Allied Oilfield Machine & Pump, LLC Employee Benefits Guide Updated January 1, 2017 Allied Oilfield 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 Allied Oilfield family.
What s Inside Eligibility & Enrollment Guidelines 3 Payroll Deduction Options 3 Medical Plans 4 Plan Features 5 Dental Plans 6 Vision Plans 7 Basic Term Life and AD&D 8 Voluntary Term Life 8 Simple Individual Retirement Account 9 www.myalliedbenefits.com 9 Common Terms 10 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
Eligibility & Enrollment Guidelines Employees are eligible on the first day of the month following 60 days of continuous full time employment. If coverage is declined during initial eligibility, the employee must wait to enroll during the next Open Enrollment, unless there is a qualifying event. The medical plan open enrollment takes place in September, and the Dental, Vision, and Life open enrollment takes place in December. These are your opportunities 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 Payroll Deduction Options Allied Oilfield 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. The Plans below are in effect from October 1, 2016 to September 30, 2017. Copays FIRSTCARE HMO (HL-5) PPO (EL-3) Primary Care Physician $25 $25 Prescription Drugs Policy Year Deductible 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 $1,500 $1,500 Out of Pocket Limit (Includes Deductible) Member Coinsurance Family $3,000 $3,000 Individual $4,500 $4,500 Family $9,000 $9,000 Preventive Care Covered at 100% Covered at 100% Routine Lab and X-ray Covered at 100% Covered at 100% Diagnostic Imaging (MRI, Pet Scans, CT Scans, etc.) Hospital Services Emergency Services $250 copay per test, after deductible 20% coinsurance, after deductible $400 copay per visit, after deductible Bi-weekly Employee Contributions beginning 10/01/2016 $250 copay per test, after deductible 20% coinsurance, after deductible $400 copay per visit, after deductible Employee Only $36.92 $105.33 Employee + Children $192.97 $316.10 Employee + Spouse $231.98 $368.79 Employee + Family $407.54 $605.91 The illustration shows in-network benefits only. The HMO plan offers NO out of network benefits. See carrier documents for more plan information.
HMO Plan Plan Features The HMO Plan offers healthcare services through a specific local-centric network of providers. To enroll in the HMO plan you must reside AND work within FirstCare s service area. The HMO plan has NO Out-of-Network Benefits. To access plan benefits you MUST see an In-Network provider. To find In-Network providers go to www.firstcare.com, click on Find a Provider, enter your location, then look up a specific provider name or search by type of care. Call FirstCare at 800-884-4901 for assistance. PPO Plan Features The PPO plan provides In-Network and Out-of-Network benefits. Always try to use In-Network providers to obtain the highest benefit level. If you are seeking care within the service area, find in-network providers at www.firstcare.com, click on Find a Provider, enter your location, then look up a specific provider name or search by type of care. If you are seeking care outside the service area, find In-Network providers at www.multiplan.com, click on Search for a Doctor or Facility, select on Back of Card section the MultiPlan Complementary logo, then select provider type and continue the prompts. You can also call FirstCare at 800-240-3270 for help finding in-network providers. 5
Dental Plans Your dental plans are administered by MetLife. The plans below are in effect from January 1, 2017 to December 31, 2017. Copays METLIFE BASE PLAN BUY UP PLAN Calendar Year Deductible Individual $25 Family $75 Individual $50 Family $150 Preventive Care (i.e. cleanings) 100%, Deductible waived 100%, Deductible waived Basic Care (e.g. fillings) 80%, After deductible 80%, After deductible Major Care (e.g. crowns, dentures) Not covered 50%, After deductible Annual Maximum Benefit $1,000 per covered person $1,500 per covered person Orthodontia (children and adults) Orthodontia Lifetime Benefit Not covered N/A Bi-weekly Dental Payroll Deductions beginning 01/01/2017 Employee Only $0.00 $5.75 50%, After deductible $1,500 per covered person Employee + Child/ren $10.24 $24.02 Employee + Spouse $6.58 $19.16 Employee + Family $18.72 $40.82 Dental Plan Highlights Receive two routine cleanings/year at no cost when visiting network providers. Find in-network dentists at www.metlife.com (select PDP Plus Network). You may choose any dentist. However, if you elect to see and out-of-network provider, you may be balance billed for anything over the usual and customary amount allowed by MetLife. 6
Vision Plans Your vision plans are administered by MetLife/VSP. The plan below is in effect from January 1, 2017 to December 31, 2017. METLIFE VISION BENEFITS Annual deductibles Eye Exam $10 Materials $25 Lenses Single Vision Covered at 100% Bifocal Covered at 100% Trifocal Covered at 100% Lenticular Covered at 100% Frames Frames Up to $130 Contact Lenses (in lieu of Glasses) Exam and fitting Up to $60 copay Contacts Up to $150 Frequencies Exams Once every 12 months Lenses Once every 12 months Frames Once every 24 months Contacts Once every 12 months Bi-weekly Vision Payroll Deductions beginning 01/01/2016 Employee Only $3.46 Employee + Child/ren $5.87 Employee + Spouse $6.94 Employee + Family $9.68 Vision Plan Highlights Locate an in-network vision provider at www.vsp.com or call 1-800-877-7195. If you use an out-of-network provider the benefits will be reduced and you will be required to submit a reimbursement to MetLife along with the receipt for your related expenses. MetLife/VSP offers an average discount of 15% for laser vision correction. 7
Basic Term Life and AD&D Your employer paid Basic Term Life and Accidental Death & Dismemberment coverage is through OneAmerica. All full time employees enrolled in the medical plans are Eligible for the following benefits: ONEAMERICA AMOUNT Life Benefit $15,000 AD&D Benefit $15,000 Accelerated Death Benefit Age Reduction Schedule: 25%, 50% or 70% as defined in Certificate 65 65% of Benefit Amount 70 50% of Benefit Amount Voluntary Term Life Your optional Term Life Insurance coverage is through OneAmerica. Rates are based on age and coverage amount. All full time employees enrolled in the medical plan are eligible for the following benefits: Please be sure you have a current beneficiary form on file! ONEAMERICA Employee Benefit Spouse Benefit AMOUNT In $1,000 increments, a minimum of $10,000 up to a maximum of $500,000, or 5x the Employee s Annual Basic Salary then rounded up to the next $10,000, whichever is less. In $500 increments, a minimum of $5,000 up to a maximum of $150,000 limited to 50% of employee s coverage amount. GUARANTEE ISSUE* $100,000* $25,000* Child Benefit $5,000 or $10,000 $10,000* 8 *Guarantee issue amounts are only available at initial eligibility
Simple Individual Retirement Account Allied Oilfield makes available to employees a Simple Individual Retirement Account (IRA) This is an employer sponsored plan that allows employees to set aside money and invest it to grow for retirement. Please contact Human Resources for enrollment information and questions. www.myalliedbenefits.com Visit your website to access your benefit information and relevant documents such as: Benefit Summaries Plan Documents Claim Forms Contact Information 9
Common Terms Allowed Amount: Maximum amount on which payment is based for covered health care services. This may be called eligible expense, payment allowance or negotiated rate. If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing) Annual Maximum Benefit: A cap on the benefits your insurance company will pay in a year while you re enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations. After an annual limit is reached, you must pay all associated health care costs for the rest of the year. Balance Billing: When a provider bills you for the difference between the provider s charge and the allowed amount. For example, if the provider s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Coinsurance: The percentage of costs of a covered health care service you pay (20%, for example) after you ve paid your deductible. Copayment (copay): A fixed amount ($20, for example) you pay for a covered health care service after you ve paid your deductible. Copays can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest. Guarantee Issue: A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn t limit how much you can be charged if you enroll. In-Network: Health care providers who contract with your health insurance or plan. In-network coinsurance and copayments usually cost you less than out-of-network providers Out-of-Network: Health care providers who don t contract with your health insurance or plan. Out-of-network coinsurance and copayments usually costs you more than innetwork coinsurance. Out of Pocket Max: The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn t include your monthly premiums. It also doesn t include anything you may spend for services your plan doesn t cover. Outof-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren t covered. Prescription Drug Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list. Prior Authorization: Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan. Preventive Care: Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. 10
Contacts Allied Oilfield David Owens, Human Resources Manager dowens@alliedoilfield.com 806.894.7263 iaconsulting Natalia Moore, Senior Account Manager 1-806-765-7264 866-765-7264 (toll free) nmoore@iabenefits.com Benefit Contacts MEDICAL BENEFITS FirstCare 800.884.4901 www.firstcare.com DENTAL & VISION BENEFITS MetLife Dental: 800.942.0854 metlife.com Vision: 800.877.7195 vsp.com LIFE BENEFITS OneAmerica 800.553.5318 employeebenefits.aul.com 11
Allied Oilfield Machine & Pump, LLC P.O. Box 879 / Hulon Moreland Road Levelland, TX 79336 806.894.7263