For eligible US employees. - BMO U.S. Benefits
Introducing your benefits.
For eligible US employees. The benefits we offer are an important part of your Total Rewards at BMO. This overview provides highlights of BMO Financial Group's benefit plans. It does not provide every plan detail and does not create contractual rights. The plan documents that govern these plans provide full details. If there are any discrepancies between this booklet and the legal plan documents, the plan documents rule. BMO Financial Group reserves the right to suspend, amend or terminate any or all benefits, at any time.
Introducing your U.S. benefits
What's inside
About the BMO U.S. Benefits Program ............................................................................................................................... 1 Eligibility ...................................................................................................................................................................... 1 Dependent Verification Requirement .............................................................................................................................. 2 Enrolling in benefits......................................................................................................................................................3
Health and insurance plans ............................................................................................................................................... 4 Medical ....................................................................................................................................................................... 4 Dental .........................................................................................................................................................................6 Vision ..........................................................................................................................................................................6 Health Savings Account.................................................................................................................................................7 Health Care Flexible Spending Account...........................................................................................................................8 Limited Purpose Flexible Spending Account ....................................................................................................................8 Dependent Care Flexible Spending Account ....................................................................................................................8 Commuter Benefits.......................................................................................................................................................9 Life and Accident plans ................................................................................................................................................. 9 Other Voluntary Benefits ............................................................................................................................................. 10
Retirement and Savings Plans ......................................................................................................................................... 11 401(k) Savings Plan.................................................................................................................................................... 11 Non-Qualified Savings Plan .........................................................................................................................................13 Employee Share Purchase Plan....................................................................................................................................14
Time away from work .................................................................................................................................................... 15 Paid holidays ............................................................................................................................................................. 15 Vacation .................................................................................................................................................................... 15 Sick time ................................................................................................................................................................... 16 Short-term disability (STD)...........................................................................................................................................16 Long-term disability (LTD)............................................................................................................................................16 Maternity and Parental leaves .....................................................................................................................................17 Military Leave ............................................................................................................................................................17 Other types of paid time away from work ..................................................................................................................17
Additional employee benefits and programs .................................................................................................................... 18 Employee Assistance Program (EAP) ............................................................................................................................18 Best of BMO U.S. ...................................................................................................................................................... 18 Adoption assistance....................................................................................................................................................18 Tuition reimbursement................................................................................................................................................18 Sir Vincent Meredith Fund ...........................................................................................................................................18
Legal notices ................................................................................................................................................................. 19 Note to rehired employees ............................................................................................................................................. 19
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Introducing your U.S. benefits
Benefits Program Designed With You in Mind
BMO is dedicated to providing you with comprehensive benefits for you and your family and is one way we strive to Boldly Grow the Good in Business and Life. From health and well-being to retirement savings, insurance and income protection, BMO's benefits offer value and peace of mind. And, through our partnership approach to benefits -- with shared costs and shared responsibilities -- together we'll ensure that our benefits continue to deliver value for the future.
You can choose what options to participate in based on what is important to you and your family.
Eligibility
Employee eligibility
Full-time and part-time employees scheduled to work at least 20 hours per week are eligible for the full benefits program described in this overview.
Part-time employees scheduled to work less than 20 hours per week are eligible only for the 401(k) Savings Plan, Employee Share Purchase Plan, Vacation and Sick Time.
Dependent eligibility
Eligible dependents include your legal spouse or domestic partner1, and your dependent children2. You will be required to provide documentation to verify dependent eligibility. Eligible dependent children include:
? Biological or legally adopted children ? Child placed with you for adoption ? Stepchildren ? Child for whom you have legal custody ? Foster children living with you ? Domestic partner's children (must qualify as your tax dependent) ? Adult children with disabilities who exceed the plan age limits but are dependent on you may also be eligible, if their
disability existed while they met BMO's definition of a child. See the Summary Plan Descriptions available on for more detailed information on dependent eligibility for each plan.
You are responsible for changing coverage levels and adding/updating your covered dependent's information. If your dependent's eligibility for coverage changes, update the information in the Benefits enrollment site or call the Human Resources Centre at 1-888-927-7700, within 31 calendar days of the change.
1 Same-gender or opposite-gender partner who meets specified eligibility requirements, including that the relationship must have been in place for at least one year. Depending on your individual situation, your domestic partner may qualify as either a "tax-dependent" or a "non-tax dependent."
2 Eligible dependent children under age 26 can be covered through the end of the month in which they turn age 26.
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Introducing your U.S. benefits
Dependent Verification Requirement
If you enroll dependents on your medical, dental or vision coverage, you will be required to complete the dependent verification process. After you complete your online enrollment, you can expect to receive a packet from "Dependent Verification Services" that will explain what, how and when to submit your required documentation. If you do not submit the appropriate documentation by the deadline date, your unverified dependents will be canceled 60 days following your coverage effective date. It may take time to locate your documentation, so we encourage you to start preparing in advance.
Dependent Type
Required Documentation Category 1
Required Documentation Category 2
Spouse
(1 document from each category required)
Domestic Partner
(1 document from each category required)
Biological Child
(1 document from category 1 required)
Adopted Child
(1 document from category 1 required)
? Government issued Marriage Certificate; or ? Notarized Affidavit of common law marriage
? Certificate of Domestic Partner registration; or ? Notarized Affidavit of Domestic Partnership;
or ? Government issued certificate of Civil Union
Partnership
? Government issued Birth certificate including parent's names
? Joint Federal tax return filed within prior 2 years; or
? Proof of joint ownership within last 6 months
? Joint tax return filed within prior 2 years; or ? Proof of joint ownership within last 6 months
? Government issued Birth certificate; or ? Adoption Certificate; or ? Placement Agreement
Step-Child
(documents from both categories required)
? Government issued Birth certificate including parent's names
Domestic Partner's Child
(documents from both categories required)
? Government issued Birth certificate including parent's names
Legal Ward
(documents from both categories required)
? Government issued Birth certificate including parent's names
Grandchild
? Grandchild's Government issued Birth
(All documents from
certificate including parent's names; and
both categories required) ? Biological parent' s Government issued Birth
certificate including parent's names
Foster Child
(documents from both categories required)
? Government issued Birth certificate
Disabled Adult Child
? Documentation listed above to prove child
(All documents from
relationship status; and
both categories required) ? Proof of disability document
? Verification of parent's spouse relationship status to the employee (must satisfy documentation requirements for spouse)
? Verification of parent's partner relationship status to the employee (must satisfy documentation requirements for Domestic Partner)
? Court ordered document of legal guardianship
? Federal tax return filed within prior 2 years claiming grandchild as tax dependent
? Foster care letter of placement
? Federal tax return filed within prior 2 years claiming disabled adult child as tax dependent
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Introducing your U.S. benefits
Enrolling in benefits
Plan(s)
When to enroll
Effective date
How to enroll
Health and
insurance benefits plans 3
Within 31 days of your hire/rehire date
1st of the month following 30 days from your hire/rehire date
1. Within Workday*, click on the My Benefits & Retirement application.
2. Under "My Benefits & Retirement", click on the Employees in Canada and US (on BMO Network) link if you are logged into the BMO Network for single sign-on access or click on the Employees in Canada and US (off BMO Network) link4 if you are accessing from a non-BMO network.
3. Then click the Enroll in your benefits coverage tile.
401(k) savings
Employee share purchase plan
Commuter benefits
Automatic after 60days, or make your own election at any time
Quarterly opportunity following 6 months of employment
Monthly opportunity ? elections must be made before the 10th of month prior to the effective month
Within 1-2 pay periods, depending on when you make your election
1st month of each quarter, depending on when you make your election
1st of the month, depending on when you make your election
1. Within Workday*, navigate to My Pay. 2. Click on 401(k).
See page 13 for alternate enrollment instructions
1. Within Workday*, navigate to My Pay. 2. Click on Employee Share Purchase Plan.
See page 14 for alternate enrollment instructions
1. Within Workday*, click on the My Benefits & Retirement application.
2. Under "My Benefits & Retirement", click on the Employees in Canada and US (on BMO Network) link if you are logged into the BMO Network for single sign-on access or click on the Employees in Canada and US (off BMO Network) link4 if you are accessing from a non-BMO network. Click on the Reimbursement Accounts tile.
* You will not have access to Workday until your start date with BMO. The Workday URL is .
Changes to health and insurance plans after initial eligibility
Each year, BMO conducts an Annual Enrollment in the fall. During Annual Enrollment, you can change your health and insurance elections for January 1st of the following year.
Outside of Annual Enrollment, the only other opportunity you will have to make changes will be if you experience a Qualifying Life Event. You will have a 31-day window following the effective date of the qualifying life event to make any necessary benefit enrollment changes. See Life Events on for more detailed information.
3 Health and insurance benefits include medical, dental, vision, HSA, spending accounts, life, accident, and supplemental long term disability plans. For the HSA plan only, after your initial effective date, you can newly enroll or make changes at any time during the year.
4 Your username is your Employee ID and you will need to click New User? The first time you access the site to set-up your password.
For the 2023 Benefit year
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Introducing your U.S. benefits
Health and insurance plans
Maintaining good health and protecting your family are important priorities in your life. That's why BMO offers a variety of options under our Health and Insurance Plans, such as the Medical, Dental, Vision, Spending Accounts, Life and Accident Insurance, and Supplementary Long-Term Disability. These provide you with the opportunity to select health and insurance benefits that best meet the needs of you and your eligible dependents.
Medical
As a BMO U.S. employee you and your eligible dependents can participate in medical coverage through the Consumer Choice Plan. The Consumer Choice Plan is a qualified High Deductible Health Plan (HDHP).
The Consumer Choice Plan provides comprehensive coverage: from unexpected emergencies and hospital visits to routine expenses such as preventative care, mental health, and physician visits. You have the flexibility to see any provider (doctor) that you choose, however you will receive better coverage levels when you see in-network providers. In addition, you automatically receive prescription drug coverage through Express Scripts.
With the Consumer Choice Plan you are also eligible to contribute to the Health
Savings Account (HSA) plan to save for your out-
of-pocket medical, prescription, dental and vision expenses on a pre-
tax basis!
Plan Administrator
Group #
Blue Cross Blue Shield of Illinois
266889 ? For Florida (FL) residents
266820 ? For Wisconsin (WI) residents
190565 ? For Non-WI or non-FL residents
Network Name Network Blue
Blue Preferred POS (Wisconsin)
Preferred Provider Organization
Express Scripts (for BMOFGRX
Rx Coverage)
BIN# 610014
N/A
Contact Information
(888) 979-4516 (Members)
(877) 795-2926
bmofinancialgroup
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Introducing your U.S. benefits
In the hospital
Medical Coverage Overview
Medical Plan Features
Deductible*
(includes medical and Rx)
Out-of-pocket Maximums
(includes deductible, copays and coinsurance)
Inpatient Services, Physician Visits and Outpatient Surgery
Emergency Room
In-Network
Individual: $1,750 Family: $3,500 Individual: $3,425 Family: $6,850 20% after deductible
20% after deductible and $100 copay (copay waived if admitted)
In the doctor' s office
Office Visits Lab Tests and X-rays
20% after deductible 20% after deductible
Preventive Care (Adult/Children)
Outpatient Mental Health & Chemical Dependency
You pay nothing 20% after deductible
Out-of-network
(usual & customary applies)
Individual: $3,500 Family: $7,000 Individual: $6,850 Family: $13,700 40% after deductible
40% after deductible and $100 copay
(copay waived if admitted) In-Network benefits apply if considered an emergency
40% after deductible 40% after deductible
40% no deductible
40% after deductible
Mental Health & Chemical
Dependenc y Treatment
Inpatient Mental Health & 20% after deductible Chemical Dependency
40% after deductible
* True deductible, a family can meet the deductible by pooling the deductible expenses, there is no limit one member can pay towards the family deductible.
Rx Category
Prescription Coverage Overview Rx Plan Features
Deductible Out-of-pocket Maximums
Generic Formulary Nonformulary
Retail ? Network Pharmacy
Mail-Order
Rx applies toward the in-network medical deductible Rx applies toward the in-network medical out-of-pocket maximums
$10 copay
$20 copay
25% copay (min. $20, max. $50)
25% copay (min. $40, max. $100)
35% copay (min. $40, max. $70)
35% copay (min. $80, max. $140)
For the 2023 Benefit year
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Introducing your U.S. benefits
Dental
BMO offers comprehensive dental coverage through Delta Dental of Illinois. You have the flexibility to see any dentist you choose, however the "Delta Dental PPO" or "Delta Dental Premier" network dentists can save you money. To find participating network providers, go to the Delta Dental ().
Features
Delta Dental
Deductible
$50 per person; $150 family maximum (three individual deductibles per family)
Coinsurance
Annual Maximum Benefit Preventive Services Basic Services Major Services Orthodontia (dependent
children age 19 or younger)
$2,000 100% 80% 50%
50%, up to $2,000 individual lifetime benefit
Vision
BMO offers vision coverage through VSP. To find providers, go to the VSP () site.
Features Wellvision Exam (Every calendar year) Prescription Glasses Frame
(Every other calendar year)
Lenses
(Every calendar year)
Lens Enhancements
Primary EyecareSM
Contacts instead of glasses
(Every calendar year)
Extra Savings
Your coverage with a VSP Provider
$10 copay
$20 copay
? $150 frame allowance ? $170 featured frame brands allowance ? 20% savings on the amount over your allowance ? $80 Walmart?/Sam's Club?/Costco? frame allowance
? Single vision, lined bifocal, and lined trifocal lenses ? Impact-resistant lenses for dependent children
? $0 copay for standard progressive lenses, tinted lenses, scratch-resistant coating, UV protection ? $50 copay for premium progressive lenses, custom progressive lenses ? Average savings of 30% on other lens enhancements
? $0 copay for Retinal screening for members with diabetes ? $20 per exam:
o Additional exams and services for members with diabetes, glaucoma, or age-related macular degeneration.
o Treatment and diagnoses of eye conditions, including pink eye, vision loss, and cataracts available for all members.
o Limitations and coordination with your medical coverage may apply. Ask your VSP doctor for
details.
? $150 allowance for contacts; copay does not apply ? Up to $60 Contact lens exam (fitting and evaluation)
20% savings on additional glasses and sunglasses, 15% discount Laser Vision correction. Go to offers for details.
For the 2023 Benefit year
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