2021 Employee Benefits Guide
We’ve Got You Covered!
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 separate legal notices packet online for more details.
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
YOUR 2021
BENEFITS
The benefits described in this guide are effective January 1—December 31, 2021. Welcome! 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. Each year during the annual 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 proud to provide the following benefits to our employees at no cost to you:
Basic Life and Accidental Death & Dismemberment (AD&D) Insurance
Short-Term Disability
Long-Term Disability
Employee Assistance Program (EAP)
Business Travel Accident (BTA) Insurance
In addition to the company-provided benefits, we are pleased to offer the following benefits at competitive rates:
Medical, Prescription Drug, Dental, and Vision coverage
Health Savings Account (HSA), available with enrollment in a CDHP
Voluntary Life and AD&D Insurance
Voluntary benefits, including Hospital Indemnity, Critical Illness Insurance, and Accident Insurance
We invite you to take a closer look at the information provided in this guide to learn more about the benefit programs Total Safety offers to you and your family. Taking the time to research your options now will help you choose the plans that best meet your family’s needs now and in the future.
2021 Employee Benefits Guide
1
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
Eligibility & Making Changes As a regular, full-time employee who is scheduled to work at least 30 hours per week, you are eligible for benefits on the first of the month following your date of hire (or date of eligibility if assignment status change). If you are a part-time, temporary employee, you may not be eligible for all of the benefits described in this guide. If you have questions about your eligibility, please contact totalrewards@totalsafety.com. 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 upon 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.
When Can I Enroll? As a New Hire
Annual Benefits Enrollment
Qualified Life Event
You can enroll in benefits online within 31 calendar days of your eligibility date, which is typically your date of hire.
Annual Enrollment is your once-ayear opportunity to review and make changes to your benefit elections for the upcoming year.
You have 31 calendar days from the date of a qualified life event to submit any election changes to Human Resources(see below).
The election choices you make when you first become eligible or during annual enrollment are in effect for the remainder of the plan year (January 1—December 31). It’s important to review your benefit options and choose the best coverage for you and your family.
Changing Your Benefits During the Year The benefit choices you make during enrollment will remain in effect for the entire year unless you experience a “qualified status change.” Qualified status changes can include, but are not limited to, the following: Marriage or divorce Birth or adoption of a child Change in employment for you or your spouse that affects your benefit eligibility Loss of other health coverage
You have 31 calendar days following the date of a qualified status change to complete and submit your enrollment change, including any dependent verification documentation, to the Total Safety Benefits 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.
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 relationship to the dependent. When you enroll a dependent, a member of the Total Safety Benefits Center will contact you requesting the appropriate documentation. Please note: if documents are not received within the time period allowed, your dependent(s) coverage is subject to cancelation. 2
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
The Total Safety Benefits Center The Total Safety Benefits Center is a valuable resource for your company-sponsored health, welfare, and insurance benefits. Talk to a personal benefits advocate about your eligibility, enrollment, benefit questions, finding a provider, billing or claim questions, and more! The Total Safety Benefits Center is available Monday—Friday, 7:00 AM—6:00 PM Central Time.
844-201-6552
bac.totalbenefits@ajg.com
How to Enroll Follow these steps to enroll in your benefits. 1. Evaluate your needs Be a smart health care consumer and ask yourself the following questions:
Who should I cover? Evaluate your coverage options for all of your dependents who meet the eligibility criteria.
How much did I spend on health care last year? Consider your past expenses to help plan for your future healthcare needs.
Will I need more, or less, health coverage next year? Estimate the amount of health care you will require in the upcoming year.
2. Review your options Review this benefit guide to compare your options and evaluate costs and potential savings.
Attend an annual enrollment informational session to learn more about the Total Safety benefits offerings and answer any questions you may have.
3. Enroll online at https://n22.ultipro.com/login.aspx Log in to UltiPro using your username and password. For login help or to reset your password, email UltiproSupport@totalsafety.com.
Instructions for enrolling online are available in UltiPro under the “My Company” > “Electronic Forms” folder.
Questions? Contact the Total Safety Benefits Center by email at bac.totalbenefits@ajg.com or call 844201-6552.
4. Confirm your elections Review your enrollment confirmation statement carefully to make sure your benefits and dependent information are correct. 2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
MEDICAL BENEFITS Total Safety offers three medical plans through Blue Cross Blue Shield of Texas (BCBSTX). A fourth plan option— an HMO plan through Kaiser Permanente—is available to California employees. Please note that out-of-network services are NOT covered on any of the plans except in cases of true emergency. Medical Services
Kaiser HMO Plan
BCBS Premier Plan
BCBS Core CDHP
BCBS Base CDHP
In-Network ONLY
In-Network ONLY
In-Network ONLY
In-Network ONLY
$2,000 / $4,000
$2,800 / $5,600
$4,000 / $8,000
$2,800 / $5,600
You pay 20% Plan pays 80%
You pay 20% Plan pays 80%
You pay 10% Plan pays 90%
You pay 30% Plan pays 70%
$5,000 / $10,000
$5,400 / $10,800
$6,000 / $12,000
$5,250 / $10,500
N/A
$500 / $1,000
N/A
$500 / $1,000
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 100%
$30 copay / $60 copay
20% after deductible
10% after deductible
$30 copay after deductible
Virtual Visit
$10 copay
20% after deductible
10% after deductible
$30 copay after deductible
Urgent Care Center
$50 copay
20% after deductible
10% after deductible
$30 copay after deductible
20% after deductible
20% after deductible
10% after deductible
30% after deductible
20% after deductible
10% after deductible
30% after deductible
20% after deductible
10% after deductible
30% after deductible
Annual Deductible Individual / Family
Coinsurance Out-of-Pocket Maximum Individual / Family
Employer HSA Contribution Individual / Family
Preventive Care Physician Office Visit Primary Care Physician / Specialist
Independent Lab/X-Ray Emergency Room Inpatient/Outpatient
TERMS TO
KNOW 4
20% after $250 copay Copay waived if admitted
20% after deductible
(California Employees ONLY)
Out-of-Pocket Maximum
Deductible
Copay
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copays, and/or coinsurance, your plan will pay 100% of the cost of covered services for the rest of the year.
The amount you pay for covered health care services before the plan will begin to pay.
A fixed amount you pay for a covered health care service. Copays count toward your out-of -pocket maximum, but they do not count toward your deductible.
Coinsurance The percentage of costs you pay after you’ve met your deductible.
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
Comparing Your Medical Plan Options The main difference between a traditional PPO plan—like the Premier Plan—and a Consumer Driven Health Plan (CDHP)—like the Core CDHP, the Base CDHP, and the Kaiser HMO—is how and when you pay for your health care. Choosing the right medical plan is an important decision. Take the time to learn about your options to ensure you select the right plan for you and your family.
Consumer Driven Health Plan (CDHP)
Traditional PPO Plan
Lower cost per pay period
Higher cost per pay period
Higher deductible You pay all medical expenses until
your deductible is met You can budget for your out-of-pocket
expenses by funding a Health Savings Account (HSA)
$
VS.
Lower deductible You have first dollar coverage on
certain services that charge a copay, meaning you do not have to meet your deductible first
If you enroll in the Core CDHP or the Kaiser HMO Plan, Total Safety will contribute annually to your Health Savings Account (HSA): Employee Only: $500
Employee + Child(ren): $1,000
Employee + Spouse: $1,000
Employee + Family: $1,000
1. Do you prefer to pay more for medical insurance out of your paycheck, but less when you need care? (PPO) Or, do you prefer to pay less out of your paycheck and only pay if you need care? (CDHP)
THREE
THINGS TO CONSIDER
2. What planned medical services or prescriptions do you expect to need in the upcoming year? 3. Are you able to budget for your deductible by setting aside pre-tax dollars from your paycheck in a Health Savings Account (HSA)?
Tip: The voluntary benefits through Allstate can also provide additional protection to help cover expenses related to accidents, critical illnesses or hospital stays. See page 17 for more details! BCBS Premier Plan
BCBS Core CDHP
BCBS Base CDHP
Kaiser HMO Plan
Coverage in the Blue Choice Network
In-network preventive care covered 100%
Lower deductible & out-of-pocket maximum
Lower premium cost per paycheck
Contribute pre-tax dollars from your paycheck to a Health Savings Account (HSA)
2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
TELEHEALTH
BENEFITS Get Care When and Where You Need It MDLive provides you and your covered dependents with access to board-certified doctors anytime and anywhere it’s most convenient for you—at home, work, or on the go. MDLive has the nation’s largest telehealth network of doctors ready to provide convenient, quality care by phone or secure video. Doctors can diagnose a wide range of non-emergency medical issues and even send prescribed medications to your pharmacy of choice. MDLive physicians can treat the following:
Flu
Sore throat
Headache
Rash
Allergies
Fever
Nausea/vomiting
Ear problems
Cough
Sinus infection
Pink eye
UTI
PREMIER PLAN:
$10 COPAY
How to Get Started To register, go to www.mdlive.com/bcbstx. Enter your first and last name, date of birth, and BCBSTX member ID number. Once you have an account, you can browse doctor profiles, view available appointment times, and schedule an appointment with the doctor of your choice.
CORE & BASE PLANS:
$44 PER VISIT www.mdlive.com/bcbstx 888-680-8646 www.mdlive.com/getapp
*Visit fee for a non-emergency medical consultation is $44 per visit. Pay no more than $44 per visit before your deductible is met on the Core HSA Plan or Base HSA Plan.
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*
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
BCBSTX Health Advocacy Solutions Are you ready for health care made easy? You have a Blue Cross Blue Shield of Texas (BCBSTX) health advocate waiting to help with your benefits questions and health care needs. Health advocates can help you and your covered family members: Get personal assistance with your health care matters Understand your health benefits Talk to your BCBSTX clinician about health questions Sort out a new diagnosis and what to do next Shop for quality, lower-cost health care Call 855-676-9520 or download the BCBSTX App to live chat.
Blue Access For Members Get information about your health benefits anytime, anywhere. Use your computer, phone or tablet to access the Blue Cross Blue Shield of Texas (BCBSTX) secure member website, Blue Access for Members. With Blue Access for Members, you can: Find a Provider Locate a doctor, hospital or facility in the BCBSTX Blue Choice PPO Network ID Cards Request a new ID card, or print a temporary one Wellness Tools & Resources Access handy tools like Well onTarget, which has fitness trackers, food diaries, and more Claims View or print Explanation of Benefits statements, and check the status or history of a claim My Coverage See your benefits at a glance or in detail Customer Service Use secure messaging to get in touch with helpful customer service representatives
It’s easy to get started! Visit www.bcbstx.com/member and click on “Register Now” under the blue Member Login button. You will need the information on your BCBSTX ID card to complete your registration. If you do not have this information, you can call the BCBSTX Help Desk at 888-706-0583 for assistance.
IT’S EASY TO GET
CONNECTED
BCBSTX Mobile App Many of the services and resources available through Blue Access for Members can also be found right in the palm of your hand! With the BCBSTX Mobile App, you can access your important health plan information wherever you are. Text* BCBSTXAPP to 33633 to get the app, or download it directly from the App Store or Google Play. *Message and data rates may apply. Terms and conditions and privacy policy at bcbstx.com/mobile/text-messaging.
2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
Blue365 Discounts Blue365 is just one more advantage you have by being a Blue Cross Blue Shield of Texas (BCBSTX) member! With this program, you may save money on health and wellness products and services from top retailers that are not covered by insurance. There are no claims to file and no referrals or preauthorizations. Once you sign up for Blue365 at blue365deals.com/bcbstx, weekly “Featured Deals” will be emailed to you. These deals offer special savings for a short period of time. Below are some of the ongoing deals you can access on the Blue365 website:
Fitbit® You can customize your workout routine with Fitbit’s family of trackers and smartwatches that can be employed seamlessly with your lifestyle, your budget, and your goals. You’ll get a 20% discount on Fitbit devices plus free shipping.
TruHearing® | Beltone™ | American Hearing Benefits You could get savings on hearing tests, evaluations and hearing aids. Discounts may also be available for your immediate family members.
Jenny Craig® | Sun Basket | Nutrisystem® Help reach your weight loss goals with savings from leading programs. You may save on healthy meals, membership fees (where applicable), and nutritional products and services.
Gym Network 360 Blue365 members enjoy exclusive discounts up to 20% off on memberships at thousands of fitness centers and specialty studios nationwide, including Gold’s Gym, 24 Hour Fitness, LA Fitness, Curves, as well as yoga, pilates, CrossFit, and more!
Reebok | SKECHERS® Reebok makes top athletic equipment for all people, from professional athletes to kids. Get 20% off select models. SKECHERS, a leader in the footwear industry, offers exclusive pricing on men’s and women’s styles—get 30% off plus free shipping online.
Livekick Livekick is the future of private fitness. Choose from training or yoga over live video with a private coach. Get fit and feel healthier with action-packed 30-minute sessions that you can do from home or in the gym. Get a free 2-week trial and 20% off a monthly plan. 8
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
PHARMACY
BENEFITS All Total Safety medical plans include comprehensive prescription drug coverage. You are automatically enrolled in prescription drug coverage when you enroll in any Total Safety medical plan. Prescription drug coverage for the Premier Plan, the Core CDHP, and the Base CDHP is administered by Express Scripts. The Kaiser HMO Plan’s prescription drug coverage is administered by Kaiser Permanente. Prescription Drug Benefits
Premier Plan
Core CDHP
Base CDHP
Kaiser HMO Plan
$20 copay $40 copay $70 copay
20% after deductible 20% after deductible 20% after deductible
10% after deductible 10% after deductible 10% after deductible
$15 copay after deductible $30 copay after deductible $30 copay after deductible
$50 copay $100 copay $175 copay
20% after deductible 20% after deductible 20% after deductible
10% after deductible 10% after deductible 10% after deductible
$30 copay after deductible $60 copay after deductible $60 copay after deductible
$110 copay
20% after deductible
10% after deductible
20% ($200 maximum) after deductible
Retail Pharmacy* 30-day supply
Generic Drugs Preferred Brand Drugs Non-Preferred Brand Drugs Home Delivery Pharmacy 90-day supply
Generic Drugs Preferred Brand Drugs Non-Preferred Brand Drugs Specialty Drugs** 30-day supply
*The prescription drug plans cover prescriptions filled at in-network pharmacies ONLY. Visit www.express-scripts.com or www.kp.org to find a network pharmacy near you. ** Specialty drugs are required to be filled through Accredo Specialty Pharmacy for Premier Plan, Core CDHP, and Base CDHP. For questions about specialty drugs or Accredo, please call 1-877-222-7336.
About Step Therapy The Step Therapy Program encourages safe and cost-effective medication use, and is designed to keep members safe and save money when possible. To receive coverage for certain medications, you may need to first try a proven, generic equivalent before using a more costly treatment, if needed. For a complete list of drugs covered by your plan, as well as a list of Step Therapy drugs, visit express-scripts.com.
TERMS TO
KNOW
2021 Employee Benefits Guide
Generic Drugs
Non-Preferred Brand Drug
You can save on your out-of-pocket costs by choosing generic drugs. Brand and generic drugs are regulated by the FDA and are chemically and medically the same. However, generic drugs typically cost significantly less. Talk to your doctor to find out if generic drugs are right for you.
A name brand drug that may have a therapeutic alternative available as either a generic or preferred brand drug. These drugs will generally be the most expensive.
Preferred Brand Drug
Preferred brand drugs are commonly prescribed name-brand drugs that have been selected based on their clinical effectiveness, safety, and cost. Preferred brand drugs will generally be more expensive than Formulary generic drugs, but less expensive The list of prescription drugs covered than non-preferred brand drugs. by the plan. Also called a “drug list.”
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
Preventive Medications on a CDHP Preventive medications are those taken on an ongoing basis for preventive purposes, such as high blood pressure. When you are prescribed a medication for preventive purposes, it is not subject to the plan deductible. This means you can begin to fill your preventive medications immediately at the coinsurance structure prior to meeting your plan’s deductible. As a reminder, these drugs could also be prescribed for treatment or other purposes, making them subject to the deductible. Please review the Preventive Drug Guide for details and discuss with your doctor to determine how your medication will be covered.
Express Scripts Smart 90 & Mail Order Pharmacy Do you take maintenance medication every day for diabetes, asthma, high blood pressure, or another condition? The coverage of maintenance medications is limited to two fills at a retail network pharmacy other than a Walgreens pharmacy. Before your third fill, you will need to fill your maintenance medications through the Home Delivery service or a retail Walgreens pharmacy to avoid paying a higher cost for your medication. Smart 90 allows you to fill 90-day supplies of your maintenance medications at retail Walgreen’s pharmacies. Home Delivery will deliver your medications right to your door about 8 days after your prescriptions is received, and delivery is free! Here’s how you can get started with Home Delivery: ePrescribe Ask your doctor to send your prescription electronically to the Express Scripts Pharmacy. Phone Call 800-413-7198 to speak with a prescription plan specialist. Online Log in at express-scripts.com and scroll down to the ‘Transfer to Home Delivery’ section. Select the medicines you want to refill to Home Delivery, and check out.
Register with Express Scripts Manage your medicines anywhere, any time at express-scripts.com or the Express Scripts Mobile App. When you register online with Express Scripts, you gain online access to savings and convenience: compare prices of medicines at multiple pharmacies, manage and track home delivery medications, speak with a pharmacist about your medications, locate nearby in-network pharmacies, and more! Registering is safe and simple, and your information is secure and confidential. To register, simply go to express-scripts.com and select ‘Register’, or download the Express Scripts Mobile App from your device’s app store and select ‘Register’. Please have your member ID number or Social Security Number (SSN) available. 10
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
HEALTH SAVINGS
ACCOUNT
A Health Savings Account (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 using your HSA debit card. 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. Please note that the HSA is ONLY available to employees enrolled in the Core CDHP, Base CDHP, and Kaiser HMO Plan. For employees enrolled in the Core CDHP and Kaiser HMO Plan, Total Safety will contribute annually to your HSA. Total Safety’s contribution to your HSA will be funded in equal amounts per pay period over the course of the plan year (January 1—December 31, 2021). For 2021, Total Safety will contribute $500 for individual coverage or $1,000 for family coverage. Employees must contribute at least $1.00 per paycheck to their HSA in order to receive Total Safety’s contribution. Important HSA Information Must be enrolled in the Core CDHP, Base CDHP, or Kaiser HMO Plan for 2021. Cannot be enrolled in Medicare (if you are age 65+ and enrolled in Medicare, an existing HSA may Eligibility
Contribution Limits
remain open, but you cannot make any additional contributions to the account).
Cannot be claimed as a dependent on someone else’s 2020 tax return. Do not have any other health coverage except what is permitted by the IRS.
Combined employer and employee contributions cannot exceed $3,600 for individual coverage or $7,200 for family coverage in 2021. Individuals age 55 and older may contribute an additional $1,000 in 2021.
Account Management
Your HSA is managed through Optum Bank. www.optumbank.com | 866.234.8913
Employer Contribution
$500 for individual coverage or $1,000 for family coverage will be funded in equal installments throughout the year if enrolled in the Core CDHP or Kaiser HMO Plan. You must contribute at least $1.00 per paycheck to receive the employer contribution. If you join the plan mid-year, you will receive a prorated amount.
Portability Contribution Changes Withdrawals Rollover Taxes
2021 Employee Benefits Guide
The money in your HSA stays with you even if your employment changes. Contributions can be changed at any time, but cannot exceed the IRS maximum. You can only withdraw funds already present in the account. Unused balances roll over from year-to-year. Contributions are made pre-tax, and withdrawals for qualified expenses are tax-free.
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
DENTAL
BENEFITS Dental coverage is important to your overall health and wellness. Eligible employees can enroll in dental benefits through Blue Cross Blue Shield of Texas (BCBSTX). The Dental PPO Plan helps you with the cost of preventive, basic, and major dental services for yourself and your eligible dependents. This plan gives you the freedom to select any dentist, but you will pay less out-of-pocket when you choose a provider in the Blue Care Dental Network. To find an in-network provider, go to www.bcbstx.com and click on “Find a Doctor.” Next scroll to the bottom of the page and select “Find a Dentist.” Choose the BlueCare Dental Network and enter your search criteria to find in-network dentists near you. Dental Services
Dental PPO Plan In-Network and Out-of-Network
Annual Deductible Individual / Family
Annual Benefit Maximum Diagnostic & Preventive Services Exams, cleanings, x-rays, sealants
Basic Services Endodontics, periodontics, root canals, fillings, oral surgery
Major Services Crowns, inlays, onlays, dentures, bridges
Orthodontic Services
$50 / $150 $2,000 per person Plan pays 100%; deductible waived Includes 2 cleanings per calendar year
You pay 20% after deductible You pay 50% after deductible You pay 50%; deductible waived Dependent children up to age 19 only $2,000 lifetime benefit maximum per dependent
Out-of-Network Dental Claims While benefits appear to be the same for in-network and out-of-network dentists, please remember that if you choose an out-of-network dentist, there will be a maximum limit that BCBSTX will reimburse those providers. The Dental PPO Plan reimburses out-of-network dentists at 90% of “usual and customary.” If an out-ofnetwork provider charges over this amount, you may be balance billed for the difference between the provider’s charge and the maximum reimbursement allowed by the plan. Additionally, you must file your own claim to be reimbursed for out-of-network services. 12
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
VISION
BENEFITS Total Safety offers all eligible employees vision coverage through UnitedHealthcare (UHC). Eye care is a vital component of a healthy lifestyle. Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages. Your vision plan makes regular exams and purchasing contacts or glasses simple and affordable. The plan uses UHC’s network of vision care providers, including retail optical centers, optometrists, and opticians. To access a list of in-network providers and retail centers, go to www.myuhcvision.com. Vision Services
Vision Plan
Eye Examinations Lenses Single Vision Lenses Lined Bifocal Lenses Lined Trifocal Lenses Lenticular Lenses Frames
In-Network
Out-of-Network
$10 copay
Reimbursed up to $40
$25 copay $25 copay $25 copay $25 copay
Reimbursed up to $40 Reimbursed up to $60 Reimbursed up to $80 Reimbursed up to $80
$130 allowance
Reimbursed up to $45
30% off amount over $130
Elective Contact Lenses Selection Contact Lenses Non-Selection Contact Lenses
Covered in full* after $25 copay $105 allowance
N/A Reimbursed up to $105
Benefit Frequency Examination Lenses OR Contact Lenses Frames Laser Vision Discounts
Once per calendar year Once per calendar year Once per calendar year Receive 15% off standard or 5% off promotional pricing at locations in the Laser Vision Network of America, with even greater discounts at LasikPlus locations. For more information, call 1-888-563-4497 or visit www.uhclasik.com.
*If you choose disposable contacts, up to 4 boxes are included (subject to applicable allowance). “Selection” contact lenses refers to the formulary contact list. A copy of the list can be found at www.myuhcvision.com.
2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
2021 PAYROLL
DEDUCTIONS Medical/Rx Rates
Per Bi-Weekly Pay Period:
Per Weekly Pay Period:
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$91.99 $178.83 $138.62 $274.58
$45.99 $89.41 $69.31 $137.29
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$53.28 $117.21 $86.83 $190.79
$26.64 $58.61 $43.41 $95.40
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$28.75 $69.05 $38.85 $141.99
$14.38 $34.53 $19.43 $71.00
$62.00 $328.00 $284.00 $512.00
$31.00 $164.00 $142.00 $256.00
Per Bi-Weekly Pay Period:
Per Weekly Pay Period:
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$11.61 $27.76 $18.96 $40.98
$5.80 $13.88 $9.48 $20.49
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$2.39 $4.53 $5.31 $7.47
$1.19 $2.26 $2.65 $3.73
Premier Plan
Core CDHP
Base CDHP
Kaiser HMO Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
Dental & Vision Rates Dental Plan
Vision Plan
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
LIFE, AD&D & DISABILITY Life and AD&D With Life and Accidental Death & Dismemberment (AD&D) insurance provided through Unum, your family will be protected with benefits and a variety of support services designed to help cope with both emotional and financial issues. Total Safety provides all eligible employees with Basic Life and AD&D insurance at no cost to you, and you also have the option to purchase Voluntary Life and AD&D coverage for yourself and your dependents. During this annual enrollment period only, all eligible employees have the opportunity to elect up to the Guarantee Issue Amount without Evidence of Insurability. After this annual enrollment period, standard Evidence of Insurability rules will apply—any new elections or increases in coverage will require Evidence of Insurability and will not be effective until and unless approved by Unum. Basic Life/AD&D
Benefit Amount Maximum Benefit Guarantee Issue Amount Benefit Paid By
Voluntary Life/AD&D
Employee
Employee
Spouse
Child(ren) up to Age 26
1x annual base salary
Increments of $10,000
Increments of $5,000
$10,000*
$100,000
5x annual base salary up to $500,000
$250,000 up to 100% of employee amount
$10,000
N/A
$200,000
$25,000
$10,000
Total Safety
Employee
Employee
Employee
* Children 6 months up to age 26 receive a flat $10,000 benefit. Coverage for children from live birth up to 6 months is $1,000. Note: Benefit age reduction schedule applies to employee and spouse—see policy for details.
Keep Your Beneficiary Information Updated When you enroll in benefits, you must designate a beneficiary (the person who will receive the benefit) for your Life and AD&D insurance. You may have both a primary and contingent (secondary) beneficiary, as long as the total percentage adds up to 100%. Annual enrollment is a great time to revisit your beneficiary information. It is important to confirm that your beneficiary information (i.e., address, Social Security Number, date of birth) is correct. You can easily and quickly confirm and/or update beneficiary information through UltiPro. 2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
Short-Term Disability Short-Term Disability insurance is designed to replace a portion of your weekly income when you are unable to work due to a covered, non-occupational injury or illness. Total Safety provides Short-Term Disability insurance through Unum for all eligible employees at no cost to you. You are eligible to receive this benefit on the first of the month following 90 days of continuous service. Short-Term Disability (STD)
Benefit Description
Weekly Benefit
60% of your base weekly earnings
Elimination Period
7 days
Maximum Weekly Benefit
$1,846
Maximum Benefit Duration
12 weeks
Pre-Existing Condition Limitation
None
Long-Term Disability Long-Term Disability insurance is designed to replace a portion of your monthly income if you continue to be disabled and your Short-Term Disability period ends. Total Safety provides Long-Term Disability insurance through Unum for all eligible employees at no cost to you. You are eligible to receive this benefit on the first of the month following 90 days of continuous service. Long-Term Disability (LTD)
Benefit Description
Monthly Benefit
60% of your base monthly earnings
Elimination Period
90 days
Maximum Monthly Benefit
$8,000
Maximum Benefit Duration
Social Security Normal Retirement Age
Pre-Existing Condition Limitation
If an injury or illness is treated or diagnosed within the 3 months prior to the effective date of coverage, benefits will not be payable for a disability related to that condition for the first 12 months of coverage. First 24 months: your own occupation After 24 months: any occupation
Definition of Disability
TERMS TO
KNOW 16
Base Salary/Earnings
Guarantee Issue Amount
“Base salary” or “base earnings” does not include overtime, bonuses, commissions, or other forms of extra compensation.
When you are newly eligible, you can elect Voluntary Life/AD&D insurance up to the Guarantee Issue Amount without Evidence of Insurability (i.e. answering medical questions), but any coverage over the Guarantee Issue will require Evidence of Insurability. If you previously waived coverage, any amount elected will require Evidence of Insurability.
Elimination Period This is the amount of time you must be disabled before disability benefits will begin to pay.
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
VOLUNTARY
BENEFITS All eligible employees have the opportunity to enroll in additional income protection benefits provided by Allstate, including Accident, Critical Illness, and Hospital Indemnity coverage. These benefits are designed to supplement and strengthen your overall benefits package so that you are covered in the event of an accident, critical illness, or hospitalization. These benefits allow you to customize your coverage based on your needs and affordability. Please review the full plan documents available in UltiPro for plan limitations or exclusions.
Accident Insurance While your medical coverage is designed to cover the cost of treatment, this supplemental Accident policy can help to pay for out-of-pocket costs that arise due to a covered accidental injury. This policy pays cash benefits directly to you as the policyholder, which can be used however you want—groceries, rent or mortgage payments, childcare, etc. Covered accidents include sports-related injuries, burns, concussion, laceration, fractures, dislocations, and more!
Critical Illness Insurance It takes a lot to beat a serious illness. Unfortunately, it can also cost a lot. When you or a family member suffers a serious illness like a stroke, heart attack or cancer, Critical Illness insurance can help with expenses that Medical insurance doesn’t cover, such as deductibles, out-of-pocket costs or services like experimental treatment. The lump sum benefit is paid directly to you when you need it most, upon diagnosis, so you can focus on your health.
Hospital Indemnity Insurance Being hospitalized can be financially stressful. While your Medical insurance is designed to cover the cost of treatment, Allstate’s Hospital Indemnity policy pays a cash benefit directly to you as the policyholder, which can be used however you choose. Hospital Indemnity insurance helps provide financial peace of mind, allowing you to focus on recovery during your hospital stay—not your expenses. This plan has no pre-existing condition waiting period, and pregnancy is fully covered. 2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
LegalShield LegalShield members can talk to a lawyer about any personal legal matter, no matter how trivial or traumatic, all without worrying about high hourly costs. Membership includes legal advice, letters or calls made on your behalf, contract and document review, will preparation, health care power of attorney, trial defense, moving traffic violations, IRS audit assistance, uncontested divorce, separation, adoption, and/or name change representation (available 90 days after enrollment) and more!
IDShield The IDShield membership includes privacy and security monitoring of personal information such as SSN, date of birth, credit cards, bank accounts, etc., as well as 24/7/365 live support for covered emergencies, identity alerts, data breach notifications, and lost wallet protection. Complete identity recovery services by Kroll Licensed Private Investigators and a $5 million service guarantee ensures that if your identity is stolen, IDShield will restore it to its pre-theft status. Accident
Weekly
Bi-Weekly
Employee Only
$1.96
$3.91
Employee + Spouse
$4.50
$9.00
Employee + Child(ren)
$5.66
$11.31
Employee + Family
$7.29
$14.59
Critical Illness
Weekly
Bi-Weekly
$10,000 Benefit
$20,000 Benefit
$10,000 Benefit
$20,000 Benefit
Employee Only or Employee + Child(ren)
$2.68
$5.05
$5.37
$10.10
Employee + Spouse or Employee + Family
$4.19
$7.74
$8.37
$15.48
Spouse coverage at 50% of employee election. Children up to age 26 covered at 50% of employee election at no additional cost
Hospital Indemnity
Weekly
Bi-Weekly
Employee Only
$3.15
$6.30
Employee + Spouse
$8.25
$16.50
Employee + Child(ren)
$5.46
$10.92
Employee + Family
$8.97
$17.94
Weekly
Bi-Weekly
Individual
$3.91
$7.82
Family
$4.37
$8.74
IDShield
Weekly
Bi-Weekly
Individual
$2.07
$4.14
Family
$4.37
$8.74
LegalShield
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
WORK-LIFE
BALANCE 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 Personal relationship information Health information and online tools
Legal consultations with licensed attorneys Financial planning assistance 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 6 times per issue for short-term problem resolution (in California and Nevada, you may see a local counselor up to 3 times in a 6-month period). Educational materials: receive information through an online library of downloadable materials and interactive tools. To learn more, call 1-800-854-1446 or visit www.unum.com/lifebalance.
Travel Assistance You and your family can get support while traveling 100+ miles from home, including help replacing lost passports, referrals to Englishspeaking medical providers, emergency medical evacuation, legal and interpreter referrals, and more! While assistance is free, some services may have a cost. Travel assistance is available worldwide 24/7: In the U.S.: 1-800-872-1414 Outside the U.S.: +(US access code) 609-986-1234 Email: medservices@assistamerica.com Reference Number: 01-AA-UN-762490 2021 Employee Benefits Guide
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Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
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 2021 Benefits Guide 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. 20
Your 2021 Benefits
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Life, AD&D Disability
Additional Benefits
IMPORTANT
CONTACTS Benefit
Vendor
Phone
Website/Email
The Total Safety Benefit Center
Gallagher Benefit Services
844.201.6552
bac.totalbenefits@ajg.com
Health Advocacy Solutions
Blue Cross Blue Shield of Texas (BCBSTX)
855.676.9520
www.bcbstx.com
Medical
Blue Cross Blue Shield of Texas (BCBSTX)
800.521.2227
www.bcbstx.com
Prescription Drugs
Express Scripts
800.413.7198
www.express-scripts.com
Kaiser HMO Plan
Kaiser Permanente
1.833.574.2273
www.kp.org
Health Savings Account (HSA)
Optum
866.234.8913
www.optumbank.com
MDLive Virtual Visits
MDLive
888.680.8646
www.mdlive.com/bcbstx
Dental
Blue Cross Blue Shield of Texas (BCBSTX)
800.521.2227
www.bcbstx.com
Vision
UnitedHealthcare
800.638.3120
www.myuhcvision.com
Disability
Unum
800.421.0344
www.unum.com
Life and AD&D
Unum
800.421.0344
www.unum.com
Voluntary Benefits
Allstate
800.840.6580 ext. 4
www.allstatebenefits.com/mybenefits
Retirement Services
Voya Financial
800.584.6001 Fax: 800.643.8143
www.voyaretirementplans.com
Travel Assistance
Unum
Within the US: 800.872.1414 Outside the US: +609.986.1234
www.unum.com
Legal Assistance & ID Theft Protection
LegalShield
800.654.7757
www.legalshield.com www.idshield.com
Work-Life Balance Employee Assistance Program
Unum
800.854.1446
www.unum.com/lifebalance EAPinfo@HealthAdvocate.com
Total Rewards
Total Safety
855.678.3657
totalrewards@totalsafety.com
2021 Employee Benefits Guide
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This benefits guide prepared by