Below we’ve answered some of the most frequently asked questions that the Benefits Team receives. Select the “+” to open the answer to each question.
Open Enrollment is generally mid-April with changes becoming effective June 1. This is your opportunity to enroll or decline benefit elections. All benefits-eligible associates are required to take action during the Open Enrollment period or you will lose coverage on May 31. You will not be eligible to make changes to coverage until the next open enrollment period unless you experience a qualifying life event. Examples of qualifying events include marriage, divorce, birth, adoption of a child, or an employment status change for yourself or your spouse.
2022 Open Enrollment details yet to be confirmed.
Once you update your address in UKG Pro, the update will automatically flow to our providers during the next scheduled update.
Choosing your health plan is a personal decision. Review the open enrollment and legal notice pages of The Pacsun Collective to help you decide. Don’t forget to add in the cost that you pay each pay period in premiums when you are considering which plan works best for you. The Summary of Benefits and Coverage (SBC) for each plan also provides an easy-to-understand summary about benefits and coverage on each plan. SBCs are found on the Benefit Plan Documents page of The Pacsun Collective. To request a printed copy, contact the Benefits Team at email@example.com or 1.866.989.6958, option #2.
No, you are not required to designate a primary care provider for your medical plan.
The Aetna HRA and PPO medical plans give you the choice to have your treatment provided by an in- or out-of-network provider. However, you will have lower out-of-pocket costs when care is received from an in-network physician.
Follow these steps to find in-network providers or to see if your current physicians are in-network.
A health reimbursement account (HRA) is an account that Pacsun funds to help you pay for covered healthcare services. This includes paying for services that apply to your deductible and coinsurance when you elect the HRA medical plan. You may also use HRA funds to pay for prescription drug co-pays.
Participants receive the following annual amounts in your HRA Fund:
If you have funds remaining in your HRA on May 31, your unused balance will roll over to the next year’s HRA account. However, the maximum amount that can be accumulated in your account is:
Your HRA Fund will automatically pay for all covered services first based on the balance of your account when the claim is processed. You won’t pay as long as you have money in your fund. If you spend all of the money, you will need to pay for covered services out of your pocket.
No, your HRA Fund is available for eligible health care expenses incurred through your medical plan.
Yes, HRA Funds may be used to cover prescription co-pays.
As part of our commitment to keeping you healthy, Pacsun offers US and Puerto Rico medical plan members a non-tobacco user discount. If you or your enrolled spouse are tobacco users, you can become eligible to receive the non-tobacco user discount once you or your spouse have completed the tobacco cessation program. Contact the benefits team to learn more.
When you enroll online in UKG Pro, you will be required to indicate whether you and/or your spouse is a tobacco user. This will determine whether or not the discount will apply.
Yes. If you and/or your enrolled spouse would like help cutting the tobacco habit, contact the Benefits Team to learn more about our Tobacco Cessation options. Once you have completed the program, you will be eligible to receive the non-tobacco user discount.
This is an industry best practice and supports us in keeping rates as low as possible for our associates.
During your online enrollment in UKG Pro, you will be required to indicate whether your spouse has access to other coverage and whether or not the surcharge will apply.
Yes. Your spouse’s loss of coverage would be considered a qualifying life event, which means they could be enrolled in a Pacsun medical plan, effective the first day following their loss of coverage and you would not be required to pay the surcharge. Written documentation from your spouse’s employer regarding the loss of coverage would be required within 30 days of the loss of coverage; along with completion of the Life Event enrollment in UKG Pro. Contact the Benefits Team for more information.
When you enroll online in UKG Pro, you will be required to indicate whether your spouse has access to other coverage and whether or not the surcharge will apply.
It is your responsibility to provide complete, accurate and timely information to the Benefits Team when you enroll in your benefits. We will not retroactively reimburse for surcharge amounts already paid however, we will help you update your spouse’s status on a go-forward basis. Contact the Benefits Team for more information.
The IRS regulations on Section 125 Cafeteria plans permit employers to allow associates to change their election mid-year if it is being done during the open enrollment of the associate’s spouse. For example, if Pacsun’s open enrollment is effective June 1, but your spouse’s enrollment is effective January 1, the IRS would typically view a change during either enrollment period as valid. The IRS regulations also permit benefit changes mid-year if there is a significant change in the cost of the medical plan. As an example, the spousal surcharge, when applicable, is approximately $1,200/year and so could be a legitimate reason for a mid-year change. Check with your spouse’s employer to verify that they permit either of these IRS-qualified status changes.
No, the spousal surcharge only applies if your spouse stays on a Pacsun medical plan when they are eligible for coverage through his/her own employer.
While he/she is employed and has access to employer-provided coverage, you will have to pay the surcharge if you choose to add him/her to your Pacsun medical plan. If he/she loses that coverage in the future, that is a qualifying life event, and you will re-enroll in benefits at that time. Once processed, you will not be subject to the surcharge as long as your spouse remains ineligible for coverage through his/her own employer. Contact the Benefits Team within 30 days of the change in order to update your benefit coverage.
Yes, if you choose to keep him/her on a Pacsun medical plan. You would need to update your dependent(s) information to change your spouse’s status. Contact the Benefits Team within 30 days of the change in order to update your benefit coverage. The surcharge will take effect on the next available pay date following your updated status change.
No, the loss of a spouse’s employment and benefits is considered a qualifying life event that would allow an associate to enroll the spouse and any affected dependents into healthcare coverage through Pacsun within 30 days of the qualifying event. Contact the Benefits Team to learn more.
No, you may cover your eligible dependent children on a Pacsun medical plan of your choice without incurring the surcharge. If your child(ren) are also employed by Pacsun and eligible for coverage themselves, they are not eligible to be added to your coverage as an eligible dependent.
No, the surcharge applies only to the medical plan. If your spouse is only enrolled in the dental and/or vision plan, you will not be subject to the spousal surcharge. You should choose “not enrolling in medical” when asked to attest to your spouse’s status during enrollment in UKG Pro.
The surcharge will not apply when you pay the COBRA rate.
CVS Caremark is our prescription provider that will manage your prescription coverage and benefits.
Yes! HRA Funds may be used to cover prescription co-pays.
Prescription Drug expenses do not apply towards the medical deductible. However, it does apply towards the medical Out-of-Pocket Limit.
A healthcare spending account permits associates to set aside money on a pre-tax basis to pay for qualified health-related expenses during the plan year. By setting aside the money on a pre-tax basis you are reducing your taxable income and the taxes you would pay on that money. The maximum contribution is $2,750 for the 2021 tax year. The funds can be used to pay for medical, dental, or vision expenses that are not covered by the plan for you or your family. Expenses that are not covered include items that are beneficial to your general health such as vitamins and herbal supplements.
Under IRS regulations, a married employee with a working spouse or a single parent may allocate up to $5,000 in pre-tax dollars to a dependent care account. Expenses payable through the account are those incurred in order to permit the individual (and if married, the spouse) to work, rather than caring for their dependent full-time. Divorced spouses with joint custody or married spouses who file separately are limited to $2,500 per year.
A commuter FSA allows you to pay for eligible commuter expenses including parking, subway, train, ferry, and bus expenses. The maximum you may contribute is $270 per month. This election may be changed monthly but will only be deducted from 24 pay periods per year (the first and second pay period each month, as applicable).
Expenses for non-debit card claims are reimbursed weekly. Claims submitted by Friday will be reimbursed the following week.
Dependents who qualify include children up to age 13 and any other dependent (such as a disabled spouse or elderly parent) who is physically or mentally incapable of self-support and who is claimed as a dependent on the employee’s federal tax return. Reimbursable expenses include care provided inside or outside the home, day care centers that meet state licensing requirements, and preschool tuition.
You will have an additional 30-days after termination to submit claims for reimbursement. However, you will only be reimbursed for services you received while you were employed (unless you are eligible to continue to contribute to your healthcare FSA through COBRA).
You are not allowed to keep any money left in your account at the end of the plan year. This is called the “use-it-or-lose-it” rule.
No, you may not change your annual election amount until the next open enrollment period. Only if there is a qualifying event may you change your election amount during the plan year. Examples of a qualifying event include marriage, divorce, birth or adoption of a child or an employment status change for yourself or your spouse.
Newly benefit-eligible associates will receive communication from the Pacsun Benefits Team regarding their enrollment and with instructions on how to enroll.
Review the eligibility chart on the Eligibility & Enrollment page. If you do not see all benefits for which you are eligible, please contact the Benefits Team.
Most likely, you’ve missed a required step along the way. Scroll to the top of the confirmation screen and look for a blue box – this will give you detailed instructions on what you’ll need to correct prior to submitting your elections to the Benefits Team. You need to make a selection on every screen, even benefits that are provided at no cost to you.
Return to the Enrollment session that you’d like to print a confirmation statement for. When you select the hyperlink, you will be taken directly to the confirmation screen. Select the “print” button in the upper left to print a hard copy or PDF of your elections.