Fiesta Companies. Employee Benefits Guide for Plan Year: July 1, June 30, 2018

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Fiesta Companies Employee Benefits Guide for Plan Year: July 1, 2017 - June 30, 2018 Fiesta Companies takes great pride in offering an excellent selection of benefits to all full-time employees.

1 Fiesta Companies Employee Benefits Guide for Plan Year: July 1, June 30, 2018 Fiesta Companies takes great pride in offering an excellent selection of benefits to all full-time employees. This guide provides quick access to information about your employee benefit program, which is an important part of your total compensation package. Please take a few moments to familiarize yourself with the benefit programs available to you as part of the Fiesta Companies family.

2 What s Inside Eligibility & Enrollment Guidelines 3 Payroll Deduction Options 3 Medical Plans 4 Telemedicine 5 Dental Plans 6 Vision Plans 7 Basic Term Life and AD&D 8 Voluntary Term Life 8 Common Terms 9 Contacts 10 Benefit Contacts 11 DISCLAIMER: The information provided in this booklet is for summary purposes only, and is not a comprehensive explanation of benefits or legal document. Please refer to the full Summary Plan Description provided by the insurance companies. In the event of a discrepancy between the Summary Plan Description and this document, the carriers Summary Plan Description will prevail. The benefits illustrated in this book are in-network* benefits. Check your individual plan for out-of-network* benefits. If you use an out-of-network provider you may be balanced billed* for any charges that are greater than the allowable amount* defined by your network. *see Common Terms section iaconsulting, a Marsh & McLennan Agency All Rights Reserved.

3 Eligibility & Enrollment Guidelines Employees are eligible on the First day of the month following 30 days. If coverage is declined during initial eligibility, the employee must wait to enroll during the next Open Enrollment, unless there is a qualifying event. Open enrollment takes place in June and it is the one opportunity during the year to make changes to benefit elections. Qualifying events allow an employee to make coverage election changes within 30 days of the event. These include: Marriage Birth or adoption of a child Divorce Loss of a dependent Court Order Loss of other coverage Significant change in employee s or spouse s employment status The benefit elections you make during open enrollment will be effective July 1, June 30, Payroll Deduction Options Fiesta Companies has a Section 125 Cafeteria Plan. Participation allows you to pay for health, dental and vision premiums on a pre-tax basis. Employees enrolled in these benefit plans are automatically enrolled in the Cafeteria plan. Employees can opt out in writing to Human Resources prior to the start of coverage each plan year. 3

4 Medical Plans Your medical plans are administered by FirstCare. Copays Prescription Drugs FirstCare HMO PPO Primary Care Physician $35 $35 Policy Year Deductible Out of Pocket Limit (Includes Deductible) Member Coinsurance Specialist $55 $55 Urgent Care $50 $50 Tier 1 $5 $5 Tier 2 $20 $20 Tier 3 $55 $55 Tier 4 $100 $100 Tier 5 20% 20% Individual $2,500 $2,500 Family $5,000 $5,000 Individual $6,000 $6,000 Family $12,000 $12,000 Preventive Care Covered at 100% Covered at 100% Lab and X-ray Covered at 100% Covered at 100% Diagnostic Imaging (MRI, Pet Scans, CT Scans, etc.) $250 per test after deductible $250 per test after deductible Hospital Services 30% after deductible 30% after deductible Emergency Services $400 after deductible $400 after deductible Weekly Employee Contributions beginning 07/01/2017 Employee Only $0.00 $63.74 Employee + Child/ren $84.55 $ Employee + Spouse $ $ Employee + Family $ $

5 Telemedicine Fiesta Companies offers Teladoc services to all employees enrolled in the medical plan. Teladoc gives you access to a doctor through the convenience of phone 24 hours a day, 7 days a week, 365 days a year, at no cost to you! Talk to a doctor ANYTIME, ANYWHERE you happen to be for treatment of many NON-EMERGENCY medical conditions, including: Cold & flu symptoms Allergies Bronchitis Skin problems Sinus problems Respiratory infection And more! Save time spent waiting, and save your office visit copay! Set Up Your Account at 5

6 Dental Plans Your dental plans are administered by Ameritas. AMERITAS Benefit Level 1 DENTAL PLAN 100% of the first $200 for preventive procedures Benefit Level 2 0% of next $200 Benefit Level 3 Annual Maximum Benefit Allowance Orthodontia - Adults & Children Annual Maximum Benefit 85% of remaining eligible expenses $1,000 per covered person 90% U&C 50% up to $1,000 Lifetime Maximum $1,000 per covered person Weekly Employee Contributions beginning 07/01/2017 Employee Only $6.99 Employee + Child/ren $21.90 Employee + Spouse $13.96 Employee + Family $

7 Vision Plans Your vision plans are administered by Ameritas. AMERITAS USING THE VSP NETWORK Annual deductibles Eye Exam $10 Materials $25 Lenses Single Vision Covered in full Bifocal Covered at 100% Trifocal Covered at 100% Lenticular Covered at 100% Frames Up to $120 Contact Lenses (in lieu of Glasses) Exam and fitting 15% discount Elective Up to $120 Frequencies Exams Once every 12 months Lenses Once every 12 months Frames Once every 24 months Weekly Employee Contributions beginning 07/01/2017 Employee Only $2.39 Employee + Child/ren $4.17 Employee + Spouse $5.16 Employee + Family $6.94 7

8 Basic Term Life and AD&D Your Basic Term Life and Accidental Death & Dismemberment coverage is through Liberty Mutual. All Active Full-Time Employees are Eligible for the following benefits: LIBERTY MUTUAL AMOUNT Life Benefit $10,000 AD&D Benefit $10,000 Accelerated Death Benefit Age Reduction Schedule: 75% of benefit amount 70 50% Voluntary Term Life Your Term Life Insurance coverage is through Liberty Mutual. All active Full-Time Employees are Eligible for the following benefits Please be sure you have a current beneficiary form on file! LIBERTY MUTUAL EMPLOYEE SPOUSE* CHILD/REN Benefit Amount $10,000 - $500,000 $10,000 - $500,000 $2,500 - $10,000 Increments $10,000 $10,000 $2,500 Guarantee Issue $100,000** $25,000** $10,000** *Spouse benefit not to exceed 50% of employee s coverage **At initial eligibility, employees under age 60 Age Reduction Schedule: 70 50% 8

9 Short & Long Term Disability Your Short and Long Term Disability coverage is through Liberty Mutual. Fiesta Motors proudly offers you Long Term Disability Coverage at no cost to you! All Active Full-Time Employees are Eligible for the following benefits: Liberty Mutual Voluntary Short Term Disability Employee Benefit Amount 60% of Weekly Earnings Weekly Maximum Benefit $1,000 Elimination Period 14 Days Injury or Illness Benefit Duration 13 weeks Pre-Ex Limitation 3 month/12 month Employer Paid Long Term Disability Employee Benefit Amount 60% of Monthly Earnings Monthly Maximum Benefit $8,000 Elimination Period 90 days Benefit Duration SSNRA Pre-Ex Limitation 3 month/12 month 9

10 401(k) Plan Fiesta Companies is pleased to offer all employees the opportunity to participate in a retirement/401k plan. Employees that have attained the age of 19, and Employees, whether full or part time, who have been with the company at least 6 months are eligible to participate in the 401(k) Plan. All contributions are immediately 100% vested! Contributions Employees will be automatically enrolled in a pre-tax plan at 4% contribution after 6 months continuous employees unless: The employee elects to contribute at a different level. The employee opts-out of the program entirely. Fiesta Companies will match 100% of your contribution up to 4% of your compensation. Changes in your contribution level can be made at the beginning of each quarter. Account Types Pre-tax: taxes are not paid upon investment; taxes are paid upon withdrawal. Roth: taxes are paid upon investment; no taxes paid upon withdrawal. You may choose the standard allocation of investment categories, or chose the types of investments on your own. Withdrawal Options while still Employed: Hardship withdrawal: must provide proof meeting specific criteria, minimum $500, only one per year, results in automatic suspension of contributions for six months Loans: up to 50% of amount vested, minimum of $1,000, fees and interest apply; only one loan at a time Upon age 59.5 Withdrawal Options when no Longer Employed: Termination (voluntary or involuntary) Death, disability (by SSA), or normal retirement age

com 1-806-765-7264 866-765-7264 (toll free)

11 Contacts Fiesta Companies Carol Kent, Compliance & HR Director (806) iaconsulting, a Marsh & McLennan Agency Julie Lawson, Senior Account Manager jlawson@iabenefits.com (toll free) Carrier Contacts MEDICAL BENEFITS FirstCare firstcare.com DENTAL BENEFITS Ameritas ameritas.com VISION BENEFITS Ameritas vsp.com Network: VSP Signature LIFE BENEFITS Liberty Mutual libertymutual.com 401(k) BENEFITS John Hancock Jhgoenroll.com Contract Number: Enrollment Number:

12 Fiesta Companies th Street Lubbock, TX (806)

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