🇺🇸 United States - Local Benefits Packages, Customer Overview

Local benefits packages enable you to choose from 4 pre-created benefits packages and offer country-tailored benefits to your team. Those packages include the following:

  • Multiple insurances
  • Pension (401k)
  • Voluntary benefits

Companies can choose between Essential, Competitive I, Competitive II, and Best-in-class packages. Some of the coverage highlights include:

  • Unlimited outpatient (appointments, exams and drugs, and inpatient care)
  • Maternity, dental, and vision
  • Mental care (psychologist and psychiatrist) 
  • Preventative care and immunizations at no charge
  • Employee Assistance Program
  • Life, accidental death and dismemberment (AD&D)
  • Long and short-term disability
  • Pension (401k)
  • Voluntary Benefits (no employer contribution)

Benefits providers

Oyster works with top local insurance providers in the US who understand the market and offer reliable service.

  • Health Insurance: Aetna and Kaiser
  • Other Insurances: Guardian
  • Pension: Slavic
  • Voluntary Benefits: Guardian, HealthEquity and MetLife

Plan selection

Considering the local context in the US, a one-fit-for-all solution would not offer a good experience for the team members as hardly a single plan would be able to offer consistent coverage across the country. Also, due to the high cost of health insurance, team members in packages other than Best-in-Class might opt to enroll in more affordable plans. With that in mind, Oyster team members in the US can choose from 7 different health insurance plans:

National Plans: Plans are aimed at team Members across the US, including California. The team member can choose between two plans. Aetna offers those products.


Remote Location Plan: For team members that reside in remote locations in which the coverage in other plans is very limited/non-existent. There is only one option of the plan. This plan is also provided by Aetna

California Plans: For those Team Members located in California, Oyster offers specific plans through Kaiser.

You can find more details on each of those plans in the Benefits guide at the end of this page. 

Pricing

Pricing is based on which package you select and the plan chosen by the team member.

Currently, we offer four options:

  • Essential: The most basic tier. For this package, the company pays only 80% of the team member's health insurance premium. For the other insurances, the company will pay 100% of the team member's premium and 50% for his family (considering the dental standard plan value).
  • Competitive I: For this package, the company pays 100% of the team member's health insurance premium. For the other insurances, the company will pay 100% of the team member's premium and 50% for his family (considering the dental standard plan value).
  • Competitive II: For this package, the company pays 100% of the team member's health insurance premium and 50% for his family. For the other insurances, the company will pay 100% of the team member's premium and 50% for his family (considering the dental standard plan value).
  • Best-in-Class: The highest tier. In this package, the company will cover 100% of the premium cost for the most comprehensive insurance plans offered by Oyster for both the team member and his family.
  Essential Competitive I Competitive II Best-in-Class
Health $562,19 $702,74 $1,442.58 $ 2,182.41
Dental $31.98 $71.47 $71.47 $158.99
Vision $6.54 $12.41 $12.41 $18.27
Life, AD&D $28 $28 $28 $28
Total $674.07 $814.62 $ 1,554.46 $2,387.67
  • The above premiums are monthly and quoted in USD and will be converted to local currency at the time of invoicing.
  • The above prices are estimations based on the most expensive plan offered by Oyster and considering the enrollment of spouses and children.
  • Life AD&D price is an estimation. The final price will depend on the team member’s salary.

Pension

All team members employed by Oyster are enrolled on a mandatory 401k pension fund (managed by Slavic) effective at their date of hire, with a 3% company contribution. This will be contributed regardless of whether the team member also contributes to their retirement account. 

All contributions are fully vested as they are contributed, and there is no minimum age required to be eligible. Team members will be able to select either a Traditional or Roth 401k under a traditional account.

Retirement investment funds are only taxed at the time of withdrawal. Roth accounts are taxed at the time the contribution is made and withdrawn tax-free. 

You can find more details on the Oyster pension offering on the brochure at the end of this page.

Benefit Support Fee

From February 1st, 2024, We are also introducing a $50/ €45/ £40/ CA$70 per month Benefit Support Fee in Competitive I, Competitive II, and Best-in-class packages to cover the costs of handling the benefits lifecycle:

  • Market research
  • Vendor negotiation
  • Enrollment and modifications
  • Vendor management
  • General administration

This fee is part of our overhead as set out in our Terms & Conditions.

Voluntary Benefits

At the time of their enrollment, team members can opt-in to the below additional voluntary benefits. The cost of such additional coverages is fully paid by them.

Voluntary Life

Like basic life insurance, voluntary life insurance provides financial assistance to cover funeral costs, and ongoing financial obligations, such as daily living expenses, children’s education, and future mortgage payments.

Accident Insurance

Accident insurance, also known as personal or supplementary accident insurance, can be used to cover the costs of accidental injuries. This plan will help cover medical expenses that include fractures, dislocations, and lacerations. Plan coverage ranges from non-occupational coverage and full coverage to minimal coverage. Additional accident insurance benefits may include a wellness option for the insured, as well as the insured’s family members.

Critical Illness

Also known as catastrophic illness insurance, critical illness insurance has the goal to protect the policyholders from costs associated with life-threatening illnesses, like heart attack, stroke, renal failure, loss of vision, speech or hearing, cancer, or other medical emergencies. Critical illness plans allow participants to allocate as much money as they need, and pay for costs not related to the illness directly, including childcare, household bills, diagnostic testing, deductibles, or transportation.

Hospital Indemnity

Hospital indemnity insurance is a complement to medical coverage plans aimed to lessen the financial burden of medical costs. Hospital indemnity insurance is used to cover the costs of hospitalizations, including hospital confinement, hospital admission, hospital intensive care, and intermediate intensive care step-down unit. Hospital indemnity insurance can range in coverage from low and mid-point plans to full (high) coverage plans.

A lump sum payment is provided that the insured can use to cover hospital admissions, hospital stay costs, rehabilitation, or additional expenses.

Voluntary Commuter Benefits

Team members can enroll in voluntary commuter benefits for metro cards, gas expenses, or toll fees, and enjoy the payroll (FICA) tax savings of 7.65%.

Flexible Spending Account (FSA)

A flexible spending account (FSA) is a type of savings account that allows the team member to contribute a portion of his pre-tax earnings. With those funds, he can cover a wide variety of qualified medical expenses for himself and his dependents. Those expenses include but are not limited to, deductibles, copays, and prescribed medication.

Dependents Flexible Spending Account (Dep FSA)

This account works just like the Flexible Spending Account (FSA), but the funds can be utilized for eligible expenses related to dependents such as daycare, after-school activities, and elderly care.

Pet Insurance

You can purchase insurance for your pet dogs and cats with up to 90% reimbursement for eligible expenses.

For more details on the Voluntary Benefits coverages and prices, please refer to the links at the end of this page.

Dependents

Team members can include dependents (spouse and children) in their health, dental, and vision plans.

Dependents can be added to the plan, and Oyster will provide a 30-day window from the time the team members are enrolled to allow them to add their dependents to cover. They cannot be added outside this 30-day Team Member joining window unless due to a Qualifying Life Event (i.e., birth, adoption, marriage).

Taxation

These Prices are inclusive of local and country-specific Insurance Premium Taxes (IPTs) payable by your organization. There are no employer taxes applicable to those benefits in the United States.

Renewal

The benefits provided by Oyster in the United States are renewed on a yearly basis. Hence, price readjustments and coverage changes should be expected every year. Such changes, if any, always happen during the open enrollment period, which happens at the end of each year.

During this period, all the concerned parties are made aware of the changes, and team members will be able to change their benefits or add dependents.

All changes will come into effect on the first day of the next year.

How to enroll your Team Members in Local Benefits?

You can enroll your team in the local benefits from the hiring flow or from the in-app benefits flow. 

From the hiring flow:

  1. After you fill out the compensation details, you will be taken to the Benefits section of the hiring form.
  2. Select a benefits package based on your company’s benefits strategy. 
  3. Make a selection to see the total estimated monthly costs. 

From the benefits flow:

  1. Click People > Benefits from the left menu in your Oyster account.
  2. On the Benefits page, review the list of engaged Team Members and their benefits enrollment status. Click Enroll Benefits to enroll a Team Member in benefits.
  3. The Request Benefits Enrollment page opens. Select a plan.

Click Send request. Wait for the success message to appear.

  1. The Oyster support team will begin the enrollment process along with the benefits vendors.

FAQs - Enrollment

Is offering benefits in the US mandatory? Can I offer only selected benefits?

All team members must be enrolled in one of the tiers offered by Oyster, and the packages cannot be customized.

Can I offer Allianz Global Health as a replacement for the local solutions or as an add-on?

No. Allianz is not available in the US.

Do these benefits apply to all my Team Members regardless of whether an Oyster direct or indirect entity employs them? And what about contractors and part-time employees?

Only Team Members who are employed full-time by Oyster’s direct/owned entities can be enrolled in these benefits. Contractors and part-time employees are not eligible for those benefits.

Can I choose the plan to be offered to my team?

No. The team member will decide which plan suits best his healthcare needs. The company will define the cost strategy applicable to them.

When does the coverage start?

Your team coverage will start on the 1st of the next month of his enrollment. For instance, if the team member's date of joining is January 15th, his policy start date will be February 1st.

When my Team Members can enroll? What information they must provide?

During their onboarding, they will receive an e-mail from our broker, Vensure, requesting them to elect their benefits and add dependents.

Can dependents be added?

Dependents (spouse and children) can also be covered.

FAQs - Coverage

Do the carriers have a provider network? Can team members pursue care outside of this network?

All carriers have provider networks that have more favorable out-of-pocket conditions. For Kaiser plans (which are exclusive for California residents), there are some limitations to out-of-network care. You can find more details on the brochure at the end of this page.

Where will my team be covered by Aetna and Kaiser?

Aetna plans have countrywide coverage, while Kaiser plans coverage is limited to the state of California.

Are there any waiting periods applicable?

No, there are no waiting periods applicable to the plans offered by Oyster.

How Team Members can view their enrollment status?

After they finalize your enrollment process in the Vensure platform, they will receive a confirmation mail informing them of the start date of your elected benefits.

When will their insurance coverage be active?

Their insurance will be active from the first day of the subsequent month of their joining date. For example, if they join Oyster on May 10th, their benefits will be active from June 1st.

What will happen if they want to enroll at a later date?

They will only be able to enroll themselves or their dependents after the onboarding in two scenarios:

  • At the open enrollment period at the end of the year.
  • In case of a life-qualifying event such as the birth of a child, marriage, or loss of coverage through a spouse. In this case, they will have to reach out to Vensure (our broker) up to 30 days after the fact to initiate the enrollment formalities.

You can find more details on qualifying events on the linked document at the end of this page.

How they can opt-out?

They can opt out by selecting this option in the enrollment process with Vensure or by not enrolling at all.

Can Team Members extend their insurance in case they leave Oyster?

Following the Consolidated Omnibus Budget Reconciliation Act (COBRA), employees who previously elected coverage after they are terminated can remain covered under their existing health plan for up to 36 months. During this period, the premium must be fully paid by the employee. They should reach out to our broker, Vensure for more details on this process. They can do so through benefits@vensure.com or by calling 800.409.8958.

Is there an insurance card?

Yes. Team members will be mailed the card up to 30 days after their enrollment date. Yet, in case they require medical attention before, they will be able to claim any eligible expense from the day of their coverage start date.

Does the life insurance cover death abroad?

Death abroad is covered under the same conditions as an in-country event. However, repatriation expenses are not included in the coverage.

Are there any copay and deductibles applicable?

Yes. However, the values will vary according to the plan.

Do the deductibles/out-of-pocket limits from my team member's previous insurance carry over to Oyster's?

 

There are no limits carryovers from previous health insurances.

Where can I find more details on the coverage?

You can find more details related to reimbursements, network, and procedures covered on the links at the end of this page. 

FAQs - Voluntary Benefits

Can I cover the costs of voluntary benefits just like for the other benefits? 

No, there is no employer contribution for voluntary benefits, including contributions towards FSAs.

What are the contribution limits for the Flexible Spending Accounts (FSAs)?

As of 2024, the limit towards FSA is $3,200. For dependent FSA the limit is $5,000 per household or $2,500 for married individuals filing taxes separately.

What will happen to unspent funds in my FSA?

Funds deposited in FSAs are not returnable. This means if they are not spent by the end of the year, the team member won't be able to recover them. Hence, we recommend them to plan ahead to make sure that the whole balance is spent.
However, they will have a 2.5-month grace period after the year's end to spend any values left in the account.

Can their spouse contribute to my FSA account?

Healthcare FSAs can only be contributed to by an individual. There is no family contribution option. Both the Team Member and their spouse can each have an FSA account through their respective employers and both can contribute the maximum amount to each account.

Coverage Documentation

Benefits Overview

US Benefits Overview 2024

Health

Dental

Vision

Life and Disability

Pension

Voluntary Benefits

Qualifying Life Events Guide

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