2011 SEMI U.S. Employee Benefits Summary

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KAISER - 2011

Plan

Traditional PPO Plan
 
In & Out: $500/$1,500
In OOP: $1,500/$4,500

IN NETWORK

OUT OF NETWORK

Calendar Year Deductible

Individual

$500

Family

$1,500

Out of Pocket Maximum

Individual

$1,500 ¹

$4,500

Family

$4,500 ¹

$13,500

Office Visits

General physician & Specialist

$20 ²

50%

Preventive Care

No charge

50% ²

Preventive Care Annual Max

None

N/A

Well Child Care

No charge

50% ²

Physical, Occupational, Respiratory & Speech Therapies

30%

50%

Maximum # of Visits/Year

60 visits ⁴

Chiropractic Care

Not covered

Not covered

Maximum # of Visits/Year

N/A

Prescriptions

30-day supply
from MedImpact Pharmacies

N/A

Generic

$15 ²

Not covered

Formulary Brand

$40 ²

Non-Formulary Brand

Not covered

Mail Order

2x Copay for 100-day supply

Laboratory

30%

50%

Inpatient Hospitalization

$250 ded,
then 30%

$500 ded,
then 50%

Outpatient Surgery

$100 ded, then 30%

$150 ded, then 50% ³

Emergency Room

Emergency: $100 ded, then 10%
Non-emergency: 30%

Copay Waived if Admitted

Yes

Mental Health

Inpatient

Severe

$250 ded,
then 30%

$500 ded,
then 50%

Non-Severe

Outpatient

Severe

$20 ²

50%

Non-severe

Maximum # of Visits/Year

None

Dependent Child Coverage

Under Age 26/FTS under age 26

Lifetime Maximum

No Limit in Plan Only

$5 Million Out of Plan

1 - Only coinsurance paid for Covered Services contribute towards the Out of Pocket Maximum.

2 - Exempt from Calendar Year Deductible.

3 - Benefit limited to $600 per procedure.

4 - All outpatient therapies are limited to 60 visits per Calendar year combined for both PHCS Providers and Non-Participating Providers.

IMPORTANT NOTE: Pre-existing conditions

Regarding pre-existing conditions for all medical insurance listed above: If you had a break in medical coverage from your last employer before employment at SEMI, you may be subject to ‘pre-existing conditions’. Please check the definition of a pre-existing condition in your medical insurance enrollment booklet. If you are unsure after reading the definition, please contact SEMI Human Resources.

2011 Employee Contribution Table per Pay Period for the HMO and the HSA Deductible-HMO Plans

HMO & HSA Plan Coverage

Employee Only

Employee & Spouse

Employee & Children

Employee & Family

Contribution before tax

$48.46

$110.77

$99.23

$150.00

Average after tax pay effect

$33.92

$77.54

$69.46

$105.00

2011 Employee Contribution Table per Pay Period for the Traditional PPO Plan

PPO Coverage

Employee Only

Employee & Spouse

Employee & Children

Employee & Family

Contribution before tax

$180.00

$392.31

$355.38

530.77

Average after tax pay effect

$126.00

$274.62

$248.77

$371.54

Dental – Administered by Benxcel

Employee & Dependents

Cost: $0.0

$25 Deductible Individual 

$50 Deductible Family

$2500 Maximum calendar year100%Preventive/80% Basic/75% percent Major/ up to 50 percent Orthodontia for employee/dependents Orthodontia Lifetime benefit $2,500

LIFE INSURANCE: The Prudential Insurance Co of America

Employee only

Cost: $0.0

Basic Term Life: 2 ½ times annual salary to a maximum of $500,000

AD&D—2 ½ times annual salary to a maximum of $500,000

Optional Term Life Insurance - Prudential Insurance Company of America

Cost: Per rate sheet on Benxcel Web site

Basic Term Life for employee and dependents, paid for by the employee through payroll deductions.

LONG TERM DISABILITY - Prudential Insurance Company of America

Employee only

Cost: $0.0

Provides up to 66 2/3 percent of earnings until Age 65. $10,000 monthly maximum benefit. Coverage: Employee only 90-day elimination period

LONG TERM CARE - Prudential Insurance Company of America

Employee only

Cost: $0.0

Core Plan for Employees :

Nursing Home Care, Assisted Living, Residential Care Daily Maximum Benefit $100 per day;

Home or Community Based Care DMB %60 per day

Optional Long Term Care Insurance - Prudential Insurance Company of America

Cost: See rates from Prudential on Benxcel Web site

Upgrade Long Term Care policy for employee and/or add spouse or parents.  The employee pays through payroll deductions for this supplemental coverage.

EAP - ComPsych/Guidance Resources

Employee & Dependents

Cost: $0.0

Confidential counseling service for Marital/Relationship Issues • Work Issues • Dependent Care *Referrals •Parenting Issues • Domestic Violence • Substance Abuse • Anxiety/Depression • Health Questions • Legal Issues • Financial Matters •Most other Personal Concerns. Three free visits per incident per individual every year.  Pre-authorization required.  1.800.311.4327 U.S begin_of_the_skype_highlighting            1.800.311.4327 U.S      end_of_the_skype_highlighting./toll free 1.800.441.5555 begin_of_the_skype_highlighting            1.800.441.5555      end_of_the_skype_highlighting. Travel assistance services include Medical and Personal, and are available to employees engaged in temporary travel, including their accompanying spouse and children.

EDUCATIONAL ASSISTANCE

Employee only

Cost: $0.0

Financial assistance for undergraduate degree is available to a coverage maximum of: Employee $5,250 per calendar year, providing your course of study is business related and you are a full-time employee. Administered by the HR Department.

SICK LEAVE

On the first day of each year, full-time (40 hours per week) employees will be issued 80 hours (10 days) of sick leave. Newly hired, full time employees will be issued a prorated number of hours in accordance with the number of months remaining in the year. Sick leave unused at year-end will be carried over for future serious illness. Employees will not be paid for any unused sick days at termination.

SHORT TERM DISABILITY

SEMI will pay the difference between state or federal disability income and the employee's current salary for a period not to exceed 90 days or until Long Term Disability payments begin, whichever comes first, providing the employee has been with SEMI five years and is an active, full time employee. This benefit applies to personal illness after seven continuous days of sick leave. The employee’s accrued vacation and sick leave are the only pay categories available to pay for the first week of absence. STD ceases when Long Term Disability begins. Employees, with less than five years of service, will accrue any unused, annual days of sick leave.

 VACATION PAY

Regular full-time employee, who regularly works 30 or more hours a week, accumulate credit toward an annual vacation pay at an accrual rate of 4.616 hours per two-week, pay period (three weeks per year). Once an employee reaches 240 accrued vacation hours, the vacation hours stop accruing, until previously accrued vacation is taken. SEMI will not retroactively grant the employee the amount he/she would have earned during the time the vacation was at the cap.

Each year, employees may elect to receive one week's pay in lieu of taking the vacation if they have accrued at least two weeks of vacation at the time they make the request.

Years of Service and Vacation Hours per Pay Period, Accumulated per Year

1-9

4.616 120 hours (3 weeks per year)

10-14

6.154 160 hours (4 weeks per year)

15 +

7.693 200 hours (5 weeks per year)