Download Employee Flexible Benefits Profile

Employee Flexible Benefits Profile
Employee Name: _______________________________________________________________
Employee Address: _____________________________________________________________
This report has been prepared to give you a better idea of our flexible benefits program as it
applies to you and your family as of [date].
The information in this statement is based on the following:
Your date of birth:
______________________
Your Social Security number:
______________________
Your most recent date of hire:
______________________
Your base regular earnings:
______________________
Your employee number:
______________________
Health Benefits
Your flexible benefits medical plan provides valuable protection for you and your family. The
plan covers a broad range of health services and supplies. Depending on the option selected,
expenses are covered at either: 80 percent, 90 percent, or 100 percent of “reasonable and
customary” (R&C) charges after an annual deductible has been met.
Regardless of the option you have selected, catastrophic protection is provided at 100 percent of
R&C charges if covered expenses exceed $________. Benefits are payable up to a lifetime
maximum of $___________ per covered individual.
During the period January 1, [2006] to December 31, [2006], the Company paid health expenses
of $ [1000.00] on behalf of your family.
Our records show that as of January 1, [2006] you are enrolled in the following plans:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Life Insurance and Survivor Benefits
Your survivor benefits provide valuable protection for your family during your career, and, if
you retire from the Company with at least [20] years of service, after you retire.
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Our records show that as of January 1, [2006] you are enrolled in the following plans:
______________________________________________________________________________
______________________________________________________________________________
The following summarizes your current coverage levels based on your salary as indicated below:
Amount
of coverage
Current annual
employee
contribution
Core life insurance
$___________
$___________
Core travel accident insurance
____________
____________
*Core ten-year survivor coverage
____________
____________
*Core twenty-five-year survivor coverage
____________
____________
Option ________________ life insurance
____________
____________
Accidental death and dismemberment
____________
____________
Dependent coverage:
Spouse
____________
____________
Child
____________
____________
*Assumes beneficiary is same age as you.
Vacation
Based on your accredited service with the Company, during [2006], you were entitled to [3]
weeks of regular paid vacation. During [2006] you are eligible for [2007] weeks of regular paid
vacation.
In addition, during each enrollment period, you are eligible to purchase up to [5] extra vacation
days with flexible credits. The flex cost of each day depends on your base annual salary.
In [2005] you purchased ____ extra days at a cost of $______ flexible credits.
In [2006] you purchased ____ extra days at a cost of $ ______ flexible credits.
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Disability Benefits
If you are unable to work because of illness or injury, your core disability plans provide a
continuous source of income. In addition, you can supplement this income by choosing among
the optional coverage available.
Our records indicate that as of January 1, [2006] you are enrolled in the following plans:
______________________________________________________________________________
______________________________________________________________________________
If you were to become temporarily disabled your income from the plan would be:
$_____ per month for up to [6] months and
$_____ per month for an additional [6] months (including any Social Security payments)
If you were to become totally disabled your income from the plan would be:
$______ per month for up to [12] months and
$______ per month until the earlier of the date you recover, die, reach age 65, or retire
(including any Social Security payments).
During total disability, your retirement plan benefits would continue to provide a continuous
source of income after you retire. Depending on the form of payment you choose, you can also
provide a monthly income to your eligible designated beneficiary after your death.
Retirement Plan
Your retirement plan, in combination with Social Security, is intended to provide a continuous
source of income after you retire. Depending on the form of payment you choose, you can also
provide a monthly income to your eligible designated beneficiary after your death.
Shown in the accompanying tables is the estimated monthly income payable to you when you
retire. These illustrations assume that your current annual earnings will remain unchanged
between now and when you retire. In addition, these illustrations do not take into account any
other additional forms of includable compensation such as overtime pay and/or incentive
bonuses that you may have received in the past or may receive in the future.
Depending on your circumstances, additional Social Security may be payable to your spouse as
early as age 62.
If you retire prior to age 62 your benefits will not be reduced to reflect the Social Security offset
until you reach age 62.
The following examples assume that your spouse is the same age as you.
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50 percent Joint and Survivor Benefits:
If you retire at age
62
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65
Monthly income from retirement plan
$_____
$_____
$_____
Monthly income from Social Security
$_____
$_____
$_____
Total monthly retirement income
$_____
$_____
$_____
Total monthly retirement as a
percentage of final average earnings
______ %
______ %
______ %
Straight Life Annuity:
If you retire at age
62
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65
Monthly income from retirement plan
$_____
$_____
$_____
Monthly income from Social Security
$_____
$_____
$_____
Total monthly retirement income
$_____
$_____
$_____
Total monthly retirement as a
percentage of final average earnings
______ %
______ %
______ %
The 50 percent joint and survivor form of pension provides you with a lower level of benefits
during your lifetime, but after your death your spouse will receive a lifetime monthly benefit
equal to one-half the amount you were receiving before your death. Unless you elect otherwise,
this is the normal form of payment you will receive if you are married.
The life annuity form of pension provides you with a lifetime monthly income with no payments
made after your death, unless you elect otherwise. This is the normal form of payment you will
receive if you are not married at the time you retire. Other forms of retirement benefits are
available.
Note: The benefit levels indicated above are only illustrations. They do not take into account
possible changes in the Social Security law or any increases in salary that you may receive
between now and the time you retire. The closer you are to retirement, the more accurate these
estimated benefits are. In any event, the retirement plan, along with Social Security, should
provide you with an ongoing monthly retirement income approximately equal to the percentage
of final average earnings indicated above, regardless of changes in your salary.
Capital Accumulation Plan
In [2006] you and the Company contributed to your account as follows:
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Amount of annual contributions from:
Payroll deductions
Company match of
payroll deductions
Flexible credits
Allocated to:
$ ____________
$ ____________
$ ____________
Company stock
$ ____________
$ ____________
$ ____________
Guaranteed interest fund
$ ____________
$ ____________
$ ____________
Diversified investment fund
The total amount contributed to your account during [2006] was $______.
The total value of your accounts as of December 31, [2006] was $______.
When you reach age 65 your capital accumulation plan account will have a total value of
$______ and will be capable of providing an estimated average monthly income of $______ for
the rest of your life assuming that (1) annual contributions are made into your account at the
same level as during [2006]; (2) no withdrawals are made; (3) the average annual investment
yield is ____ percent between now and when you reach age 65; and (4) your monthly payment is
in the form of a single life annuity.
Employee's Stock Purchase Plan.
In [2006] you and the Company contributed to your account as follows:
$ ______ in payroll deductions
$ ______ in Company match of payroll deductions
$ ______ total
Value of Your Benefits and Compensation
As an employee of [Company], you and your family are protected by a wide variety of benefits,
as described above. Your benefits have the following value:
Value of your benefits during [2006]
Health
$ ____________
Disability
$ ____________
Vacation/holiday
$ ____________
Life and survivor
$ ____________
Retirement
$ ____________
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Capital accumulation
$ ____________
Stock purchase
$ ____________
Total value of summarized benefits
$ ____________
Employee payroll deductions
$ ____________
Total value of Company-provided benefits
$ ____________
Regular base earnings as of December 31, [2006]
$ ____________
Social Security paid on your behalf during [2006]
$ ____________
Total value of compensation and summarized benefits
$ ____________
Additional Benefits
[Company] also provides the following additional benefits:






Paid holidays
Excused absences
Full pay while on jury duty
Military reserve salary differential
Service awards


Matching gifts to colleges and
universities
Tuition refund to help improve your
education
Student loans to help your children
continue their education
These benefits, along with those summarized in this profile, significantly increase the value of
your total compensation.
How Your Flexible Benefits Profile Was Prepared
This benefit report has been prepared by the human resources department, on the basis of the
information available in our records. Every effort has been made to provide you with data that is
accurate and up to date; nevertheless errors can occur. If you have any questions about anything
shown on your statement, please contact your employee relations officer.
Eligibility for benefits and the actual amount payable under the various benefit plans described
will be determined in accordance with the formal documents creating and governing such plans.
If there is any discrepancy between a benefit described in this report and the benefits provided
under the plan documents, the documents will determine the actual benefit.
Social security benefits shown in this report and used in the calculation of retirement benefits are
estimates based on the law in effect on December 31, [2006], and assume that you have had, and
will continue to have, covered wages until you retire. You actual benefits from Social Security at
the time you retire will depend on the law in effect at that time and your actual earnings history.
If you want additional information about your Social Security earnings and benefits, you can ask
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for a “Request for Earnings and Benefit Estimate Statement” (Form SSA-7004) from the Social
Security Administration.
Courtesy of American Can Company, Greenwich, Conn.
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