Health

Health

Medical

Your benefit needs change as your life changes. Whether you’re just out of college, have an active family, or are getting close to retirement, we offer plans that fit your stage of life. Taking the time to research your options will help you make the most of the benefits available to you and choose the right coverage for you and your family. We understand that information is key when it’s time to make choices about your health benefits. We encourage you to carefully review the plans and select the right coverage for your unique needs.

United Healthcare PPO Medical Plans

The United Healthcare PPO medical plans give you the option to seek medical treatment from a contracted medical provider, at negotiated rates, or from an out-of-network provider, at an additional cost. You must pay a copay for select services, apart from preventive care, which is covered in full.

Other services may be subject to the annual deductible and coinsurance. Once you reach the out-of-pocket maximum, the plan will pay 100% for all eligible expenses for the remainder of the plan year. While you can visit any doctor, you’ll save the most money by using in-network providers.

Consider the Annual Deductible and Annual Out of Pocket Maximum for each plan with the Per Year Cost when selecting your plan.

United Healthcare PPO 250

Policy # 909202 | Phone: (866) 633-2446 | www.myuhc.com | Summary of Benefits CA, non-CA

Employee
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
Per Paycheck
$0.00
$323.92
$215.53
$566.79
Per Year
$0.00
$7,774.08
$5,172.72
$13,602.96
Annual Deductible + Annual Out of Pocket Maximum (In-Network)
$250 & $2,250
$500 & $4,500
$500 & $4,500
$500 & $4,500
Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner Imputed Income Rate Table coverage).

United Healthcare PPO 1500

Policy # 909202 | Phone: (866) 633-2446 | www.myuhc.com | Summary of Benefits CA, non-CA

Employee
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
Per Paycheck
$0.00
$235.69
$144.06
$443.28
Per Year
$0.00
$5,656.56
$3,457.44
$10,638.72
Annual Deductible + Annual Out of Pocket Maximum (In-Network)
$1,500 & $4,500
$3,000 & $9,000
$3,000 & $9,000
$3,000 & $9,000
Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner Imputed Income Rate Table coverage).

United Healthcare PPO HSA

Policy # 909202 | Phone: (866) 314-0335 | www.myuhc.com | Summary of Benefits

With the United Health Care High Deductible Health Plan, you can receive medical services from in-network or out-of-network providers. You pay for all medical services until you reach the annual deductible, except for in-network preventive care which is covered in full.

After your annual deductible is met, the plan pays for a percentage of covered services known as coinsurance. When you reach the out-of-pocket maximum, the plan will pay 100% for all eligible expenses for the remainder of the calendar year. When you enroll in the HDHP, you are eligible to open a Health Savings Account (HSA) to help pay for eligible health care expenses (deductibles, coinsurance, and prescriptions) with pre-tax dollars.

Employee
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
Per Paycheck
$0.00
$161.17
$83.20
$337.65
Per Year
$0.00
$3,868.08
$1,996.80
$8,103.60
Annual Deductible + Annual Out of Pocket Maximum (In-Network)
$2,800 & $3,000
$5,600 & $6,000
$5,600 & $6,000
$5,600 & $6,000
Rimini Street will deposit up to $1,500 annually for individual coverage and up to $2,500 annually for family coverage. Rimini Street contributions to the HSA are pro-rated based on your effective date in the HSA plan. Mid-year hires will have their contributions pro-rated.
Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner Imputed Income Rate Table coverage).

Kaiser HMO (California Only)

With the Kaiser HMO, you are restricted to using providers within the Kaiser HMO network and the plan requires that you select a Primary Care Physician (PCP) to coordinate all your health care needs, including arranging for hospitalization and referrals to specialists.

Kaiser

Policy # 063239 | Phone: (800) 464-4000 | www.KP.org | Summary of Benefits

Employee
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
Per Paycheck
$0.00
$151.07
$122.39
$266.34
Per Year
$0.00
$3,625.68
$2,937.36
$6,392.16
Annual Deductible + Annual Out of Pocket Maximum (In-Network)
$1,500
$3,000
$3,000
$3,000
Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner Imputed Income Rate Table coverage).

Medical Dependent Eligibility

  • Your spouse or domestic partner. Documentation of your Marriage/ Domestic Partnership for benefits will be needed before enrollment can be approved. Please note: after tax contributions and imputed income may apply when covering a domestic partner.
  • Your child(ren), your spouse’s / domestic partner’s child(ren), your foster child(ren), the minor(s) you have legal guardianship of are eligible for medical coverage until age 26, regardless of marital or student status.

Dental

Rimini Street offers dental coverage through Delta Dental. Delta Dental plan covers most preventive, restorative, orthodontia and major dental procedures. Preventive care, including routine exams and cleanings are covered at 100% with no deductible.

Preferred provider organization (PPO): As with a health insurance PPO, these plans come with a list of dentists that accept the plan. You have the option of going out of network, but your out-of-pocket costs will be higher.

Delta Dental PPO

Policy # 4103 | Phone: (800) 765-6003 | www.deltadentalins.com | Summary of Benefits

Employee
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
Per Paycheck
$0.00
$27.02
$34.52
$60.15
Per Year
$0.00
$648
$828.48
$1,443.60
Annual Deductible + Annual Out of Pocket Maximum (In-Network)
$50 & $1,500
$150 & $1,500
$150 & $1,500
$150 & $1,500
Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner Imputed Income Rate Table coverage).

Dental Dependent Eligibility

  • Your spouse or domestic partner. Documentation of your Marriage/ Domestic Partnership for benefits will be needed before enrollment can be approved. Please note after tax contributions and imputed income may apply when covering a domestic partner.
  • Your child(ren), your spouse’s / domestic partner’s child(ren), your foster child(ren), the minor(s) you have legal guardianship of are eligible for medical coverage until age 26, regardless of marital or student status.

Vision

Rimini Street offers vision coverage through Vision Service Plan (VSP). Keep your vision clear and your eyes in good health with regular eye exams. VSP vision coverage offers an extensive network of optometrists and vision care specialists. You have the choice to see any provider, but you’ll save money by visiting VSP’s in-network providers.

The Vision Service Plan (VSP) network of providers includes both optometrists and ophthalmologists. To see if your vision provider is in-network, visit VSP find a doctor. To find an in-network provider visit www.vsp.com *VSP does not send out ID Cards.

Vision Service Plan PPO*

Policy # 30023839 | Phone: (800) 877-7195 | www.vsp.com | Summary of Benefits

*VSP does not send out ID Cards.

Employee
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
Per Paycheck
$0.00
$3.97
$4.08
$9.89
Per Year
$0.00
$95.28
$97.92
$237.36
Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner Imputed Income Rate Table coverage).

Vision Dependent Eligibility

  • Your spouse or domestic partner. Documentation of your Marriage/ Domestic Partnership for benefits will be needed before enrollment can be approved. Please note after tax contributions and imputed income may apply when covering a domestic partner.
  • Your child(ren), your spouse’s / domestic partner’s child(ren), your foster child(ren), the minor(s) you have legal guardianship of are eligible for medical coverage until age 26, regardless of marital or student status.

An important note with a Limited Purpose FSA and a High Deductible Health Plan with Health Savings Account participants are eligible to participate in the Limited Purpose Health Care FSA to set aside pre-tax dollars for eligible dental and vision expenses only.

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