Warehouse Worker Delivery Driver
Resume:
Benefit Summary
Benefit Summary Generated On **/*5/2023 At 08:52:16 CDT
About You
Your Information
Name Octavius May
Address
Jersey City, NJ 07304
US
Date of Birth 05/25/1975
Gender Male
Home Phone 646-***-****
Dependents - 1
Charlotte Ward
Spouse Date of Birth: 06/13/1974 Gender: Female
Page 1 of 7
Pending Approval
My Health
Pending Dependent Verification
Medical Covered Members
Members Covered
Octavius May
Effective Date: 07/02/2023
Yes
Charlotte Ward
Effective Date: 07/02/2023
Yes
Pending Dependent Verification
Medical - Reliance Care Plan $26.89
Weekly
Pending Dependent Verification
Dental Covered Members
Members Covered
Octavius May
Effective Date: 07/02/2023
Yes
Charlotte Ward
Effective Date: 07/02/2023
Yes
Pending Dependent Verification
Dental Cost Breakdown
Employee Cost
Your employer will be paying $0.00 for this benefit.
$13.34
Weekly
Dental - Base PPO Plan $13.34
Weekly
Pending Dependent Verification
Vision Covered Members
Members Covered
Octavius May
Effective Date: 07/02/2023
Yes
Charlotte Ward
Effective Date: 07/02/2023
Yes
Pending Dependent Verification
Vision Cost Breakdown
Employee Cost
Your employer will be paying $0.00 for this benefit.
$2.71
Weekly
Vision - Basic Vision $2.71
Weekly
Page 2 of 7
Your Employer's Cost
$1.50
Weekly
This is the total amount your employer will be paying for these benefits to lower your overall cost. Total Cost
If Approved $61.29
Weekly
Page 3 of 7
Current
My Health
Medical Covered Members
Members Covered
Octavius May
Effective Date: 07/02/2023
Yes
Charlotte Ward
Effective Date: 07/02/2023
Pending
Medical - Reliance Care Plan $10.02
Weekly
Dental Covered Members
Members Covered
Octavius May
Effective Date: 07/02/2023
Yes
Charlotte Ward
Effective Date: 07/02/2023
Pending
Dental Cost Breakdown
Employee Cost
Your employer will be paying $0.00 for this benefit.
$5.80
Weekly
Dental - Base PPO Plan $5.80
Weekly
Vision Covered Members
Members Covered
Octavius May
Effective Date: 07/02/2023
Yes
Charlotte Ward
Effective Date: 07/02/2023
Pending
Vision Cost Breakdown
Employee Cost
Your employer will be paying $0.00 for this benefit.
$1.36
Weekly
Vision - Basic Vision $1.36
Weekly
Voluntary Critical Illness - Coverage Waived
Page 4 of 7
My Savings
My Security
Hospital Indemnity Covered Members
Members Covered
Octavius May
Effective Date: 04/03/2023
Yes
Charlotte Ward
Effective Date: 04/03/2023
Yes
Hospital Indemnity - Hospital Indemnity Plan $6.70 Weekly
Accident Covered Members
Members Covered
Octavius May
Effective Date: 04/03/2023
Yes
Charlotte Ward
Effective Date: 04/03/2023
Yes
Accident - Accident Plan $3.51
Weekly
Health Care FSA - Coverage Waived
Dependent Care FSA - Coverage Waived
Effective Date 07/02/2023
Basic Life Coverage Amount
Coverage Amount 1 1/2x Salary
Employee Cost
Your employer will be paying $1.50 for this benefit.
$0.00
Weekly
Basic Life Beneficiaries
Name Beneficiary Type Allocation
Jarel Ward Primary 100.00%
Charlotte Ward None
Terrell Ward None
Basic Life - Basic Life $0.00
Weekly
Page 5 of 7
Effective Date 07/02/2023
Supplemental Life Insurance Coverage Amount
Coverage Amount 5x Salary
Employee Cost
Your employer will be paying $0.00 for this benefit.
$5.72
Weekly
Supplemental Life Insurance Beneficiaries
Name Beneficiary Type Allocation
Jarel Ward Primary 100.00%
Charlotte Ward None
Terrell Ward None
Supplemental Life Insurance - Supplemental Life $5.72 Weekly
Spouse Life Insurance Covered Members
Members Covered
Charlotte Ward
Effective Date: 07/02/2023
Yes
Spouse Life Insurance Coverage Amount
Coverage Amount $50,000.00
Spouse Life Insurance - Supplemental Spouse Life $2.42 Weekly
Child(ren) Life Insurance - Coverage Waived
Accidental Death and Dismemberment (ADD) Insurance - Coverage Waived Effective Date 09/30/2023
Short Term Disability Cost Breakdown
Employee Cost
Your employer will be paying $0.00 for this benefit.
$0.00
Weekly
Short Term Disability - Short Term Disability $0.00 Weekly
Page 6 of 7
This online benefit summary is reflective of benefits information contained within the Businessolver, Inc. database on the date this information is being displayed. This information is not intended to be an all inclusive or exhaustive list of benefit enrollment information. Modifications, deletions, and additions to coverage are not immediately effective upon submission. Please contact your Benefits Administrator with questions. Important Note: The insurance carriers make the final determination regarding the payable benefit amount and the designated beneficiaries. The information shared reflects the current enrollment system data, but the ultimate benefit recipient or benefit amount to be paid may change based on plan rules, Evidence of Insurability and approvals, and other factors.
Every effort has been made to report information accurately, but the possibility of error exists. In case of any conflict between your benefits election confirmation and an official plan document, the plan document will be the final authority. Please note, some insurance coverage elections only become effective upon approval of your evidence of insurability (EOI) by the carrier.
* -Any personal or dependent information that appears in red font indicates a change that is currently pending approval. Effective Date 09/30/2023
Long Term Disability Cost Breakdown
Employee Cost
Your employer will be paying $0.00 for this benefit.
$0.00
Weekly
Long Term Disability - Long Term Disability 50% Option $0.00 Weekly
Legal Services - Coverage Waived
Effective Date 04/03/2023
EAP - Employee Assistance Plan $0.00
Weekly
Effective Date 04/03/2023
FMLA Administration - FMLA - Reliance $0.00
Weekly
Your Employer's Cost
$1.50
Weekly
This is the total amount your employer will be paying for these benefits to lower your overall cost. Total Cost $35.53
Weekly
Page 7 of 7
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