A Guide to KPMGs 2015 Benefits Options
kpmg.com
The KPMG Benefits Program
When it comes to benefits, everyones needs are different. Thats why KPMG offers a variety of benefits from which to choose. Some are provided automatically once you become eligible. Others are optional, and you must contribute toward their cost.
This brochure provides a convenient summary of KPMGs benefits program. Once you join the firm, you will have access to more extensive details about our benefits programs.
If you have questions about any of our benefits, call KPMGs Human Resources Service Center at 1-888-ONE-HRSC (1-888-663-4772). The HRSC is open Monday through Friday, 7:00 a.m. to 5:00 p.m., Central Time.
Weve designed this brochure to provide general information about KPMGs benefits programs, practices, and policies. It is not intended to constitute a complete guide.
It is important to remember that individual situations do and will vary, and there are no guarantees of any particular benefit or program eligibility. Further, the programs, policies, and practices described herein do change from time to time, and KPMG reserves the right to make such changes or discontinue any programs, policies, or practices at any time and for any reason, subject to applicable federal, state, and local laws.
This brochure and the information, programs, policies, and practices mentioned within and associated with it do not create an employment contract. KPMG does not create any express or implied contractual rights by issuing this brochure or by offering the programs and benefits noted within. Employment at KPMG remains at will, which means that either you or the firm has the right to terminate your employment at any time, for any or no reason, with or without notice.
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Contents
HOW KPMGS BENEFITS PROGRAM WORKS Paying for Your Benefits 2
CHOOSING HEALTH INSURANCE Medical Care 3
Medical Plans 3
Important Information for All Non-HMO Plan Participants 6
Health Savings Account 7
Vision Care 9
Dental Care 10
Charts: Highlights of Our Medical Plans 1113
Chart: Highlights of Our Dental Plans 1415
Charts: Highlights of Our Vision Care Plans 1516
DISABILITY PLANS ShortTerm Disability 17
LongTerm Disability 17
LIFE INSURANCE PROGRAMS Life Insurance 18
BusinessTravel Accident Insurance 18
BusinessPleasure Accident Insurance 18
FLEXIBLE SPENDING ACCOUNTS Healthcare Flexible Spending Account 19
Dependent Day Care Flexible Spending Account 19
MYLIFE TO HELP MANAGE YOUR LIFE LifeWorks 21
Flexibility 21
GlobalFit 22
The iCan Series 22
MetLife Center for Special Needs Planning 22
Backup Care 23
KPMG Foundation 23
Special Offers and Discounts 24
RETIREMENT AND SAVINGS PLANS KPMG Pension Plan 25
KPMG 401(k) Plan 26
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A Guide to KPMGs 2015 Benefits Options 1
How KPMGs Benefits Program Works
When Your Coverage Becomes EffectiveCoverage becomes effective on the first day of the month following your date of hire under those benefits plans for which you pay all or part of the cost. Coverage under firm-provided benefits becomes effective on your date of hire. If your date of hire is on the first day of the month (for example, February 1), all coverage becomes effective on that date, provided you return your enrollment form(s) within 30 days of your date of hire. You must be actively at work on the benefits effective date for your coverage to begin.When you first become eligible, and each year thereafter, you will have the opportunity to enroll in KPMGs benefits plans. In addition, some benefits, such as personal days, short-term disability coverage, basic life insurance, and business-travel accident insurance, are provided automatically on your date of hire (your first day of active employment).
You also may elect coverage for eligible dependents, including your:
Legal spouse or domestic partner*
Children and stepchildren until the end of the calendar year in which he or she turns 26 years of age
To ensure that dependents enrolled in our health plans are eligible for coverage, you will be asked to provide supporting documentation to confirm the eligibility of your dependents that are enrolled in your health plan.
Children include:
biological children
adopted children from the time you become financially responsible for the child (this includes children born from a surrogate mother)
stepchildren
any other child you support who lives with you in a parent-child relationship for whom you are responsible under permanent court order
disabled children over age 26 who depend chiefly on you for support and maintenance
You may select benefits coverage as follows:
For you only
For you and your spouse
For you and your children
For your family (you, your spouse, and one or more children)
You may choose different coverage levels for different benefits. For example, if your spouse has medical benefits through his or her employer (but doesnt receive dental coverage), you may elect medical coverage for just you and your children and choose dental benefits for your entire family.
Paying for Your BenefitsKPMG pays the full cost of a number of your benefits, and some of the cost for other benefits. In some cases when you contribute toward the cost of your benefits, you may do so before taxes are withheld (on a pretax basis).
* Throughout this document, and for the purpose of enrolling in benefits offered by the firm, the term domestic partner refers to an individual who lives with an employee and is registered as a domestic partner with any state, county, or city that authorizes such registration. Anywhere the term spouse is used, it is understood to include both opposite and same gender domestic partners. In general, those benefits made available by KPMG to spouses also will be offered to domestic partners. Misuse of domestic partner benefits and/or the falsification of information for the purpose of obtaining such benefits are grounds for disciplinary action, up to and including termination of employment.
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A Guide to KPMGs 2015 Benefits Options 2
Choosing Health Insurance
Medical CareKPMG benefit-eligible employees have a number of medical plans from which to choose: Aetna HealthFund, Choice POS II, MED 2500, MED 5000, or one or more health maintenance organizations (HMOs). Regardless of which plan you choose, you receive comprehensive coverage for a variety of medical services.
Please note that your eligibility for any particular plan is determined by where you live. When you first enroll, and during each subsequent benefits enrollment period, your benefits enrollment form will list the plans available to you.
Earn Incentives to Reduce Your Medical Out-of-Pocket CostsIf you enroll in the Choice POS II or Aetna HealthFund plan you are eligible to earn incentives to reduce your healthcare out-of-pocket costs.
The medical plan you are enrolled in will determine how your incentive money will be applied. If you are enrolled in the Aetna Healthfund or Aetna Choice POS II
medical plans, you can earn up to an extra $200 for yourself or up to $400 for your family, to cover out-of-pocket medical costs. If you're enrolled in Choice POS II, your earned incentive credits will be applied to your deductible or coinsurance. If you're enrolled in Aetna HealthFund, your earned incentives will be added to your HealthFund.
Health Screenings with Quest Diagnostics: Your benefit plan includes coverage for biometric screenings available through Quest Diagnostics. The testing will screen for the following health and wellness indicators:
Blood Pressure (High, Low and/or Normal)
Cholesterol/Lipids (HDL and LDL)
Body Mass Index (BMI)
Blood Glucose/Blood Sugar
Triglycerides
Medical PlansAetna HealthFund
Aetna HealthFund is a consumer-directed health plan that allows you to select how your healthcare dollars are spent. The program has several components:
A $500 individual and $1,000 family HealthFund, provided by KPMG. Your first medical expenses, other than for prescription drugs, are paid out of your HealthFund. If you or your familys medical expenses exceed the HealthFund, subsequent expenses are applied to your remaining deductible ($900 individual or $1,800 family).
Once your deductible is satisfied, the plan will reimburse your covered expenses at 80 percent if network providers are used or 60 percent if non-network providers are used.
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A Guide to KPMGs 2015 Benefits Options 3
Preventive Care: The plan covers preventive care in network, such as routine physicals and vaccinations, as recommended by the U.S. Preventive Services Task Force (USPSTF) website at http://www.ahrq.gov/clinic/uspstfix.htm. The most current recommendations for vaccines can be found at the Centers for Disease Control and Preventions website at www.cdc.gov/vaccines). Mammograms will also be covered out-of-network.
In-Network Benefits: If you use a network provider, your benefits will be covered at the in-network level of 80 percent once you have used all of your HealthFund dollars and satisfied your deductible. HealthFund dollars are applied to the deductible. The in-network deductible is $1,400 if you are included in Individual coverage and $2,800 if you are enrolled for Individual & Spouse, Individual & Child(ren), or Family coverage. The HealthFund, your deductible, and your coinsurance all apply to your out-of-pocket maximum. The HealthFund plan does not require election of a primary care physician or referrals for specialty care.
Out-of-Network Benefits: If you use a provider that does not participate in the network, your expenses will still be applied to your HealthFund dollars. Once you have used all of your HealthFund dollars, benefits will be paid at 60 percent of the usual and prevailing charge after you satisfy your deductible. The out-of-network deductible is $1,400 if you are enrolled for Individual coverage and $2,800 if you are enrolled for Individual & Spouse, Individual & Child(ren), or Family coverage. The HealthFund, your deductible, and your coinsurance all apply to your out-of-pocket maximum.
For details on Aetna HealthFund, see the charts on page 11.
Control Your Healthcare DollarsThe Aetna HealthFund plan pays your medical claims, up to the HealthFund amount, before you pay the deductible or any coinsurance. If you use network providers, you can stretch your HealthFund dollars further.
Choice POS II planThe Choice POS II plan offers comprehensive coverage with low out-of-pocket costs. If you live within a network area you will be eligible to participate in the Choice POS II plan.
In-Network Benefits: When you elect the Choice POS II plan, you may select a doctor from the Choice POS II network to provide your care. If you use a network provider, you are eligible for in-network coverage, including:
100 percent coverage after you pay a $20 co-pay on most primary care doctors office visits, including internists, family practitioners, pediatricians, and OB/GYNs
100 percent coverage after you pay a $35 co-pay for specialists office visits
100 percent coverage for well-child exams, regular physical exams, and routine OB/GYN exams subject to certain frequency limitations*
85 percent coverage, after the deductible for hospitalization, including physician charges and surgery
There is a $600 deductible if you are enrolled for Individual coverage, and $1,200 if you are enrolled for Individual and Spouse, Individual and Child(ren) or Family coverage for in-network services other than those that require a co-payment.
There are no claim forms. Your network provider will submit your claims for you.
Out-of-Network Benefits: With the Choice POS II plan, youre still covered if you wish to obtain care from a non-network provider. In this case, your care is subject to a deductible of $750 if you are enrolled for Individual coverage and $1,500 if you are enrolled for Individual and Spouse, Individual and Child(ren), or Family coverage. The coinsurance percentage is 65 percent of the usual and prevailing charge. However, there is no well-care coverage except for routine mammography.
Important ConsiderationsEmergency Care: If you or your dependent has a medical emergencysuch as an apparent heart attack, stroke, convulsions, unconsciousness, severe bleeding, or serious burnsyou should immediately proceed to the nearest hospital emergency room.
Its important to know that a medical emergency is defined as a sudden and unexpected change in your physical or mental condition, which, if left untreated, could result in the loss of life, limb, or bodily function. If your visit to the emergency room does not meet this definition, no benefits will be paid.
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A Guide to KPMGs 2015 Benefits Options 4
If youre sent home after your visit, you will need to pay a separate $100 emergency room co-pay in addition to your deductible and coinsurance. Also, if you received treatment from an out-of-network hospital emergency room, any follow-up care rendered at that hospital will be paid at the out-of-network benefit level.
If youre admitted to the hospital from the emergency room, the $100 co-pay will be waived. You should call the number on your medical ID card within two business days to certify your admission.
Hospitalization Precertification: If you are being admitted to a hospital for nonemergency reasons, you must have your admission pre-certified by calling the number on your medical ID card. Failure to call will lead to a $400 reduction of your otherwise payable benefits.
For details on Choice POS II, see the charts on page 12. For additional information, visit Benefits Connection.
*As indicated on the U.S. Preventive Services Task Force website at http://www.ahrq gov/clinic/uspstfix.htm, and www.cdc.gov/vaccines
You Decide With Choice Pos IIThe Choice POS II plan offers in network benefits with low out-of-pocket expense when you obtain care through a network provider.
MED 2500With MED 2500, most care provided by an in-network provider is covered at 75 percent after you satisfy the plan-year deductible: $2,500 for an individual and $5,000 if two or more family members are covered under the plan. If you use a non-network provider, the coinsurance percentage is 65 percent, after you satisfy the plan-year deductible.
The plan also has a $6,000 individual and $12,000 family plan-year out of pocket limit, including the deductible for in-network providers and $7,000 individual and $14,000 family for out-of-network providers. The in-network and out-of-network limit will cross-apply.
Preventive exams are covered annually, subject to frequency limitations (as determined by Aetna).*
If you enroll in MED 2500, you may be eligible to establish a Health Savings Account (HSA). For details on HSAs, see page 7.
For details on MED 2500, see the chart on page 13.
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A Guide to KPMGs 2015 Benefits Options 5
MED 5000With MED 5000, most care provided by an in-network provider for illness or injury is covered at 100 percent after you satisfy the plan-year deductible: $5,000 for an individual, and $10,000 if two or more family members are covered under the plan for in-network providers and $6,000 for individual or $12,000 if two or more family members are covered under the plan for out-of-network providers. The in-network and out-of-network deductible will cross-apply. If you use a non-network provider, the coinsurance percent is 80 percent, after you satisfy the plan-year deductible.
The plan also has a $5,000 individual and $10,000 family plan-year out-of-pocket limit for in-network providers, including the deductible. In other words, once youve paid $5,000 toward eligible charges ($10,000 for family coverage), the plan will pay 100 percent of eligible expenses for the remainder of the year. The out-of-pocket limit for out of-network providers is $8,000 for individual coverage and $16,000 for family coverage.
Preventive exams are covered annually, subject to frequency limitations (as determined by Aetna).
Most doctors and hospitals will bill the plan directly. However, some doctors may require you to pay all or a portion of your bill and then file a claim for reimbursement.
If you enroll in MED 5000, you may be eligible to establish a Health Savings Account (HSA). For details on HSAs, see page 7.
Important Information for All Non-HMO Plan Participants Emergency Room Coverage To help control the high cost of emergency room care, any qualified visits to the emergency room are subject to a separate $100 co-pay in addition to your deductible and coinsurance. This co-pay is waived if you are admitted to the hospital from the emergency room.
If your visit to the emergency room is not for a medical emergency, no benefits will be payable. If you need urgent but nonemergency care, call your physician, regardless of the time of day, to talk about your urgent care needs.
Hospitalization PrecertificationIf you are being admitted to a hospital for nonemergency reasons, you must have your admission precertified by calling the number on your medical ID card. Failure to precertify your admission will lead to a $400 reduction of your otherwise payable benefits. (Under the Choice POS II plan and the Aetna HealthFund, your in-network provider will obtain precertification for you.)
For details on MED 5000, see the chart on page 14.
Prescription Drug ProgramIf you enroll in a medical plan, your coverage will include prescription drugs. The prescription drug coverage will depend on which medical plan you enroll in. If you enroll in the Choice POS II plan or the Aetna HealthFund, you will have the following prescription drug coverage.
Retail PrescriptionsWhen you purchase short-term prescriptionsup to a 30-day supplythrough network pharmacies you will pay a co-payment of $10 for formulary generic drugs, $40 for formulary brand-name drugs, and $60 for drugs not listed on the formulary. Specialty prescriptions, typically injectables, have a $120 co-payment. Specialty drugs are available through Aetna Specialty Pharmacy, not the Aetna mail order program.
If you are enrolled in an Aetna medical plan, you have access to Teladoc, which is an affordable alternative to ER and urgent care that can help resolve common medical issues through the convenience of phone or online video consultations. Teladoc is available 24/7, 365 days per year. To access a Teladoc provider, call 1-855-TEL-ADOC (1-855-835-2362) or visit www.teladoc.com/aetna.
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A Guide to KPMGs 2015 Benefits Options 6
Mandatory Mail Order Prescription Drug ServicePrescriptions for maintenance medications must be purchased through Aetnas mail-order service or at a CVS pharmacy. The mail order co-payment is $20 for formulary generic drugs, $80 for formulary brand-name drugs, and $120 for drugs not listed on the formulary.
Mandatory Generic PrescriptionsThe plan will cover the generic drug for prescriptions with an FDA-approved generic equivalent. If you choose to fill a brand-name drug instead, you will be required to pay the co-pay plus the difference in cost between the generic and the brand name drug. You may request an exception to receive a brand name drug if there is a clinical reason you cannot use the generic equivalent.
Generic Contraceptives are covered at 100%
If you have any questions about our prescription drug programs, call Aetna at 18003555764.
If you enroll in MED 2500 or MED 5000 the prescription drug coverage is included in your medical coverage.
The mandatory mail order and mandatory generic programs apply to these plans also. In addition, preventive drugs (according to Aetna) are covered at 100 percent, not subject to the deductible. Eligible non-preventive drugs are covered at 75 percent under MED 2500 and 100 percent under MED 5000 after satisfaction of the deductible.
Health Savings AccountIndividuals covered under qualified high-deductible health plans (HDHPs) can establish Health Savings Accounts (HSAs) with qualified HSA trustees, make tax-deductible contributions to their HSA accounts, and be reimbursed from their HSA accounts for unreimbursed medical expenses. HSA funds also can be saved to be used for future medical expenses. To be eligible to contribute to an HSA, you cannot be claimed as another persons tax dependent, you cannot be entitled to Medicare benefits, and you cannot have any health insurance other than a qualified HDHP. You also are precluded from establishing an HSA if you are covered under a Healthcare Flexible Spending Account through either KPMG or your spouses employer, if the flexible spending account provides first-dollar coverage.
Based on the deductibles and out-of-pocket maximum requirements of an HDHP plan, the KPMG plans that qualify as HDHPs for 2015 are MED 2500 and MED 5000. The allowable tax deductible contribution to an HSA is a maximum of $3,350 for an individual and $6,650 for a family. Individuals ages 55 and over can make additional contributions.
HSAs are portable and can be taken with you if you leave KPMG. There is no use it or lose it provision.
Establishing a Health Savings AccountYou may establish an HSA with the vendor of your choice; however, you are responsible for determining and monitoring whether participation in a HSA plan is compliant with firm independence requirements. For your ease and convenience, you may want to consider establishing an account with the Bank of America which provides the convenience of making contributions through payroll..
Bank of Americas Health Savings Account You have the option to establish an HSA with the Bank of America, which offers the convenience of pre-tax payroll deductions from your paycheck. Once you enroll in a Bank of America HSA, you will receive a debit card that allows you to easily access and manage the funds in your account. You may present this card at your doctors office, pharmacy, or other service provider to pay for eligible healthcare expenses. Enrolling in this benefit allows you to gain more control over how your health care dollars are spent because contributions, interest and withdrawals for eligible health care expenses are all tax-advantaged.
Note: If you are enrolled in a Healthcare FSA, you cannot contribute to a Health Savings Account.
For more information, please visit www.treas.gov (click on Health Savings Accounts HSA).
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A Guide to KPMGs 2015 Benefits Options 7
Choosing the Plan Thats Right for YouAs you review your medical plan options, here are some things you may wish to consider:
Think about your current healthcare needs. Are you and your family healthy? Do you require regular visits to the doctoras is typical, for example, for someone with young children? Is your current doctor a member of the Choice POS II or HMO network? How important is this relationship to you?
Review the medical plan charts on pages 11 to 15. These charts provide a comparison of our plans.
Consider coverage versus cost. Look at cost in terms of both the amount you contribute to your plan and your out-of-pocket expenses when you need care. Can money youre spending on medical coverage be put to better use on other benefits, such as dental care, life insurance, or saving for retirement?
Use the Aetna Plan Selection & Cost Estimator tool to compare costs and level of coverage of the Aetna plans with one non-Aetna plan, such as an HMO.
By carefully considering your benefits choices, youre more likely to end up with benefits that work best for youboth when youre sick and when youre healthy.
Womens Preventive CareOur medical plans have long offered coverage for many preventive health services in order to help you better care for you and your family. As a result of the Affordable Care Act (ACA), preventive care coverage has been expanded to cover a range of additional services for women.
Preventive services are covered under all of our medical plans, as required by the ACA, and will be paid without cost-sharing such as payment percentages, copays and deductibles (except for the Choice POS II and Aetna HealthFund plans, which will only cover these services if they are provided by a network provider).
Please note that in order to be covered, services must be provided by a member of a medical profession, who is properly licensed or certified to provide care within the scope of that license or certification, under the laws of the state where the individual practices.
An annual routine physical exam for covered persons through age 21.
For covered females: Screening and counseling services as provided for in the comprehensive guidelines recommended by the Health Resources and Services Administration.
Screening and counseling services, for ages 22 and older, to aid in weight reduction due to obesity.
Screening and counseling services to aid in the prevention or reduction of the use of an alcohol agent or controlled substance,
Screening and counseling services to aid you to stop the use of tobacco products.
Prenatal care.
For females with the ability to reproduce, coverage includes:
FDA-approved contraceptive methods
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A Guide to KPMGs 2015 Benefits Options 8
Counseling services provided by a physician, in either a group or individual setting, on contraceptive methods covered as a preventive visit and paid without cost-sharing.
Female voluntary sterilization procedures and related services and supplies.
FDA-approved female generic emergency contraceptive methods that are prescribed by your physician.
Note: The drug list is subject to change, as new drugs may be added to the list. Visit Medication Search on your secure member website at www.aetna.com for the most up-to-date information on drug coverage for your plan.
HMO OptionsDepending on where you live, KPMG makes a number of health maintenance organizations (HMOs) available. While each HMO is slightly different, most operate similarly in that:
Your HMO provides all your care; in most cases, your care is covered 100 percent after a small co-payment. Most also offer prescription drug coverage.
You select a doctor to serve as your primary care physician (PCP).
To be covered, nonemergency care must be obtained or authorized through your PCP. Failure to do so will result in care that is not covered.
Most HMOs cover care outside your area on an emergency basis only. This is an important consideration if you travel frequently or have a covered dependent who lives elsewhere or who is away at school.
When you first enroll, and during each subsequent benefits enrollment period, your personalized enrollment form will list the HMOs that are available to you.
For HMO information, please call your local HMO.
Vision CareKPMG offers two choices for its vision care benefits: EyeMed and Vision Services Plan (VSP)
With two choices available, employees can select from a wide array of vision care providers. Check out the list of vision care providers for both plans, and consider which plan includes providers who are most convenient, and/or with whom you are comfortable. Be sure to understand the benefits each program offers.
For more information on EyeMed, including a list of providers, go to www.eyemedvisioncare.com. For more information on VSP and a list of its providers, go to www.vsp.com.
Also, see the summary charts on page 15.
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A Guide to KPMGs 2015 Benefits Options 9
Dental CareGood dental care is an important part of your total healthcare. Thats why KPMG offers three options for dental care.
All three options provide a broad range of coverage, from routine checkups to orthodontia.
Aetna Dental Maintenance Organization (DMO)Dental care is covered with no deductibles, no annual maximums, lower out-of-pocket costs, and no claim forms to complete, as long as you use a DMO network dentist youve elected with Aetna.
Aetna Preferred Provider Organization (PPO) Dental care is subject to:
A $50 deductible per person ($100 maximum for two or more covered family members)
Coinsurance (plan pays 50 to 100 percent of the cost of most services)
An annual benefit maximum of $2,000 per person
Orthodontia is covered at 40 percent, up to a $1,500 lifetime limit
Under the PPO, you do not have to elect a primary dentist nor do you have to use only dentists who are in the network. If you receive treatment from a dentist in Aetnas PPO network, you will receive discounted rates.
For a list of DMO and PPO dentists near you, visit Aetnas Web site at www.aetna.com. For more details about your dental coverage options, see the charts on pages 1415.
Delta Dental DeltaCare USA, a dental DMO plan from Delta Dental offers quality dental benefits that include no restrictions on pre-existing conditions (except for work in progress), no claim forms to complete, and no deductibles or annual or lifetime dollar maximums. It also offers a benefit that most dental insurance doesn't cover: Teeth whitening is covered under the program.
If you choose the DeltaCare USA Plan option, you will automatically be assigned to a Primary Care Dentist (PCD). If you would like to use a different PCD, please contact Delta Dental at 1-800-422-4234 (1-800-932-3067 if you live in Minnesota) or visit Delta Dental's website, www.deltadentalins.com.
All three options provide a broad range of coverage, from routine checkups to orthodontia.
Tobacco Surcharge on Health Plan ContributionsEmployees who use tobacco will be charged a $20 surcharge per pay period. Using tobacco is directly linked to many diseases, including cancer and heart disease, and can aggravate even simple illnesses like colds and flu for children in a home where tobacco is used. It can potentially endanger the health and financial stability of you and your family.
What are some ways I can become tobacco-free?KPMG offers the iCanQuit tobacco cessation program to all employees and their dependents (whether or not you are enrolled in a KPMG medical plan), as well as Aetna's, HLC Tobacco Free, tobacco cessation program for those who are enrolled in an Aetna medical or dental plan. Both of these programs are available to you at no cost.
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A Guide to KPMGs 2015 Benefits Options 10
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
Aetna HealthFundIn-Network BenefitsPlan Eligibility You must live in an area where the Choice POS II network is available. Members who reside out-
side the United States are not eligible for this plan.
Choice of Provider To be eligible for in-network benefits, you must select and obtain care from a provider that participates in the Choice POS II network.
Medical
HealthFund Covers medical expenses $500 Individual$1,000 Individual and Spouse
$1,000 Individual and Child(ren)$1,000 Family
Incentive*** +$200 Individual+$400 Individual and Spouse
+$400 Individual and Child(ren)+$400 Family
Medical Deductible (includes HealthFund)
$1,400 Individual$2,800 Individual and Spouse
$2,800 Individual and Child(ren)$2,800 Family
Medical Out-of-Pocket Maximum(includes deductible and medical copays)
$5,000 Individual$10,000 Individual and Spouse
$10,000 Individual and Child(ren)$10,000 Family
Lifetime Maximum Unlimited
Usual and Prevailing Fees Not applicable
PL
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Physician Services (office visit) 80% after deductible
Urgent Care 80% after deductible
Teladoc Provider $40 cost, subject to plan design
Hospital Services (physician services and inpatient and outpatient hospital charges)
80% after deductible
Surgery 80% after deductible
Emergency Room Services (Nonemergency use of the emergency room is not covered.)
80% after $100 co-pay and plan deductible (co-pay waived if admitted).
Diagnostic X-ray and Lab 80% after deductible
Preventive Care (subject to frequency limitations) Well-child visits, adult care, routine OB/GYN exams Routine mammography Routine eye exam Routine hearing exam Womens preventive services
100%, no deductible100%, no deductible100%, no deductible100%, no deductible100%, no deductible100%, no deductible
Skilled Nursing Facility (requires precertification)* 80% after deductible, up to 120 days per plan year
Home Healthcare (requires precertification)* 80% after deductible, up to 120 days per plan year
Private-Duty Nursing (requires precertification)* 80% after deductible, up to 70 eight-hour shifts per plan year (Private-duty nursing in a hospital/facility is not covered.)
Hospice Care (requires precertification)** 80% after deductible
Speech, Physical, and Occupational Therapy 80% after deductible
Early Intensive Intervention (Including Applied Behavioral Analysis (ABA) Therapy)
Pre-certification Required
Durable Medical Equipment 80% after deductible
Mental/Nervous and Alcohol/Drug Treatments Inpatient mental/nervous care (requires precertification) Inpatient alcohol/drug treatment (requires precertification) Outpatient
80% after deductible80% after deductible80% after deductible
Prescription Drugs
Prescription drug expenses, including copay, are not applied to the Fund or the medical out-of-pocket maximum.
Subject to mandatory generics and mandatory mail order
Generic contraceptives 100%, not subject to deductible
Retail prescriptions up to a 30-day supply at network pharmacies (subject to the prescription deductible)
Member pays:
Generic formulary $10 | Brand-name formulary $40 Non-formulary $60 | Specialty $120
Mail order prescriptions up to a 90-day supply (subject to the prescription deductible)
Member pays:
Generic formulary $20 | Brand-name formulary $80 Non-formulary $120 | Specialty $120
Prescription Deductible $50 Individual$100 Individual and Spouse
$100 Individual and Child(ren)$100 Family
Prescription Drug Out-of-Pocket Maximum (The out-of-pocket maximum is not applied to your medical plan out-of-pocket maximum.)
$1,500 Individual$3,000 Individual and Spouse
$3,000 Individual and Children$3,000 Individual and Family
Per calendar year for prescriptions purchased through network retail pharmacy and mail-order programs combined.
Hospital Precertification** Penalty for failure to precertify
Provider initiates None if provider responsibility
Claim Submission Provider initiates
* Maximums combined for in-network and out-of-network providers.** Includes inpatient hospital confinement, skilled nursing facility, home healthcare, hospice care, and private-duty nursing.*** For details on the Incentive, go to the Annual Benefits Enrollment website.
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
Aetna HealthFundOut-of-Network BenefitsPlan Eligibility You must live in an area where the Choice POS II network is available. Members who reside out-
side the United States are not eligible for this plan.
Choice of Provider Benefits for services received from an out-of-network provider are payable as described on this page.
Medical
HealthFund Covers medical expenses $500 Individual$1,000 Individual and Spouse
$1,000 Individual and Child(ren)$1,000 Family
Incentive*** +$200 Individual+$400 Individual and Spouse
+$400 Individual and Child(ren)+$400 Family
Medical Deductible (includes HealthFund)
$1,400 Individual$2,800 Individual and Spouse
$2,800 Individual and Child(ren)$2,800 Family
Out-of-Pocket Maximum(includes deductible)
$6,000 Individual$12,000 Individual and Spouse
$12,000 Individual and Child(ren)$12,000 Family
Lifetime Maximum Unlimited
Usual and Prevailing Fees All services received from out-of-network providers are subject to usual and prevailing fees.
PL
AN
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Physician Services (office visit) 60% after deductible
Urgent Care 80% after deductible
Teladoc Provider $40 cost, subject to plan design
Hospital Services (physician services and inpatient and outpatient hospital charges)
60% after deductible
Surgery 60% after deductible
Emergency Room Services (Nonemergency use of the emergency room is not covered.)
80% after $100 co-pay and plan deductible (co-pay waived if admitted).
Diagnostic X-ray and Lab 60% after deductible
Preventive Care (subject to frequency limitations) Well-child visits, adult care, routine
OB/GYN exams
Routine mammography
Routine eye exam
Routine hearing exam
Womens preventive services
Not covered
100%, no deductible
Not covered
Not covered
Not covered
Skilled Nursing Facility (requires precertification)* 60% after deductible, up to 120 days per plan year
Home Healthcare (requires precertification)* 60% after deductible, up to 120 days per plan year
Private-Duty Nursing (requires precertification)* 60% after deductible, up to 70 eight-hour shifts per plan year (Private-duty nursing in a hospital/facility is not covered.)
Hospice Care (requires precertification)** 60% after deductible
Speech, Physical, and Occupational Therapy 60% after deductible
Early Intensive Intervention (Including Applied Behavioral Analysis (ABA) Therapy)
Pre-certification Required
Durable Medical Equipment 60% after deductible
Mental/Nervous and Alcohol/Drug Treatments Inpatient mental/nervous care (requires precertification)
Inpatient alcohol/drug treatment (requires precertification)
Outpatient
60% after deductible
60% after deductible
60% after deductible
Prescription Drug (at non-network pharmacies)
Subject to mandatory generics and mandatory mail order
Prescription Deductible $50 Individual$100 Individual and Spouse
$100 Individual and Child(ren)$100 Family
Generic contraceptives 100%, not subject to deductible
Retail prescriptions up to a 30-day supply 60% after deductible
Prescription Drugs Out-of-Pocket Maximum Subject to medical plan out-of-pocket maximum
Hospital Precertification** Penalty for failure to precertify
You initiate $400 per occurrence, which does not apply to deductible or out-of-pocket maximum
Claim Submission You initiate
* Maximums combined for in-network and out-of-network providers.** Includes inpatient hospital confinement, skilled nursing facility, home healthcare, hospice care, and private-duty nursing.*** For details on the Incentive, go to the Annual Benefits Enrollment website.
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A Guide to KPMGs 2015 Benefits Options 11
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
Choice POS IIIn-Network BenefitsPlan Eligibility You must live in an area where the Choice POS II network is available. Members who reside
outside the United States are not eligible for this plan.Choice of Provider To be eligible for in-network benefits, you must select and obtain care from a provider that
participates in the Choice POS II network. If a network provider refers you to a nonnetwork provider for care, benefits will be covered at the out-of-network level.
Medical
Medical Deductible $600 Individual$1,200 Individual and Spouse
$1,200 Individual and Child(ren)$1,200 Family
Incentive*** +$200 Individual+$400 Individual and Spouse
+$400 Individual and Child(ren)+$400 Family
Out-of-Pocket Maximum(includes medical deductible and medical copays)
$2,500 Individual$5,000 Individual and Spouse
$5,000 Individual and Child(ren)$5,000 Family
Lifetime Maximum UnlimitedUsual and Prevailing Fees Not applicable
PL
AN
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Physician Services (office visit) Primary care physicians Specialist
100% after $20 co-pay (includes internists, family practitioners, pediatricians, and OB/GYNs)100% after $35 co-pay
Urgent Care $30 copayTeladoc Provider $40 cost, subject to plan designHospital Services (physician services and inpatient and outpatient hospital charges)
85% after deductible
Surgery 85% after deductibleEmergency Room Services (Nonemergency use of the emergency room is not covered.)
85% after $100 co-pay and plan deductible (co-pay waived if admitted).
Diagnostic X-ray and Lab In physicians office Outside physicians office
100%85% after deductible
Preventive Care (subject to frequency limitations) Well-child visits, adult care, routine OB/GYN exams Routine mammography Routine eye exam Routine hearing exam Womens preventive services
100%, no deductible100%, no deductible100%, no deductible100%, no deductible100%, no deductible
Skilled Nursing Facility (requires precertification)* 85% after deductible, up to 120 days per plan yearHome Healthcare (requires precertification)* 85% after deductible, up to 120 days per plan yearPrivate-Duty Nursing (requires precertification)* 85% after deductible, up to 70 eight-hour shifts per plan year (Private-duty nursing in a hospi-
tal/facility is not covered.)Hospice Care (requires precertification) 85% after deductibleSpeech, Physical, and Occupational Therapy 85% after deductibleEarly Intensive Intervention (Including Applied Behavioral Analysis (ABA) Therapy)
Pre-certification Required
Durable Medical Equipment 85% after deductibleMental/Nervous and Alcohol/Drug Treatments Inpatient mental/nervous care (requires precertification) Inpatient alcohol/drug treatment (requires precertification) Outpatient
85% after deductible 85% after deductible 100% after $20 co-pay
Prescription Drugs Prescription drug expenses, including copay, are not applied to the Fund or the medical out-of-pocket maximum. Subject to mandatory generics and mandatory mail orderPrescription Deductible $50 Individual
$100 Individual and Spouse$100 Individual and Child(ren)$100 Family
Generic contraceptives 100%, not subject to deductible Retail prescriptions up to a 30-day supply at network
pharmacies (subject to the prescription deductible)Member pays:
Generic formulary $10 | Brand-name formulary $40 Non-formulary $60 | Specialty $120
Mail order prescriptions up to a 90-day supply (subject tothe prescription deductible)
Member pays:
Generic formulary $20 | Brand-name formulary $80 Non-formulary $120 | Specialty $120
Prescription Drug Out-of-Pocket Maximum (The out-of-pocket maximum is not applied to your medical plan out-of-pocket maximum.)
$1,500 Individual$3,000 Individual and Spouse
$3,000 Individual and Children$3,000 Individual and Family
Per calendar year for prescriptions purchased through network retail pharmacy and mail-order programs combined.
Claim Submission Provider initiates
* Maximums combined for in-network and out-of-network providers.** Includes inpatient hospital confinement, skilled nursing facility, home healthcare, hospice care, and private-duty nursing.*** For details on the Incentive, go to the Annual Benefits Enrollment website.
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
Choice POS IIOut-of-Network Benefits
Plan Eligibility You must live in an area where the Choice POS II network is available. Members who reside outside the United States are not eligible for this plan.
Choice of Provider Benefits for services received from an out-of-network provider are payable as described on this page.
Medical
Medical Deductible $750 Individual$1,500 Individual and Spouse
$1,500 Individual and Child(ren)$1,500 Family
Incentive*** +$200 Individual
+$400 Individual and Spouse
+$400 Individual and Child(ren)
+$400 Family
Out-of-Pocket Maximum (includes medical deductible and medical copays)
$3,500 Individual$7,000 Individual and Spouse
$7,000 Individual and Child(ren)$7,000 Family
Lifetime Maximum Unlimited
Usual and Prevailing Fees All services received from out-of-network providers are subject to usual and prevailing fees.
PL
AN
P
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Physician Services (office visit) 65% after deductible
Urgent Care $30 copay
Teladoc Provider $40 cost, subject to plan design
Hospital Services (physician services and inpatient and outpatient hospital charges)
65% after deductible
Surgery 65% after deductible
Emergency Room Services (Nonemergency use of the emergency room is not covered.)
85% after $100 emergency room co-pay and plan deductible (co-pay waived if admitted).
Diagnostic X-ray and Lab 65% after deductible
Preventive Care (subject to frequency limitations)
Well-child visits, adult care, routine OB/GYN exams
Routine mammography
Routine eye exam
Routine hearing exam
Womens preventive care
Not covered
100%
Not covered
Not covered
Not covered
Skilled Nursing Facility (requires precertification)* 65% after deductible, up to 120 days per plan year
Home Healthcare (requires precertification)* 65% after deductible, up to 120 days per plan year
Private-Duty Nursing (requires precertification)* 65% after deductible, up to 70 eight-hour shifts per plan year (Private-duty nursing in a hospital/facility is not covered.)
Hospice Care (requires precertification) 65% after deductible
Speech, Physical, and Occupational Therapy 65% after deductible
Early Intensive Intervention (Including Applied Behavioral Analysis (ABA) Therapy)
Pre-certification Required
Durable Medical Equipment 65% after deductible
Mental/Nervous and Alcohol/Drug Treatments
Inpatient mental/nervous care (requires precertification)
Inpatient alcohol/drug treatment (requires precertification)
Outpatient
65% after deductible
65% after deductible
65% after deductible
Prescription Drugs (at non-network pharmacies)
Subject to mandatory generics and mandatory mail order
Prescription Deductible $50 Individual$100 Individual and Spouse
$100 Individual and Child(ren)$100 Family
Generic contraceptives 100%, not subject to deductible
Retail prescriptions up to a 30-day supply 65% after deductible
Prescription Drug Out-of-Pocket Maximum Subject to medical plan out-of-pocket maximum
Hospital Precertification** Penalty for failure to precertify
You initiate $400 per occurrence, which does not apply to deductible or out-of-pocket maximum
Claim Submission You initiate
* Maximums combined for in-network and out-of-network providers.** Includes inpatient hospital confinement, skilled nursing facility, home healthcare, hospice care, and private-duty nursing.*** For details on the Incentive, go to the Annual Benefits Enrollment website.
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A Guide to KPMGs 2015 Benefits Options 12
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
MED 2500
Plan Eligibility Available to all employee plan participants.
Choice of Provider You may use the provider of your choice each time you need care.
Deductible $2,500 Individual
$5,000 Individual and Spouse $5,000 Individual and Child(ren)
$5,000 Family
Out-of-Pocket Maximum(includes deductible) In-network Out-of-network
$6,000 Individual
$12,000 Individual and Spouse
$12,000 Individual and Child(ren)
$12,000 Family
$7,000 Individual
$14,000 Individual and Spouse
$14,000 Individual and Child(ren)
$14,000 Family
Lifetime Maximum Unlimited
Usual and Prevailing Fees Applicable to all surgical expensesyou are responsible for any charges above those con-sidered usual and prevailing.
PL
AN
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Physician Services (office visit) In-network: 75% after deductibleOut-of-network: 65% after deductible
Urgent Care 75% after deductible
Teladoc Provider $40 cost, subject to plan design
Hospital Services (physician services and inpatient and outpatient hospital charges)
In-network: 75% after deductibleOut-of-network: 65% after deductible
Surgery In-network: 75% after deductibleOut-of-network: 65% after deductible
Emergency Room Services (Nonemergency use of the emergency room is not covered.)
75% after $100 emergency room co-pay and plan deductible (co-pay waived if admitted).
Diagnostic X-ray and Lab In-network: 75% after deductible Out-of-network: 65% after deductible
Preventive Care (subject to frequency limitations)
Well-child visits, adult care, routine OB/GYN exams
Routine mammography
Routine eye exam
Routine hearing exam
Womens preventive services
100%, no deductible
100%, no deductible
100%, no deductible
100%, no deductible
100%, no deductible
Skilled Nursing Facility (requires precertification)* In-network: 75% after deductible, up to 120 days per plan year Out-of-network: 65% after deductible
Home Healthcare (requires precertification)* In-network: 75% after deductible, up to 120 days per plan year Out-of-network: 65% after deductible
Private-Duty Nursing (requires precertification)* In-network: 75% after deductible, up to 70 eight-hour shifts per plan year Out-of-network: 65% after deductible (Private-duty nursing in a hospital/facility is not covered.)
Hospice Care (requires precertification)* In-network: 75% after deductible Out-of-network: 65% after deductible
Speech, Physical, and Occupational Therapy In-network: 75% after deductible Out-of-network: 65% after deductible
Early Intensive Intervention (Including Applied Behavioral Analysis (ABA) Therapy)
Pre-certification Required
Durable Medical Equipment In-network: 75% after deductible Out-of-network: 65% after deductible
Mental/Nervous and Alcohol/Drug Treatments
Inpatient mental/nervous care (requires precertification)
Inpatient alcohol/drug treatment (requires precertification)
Outpatient
In-network: 75% after deductible
In-network: 75% after deductible
In-network: 75% after deductible
Out-of-network: 65% after deductible
Out-of-network: 65% after deductible
Out-of-network: 65% after deductible
Prescription Drugs (retail and mail order)
Subject to mandatory generics and mandatory mail order
Generic contraceptives
Preventive
Nonpreventive
100%, not subject to deductible
100%, not subject to deductible
In-network: 75% after deductible
Out-of-network: 65% after deductible
Hospital Precertification* Penalty for failure to precertify
You initiate $400 per occurrence, which does not apply to deductible or out-of-pocket maximum
Claim Submission You initiate
* Includes inpatient hospital confinement, skilled nursing facility, home healthcare, hospice care, and private-duty nursing.
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
MED 5000Plan Eligibility Available to all employee plan participants.Choice of Provider You may use the provider of your choice each time you need care.
Deductible In-network Out-of-network
$5,000 Individual
$10,000 Individual and Spouse
$10,000 Individual and Child(ren)
$10,000 Family
$6,000 Individual
$12,000 Individual and Spouse
$12,000 Individual and Child(ren)
$12,000 FamilyOut-of-Pocket Maximum (includes deductible) In-network Out-of-network
$5,000 Individual
$10,000 Individual and Spouse
$10,000 Individual and Child(ren)
$10,000 Family
$8,000 Individual
$16,000 Individual and Spouse
$16,000 Individual and Child(ren)
$16,000 FamilyLifetime Maximum UnlimitedUsual and Prevailing Fees Applicable to all surgical expensesyou are responsible for any charges above those consid-
ered usual and prevailing.
PL
AN
P
AY
S
Physician Services (office visit) In-network: 100% after deductibleOut-of-network: 80% after deductible
Urgent Care 100% after deductibleTeladoc Provider $40 cost, subject to plan designHospital Services (physician services and inpatient and outpatient hospital charges)
In-network: 100% after deductibleOut-of-network: 80% after deductible
Surgery In-network: 100% after deductibleOut-of-network: 80% after deductible
Emergency Room Services (Nonemergency use of the emergency room is not covered.)
100% after $100 emergency room co-pay and plan deductible (co-pay waived if admitted).
Diagnostic X-ray and Lab In-network: 100% after deductibleOut-of-network: 80% after deductible
Preventive Care (subject to frequency limitations)
Well-child visits, adult care, routine OB/GYN exams
Routine mammography
Routine eye exam
Routine hearing exam
Womens preventive services
100%, no deductible
100%, no deductible
100%, no deductible
100%, no deductible
100%, no deductibleSkilled Nursing Facility (requires precertification)* In-network: 100% after deductible, up to 120 days per plan year
Out-of-network: 80% after deductibleHome Healthcare (requires precertification)* In-network: 100% after deductible, up to 120 days per plan year
Out-of-network: 80% after deductiblePrivate-Duty Nursing (requires precertification)* In-network: 100% after deductible, up to 70 eight-hour shifts per plan year
Out-of-network: 80% after deductible (Private-duty nursing in a hospital/facility is not covered.)
Hospice Care (requires precertification)* In-network: 100% after deductible Out-of-network: 80% after deductible
Speech, Physical, and Occupational Therapy In-network: 100% after deductible Out-of-network: 80% after deductible
Early Intensive Intervention (Including Applied Behavioral Analysis (ABA) Therapy)
Pre-certification Required
Durable Medical Equipment In-network: 100% after deductible Out-of-network: 80% after deductible
Mental/Nervous and Alcohol/Drug Treatments In-network:
Inpatient mental/nervous care (requires precertification)
Inpatient alcohol/drug treatment (requires precertification)
Outpatient
In-network: 100% after deductible
In-network: 100% after deductible
In-network: 100% after deductible
Out-of-network: 80% after deductible
Out-of-network: 80% after deductible
Out-of-network: 80% after deductiblePrescription Drugs
Subject to mandatory generics and mandatory mail order
Generic contraceptives
Preventive
Nonpreventive
100%, not subject to deductible
100%, not subject to deductible
In-network: 100% after deductibleOut-of-network: 80% after deductible
Hospital Precertification* Penalty for failure to precertify
You initiate $400 per occurrence, which does not apply to deductible or out-of-pocket maximum
Claim Submission You initiate * Includes inpatient hospital confinement, skilled nursing facility, home healthcare, hospice care, and private-duty nursing.
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A Guide to KPMGs 2015 Benefits Options 13
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
Dental Plan
DMO PPO
Choice of Provider You (and each covered family member) must be enrolled, through Aetna, with a DMO dentist.
You may use any provider of your choice.
Annual Deductible None $50 Individual$100 Individual and Spouse$100 Individual and Child(ren)$100 Family
Annual Benefit Maximum None $2,000 per person
PL
AN
P
AY
S
Preventive Services The limitations indicated below apply whether services are for routine or emergency care.
Oral exams 100% (two routine exams and two problem-focused exams per year)
100% (two per year)
Prophylaxis, including scaling and polishing 100% (two per year) 100% (two per year)
Fluoride 100% (once a year through age 17) 100% (once a year through age 14)
Oral hygiene instruction 100% Not covered
Sealants (permanent molars only) 100% (one treatment every three years through age 15)
100% (one treatment every three years through age 15)
Bitewing X-rays 100% (two per year) 100% (two per year)
Periapical X-rays 100% 100%
Full mouth series 100% (once every 36 months) 100% (once every 36 months)
Basic & Restorative Services*
Amalgam and composite fillings Stainless steel crowns Pulp capping Pulpotomy Incision and drainage of abscess Root canal therapy (anterior and bicuspid) Scaling and root planingup to four quadrants per year Periodontal surgery (except osseous surgery and
gingivectomy) Uncomplicated extractions Surgical removal of erupted tooth
100% 80%, after deductible
Space maintainers Root canal therapy (molar tooth) Full and partial dentures and denture repair
(five-year frequency maximum) General anesthesia
*must be Medically necessary
60% 80%, after deductible
Inlays, onlays, and crowns(other than stainless steel crowns(five-year frequency maximum)
Bridge pontics and abutment(five-year frequency maximum)
60% 50%, after deductible
Apicoectomy (root amputation) Removal of soft tissue impacted tooth Gingivectomy Subgingival curettage (four per year)
100% 80%, after deductible
Removal of full or partial bony impacted tooth Osseous surgery Implants**
60% 80%, after deductible
Not covered Not covered
Orthodontia Services (no age restriction)
60%. One course of treatment per individual per lifetime. Does not cover treatment already in progress.
40% of usual and prevailing expenses after deduct-ible. $1,500 lifetime limit per individual. Expenses are spread over the entire course of treatment, for both new work and work in progress, and are reimbursed on a quarterly basis.
* Certain expenses related to the mouth that are medical in nature may be covered under your medical plan. These include fractures to the jaw, jaw surgery, and conditions such as tumors or cysts. Expenses that are dental in nature such as for teeth, gums, or impacted wisdom teeth would be covered under the dental plan. There is no cross application of expenses between the medical and dental plan. Expenses should be submitted to your medical plan for a predetermination of benefits. If you receive medical coverage through an HMO, check with your HMO for information about how these procedures would be covered.
** Implants are not covered under the dental benefits, however, if you receive an implant to replace a tooth that was extracted while covered under the plan (eligible for replacement), an alternate benefit of a 3 unit bridge may be applied to this implant.
2014 BENEFITS ENROLLMENT 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
Delta Dental DeltaCare USA
Choice of Provider: You (and each covered family member) must be enrolled, through DeltaCare USA, with a DMO dentist.
Coverage DMO
Annual Deductible N/A
Annual Benefit Maximum N/A
Orthodontic Deductible N/A
Orthodontic Lifetime Maximum N/A
Preventive Services Copayment Amounts
Oral Exams No Cost
Prophylaxis (Basic Cleaning) No Cost - $45
Fluoride No Cost
Oral hygiene instruction No Cost
Sealants (permanent molars only) $10
Bitewing X-rays No Cost
Vertical bitewing X-rays No Cost
Periapical X-rays No Cost
Full mouth series No Cost
Basic & Restorative Services Copayment Amount
Amalgam (silver) fillings No Cost
Composite fillings $5- $50
Stainless steel crowns $65
Pulp capping No Cost
Pulpotomy $35
Full and partial denture $295 - $415
Denture repairs $25 -$180
Inlays $170- $350
Onlays $185 - $380
Crowns $160 - $380
Pontics $220 -$380
Implants Not Covered
Root canal therapy Anterior and Bicuspid $110 -$200
Root canal therapy, molar teeth $350
Scaling and Root planing, up to four quadrants per year $45- $55
Periodontal surgery (except Osseous and gingivectomy) $75 - $225
Simple extractions $5 - $8
Incision & drainage of abscess No Cost
Space maintainers $60- $70
Surgical removal of erupted tooth $50
Surgical removal of impacted tooth, soft tissue $60
Surgical removal of impacted tooth, partial bony $80
Surgical removal of impacted tooth, full bony $110 -$130
Apicoectomy $90 -$140
Gingivectomy (per tooth) $210
Osseous surgery $275 - $345
Anesthesia
General Anesthesia/IV Sedation $80 - $165
Orthodontics
Copayment $1150 - $2100
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A Guide to KPMGs 2015 Benefits Options 14
2014 BENEFITS ENROLLMENT 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
DeltaCare USA (Minnesota)*
Coverage DMO
Annual Deductible N/A
Annual Benefit Maximum N/A
Orthodontic Deductible N/A
Orthodontic Lifetime Maximum N/A
Preventive Services Copayment Amounts
Oral Exams No Cost -$30**
Prophylaxis (Cleaning) No Cost
Fluoride No Cost
Oral hygiene instruction No Cost
Sealants (permanent molars only) $12
Bitewing X-rays No Cost - $30**
Vertical bitewing X-rays No Cost
Periapical X-rays No Cost
Full mouth series No Cost
Basic & Restorative Services Copayment Amount
Amalgam (silver) fillings $24- $31
Composite fillings (anterior teeth only) $25- $36
Stainless steel crowns $66
Pulp capping No Cost
Pulpotomy $19
Full and partial denture $300 -$384
Denture repairs $12 -$185
Inlays $190- $210
Onlays $208 - $226
Crowns $140 - $270
Pontics $270
Implants Not Covered
Root canal therapy Anterior and Bicuspid $72- $144
Root canal therapy, molar teeth $216
Scaling and Root planing, up to four quadrants per year $54
Periodontal surgery (except Osseous and gingivectomy) $175 - $280
Simple extractions $22
Incision & drainage of abscess $25
Space maintainers $66
Surgical removal of erupted tooth $36
Surgical removal of impacted tooth, soft tissue $60
Surgical removal of impacted tooth, partial bony $90
Surgical removal of impacted tooth, full bony $120
Apicoectomy $60 -$120
Gingivectomy (per tooth) $210
Osseous surgery $360
AnesthesiaGeneral Anesthesia/IV Sedation Not Covered
OrthodonticsCopayment $1950 - $2350
*For state regulation purposes, Delta Dental must administer a separate plan for Minnesota residents. The Summary Chart below is specific for Minnesota residents and is meant to provide an overview of benefits only. For specific information please call Delta Dental at 1-800-932-3067.
Please note that benefits under the DMO must be provided by a network dentist.
**Cost incurred for use of specialty network 2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
EyeMed Vision Care Plan
Frequency Limitations Examination*
Frame*
Lenses or contact lenses*
Once per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Member Cost In-Network Out-of-Network Maximum Allowance
Exam with Dilation as Necessary No cost to you $35
Exam Options
Standard Contact Lens Fit and Follow-Up (spherical clear contact lenses in conventional wear and planned replacement)
Up to $55 Not covered
Premium Contact Lens Fit and Follow-Up (all lens designs, materials, and specialty fittings other than standard contact lenses, such as toric and multifocal)
90% of retail Not covered
Frames Any available frame at provider location
Plan pays up to $150 Member pays 80% of amount over $150
$65
Standard Plastic Lenses
Single Vision
Bifocal
Trifocal
No cost to you
No cost to you
No cost to you
$25
$40
$60
Lens Options
UV Coating
Tint (Solid and Gradient)
Standard Scratch Resistance
Standard Polycarbonate
Standard Anti-Reflective Coating
Standard Progressive (Add-on to Bifocal)
Other Add-Ons and Services
$15 Co-pay
$15 Co-pay
$15 Co-pay
No Cost to You
$45 Co-pay
No cost to you
80% of retail
Not covered
Not covered
Not covered
$28
Not covered
Not covered
Not covered
Contact Lenses (covers materials only) Conventional
Plan pays up to $150 Member pays 85% of amount over $150
$104
Disposable Plan pays up to $150 Member pays balance over $150
$104
Medically Necessary No cost to you $200
COVERAGE FOR GLASSES FOR COMPUTER USE
Frequency Limitations
Examination*
Frame*
Lenses*
Once per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Exam Refraction Only No cost to you $35
Frames Any available frame at provider location
Plan pays up to $100 Member pays 80% of amount over $100
$50
Standard Plastic Lenses
Single Vision
Bifocal
Trifocal
No cost to you
No cost to you
No cost to you
$25
$40
$60
Lens Options
UV Coating
Tint (Solid and Gradient)
Standard Scratch Resistance
Standard Polycarbonate
Standard Anti-Reflective Coating
Standard Progressive (Add-on to Bifocal)
Other Add-Ons and Services
$15 Co-pay
$15 Co-pay
$15 Co-pay
$40 Co-pay
$45
No cost to you
80% of retail
Not covered
Not covered
Not covered
$28
Not covered
Not covered
Not covered
* Benefits limited to either in-network or out-of-network, one time per year.
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A Guide to KPMGs 2015 Benefits Options 15
2015 Benefits enrollment 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. NDPPS 312960
VSP Vision Care Plan
Frequency Limitations Examination
Frame and lenses or contact lensesOnce per calendar year
Once per calendar year
Once per calendar year
Once per calendar year
Member Cost In-Network Included in prescription glasses
Out-of-Network Maximum Allowance
Exam with Dilation as Necessary $10 Co-pay Up to $50
Frames* Any available frame at provider location
Plan pays up to $200
Member pays 80% of amount over $200:
$110 Allowance at Costco
Up to $70
Plastic or Glass Lenses
Single Vision
Bifocal
Lined Trifocal
Included in prescription glasses
Included in prescription glasses
Included in prescription glasses
Up to $25
Up to $65
Up to $85
Lens Options
Anti-reflective coating
Standard progressive lenses
Premium progressive lenses
Custom progressive lenses
Average 35%-40% off other lens options
$0
$50
$80-$90
$120-$160
Up to $75 for progressive lenses
Contact Lenses
Fitting and evaluation $60 Co-pay
Materials
Conventional or Disposable
Medically Necessary
Plan pays up to $200
$10 Co-pay
Up to $150
Up to $210
Glasses and Sunglasses 30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same days as your well vision exam or 20% off from any VSP doctor within 12 months of your last well vision exam.
Not covered
Laser Vision Correction Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.
Not covered
* Featured frames will receive an additional $20 benefit from VSP. Visit vsp.com to find a doctor who carries these frames.
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A Guide to KPMGs 2015 Benefits Options 16
Short-Term DisabilityIn addition to providing personal days for when a minor illness prevents you from working, KPMG protects your pay if you need to be away from work for a lengthy illness or injury.
The short-term disability program provides benefits for up to 25 weeks after five consecutive days of illness or injury. The five-day waiting period is included as part of the 26-week maximum benefit period.
In most cases, your pay is continued at up to 100 percent of your base pay for the first 12 weeks of disability and 66 23 percent for the balance of the 25-week period. Employees with fewer than three months of service will receive 66 23 percent of base pay for the 25-week period. Benefits are offset by workers compensation, statutory disability benefits, etc. There is no cost to you for this coverage.
Long Term DisabilityIn the event your illness or injury lasts longer than 26 weeks, the long-term disability program provides benefits up to 60 percent of your base pay for as long as you are disabled or until you reach age 65. (There are maximums for certain conditions.)
Benefits payable under the long-term disability plan may be offset by other disability benefits, including statutory, social security, or workers compensation disability benefits. Where allowable, coverage under the long-term disability program is mandatory, unless you have coverage elsewhere. You contribute toward the cost of this coverage through payroll deduction on an after-tax basis. This means that any benefits you receive will not be taxable.
Preexisting condition exclusions exist under this program for new hires and late enrollees.
Calculating your Disability BenefitsWhen calculating your disability benefits, KPMG uses your annual base paythat is, your regular base pay not including variable pay (such as bonuses or incentive plan payments) or premium pay (such as overtime).
With long-term disability coverage, your benefits under the short- and long-term disability plans are coordinated if you are away from work for more than 26 weeks. This means that you need to file only one claim for benefits when you first become disabled. Periodic medical evaluations will still be required.
Family and Medical Leave ActYou may be eligible for up to 12 weeks of leave under the Family and Medical Leave Act (FMLA) within any 12-month period for the following reasons:
The birth or adoption of a child, or the placement of a child with you for foster care (KPMG extends this leave for up to 26 weeks)
To care for a child, spouse, or parent with a serious health condition
For your own serious health condition
A qualifying military exigency leave
A military service member care leave (up to 26 weeks)
Additional information about FMLA leave, including eligibility guidelines, is available from the Human Resources Service Center.
Time Off for New Parents
KPMG offers generous time off for new parents that provides new moms with up to 18 weeks off at 100% of their salary. Other primary
caregivers can receive up to six weeks of paid parental time off at 100% salary, and non-primary caregivers can receive up to two weeks
of paid parental time off at 100% salary.
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A Guide to KPMGs 2015 Benefits Options 17
Disability Plans
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A Guide to KPMGs 2015 Benefits Options 18
Life Insurance PROGRAMS
Life InsuranceKPMGs benefits program also makes life insurance benefits availablefor both you and your spouse. KPMG automatically provides, at no cost to you, term life insurance equal to your annual base pay, up to a maximum of $50,000. When calculating your life insurance benefits, your annual base pay represents your regular base pay not including variable pay (such as bonuses or incentive plan payments) or premium pay (such as overtime).
You may elect to purchase additional term life insurance for yourself at favorable group rates in amounts from one to six times your annual base pay. The amount you pay for coverage is based on your age and whether you are a smoker or nonsmoker. The combined maximum for your firmprovided and your elective life insurance coverage is $1,050,000.
If you elect or increase life insurance coverage (greater than a multiple of one) after you are initially eligible, you must submit evidence of your good health for review and determination by the carrier.
For more information call the Human Resources Service Center at 1888ONEHRSC.
You may purchase term life insurance for your spouse in increments of $50,000. The maximum amount of spousal coverage you may elect for your spouse is the lesser of three times your annual base pay or $500,000.
You may also elect to purchase life insurance for your eli