benefits guide 2017 - bsn sports guide 2017... · •read your 2017 benefits guide. •review and...

BENEFITS GUIDE 2017

A healthy balance Welcome to the BSN SPORTS, LLC Employee Benefits Guide. As you review this guide, you will notice that not only do you have a full array of benefits, but also a number of choices. Having choices means that employees can select those plans and options best suited to their family’s particular needs. To make informed choices regarding your benefits, please take the time to learn about the features of the various plans offered. The information in this guide can help you do this by providing an overview of the benefits.

This guide also contains information on how to enroll in each benefit plan and how to change your current elections.

This summary contains highlights only and is subject to change. The specific terms of coverage, exclusions, and limitations are contained in the Plan Document or insurance certificate. If you have any questions about a specific service or treatment, please contact the Dallas Human Resources department directly at 1.800.230.0055.

A HEALTHY BALANCE

What’s New in 2017… AT A GLANCE Benefits Eligibility changes to the 1st of the month following 30 days of employment

for all benefits including 401k. New Care Management resources to assist you and your family through major

medical conditions via proactive outreach and engagement with dedication clinical teams

New Pharmacy Management changes that could impact the cost of your medication(s) (higher or lower) for the coming year. Some medications could also require pre-authorizations or be excluded for a therapeutic equivalent.

Dental Orthodontic maximum is increased from $1,000 to $1,500

GETTING STARTED WITH OPEN ENROLLMENT • Review your current benefits enrollment and contributions on the ADP portal or

contact HR for assistance.

• Watch all enrollment videos. Your HR Department is available to answer your questions.

• Read your 2017 Benefits Guide.

• Review and compare the benefit plans that are available through your spouse’s employer or other available plans.

• Compare premium costs that are available, keeping in mind that all premium costs are based on 24-paycheck deductions.

• If you are enrolling dependents for the first time, you will be required to furnish to your HR Department eligible proof of your dependents (e.g. birth certificate, marriage license or latest tax returns). If you have provided this information in the past you do not need to do it again. This only applies to new dependents enrolling into the plan.

• All full-time employees must complete open enrollment. Elections and deductions do not carry forward from the previous year. You must elect or waive all benefits offered to you during any enrollment period.

• Remember if you do not enroll, your benefits will end effective December 31st.

• If you are enrolling outside of open enrollment, you must enroll before the 1st day of the month following 30 days of employment.

WHAT’S NEW IN 2017...

4 Table of Contents

Willis Patient Care…………………………………………………………….……..….…………………….…..…5 New Hire Enrollment/Life Event Changes …………….……..….………………..……………….…...…6 Eligibility ……………………………………………………………..…………………….…..……………….…...…7

Benefits……………………………...……………………..………………………………………..…………………...8

Medical Plan Summary ..……………………………………………………..…………………………………...9

Medical Plan Options.………………………………….......................................................................10

Non-Traditional Plan FAQ..………………………….......................................................................11

Traditional Plan FAQ..……………………........................................................................................12

Benefit Rates……………….………………………………….............................................................................13

Prescription Drug Information………………..................................................................................14-15

Know Before You Go……….……………………………...............................................................................16

Dental Benefits………………………………………………………………………………..………..………...…17

Vision Benefits….…………..……………………..…..……………………………………………………….……18

Flexible Spending Accounts……………………………..............................................................................19

TelaDoc/LifeLock…………….…………………….........................................................................................20

Colonial Plan Offerings

Accident Plan …………………………………………….......................................................................21

Cancer Plan ……………………………………………….......................................................................22

Critical Illness Plan……………………………………........................................................................23

Short Term Disability ……………………………….........................................................................24

Long Term Disability (Unum)..……………………......................................................................25

Hospital Confinement (Medical Bridge)………......................................................................26

Term Life Insurance ……………………………...............................................................................27

Whole or Universal Life…..………………………….......................................................................28

401(k)………….…………………….………………………..................................................................................29

How to Enroll …………………….………………………………................................................................30-32

Benefits Contact Information………..…………………………………………………..………………....…33

Table of Contents Willis Patient Care…………………………………………………………….……..….…………………….…..…5 New Hire Enrollment/Life Event Changes …………….……..….………………..……………….…...…6 Eligibility ……………………………………………………………..…………………….…..……………….…...…7

Benefits……………………………...……………………..………………………………………..…………………...8

Medical Plan Summary ..……………………………………………………..…………………………………...9

Medical Plan Options.………………………………….......................................................................10

Non-Traditional Plan FAQ..………………………….......................................................................11

Traditional Plan FAQ..……………………........................................................................................12

Benefit Rates……………….………………………………….............................................................................13

Prescription Drug Information………………..................................................................................14-15

Know Before You Go……….……………………………...............................................................................16

Dental Benefits………………………………………………………………………………..………..………...…17

Vision Benefits….…………..……………………..…..……………………………………………………….……18

Flexible Spending Accounts……………………………..............................................................................19

TelaDoc/LifeLock…………….…………………….........................................................................................20

Colonial Plan Offerings

Accident Plan …………………………………………….......................................................................21

Cancer Plan ……………………………………………….......................................................................22

Critical Illness Plan……………………………………........................................................................23

Short Term Disability ……………………………….........................................................................24

Long Term Disability (Unum)..……………………......................................................................25

Hospital Confinement (Medical Bridge)………......................................................................26

Term Life Insurance ……………………………...............................................................................27

Whole or Universal Life…..………………………….......................................................................28

401(k)………….…………………….………………………..................................................................................29

How to Enroll …………………….………………………………................................................................30-32

Benefits Contact Information………..…………………………………………………..………………....…33

Online Benefits Information Center...............................Take Some “Notes”.............................................................

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BSN has partnered with Willis Patientcare to provide employees with an independent confidential healthcare advocate to assist you with your everyday benefits needs. They are here to help you navigate through the healthcare system and help you become a better healthcare consumer. Your Patientcare representative is not affiliated with any insurance company. Headquartered in Milwaukee WI they are available to assist you with all of the following: Explain in detail the plan options available to you through BSN Help you make your Plan Choices each year Billing questions and concerns Work with providers to get questions answered Answer Network questions Estimate Procedure and Plan Costs Audit Explanation of Benefits and provider bills Get billing errors corrected Assist with questions about Medicare & Medicaid

1-800-640-1898Monday – Friday 8am–9pm ET

Saturday 9am–2pm ET

[email protected]

Se habla español Online Benefits Information Center...............................

Take Some “Notes”.............................................................

6

NEW HIRE/LIFE EVENT CHANGES… NEW HIRE ENROLLMENT • You are eligible to enroll in benefits the first of the month following 30 days of

employment.

• If you are part of an acquisition and are considered “Grandfathered” or you converted from Temporary to Permanent Employment you are eligible to enroll in the benefits the first of the month following the date of acquisition of your previous company or your date of conversion.

• You should watch the benefits videos after you begin employment with BSN or at close of acquisition of your previous company. Once you have completed the video’s you can log onto ADP to complete your enrollment. If you have any questions about your benefits, you contact Patientcare or Human Resources.

• To complete your enrollment, watch the ADP enrollment video by visiting: https://support.adp.com/basic/cr/matraining/sims/wfn/80929/enroolinginabenefitplan.htm or by signing into the ADP portal, clicking on “MYSELF”, “BENEFITS”, “ENROLLMENTS” then click on the play button next to the question mark at the top of the page. Finally click on “Enrollments Learning Byte(s), “Enrolling in a Benefit Plan”.

• Review your first paycheck after enrolling to make certain your deductions are coming out of your check appropriately. If you find any errors, notify Human Resources immediately. BSN will only make corrections retroactively for 60 days. Mistakes beyond that time period may not be changed until the next open enrollment period.

LIFE EVENT CHANGES You may be able to change your coverage if you have a life changing event. YOU MUST NOTIFY HUMAN RESOURCES WITHIN 30 DAYS OF THE LIFE EVENT IN ORDER TO QUALIFY FOR COVERAGE. Requests for changes after that date are not allowed and will not be considered. The following list constitutes a life changing event, but is not limited to:

Change in the marital status (marriage, death of spouse, divorce, legal separation).

Change in number of dependents (birth, death, adoption, eligibility status, child support order).

Change in employment status for you or your spouse (commencement, termination, leave of absence, full-time to part-time or vice-versa).

Special enrollment right under HIPAA You, your spouse or child gains or loses Medicare or Medicaid coverage.

NEW HIRE / LIFE EVENT CHANGES

7

ELIGIBILITY… WHO IS ELIGIBLE TO ENROLL IN BSN HEALTH PLANS? If you are a full-time employee, or a part time employee working 30 hours per week or more you are eligible for all health benefits summarized in this guide. Eligible dependents may include: Your lawful spouse. Your unmarried child who is less than 26 years old.* Your same sex domestic partner.

Note: The term “child” means a child born to you, legally adopted by you, a stepchild living with you, or a child related to you by blood or marriage or which you are the legal guardian. A dependent child who is no longer eligible, due to attainment of the limiting age of 26, is eligible to continue benefits under COBRA. Note: If you are enrolling dependents for the first time, you will be required to furnish proof of dependents to your HR Department (i.e. latest tax returns or birth certificate and/or marriage license or domestic partner affidavit) before coverage will take effect. Both full-time and part-time employees are eligible to participate in the 401(k) plan the 1st of the month following 30 days of employment and have met the age requirement of 21 years of age.

Once eligible, you can enroll in the 401(k) plan or make changes to your contribution the first of any month by visiting the Principal website at www.principal.com. If you have not registered on the site before, you will need your Social Security Number and address on file with BSN in order to complete the registration process. Human Resources is available to assist you with any questions you may have or address any concerns with the registration process.

ELIGIBILITY

8

Benefits…

High quality, affordable health care is the number one concern for most people. That’s why BSN SPORTS, LLC “BSN” is pleased to offer you options when choosing your benefit plans.

BSN pays a large portion of the cost of your health coverage. The amount you contribute depends upon the plan(s) you choose and the coverage level you select.

WE OFFER A FULL BENEFIT PACKAGE INCLUSIVE OF THE FOLLOWING Health Plan sponsored by AETNA Dental Plan sponsored by MetLife Prescription plan sponsored by AETNA Home Delivery & Specialty Pharamacy HSA Bank Account sponsored by PayFlex Flexible Spending Account (FSA) administered by ADP 401(k) Plan with a Match administered by Principal Financial TelaDoc/LifeLock/Petassure Long Term Disability Insurance through Unum Vision Plan through EYEMED Ancillary Benefits sponsored by Colonial Life

• Accident Insurance • Cancer Insurance • Critical Illness Insurance • Short Term Disability through Colonial • Hospital Confinement (Medical Bridge) • Term Life Insurance • Universal Whole Life Insurance

OPTIONS FOR MEDICAL COVERAGE To provide all employees and their families with the most suitable coverage, BSN offers two (2) medical options from which to choose:

Traditional Plan Non-Traditional Plan with a Health Savings Account (HSA)

All of our options provide high quality, affordable medical care, which include doctor’s visits, hospitalization, pharmacy and prescription, and emergency care. Each option has unique characteristics and advantages. In the following pages, we will look at each of these options and by learning about the options, you can make an informed decision about the coverage that best meets your needs and those of your covered dependents.

HIPPA - PRIVACY

Please be aware that your personal data, including any nonpublic information we receive enrolling you in your individual and group benefits, is protected in accordance with the Health Insurance Portability and Accountability Act

BENEFITS

9

Medical Plan Benefits… AETNA PLAN SCHEDULE OF MAJOR MEDICAL BENEFITS

Plan Design Traditional Non-Traditional With HSA

Deductible (Individual/Family) $3,500 / $7,000 $2,000 / $4,000

HSA Embedded Family Deductible N/A $2,600 Out of Pocket Maximum (Includes Deductible, Co-pays, RX charges) $6,350 / $12,700 $5,000 / $10,000

Coinsurance You Pay 30% You Pay 20%

Preventative Free Free

Primary Care $30 D/Coinsurance

Specialist $60 D/Coinsurance

Urgent Care $50 D/Coinsurance

ER $150 D/Coinsurance Hospitalizations/Mental Health & Substance Abuse (In Patient) D/Coinsurance D/Coinsurance

Mental Health & Substance Abuse (Out Patient) $30 or $60 D/Coinsurance

RX Retail (Generic, Formulary, Non-Formulary, Specialty) $10, $30, $50, $200 D/Coinsurance

RX Mail Order (Generic, Formulary, Non-Formulary, Specialty) $10, $60, $100, $200 D/Coinsurance

COVERAGE TIER

MONTHLY TRADITIONAL

PLAN

24 – CHECK DEDUCTION

AMOUNT

MONTHLY NON-

TRADITIONAL PLAN WITH

HSA


AMOUNT

HSA ANNUAL FUNDING

Employee Only $167.41 $83.71 $131.28 $65.64 $350* Employee & Spouse $466.12 $233.06 $393.86 $196.93 $700* Employee & Child(ren) $396.19 $198.10 $334.77 $167.39 $700*

Family $713.92 $356.96 $612.75 $306.38 $700* Note: HSA Funding is done in two Semi-annual payments $175/$350 on 1/1 & 7/1 with New hires prorated

MEDICAL PLAN BENEFITSMedical Plan Benefits… AETNA PLAN SCHEDULE OF MAJOR MEDICAL BENEFITS

Plan Design Traditional Non-Traditional With HSA

Deductible (Individual/Family) $3,500 / $7,000 $2,000 / $4,000

HSA Embedded Family Deductible N/A $2,600 Out of Pocket Maximum (Includes Deductible, Co-pays, RX charges) $6,350 / $12,700 $5,000 / $10,000

Coinsurance You Pay 30% You Pay 20%

Preventative Free Free

Primary Care $30 D/Coinsurance

Specialist $60 D/Coinsurance

Urgent Care $50 D/Coinsurance

ER $150 D/Coinsurance Hospitalizations/Mental Health & Substance Abuse (In Patient) D/Coinsurance D/Coinsurance

Mental Health & Substance Abuse (Out Patient) $30 or $60 D/Coinsurance

RX Retail (Generic, Formulary, Non-Formulary, Specialty) $10, $30, $50, $200 D/Coinsurance

RX Mail Order (Generic, Formulary, Non-Formulary, Specialty) $10, $60, $100, $200 D/Coinsurance

COVERAGE TIER

MONTHLY TRADITIONAL

PLAN


AMOUNT

MONTHLY NON-

TRADITIONAL PLAN WITH

HSA


AMOUNT

HSA ANNUAL FUNDING

Employee Only $167.41 $83.71 $131.28 $65.64 $350* Employee & Spouse $466.12 $233.06 $393.86 $196.93 $700* Employee & Child(ren) $396.19 $198.10 $334.77 $167.39 $700*

Family $713.92 $356.96 $612.75 $306.38 $700* Note: HSA Funding is done in two Semi-annual payments $175/$350 on 1/1 & 7/1 with New hires prorated

10

Medical Plan Options…

WHICH PLAN IS RIGHT FOR YOU? When choosing medical coverage for you and your family members, it’s important to first review how you and your family members use health care.

TRADITIONAL PLAN OPTION The Traditional Plan is comprehensive health coverage that is designed to reduce up front medical out of pocket costs through utilization of Co-pay’s for payment of routine office visits and prescription needs. The Traditional Plan Option offers the following: Coinsurance Deductible Maximum Out of Pocket Co-pay’s Pharmacy Co-pay’s with Mail Order options for maintenance medications

The Traditional Plan can be paired with the Regular FSA account which allows you set aside up to $2,550 on a pretax basis to help cover any out of pocket expenses you incur.

NON-TRADITIONAL PLAN WITH HSA OPTION The Non-Traditional Plan is comprehensive health coverage that is designed for those who are light users of health care. The non-traditional plan has a Health Savings Account paired with it that allows you to set aside additional funds on a pretax basis to cover out of pocket costs for medical, dental and vision expenses. BSN funds a portion of the account and then you can invest the account in mutual funds so that your account grows in value over time into a nest egg. The Non-Traditional Plan with the HSA Option offers the following: Coinsurance Deductible Maximum Out of Pocket Pharmacy benefits with Mail Order options for maintenance medications Tax Free Savings Account of up to $3,400/$6,750 for individuals/family with

investment options Bank account with PayFlex that includes a Debit MasterCard

The Non-Traditional Plan can be paired with the Limited FSA account to increase your pretax savings and allows you to set aside up to $2,550 additional to help cover any out of pocket expenses you incur for Dental and Vision only.

MEDICAL PLAN OPTIONS

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Non-Traditional (HSA)…

HOW DOES THE NON-TRADITIONAL HSA PLAN WORK?

What do I pay if I go to a physician’s visit, Urgent Care Center, or ER? You pay the discounted cost out of your HSA account. Once you have met your deductible of $2,000 for individual or $4,000 for any other coverage, you pay 20% of the discounted charges until you have paid another $3,000 for invidual or $6,000 for any other coverage.

What do I pay if I’m admitted to the Hospital? You pay the discounted cost out of your HSA account. Once you have met your deductible of $2,000 for individual or $4,000 for any other coverage, you pay 20% of the discounted charges until you have paid another $3,000 for invidual or $6,000 for any other coverage.

What do I pay if I have lab work done? You pay the discounted cost out of your HSA account. The deductible on lab work for this plan is not waived. Once you have met your deductible of $2,000 for individual or $4,000 for any other coverage, you pay 20% of the discounted charges until you have paid another $3,000 for invidual or $6,000 for any other coverage.

If I have more than Employee Only coverage how many deductibles do I have to meet? Once one person has met $2,600 the plan will begin to pay per person once a total of $4,000 has been paid towards deductibles of all combined persons you are done with deductibles for the year.

What do I pay if what I’m doing is preventative services? All preventative is covered at 100% under the plan so you pay nothing.

What do I pay if I have prescriptions? You pay the discounted cost out of your HSA account. Once you have met your deductible of $2,000 for individual or $4,000 for any other coverage, you pay 20% of the discounted charges. Prescriptions count against your deductibles and out of pocket maximums.

What if I don’t have enough money in my HSA account to pay, can I change it? You would pay the charges out of your pocket at the discounted rates. You can fund your HSA post tax directly via bank to bank transfer at any time.

NON-TRADITIONAL HSA

12

Traditional Plan…

HOW DOES THE TRADITIONAL PLAN WORK?

What do I pay if I go to a physician’s visit? You pay the office visit Co-pay of $30 primary care or $60 for a specialist.

What do I pay if I have to go to an Urgent Care Center? You pay the office visit Co-pay of $50.

What do I pay if I have to go to the ER? You pay the Co-pay of $150. If your admitted, the Co-pay is waived.

What do I pay if I’m admitted to the Hospital? You pay the first $3,500 out of your pocket. After that, you pay 30% of the remaining charges until you have paid another $2,850 for a total out of pocket of $6,350 for the year for an individual, or $7,000 for family, then another $5,700 for a total family out of pocket of $12,700 for the year.

What do I pay if I have lab work done? The deductible for lab work is waived on this plan, therefore, you pay 30% of the lab charges until you have met your total out of pocket for the year.

If I have more than Employee Only coverage how many deductibles do I have to meet? Once two individuals have met their deductible you are done with deductibles for the year.

What do I pay if what I’m doing is preventative services? All preventative is covered at 100% under the plan so you pay nothing.

What do I pay if I have prescriptions? You pay your RX Co-pay of $10 for generic, $30 for formulary, $50 for non-formulary and $100 for Speciality Drugs if you use Prime or $200 if you use Retail Walk-in.

Do my Co-Pays count towards my deductible and Out of Pocket? All Co-pays count toward your deductible and Out of Pocket Maximum.

TRADITIONAL PLAN

13

2017 Benefit Rates… The cost of your coverage is paid with deductions from your pay checks. The monthly cost of coverage is listed below along with the deduction amount taken from each pay check. BSN will make all benefit deductions in 24 pay-periods. AETNA

COVERAGE TIER MONTHLY

TRADITIONAL PLAN


AMOUNT

MONTHLY NON-TRADITIONAL

PLAN WITH HSA


AMOUNT

HSA ANNUAL FUNDING

Employee Only $167.41 $83.71 $131.28 $65.64 $350*

Employee & Spouse $466.12 $233.06 $393.86 $196.93 $700* Employee & Child(ren) $396.19 $198.10 $334.77 $167.39 $700*

Family $713.92 $356.96 $612.75 $306.38 $700*

*Note: HSA Funding is done in two Semi-annual payments $175/$350 on 1/1 & 7/1 with New hires prorated METLIFE DENTAL PLAN


DEDUCTION AMOUNT


AMOUNT

Employee Only $16.00 $8.00

Employee & Spouse $36.00 $18.00

Employee & Child(ren) $43.00 $21.50

Family $66.00 $33.00

EYEMED


DEDUCTION AMOUNT


AMOUNT Employee Only $7.54 $3.77



Family $22.18 $11.09

TELADOC/LIFELOCK


DEDUCTION AMOUNT



COLONIAL & UNUM VOLUNTARY PRODUCTS Priced individually based on coverage choices



TRADITIONAL PLAN


AMOUNT


PLAN WITH HSA


AMOUNT

HSA ANNUAL FUNDING

Employee Only $167.41 $83.71 $131.28 $65.64 $350*


Family $713.92 $356.96 $612.75 $306.38 $700*



DEDUCTION AMOUNT


AMOUNT




Family $66.00 $33.00

EYEMED


DEDUCTION AMOUNT





Family $22.18 $11.09

TELADOC/LIFELOCK


DEDUCTION AMOUNT






TRADITIONAL PLAN


AMOUNT


PLAN WITH HSA


AMOUNT

HSA ANNUAL FUNDING

Employee Only $167.41 $83.71 $131.28 $65.64 $350*


Family $713.92 $356.96 $612.75 $306.38 $700*



DEDUCTION AMOUNT


AMOUNT




Family $66.00 $33.00

EYEMED


DEDUCTION AMOUNT





Family $22.18 $11.09

TELADOC/LIFELOCK


DEDUCTION AMOUNT




2017 BENEFIT RATES

14

Prescription Drugs… WE OFFER A 4-TIER DRUG PLAN WITH GENERICS AUTOMATICALLY DISPENSED. MAIL ORDER PRESCRIPTIONS ARE DEEPLY DISCOUNTED PROVIDING YOU WITH ADDITIONAL SAVINGS FOR A 90-DAY SUPPLY OF MEDICATIONS. You receive prescription drug coverage automatically by enrolling in any of the BSN medical plans. AETNA utilizes AETNA Home Delivery and AETNA Specialty as their providers to manage the administration of our prescription drug programs.

The prescription plan divides medications into four tiers: • Generic (1st tier) drugs: A generic drug has the same active ingredients, safety,

dosage, quality and strength as its brand drug counterpart and is sold under the chemical or scientific name for the drug. These medications typically cost less than brand name drugs. If you choose to take a brand name drug when a generic is available, you will pay the applicable brand name cost plus the difference in cost between the brand and generic medications.

• Preferred Brand (2nd tier) drugs: Preferred brand drugs are those which generally have no generic equivalent and are either more effective than other drugs in the same class or are equally effective but less costly than the other drugs. If your physician requires you to take a brand name medication, the prescription must indicate “dispense as written”.

• Non-Preferred Brand (3rd tier) drugs: Non-preferred brand drugs are those which generally have generic equivalents and/or have one or more Preferred Brand options within the same drug class. These medications are typically expensive medications.

• Specialty Drugs (4th tier) drugs: These medications are used to treat complex, chronic and often costly conditions and require special handling. Check with your provider to see if there are other medications available.

• Drugs that REQUIRE a Prior Authorization: As a plan cost control measure, some drugs may require a prior authorization before being dispensed. A complete list of these drugs can be obtained from HR.

PRESCRIPTION DRUGS

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Prescription Drugs…

MAIL ORDER PHARMACY BSN incentivizes you to fill your prescriptions through AETNA Home Delivery. A 30-day supply of your medication will cost you less for generic, formulary and non-formulary than at your retail center. You can get 90 days worth of medication for one or two times the cost you pay at the retail center for 30 days! Please note: You are required to use the AETNA Speciality Pharmacy if you are taking a speciality medication. Start the Mail Order Program in two easy steps: Tell your physician you would like to start mail order service. Once you and your physician are confident you will continue taking medication on an ongoing basis, your physician will write you a prescription for a 90-day supply plus 3 refills.

Log-on to www.aetnanavigator.com. Register as a user then enter your prescription information. If you are not comfortable doing this via their website, you can complete the New Prescription Mail-In Form that you can obtain from Human Resources. You can also call AETNA Home Delivery at (888)792-3862.

When your order arrives, it enters their automated system. A licensed pharmacist reviews your order for drug interactions, allergies and dosage information. After your medication is dispensed, another pharmacist reviews it a final time to ensure accuracy. Your medication is then sealed in a discreet, tamper-evident package. It is then mailed directly to you and they let you know when it has been shipped.

New orders should arrive approximately 7 days after your completed order is received, unless they need additional information from your prescribing physician. They will notify you automatically when it is time to refill your prescription. You can reorder by mail, phone or online.

How to start the Specialty Drug Program: Contact AETNA Specialty Customer Service at (866)782-2779. Getting your Specialty Medications through AETNA Specialty Pharmacy provides our members with savings, safety and superior support with their specialty medications.

PRESCRIPTION DRUGS

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Know Before You Go… WHAT YOU MUST KNOW & ASK BEFORE YOU USE YOUR BENEFITS EVERY TIME When you schedule your appointment ask...

• Are you a member of the AETNA POS II Network? • Will I need to have any lab work or diagnostic testing done? • Do you use Quest Labs?

When you arrive for your visit ask... • Are you STILL a member of the AETNA POS II Network? • Is my lab work/diagnostic testing processed/read/evaluated here or do you send

any part of it out? • If you send it out, where is it sent? • Will you send it to Quest for me? If not, please provide me with what I need so I

can take it to Quest? • Will anything I have done today be billed as a surgical procedure?

When you are with the doctor or pharmacy ask... • Is there a Generic equivalent available for the script you are giving me today? • If not, is there a Non-Formulary equivalent available? • Are there any other equivalent drugs that might be more cost effective (over-the-

counter)? • If this is a maintenance or long-term medication, can you give me a 90-day script for

the mail-order program? • Is there any quantity or duration dispensing limit on any of the medications you

have prescribed for me today?

If you are having surgery, be sure BEFORE your surgery you ask... • Can this procedure be done as an outpatient or day surgery? • If not, what In-Network hospitals do you have rights at? • Is the Anesthesiologist an In-Network provider? • If not, do I have a choice of providers that are In-Network? • How long will I be in the hospital? • How much time will I need for recovery? • Will I require any Durable Medical Equipment for my recovery? • Will I need any Physical Therapy or Rehabilitation during my recovery? • Will I be able to drive after the procedure? If not, for how long?

At the Pharmacy: • If the pharmacy says the drug is not covered, then what? Ask the pharmacist if there

are dispensing limitations for the drug and if your doctor’s prescription is outside of those guidelines. If this is the case, call your doctor for a prescription that is within the dispensing limits for the drug (Note: This may mean more refills for fewer pills at one time).

KNOW BEFORE YOU GO

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Dental Benefits… Dental care is an important part of total health care. To reduce high dental expenses and help prevent uncomfortable treatments, prevention is the key. The dental plan pays a higher level of benefit when you utilize contracted MetLife providers. Should you decide to use a dentist of your choice, the plan will reimburse up to usual and customary charges.

Plan Design In-Network Out of Network

Deductible $50/$150 $50/$150

Plan Year Maximum $1,500 $1,500

Orthodontia Lifetime Maximum

50% $1,000

50% $1,000

Type I – Diagnostic & Preventative (Deductible waived for Preventative) 100% 100%

Type II – Basic Services 80% 60%

Type III – Major Services 50% 35%

Waiting Periods None None

Orthodontia Age Limit 19 19

Rates Monthly Pay period




Family $66.00 $33.00

To find a nearby provider or to check on your benefits you can logon to the MetLife web site at www.mybenefits.metlife.com and choose the PDP Plus Network.

Dental Benefits… Dental care is an important part of total health care. To reduce high dental expenses and help prevent uncomfortable treatments, prevention is the key. The dental plan pays a higher level of benefit when you utilize contracted MetLife providers. Should you decide to use a dentist of your choice, the plan will reimburse up to usual and customary charges.


Deductible $50/$150 $50/$150



50% $1,000

50% $1,000










Family $65.94 $32.97


DENTAL BENEFITSDental Benefits… Dental care is an important part of total health care. To reduce high dental expenses and help prevent uncomfortable treatments, prevention is the key. The dental plan pays a higher level of benefit when you utilize contracted MetLife providers. Should you decide to use a dentist of your choice, the plan will reimburse up to usual and customary charges.


Deductible $50/$150 $50/$150



50% $1,000

50% $1,000










Family $66.00 $33.00


18

VISION BENEFITSVision Benefits…

Your eyesight is an integral part of your overall health and a key component to safety. Good vision care is essential. Your vision benefits will be provided through EYEMED, which provides coverage for preventive care, as well as for eyeglasses and contact lenses.

EYEMED has one of the nation’s largest eye care doctor networks, with thousands of doctors throughout the United States. Your membership gives you immediate access to benefits without any paperwork hassle. By obtaining your vision care and materials through the EYEMED network, you can count on a uniform schedule of rates that are significantly below retail prices. To find a nearby provider or to check on your benefits logon to www.eyemed.com

Plan Services Every 12 Months

Member Services

Out of Network

Exam with Dilation $10 Up to $35

Lenses: Single Vision

Bifocal Trifocal

Lenticular

$15 $15 $15 $15

Up to $30 Up to $45 Up to $60 Up to $60

Frames Allowance towards any frame at provider location $150 & 20% off Up to $75

Lens Options Standard Plastic: UV Coating

Tint (Solid and Gradient) Standard Scratch Resistance

Standard Polycarbonate Standard Progressive

Standard Anti-Reflective Coating Other Add-Ons and Services

$15 $15 $15 $40 $65 $75

20% off Retail

N/A N/A N/A N/A N/A N/A N/A

Contact Lenses: In lieu of frames and lenses

Fit & follow-up Conventional Disposables

Medically Necessary

Up to $55 Up to $150 Up to $150

100%

N/A Up to $120 Up to $120 Up to $200





Family $22.18 $11.09

Vision Benefits…

Your eyesight is an integral part of your overall health and a key component to safety. Good vision care is essential. Your vision benefits will be provided through EYEMED, which provides coverage for preventive care, as well as for eyeglasses and contact lenses.

EYEMED has one of the nation’s largest eye care doctor networks, with thousands of doctors throughout the United States. Your membership gives you immediate access to benefits without any paperwork hassle. By obtaining your vision care and materials through the EYEMED network, you can count on a uniform schedule of rates that are significantly below retail prices. To find a nearby provider or to check on your benefits logon to www.eyemed.com

Plan Services Every 12 Months

Member Services

Out of Network

Exam with Dilation $10 Up to $35

Lenses: Single Vision

Bifocal Trifocal

Lenticular

$15 $15 $15 $15

Up to $30 Up to $45 Up to $60 Up to $60

Frames Allowance towards any frame at provider location $150 & 20% off Up to $75

Lens Options Standard Plastic: UV Coating

Tint (Solid and Gradient) Standard Scratch Resistance

Standard Polycarbonate Standard Progressive

Standard Anti-Reflective Coating Other Add-Ons and Services

$15 $15 $15 $40 $65 $75

20% off Retail

N/A N/A N/A N/A N/A N/A N/A

Contact Lenses: In lieu of frames and lenses

Fit & follow-up Conventional Disposables

Medically Necessary

Up to $55 Up to $150 Up to $150

100%

N/A Up to $120 Up to $120 Up to $200





Family $22.18 $11.09

19

Flexible Spending (FSA)…

A Flexible Spending Account (FSA) offers you a tax-free way to set aside money for certain health care and/or dependent day care expenses. If you have eligible expenses, a medical or dependent day care reimbursement account may be a useful addition to your benefits package. Because FSA contributions are taken out of your pay BEFORE federal or state income and Social Security taxes, 100% of each dollar you contribute goes toward your eligible expenses. As a result, you save on taxes. The amount you save in taxes by using one or both of these reimbursement accounts depends upon your income and tax bracket. The minimum annual contribution for the medical account is $250 per year and the maximum is $2,550 per year.

Regular - FSA Standalone or paired with the Traditional Plan (Healthcare, Dental & Vision) This tax-sheltered account helps you pay for health care expenses that are not covered by your health plan. You can claim reimbursement for expenses incurred by you and dependents, through the convenience of your debit card, or file a claim and have your reimbursement direct deposited into your bank account. The regular FSA account can’t be used with the Non-Traditional HSA plan. Examples of eligible expenses include: • Medical co-payments, deductibles and coinsurance • Uninsured expenses such as hearing aids, eyeglasses, contact lenses and certain eye

surgeries • Your out-of-pocket costs for dental expenses, including orthodontia.

Limited – FSA paired with the Non-Traditional HSA (Dental & Vision Only) This tax-sheltered account helps you pay for Dental and Vision care expenses that are not covered in excess of your HSA account expenses. You can claim reimbursement for expenses incurred by you and dependents, through the convenience of your debit card, or file a claim and have your reimbursement direct deposited into your bank account.

Dependent Care FSA This account allows you to set aside tax-free dollars to pay the cost of child or elder care that enables you and your spouse (if you are married) to work or attend school. You may claim eligible day care expenses for a child under age 13 whom you claim as a dependent on your federal tax return or a dependent parent or spouse who is incapable of self-care and who depends on you for support. Examples of eligible expenses include: • Day care provided in your home or another person’s home • Licensed daycare center expenses • Elder care expenses for a parent or their relative who lives with you

Flexible Spending (FSA)…

A Flexible Spending Account (FSA) offers you a tax-free way to set aside money for certain health care and/or dependent day care expenses. If you have eligible expenses, a medical or dependent day care reimbursement account may be a useful addition to your benefits package. Because FSA contributions are taken out of your pay BEFORE federal or state income and Social Security taxes, 100% of each dollar you contribute goes toward your eligible expenses. As a result, you save on taxes. The amount you save in taxes by using one or both of these reimbursement accounts depends upon your income and tax bracket. The minimum annual contribution for the medical account is $250 per year and the maximum is $2,550 per year.

Regular - FSA Standalone or paired with the Traditional Plan (Healthcare, Dental & Vision) This tax-sheltered account helps you pay for health care expenses that are not covered by your health plan. You can claim reimbursement for expenses incurred by you and dependents, through the convenience of your debit card, or file a claim and have your reimbursement direct deposited into your bank account. The regular FSA account can’t be used with the Non-Traditional HSA plan. Examples of eligible expenses include: • Medical co-payments, deductibles and coinsurance • Uninsured expenses such as hearing aids, eyeglasses, contact lenses and certain eye

surgeries • Your out-of-pocket costs for dental expenses, including orthodontia.

Limited – FSA paired with the Non-Traditional HSA (Dental & Vision Only) This tax-sheltered account helps you pay for Dental and Vision care expenses that are not covered in excess of your HSA account expenses. You can claim reimbursement for expenses incurred by you and dependents, through the convenience of your debit card, or file a claim and have your reimbursement direct deposited into your bank account.

Dependent Care FSA This account allows you to set aside tax-free dollars to pay the cost of child or elder care that enables you and your spouse (if you are married) to work or attend school. You may claim eligible day care expenses for a child under age 13 whom you claim as a dependent on your federal tax return or a dependent parent or spouse who is incapable of self-care and who depends on you for support. Examples of eligible expenses include: • Day care provided in your home or another person’s home • Licensed daycare center expenses • Elder care expenses for a parent or their relative who lives with you

FLEXIBLE SPENDING (FSA)

20

TelaDoc/LifeLock/PetAssure…

TELADOC National network of state licensed primary care physicians providing cross coverage consultations 24 hours/365 days a year at no extra fee.

• Physicians diagnose medical problems and prescribe short-term medication when appropriate • Service provided for dependents 10 years of age or older. • TelaDoc is not available in the state or to the residents of ARK & does not prescribe DEA controlled

substances or lifestyle drugs.

LIFELOCK • Place fraud alerts on your credit reports so only you can use them. • A $1 million service guarantee • Reduce credit card offers and reduce junk mail • Wallet lock assistance in the event that your wallet is stolen.

PETASSURE Pet Assure will give you 25% off all in-house medical services, no questions asked. The discount is on:

• Office Visits & Exams • Vaccines & Shots • Elective Procedures (e.g., dental care) • Surgery (e.g., spaying & neutering, emergency surgery) • Hospitalization (in Network) • Any other medical service and procedure • Pet Assure has no preexisting exclusions, no annual limits, no deductibles and no waiting periods.

ROADSIDE/EMERGENCY TRAVEL ASSISTANCE • Emergency roadside assistance available 24 hours a day, 365 days a year • Flat tire, lock-out, battery, and collision assistance. • Fuel, oil, and other fluid delivery. • Members have access to a worldwide network of medical and travel assistance personnel and emergency

evacuation benefits when traveling over 100 miles away from home and suffering illness or injury. • Not available to OR, CT, and WA residents.

PHARMACY DISCOUNT • Save 10% to 60% on most acute-care medications with over 56,000 participating locations • The Mail Order Prescription Plan delivers your maintenance medications directly to your door

DENTAL/VISION CARE DISCOUNT/HEARING • Dental Services – Save 15% to 50% at over 71,000 dental providers. • Eyewear and Eye Care-Save 20% to 60% off normal retail on frames, lenses and specialty items at over

12,000 eye care professionals nationwide. Save 10% to 30% on eye exams. Save 40% to 50% off the overall national average on LASIK surgery (PRK and CK available at select locations). Replacement Contact Lenses -Save 10% to 40% on most mail order replacement contact lenses.

• Hearing Aids- Save 15% at retail locations and 40%-60% off retail pricing Monthly Rate: $19.50 for Employees and Dependents or $9.75 a paycheck

TELADOC. LIFELOCK. PETASSURE

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Colonial – Accident…

COMPREHENSIVE ACCIDENT COVERAGE WITH FLEXIBLE DESIGN PARAMETERS Accidents happen in places where you and your family spend the most time – at work, in the home or during sports and leisure activities. The benefits are paid regardless of other coverage that may be in force, including primary health insurance. Coverage is available to the insured, spouse, and children – it’s a plan the whole family can utilize over and over because there are no calendar year maximums.

ACCIDENT CARE IS MORE THAN AN ORDINARY ACCIDENT PLAN Accident Care is supplemental accident insurance that provides employees with 24-hour coverage for accident related expenses such as ambulance services, emergency room visit, hospital confinement and medical treatment. The embedded features of Accident Care include:

• Accident Medical Expense – Pays $150 per accident for emergency room visit and $50 per accident for initial doctor’s office visit, including an additional $50 for follow up care.

• Ambulance Benefit –Pays $500 for air ambulance and $100 for ground ambulance.

• Hospital Confinement – Provides a $750 hospital admission benefit and a $200 daily benefit for up to 365 days.

• Accidental Death, Dismemberment – Provides a death benefit of $25,000, as a result of an accidental death. A percentage of the benefit is paid for dismemberment or loss of sight, hearing, or speech, due to a covered accident.

INCLUDED IN YOUR COVERAGE ARE THE FOLLOWING BENEFITS:

• Hospital Intensive Care – Provides coverage for intensive care costs due to a covered accidental injury. The benefit is payable for a maximum of 15 days for any one accident. Benefits are paid up to $400 per day.

• Bone Fracture and Dislocation – Pays for a single covered bone fracture or dislocated joint up to $2,500. Medical equipment and physical therapy included.

COLONIAL - ACCIDENT

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Colonial – Cancer…

PLAN FOR THE UNEXPECTED

Cancer is one of life’s most devastating experiences for two major reasons. First, it almost always takes individuals by surprise. Second, the expenses associated with its treatment, plus ancillary costs take those affected and their families, by surprise as well – even if they are already covered by existing health insurance. The great news is the number of people surviving cancer increases annually with about 10 million survivors today. The increased survival rate is attributed to earlier diagnosis and improvements in treatment. The challenge is the costs for fighting cancer are also increasing. Cancer 1000 is a cancer expense insurance policy designed to provide funds to help offset expenses incurred for a covered cancer. Cancer 1000 is unlimited which means the benefits will continue as expenses are incurred. This benefit helps offset the long-term costs which may be associated with cancer.

A WIDE MENU OF BENEFITS Cancer 1000 offers a comprehensive array of services and benefits:

• Benefits are paid directly to the insured • Plan types: employee, employee and spouse, employee and child(ren) or family • Unlimited lifetime benefits • Guaranteed renewable for life • Pays various charges, including, but not limited to:

• Hospital stays (daily benefit) • Surgical Procedures • Laboratory tests • Chemotherapy/Radiation • Transportation/Lodging • Skin Cancer

• The policy is fully portable • No deductibles • Issue ages 18-69 varies by state

COLONIAL - CANCERColonial – Cancer…

PLAN FOR THE UNEXPECTED

Cancer is one of life’s most devastating experiences for two major reasons. First, it almost always takes individuals by surprise. Second, the expenses associated with its treatment, plus ancillary costs take those affected and their families, by surprise as well – even if they are already covered by existing health insurance. The great news is the number of people surviving cancer increases annually with about 10 million survivors today. The increased survival rate is attributed to earlier diagnosis and improvements in treatment. The challenge is the costs for fighting cancer are also increasing. Cancer 1000 is a cancer expense insurance policy designed to provide funds to help offset expenses incurred for a covered cancer. Cancer 1000 is unlimited which means the benefits will continue as expenses are incurred. This benefit helps offset the long-term costs which may be associated with cancer.

A WIDE MENU OF BENEFITS Cancer 1000 offers a comprehensive array of services and benefits:

• Benefits are paid directly to the insured • Plan types: employee, employee and spouse, employee and child(ren) or family • Unlimited lifetime benefits • Guaranteed renewable for life • Pays various charges, including, but not limited to:

• Hospital stays (daily benefit) • Surgical Procedures • Laboratory tests • Chemotherapy/Radiation • Transportation/Lodging • Skin Cancer

• The policy is fully portable • No deductibles • Issue ages 18-69 varies by state

23

Colonial – Critical Illness…

VOLUNTARY CRITICAL ILLNESS INSURANCE Critical Illness protection for the way employees live Critical Illness helps to protect an employee’s and family’s assets in the event of a critical illness. It offers valuable peace of mind from the rising costs of specialized healthcare, which are often not covered by ordinary health insurance. A strong base of coverage Critical Illness offers benefits for vascular coverage and other critical illnesses. All benefit payments are made directly to you. Benefits are payable in addition to any other coverage you may have. Vascular coverage includes benefits for:

• Heart attack • Transplant as a result of heart failure • Stroke • Coronary artery bypass surgery as a result of

coronary artery disease (25% of the benefit) Benefits are also available for other critical illnesses such as

• Transplant, other than heart • End-stage renal failure • Blindness • Coma • Permanent paralysis due to an accident • Occupational HIV or Hepatitis B,C, or D

Benefit amounts:

• $5,000 to $50,000 for employees • 50% of the employee benefit to a maximum of

$25,000 for a spouse • 25% of the employee benefit to a maximum of

$12,500 for each eligible child Health Screening Benefit:

• Included in coverage up to $50

COLONIAL - CRITICAL ILLNESS

24

BSN & Colonial Disability…

BSN SHORT TERM DISABILITY BSN provides all full-time employees who have completed 12 months or more with short term disability. Benefits for STD are paid at 60% of base wages (Base Draw) for each day missed after an employee has missed 5 consecutive work days due to their own illness. You can purchase additional coverage through Colonial as outlined below.

VOLUNTARY SHORT TERM DISABILITY Disability 1000 can be there to help you when an accident or illness totally disables. This voluntary disability coverage provides a monthly disability income benefit due to a non-occupational “off-the-job” accident or sickness, covering you above and beyond any existing disability coverage you may have.

Your coverage includes both accident and sickness

Accident and sickness – Provides coverage for disabilities caused by either an accidental injury or sickness. Coverage is available from a minimum of $400 per month to a maximum $3,000 per month up to 60 percent of monthly income with various elimination and benefit period options.

Elimination period is the number of continuous days, beginning with the first day of a total disability, before any monthly benefit amount is payable. Your elimination period may be 7 days for both accident and sickness

Benefit period is that period of time for which monthly income benefits are payable after the Elimination Period ends. You can choose a benefit period of either 3, 6, 12, or 24 months.

Disability Definition

Total Disability – Unable to perform the material and substantial duties of your job and under the regular and appropriate care of a doctor

Partial Disability – Unable to perform the material and substantial duties or your job for 20 hrs. or more and under the regular and appropriate care of a doctor. The total disability benefits must have been paid for at least one full month immediately prior to your being partially disabled.

When accidents or illnesses totally disable employees, Disability 1000 can be there to help pay the bills that won’t go away, just because they can’t work. The benefit may be used to cover every day costs such as housing, food, car payments, and even additional medical costs. Disability 1000 can help employees concentrate on what’s most important – a full recovery and successful return to the workplace, free from the burden of excess accumulated debt.

BSN & COLONIAL DISABILITY

25

Unum - Disability… VOLUNTARY LONG TERM DISABILITY

If you can’t work, why should your bank account suffer? Help keep your finances together with Unum’s Group Long Term Disability Insurance.

Your disability benefits help cover what matters most. Unum’s long term disability (LTD) insurance pays you a percentage of your gross monthly salary if you cannot work due to a covered injury or illness. It can provide a benefit whether your disability is total or partial. These benefits can help you cover your expenses and protect your finances at a time when you’re paying extra medical bills. Reason to buy this coverage at work - now • No medical questions to answer. If you sign up during your initial enrollment at

work*. • No checks to write - your cost is conveniently deducted from your paycheck. • You can take advantage of affordable group rates.

Plan features • Monthly Benefit - 60% of monthly earnings to a maximum benefit of $6,000 per

month • Definition of Disability

• Two (2) year regular occupation • Zero-day residual • Accelerated elimination period • Work incentive benefit during the first 12 months of disability payments

• Elimination Period - this is the number of days that must pass between your first day of a covered disability and the day you can begin to accrue your disability

• 90 days & 30 day accumulation feature • Benefit Duration - to age 65/reducing benefit duration (ADEA I) • Social Security Integration - Primary and Family • Work-life balance employee assistance

program • Worldwide emergency travel assistance • Rehabilitation and return to work

assistance program • HR compliance solutions • Dependent care benefit • Guaranteed insurability • Full maternity benefits

*Benefits may be subject to pre-existing condition provision

UNUM - DISABILITY

26

Colonial – Medical Bridge… VOLUNTARY HOSPITAL CONFINEMENT INSURANCE The perfect supplement to your medical plans Medical Bridge is a supplemental medical plan that may be beneficial to employees because it offers additional benefits for everyday medical costs such as physician’s office and emergency room treatment. There is no coordination of benefits with existing coverage, so this is truly a benefit you can reap immediately. Medical Bridge is a great way to pay “first dollar” health care expenses. With increasing co-pays and high risk deductibles required by many major medical plans, this is a good solution for recouping that payment. This plan offers these benefits:

• Pays a specified amount for covered hospital confinement or outpatient surgery. • This benefit is payable regardless of any additional coverage in force. • There is no coordination of benefits. • Covers sickness and injuries after date of policy, subject to pre-existing

condition and policy limitations. • Includes coverage for pregnancy (subject to state mandated waiting periods). • No physical examination is required. • Covers pre-existing conditions after 12 months from the date of policy.

Sickness and wellness benefits

• Physician’s office visit – Pays $25 for each visit to a physician’s office for non-emergency sickness up to three (3) visits per year.

• Wellness benefit – Pays $50 each calendar year for an annual physical conducted 30 days or more after the date of policy. If more than one person is insured under the policy, the calendar year maximum is a total of $100.

• Hospital admission – Pays $1,000 lump sum per occurrence for an overnight stay in the hospital due to an accident or sickness.

• Outpatient surgery – Pays a lump sum benefit of $750 to $1,500 per occurrence, based on a surgical schedule for a particular procedure.

• Rehabilitation unit - Pays $100 day for up to 15 Days.

Insuring family members is simple The benefit amount that you select will be the same amount of coverage available to your spouse and/or dependents. Children from newborn to age 18, or up to age 25 if unmarried and a full-time student, may be covered. There is no waiting period for newborns or newly adopted children.

Help cover first dollar costs Medical bridge is an effective way to add another layer of insurance protection to help cover “first dollar costs”. Since there is no coordination of benefits and no co-pays required, receiving reimbursement is a simple one-page form. Sometimes the little things in life do make life a little better!

COLONIAL - MEDICAL BRIDGE

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Colonial – Term Life… VOLUNTARY TERM LIFE INSURANCE Term Life Insurance Helps protect your assets Employees (and their loved ones) are concerned about financial security. Each plan offers employees coverage they can access in health, life and death circumstances. When you compare these plans to comparable coverage, you’ll find level Term Life offers solid coverage per payroll deduction dollar. That means you get increased protection at surprisingly affordable rates. If you enroll when you are first eligible you can receive guarantee issue without a medical review (levels depend on age). The benefits are clear and easy to understand. Best of all, you can enroll at work with just a few simple questions — and there’s no medical exam. What could be simpler? Term Life is a dependable plan Coverage begins with level term life insurance for a duration of 10, 20, or 30 year options.

• Premiums are based on age and tobacco/non-tobacco use. • Death benefit ranges from $10,000 - $100,000 • Offers portability should you terminate or retire. • Protection is offered through age 75 • Work life benefits offer 24/7 grief counseling as well an access to an exclusive

web portal which features articles, videos and financial planning tools. • Terminal illness benefits accelerate payment of the life insurance death benefit.

Payment is available in the event of your future terminal illness diagnosis (with 12 months or less to live). For the terminal illness benefit, the maximum advance is 75 percent of the base policy.

Optional benefits

• Waiver of premium – Available to employees through age 55. This optional benefit waives the employee’s premium in the event his or her total disability lasts for more than 6 months.

• Accidental death, loss of sight and dismemberment – Offers an additional payment of the life insurance benefit when a loss results from a serious accident or death.

• Increasing death benefit – At each of the first five coverage anniversaries, the death benefit can be increased by the coverage amount purchased for an additional $1 or $2 weekly premium.

• Family coverage – Offers spouse (to Age 65) coverage up to $50,000 and child coverage up to $10,000 (for each insured child). Insurance for a dependent cannot exceed the employee’s coverage amount.

• Children are covered through age 25. All children are covered with a single premium, regardless of the number of children.

Colonial – Term Life… VOLUNTARY TERM LIFE INSURANCE Term Life Insurance Helps protect your assets Employees (and their loved ones) are concerned about financial security. Each plan offers employees coverage they can access in health, life and death circumstances. When you compare these plans to comparable coverage, you’ll find level Term Life offers solid coverage per payroll deduction dollar. That means you get increased protection at surprisingly affordable rates. If you enroll when you are first eligible you can receive guarantee issue without a medical review (levels depend on age). The benefits are clear and easy to understand. Best of all, you can enroll at work with just a few simple questions — and there’s no medical exam. What could be simpler? Term Life is a dependable plan Coverage begins with level term life insurance for a duration of 10, 20, or 30 year options.

• Premiums are based on age and tobacco/non-tobacco use. • Death benefit ranges from $10,000 - $100,000 • Offers portability should you terminate or retire. • Protection is offered through age 75 • Work life benefits offer 24/7 grief counseling as well an access to an exclusive

web portal which features articles, videos and financial planning tools. • Terminal illness benefits accelerate payment of the life insurance death benefit.

Payment is available in the event of your future terminal illness diagnosis (with 12 months or less to live). For the terminal illness benefit, the maximum advance is 75 percent of the base policy.

Optional benefits

• Waiver of premium – Available to employees through age 55. This optional benefit waives the employee’s premium in the event his or her total disability lasts for more than 6 months.

• Accidental death, loss of sight and dismemberment – Offers an additional payment of the life insurance benefit when a loss results from a serious accident or death.

• Increasing death benefit – At each of the first five coverage anniversaries, the death benefit can be increased by the coverage amount purchased for an additional $1 or $2 weekly premium.

• Family coverage – Offers spouse (to Age 65) coverage up to $50,000 and child coverage up to $10,000 (for each insured child). Insurance for a dependent cannot exceed the employee’s coverage amount.

• Children are covered through age 25. All children are covered with a single premium, regardless of the number of children.

COLONIAL - TERM LIFE

28

Colonial – Universal Life...

VOLUNTARY UNIVERSAL LIFE INSURANCE Universal Life insurance offers permanent protection while living. Universal life insurance can be a solid foundation upon which to build a long-term financial plan because it guarantees lifetime protection for your family. Purchasing life insurance is an important decision — one that impacts both current financial needs as well as future financial requirements. Universal life insurance is a product that can have a positive influence on both of these areas of life. Universal Life ensures that family and dependents are financially protected with money that can be used for:

• Final expenses such as funeral costs. • Immediate needs such as probate expenses. • Continuing needs – ongoing bills such as utilities. • Debt liquidation such as paying off loans or a mortgage. • Future expenses such as education funds or retirement needs.

Universal Life plan features: • Guaranteed renewable to age 100 with a guaranteed death benefit payable to your

beneficiary’s tax free. • Guaranteed cash value - The policy accumulates cash that can be withdrawn (upon the

policy’s surrender), borrowed against as a loan, annuitized and paid out as a monthly income (upon the policy’s surrender), or used to purchase extended term or reduced paid-up insurance.

• Policy is portable. • Loans available at any time while policy has a cash value. • Accelerated Benefit for Terminal Illness: • Provides a lump sum of 75% of death benefit (base and term rider) upon diagnosis of a

terminal illness. • Life expectancy of 12 months or less. • Twelve (12) month waiting period (illness must be diagnosed at least 12 months after

the date of policy). • Benefit may be used only once.

Family Term Rider • May be added at original policy issue • Terminates when base plan is terminated • Spouse Benefit • Benefit Amount – Up to $50,000 (not to exceed primary insured’s benefit) • Issue Ages and Rate Ages – 18-55; Uni-sex / Uni-Tobacco • Child(ren) Benefit Amount – Coverage up to $10,000 not to exceed primary insured’s

benefit available in ($1,000 increments).

Available on employee or spouse standalone policy.

COLONIAL - UNIVERSAL LIFE

29

401K… There are many great benefits to being part of the BSN 401(k) Plan. One of those benefits is exceptional customer service – online or by phone. In fact, you can count on your company and Principal Financial to help support you every step of the way.

Best practices to consider: • The impact of an early start. Your decision to start today could give you quite a bit more at

retirement than starting five years from now. • We recommend starting your 401(k) at 3% to take full advantage of the BSN match but do

what you can afford. You can change it the first of any month. The important thing is to invest what you can afford and start right away.

• Invest more in your plan, pay less in taxes. Your pretax contributions come out of your pay before income taxes are taken out. You can actually lower your current taxes by investing in the plan today. The plan also offers a post-tax or Roth contribution option. You can enroll in by visiting the Principal Fidelity website at www.principal.com or call (800)986-3343. Enroll Today!!!!

Who can join the plan?

Eligibility Requirements

All contributions Attain Age 21 Completed 1 month of service

Contributions

Employee Contributions

1% to 80% of eligible pretax pay EGTRRA Catch Up Provision

Company Matching Discretionary

Vesting Employee Contributions 100% immediate Company Matching

Years of Service for Vesting Percentage less than 2 0

2 20 3 40 4 60 5 80 6 100

Loans You may have one (1) loan outstanding at one time. Be sure you understand the plan guidelines and impact of taking a loan before initiating a loan from your plan.

Withdrawals They are generally permitted in the event of termination of employment, retirement, disability, or death. You may also be eligible for a withdrawal in the case of a severe financial hardship as defined by your plan and at age 59.5 years of age.

2016 Calendar year Limits

Regular 401k Employee Contributions $18,000

Catchup Contributions (Age 50 Older) $6,000

Roth Contributions $5,500

Catchup Contributions for Roth $1,000

401K

30

Enrolling is Easy... TAKE CARE OF YOUR BENEFITS IN A FEW SIMPLE STEPS. Just follow the steps below to make your benefit choices. For benefits and/or enrollment questions, contact HR at 800-230-0055. FOR PASSWORD RESETS CONTACT THE IT HELP DESK.

STEP 1 Review your Benefits Guide so you are prepared for your enrollment. Keep a pen or pencil handy to make notes about your benefit elections. Have the social security numbers and dates of birth of your applicable

dependents and beneficiaries. Go to www.workforcenow.adp.com to enroll online. The Company Key is BSNSPORTS-IPAY

If you have never registered on the portal before, please go to First Time Users and click on “REGISTER HERE” and follow the screen prompts to get registered.

If you have previously registered, begin by clicking on “User ID”. Your user name, in most cases, is your first initial and your last name@BSNsports. Note, there is no “.com” after the BSNsports. Example: Joe Sport’s login would be jsport@BSNsports Your password is something you set up when you registered. If you forget your password, click on “Forgot Your User ID/Password” and answer the challenge questions.

If you are still unable to access the ADP portal, please contact the IT Helpdesk at (877)711-2920 or email them at [email protected].

ENROLLING IS EASY

31

Enrolling is Easy… STEP 2

Once you enter the site, click on “MYSELF” then “BENEFITS” then “ENROLLMENTS”

STEP 3

Watch the how to enroll video by clicking on the “Play Button” then click on “Enrollments Learning Byte(s)”

ENROLLING IS EASY

32

The following webpage will open, click on “Enrolling in a Benefit Plan”, the instructional video will play.

The video will show you step by step instructions on how to complete your enrollment. You can re-watch the video at any time for help.

THINGS YOU NEED TO KNOW: You will not be able to see Colonial benefits pricing. If you are interested in

obtaining pricing for the colonial products, contact: Melinda Albritton at (817)992-0262 or via email at [email protected]. HR will enter the appropriate deduction into payroll once received from Colonial.

If you are enrolling dependents, you must add them to the ADP database before

you can enroll as outlined in the video.

You cannot be enrolled in the regular FSA and the HSA at the same time. If you elect the Non Traditional plan with the HSA you may elect to participate in the Limited FSA plan. If you elect the Traditional Plan you may enroll in the Regular FSA plan.

Your enrollment is not complete until you have clicked on “Complete

Enrollment” and see the green changes submitted bar.

ENROLLING IS EASY

33

BENEFITS INFORMATION CENTER

www.BSNSPORTS.com/hrbenefits2017Watch our series of helpful videos @

34

NOTES

35

Benefits Contacts… BSN HR CONTACTS

Benefits Manager (800)230-0055 X 7189

VPHR (800)230-0055 X 7187

Payroll Manager (800)230-0055 X 7186

AETNA MEDICAL & METLIFE DENTAL

AETNA – (800)222-1519 Group# 283924

Website: www.aetnanavigator.com Medical Network: POS II

MetLife – (800)942-0854

Group#0314118 Website: www.mybenefits.metlife.com

Dental Network: MetLife PDP Plus

VOLUNTARY PROVIDERS

Colonial & Unum: Melinda Albritton

[email protected] (817)992-0262

EYEMED – (866)804-0982 Group # 1003330

Website: www.eyemed.com

TelaDoc/LifeLock – (800)800-7616 Client ID# 75241L

Website: http://www.mymemberportal.com

Colonial Life – (800)325-4368 Website: www.coloniallife.com

Unum – (800)679-3054 Website: www.unum.com

Principal Financial (800)986-3343 Website: www.principal.com



VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330









VPHR (800)230-0055 X 7187



AETNA – (800)222-1519 Group# 283924


MetLife – (800)942-0854



VOLUNTARY PROVIDERS



EYEMED – (866)804-0982 Group # 1003330







BENEFITS CONTACTS


Website: www.coloniallife.com

Website: www.unum.com

Website: www.mybenefits.metlife.com

36

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Farmers Branch, TX 75234(800) 230-0055

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our promises and wow our customers.

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1901 Diplomat Drive Farmers Branch TX 75234

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