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23.3: Case 2 - Galaxy Max, Inc., Employee Benefits Package

  • Page ID
    34255
  • Learning Objectives

    In this section we elaborate on the benefits and plan structure that can be expected in a sample employee benefits portfolio:

    • Features of each employee benefit (eligibility, costs, exclusions, etc.)
    • Group life insurance and any supplemental options
    • Group disability insurance and any supplemental options
    • Group health insurance plans
    • Flexible benefits
    • Defined benefit and/or defined contribution retirement plans
    • Explain the following laws within the Ideal Gas Law

    Preface

    This case, like Case 1, is a group project that is part of employee benefits classes taught by the author of this textbook. Following is the employee benefits portfolio of a compilation of the ten groups of the fall 2002 class (and some of the fall 2000 class), in the words of the students.The work of the following students is reflected in this case: Donna Biddick, Lavonnia Bragg, Katrina Brand, Heather Cartes, Robert Cloud, Maria Conway, Thomas Dabney Clay, Lillian Dunlevy, Daniel Fleming, Shannon Fowlkes, Caroline Garrett, Barbara Guill, Steven Hall, Georgette Harris, Shirelle Harris, Tyron Hinton, Tiffany Jefferson, Tennille McCarter, Pamela Nicholson, Hiren Patel, Susan Shaban, Carolyn Shelburne, Gaurav Shrestha, Stephanie Soucy, Christopher Speight, Cassandra Townsend, Geoff Watkins, and Tresha White, from fall 2002. Also included is the work of Margaret Maslak and Shelisa Artis from fall 2000. The case is a typical project that lasts for the students throughout the semester. The students present portions of the case as the material is covered in class. In most cases, the whole employee benefits portfolio of the hypothetical company created by the students is presented at the conclusion of the semester as part of the final grade. This case does not provide a long-term care coverage plan. Most of the retirement plans offered by the hypothetical employers of these projects are not realistic in terms of the amounts and variety. The students are requested to provide a defined benefit plan, a defined contribution plan, and a 401(k) plan in order to experience the workings of these plans. The students did not offer a complete cafeteria plan—only a flexible spending account.The students used information from the following companies and sources: Dominion Co., www.dominion.com; Dominion Virginia Power, http://www.dom.com/; Phillip Morris, USA, http://www.philipmorrisusa.com/en/cms/Home/default.aspx; Virginia Retirement System, www.state.va.us/vrs/vrs-home-htm; Henrico County, Virginia, www.co.henrico.va.us.; Minnesota Life, www.minnesotalife.com; A. M. Best Company, ambest.com; Federal Reserve Board, http://www.federalreserve.gov/; Stanley Corp.; Ethyl Corporation, www.ethyl.com/index.htm; Aetna, www.aetna.com; Anthem, http://www.anthem.com/; CIGNA, www.cigna.com; and more.

    Welcome, Galaxy Max Employees

    The Board of Directors and the corporate executives of Galaxy Max, Inc., have developed a comprehensive benefits package to meet the needs of our employees and their families. This handbook includes a brief overview of the organization and its structure and a detailed description of benefits related to group life insurance, health care, dental and vision coverage, flexible spending accounts, and retirement benefits. The information provided will enable you to understand your benefits. General information may be secured from the company’s Web site, www.galaxymax.com. Additional questions may be addressed to the Human Resources Department, 7500 Galaxy Max Road, Richmond, VA 23228; telephone 1-800-674-2900; e-mail hrgalaxymax@vcu.edu. Suggestions are always welcome as we continue to improve customer service.

    Background and Current Information

    • Galaxy Max, Inc. (the “Company”), is a multimillion-dollar business equipment retail chain established in 1985 to service the needs of companies and consumers.
    • The company specializes in direct sales and e-commerce of office equipment, business accessories, and computer hardware and software, and provides technical support for all facets of the industry involved in maintaining the business environment. The company plans to expand its service capabilities throughout the global marketplace.
    • The corporation is headquartered in Richmond, Virginia, and has one retail outlet and two regional stores in northern Virginia and the Tidewater area (see Figure 23.4 ).
    ee23dd14bab690017f06931e6560755f.jpgFigure \(\PageIndex{1}\): Galaxy Max, Inc., Organizational Structure

    Employee Description

    Galaxy Max employs 758 staff members: 338 full-time salaried and 420 hourly employees. Our rapid growth in size and value allows us to provide a substantial benefit package to salaried and full-time employees.

    Employee Benefits

    Galaxy Max has developed a competitive and comprehensive benefits package for our employees because we value their service to the organization and we want to maintain a healthy, motivated, and high-quality staff. Our commitment to employees is to support their personal needs and financial goals for retention and to reward dedicated individuals. The benefits package is summarized in Table 23.9.

    Table 23.9 Galaxy Max Benefits Package
    Full-Time Salaried Employees (32 or More Hours per Week) Hourly and Part-Time Employees
    Group term life insurance None
    Short- and long-term disability None
    Health Optional
    Dental Optional
    Flexible spending account Flexible spending account
    Defined benefit plan Defined benefit plan available for those working more than 1,000 hours per year
    Profit-sharing plan Profit-sharing plan available for those working more than 1,000 hours per year
    401(k) plan with matching 401(k) plan with matching available for those working more than 1,000 hours per year

    Mission Statement

    Galaxy Max is committed to providing superior customer satisfaction in administering sales and service to consumers while maintaining competitive prices, quality products, and active growth within the international business community. We strive for technological advancement and excellence in the delivery of services, and we promote partnerships.

    Part I: Group Insurance Benefits

    Life Insurance

    Galaxy Max provides you with basic life insurance at one times your annual base pay (1 × annual salary) at no cost to you. Benefits are rounded to the next higher $1,000. The minimum benefit is $5,000. You may purchase supplemental coverage. The maximum benefit is five times your current annual base pay or $1,000,000, whichever is less. Table 23.10 outlines the main features of the company’s life insurance plan. The cost of supplemental life insurance coverage is shown in Table 23.11.

    Table 23.10 Group Term Life Insurance: Major Plan Provisions
    Benefits Basic life insurance is equal to one times your annual base pay—employer pays Additional coverage up to five times your annual base pay as supplemental coverage—you pay (see costs in Table 23.11)
    Added coverage for dependents—you pay (see costs in Table 23.11)
    Accidental death and dismemberment (AD&D)—employer pays
    Waiver of premium in case of disability (life coverage continues without charge)—part of the basic coverage
    Convertibility (in case of termination of the term life, you can convert the policy to whole life policy without evidence of insurability)—part of basic coverage Accelerated benefits (living benefits)—in case of becoming terminally ill, you can collect up to 50 percent of the policy benefits while still living—part of basic coverage
    Eligibility Regular, full-time employees (working 32 hours per week or more) who are active at work
    Enrollment Coverage is automatic
    When coverage begins 30 days after employment date
    Cost The company pays the full cost of basic life insurance; you pay for any additional coverage (supplements of 2×, 3×, 4×, or 5× annual salary, and for dependent coverage)
    Evidence of insurability For basic coverage paid by the employer, no evidence of insurability is required
    For supplemental amounts greater than $150,000, evidence of insurability is required
    Provider, A.M. Best Rating Minnesota Life (Minnesota, USA), A++ Rating
    Taxes Premiums on coverage greater than $50,000 are taxable income to you (based on IRS Table PS-58)
    Death benefits paid to the beneficiary are not taxed
    Table 23.11 Costs for Supplemental Life and Dependent Life
    Supplemental Term Life
    Age Cost per Month per $1,000 of Coverage Age Cost per Month per $1,000 of Coverage
    29 and under $0.06 50–54 $0.42
    30–34 $0.07 55–59 $0.69
    35–39 $0.09 60–64 $1.10
    40–44 $0.15 65–69 $2.00
    45–49 $0.25 70 and over $3.60
    Dependent: Rates for Spouse
    Amount Cost
    $5,000 $0.58
    $10,000 $1.15
    $15,000 $1.73
    $20,000 $2.31
    $25,000 $2.88

    Beneficiary

    The employee names the beneficiary. It cannot be the employer.

    Termination

    Coverage shall terminate automatically when any of the following conditions exist:

    • The employee terminates employment.
    • The employee ceases to be eligible.
    • The policyholder terminates the master contract.
    • The insurer terminates the master contract.
    • Contributions have not been made.

    Important Features of Your Life Insurance Plans

    • Wavier of the payment of your premium if you become disabled
    • The right to convert to an individual policy if you terminate your employment
    • Accelerated benefits if you become terminally ill

    Accelerated Benefits

    If a covered employee is diagnosed with a qualifying condition, the employee may request that an accelerated benefit be paid immediately. The amount payable is 50 percent, up to a maximum benefit of $50,000. Qualifying conditions include the following:

    • The diagnosis of a terminal illness that is expected to result in death within six to twelve months
    • The occurrence of a specified catastrophic illness, such as AIDS, a stroke, or Alzheimer’s disease

    Dependent Life Insurance

    Life insurance on a spouse can be purchased by full-time employees in increments of $5,000 up to $25,000. Life insurance on children can be purchased in the amount of $5,000 per child.

    Accidental Death and Dismemberment

    Benefits under the accidental death and dismemberment (AD&D) plan are in addition to any benefits payable under the life insurance plan. AD&D benefits are payable in the event of an accident resulting in the following:

    • Your death
    • Loss of one or more of your body parts (such as hand or foot)
    • Loss of sight in one or both eyes

    Table 23.12 outlines the main features of the Company’s AD&D plan. If you survive an accident but sustain certain injuries, AD&D benefits would be payable as shown in Table 23.13.

    Table 23.12 AD&D Plan Provisions
    Benefit In case of accidental death, the basic and supplemental amounts are doubled (in case of a loss, see Table 23.13)
    Eligibility Regular, full-time employees (working 32 hours per week or more) who are active at work
    Enrollment Coverage is automatic
    When coverage begins 30 days after employment date
    Cost The company pays the full cost of basic AD&D insurance; you pay for any additional coverage (supplements of 2×, 3×, 4×, or 5× annual salary)
    Evidence of insurability Same as for regular group term life
    Provider, A.M. Best Rating (periods as elsewhere) Minnesota Life, A++ Rating
    Table 23.13 AD&D Loss Provisions
    If You Have This Loss You Will Receive This Percentage of Your AD&D Coverage
    Loss of hand 50%
    Loss of foot 50%
    Loss of eye 50%
    Multiple loss 100%

    Life insurance will not pay out if you survive an accident; it pays only in the event of your death.

    Losses not covered under AD&D include the following:

    • Bodily or mental infirmity
    • Disease, ptomaine, or bacterial infection, unless resulting directly from the injury or any resulting surgery
    • Medical or surgical treatment, unless resulting directly from the injury or any resulting surgery
    • Suicide or attempted suicide while sane or insane
    • Intentionally self-inflicted injury
    • War or any act of war, whether declared or undeclared

    Provider

    Life insurance is provided by Minnesota Life Insurance Company, which is rated A++ by A.M. Best.

    Life Insurance Loss/Benefit Examples

    Life Insurance Example 1

    A forty-year-old employee making annual base salary of $45,000 dies in an automobile accident. He had chosen to purchase supplemental insurance for both life (one times salary) and AD&D (one times salary).

    Beneficiary will receive the following:

    • 1 times pay or $45,000 from Minnesota Life for basic life
    • 1 times pay or $45,000 from Minnesota Life for AD&D
    • 1 times pay or $45,000 for his supplemental life
    • 1 times pay or $45,000 for his supplemental AD&D

    Total received is $180,000.

    Life Insurance Example 2

    A life insurance claim was filed by Mary Jones after the death of her husband, Robert, in June 2002. He died after a short battle with cancer. He was a full-time employee at Galaxy Max for five years and his salary at the time was $55,000 annually. He has life insurance in the amount of three times his salary: \($55,000 × 3 = $165,000\). Therefore, his benefit is $165,000, payable to his beneficiary, which is his spouse, Mary Jones. Mrs. Jones filed the claim within two weeks of Mr. Jones’s death. Mrs. Jones had to present a copy of his death certificate and fill out the required forms. She was informed that she would receive her benefit within sixty days from the date of the claim.

    Mrs. Jones has chosen to receive the life insurance benefit in a lump-sum payment. She received this payment fifty-eight days from the date of the claim.

    Internal Revenue Service Code Section 101 provides that the death benefits are not counted toward taxable income.

    Sick Leave, Short-Term Disability, and Long-Term Disability

    Table 23.14 summarizes all the disability plans provided by Galaxy Max.

    Table 23.14 Sick Leave, Group Short-Term Disability, and Group Long-Term Disability—Major Plan Provisions
    Benefits Sick leave—7 days, 100% of pay
    STD (7 days to 6 months)—80% of pay up to $5,000 benefit per month
    LTD (6 months to age sixty-five)—60% of pay up to $6,000 benefit per month coordinated with workers’ compensation and Social Security
    Eligibility Regular, full-time employees (working 32 hours per week or more) who are active at work
    Enrollment Coverage is automatic
    When coverage begins 30 days after employment date
    Cost The company pays the full cost of STD; employee pays for LTD through payroll reduction
    Definition of disability Sick leave and STD—unable to do your own job due to nonoccupational injury or illness
    LTD—from 6 months to 2 years, unable to do any job relating to your training and education; after two years, unable to do any job
    Evidence of insurability Required if joining after open enrollment
    Provider, A. M. Best Rating Sick leave and STD—self-insured
    LTD—Aetna (rated “A” for excellent by A.M. Best)
    Taxes Employees do not pay taxes on premiums paid by employer for STD; but in the case of receiving benefits, taxes will be paid on the benefits
    For LTD, employee pays the premium from income after taxes, and benefits in the case of disability are nontaxable

    Sick Leave

    Benefits

    The employee will receive regular pay for time missed due to illness or injury (nonoccupational) up to seven days per calendar year.

    Cost of Sick Time

    Galaxy Max pays for sick leave from its operating budget.

    Short-Term Disability

    Definition of Disability

    “Disability” is the total and continuous inability of the employee to perform each and every duty of his or her regular occupation.

    Benefits

    Short-term disability (STD) benefits are 80 percent of salary up to $5,000 per month after a seven-day waiting period. The maximum length of the benefit is six months. There is no integration of benefits under short-term disability.

    Premium

    Galaxy Max pays STD premiums and deducts such as normal business expense. Galaxy Max will continue to pay premiums for disabled employees.

    Exclusions

    An employee cannot collect STD benefits under the following conditions:

    • For any period during which the employee is not under the care of a physician
    • For any disability caused by an intentionally self-inflicted injury
    • If the employee is engaged in any occupation for remuneration
    • If the disability was incurred during war, whether declared or undeclared
    • If the disability was incurred while participating in an assault or felony
    • If the disability is mental disease, alcoholism, or drug addiction
    Termination

    Disabled employees will not be considered terminated and, when able to return to work, will not have to satisfy any waiting period for coverage.

    Long-Term Disability

    Definition of Disability

    Long-term disability (LTD) is defined as the total and continuous inability of the employee to engage in any and every gainful occupation for which he or she is qualified or shall reasonably become qualified by reason of training, education, or experience for the first two years. After two years, it is the inability to engage in any gainful employment.

    Benefits

    LTD provides for the following:

    • LTD benefit amount is 60 percent of your basic monthly earnings, to a maximum monthly benefit of $6,000.
    • Monthly LTD benefit will be reduced by amounts received from other benefit programs such as Social Security, workers’ compensation, and any other coinciding retirement plan. However, your monthly benefit can never be less than 10 percent of the gross benefit or $100, whichever is greater.
    • LTD benefit is 60 percent of your basic monthly earnings to a maximum benefit of $6,000 per month. Your benefit is coordinated with (that is, reduced by) other income benefits received.

    “Basic monthly earnings” means your monthly salary in effect just prior to the date disability begins. It includes earnings received from commissions and incentive bonuses but not overtime pay or other extra compensation. Commissions and incentive bonuses will be averaged for the thirty-six-month period of employment just prior to the date disability begins.

    Cost of Coverage

    The employee will pay the full cost through payroll deduction. The Human Resources representative will advise of the contribution amount, which is based on a rate per $1,000 of your annual base pay. The cost of coverage is determined by the insurance company, Aetna (rated “A” for excellent by A.M. Best). Galaxy Max will notify you in advance in the event of a rate change.

    LTD Exclusions

    An employee cannot collect LTD benefits under the following conditions:

    • Any disability caused intentionally
    • Any period not under the care of a physician
    • Active participation in a riot
    • War, declared or undeclared, or any act of war
    Taxation

    Because the employee pays the entire premium from income after taxes, benefits are not taxable to the employee.

    Rehabilitation

    A disabled employee may enter a trial work period of up to two years in rehabilitative employment. During this time, benefits will be reduced by 50 percent. If the trial is unsuccessful, original long-term benefits will resume without penalty.

    Termination

    Disabled employees will not be considered terminated and, if able to return to work, will not have to satisfy any waiting period for coverage. Long-term disability coverage cannot be converted upon termination of employment.

    Health Insurance Coverage

    Galaxy Max offers two plans for health insurance, an HMO and PPO. The broad benefits are described in Table 23.15. The medical plans pay the cost of necessary and reasonable medical expenses for non-work-related illness or injury and are completely optional.

    Table 23.15 Health Plan Provisions
    Benefits You have a choice between an HMO and a PPO.
    Eligibility Regular, full-time salaried and part-time employees scheduled to work at least 32 hours per week and their eligible dependents: spouse; unmarried dependent child under age 19, or under age 25 in school full-time; disabled dependent child; eligible child with qualified medical child support order.
    Enrollment You may enroll when eligible. You may elect to enroll eligible dependents for extra charges provided they meet the qualifications of a “dependent.”
    Annual open enrollment period for current plan participants is October 1 to November 1 every year. Changes made during open enrollment become effective January 1 the following year.
    Waiting period 30 days after the first day of employment
    Coverage categories Employee only
    Employee and child(ren)
    Employee and spouse
    Employee and family
    Cost You and Galaxy Max share the cost of coverage (see Table 23.17 "Employee Premiums")
    What is covered Medically necessary services and supplies
    Inpatient and outpatient hospital care
    Doctors’ care and treatment
    Home or office visits
    Prescription drugs
    In-patient and out-patient mental health care
    Routine physical exams and preventive care (in network only)

    Insurers

    Galaxy Max has chosen Healthkeepers, Inc., for HMO coverage. Healthkeepers’ most recent A.M. Best rating is “A” (excellent). Cigna Healthcare of Virginia, Inc., is Galaxy Max’s PPO provider and has also earned A.M. Best’s rating of “A.” Benefits paid are at the discretion of the insurance companies.

    Benefits

    The benefits under each plan are explained in Table 23.16.

    Table 23.16 HMO and PPO Plan Benefits
    HMO PPO in Network PPO out of Network
    Annual Deductible
    None None $300/individual, $600/family
    Outpatient Care
    Copay per Visit ($) Coinsurance (%) or Copay ($) per Visit Coinsurance (%) per Visit
    Primary care physician $10 $15* 30%
    Diagnostic labs/X-rays Fully covered 10% 30%
    Preventive care $10 $15† 30%
    Well-baby care $10; no age limit $15 plus 10% of screening and diagnostic tests; through child’s seventh birthday† 30%
    Maternity care for all routine pre and postnatal care of mother rendered by ob/gyn Routine care fully covered; $10 for diagnostic testing $15 for initial visit if doctor submits one bill after delivery 30%
    Mammogram screenings $20 20% 30%
    Ob/gyn visit (includes pelvic exam, breast exam, and pap smear) $10 $15 30%
    Specialist office visit $20 with PCP referral $15 30%
    Emergency services $50 (waived if admitted) $50 plus 20%; $15 for doctor’s services 30%
    Annual vision exams $10 no
    Out-patient surgery $75 $50 plus 20%; $15 for doctor’s services 30%
    Out-patient nonsurgical services $20 $50 plus 20%; $15 for doctor’s services 30%
    Mental health and substance abuse $20 26 visits per calendar year: $15 for visits 1–13; 50% for visits 14–26 30%
    Home health care Fully covered Fully covered 30%
    Out-patient physical, speech, and occupational therapy $20 (90 days maximum) § limits per calendar year: physical, $2,000; speech, $750; occupational, $2,000 30%
    In-Patient Care (Preauthorization Required)
    Copay per Visit ($) Coinsurance (%) or Copay ($) per Visit Coinsurance (%) per Visit
    Hospital care for illness, injury, or maternity in a semiprivate room $250 per admission $250 plus 10% per admission 30%
    In-hospital physician’s services Fully covered 10% 30%
    In-patient mental health and substance abuse $250 per admission§ $250 plus 10% per admission 30%
    Skilled nursing facility care Fully covered (limited to 100 days per illness or condition)§ 20% (limited to 100 days per illness or condition) 30%
    Durable medical equipment and supplies Fully covered up to $1,000 per calendar year§ 10%; limited to $5,000 per calendar year§ 30%
    Hospice services Fully covered for patients diagnosed with a terminal illness with a life expectancy of 6 months or less Fully covered for patients diagnosed with a terminal illness with a life expectancy of 6 months or less 30%
    Annual Out-of-Pocket Expense Limit Through Deductibles, Coinsurance, and Copayments for Covered Services
    Individual $1,000 $2,000 $4,000
    Family $2,000 $4,000 $8,000
    Lifetime Maximum
    $500,000 $750,000 $750,000
    * Primary care physician or specialist visit.
    † Coverage includes annual checkups, annual gynecological exam and pap smear, prostate specific antigen (PSA) test and prostate exams for men age forty and over, one baseline mammogram for women ages thirty-five to thirty-nine, annual mammogram for women age forty and over, and annual colorectal cancer screening; up to $200 per calendar year for family members age seven and older for all other routine immunizations, labs, and X-rays done in connection with annual checkups whether received in-network or out-of-network.
    † No coinsurance for immunizations.

    Financing

    Galaxy Max will pay a generous 85 percent of the health care premiums. Table 23.17 lists employee obligations.

    Table 23.17 Employee Premiums
    Plan HMO PPO
    Biweekly premium per insured $35.67 $51.09
    Each additional dependent $12.00 $18.00

    Coverage Area

    The PPO is comprised of specific in-network offices. Consult your Benefits Liaison for a complete list of providers in your area. All employees residing in Virginia are considered in-area.

    Exclusions

    The items listed below, among others, are not covered in any of the plans. If you have any questions regarding the coverage of a treatment or service, you must contact the appropriate provider.

    • Treatment that is not medically necessary in accordance with the designated insurers
    • Experimental drugs or investigative procedures
    • Chiropractic services

    Termination of Coverage

    Coverage is terminated at the following times:

    • The date on which employment terminates
    • The date on which the employee becomes ineligible
    • The end of the last period for which the employee has made any required contributions
    • Dependent coverage is terminated in the following cases:
    • The date on which the dependent ceases to meet the definition of a dependent
    • The date on which the dependent receives the maximum benefit of major medical coverage

    Conversion

    The employee may convert to individual health coverage within thirty-one days of losing eligibility. Galaxy Max complies with all local, state, and federal legislation with regard to group health plans.

    COBRA

    The Consolidated Omnibus Budget Reconciliation Act (COBRA) extends coverage for eighteen to thirty-six months following a qualifying eventA qualifying event is a marriage or divorce, adoption of a child, death of a covered dependent, a change in status or eligibility of a dependent, and so forth. that causes the employee to lose eligibility. The employer does not have to pay the premium, and the premium may be increased to a maximum of 102 percent of the group rate. The employee may elect COBRA within sixty days of the qualifying event. As noted above, the thirty-one-day period of conversion may be applied after COBRA coverage. COBRA does not protect an employee who is fired for cause.

    HIPAA

    The Health Insurance Portability and Accountability Act (HIPAA) forbids insurers from imposing preexisting-condition exclusions when an eligible individual transfers from one plan to another. After you have been covered in a health plan for twelve months, preexisting-condition exclusions are no longer in effect. Prior coverage would not qualify if there is a break in health insurance coverage for more than sixty-three days.

    Group Dental

    Group dental provides coverage for any dental work you may incur. Like group medical, group dental has many variations, and coverage can be obtained from two different providers. However, there are some clear differences between the two plans. For example, group dental plans are more likely to provide benefits on a fee-for-service basis but provide the benefits under a managed-care arrangement.

    Eligibility

    Full-time (thirty-five hours or more per week) and salaried employees are eligible to enroll for group dental coverage. You may enroll your spouse and child(ren) for an additional premium.

    Waiting Period

    You may enroll when eligible. Coverage becomes effective the first day of the month following employment. For example, if you start employment on the first of the month, coverage begins immediately.

    Plan Highlights

    Table 23.18 summarizes the key features of the dental plan, including benefits, types of service, and cost information.

    Table 23.18 Major Dental Plan Provisions
    Annual deductible $30 per person, with $90 family maximum
    Cost You and the company share the cost
    Plan maximums $1,000 per person per year
    $1,000 lifetime under age 19 for orthodontics
    Coverage Examples of Items Covered Plan Pays Up To …
    Preventive Nonorthodontics X-rays, oral exams, and cleaning of teeth 100% of reasonable and customary fees (R&C) for cleanings, X-rays, exams, fluoride treatments
    Restorative Fillings, extractions 80% R&C fillings, extractions
    Prosthodontics Replacement of natural teeth with bridgework or dentures 50% R&C for bridgework
    Orthodontics Straightening of teeth with braces 50% of R&C for orthodontic services

    Conversion

    Dental coverage cannot be converted to an individual policy if employment terminates. You, your spouse, or your dependent children may elect to continue coverage under the company’s dental plan as provided by COBRA if the original coverage ends because of one of the following life events:

    • Termination of employment by employee
    • Retirement
    • Disability
    • Death
    • Reduction in hours to less than full-time

    Provider

    Galaxy Max has chosen Cigna Corporation for dental coverage because the company has a strong presence in the insurance business and has been one of the leaders in coverage. Cigna’s A.M. Best rating is NR-5, meaning that they have not been formally evaluated for the purpose of assigning a rating opinion.

    Flexible Spending Account

    To accommodate the needs of our diverse work force, Galaxy Max has created a flexible spending account (FSA) plan to help employees to meet expenses that are not covered under any benefit plan. Money deposited in these accounts is not taxed when it goes into the accounts or when it is paid back to you. Employees can use these pretax dollars to pay for miscellaneous items such as eyeglasses or unreimbursed medical/dental expenses. This plan also allows employees to pay dependent care expenses with pretax dollars. Any amount not spent at the end of the plan year is forfeited by the employee (use it or lose it). See Table 23.19 for details. In addition, a premium conversion plan is offered to employees for payment of health insurance premiums on a pretax basis.

    Table 23.19 Summary of FSA: Major Plan Provisions
    Eligibility Regular, full-time salaried employees and part-time employees scheduled to work 1,000 hours or more during a year
    When coverage begins Employment date; or
    Each January, following annual open enrollment; or
    Date of life event
    When coverage ends Employment termination or your pay ceases for any reason (death, retired, or disabled)
    You or your survivors may continue to submit claims expenses incurred prior to the date you left the payroll
    Contributions Your selected contributions will be deducted from each pay before federal income tax and, in most cases, state income tax and Social Security tax are withheld
    Minimum annual contribution: health care and/or dependent day care: $120
    Maximum annual contribution: health care and/or dependent day care: $5,000
    Accounts Health care accounts for tax-deductible health care expenses
    Dependent day care accounts for work-related dependent day care expenses
    Maximums Health care: $5,000 per year to each account
    For dependent day care:
    Amount of spouse’s earnings, if less than $5,000
    Maximum of $2,500 if married and filing separate returns
    Reimbursement Eligible claims paid monthly
    Minimum claim of $10/month
    Claims must be received by administrator by April 1 for prior year’s expenses
    Unclaimed account balances must be forfeited

    Part II: Pension Plan

    Galaxy Max offers to its eligible employees a defined benefit pension plan. The pension plan is designed to provide you or your beneficiary with monthly benefit payments at retirement. The pension plan is funded entirely by the company; employees do not contribute. In addition, Galaxy Max offers a 401(k) plan and a profit-sharing plan.

    Defined Benefit Plan

    A defined benefit plan explicitly defines the amount of benefit available at retirement. Table 23.20 summarizes the major pension program provisions.

    Table 23.20 Defined Benefit Plan
    Benefit formula (1.3% of your final average salary up to the Social Security–covered compensation level) + (1.8% of your final average salary in excess of the Social Security–covered compensation level, if any) × (years of creditable service). See example in Table 23.21.
    Eligibility Full- or part-time employees who are scheduled to work or who actually work at least 1,000 hours in a twelve-month period are eligible
    Participation begins on your date of hire or your twenty-first birthday, whichever is later
    Normal retirement You may retire and receive normal retirement benefits the first day of the month on or after your sixty-fifth birthday
    Early retirement You may retire and receive an early retirement benefit on or before you reach age sixty-five
    You are eligible for early retirement on the first day of the month on or after your fifty-fifth birthday with three years of vesting service
    Insured Plan is insured by the Pension Benefit Guaranty Corporation
    Vesting You become fully vested when you complete three years of vesting service (including vesting service with an acquired company) or reach age sixty-five
    Vesting credit begins when you are eligible for the pension program

    Payments

    Your pension benefit is paid to you in monthly installments at the end of the month. Your benefits will be paid as a lump-sum payment if the present value of your pension is $5,000 or less. The normal form of benefit paid by the retirement plan is based on your marital status. Unless you elect a different option, you will receive your benefit in one of the following forms, which are actuarially equivalent:

    • If you are single, you will receive a single life pension.
    • If you are married, you will receive a 50 percent survivorship pension with your spouse as the beneficiary. If you are married and would like to receive your benefit in another form, you will need to provide your spouse’s written consent.

    The survivorship option pays you for as long as you live. When you die, benefits continue to be paid to your designated beneficiary, assuming your beneficiary survives you. Written spousal consent is required before you can designate a beneficiary other than your spouse. Benefits are reduced for the survivorship option because payments will be made over two lives rather than one. Payments depend on your age and your beneficiary’s age when you begin receiving payments. If you choose the survivorship option and your beneficiary dies before you do, your payment will be increased to the amount that you would have received under the single life option. Additionally, you may choose the amount (50 percent, 75 percent, or 100 percent) your surviving beneficiary will receive after you die.

    Formula and Calculations

    The traditional formula used in calculating your retirement benefit is based on your final average salary, your creditable service, and the Social Security–covered compensation level based on your age. Your retirement pension benefit may not be more than 100 percent of your final average salary, or $160,000 in 2002. These formula components are outlined below. See Table 23.21 for an example of how the formula works.

    Table 23.21 Example of Defined Benefit Formula
    Suppose Joe, a sales representative for Galaxy Max, was born in 1942 and retired after thirty years of service to Galaxy Max with a final average salary of $40,000. At the time of Joe’s retirement, the Social Security–covered compensation level is $37,212. To calculate Joe’s benefit:
    1. Multiply Joe’s final average salary, up to Social Security–covered compensation level, by the benefit percentage \($37,212 × 1.3% = $484\)
    2. Multiply Joe’s final average salary in excess of Social Security–covered compensation level by the excess benefit percentage \(($40,000 – $37,212) × 1.8% = $50\)
    3. Add amounts calculated \($448 + $50 = $534\)
    4. Multiply by years of service to calculate Joe’s annual retirement benefit \($534 × 30 = $16,018\)
    Thus, Joe’s annual pension benefit from Galaxy Max is $16,018.

    Final Average Salary

    Your final average salary is your highest average annual compensation during any consecutive sixty-month period. It includes base pay, commission payments, bonuses, and overtime.

    Creditable Service

    Your service with Galaxy Max, including approved leaves of absence up to six months, certain periods of military and public service, and periods in which you are totally disabled (as defined in the LTD plan), is considered your creditable service. Service for part-time work is reduced to the equivalent portion of the year worked.

    Social Security Compensation Level

    The average of the Social Security wage bases (maximum amount on which you pay Social Security taxes) for the thirty-five years before the date of your retirement is the Social Security compensation level that is used to calculate your benefits. These amounts change each year according to the Covered Compensation Table provided by the Social Security Administration.

    Vesting

    We at Galaxy Max chose to use a cliff vesting option. You become 100 percent vested after three years of creditable service. Our plan provides you with a cash settlement option if your employment at Galaxy Max is terminated. The cash settlement option is effective on your termination date. This distribution is considered taxable income in the year the distribution is made. The only exception to this rule is if you choose to shift this payment into an IRA.

    Loans

    Loans are not available under the retirement plan

    Distributions

    As a valued employee of Galaxy Max, you or your beneficiaries may choose one of the following distribution options:

    Guaranteed Payment

    You may choose to have your pension payments guaranteed for a certain period of time after retirement. The payment options include either five or ten years for a single life pension or five years for a survivorship pension benefit.

    Lump-Sum Payment

    You may request a lump-sum payment of $1,000 or more (in $100 increments) to your designated beneficiary from your pension benefit, payable after you die.

    Level Income Payment

    If you retire early and want to start receiving benefits before age sixty-two, you may choose this payment feature. You will receive larger benefit payments prior to age sixty-two and then receive lower benefit payments upon reaching age sixty-two. At age sixty-two, you will be eligible to receive Social Security benefits. The intent of this plan is to provide level retirement income before and after Social Security payments begin at age sixty-two.

    So … When Can I Retire and Receive Benefits?

    Depending on your age and length of service, you may choose normal retirement or early retirement. Normal retirement is when you retire at or after age sixty-five. If you choose this option, you will receive normal retirement pension benefits.

    Early Retirement

    You become eligible for early retirement benefits when you reach age fifty-five with three years of vested service. You can retire on the first day of any month on or after your fifty-fifth birthday. If you retire before you reach age sixty-five, the date you retire will be known as your early retirement date.

    Benefits for early retirement are less than normal retirement benefits because the plan adjusts the payment amount to allow the benefits to be paid over a longer period of time. The amount of your normal retirement benefit is available to you, without reduction, if you retire early on or after your sixtieth birthday. If you retire on or after your fifty-fifth birthday and before your sixtieth birthday, your pension benefit will be reduced, as explained in Table 23.22.

    Table 23.22 Early Retirement Reduction in Defined Benefit Plan
    If you retire between the ages of fifty-eight and sixty, your pension benefit will be reduced by 0.25% for each month that remains until your sixtieth birthday. For example, if you retire on your fifty-eighth birthday, your pension will be reduced by (24 months × 0.25% per month) = 6%. If you retire between the ages of fifty-five and fifty-eight, your pension will be reduced by that 6% plus an additional 0.50% for each month that remains until your fifty-eighth birthday. For example, if you retire on your fifty-sixth birthday, your benefit will be reduced by (6% + [24 months × 0.50% per month]) = 18%. This table shows the percentage your benefit would be reduced if you retired on your birthday.
    Retirement Age Benefit Reduction
    60 or older None
    59 3%
    58 6%
    57 12%
    56 18%
    55 24%

    The benefit in Galaxy Max’s defined plan is protected by the Pension Benefit Guaranty Corporation (PBGC). The cost of $19 per year per employee is paid by Galaxy Max.

    401(k) Plan

    Galaxy Max offers you a Section 401(k) plan, hereinafter referred to as the Galaxy Max 401(k) Plan, as a supplement to the retirement plan. You have the opportunity to put aside salary dollars on a pretax basis, and Galaxy Max makes employer-matching contributions to help build retirement savings more quickly. You can choose your own level of deferral, if any. The plan also offers you several investment options with varying portfolios to allow your savings to grow over time. Taxes are deferred on employer matching contributions, your pretax deferral, and investment returns until you withdraw the funds from your account.

    Eligibility

    All full-time and part-time employees are eligible. You become eligible for the Galaxy Max 401(k) Plan after completing one year of continuous service and must complete at least 1,000 hours of service during the year. Your enrollment commences on the first day of the month following the completion of that first year of service. You are not eligible to participate in the plan if you are no longer an employee as of fiscal year end or if you are a temporary employee.

    Maximum Contributions

    For employees under the age of fifty, the 2009 contribution limit is $16,500. If you are fifty years old or older, this limit is $22,000 in 2009.

    Employer Matching

    During each of your first five years of service, Galaxy Max will match 80 percent ($0.80 for every $1.00) that you contribute to the plan, up to 6 percent of your salary. After five years of service, our matching increases to 100 percent ($1.00 for every $1.00) that you contribute to the plan, up to 6 percent of your salary.

    Vesting

    Vesting is your right to the money in your 401(k) account. You are always 100 percent vested in the value of your own contributions and the earnings on your investments. You are vested on Galaxy Max’s matching contributions at the rate of 20 percent each year of service, and thus fully vested after five years. For example, if you left Galaxy Max three full years after joining the 401(k) plan, you would have the right to all your investments and their earnings and to 60 percent of the matching funds plus their earnings. The vesting schedule for the 401(k) matching contribution is summarized in Table 23.23 below.

    Table 23.23 Galaxy Max 401(k) Matching Contribution Vesting Schedule
    Completed Years of Service Percentage Vested on Employer’s Match
    1 20%
    2 40%
    3 60%
    4 80%
    5 100%

    Withdrawals

    In-service withdrawals for certain hardships are permitted under the Galaxy Max 401(k) Plan, as long as two conditions are met:

    1. The withdrawal must be necessary and follow severe financial hardships. Examples include the following:
      • Purchasing your primary residence
      • Preventing foreclosure or eviction from your primary residence
      • Paying for major uninsured medical expenses for you or your eligible dependents
      • Paying tuition, room and board, and related education expenses for the next twelve months for you or your eligible dependents to attend college
    2. The funds are not reasonably available from any other resources. The requirements are met if the following circumstances exist:
      • The distribution does not exceed the amount of the severe financial hardship
      • The employee has obtained all other forms of distributions other than hardship distributions

    Contributions will be suspended twelve months after the distribution and the maximum contribution in the next year will be reduced by the amount contributed in the prior year.

    Loans

    The minimum loan amount is $1,000. The maximum loan amount is the lesser of $50,000 or 50 percent of your vested balance. The following two types of loans are available under the plan.

    General-Purpose

    You can take between six and sixty months to repay a general-purpose loan.

    Primary Residence

    You can take between sixty-one and 180 months to repay this loan. Eligible residences include house, condominium, co-op, mobile home, new home construction, or land for new construction or mobile home.

    Investment and Investment Risk

    You bear the risk of investments in your Galaxy Max 401(k) Savings Account. However, you can choose from several investment funds through the SunTrust Classic Funds Family, commonly referred to as the STI Classic Funds. This will enable you to select your own desired level of risk.

    Investment funds range from a fixed income fund (with very low risk and corresponding low return potential) to higher risk equity funds with higher return potential. The funds that you may choose from are as listed:

    • Galaxy Max Stock Fund
    • STI Classic Small Cap Growth Stock Fund
    • STI Classic Mid-Cap Equity Fund
    • STI Classic Appreciation Fund
    • SunTrust 500 Index Fund
    • STI Classic Growth and Income Fund
    • STI Classic Value Income Stock Fund
    • STI Classic Investment Grade Bond Fund
    • STI Classic Short-Term Bond Fund
    • STI Classic Prime Quality Money Market Fund

    Termination

    You will be terminated from the Galaxy Max 401(k) Plan if you cease to be employed by Galaxy Max.

    Profit-Sharing Plan

    Over the past five years, Galaxy Max has been financially successful because of the dedication and talent of our valued employees. We started the profit-sharing program to give you the opportunity to share in the success of our wonderful company. The primary purpose of this plan is to help you build retirement income. Along with the Galaxy Max 401(k) Plan and the defined benefit plan, the profit-sharing plan can provide you with the foundation for a financially secure retirement.

    A profit-sharing plan is a qualified, defined contribution plan that features a flexible contribution by us. When you become eligible to participate, Galaxy Max will set up an individual account in your name. In other words, you do not need to enroll in the plan. Participation in the plan is automatic and you are not required or permitted to contribute personal funds into the plan.

    Eligibility

    The eligibility requirements for the Galaxy Max Profit-Sharing Plan are the same as the Galaxy Max 401(k) Plan. Please refer to that section.

    Contributions

    Each year, Galaxy Max will contribute a portion of its pretax income for profit-sharing purposes. The contribution is made after the end of each fiscal year. The amount allocated to your account is based on a formula that includes your compensation during the fiscal year. This contribution is made at the discretion of Galaxy Max and cannot be guaranteed every year.

    Profit-Sharing Formula

    Here is how the allocation formula works. Once you become a participant, we evaluate your eligible compensation (base pay, commissions, and bonuses) and the eligible compensation of all Galaxy Max employees. Your portion of the amount of profits we contribute is the proportion of your eligible compensation to that of all employees. For example, suppose that Galaxy Max will contribute $200,000 to the profit-sharing plan, your eligible compensation is $35,000, and the eligible compensation of all employees is $950,000. Your share would be $35,000/$950,000, or 3.68 percent, of $200,000. Therefore, the allocation to your account would be $7,368.42. These numbers are used only as an example. (The total contribution from Galaxy Max and eligible compensation from all employees is much larger.)

    Investing Your Profit-Sharing Account

    The plan’s trustee, SunTrust Bank, will invest contributions to your account. At the end of each fiscal year, investment earnings are allocated to your profit-sharing account. Because the value of your investments will fluctuate, you will assume the investment risk. Therefore, your account balance will increase or decrease in value from year to year.

    Profit-Sharing Account Balance

    Once all accounts have been reconciled for the fiscal year, you will receive an annual statement of your account. It will include your beginning balance, allocation of investment income, contributions, and ending balance. These statements are typically distributed to you four to five months after the fiscal year end.

    Vesting

    You begin earning ownership rights to your account once you complete three continuous years of service. After your second full year, you are 20 percent vested, and you earn another 20 percent each year. Once you complete six years of service, you are fully vested. If your employment ends because you become permanently disabled, die, or leave Galaxy Max after age sixty-five with at least five years of service, you and your beneficiary will be entitled to receive the full value of your account, regardless of your vesting. The vesting schedule for profit-sharing plan contributions is presented in Table 23.24 below.

    Table 23.24 Galaxy Max Profit-Sharing Contribution Vesting Schedule
    Continuous Vesting Service Vested Percentage
    Less than 2 years 0%
    2 years 20%
    3 years 40%
    4 years 60%
    5 years 80%
    6 years or more 100%

    Loans

    You may borrow from your profit-sharing account under the same provisions that apply to 401(k) loans. Please refer to that section for details.

    Distributions

    You can receive the vested portion of your account after you leave Galaxy Max, retire, or become permanently and totally disabled. Your designated beneficiary will receive your vested account balance if you die before receiving your benefit.

    If your vested account balance is $6,000 or less, you or your beneficiary will receive the payment in a single lump sum. If your account balance is more than $6,000, you or your beneficiary can take a single lump sum, receive annual installments for up to five years, or delay receiving distributions until a later time. Generally, you can roll over the vested portion of your account balance into another qualified retirement account or individual retirement account (IRA) so that you can defer paying federal income taxes.

    Termination from Plan

    You will be terminated from the plan if you cease to be employed by Galaxy Max.

    Limitations on Contributions

    For all three plans, certain legal limits are placed on contributions to your account. The combined annual contributions to your retirement plans cannot exceed $40,000 or 100 percent of your compensation, whichever is lower. This limit applies to both your and Galaxy Max’s contributions to your 401(k), profit-sharing, and defined benefit plans, unless the defined benefit plan requires (under the minimum required annual contribution) a greater annual contribution. Thus, in summary, all qualified retirement plans combined cannot exceed the $40,000 or 100 percent of compensation annual limit, unless more contribution is necessary to meet the minimum requirements under the defined benefit plans.

    Conclusion

    The management of Galaxy Max hopes that the benefits we offer are clear to you. Our studies indicate that our benefits package far exceeds the norms of our industry. We are very interested in your well-being, and this has motivated us to exceed our peer group’s offerings. Should you have questions, please contact the Human Resources Department, 7500 Galaxy Max Road, Richmond, VA 23228; telephone 1-800-674-2900; e-mail hrgalaxymax@vcu.edu. Suggestions are always welcome as we continue to improve service to our employees.

    Key Takeaways

    In this section you studied the employee benefits package of a hypothetical company (Galaxy Max, Inc.):

    • Each group benefit option in an employee benefits program is explained in terms of benefits, eligibility, enrollment requirements, waiting periods, employee costs, coverage exclusions, benefit providers, tax implications, and plan termination provisions.
    • Employees are able to add beneficiaries and dependents (subject to eligibility requirements) for applicable benefits.
    • Life insurance at one-time employees’ annual salary is a typical group benefit, with options to purchase supplemental coverage wholly funded by employees.
    • Sick leave and short- and long-term disability options may be partially subsidized by employers, with options for employees to purchase supplemental long-term coverage.
    • Group health insurance usually includes a mix of HMO, PPO, or high-deductible options provided at costs shared by employer and employee.
    • Flexible spending accounts are offered within a cafeteria plan or as a stand-alone option to help employees pay for qualified out-of-pocket costs with pretax dollars.
    • Retirement plans can be a combination of a traditional defined benefit plan and various defined contribution plans.
    • A benefits package should explain the benefit or contribution formula of retirement plans, include payment options, clarify the requirements of early withdrawals or loans, define normal retirement age (and implications of early retirement), and stipulate vesting provisions.
    • Limits apply to retirement plan contributions by employers and employees; benefit plans should give an understanding of employees’ contributions and investment options.

    Discussion Questions

    1. Why are employee benefits limited for part-time (versus full-time) employees?
    2. What is the purpose of a waiting period in employee benefits?
    3. Why would an employer enforce a minimum benefit limit on life insurance?
    4. Why is the definition of disability stricter in the case of LTD than in STD?
    5. When employees pay the LTD premiums, why aren’t benefits taxable as income?
    6. Why are long-term disability benefits coordinated with Social Security? What effect does this have?
    7. How is the survivorship pension payment option made equitable to the retiree in the event that his or her beneficiary dies first?
    8. How do vesting provisions protect employers?