Benefit Highlights 2019
Contents Section Your Benefits
Medical & Prescription Drug Coverage Tax-Advantaged Health Saving Accounts Dental & Vision Coverage Payroll Contributions
Description 3–6
7–10
11
12–13
14
Income Protection Offerings
15-16
No-Cost Benefit Offerings
17-18
Optional Insurance Offerings
19-22
Important Contacts Total Safety's Benefit Center
23 24
2
What’s Changing Total Safety is committed to providing comprehensive and competitive benefit programs that meet the health and wellness needs of our employees and their families. Each year during the annual open enrollment process, we engage in a detailed review of our benefits programs and related costs to benchmark plans against our competitors, evaluate coverage options, leverage and contain costs, and identify additional programs and services. We strive to provide our employees a best-in-class benefits program. We are pleased to share with you important information about this year’s benefits open enrollment, including details about some exciting changes.
Lower Deductible for the Base HDHP Plan
Lower Employee contributions in the Core and Premiums plans
Discontinuing Employee Surcharges
Addition of an extra personal day for eligible employees
Base HDHP
Annual Deductible Core HDHP Annual Premium Cost
Premier Plan Annual Premium Cost
Surcharges
2018
2019
$6,000 — Individual
$4,000 — Individual
$12,000 — Family
$8,000 — Family
Employee Only — $1,472.76
Employee Only — $1,212.64
Employee + Spouse — $3.375.00
Employee + Spouse — $2,795.26
Employee + Children — $2,383.92
Employee + Children — $2,136.68
Employee + Family — $5,890.92
Employee + Family — $4,712.50
Employee Only — $2,512.20
Employee Only — $2,154.64
Employee + Spouse — $5,010.72
Employee + Spouse — $4,345.38
Employee + Children — $3,729.36
Employee + Children — $3,432.52
Employee + Family — $7,582.92
Employee + Family — $6,799.26
Tobacco surcharge — $100
No Surcharges for 2019
Non-Wellness surcharge — $100 Spouse Domestic Surcharge — $100
Personal Holiday
1 Personal Holiday
2 Personal Holidays
Full-Time Employees 3
Your Benefits The Purpose of This Guide This booklet highlights the main features of Total Safety’s benefit plans; full details of these benefits are contained in the legal documents governing the plan. This booklet does not replace or supersede those legal documents. For copies of Summary Plan Descriptions (SPDs), Summary of Benefits Coverage (SBC), and other plan documents and legal notices please visit SafetyNet or contact the Total Rewards Department. Total Safety reserves the right to change or discontinue plans at any time. Participation in the plans does not constitute an employment contract.
Benefits at Total Safety Total Safety is committed to providing our employees with comprehensive benefits that can provide protection, peace of mind, and savings. Whether it’s health care, income protection, retirement savings or other benefits such as the Employee Assistance Program, we’ve got you covered. We are excited about what we have to offer you, our most valued asset. This guide is intended to provide a general overview of Total Safety’s benefit choices and enrollment information to help you make informed decisions about you 2019 benefits coverage.
When Does Your Coverage Begin?
Benefit
Coverage becomes Effective:
Medical, Dental & Vision
On the 1st day of the month following hire date.
Health Savings Account (HSA)
On the 1st day of the month following hire date.
Basic & Supplemental Life and AD&D
On the 1st day of the month following hire date.
Short-Term & Long-Term Disability
On the 1st day of the month following 90 days of employment.
401(k) Retirement
On the 1st day of the month following hire date.
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see the 2019 Health and Welfare Legal Notices available in the “Electronic Forms” section in the “My Company” folder in UltiPro for more details. 4
Eligibility & Enrollment Enrolling in Benefits Open Enrollment will be held November 5 — November 25, 2018. Open Enrollment for 2019 is passive, meaning if you do not wish to change your current benefits, your 2018 elections will roll over to 2019, with the exception of your Health Savings Account (HSA) elections. You must actively elect HSA contribution each year or they will end. New Hire: If you are enrolling as a new hire, you must enroll yourself and eligible dependents within 30 calendar days of your hire date.
Online Enrollment through UltiPro You can complete your enrollment quickly and easily by logging on to UltiPro (https://n22.ultipro.com/login). Instructions for enrolling online are available under the “My Company”> “Electronic Forms” folder in Ultipro. The Benefit Advocacy Center (BAC) is available for questions and enrollment assistance by calling 844-201-6552 7:00 AM– 6:00 PM CST, Monday thru Friday .
Enrolling in Benefits Open Enrollment will be held November 5 - November 25, 2018. Open Enrollment for 2019 is passive, meaning if you do not wish to change your current benefits, your 2018 elections will roll over to 2019, with the exception of your Health Savings Account (HSA) elections. You must actively elect your HSA contribution each year or it will end. New Hire: If you are enrolling as a new hire, you must enroll yourself and eligible dependents within 30 calendar days of your hire date.
Changing Your Elections You should think carefully about the benefits you choose because you can not change your elections during the year unless you experience a “qualified status change.” Qualified status changes include:
Your marriage or divorce
Birth or adoption of your child
Death of your spouse or child
Your child reaches the age limit for the applicable benefit
Gain or loss of other coverage
When you experience a qualified status change, you have 31 calendar days after the date of the event to complete and submit a benefit enrollment/ change form, including the dependent verification documentation, to the Human Resource Center. Any changes you make must be related to the status change, as required by IRS regulations. You cannot switch medical plans mid-year due to a qualified status change. 5
Eligibility & Enrollment Employee Eligibility You are eligible for benefits if you are a regular, full-time employee who is scheduled to work at least 30 hours per week. If you are a part-time, project, or field employee you may not be eligible for all of the benefits described in this guide. If you have questions about your eligibility, please contact your Human Resources Business Partner or email Totalrewards@totalsafety.com
Covering your Eligible Dependents Total Safety extends benefit coverage to your eligible dependents. Eligible family members include:
Your legal Spouse*
Your children up to age 26, regardless of marital or student status
Unmarried children of any age who are incapable of self-support due to a mental or physical disability and who are totally dependent on you
Children include your natural children, stepchildren, legally adopted children (or placed for adoption), or other child for whom you are the legal guardian. Age limits and other restrictions may vary by plan. *Your legal spouse includes all legally married couples, including same sex marriages. We no longer cover common law spouses or domestic partnership.
Dependent Verification In order to add family members (eligible dependents) to your benefit plans, you must submit verification documentation including Social Security or qualified alternate ID’s. The required documentation will vary based on the employee’s relationship to the dependent. When you enroll a dependent, a member of the Total Safety Benefits Center will contact you requesting the appropriate documentation. Note: If the documents are not received within the time period allowed, your dependent(s) will not be added to coverage. You will not be able to add them again until a life event or next Open Enrollment. 6
Medical Coverage Our employees are our greatest asset. With you in mind, Total Safety has designed competitive and comprehensive medical plan options to meet the needs of you and your family. Total Safety offers three medical plans—a Base High Deductible Health Plan (HDHP), a Core HDHP, and a Premier Plan. Each plan has different features giving you the power to choose the plan most suitable for you and your family.
Keep in Mind The plans operate in the BlueCross and BlueShield network of providers and Prime Therapeutic Pharmacy. Utilizing in-network providers minimizes your out-of-pocket costs. Out-of-network providers are not covered under any plans.
Medical Plan Comparison HDHP Plans
Similarities
These plans cost less per paycheck in premium contributions, but has a higher deductible. HDHP plans work with an HSA (see pg. 12), which is eligible to receive employer contributions for the Core Plan. HDHPs do not include copays for services or prescriptions*, you pay the cost until the deductible is met. You can use HSA funds for these costs. After you have met your ductible, you pay a insurance percentage services until you reach out-of-pocket maximum.
decofor the
Both Plans are managed by BCBS of Texas.
Both Plans allow you to use the BCBS Blue Choice PPO network of Providers.
Neither plan requires a referral to see a specialist.
Both plans cover your preventive care services at 100%.
Both plans cover the same services.
For both plans, Total Safety pays 100% of your eligible expenses after you meet the out-ofpocket maximum.
Premier Plan
This is a “pay it up front” plan where you pay higher premium contribution in exchange for a lower deductible.
This plan is not eligible for HSA participation.
On this plan you pay a predetermined copay for certain covered expenses , such as an office visit. For other services, you are responsible for the deductible then a percentage of the remaining cost.
You’ll pay copays for all prescription drugs.
For the Core HDHP Total Safety contributes $500/$1,000 for individual/family.
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Medical at a Glance Below is a side-by-side plan comparison of in-network coverages. Please refer to the Summary Plan Descriptions for a detailed explanation of plan guidelines. The coinsurance amounts listed below show the percentage you pay. Feature
Base HDHP
Total Safety's HSA contribution ď‚Ž See how the HSA Contribution works on page 11
Core HDHP
Premier Plan
Up to $500 for Individuals and $1,000 for families $4,000 individual
$2,700 individual
$2,200 individual
$8,000 family
$5,400 family
$4,400 family
$6,000 individual
$5,400 individual
$5,000 individual
$12,000 family
$10,800 family
$10,000 family
Annual Deductible
Out-of-Pocket Maximum
Preventive Care (routine exams, well child care, and Plan pays 100% immunizations through age 12) Coinsurance Plan pays 90% after de- Plan pays 70% after Percentage of covered costs paid ductible deductible by the Plan
Plan pays 80% after deductible
Office Visits and Office Services 10% after deductible
30% after deductible
$30 copay
Specialist Office Visit and Office 10% after deductible Services
30% after deductible
$60 copay
Telehealth - MDLive
10% after deductible
30% after deductible
$10 copay
Independent Lab/X-ray
10% after deductible
30% after deductible
20% after deductible
Emergency Room
10% after deductible
30% after deductible
20% after $250 copay
Inpatient/Outpatient Hospital Services
10% after deductible
30% after deductible
20% after deductible
PHARMACY Tier 1: $20 copay Retail Pharmacy 31-day supply
10% after deductible
30% after deductible
Tier 2: $40 copay Tier 3: $70 copay Tier 1: $50 copay
Mail Order Pharmacy 90-day supply
10% after deductible
30% after deductible
Tier 2: $100 copay Tier 3: $175 copay 8
Medical Coverage Virtual Visits with Total Safety is pleased to offer MDLive as a service to Medical Plan participants. For just $44 on the HDHP plans or a $10 Premier copay, you can speak with a of board-certified physician or therapist to get fast treatment (including prescriptions, which can be sent to the pharmacy of your choice) for non-emergency medical conditions such as the flu, allergies, ear infections and more. You can also use MDLive if you’d like treatment for stress and anxiety, relationship and family problems, emotional difficulties, work pressures, grieving issue, and trauma resolution.
To register, you’ll need to provide your first and last name, date of birth and BCBSTX member ID number. For more information, go to www.mdlive.com or call 888-680-8646. There’s an app for that! Download the MDLive mobile app from GooglePlay or The AppStore.
Resources to Manage your Medical Coverage For personalized information about your health care benefits and coverage, log in to Blue Access for Members at www.bcbstx.com where you can:
Locate an in-network provider
View Explanation of Benefits and claims information
Access physician, hospital, and pharmacy network directories
Access information on prescription drugs and Preferred Drug List
Order a new ID card
Discounts Available! The Blue365 discount program gives you access to a wide range of savings from top health and wellness brands around the country plus some of your favorite local companies. To learn more and get started, go to blue365details.com/ BCBSTX.
There’s an app for that! Download the BCBS mobile app from GooglePlay or The AppStore.
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Prescription Drug Prescription drug coverage is offered through Prime Therapeutics. You are automatically enrolled in this coverage medical benefits. The Prime Therapeutics information will be included on your BCBS ID card, you will not receive a separate prescription card.
Preventive Medications on HDHP Preventive medications are those frequently taken on an ongoing basis for preventive purposes, such as high blood pressure. When you are prescribed a medication for preventive purposes they are not subject to the plan deductible. This means you can begin to fill your preventive medications immediately at the co-insurance structure prior to meeting your plans deductible. Reminder: These drugs could also be prescribed for treatment or other purposes. As a result the prescription can in some cases be subject to deductible. Please review the Preventive Drug Guide for details to insure your prescriptions are being covered appropriately.
Manage your Prescription cost with Myprime.com Myprime.com makes it easy to find information about your prescription drug coverage. You can locate in-network pharmacies, access information on covered drugs, and find ways to save time and money with low-cost generic drugs and the AllianceRx Walgreens Prime home delivery. You can also compare medications and price to make informed decisions.
AllianceRx Mail Order Pharmacy Your time is valuable! AllianceRx Walgreens Prime pharmacy can give you back more of it. AllianceRx is and easy and convenient home delivery pharmacy committed to helping you manage your long-term or specialty medications. When you fill your long-term medications in a 90day supply you also save on your co-pay. To start using your home delivery service visit alliancerxwp.com/home-delivery and follow the instructions to create an account. You can also call customer service to create an account and transfer any existing prescriptions 877-357-7463. Once you have created an account your doctor can send your prescriptions electronically to AllianceRx Walgreens Prime or fax a request to 800-3329581. 10
Tax-Advantaged Health Savings Account When you participate in a High Deductible Health Plan, you are eligible to contribute on a pre-tax basis to an Health Savings Account (HSA). An HSA gives you the opportunity to set aside money via pre-tax payroll deductions, which you can then use to pay for qualified medical expenses for yourself and your eligible dependents. This includes doctor visits, prescriptions, dental and vision expenses, and more. Because HSA contributions are made through pre-tax payroll deductions, you can decrease your taxable income and increase your take home pay by taking advantage of this account. Keep in Mind: Your HSA money is yours to keep. The account is not a use-it-or-lose-it account, so your balance rolls forward from year to year, and may grow over time through interest of investments. The account is in your name, and you can take it with you if you retire or leave the company. While Total Safety opens your HSA automatically, there may be instances when it may not be permitted to do so based on missing information or previous account closure. Contact the BAC if you have questions regarding your HSA.
How the Total Safety HSA Contribution Works When you enroll in the Core HDHP, Total Safety contributes to your account each year, providing $500 for an individual and $1,000 employee + dependent coverage. In order to receive the employer contribution, employees must contribute at least $1.00 per paycheck to their HSA. The employer contribution will be funded in equal amounts per pay period over the course of the plan year. If you are not enrolled for the full plan year, you will not receive the full employer contribution amount. There is no employer HSA contribution on the Base HDHP.
How much can I contribute? You can elect to contribute up to the federal limit into your HSA each year. Combined employee and employer contributions cannot exceed the annual IRS maximum of $3,500 for employee only and $7,000 for family coverage. Individuals age 55 and older may contribute an additional $1,000 annually to your HSA. If you are 65 or older and enrolled in Medicare, an HSA may remain open and you can continue to utilize existing funds, but you cannot make any additional contribution to the account.
There’s an app for that! Download the Optum Bank mobile app from GooglePlay or The AppStore.
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Dental Coverage
Dental coverage is important to your overall health and wellness. Eligible employees can enroll in dental benefits through BlueCross BlueShield. The PPO Dental Plan helps you with the cost of preventive, basic and major dental services for you and your eligible dependents. This plan allows you the freedom to select any dentist, but you pay less out of pocket when you choose an in-network dental provider.
How to find an in-network dentist: Go to www.bcbstx.com and click on “Find a Doctor” Scroll to the bottom of the page and click “Find a Dentist” Select “BlueCare Dental” and enter you search criteria to find an in-network dentist
Dental Plan Coverage Annual Deductible Individual
$50
Family
$150
Calendar Year Benefit Maximum
$2,000 per person
Preventive Services
No charge; deductible waived
Exams and cleanings
2 cleanings per calendar year
Basic Services Root canals, oral surgery, and fillings Major Services Crowns and bridges Orthodontic Services Eligibility Lifetime Benefit Maximum
You pay 20% after deductible
You pay 50% after deductible You pay 50%; deductible waived Dependent children up to age 19 $2,000 per dependent
*Out-of-network benefits are covered at 90% of usual customary and reasonable (UCR). Member may be balance-billed for the difference between the Allowed Amount and UCR.
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Vision Coverage Total Safety offers vision coverage through UnitedHealthcare (UHC). The plan works with UHC’s network of vision care providers including retail optical centers, optometrists and opticians. UHC offers discounts on services when you stay in-network. If you use an out-of-network provider, the plan will pay reduced benefits. To access a list of in-network providers (private practice and retail centers), go to www.myuhcvision.com.
Service
In-Network
Out-of-Network
Eye Examinations (once every 12 months)
$10 copay
Up to $40
Eye Glass Lenses (once every 12 months)
$25 copay (some lenses enhancements are not covered)
Up to: Single: $40 Bifocal/Trifocal: $60
Frames (once every 24 months)
$25 copay $130 Retail Frame Allowance (after applicable copay)
Up to $45
The following benefits are covered in full after copay: Contact Lenses (instead of glasses, once every 12 months)
· Up to 4 boxes (subject to applicable allowance) · Fitting/evaluation fees · Up to 2 follow-up visits
See Plan Details
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Payroll Contributions
Medical/RX Rates BASE HDHP
Bi-Weekly
Weekly
Employer Portion
Employee Only
$26.14
$13.07
$392.72
Employee & Spouse
$62.77
$31.39
$852.55
Employee & Child(ren)
$35.32
$17.66
$754.76
Employee & Family
$129.08
$64.54
$1,158.23
Bi-Weekly
Weekly
Employer Portion
Employee Only
$46.64
$23.32
$380.20
Employee & Spouse
$107.51
$53.75
$825.83
Employee & Child(ren)
$82.18
$41.09
$712.26
Employee & Family
$181.25
$90.63
$1,147.31
PREMIER PLAN
Bi-Weekly
Weekly
Employer Portion
Employee Only
$82.87
$41.44
$319.21
Employee & Spouse
$167.13
$83.56
$735.18
Employee & Child(ren)
$132.02
$66.01
$636.67
Employee & Family
$261.51
$130.75
$1,029.46
Bi-Weekly
Weekly
Employer Portion
Employee Only
$10.62
$5.31
$6.91
Employee & Spouse
$21.32
$10.66
$16.64
Employee & Child(ren)
$19.31
$9.65
$3.05
Employee & Family
$40.20
$20.10
$2.66
CORE HDHP
Dental Rates
Vision Rates Bi-Weekly
Weekly
Employee Only
$2.39
$1.19
Employee & Spouse
$4.53
$2.26
Employee & Child(ren)
$5.31
$2.65
Employee & Family
$7.47
$3.73 14
Income Protection Total Safety offers additional income protection benefits through Allstate, including Accident, Critical Illness, and Hospital Indemnity coverage. These benefits are designed to complement your medical coverage and help you bridge the gap between what your medical plan pays, and your associate responsibility for certain covered events. You may enroll yourself and your dependents in these benefits, and you pay the full premium cost through after-tax payroll deductions. These three additional voluntary benefits are designed to provide you additional security when faced with a major medical event – particularly participants in the HDHP. Please review the full schedule of coverage for these benefits on SafetyNet.
Accident Coverage Accident insurance pays a cash benefits for specific injuries and events resulting from a covered accident such as a dislocation or fracture. The cash benefit can help reduce your financial burden for medical treatment and a variety of other expenses you may incur, such as ambulance services.
Critical Illness Critical illness coverage offers financial support if you are diagnosed with a covered major illness such as cancer, heart attack, or stroke. Choose a level of benefit coverage based on your individual needs and budget. If diagnosed you will receive a benefit payment based on the percentage payable for the specific condition.
Hospital Indemnity Hospital Indemnity coverage pays a cash benefit to you for hospital stays resulting from illness or injury. This benefit is paid directly to you to help avoid using your personal funds or your HSA for hospitalrelated expenses. This coverage also covers Pregnancy related hospital stays.
Key Features to Consider
Benefits are Guaranteed Issue
Benefits pay direct to the policy holder (you)
Pays in addition to your medical/RX plan benefits
No Pre-existing Condition Waiting Period
Coverage is available for the entire family
Portable upon leaving employment
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Income Protection
Critical Illness Policy Weekly Coverage Level Employee or Employee + Children Employee + Spouse or Employee + Family
Bi-Weekly
$10,000
$20,000
$10,000
$20,000
$2.68
$5.05
$5.37
$10.10
$4.19
$7.74
$8.37
$15.48
Spouse coverage at 50% of employee election Children covered for free at 50% of employee election until age 26
Off the Job Accident Policy Coverage Level Employee Employee + Spouse Employee + Children Family
Weekly $1.96 $4.50 $5.66 $7.29
Bi-Weekly $3.91 $9.00 $11.31 $14.59
Hospital Indemnity Policy Coverage Level Employee Employee + Spouse Employee + Children Family
Weekly $3.15 $8.25 $5.46 $8.97
Bi-Weekly $6.30 $16.50 $10.92 $17.94
*Policy limitations and exclusions exist. This is not an application for coverage or guarantee of claim payment. Please see policy brochure for all benefits, limitations and exclusions. Where discrepancies exist, policy language will overrule. MEDICAID recipients are NOT recommended to participate in coverage. DISCLOSURE - Every effort has been taken to ensure the accuracy and completeness of the information provided. This document is not an explanation of benefits or promise of claim payment. Pre-Existing Conditions for certain policies may apply. Please refer to specific carrier brochures for a complete listing of all benefits, limitations and exclusions. Where any discrepancy exists, policy language will overrule.
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No-Cost Benefit Offerings As a regular-full time employee, Total Safety provides you with several benefits at no cost to you. These coverages are 100% employer paid, and require no action on your part to enroll.
Basic Employee Life Insurance Total Safety provides you with basic life coverage equal to one time your base annual salary* up to a maximum of $100,000. You do not have to provide any evidence of insurability. This basic coverage is 100% company-paid, though your coverage amount will be reduced after you reach age 70.
Basic Employee Accidental Death & Dismemberment (AD&D) Total Safety provides you with basic AD&D coverage equal to one time your base annual salary* up to a maximum of $100,000. You do not have to provide any evidence of insurability. This basic coverage is 100% company-paid, though your coverage amount will be reduced after you reach age 70.
If you are seriously injured as the result of an accident, you will receive all or a part of this benefit depending on the nature of your injury. Should you pass away as a result of an accident, your beneficiaries would receive your basic AD&D benefit in addition to your basic life insurance. Keep in Mind: You need to complete a Beneficiary Designation to ensure benefits are paid to your proper survivors.
Want Additional Coverage? If you would like to buy additional life or AD&D coverage for yourself or family, see pages 19-20
Short-Term Disability Disability insurance is designed to replace a portion of your income when you are unable to work due to a covered, non-occupational accident or illness. Benefits begin after you have been disabled for more than 7 days. Total Safety provides you with coverage of up to 60% of your base weekly earnings* up to $1,846 for 12 weeks.
Long-Term Disability The Long-Term Disability (LTD) benefit will pay a portion of your income if you continue to be disabled and your short-term disability period ends. Benefits begin after you have been disabled and absent from work for 90 days due to injury or illness causing disability. Total Safety provides you with 60% of your basic monthly earnings* up to $8,000 per month until you recover or reach Social Security retirement age. You are eligible to receive this benefit on the first of the month following 90 days of continuous service. *Base salary/earnings do not include overtime, bonus, or commission. 17
No-Cost Benefit Offerings Employee Assistance Program We all experience times when we need a little help preparing for and dealing with the stresses of life. Maybe it’s a relationship gone sour or challenges with loved ones. Maybe it’s time to find alternative care/living arrangements for your parents or day care for the kids and you have no idea where to go. Your Work-Life Balance Employee Assistance Program (EAP), which is provided to you at no additional cost, can help you find solutions. Please note – Total Safety does not receive information about employee usage of this program.
Childcare and/or eldercare referrals
Legal consultations with licensed attorneys
Personal relationship information
Financial planning assistance
Health information and online tools
Stress management
Help is easy to access:
Telephone consultations: Speak confidentially with a master’s-level counselor to clarify your need, evaluate options and create an action plan.
Face-to-face meeting: Meet with a local counselor up to six times per issue for short-term problem resolution.*
Educational materials: Receive information through an online library of downloadable materials and interactive tools.
Travel Assistance Whenever you travel 100 miles or more from home — to another country or just another city — be sure to pack your travel assistance phone number! Simply Enter the number into your cell phone so it’s always close at hand. Day or night, you and your family can get support for medical, legal and other important services. While the assistance is free, some services may have a cost. Here are some of the benefits of emergency travel assistance:
Help replacing lost prescriptions and passports Referrals to Western-trained, Englishspeaking medical providers Hospital admission assistance
Emergency medical evacuation
Transportation for a friend or family member to join a hospitalized patient
Care and transport of unattended minor children
If you need travel assistance anywhere in the world, contact us day or night:
Within the U.S.: 1-800-872-1414.
Outside the U.S.: (U.S. access code) +609-986-1234
Via e-mail: medservices@assistamerica.com
Reference number: 01-AA-UN-762490
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Optional Insurance Offerings Supplemental life insurance is available to you and your eligible dependents. You are responsible for paying 100% of the benefit costs, and your deductions with be taken from your paycheck in after taxdollars. Note for new hires or newly eligible employees: You may enroll in optional life insurance for yourself and your spouse during your initial enrollment period without having to submit an evidence of insurability (EOI) form as long as the coverage amount is under $200,000 for employee or $25,000 for spouse.
Optional Employee Life & AD&D Optional employee life coverage is available in increments of $10,000, up to a maximum of the lesser of $500,000 or five times your annual earnings. If you make changes to your coverage outside of your initial enrollment period, your election will be subject to EOI. Initial Enrollment: Coverage amounts over $200,000 are subject to evidence of insurability (EOI) and approval by the service provider. Open Enrollment Changes: Changes in your coverage amount up to the guarantee issue will not require EOI. If you waived coverage during your initial enrollment, any amount elected will be subject to EOI. If you elect optional life coverage, you will automatically receive the matching amount of coverage in AD&D. AD&D coverage does not require EOI.
Optional Spouse Life & AD&D You may purchase optional life and AD&D coverage for your spouse. To elect this coverage, you must also elect optional coverage for yourself. Coverage is available in increments of $5,000 to a maximum of $250,000 or 100% of employee coverage (whichever is less). Initial Enrollment: Coverage amounts over $25,000 are subject to evidence of insurability (EOI) and approval by the service provider. Open Enrollment Changes: Changes in your coverage amount up to the guarantee issue will not require EOI. If you waived coverage during your initial enrollment, any amount elected will be subject to EOI.
Optional Child Life & AD&D You may also purchase optional life and AD&D coverage for your eligible children in the amount of $10,000 for children 6 months to age 26. Coverage for children from live birth to 6 months will be inforce in the amount of $1,000. You must have elected optional employee life coverage to enroll in this plan. 19
Optional Insurance Offerings Optional Life & AD&D rates CARRIER
Unum
Employee & Spouse Life Rates per $1,000 of benefit Under 25
$0.057
25-29
$0.057
30-34
$0.076
35-39
$0.095
40-44
$0.152
45-49
$0.257
50-54
$0.390
55-59
$0.570
60-64
$0.979
65-69
$1.796
70-74
$2.613
75+
$4.332
Child(ren) Life Rate per $1,000 of benefit
$0.190
AD&D Rate per $1,000 of benefit
$0.030
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Optional Insurance Offerings LegalShield and IDShield Have You Ever?
Needed your Will prepared or updated
Had concerns regarding child support
Been overcharged for a repair or paid an
Worried about being a victim of identity theft
Been concerned about your child’s identity
Lost your wallet
Worried about entering personal information
unfair bill
Had trouble with a warranty or defective product
Signed a contract
Received a moving traffic violation
on-line
What is LegalShield? LegalShield was founded in 1972 with the mission to make equal justice under law a reality for all North Americans. LegalShield members throughout the United States and Canada can talk to a lawyer about any personal legal matter, no matter how trivial or traumatic, all without worrying about high hourly costs. LegalShield has provided identity theft protection since 2003 with Kroll Advisory Solutions.
The LegalShield Membership Includes:
Legal Advice – personal legal issues
Trial Defense including Pre-Trial & Trial
Letters/calls made on your behalf
24/7 Emergency Access for covered situations
Uncontested Divorce, Separation, Adoption and/or Name Change Representation (available 90 days after enrollment)
Contracts & documents reviewed (up to 15 pages)
IRS Audit Assistance
Residential Loan Document Assistance
25% Preferred Member Discount (Bankruptcy, Criminal Charges, Other Matters, etc.)
Attorneys prepare your Will, your Living Will and your Health Care Power of Attorney
Moving Traffic Violations (available 15 days after enrollment)
LegalShield legal plans cover the member; member’s spouse; never married dependent children under 26 living at home; dependent children under age 18 for whom the member is legal guardian; never married, dependent children up to age 26 if a full-time college student; and physically or mentally disabled dependent children. LegalShield will not assist in legal disputes between Total Safety U.S., Inc. and its employees.
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Optional Insurance Offerings The IDShield Membership Includes: Full Service Restoration Complete identity recovery services by Kroll Licensed Private Investigators and a $5 million service guarantee ensure that if your identity is stolen, IDShield will restore it to its pre-theft status. Privacy Monitoring Monitoring your name, SSN, date of birth, email address (up to 10), phone numbers (up to 10), driver’s license & passport numbers, and medical ID numbers (up to 10) provides you with comprehensive identity protection service. Security Monitoring Services include: SSN, credit cards (up to 10), and bank account (up to 10) monitoring, sex offender search, financial activity alerts and quarterly credit score tracking. Consultation Your identity protection plan includes 24/7/365 live support for covered emergencies, unlimited counseling, identity alerts, data breach notifications and lost wallet protection.
Legal & ID Shield Rates Bi-Weekly
Weekly
Individual
$7.82
$3.91
Family
$8.74
$4.37
Individual
$4.14
$2.07
Family
$8.74
$4.37
Individual
$11.96
$5.98
Family
$15.64
$7.82
LEGALSHIELD
IDSHIELD
COMBINED (LEGALSHIELD & IDSHIELD)
This is a general overview and is for illustrative purposes only. Plans and services vary from state to state. See a plan contract for your state of residence for complete terms, coverage, amounts, conditions and exclusions. An individual rate is available for those enrollees who are not married, do not have a domestic partner and do not have minor children or dependents. No family benefits are available to individual plan members. 22
Contact Information Benefit Total Safety’s Benefit Advocacy Center Medical Plan Prescription Drugs
Company
Phone
Gallagher Benefit 844-201-6552 Services BlueCross BlueShield Prime Therapeutics
Website/Email
Group/Plan Number
Email: bac.totalbenefits@ajg.com
N/A
800-521-2227
www.bcbstx.com
192561
855-457-0007
www.myprime.com
N/A
Health Savings Account
Optum
866-234-8913
www.optumbank.com
N/A
Telemedicine/Virtual Visits
MDLive
888-680-8646
www.mdlive.com
N/A
800-521-2227
www.bcbstx.com
192561
800-638-3120
www.uhc.com
903188
Unum
800-421-0344
www.unum.com
Basic and Supplemental Life and AD&D Unum Insurance
800-421-0344
www.unum.com
AllState Income Protection
800-840-6580 ext. 4
www.allstatebenefits.com/mybenefits N/A
Dental Vision Disability
BlueCross BlueShield United Healthcare
Allstate
Enroll: www.voyaretirementplans.com/ enrollmentcenter Verification Number: 77111599 Password: date of birth (mmyy) Manage: ww.voyaretirementplans.com
771115
Within the US: 800-872-1414 Outside the US: +609-986-1234
Email: medservices@assistamerica.com
01-AA-UN-762490
N/A
800-584-6001 Retirement Services — 401(k)
Travel Assistance
Voya Financial
Unum
STD: 418074 LTD: 418075 Basic Life/AD&D: 418075 Sup. Life/AD&D: 418076
Fax: 800-6438143
Legal Assistance & Identity Theft Protection
LegalShield
800-654-7757
Member Portals: LegalShield: www.legalshield.com IDShield: www.myidshield.com
Work-Life Balance Employee Assistance Program
Unum
800-854-1446
www.unum.com/lifebalance EAPinfo@HealthAdvocate.com
N/A
Total Rewards
Total Safety
855-678-3657
Email: totalrewards@totalsafety.com
N/A 23
Total Safety’s Benefit Advocacy Center
TOTAL SAFETY’S BENEFIT CENTER IS HERE FOR YOU AND YOUR DEPENDENTS Questions about your benefits?
Contact Total Safety’s Benefit Center! You have a busy life. With so much going on, it can be difficult to slow down and focus on the small details. Who can you turn to when you need help understanding your benefits? Total Safety’s Benefit Center is available to answer your questions and address any issues. When you call or email the Benefit Center, an experienced benefits advocate will be ready to help. Below are examples of the many ways the Benefit Center can assist you and your dependents:
Enrollment for New Hires, Life Events and Annual Enrollment
Answer questions about eligibility, covered services and expenses
Submitting your Physician Affidavit and/or Dependent Documentation
Help you understand your claims
Find an in-network doctor, facility or pharmacy
Request replacement benefit ID cards
Call 844-201-6552 or email bac.totalbenefits@ajg.com Monday - Friday, 7:00 AM - 6:00 PM (CST) 24
Legal Notices Medicaid and the Children’s Health Insurance Program (CHIP) Medicaid and CHIP offer free or low-cost health coverage to children and families. If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help you pay for coverage. Some states use their Medicaid or CHIP programs to help people who are eligible for employer- sponsored health coverage but need assistance in paying their health premiums. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office by calling 1-877-KIDS-NOW or visiting www.insurekidsnow.gov to find out how to apply. You must requested coverage within 60 days of being determined eligible for premium assistance.
Women’s Health and Cancer Rights Act Federal law requires a group health plan to provide coverage for the following services to an individual receiving plan benefits in connections with a mastectomy:
Reconstruction for the breast on which the mastectomy has been performed.
Surgery and reconstruction of the other breast to produce a symmetrical appearance.
Prostheses and physical complications for all stages of a mastectomy, including lymphedema (swelling associated with the removal of lymph nodes).
The group health plan must determine the manner of coverage in consultation with the attending physician and patient. Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Additional Notes Please contact Total Rewards for an expanded CHIP notice or additional information about the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Family and Medical Leave Act of 1993, Continuing of Coverage Rights Under COBRA, and the Medicare Part D Creditable Coverage Notice. Visit www.cms.gov to review other notices regarding your rights. This Employee Benefits Highlights Booklet summarizes recent plan design changes and is intended to fully comply with the requirements under the Employee Retirement Income Security Act (ERISA) as a Summary of Material Modifications and should be kept with your most recent Summary Plan Description.
Pre-Tax Payroll Deductions: Medical, Dental and Vision In most cases, Total Safety U.S., Inc. employees’ contributions for medical, dental and vision coverage are deducted from their paychecks on a pre-tax basis meaning before federal income taxes, state income taxes (in most cases), and FICA taxes are calculated. Internal Revenue Code (I.R.C.) Section 125 defines what dependent contributions are eligible for pre-tax deductions. The IRS does not allow employees’ contributions for dependent health coverage to be deducted on a pre-tax basis unless the dependent(s) meet the definition of a tax dependent under I.R.C. Section 125. If they do not meet the definition of a tax dependent, they may be either ineligible for the Plan, or in some cases, the IRS taxes the additional fair market value of these benefits and treats it as Imputed Income. Contributions for medical, dental and vision coverage for eligible dependents that do not meet the definition of a tax dependent will be made on a post-tax basis and the Imputed Income will be included on your paycheck and IRS Form W-2. 25
MISSION W3‌. To ensure the safe Wellbeing of workers Worldwide
VISION To become the premier global provider of integrated safety strategies and solutions for hazardous environments
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