Employee Benefits Overview Plan Year: July 1, 2018 - June 30, 2019
Welcome to BSI s 2018-19 Benefits Program! The success of BSI is directly related to talented and dedicated employees like yourself. As part of our commitment to providing a supportive work environment, BSI offers you a comprehensive benefits program for you and your family. Our Health benefits plan year is July 1, 2018 - June 30, 2019. You will be eligible for benefits coverage (excluding 401k) on the first of the month following date-of-hire. If you do not enroll during your initial eligibility period, you may only enroll at other times during the year should you have a qualifying event or during open enrollment. Our annual open enrollment period falls in June and applies to medical, dental, vision, short and long term disability, voluntary life coverage and commuter benefits. Annual open enrollment for FSA health and dependent care plans and commuter benefits is in December each year. 401k benefits only, participants are eligible on date of hire. You can enroll and/or change your election decision on a per payroll cycle. If you do not make an enrollment decision in your first 60 days of employment you may be automatically enrolled in the plan at a 4% contribution rate. Enclosed in this packet you will find helpful information regarding BSI's benefit programs. Please take a moment to look over the information provided as it contains details including plan summaries, application process and premium contributions, where applicable. Phone: Email: Hours: 800.986.6660 Ext. 2 helpdesk@melitagroup.com Monday Friday, 8am 5pm PST IMPORTANT: The coverage details in this booklet serve as a summary of the coverages available under each insurance carrier's plan. Refer to the Summary of Benefits & Coverages (SBC) for full coverage details. Should there be any discrepancies between this summary and the SBC, the SBC will apply. 2
Eligibility & Enrollment Who is Eligible? If you are a regular employee (working 24 hours per week or more) you are eligible to enroll in benefits described in this guide. The following family members are eligible for medical, dental, vision, and voluntary life coverage: spouse, domestic partner and children up to age 26, regardless of full-time student status. When to Enroll You have 30 days from your eligibility date to enroll when you are a new hire, or you may enroll during BSI's open enrollment period (usually in June). How to Make Changes If you have a qualified life event (marriage, divorce, birth of a child, adoption, or loss of coverage), you may make changes to your enrollment within 30 days of the life event. You may also make changes to certain plans during the annual Open Enrollment period. How to Enroll To make the enrollment process faster and easier, we use a cloud-based enrollment software, Paycom. The first step is to log into your Paycom employee access account and review your current benefit elections. Verify your personal information and make any changes if necessary. Make your benefit elections. Once you have made your elections, you will not be able to change them until the next open enrollment period or unless you have a qualifying life event. Be sure to complete the enrollment process no later than 30 days from your date of hire to ensure your enrollment is processed and you receive your ID cards. Important Note about Plan Year vs. Calendar Year Because our health benefits program plan year runs from July 1st to June 30th, it's important to note that some of the benefit plans are subject to calendar year limits as follows: Medical: The deductible and out of pocket maximum will reset every January 1st Dental: The deductible and maximum benefit will reset every January 1st Vision: Based on service plan year Flexible Spending Account (FSA): The FSA program for BSI runs on a calendar year basis beginning January 1st and concluding on December 31st. Annual open enrollment occurs in December for a January 1st effective date. 3
Your Benefits Costs Providing our employees with quality employee benefits at an affordable cost is important to us, so we subsidize a substantial portion of the costs of your benefits for employees and dependents for medical, dental, and vision. Our per pay period contributions are reflected below. Employee Per Pay Period Costs Employee Only EE + Spouse / Domestic Partner EE + Child EE + Children EE + Family Blue Shield HMO $51.06 $177.00 $159.95 $159.95 $263.88 Blue Shield PPO 90 $57.59 $201.07 $190.25 $190.25 $303.30 Blue Shield PPO 80 $40.00 $150.66 $142.55 $142.55 $227.26 Kaiser California $40.44 $149.60 $124.67 $124.67 $228.14 Kaiser Oregon $33.25 $130.10 $117.09 $117.09 $195.15 Delta Dental $4.29 $13.85 $15.23 $15.23 $22.38 VSP Vision $0.61 $1.50 $1.50 $2.38 $2.38 4
Medical - Blue Shield HMO (California Only) -Available in California Only. -You receive medical care from hospitals and doctors in the HMO network. -Your selected Primary Care Physician coordinates all of your healthcare, including office visits, prescription medications, and referrals to specialists. -HMO plans do not come with a deductible (set dollar amount you must pay before the insurance carrier begins paying for medical expenses). -You pay nothing out-of-pocket for in-network preventive care. -For other office visits and procedures, you pay a set amount (called a copay). Carrier/Plan Name Blue Shield Access+ HMO Per Day 15-500 Network Name: Access+ HMO W0002704 (855) 599-2650 Individual Deductible Family Deductible http://www.blueshieldca.com Individual Out of Pocket Max $2,500 Family Out of Pocket Max $5,000 Office Visit Copay Specialist Office Visit Copay Teladoc Consultation Inpatient Hospital Outpatient Surgery Emergency Room Lab/X-Ray Physical Therapy Chiropractic Care Acupuncture Rx Deductible - Individual Rx Deductible - Family $15/visit $15/visit $5 per consultation $500/day (up to 3 days/admission) $200/surgery (Ambulatory Surgery Center) $400/surgery (Hospital/Facility) $100/visit (waived if admitted) No charge $15/visit Not covered Not covered Rx Generic / Tier 1 $10 Rx Preferred / Tier 2 $25 Rx Non-Preferred / Tier 3 $40 Rx Specialty / Tier 4 Rx Mail Order (Generic/Preferred/Non- Preferred) 20% (Up to $200 max) $20 / $50 / $80 5 This is a reference guide only. Refer to your plan's Summary of Benefits Coverages before receiving care.
Medical - Blue Shield PPO 90 (All States) -You can choose to receive medical care from hospitals and doctors of your choice, but you get the greatest cost savings when you utilize providers within the PPO network. -You can see specialists at any time without needing a referral from your primary care doctor. -PPO plans have an annual deductible, or set dollar amount you must pay before the insurance carrier begins paying for medical expenses. -After the deductible amount is met, you are responsible for the coinsurance, which is a percentage of the total cost for services, up to the out-of-pocket max, at which point the plan pays 100% of all costs. -You pay nothing out-of-pocket for in-network preventive care. Carrier/Plan Name Network Name: Individual Deductible Family Deductible In Network Out of Network Individual Out of Pocket Max $2,250 $10,250 Family Out of Pocket Max $4,500 $20,500 Co-insurance 10% 30% Office Visit Copay $15/visit 30% (after deductible) Specialist Office Visit Copay $15/visit 30% (after deductible) Teladoc Consultation $5 per consultation Not covered Inpatient Hospital Outpatient Surgery 10% (after deductible) 10% (after deductible) 30% up to $600/day + all charges in excess of $600 (after deductible) 30% up to $350/day + all charges in excess of $350 (after deductible) Emergency Room $100/visit + 10% (not subject to deductible) $100/visit + 10% (not subject to deductible) Lab/X-Ray Blue Shield Full PPO Combined Deductible 15-250 90/70 Full PPO Lab: $15/visit (after deductible) X-Ray: 10% (after deductible) W0002704 (855) 599-2650 http://www.blueshieldca.com 30% up to $350/day + all charges in excess of $350 (after deductible) Physical Therapy $15/visit (after deductible) 30% (after deductible) Chiropractic Care $25/visit (after deductible) 30% (after deductible) 12 visits/calendar year 12 visits/calendar year Acupuncture $25/visit (after deductible) 30% (after deductible) 20 visits/calendar year 20 visits/calendar year Rx Deductible - Individual Rx Deductible - Family Rx Generic / Tier 1 $10 25% + $10 Rx Preferred / Tier 2 $25 25% + $25 Rx Non-Preferred / Tier 3 $40 25% + $40 Rx Specialty / Tier 4 30% (Up to $200 max) Not covered Rx Mail Order (Generic/Preferred/Non- Preferred) $20 / $50 / $80 Not covered $250 $500 6 This is a reference guide only. Refer to your plan's Summary of Benefits Coverages before receiving care.
Medical - Blue Shield PPO 80 (All States) -You can choose to receive medical care from hospitals and doctors of your choice, but you get the greatest cost savings when you utilize providers within the PPO network. -You can see specialists at any time without needing a referral from your primary care doctor. -PPO plans have an annual deductible, or set dollar amount you must pay before the insurance carrier begins paying for medical expenses. -After the deductible amount is met, you are responsible for the coinsurance, which is a percentage of the total cost for services, up to the out-of-pocket max, at which point the plan pays 100% of all costs. -You pay nothing out-of-pocket for in-network preventive care. Carrier/Plan Name Network Name: Individual Deductible Family Deductible In Network Out of Network Individual Out of Pocket Max $3,500 $10,500 Family Out of Pocket Max $7,000 $21,000 Co-insurance 20% 40% Office Visit Copay $35/visit 40% (after deductible) Specialist Office Visit Copay $35/visit 40% (after deductible) Teladoc Consultation $5 per consultation Not covered Inpatient Hospital Outpatient Surgery $100/admission + 20% (after deductible) 20% (after deductible) 40% up to $600/day + all charges in excess of $600 (after deductible) 40% up to $350/day + all charges in excess of $350 (after deductible) Emergency Room $100/visit + 20% (not subject to deductible) $100/visit + 20% (not subject to deductible) Lab/X-Ray Blue Shield Full PPO Combined Deductible 35-500 80/60 Full PPO Lab: $35/visit (after deductible) X-Ray: 20% (after deductible) W0002704 (855) 599-2650 http://www.blueshieldca.com 40% up to $350/day + all charges in excess of $350 (after deductible) Physical Therapy $35/visit (after deductible) 40% (after deductible) Chiropractic Care $25/visit (after deductible) 40% (after deductible) 12 visits/calendar year 12 visits/calendar year Acupuncture $25/visit (after deductible) 40% (after deductible) 20 visits/calendar year 20 visits/calendar year Rx Deductible - Individual Rx Deductible - Family Rx Generic / Tier 1 $10 25% + $10 Rx Preferred / Tier 2 $25 25% + $25 Rx Non-Preferred / Tier 3 $40 25% + $40 Rx Specialty / Tier 4 30% (Up to $200 max) Not covered Rx Mail Order (Generic/Preferred/Non- Preferred) $20 / $50 / $80 Not covered $500 $1,000 7 This is a reference guide only. Refer to your plan's Summary of Benefits Coverages before receiving care.
Medical - Kaiser (California Only) -Available in California Only. -You receive all medical care from hospitals and doctors within Kaiser. -Your selected Primary Care Physician coordinates all of your healthcare, including office visits, prescription medications, and referrals to specialists. -HMO plans do not come with a deductible (set dollar amount you must pay before the insurance carrier begins paying for medical expenses). -You pay nothing out-of-pocket for in-network preventive care. -For other office visits and procedures, you pay a set amount (called a copay). Carrier/Plan Name Network Name: Kaiser HMO - CA HMO 35965 (800) 464-4000 Individual Deductible Family Deductible http://www.kp.org Individual Out of Pocket Max $1,500 Family Out of Pocket Max $3,000 Co-insurance Office Visit Copay Specialist Office Visit Copay Inpatient Hospital Outpatient Surgery Emergency Room Lab/X-Ray Physical Therapy Chiropractic Care Acupuncture Rx Deductible - Individual Rx Deductible - Family $15/visit $15/visit $500/admission $15/procedure $100/visit (waived if admitted) No charge $15/visit Not covered Not covered Rx Generic $10 Rx Preferred $30 Rx Non-Preferred Rx Specialty Rx Mail Order (Generic/Preferred/Non- Preferred) Same as preferred brand drugs Same as preferred brand drugs $20 / $60 8 This is a reference guide only. Refer to your plan's Summary of Benefits Coverages before receiving care.
Medical - Kaiser (Oregon Only) -Available in Oregon Only. -You receive all medical care from hospitals and doctors within Kaiser. -Your selected Primary Care Physician coordinates all of your healthcare, including office visits, prescription medications, and referrals to specialists. -HMO plans do not come with a deductible (set dollar amount you must pay before the insurance carrier begins paying for medical expenses). -You pay nothing out-of-pocket for in-network preventive care. -For other office visits and procedures, you pay a set amount (called a copay). Carrier/Plan Name Network Name: Kaiser HMO - OR HMO 18750 (800) 813-2000 Individual Deductible Family Deductible http://www.kp.org Individual Out of Pocket Max $2,000 Family Out of Pocket Max $4,000 Co-insurance Office Visit Copay Specialist Office Visit Copay Inpatient Hospital Outpatient Surgery Emergency Room $15/visit $25/visit $250/admission $100/visit $150/visit (waived if admitted) Lab/X-Ray $15 / $50 Physical Therapy Chiropractic Care Acupuncture Rx Deductible - Individual Rx Deductible - Family $15/visit (20 visits/year) Not covered Not covered Rx Generic $15 Rx Preferred $30 Rx Non-Preferred Rx Specialty Rx Mail Order (Generic/Preferred/Non- Preferred) Applicable Generic or Preferred brand drugs cost shares apply Applicable Generic, Preferred brand, Non-preferred brand drugs cost shares apply $30 / $60 9 This is a reference guide only. Refer to your plan's Summary of Benefits Coverages before receiving care.
Dental Plan -Dental plans offer flexibility to see any dentist or specialist in or out of network. -Costs are lowest when enrollee visits a participating network provider. -No ID cards needed. Simply provide the identifying information requested by the dental office. Carrier/Plan Name Network Name: Delta Dental PPO PPO 03290-04851 (800) 765-6003 http://www.deltadentalins.com Delta Preferred Delta Premier/Out-of-Network* Annual Maximum $1,500/person Individual Deductible $50 $50 Family Deductible $150 $150 Deductible Waived for Preventive? Yes Yes Preventive Coinsurance 100% 100% Basic Coinsurance 90% 80% Endodontics/Periodontics Coinsurance 90% 80% Major Coinsurance 60% 50% Orthodontia Coinsurance Orthodontia Max Lifetime Benefit Adult Orthodontia Coverage 50% $1,500/person Yes NOTE: 1. Percentages shown above are carrier's responsibility. 2. Non-Delta Dental dentists may balance bill the difference between the contracted rate and their usual fee for services.* 10
Vision Plan -Vision benefits offer the enrollee flexibility to see any eye doctor or specialist in or out of network. -Costs are lowest when enrollee visits a participating network provider. -Frequency limits are based upon a service year and are calculated based upon the last date of service. -No ID cards needed. Simply provide the identifying information requested by your vision service provider. Carrier/Plan Name VSP Choice Plan B 12124595 (800) 877-7195 http://www.vsp.com In Network Out of Network Exam $20 Up to $45 Materials $20 Varies Eye Exam - Frequency Lenses - Frequency Frames - Frequency Every 12 months Every 12 months Every 24 months Frame Allowance $150 Up to $70 Contacts (instead of glasses) $150 Up to $105 Life Insurance -Life insurance is designed to provide protection for your family against loss of income due to death. -Provided to you at no cost, however, you are subject to imputed income on amounts in excess of $50,000 -The IRS requires employers to impute income on the dollar value of Group Term Life (GTL) insurance premiums paid by employers in excess of $50,000, per Section 79 of the IRC). -Please designate and maintain your life insurance beneficiary within the Paycom system. Carrier/Plan Name Life/AD&D Coverage Maximum Benefit Guarantee Issue Amount Benefit Reduction Lincoln Financial Group 000010218821 (800) 423-2765 http://www.lincoln4benefits.com 1 x annual salary $175,000 $175,000 Benefits will reduce: 33% at age 70; An additional 17% of original amount at age 75; Benefits terminate at retirement 11
Voluntary Life Insurance -For additional protection, employees have the option to purchase additional life insurance. -Monthly premiums vary based on your desired coverage level and will be deducted directly from your paycheck posttax. -The Guarantee Issue amount is only available to new hires. -For coverage amounts above the Guarantee Issue, you will need to fill out an Evidence of Insurability (EOI) form. -If coverage has been in force for at least 12 months, you may continue coverage for a specified period of time after your employment by paying the required premium. Portability is available if you cease employment for a reason other than total disability or retirement at Social Security Normal Retirement Age. A written application must be made within 31 days of your termination Carrier/Plan Name Employee Coverage Employee Max Benefit Employee Guaranteed Issue Spouse Coverage Spouse Max Benefit Spouse Guarantee Issue Child Coverage Child Max Benefit Lincoln Financial Group 000400001000 21356 (800) 423-2765 Choice of $25,000, $50,000, $100,000, $150,000, $200,000, $300,000 5 x annual salary (max $300,000) $100,000 Choice of $10,000, $25,000, $50,000, $75,000, $100,000 50% of employee amount (max $100,000) $25,000 $250 (Age 1 day to 6 months) $10,000 (6 months to age 26) $10,000 12
Disability Insurance -Disability benefits protect you and your family by providing a portion of your income during times when you are unable to work. -Duration of disability is determined by treating physician. Periods below are the max allowable. -These benefits are provided at no cost to you. Short-Term Disability Plan - Taxable & Tax-Free Benefit Carrier/Plan Name: Lincoln Financial Group 000010218823 (800) 423-2765 http://www.lincoln4benefits.com Elimination Period Benefit Percentage Maximum Weekly Benefit Benefit Duration Hospitalization: benefits begin on 1st day Accident & Illness: benefits begin on 8th day 66.67% $2,308 13 weeks Long-Term Disability Plan - Taxable & Tax Free Benefit Carrier/Plan Name: Lincoln Financial Group 000010218822 (800) 423-2765 http://www.lincoln4benefits.com Elimination Period Benefit Percentage Maximum Monthly Benefit Benefit Duration Definitions Elimination Period Benefit Duration Taxable Benefit Tax-Free Benefit SSNRA The elimination period is the number of days or months from the start of a valid disability before the disability benefit is paid. The length of time that the STD/LTD benefits will be paid to an employee. The max benefit period is determined by your age when you become disabled. STD/LTD benefits will be paid from the end of the elimination period until the earliest of: (1) Completion of the benefit duration, (2) Employee's recovery, or (3) Employee's death. Employee pays 100% of the taxes on the premiums with post-tax dollars so if you receive a benefit under this policy it will not be taxable as income. Social Security Normal Retirement Age 90 days 66.67% $10,000 Employee's Social Security Normal Retirement Age or maximum benefit period based upon age when employee becomes disabled Employer pays 100% of the premiums with post-tax dollars so if you receive a benefit under this policy it will be taxable as income. 13
Flexible Spending Account -FSAs are like checking accounts that can be funded using pre-tax dollars deducted from your paycheck and those dollars can be used for eligible health care and dependent care expenses. -You must enroll in your FSA every year in which you plan to participate, even if you are currently enrolled in the FSA. Vendor Name Our Plan Year WageWorks January 1 - December 31 N/A (800) 950-0105 http://www.takecarewageworks.com Health Care Account Dependent Care Account Maximum Contribution Amount Up to $2,650 per employee annually Up to $5,000 per household annually What expenses are allowed? -Health related costs (medical, dental, orthodontia, and vision expenses) -Prescription medication expenses -Dependents 12 and under or physically disabled dependents -Work day childcare services -Cost of care at a licensed daycare -Before or after-school care What happens to unused account funds at the end of the year? How do I make changes to my participation? Where can I get more information? If you have a balance in your healthcare account at the end of the plan year, up to $500 will be rolled over to your account for the following plan year. Any unused funds exceeding $500 will be forfeited, as mandated by IRS regulations. If you do not use the money you contribute to your Dependent Care FSA account, it will be forfeited. This is a mandated provision known as the use-itor-lose-it rule. Please note, the Dependent Care account does not include the Rollover provision. You can make changes to your participation and/or contribution amount during the open enrollment period or with a qualifying event only. Make sure you budget and plan ahead according to your projected health and dependent care needs. IRS Publication 502: Medical and Dental Expenses, and IRS Publication 503: Child and Dependent Care Expenses list eligible expenses. The publications are available online from the IRS website at www.irs.gov 14
Commuter Program -Pay for your monthly commuter and parking expenses tax-free. -Funds are directly deducted from your paycheck. -Contribution amount can be changed twice a year - January & July. Vendor Name Group Number Customer Service Website Vendor Info WageWorks N/A (800) 950-0105 http://www.takecarewageworks.com Transportation Parking Maximum Contribution Amount Up to $260 per month Up to $260 per month What expenses are allowed? What expenses are not allowed? -Mass transit fares -Monthly bus passes -Vanpooling fees -Taxi fares -Bridge tolls -Cost of auto maintenance Employee Assistance Plan (EAP) -Parking at or near your work location -Parking at a location from which you participate in a carpool or board mass transit -Parking costs at home -Parking when not commuting to or from work location The EAP is an invaluable company-paid benefit that is available to you and your dependents 24/7. We encourage you to access the counselors and referral services of the EAP to assist you with challenges you are experiencing in your life including marital / family / relationship issues, addiction, stress, financial troubles, legal concerns, and child care. Vendor Name Customer Service User Name/Password Website Vendor Name Customer Service User Name/Password Website Vendor Info CONCERN EAP (800) 344-4222 BSI http://www.concern-eap.com Vendor Info Lincoln Financial Group via GuidanceResources (888) 628-4824 LFGsupport/LFGsupport1 http://www.guidanceresources.com 15
Travel Assistance Plan Travel assistance may help you avoid unexpected bumps in the road anywhere in the world. For you, your spouse and dependent children on any single trip up to 90 days in length and more than 100 miles from home. Services include pretrip assistance, emergency travel support services, and medical assistance. Vendor Name Group Number Customer Service Website Vendor Info Lincoln Financial Group - TravelConnect SM 322541 (800) 527-0218 www.lincoln4benefits.com 401(k) Retirement Savings Plan 401(k) plans allow you to defer money pre-tax and post-tax (Roth contributions) into investments that will accumulate tax-free until retirement Vendor Name Plan Recordkeeper Mercer Wise (Effective 1/1/2018) Transamerica Retirement Solutions PF62014 (888) 976-4907 mercerwise.trsretire.com Plan Provision Maximum annual elective employee deferral Safe harbor Match Description You may contribute up to 75% of your total compensation up to the IRS limit of $18,500 for 2018. Catch up limit for 2018 is $6,000 The company will make a qualified matching contribution based on the following formula: 100% of the first 4% of compensation that you contribute in 2018. A new match percent will be communicated next year. 529 College Savings Plan Money from a 529 plan can be used for tuition, fees, books, supplies and equipment required for study at any accredited college, university, or vocational school in the US and at some foreign universities. All employees are eligible to participate. Vendor Name Fidelity Investments 19248 (800) 522-7297 https://advisorxpress.fidelity.com/login This is an informational summary only. Refer to the vendor materials for the complete details of the plan provisions. 16
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If you have questions or need support contact the Melita Help Desk 1.800.986.6660 Ext. 2 helpdesk@melitagroup.com Monday - Friday 8:00 AM - 5:00 PM PST