Employee Benefits Enrollment Guide

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1 Employee Benefits Enrollment Guide January 1, 2019 to December 31, 2019

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3 Welcome to Open Enrollment for your employee benefits! Republic Health Resources offers you and your family members a comprehensive and valuable benefits program. Our employees are our most valuable asset that is why we are committed to an employee benefit program that helps our employees stay healthy, feel secure, and maintain a work/life balance. Every effort is made to provide you with a thorough plan of benefits while still keeping costs fair and manageable for both the company and our employees. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. The elections you make during open enrollment will become effective on January 1, You must make all benefit elections by December 14, 2018! 3

4 Enrollment Guidelines Who is Eligible? If you are a full-time employee (working 30 or more hours per week) you are eligible to enroll in the benefits described in this guide. The following family members are eligible for the benefits in the this summary: spouse and/or dependent children to age 26. Disabled children may be eligible beyond age 26 with proof of disability. How to Enroll? The first step is to review your current benefit options. Make sure you understand your options, ask questions, and then make your benefit elections online through the TBX Website. *Once you have made your elections you will not be able to change them until the next open enrollment period unless you have a qualified change in status, per the IRS rules and regulations. When to Enroll? New Hires New hires will become eligible for medical, dental and vision benefits on the first of the month following your date of hire. You will become eligible for employer paid life and Telemed benefits on your date of hire. ALL new hire elections MUST be made within 7 days of your hire date or you will have to wait until the next Open Enrollment period. Current Employees Open enrollment will occur during the month of December. The benefits you elect during open enrollment will be effective on January 1, 2019 through December 31st, When to Make Changes? You cannot make changes to the benefits you elect until the next open enrollment period unless you have one of the following events: Marriage, divorce, or legal separation Birth/adoption of child or change in child s dependent status Death of spouse, child or other qualified dependent Commencement or termination of adoption proceedings Change in spouse s benefits or employment status Loss of eligibility for other coverage Gain of Coverage i.e. individual policy, Medicare, Tricare, Spouse s Employer, etc. You must notify HR within 30 days of a qualifying event in order to make changes. Documentation will be required to verify your qualifying event. Don t wait until the 30th day! 4

5 Medical Insurance Network Name: Blue Choice PPO To find in an in-network provider, please visit: In-Network Benefits H.S.A. Plan (MTBCP609) Base Plan (MTBCP813) Buy Up Plan (MTBCP808) Annual $6,000 Individual $12,000 Family $5,000 Individual $14,700 Family $2,500 Individual $7,500 Family Coinsurance Covered 100% After Covered 70% After Covered 80% After Out-of-Pocket Maximum $6,000 Individual $12,000 Family $5,600 Individual $14,700 Family $5,500 Individual $14,700 Family Health Savings Account Eligible to participate Not Eligible Not Eligible Office Visits $45 Copay $30 Copay Specialist Visits $90 Copay $60 Copay Preventive Care Covered 100%, No Copay Urgent Care $75 Copay $75 copay Emergency Room - Facility $500 Copay then 30% $500 Copay then 20% Emergency Room - Provider then 30% then 20% Inpatient Hospital Services then 30% then 20% Outpatient Services (Limits Apply) then 30% (Limits Apply) then 20% (Limits Apply) Pharmacy Benefits Preferred Generic Non-Preferred Generics Preferred Brand Non-Preferred Brand Specialty Mail Order Please note CVS pharmacies will be considered out-of-network with BCBS 3 X Retail $0 / $10 Copay** $10 / $20 Copay** $50 / $70 Copay** $100 / $120 Copay** $150 / $250 Copay** 3 X Copay $0 / $10 Copay** $10 / $20 Copay** $50 / $70 Copay** $100 / $120 Copay** $150 / $250 Copay** 3 X Copay *Out of Network Disclaimer: Please see benefit summary for out of network benefits **The lesser copay amount applies when using a pharmacy in the BCBS Preferred Pharmacy Network. Weekly Costs H.S.A. Plan Base Plan Buy Up Plan Employee Only $59.16 $88.80 $ Employee + Spouse $ $ $ Employee + Child(ren) $ $ $ Family $ $ $

Health Savings Account (HSA) If you are interested in opening an account and contributing funds through a payroll deduction, please contact Human Resources for further information.

You can set aside money in a Health Savings Account (HSA) before taxes to pay for eligible medical, dental and vision expenses. You are allowed to pay for eligible expenses with pre tax dollars.

There is NO use it or lose it policy, therefore providing incentive to save and grow your money! 3.

If you have any money remaining in your HSA after retirement, you may withdraw the money as cash (after age 65) with no penalty.

6 Health Savings Account (HSA) If you are interested in opening an account and contributing funds through a payroll deduction, please contact Human Resources for further information. There are several advantages of choosing to participate in the high-deductible health plan (HSA): 1.You can set aside money in a Health Savings Account (HSA) before taxes to pay for eligible medical, dental and vision expenses. You are allowed to pay for eligible expenses with pre tax dollars. Certain items such as cosmetic procedures are NOT eligible. 2.Unused money in an HSA account is NOT forfeited at the end of the year and is carried forward. There is NO use it or lose it policy, therefore providing incentive to save and grow your money! 3.The HSA account is yours to keep which means that you can take it with you if you change jobs or retire. If you have any money remaining in your HSA after retirement, you may withdraw the money as cash (after age 65) with no penalty. If you should choose not to participate in an HSA plan again next year, you can still use the funds in the account for qualified expenses. However, you are no longer eligible to put money in the account if you do not have a high deductible health plan that meets the IRS requirements, such as the HSA plan offered by your employer. 4.You can use the HSA funds for any immediate family member, even if they are not covered on your medical plan. However, if you have a spouse or dependents covered on a plan with copays they can NOT be enrolled as a dependent on the HSA plan. 5.Per IRS regulations, you are NOT eligible to contribute to an HSA pre-tax if you are currently enrolled in a traditional Flexible Spending Account (FSA) or if you are enrolled in Medicare part A or B, Tricare, or other coverage. HSA Limits for 2019: HSA Maximum Contribution Amount 2019 Individual $3,500 Family $7,000 Catch-Up Contributions (age 55 and older) $1,000 H.S.A. Bank Fees and Limits: Monthly Account Fee: $2.50 Daily Account Balance requirement to waive monthly fee: $5,000 Please visit for additional information. 6

7 Know Your Benefits H.S.A. Pros and Cons The health savings account (HSA) is a growing trend in health care, but is it right for you? An HSA is a cost-effective option for many individuals and families but it is not the best choice for everyone. The Differentiators Comparing HSAs to traditional health plans can be difficult, as each has pros and cons. For example, traditional health plans typically have a smaller deductible and fixed copays and/or coinsurance. You may pay less out-of-pocket due to the lower deductible and copay Benefits HSAs are designed to offer the user triple tax benefits - you put money in tax-free, it accrues interest tax-free and you can withdraw it tax-free (for qualified medical expenses). You can budget how much to contribute and unspent dollars are rolled over each year, making it a good retirement savings vehicle as well. In addition, you may choose to contribute to your HSA. Drawbacks It is tough to accurately budget for your yearly medical expenses, as illness is unpredictable. Also, finding accurate information about health care costs is sometimes difficult, reducing your ability to budget for expenses. If you do not budget enough for a given year, you may have significant, unexpected out-of-pocket costs, especially if you face a large medical expense. Also, because the HSA is such a valuable savings opportunity, some people forgo care they need to avoid spending money from the account. Rx Formulary Reminders Please note, CVS pharmacies are out-of-network with BCBS. This includes the pharmacies in Target stores. BCBS Preferred Pharmacies include: Walgreens Walmart Albertsons HEB Access Health. For a full list of BCBS Preferred Pharmacies, please visit: 7

Where to go for Care? Right care. Right place. Right Savings. With many options for getting care, how do you choose?

tablet, or computer. Visit a convenience care clinic when you can t see your doctor and your health issue isn't urgent. These clinics are often in stores.

Urgent care is ideal for when you need care quickly, but it is not an emergency (and your doctor isn t available). Urgent care centers treat issues that aren t life threatening.

8 Where to go for Care? Right care. Right place. Right Savings. With many options for getting care, how do you choose? This chart can help you Where to go What it is Type of Care Cost Virtual Visit Convenience Care Clinics Primary Care Physician Urgent Care A virtual visit lets you see a doctor via your smartphone, tablet, or computer. Visit a convenience care clinic when you can t see your doctor and your health issue isn't urgent. These clinics are often in stores. Go to a doctor s office when you need preventive or routine care. Your primary doctor can access your medical records, manage your medications and refer you to a specialist if needed. Urgent care is ideal for when you need care quickly, but it is not an emergency (and your doctor isn t available). Urgent care centers treat issues that aren t life threatening. Emergency Room The ER is for life-threatening or very serious conditions that require immediate care. This is also when to call 911. Allergies Bladder Infections Bronchitis Cough/colds Diarrhea Fever Pink eye Rashes Seasonal flu Sinus problems Sore throats Stomach aches Common infections (e.g. strep throat) Minor skin conditions (e.g. poison ivy) Vaccinations Pregnancy tests Minor injuries Ear aches Checkups Preventive Services Minor skin conditions Pregnancy tests Vaccinations General Health Management Sprains Strains Small cuts that may need a few stitches Heavy Bleeding Large open wounds Sudden change in vision Chest Pain Sudden weakness or trouble talking $ $$ $$ Minor burns Minor infections Minor broken bones $$$ Major burns Spinal Injuries Severe head injury Breathing difficulty Major broken bones $$$$ 8

9 Virtual Visits Getting sick is never convenient, and finding time to get to the doctor can be hard. Blue Cross and Blue Shield of Texas (BCBSTX) provides you and your covered dependents access to care for non-emergency medical issues and behavioral health needs through MDLIVE. Whether you re at home or traveling, access to a board certified doctor is available 24 hours a day, seven days a week. You can speak to a Doctor immediately or schedule an appointment based on your availability. Virtual visits can also be a better alternative than going to the emergency room or urgent care center. MDLIVE doctors or therapists can help treat the following conditions and more: General Health Pediatric Care Behavioral Health Allergies Asthma Nausea Sinus Infection Cold/Flu Ear Problems Pinkeye Anxiety/Depression Child behavior/learning issues Marriage problems Get connected today! To register, you ll need to provide your first and last name, date of birth, and BCBSTX member ID number 9

Benefits Resources www.goodrx.com Use GoodRx s drug price search to compare prices (just like you do for travel or electronics on other sites) for your prescription at pharmacies near you.

GoodRx will show you prices, coupons, discounts, and savings tips for your prescription at pharmacies near you. Download GoodRx s iphone or Android app to get drug prices and coupons on the go.

Health Plan Cost Estimator Have you ever wondered if a tool existed to help your employees choose the plan that is best for them?

The Health Plan Cost Estimator: Compares costs and benefits of plans Estimates out-of-pocket expenses that your employees might expect to pay for each health plan based on how often they anticipate

10 Benefits Resources Use GoodRx s drug price search to compare prices (just like you do for travel or electronics on other sites) for your prescription at pharmacies near you. GoodRx does not sell the medications, they tell you where you can get the best deal on them. GoodRx will show you prices, coupons, discounts, and savings tips for your prescription at pharmacies near you. Download GoodRx s iphone or Android app to get drug prices and coupons on the go. Please note if you use Good RX Coupon you will not be able to use your medical insurance to receive deductible/out of pocket credit. Health Plan Cost Estimator Have you ever wondered if a tool existed to help your employees choose the plan that is best for them? The Health Plan Cost Estimator, from Blue Cross and Blue Shield of Texas, is a tool to help your employees estimate their health care plan costs for a variety of health benefits. The Health Plan Cost Estimator: Compares costs and benefits of plans Estimates out-of-pocket expenses that your employees might expect to pay for each health plan based on how often they anticipate using health care throughout the year Helps determine flexible spending account (FSA) or health savings account (HSA) contributions and estimate tax savings Members can compare the cost summaries and savings from the different plans available to help them make the most informed decisions about which plan might be right for them. 10 More options. Informed choices. Cost Management. The Health Plan Cost Estimator displays the member s name, age and gender. It also defaults to an overall health classification of good health, which the user can change as needed. The user is able to anticipate medical expenses, health conditions, expected visits and medications. This allows for a more personalized display for the selected benefit period. The user can even add family members and estimate out-ofpocket costs for all plans that are available to the member.

11 Voluntary Dental Insurance Network Name: BlueCare Dental Network To find in an in-network provider, please visit: The BCBS dental plan allow you to seek treatment from the provider of your choice. However, you will get the benefit of network discounts and have lower out of pocket costs if you use the BlueCare Dental Network of dental providers. If you see an out-of-network dentist, you can be balance billed. Plan Features BCBS Dental Plan Dental Plan (DTNHR03) Dental Annual Max (Waived for Preventive) $1,500 per Member $50 Employee / $150 Family Preventive Covered 100% Basic Services (i.e. fillings, extractions) Major Services (i.e. crowns, dentures) Orthodontia Services Orthodontia Lifetime Maximum (Adult & Children) Out-of-Network Benefits 20% After 50% After 50% After $1,500 (per member) 90th Percentile *Please reference the BCBS Benefit Summary for detailed plan benefits. For any services estimated to cost over $200, it is recommended that your provider submit a predetermination of benefits to BCBS before the services are rendered. Summary of Employee Costs Weekly Costs Employee Only $9.01 Employee + Spouse $18.02 Employee + Child(ren) $23.46 Employee + Family $

12 Voluntary Vision Insurance To find an in-network provider, please visit: or call (800) The Humana vision plans allow you to seek treatment from the provider of your choice, however you will get the benefit of network discounts and have lower out of pocket costs if you use the EyeMed Network of vision providers. If you do see a provider who is out-ofnetwork, you will pay 100% for those services, then submit the receipt for reimbursement. Humana Vision Plan Plan Features In-Network Out-of-Network Exam $10 per Member Up to $39 Maximum Glass Lenses Single Bifocal Trifocal Lenticular $15 Copay Please Note - Upgrades such as no-line bifocals, transition lenses, etc. will be an additional cost Up to $25 Maximum Up to $40 Maximum Up to $60 Maximum Up to $100 Maximum Frames $130 Allowance and 20% off remaining balance $65 Maximum Contact Lenses $130 Allowance; 15% off remaining balance $104 Maximum Medically Necessary Lenses $15 Copay $210 Maximum Frequency (Based on date of service) Exam - once every 12 Months Lenses - once every 12 Months Frames - once every 24 Months You are eligible to purchase eyeglasses and contacts in the same plan year. Summary of Employee Costs Weekly Costs Employee Only $2.13 Employee + Spouse $4.25 Employee + Child(ren) $4.04 Employee + Family $

Life and AD&D Basic Life Insurance Republic Health Resources provides all full-time active employees with Group Life and Accidental Death (AD&D) policies through Humana.

13 Life and AD&D Basic Life Insurance Republic Health Resources provides all full-time active employees with Group Life and Accidental Death (AD&D) policies through Humana. The Life policy will provide $25,000 in Life and AD&D benefits. The AD&D policy will pay your beneficiary double the benefit, if you were to pass away as a result of an accident. Republic Health Resources pays the full cost of these benefits. Please use the TBX enrollment system if you need to update your beneficiary at any time. 13

14 Important Notices The following notices applies to all benefits eligible employees: Notice Regarding Availability of Health Insurance Marketplace Coverage Options (Employer Exchange Notice) Summary of Benefits and Coverage (SBC) and Uniform Glossary Notice of Special Enrollment Rights Women s Health and Cancer Rights Act (WHCRA) Notices Employer CHIP Notice HIPAA Notice of Privacy Practices for Protected Health Information General Notice of COBRA Rights Plan Document Summary Plan Description (SPD) This booklet is a summary of plan highlights only. Please consult the carrier s contract for full information on covered charges, limitations, and exclusions. This is not a binding contract. In the event of a discrepancy, the carrier s contract will prevail. If you have further questions, please contact your Human Resources representative or Gus Bates Insurance & Investments. 14

15 Contact Information Carrier Contact Information Medical Provider Name: Blue Cross Blue Shield Group #: Phone Number: (800) Website: Dental Provider Name: Blue Cross Blue Shield Phone Number: (800) Website: Vision Provider Name: Humana Group #: Phone Number: (866) Website: Basic Life and AD&D Provider Name: Humana Group #: Life and Voluntary Life Customer Service: (800) Website: Please refer to this list when you need to contact one of your benefit vendors. 15

16 GBC Contact Information Gus Bates Insurance & Investments 3221 Collinsworth Street Fort Worth, TX Phone: (817) Fax: (817) Benefits Consultant Justin Phipps (817) Account Manager Megan Lewis (817) Account Manager Olivia Cummings (817) Please refer to this list if you have any questions regarding your benefits. For general information, contact your Human Resources department Internal Service Support (Bilingual) Claudia Deleon (817) Claims Assistance April Harris (817)

Employee Benefits Enrollment Guide

Employee Benefits Enrollment Guide January 1, 2018 to December 31, 2018 Welcome to Open Enrollment for your employee benefits! Republic Health Resources offers you and your family members a comprehensive