Please make your selection for each benefit below. All rates are per pay period. Benefit premiums are deducted twice per month. When there are three pay dates in a month, deductions will only be taken for two of them.
A Health Savings Account (HSA) is a tax-advantaged account that helps you pay for qualified medical expenses.
System Automation contributes to your HSA account! Monthly contributions totaling $1,375 (individual) and $2,750 (individual + dependents) will be paid during the calendar year to all active employees enrolled in SA's medical plan. (Contributions will be deposited into your Optum Bank HSA.)
You can contribute additional amounts up to the maximum annual contribution amount: $3,500 for employee-only; $7,000 for employee plus dependent(s). If you are age 55+, you can make an additional catch-up contribution of $1,000.
Note: the HSA contribution limit is the combined total of employee and employer contributions.
Eligible Healthcare Expenses
Dependent Care List of Qualifying Expenses - See the top right of Page 2
System Automation provides full-time employees with $20,000 of group life and accidental death and dismemberment (AD&D) insurance, and pays the full cost of this benefit. Employees may purchase additional coverage for themselves and dependents.
System Automation pays the full cost of your long-term disability benefit (payable up to five years for disabilities occuring before age 60). You have the option to purchase additional LTD benefits which will provide income replacement until your full ("normal") Social Security retirement age.
You may print this form prior to submitting it.