Dear Valued Independent Contractor, At United Vision Logistics, we know you have a choice of carriers to work with. And we d like to make that choice easy for you by making available certain third-party service offerings that may be valuable to you and your family. For the first time ever, United Vision Logistics has teamed up with third-party benefit providers who can offer you a competitively priced, comprehensive suite of high-quality programs for you to pick and choose from as an Independent Contractor. I encourage you to take the time to review these options in this Enrollment Guide and learn more about the coverages available for you and your family. The program is administered by Complete Benefit Alliance, and they will take you through the steps to sign up for any of these offerings. We know you have a choice, and at United Vision Logistics, you re part of our family. Together we re driven to deliver. We re honored to have you as part of the UV Logistics team. Sincerely, John Patterson CEO United Vision Logistics United Vision Logistics, has arranged with third-party service providers to offer you, a valued eligible participant, a variety of voluntary service offerings. This guide provides an overview of these offerings to help you decide if any of the plans will meet your individual and family needs. Professional benefit counselors from Complete Benefit Alliance will conduct one on one enrollment sessions with each of our eligible participants to discuss the offerings available. Please take a moment to review this information, and keep this guide for ongoing reference throughout the year. If you decide to enroll in any of these third-party service offerings, you will have the convenience of a weekly settlement deduction from your compensation from United Vision Logistics. Enrollment is easy Just a phone call away In order to simplify your service offering, there is a telephone enrollment process that will be available throughout the year. To ensure that you have a complete understanding of these benefit offerings and to help you make the choices best suited to your needs, professional benefit counselors are available over the phone to walk you through the menu of choices available to you. After reviewing your options in this brochure, each eligible participant will need to call the Enrollment Call Center at 877-819-8517 to speak with an enrollment counselor, even if you do not wish to enroll in any of the options at this time. The enrollment counselor will then formally record those offerings you elect and/or any offerings you choose to waive. In order for you and your eligible dependents to be covered under the plans, you must call within the first 30 days of your start date. Table of Contents Medical Plan ACT Trust... 3 Dental... 4-5 Vision... 6 Interest-Sensitive Whole Life Insurance 08... 7 Accident Insurance... 8 Short Term Disability... 9-10 Resources... 11 2
MEDICAL MIDMED PLAN OFFERED BY: Preferred Health Alliance In Network (PPO) Covered Bronze Plan Gold Plan Schedule of Benefits Policy Year Deductible (Individual/Family) $250/$750 $500/$1,500 In-Patient Care Surgery-Inpatient, Physician Services 70% 80% Hospital Inpatient (Facility) 70% 80% Other Hospital Charges 70% 80% (including hospital based professional charges) Physician Services (Inpatient visits) 70% 80% Out-patient Care Categories Physician/Specialist Office Visit (co-pay does not apply to any other service rendered in the office) $20 Co-pay; then 100% $20 Co-pay; then 100% Other Office Services provided during Office Visit 70% - No Calendar 80% - No Calendar Year Deductible Year Deductible Urgent Care Facility 70% 80% Surgery, Outpatient 70% 80% Maternity Care (Insured Person and covered spouse only) 70% 80% Emergency Room (if not admitted inpatient) 1st $100; then 70% 1st $100; then 80% Cardiac, Occupational, Physical, Pulmonary, & Speech Therapies (subject to 20 visits/calendar year max per category) 70% 80% Transplant-Related Expenses 70% 80% Routine Physical Exams, including Well Child Care $15 Co-pay; then 100% $15 Co-pay; then 100% $100 Calendar Benefit $300 Calendar Benefit Other Services 70% 80% Calendar Year Plan Maximum $25,000 $50,000 Lifetime Maximum $100,000 $150,000 Prescription Drug Card (at participating pharmacies) Out-patient Generic Formulary Prescription Drugs (up to $2400/year or $200 month per person). Limited to 90 day supply; subject to $15 co-pay per 30 day supply. Brand RX is discount only. $15.00 Co-pay $15.00 Co-pay Calendar Year Deductible applies to every expense listed unless otherwise noted. Co-payments are not applied to the Calendar Year Deductible. Out of Network benefits are covered at 60% after the Calendar Year Deductible of $500 individual and $1500 family for the Bronze plan. Out of Network benefits are covered at 60% after the Calendar Year Deductible of $1000 individual and $3000 family for the Gold plan.\ Contact a benefit counselor to receive a quote on the medical plan offerings. All plans will renew on October 1st. An additional administrative fee of $2.50 per week will be deducted in the weekly settlement process when a medical plan option has been selected. 3
DENTAL PLAN 1 OFFERED BY: United Healthcare NETWORK NON-NETWORK Individual/Family Annual Calendar Year Deductible $50/ $150 $50/ $150 Annual Maximum $1000 per person per Calendar New enrollee s waiting period: 12 months Major Annual deductible applies to preventive and diagnostic services No COVERED SERVICES* NETWORK PLAN NON-NETWORK DIAGNOSTIC SERVICES PAYS** PLAN PAYS*** Periodic Oral Evaluation 100% 100% Radiographs 100% 100% Lab and Other Diagnostic Tests 100% 100% PREVENTIVE SERVICES Prophylaxis (Cleanings) 100% 100% Fluoride Treatment (Preventive) 100% 100% Sealants 100% 100% Space Maintainers 100% 100% BASIC SERVICES Restorations (Amalgam or Anterior Composite)* 80% 80% Emergency Treatment / General Services 80% 80% Simple Extractions 80% 80% MAJOR SERVICES Oral Surgery (includes surgical extractions) 50% 50% Periodontics 50% 50% Endodontics 50% 50% Inlays/Onlays/Crowns* 50% 50% Dentures and other Removable Prosthetics 50% 50% Fixed Partial Dentures (Bridges)* 50% 50% Weekly Rates: Independent Contractor - $7.17 Independent Contractor + Spouse - $14.35 Independent Contractor + Child(ren) - $14.86 Independent Contractor + Family - $23.05 * Your dental plan provides that where two or more professionally acceptable dental treatments for a dental condition exist, your plan bases reimbursement on the least costly treatment alternative. If you and your dentist agreed on a treatment which is more costly than the treatment on which the plan benefit is based, you will be responsible for the difference between the fee for service rendered and the fee covered by the plan. In addition, a pre-treatment estimate is recommended for any service estimated to cost over $500; please consult your dentist. **The network percentage of benefits is based on the discounted fees negotiated with the provider. ***The non-network percentage of benefits is based on the usual and customary fees in the geographic areas in which the expenses are incurred. 4
DENTAL PLAN 2 OFFERED BY: United Healthcare NETWORK NON-NETWORK Individual/Family Annual Calendar Year Deductible $50/ $150 $50/ $150 Annual Maximum $750 per person per Calendar New enrollee s waiting period: 12 months Major Annual deductible applies to preventive and diagnostic services No COVERED SERVICES* NETWORK PLAN NON-NETWORK DIAGNOSTIC SERVICES PAYS** PLAN PAYS*** Periodic Oral Evaluation 80% 80% Radiographs 80% 80% Lab and Other Diagnostic Tests 80% 80% PREVENTIVE SERVICES Prophylaxis (Cleanings) 80% 80% Fluoride Treatment (Preventive) 80% 80% Sealants 80% 80% Space Maintainers 80% 80% BASIC SERVICES Restorations (Amalgam or Anterior Composite)* 80% 80% Emergency Treatment / General Services 80% 80% Simple Extractions 80% 80% MAJOR SERVICES Oral Surgery (includes surgical extractions) 50% 50% Periodontics 50% 50% Endodontics 50% 50% Inlays/Onlays/Crowns* 50% 50% Dentures and other Removable Prosthetics 50% 50% Fixed Partial Dentures (Bridges)* 50% 50% Weekly Rates: Independent Contractor - $5.81 Independent Contractor + Spouse - $11.62 Independent Contractor + Child(ren) - $11.79 Independent Contractor + Family - $18.40 * Your dental plan provides that where two or more professionally acceptable dental treatments for a dental condition exist, your plan bases reimbursement on the least costly treatment alternative. If you and your dentist agreed on a treatment which is more costly than the treatment on which the plan benefit is based, you will be responsible for the difference between the fee for service rendered and the fee covered by the plan. In addition, a pre-treatment estimate is recommended for any service estimated to cost over $500; please consult your dentist. **The network percentage of benefits is based on the discounted fees negotiated with the provider. ***The non-network percentage of benefits is based on the usual and customary fees in the geographic areas in which the expenses are incurred. 5
OFFERED BY: United Healthcare Co-pays for in-network services Exam $20.00 Materials $20.00 Benefit frequency Comprehensive Exam Spectacle Lenses Frames Contact Lenses in Lieu of Eye Glasses Frame benefit Private Practice/Retail Chain Provider Once every 12 months Once every 12 months Once every 24 months Once every 12 months 6 VISION $130.00 retail frame allowance Lens options Standard scratch-resistant coating -- covered in full. Other optional lens upgrades may be offered at a discount. (Discount varies by provider.) Contact lens benefit Covered-in-full elective contact lenses The fitting/evaluation fees, contact lenses, and up to two follow-up visits are covered in full (after co-pay). If you choose disposable contacts, up to 6 boxes are included when obtained from a network provider. All other elective contact lenses A $150.00 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside the covered selection (materials co-pay does not apply). Toric, gas permeable and bifocal contact lenses are examples of contact lenses that are outside of our covered contacts. Necessary contact lenses 2 Covered in full after applicable co-pay. Out-of-network reimbursements up to (Co-pays do not apply) Exam $40.00 Frames $45.00 Single Vision Lenses $40.00 Bifocal Lenses $60.00 Trifocal Lenses $80.00 Lenticular Lenses $80.00 Elective Contacts in Lieu of Eye Glasses 2 $150.00 Necessary Contacts in Lieu of Eye Glasses 3 $210.00 Weekly Rates Independent Contractor $1.40 Independent Contractor + Spouse $2.59 Independent Contractor + Child(ren) $2.71 Independent Contractor + Family $4.06 1 The out-of-network reimbursement applies to materials only. The fitting/evaluation is not included. 2 Necessary contact lenses are determined at the provider s discretion for one or more of the following conditions: Following post cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions of anisometropia; with certain conditions of keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision confirming reimbursement that UnitedHealthcare Vision will make before you purchase such contacts.
OFFERED BY: UNUM Unum s whole life insurance is designed to provide a payment upon death to your beneficiaries but it can also build cash value you can use while you are living. This service offering offers an affordable, guaranteed level of premium that won t increase with age. Unlike term life insurance offered through the workplace, this coverage can continue into retirement. WHOLE LIFE INSURANCE ADVANTAGES OF THE PLAN Coverage is available to eligible Independent Contractors age 15 to 80 who are actively at work*. You can buy coverage for your spouse and dependent children. o This includes a children s term rider, which provides a policy to age 25 for your child. At age 25, your child has the option to purchase adult coverage without a medical exam. Guaranteed at a rate of 4%. The policy can build cash value, which you may be able to borrow from during your working years. Later in life, you can use this cash value to buy a smaller paid up policy with no more premiums due. You get affordable rates when you buy this policy through your employer. The premiums do not increase with age and are conveniently deducted from your paycheck. You own the policy so you can keep this coverage if you leave the company or retire. Unum will bill you directly for the same premium amount. Coverage becomes effective on the first day of the month in which payroll deductions begin. During enrollment, you can get this insurance up to a specified amount without taking a medical exam. You may be asked a few health questions. This policy includes a Living Benefit Option Rider. That means if you are diagnosed with a medical condition that limits life expectancy to 12 months or less you can request up to 100% of the service offering amount, to a maximum of $150,000. Your spouse and dependents have this option as well. Additional coverage options You have the option to select an Accidental Death Benefit Rider, which is available at initial enrollment to Independent Contractors and spouses ages 15 to 65. This rider pays an additional death service offering equal to the base policy amount (subject to a $150,000 maximum) if the policyholder dies before age 70 as the result of a covered accident. *Eligible Independent Contractors must be actively at work to apply for coverage. Being actively at work means on the day the Independent Contractor applies for coverage, the individual must be working at one of his/her company s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the Independent Contractor will be considered actively at work as of his/her last scheduled workday. Independent Contractors are not considered actively at work if they are on a leave of absence. This policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any service offerings payable. See the actual policy or your Unum representative for specific provisions and details of availability. Underwritten by: Provident Life and Accident Insurance Company, Chattanooga, Tennessee unum.com 2012 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Unum complies with state civil union and domestic partner laws when applicable. 7
OFFERED BY: UNUM Unum s accident insurance can provide a payment based on the injury you receive and the treatment you need, including emergency room care and related surgery. The payment can help offset the outof-pocket expenses that medical insurance does not pay, including deductibles and co-pays. ACCIDENT INSURANCE ADVANTAGES OF THE PLAN Coverage is available to eligible Independent Contractors age 17-80 (to age 64 in CA) who are actively at work*. You can buy coverage for your spouse and dependent children. No health questions to answer. If you apply, you automatically receive the base plan. Base plan is guaranteed renewable for life and covers a wide variety of injuries and accident-related expenses such as hospitalization, physical therapy, emergency room treatment, doctor office visits, fractures and dislocations, transportation, lodging and more. Service offerings are paid for accidents that occur on or off-the-job. You own the policy so you can keep this coverage if you leave the company or retire. Unum will bill you directly for the same premium amount. This plan includes convenient payroll deduction, so you don t have to remember to write a check for your premiums. Coverage becomes effective on the first day of the month in which payroll deductions begin. *Eligible Independent Contractors must be actively at work to apply for coverage. Being actively at work means on the day the Independent Contractor applies for coverage, the individual must be working at one of his/her company s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the Independent Contractor will be considered actively at work as of his/her last scheduled workday. Independent Contractors are not considered actively at work if they are on a leave of absence. This policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any service offerings payable. See the actual policy or your Unum representative for specific provisions and details of availability. THIS IS A LIMITED POLICY. Underwritten by: Provident Life and Accident Insurance Company Chattanooga, Tennessee unum.com 2012 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Unum complies with state civil union and domestic partner laws when applicable. 8
OFFERED BY: UNUM Unum s individual short term disability insurance replaces a portion of your income if you are unable to work due to a covered injury or illness. This coverage can pay a monthly service offering to provide some income during a time of need. Common reasons people use this coverage include injuries, a covered pregnancy, and digestive problems such as gall bladder surgery. INDIVIDUAL SHORT TERM DISABILITY INSURANCE ADVANTAGES OF THE PLAN Coverage is available to eligible Independent Contractors age 17-69 (to age 64 in CA) who are actively at work*. Choose a monthly service offering between $400 and $5,000 for covered disabilities due to injury or illness. Coverage of up to 60% of your gross monthly salary may be offered (coverage in CA is limited to 40%). The affordable premium is based on your age when you buy the insurance and will not increase as you get older +. Your policy is guaranteed renewable, until age 72, as long as you pay the premiums on time. Your plan includes a Waiver of Premium, included at no extra charge for covered injuries and illnesses. This means you don t have to pay your premiums after 90 days of total disability or the elimination period (whichever is longer). They ll be waived as long as the disability continues, up to the maximum service offering period. You own the policy so you can keep this coverage if you leave the company or retire. Unum will bill you directly for the same premium amount. This plan includes convenient payroll deduction, so you don t have to remember to write a check for your premiums. Coverage becomes effective on the first day of the month in which payroll deductions begin. + Premiums can be changed only if we change them on all policies of this kind in force in the state in which the policy is issued. *Eligible Independent Contractors must be actively at work to apply for coverage. Being actively at work means on the day the Independent Contractor applies for coverage, the individual must be working at one of his/her company s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the Independent Contractor will be considered actively at work as of his/her last scheduled workday. Independent Contractors are not considered actively at work if they are on a leave of absence. This policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any service offerings payable. See the actual policy or your Unum representative for specific provisions and details of availability. 9
OFFERED BY: UNUM Policy provisions Pre-existing condition limitation if you have a preexisting condition** within a 12-month period before your coverage effective date, service offerings will not be paid for a disability period if it begins during the first 12 months the policy is in-force. **A pre-existing condition is a condition for which symptoms existed (within 12 months before your coverage effective date) that would cause a person to seek treatment from a physician or for which a person was treated or received medical advice from a physician, or took prescribed medicine. The determination on whether your condition qualifies as pre-existing will be based on the date of disability and not the date you notify Unum. INDIVIDUAL SHORT TERM DISABILITY INSURANCE Pregnancy Nine months after coverage becomes effective, pregnancy is considered the same as any other covered illness. The available monthly service offerings will be paid upon fulfillment of the elimination period. Service offerings will not be paid if the insured individual gives birth within nine months after the coverage becomes effective. However, medical complications of pregnancy may be considered as any other covered illness, subject to the pre-existing condition limitation. Six-month period in TX (for applicants age 65+) Nine-month giving birth exclusion is not applicable in OK Underwritten by: Provident Life and Accident Insurance Company Chattanooga, Tennessee unum.com 2012 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Unum complies with state civil union and domestic partner laws when applicable. CU-9576 10
IMPORTANT CONTACT INFORMATION 11