AAA Employee Benefit Elections - AAA Scholarship Foundation

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Name*

First Last

AAA Email Address*

Date*

Medical Insurance

The options for medical insurance have changed this year. Please make at least one selection below (even if that selection is to waive coverage).

Medical Insurance Policy Selection - pick one*

The options for medical insurance have changed this year. Unless you waive coverage you will have to select a plan.

Medical Insurance Coverage Level - pick one*

Dental Insurance Section

There are no changes to the dental plan coverage levels. The dental premium rates went up by 4.0%. Please make at least one selection below (even if that selection is to waive coverage).

Dental Insurance Coverage Selection - pick one*

Dental Insurance Coverage Level - pick one*

Vision Insurance Section

This is a voluntary group insurance plan. Voluntary means that the employee pays the entire premium. There are no changes to the vision options. Rates decreased by 1.9%. Please make at least one selection below (even if that selection is to waive coverage).

Vision Insurance Coverage Selection - pick one*

Vision Insurance Coverage Level - pick one*

Supplemental Insurance Section

This is a voluntary group insurance plan. Voluntary means that the employee pays the entire premium. There have been no changes to the supplemental insurance options. The rates have changed. Please make at least one selection below (even if that selection is to waive coverage).

Supplemental Insurance Plan Options - choose as many or few as you wish*

Transconnect "Gap" Plan

Critical Illness Plan

Accident Plan

Waive All Three Supplemental Coverages

Transconnect "Gap" Plan Coverage Level - pick one*

Critical Illness Plan Coverage Level - pick one*

Critical Illness Plan Coverage Amount*

Please enter a number from 5000 to 20000.

You can purchase insurance in $5,000 increments up to $20,000 for you and each eligible family member. The default is $5,000.

Accident Plan Coverage Level - pick one*

Retirement Plan Section

AAA contributes a matching contribution to each eligible employee’s Simple IRA equal to the employee’s salary reduction contributions up to 3% of the employee’s compensation for the calendar year. The IRS max contribution limit for 2025 is $16,500 if under 50 years old and $20,000 if over 50 years old. Please make at least one selection below (even if that selection is to waive participation).

Retirement Plan Contribution Level (salary reduction) - Pick one*

If Other Amount is chosen, list the annual salary reduction amount here:

Please enter a number less than or equal to 20000.

Reminder before you submit your selections:

Employer Contributions: AAA contributes up to $500 per pay period (including employer taxes) towards certain benefits for eligible employees. In order of priority, AAA contributes 1) a matching contribution to each eligible employee’s Simple IRA equal to the employee’s salary reduction contributions up to 3% of the employee’s compensation for the calendar year, then 2) up to 50% of the employee’s monthly dental insurance premium, then 3) the balance (or up to $500 per pay period if not used for #1 or 2 above) may be used for an eligible employee’s monthly medical insurance premium. If the medical insurance premium is greater than the balance, the employee is responsible for the difference. If the medical insurance premium is less than the balance, the balance may be paid to the employee as a taxable “medical insurance differential” or “MID”. Please email Kim if you have any questions or if you need additional information in order to make your decisions.