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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.

2022 Annual Enrollment Information

2022 Annual Enrollment 11/2 Session Recording

2022 Annual Enrollment 11/10 Session
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Qualified Life Status Events

Once you make your enrollment selections during open enrollment or as a new hire, those elections are binding until next Open Enrollment Period or Qualifying Life Status Event.

If you experience a qualified life status event, you have 30 days to report the event and request applicable benefit changes. Please log a HR Ticket. Include any paperwork that would provide documentation of the qualifying life event.

Qualified life status events that are effective within 30 days of the event include:

Example of Documentation

• Birth certificate or application for a birth certificate
• Adoption record or placement for adoption
• Legal guardianship document
• Court order or child support order
• Verification of Birth from Hospital Letter/Form

Example of Documentation

• Marriage license (include proof of coverage for at least one, subscriber or spouse)
• Partnership affidavit
• Municipal domestic partnership registration
• State domestic partnership registration
• State Civil Union License

Example of Documentation

• Death certificate or public notice of death and proof of prior qualifying health coverage within the last 60 days

Example of Documentation

• Letter or document from employer stating the employer changed, dropped, or will drop coverage or benefits for the employee, spouse or dependent, including the date coverage ended or will end
• Letter from health insurance company showing coverage termination date
• COBRA documentation showing length of coverage with beginning and end dates

Example of Documentation

• Divorce or annulment papers including the ending of health care responsibility and proof of prior qualifying health coverage within the last 60 days

Example of Documentation

• Proof of prior qualifying health coverage within the last 60 days

Change of Address

• Update your new address in ADP (Ex. Copy of Housing Lease, Home Purchase Doc.)

Example of Documentation

• Documentation from Department of Health and Human Services indicating the reason for loss and when coverage ended or will end
• Letter from Medicaid or Children's Health Insurance Plan (CHIP) stating when coverage ended or will end
• Moved out of plan area or moved into new plan area
• Proof of prior qualifying health coverage within the last 60 days and one of the following:
• Official school documentation, including enrollment or housing documentation
• Letter from current or future employer that you relocated for work
• Green card, education certificate or visa if you moved to the U.S. from another country

Examples of Other Events

• Letter from school stating when student health coverage ended or will end
• Dated copy of military discharge papers or Certificate of Release including the date coverage ended or will end due to no longer active military service
• Letter or notice from government program, like TRICARE, Peace Corps, AmeriCorps, or Medicare stating when coverage ended or will end
• Document from the Department of Corrections, jail or prison indicating release or parole, including an order of parole, order of release or an address certification

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