Employee Benefits Guide Effective January 1, 2018
Your 2018 Benefits at a Glance The list below is a quick reference for you. As always, this is a good time of the year to review all your choices and make any appropriate changes. Benefit Please read this document carefully. It provides important information about your benefits. If you have questions about the benefits offered or the enrollment process, contact kramsay@dickinsonfleet.com or ahammond@dickinsonfleet.com. Automatically Receive at No Cost 2018 Benefit Election Required Get More Details Medical and Prescription Drug X Pages 3 & 4 Dental X Page 5 Vision X Page 6 Flexible Spending Account: Medical and Dependent Care X Page 7 Basic Life and AD&D Insurance X Page 8 Voluntary Life and AD&D Insurance X Page 8 Long-Term Disability X Page 8 Short-Term Disability X Page 8 401(k) Plan, Gap Plan X Page 9
Your Benefit Plans Dickinson Fleet Services is committed to providing a first-class benefits program for its employees. We will make every effort to provide choices to meet the diverse needs of you and your families. Some benefits are fully paid by Dickinson Fleet Services, some are shared between Dickinson Fleet Services and you, and some are fully paid by you. This will help you create the best benefits program for your family and lifestyle. Benefit Basics Most benefits become effective on the first of the month following 60 days. You must enroll within 30 days of the end of your waiting period, or you will be considered a late enrollee, and will have to wait until the next open enrollment period. Employees may make coverage changes during the annual open enrollment period. Eligibility All full-time employees of Dickinson Fleet Services who consistently work 30 hours per week are eligible to elect and participate in the benefits described in this guide. Each eligible employee may cover their dependents including legal spouse, and children up to age 26 (medical, dental, vision), to age 19 for non-students and age 23 for full-time students (Voluntary Life). Life Events Once you elect your Dickinson Fleet Services benefit options, your elections remain in effect for the plan year. You may also change coverage due to a qualified life event and must do so within 30 days of the event. These include: Change in status: marital, number of dependents, employment, dependent satisfies or ceases to satisfy eligibility Dependent s employer s open enrollment Significant cost or coverage changes HIPAA special enrollment rights FMLA special requirements Changes due to a judgment, decree or court order Entitlement to Medicare or Medicaid Choose the RIGHT Medical Plan Option for YOU Dickinson Fleet Services offers three medical plan options. Silver Plan $2,500 Deductible $10,000 Out of Pocket Gold Plan $2,500 Deductible $7,350 Out of Pocket 1 2 3 Platinum Plan $1,500 Deductible $3,000 Out of Pocket How to enroll for benefits: Go to dickinsonfleet.com Click Careers Click the Forms drop down Click Benefit Forms Follow the additional instructions provided To find a network medical provider, go to umr.com. Click Find a Provider Search for UnitedHealthcare Choice Plus Network Click Search for a Medical Provider or View Directory of Behavioral Health Providers for mental health providers Enter your search criteria and follow any additional instructions 3
Dickinson Fleet Services Medical Plan Options This chart shows the medical plan option details when using in-network providers. The deductible, coinsurance and out-of-pocket maximums are higher if you use out-of-network providers. Benefits Silver Plan Gold Plan Platinum Plan Preventive Services You pay 0% You pay 0% You pay 0% Annual Deductible (Single / Family) The amount you pay each year before the Plan pays benefits for non-copay expenses) Office Visit Copay Primary Care and Specialist Coinsurance The amount you pay after you meet the deductible $2,500 / $7,500 $2,500 / $7,500 $1,500 / $3,000 $30 $25 $20 30% after deductible 30% after deductible 30% after deductible Emergency Room You pay 30% after meeting the deductible You pay 30% after meeting the deductible You pay 30% after meeting the deductible Out-of-Pocket Maximum (Single / Family) The most you will pay for covered expenses is $10,000 / $20,000 The most you will pay for covered expenses is $7,350 / $14,700 The most you will pay for covered expenses is $3,000 / $6,750 Prescription Drugs RETAIL (30-day supply) Tier 1 $10 $10 $10 Tier 2 $25 $25 $25 Tier 3 $50 $50 $50 MAIL (90-day supply) Tier 1 $30 $30 $30 Tier 2 $70 $70 $70 Tier 3 $125 $125 $125 Coverage Level Silver Plan Gold Plan Platinum Plan Employee Only $0.00 $0.00 $19.62 $39.23 $61.15 $122.31 Employee & Spouse Employee & Child(ren) $91.70 $183.40 $111.64 $223.27 $132.37 $264.74 $76.10 $152.19 $92.64 $185.28 $109.84 $219.69 Family $128.08 $256.15 $155.77 $311.54 $184.62 $369.23 4
Don t Forget About Your Teeth... Good oral health is very important to your overall health. We encourage you to get regular checkups with your dental care provider. On this plan, charges for preventive and diagnostic services in network do not have deductibles applied. Benefit Highlights Type of Service Deductible (Waived for Preventive Care) Annual Maximum Benefit % Preventive Routine Cleanings, Oral Exams, X-Rays Basic Fillings, Endodontic, Periodontic Services Major Crowns, Bridges, Dentures Orthodontia ($1,000 lifetime maximum) Benefit $50 (3 per family limit) calendar year $1,000 per person per year 100% 90% 60% 50% Premiums for Dental Coverage The premiums for the dental coverage are paid by the employee through convenient pre-tax payroll deductions. The premiums are identified below: Coverage Category Employee Only $4.43 $8.86 Employee & Spouse $13.07 $26.14 Employee & Child(ren) $14.92 $29.85 Family $20.31 $40.62 5
... and Your Eyes... Type of Service Insight Network Member Cost Non-Network Allowance EXAM (1 every 12 months) $10 copay Up to $52 EYEGLASSES Frames (1 every 24 months) $0 copay; up to $130 Up to $57 Lenses (1 set every 12 months) Single Vision Lined Bifocal Lined Trifocal Lenticular Lenses $25 copay $25 copay $25 copay $25 copay Up to $55 Up to $75 Up to $95 Up to $125 CONTACT LENSES Elective $0 copay; allowance up to $130 Up to $105 For a complete list of providers, go to www.vsp.com and choose the Signature network or call 1-800-877-7195. You can also access a list of providers through the Sunlife website at: http://sunlife-usa.com/planmembers/ Premiums for Vision Coverage Coverage Category Employee Only $2.11 $4.21 Employee & Spouse $3.54 $7.09 Employee & Child(ren) $3.62 $7.24 Family $5.83 $11.67 6
Lower your taxes it s EASY! You can put money into these accounts directly from your paycheck BEFORE taxes are calculated. That way, you pay less in taxes, and have money set aside to pay for medical expenses and dependent care. Who administers this account for me? Ameriflex Dependent Care Account (FSA) Ameriflex Medical Reimbursement Account (FSA) What would I use this account for? What is the maximum amount that I can put in this account in 2018? Eligible dependent care expenses for children under age 14, as well as necessary adult care $5,000 $2,650 Any eligible health care expense How do I put money into the account? Through convenient pre-tax payroll deductions Through convenient pre-tax payroll deductions How do I get money out of the account? Can I change my deposit amount during the year? When are the funds available? What happens if I don t use the money during the year? You can use a debit card for approved expenses or you can file a paper claim You may only change the amount during open enrollment and if you experience a Life Event Your contribution amount is available as it comes out of your paycheck each pay period Unused funds will be forfeited at the end of the plan year. No funds rollover to the next plan year. This is Use-it-or-Lose-it. You can use a debit card for approved expenses or you can file a paper claim You may only change the amount during open enrollment and if you experience a Life Event Your entire contribution amount is available at the beginning of the year Unused funds will be forfeited at the end of the plan year. No funds rollover to the next plan year. This is Use-it-or-Lose-it. Other Considerations Participation in this will affect your eligibility for the Dependent Care Tax Credit. Carefully consider what your medical, dental, and vision out of pocket expenses may be for the year, due to Use-it-or-Loseit 7
Would Your Family Be Okay? Life & Accidental Death & Dismemberment (AD&D) Insurance Life insurance is an important part of your financial security, especially if others depend on you for support. Even if you are single, your beneficiary can use your life insurance to pay off your debts like credit cards, mortgages, and other final expenses. AD&D insurance is designed to provide a benefit in the event of an accidental death or dismemberment. Dickinson Fleet Services Life & Accidental Death and Dismemberment plans are insured by Sunlife. Life and AD&D Insurance is provided to all eligible employees at no cost to you. Employee Class All Full Time Employees Benefit 1 x your annual earnings to a maximum of $200,000 Disability Insurance Chances are you do not see yourself as becoming disabled when you think about your life five or ten years from now. Surprisingly, a number of people across the country find themselves hurt or sick and unable to work each year due to a non-work related illness or injury. That is why Dickinson Fleet Services provides Short-Term (STD) and Long-Term Disability (LTD) Insurance benefits through Sunlife. Short-Term Disability Benefit Highlights Provided at no cost to you - enrollment is automatic Benefits begin on the first day of disability due to an accident and on the 8 th day if due to an illness, for up to 26 weeks Benefit is 70% of pre-disability earnings to a maximum of $325 per week for Hourly employees and $500 per week for Salaried employees. Long-Term Disability Benefit Highlights Hourly Enrollment is voluntary. Salaried Enrollment is required. Cost is based on your age and wages Benefits begin after 180 days of disability. Benefit is 60% of pre-disability earnings to a maximum of $5,000 per month. Benefit period is 24 months for own occupation and to social security normal retirement age for any occupation. Voluntary Life Insurance and Accidental Death & Dismemberment (AD&D) Insurance Dickinson Fleet Services employees will have the option of purchasing additional term life insurance and AD&D insurance through the convenience of payroll deductions. Sunlife is the insurer for this program. Coverage is available for employees, spouses, and dependent children of employees. If you purchase Voluntary Life Insurance, you also have the option of purchasing AD&D Insurance for yourself and your spouse. Monthly premiums can be found online at dickinsonfleet.com. Employees Increments of $10,000 to $300,000 - not to exceed 6 x annual earnings $130,000 Guarantee Issue Spouses Increments of $5,000 to $150,000 not to exceed 100% of the Employee Voluntary Life benefit $40,000 Guarantee Issue Must elect Employee Voluntary Life Child(ren) - $10,000 (no AD&D available) Must elect Employee Voluntary Life 8
Saving for Later Dickinson Fleet Services offers a 401(k) retirement plan through Principal. The 401(k) retirement plan allows you to contribute tax deferred money or after-tax money into a retirement account. Employees are eligible to make elective deferrals as of the first of the month following 90 days of employment. We encourage you to participate in the retirement plan. You will be automatically enrolled at the 3% contribution level if a form waiving enrollment is not received by HR. Easy Online Enrollment When you are going through your enrollment process at dickinsonfleet.com, you will be given the chance to enroll in the 401(k) and to choose your investment options. You will be able to choose a Target Date Fund, wherein you choose an investment package based on your age and when you want to retire, or you may select your own combination of investment options from a wide variety of funds. For more information about investment options, 529 Plans for college, and tips to fight financial stress, please visit www.principal.com. GAP Insurance Do you want extra coverage to help pay for your medical plan deductible, coinsurance, and copays? Maybe the GAP plan is for you. The Gap plan provides payments that can be used to help pay for your deductible, coinsurance, and copay expenses under the Dickinson Fleet Services medical plan in which you are enrolled. It pays up to $2,500 for Inpatient care and up to $1,250 for Outpatient care, per person, per year (up to a maximum per year of two times that amount). Coverage Category EE age 18-39 EE age 40-49 EE age 50+ Employee Only $7.59 $15.18 $10.32 $20.64 $17.22 $34.45 Employee & Spouse $13.68 $27.36 $18.58 $37.16 $31.00 $62.00 Employee & Child(ren) $16.80 $33.60 $19.02 $38.03 $27.91 $55.82 Family $22.87 $45.74 $27.27 $54.54 $41.67 $83.35 9
Important Information If you have questions about any of the benefits offered or the enrollment process, please contact Human Resources. MEDICAL UMR Policy Number: 7670-00-411417 Member Services: (800) 826-9781 Website: www.umr.com Member Portal: www.myumrhealth.com DENTAL UMR Policy Number: 7670-02-411417 Member Services: (800) 826-9781 Website: www.umr.com Member Portal: www.myumrhealth.com VISION VSP Policy Number: 5487297 Member Services: (800) 877-7195 Website: www.vsp.com LIFE and AD&D/VOLUNTARY LIFE/VOLUNTARY AD&D/LTD/STD Sunlife Policy Numbers: 247444-001, 247444-002, 247444-003, 247444-004 Member Services: (800) 247-6875 Website: www.sunlife.com Member portal: http://sunlife-usa.com/planmembers/ FLEXIBLE SPENDING ACCOUNTS Ameriflex Member Services: (888) 868-FLEX (3539) Member Portal: www.myameriflex.com 401(k) RETIREMENT PLAN Principal Member Services: (800) 986-3343 Website: www.principal.com GAP Assurant Member Services: (800) 451-4531 DICKINSON FLEET SERVICES Kathy Ramsay (317) 333-8503 kramsay@dickinsonfleetservices.com Alyce Hammond (317) 333-8566 ahammond@dickinsonfleetservices.com SHEPHERD INSURANCE, LLC DeAnn Deck (317) 573-3029 ddeck@shepherdins.com 10