts; contact lens exam (fitting and evaluation) up to $60 Up to $105

Laser Vision Correction Average 15% off regular price or 5% off promotional price from contracted facilities Not covered

UV Protection $0 copay Not covered

Easy Options (choose one upgrade per year)$300 retail frame allowance, $300 elective

contact lens allowance, anti-reflective coating or photochromatic lenses

Not covered

Your Cost for CoverageThe chart below shows your 2020 monthly cost for health coverage.*

Benefit Plan Employee Only Employee + Spouse/Domestic PartnerEmployee + Child(ren)

Employee + Family

MedicalBlue Shield HDHP $82.91 $181.55 $157.52 $252.02Blue Shield PPO $146.57 $320.99 $278.49 $445.57Blue Shield EPO $219.92 $481.63 $417.85 $668.55Kaiser HMO (CA) $118.45 $248.73 $225.05 $355.34DentalMetLife Low PPO $7.86 $16.06 $17.67 $27.69MetLife High PPO $15.33 $31.06 $36.09 $56.00VisionVSP $1.96 $3.92 $4.20 $6.71

*There may be tax implications (post-tax and imputed income) when you enroll your domestic partner and/or his or her children. For the applicable rates accounting for post-tax and imputed income, visit www.mybenefitsnow.com/penumbra.

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Health Savings Account (HSA)When you enroll in the Blue Shield HDHP medical plan, you may be eligible to open a Health Savings Account (HSA) if you meet certain eligibility requirements. You can set aside money before taxes to pay for qualified health care expenses. Penumbra also funds your HSA quarterly to help offset the high deductible. For more details, visit www.mybenefitsnow.com/penumbra.

All HSA contributions made by you and Penumbra must not exceed the annual maximums set by the IRS each year.

Coverage Type 2020 Maximum Contribution Limit 12020 Penumbra HSA

Contribution2020 Maximum

Employee Contribution 1

Individual Coverage $3,550 Up to $1,400 $2,150Family Coverage $7,100 Up to $2,600 $4,500

1 If you are age 55 or over, you can contribute an additional catch-up amount of $1,000. This means that individuals can contribute a maximum of $3,150 and families can contribute a maximum of $5,500.

Flexible Spending Account (FSA)Flexible Spending Accounts (FSAs) allow you to set aside money before taxes to reimburse yourself for qualified health care and daycare expenses. For more details, visit www.mybenefitsnow.com/penumbra.

All FSA contributions must not exceed the annual maximums set by the IRS each year.

Plan Maximum ContributionDependent Care FSA $5,000 / year

Health Care FSA $2,750 / year

Limited Purpose FSA $2,750 / year

Commuter BenefitsThe Commuter Benefits Program allows you to set aside money before taxes to pay for qualified transportation expenses related to your commute.

Commuter contributions must not exceed the monthly maximums set by the IRS each year.

Plan Maximum Contribution

Transit $270 / month

Parking $270 / month

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Life and AD&D InsurancePenumbra offers Basic Life and AD&D insurance equal to 2 times your base annual earnings up to a maximum of $1,000,000 at no cost to you.You may buy additional Life and AD&D insurance for yourself, your spouse or domestic partner, and your children. Log on to UltiPro for the cost. You may elect the following amounts:

Employee: $10,000 increments up to the lesser of five times your base annual earnings or $1,450,000. Any Life insurance election over $200,000 requires evidence of insurability (EOI).

Spouse/Domestic Partner: $10,000 increments up to $150,000, not to exceed 100% of your election. Any Life insurance election over $30,000 requires EOI.

Child: $1,000 from birth to 6 months. After 6 months, coverage increases to $10,000.

Disability InsurancePenumbra offers Short-Term and Long-Term Disability (STD / LTD) insurance when you are injured or ill at no cost to you. You have the option to choose whether the benefit amount you receive on an approved claim is taxable or tax-free.

STD covers 60% of your weekly earnings up to $3,462 per week after a 7-day waiting period. Benefits last for a maximum of 25 weeks.

LTD covers 60% of your monthly earnings up to $15,000 per month after a 180-day waiting period. Benefits last as long as you meet eligibility requirements up to your normal retirement age.

Employee Assistance Program (EAP)Penumbra offers a confidential EAP at no cost to you. The EAP provides 6 face-to-face consultations per issue per year and 24/7 online and telephonic support for family, financial, and legal issues.

Auto and Home InsuranceAuto and Home insurance provides access to personal lines of property and casualty insurance at a discounted cost. Contact MetLife for a quote.

Critical Illness InsuranceCritical Illness insurance can help pay for expenses related to the diagnosis of a critical illness such as a heart attack, coma, kidney failure, or cancer. Log on to UltiPro for the cost.

Legal Services Plan The Legal Services plan provides a free 30-minute consultation, discounted attorney fees, and covered legal services such as wills, traffic disputes, and adoption. Log on to UltiPro for the cost.

401(k) PlanThe 401(k) plan allows you to set aside money before taxes to save for retirement. Contributions cannot exceed the annual maximum limit, including the additional catch-up amount, set by the IRS. Penumbra offers a discretionary match. Log on to www.mybenefitsnow.com/penumbra for details.

Employee Stock Purchase Program (ESPP)Penumbra offers an ESPP, which gives you the opportunity to buy stock at a 15% discount twice a year through payroll deductions. For questions, email [email protected].

Additional Benefits

Carrier Contacts Coverage Vendor Phone Website401(k) Plan Empower 1-800-338-4015 www.empowermyretirement.comCritical Illness MetLife 1-866-626-3705 www.metlife.com/mybenefitsDental MetLife 1-800-942-0854 www.metlife.com/mybenefits

Employee Assistance Program Concern 1-800-344-4222 https://employees.concernhealth.comCompany Code: PenumbraFSA & Commuter Benefits Navia 1-800-669-3539 www.naviabenefits.comHealth Savings Account HealthEquity 1-866-346-5800 www.healthequity.com

Legal Services MetLife 1-800-821-6400 www.info.legalplans.com Access Code: GetLawLife, AD&D & Disability Cigna 1-800-362-4462 www.cigna.com

MedicalBlue Shield of California 1-888-256-1915 www.blueshieldca.com

Kaiser Permanente (CA) 1-800-464-4000 www.kp.org

Vision VSP 1-800-877-7195 www.vsp.com

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2020 benefits snapshot - amazon web services€¦ · this benefits snapshot provides you with an...

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