2023

EMPLOYEE BENEFIT GUIDE

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M A S JAC KSO N W H ITFIE L D j a ckso n @ j t sfs.co m 501.400.1818

M ELYNDA BATS O N m ely n d a @ j t sfs.co m 501.441.3157 Fa x: 888.965.4050 Bu sin ess Ho u rs: M o n d ay-Th u rsd ay, 8:00- 5:00

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TABLE OF CONTENTS

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BENEFITS HEALTH INSURANCE.................................................... MYBLUEPRINT PORTAL................................................ DENTAL INSURANCE.................................................... DELTA DENTAL PORTAL............................................... VISION INSURANCE...................................................... SHORT TERM DISABILITY.............................................. LONG TERM DISABILITY................................................ CANCER INSURANCE.................................................... FLEXIBLE SPENDING ACCOUNT.................................. MASA.............................................................................. TRANSAMERICA WELLNESS.........................................

M A S

4-5 6 7 8 9 10 11 12 13 14 15

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EMPLOYER PAID EMPLOYEE PAID

HEALTH INSURANCE H e alt h i n su ra nce cover s yo u a n d yo ur fa m il y fo r yo ur ba s ic h ea lth need s af ter you’ve met your cove rag e dedu c t ib l e ( so m e ben efits in c l ude co pay a f ter deduc t i ble). Coverage i nclues vi si ts wi th a p r i mar y c a re physic ia n a n d s pec ia l t y phys ic ia n s, in patient a n d outpati ent hospi tal care, and a mb u lan ce ser vices.

HEALTH BENEFITS

In-Network

Out-of-Network

DEDUCTIBLES Individual

$2,000

Family

$4,000

Coinsurance

80%

E L $4,000 $8,000

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60%

OUT-OF-POCKET MAXIMUMS (INCLUDES DEDUCTIBLE AND COPAYS) Individual Family PREVENTIVE SERVICES

$7,750

M A S $15,500

$31,000 $62,000

Primary Care Physician Office Visit

$30

Specialist Office Visit (Consultation/Evaluation only)

$50

Ded + 40% coinsurance

Preventive Care / Screening / Immunization

No Charge

Not Covered

Diagnostic Testing (X-ray, Blood Work)

Ded + 20% coinsurance

Ded + 40% coinsurance

Imaging (CT/PET Scans, MRIs)

Ded + 20% coinsurance

Ded + 40% coinsurance

Outpatient Facility Fee

Ded + 20% coinsurance

Ded + 40% coinsurance

Outpatient Physician/Surgeon Fees

Ded + 20% coinsurance

Ded + 40% coinsurance

Inpatient Facility Fee

Ded + 20% coinsurance

Ded + 40% coinsurance

Inpatient Physician/Surgeon Fees

Ded + 20% coinsurance

Ded + 40% coinsurance

Emergency Room Care

Ded + 20% coinsurance

Ded + 20% coinsurance

Emergency Medical Transportation

Ded + 20% coinsurance

Urgent Care

$50 copay + Ded +20% coins

Ded + 40% coinsurance

HOSPITAL AND OTHER RELATED BENEFITS

(Ground - Limited to $1000 / Trip; Air - Limited to $5000 / Trip)

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Ded + 20% coinsurance Ded + 40% coinsurance

HEALTH BENEFITS

In-Network

Out-of-Network

MISCELLANEOUS BENEFITS (CONT.) Office Visits for Pregnancy

Ded + 20% coinsurance

Childbirth/Delivery Professional Services

Ded + 20% coinsurance

Childbirth/Delivery Facility Services

Ded + 20% coinsurance

Ded + 40% coinsurance

Home Health Care

Ded + 20% coinsurance

Ded + 40% coinsurance

Rehabilitation Services (Inpatient)

Ded + 20% coinsurance

Not Covered

Rehabilitation Services (Outpatient)

$30 copay

Not Covered

Habilitation Services (Outpatient)

$30 copay

Skilled Nursing Care

Ded + 20% coinsurance

Durable Medical Equipment

Ded + 20% coinsurance

Hospice Services

Ded + 20% coinsurance

PRESCRIPTIONS Preventive Drugs Generic Drugs

$15 copay

Preferred Brand Drugs

$40 copay

Ded + 40% coinsurance

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Not Covered Ded + 40% coinsurance

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M A S $0

Ded + 40% coinsurance

Ded + 40% coinsurance Ded + 40% coinsurance

Not Covered Not Covered Not Covered

$70 copay

Not Covered

$140 copay

Not Covered

Non-Preferred Specialty Drugs

$280 copay

Not Covered

Home Infusion Therapy Pharmacy Injectable Medications

Ded + 20% coinsurance

Ded + 40% coinsurance

Non-Preferred Brand Drugs Preferred Specialty Drugs

COVERAGE TIER Employee

BI-WEEKLY RATE $0.00

Employee + Spouse

$166.28

Employee + Child(ren)

$141.34

Family

$307.62

$15,000 USAble Basic Life/AD&D coverage is automatically included if enrolled in group Health Insurance

Benefits reduce by 35 % at age 65 Benefits reduce by 50% at age 70

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MYBLUEPRINT PORTAL B lu e Ad va nt a g e Ad m inistrato r s o f Ar k a n s a s m em ber s h ave a ccess to health plan i nfor mati on 2 4 h ou rs a d ay, seven d ays a week w ith Bl uepr int Po r ta l. Yo u c a n access, share or ord er a replacement ID card, review c l a im s st at us a n d h is to r y, a n d c h ec k yo ur deduc ti ble. You can also f i nd a prov i d e r i n n e t wor k , estim ate yo u r t reatm ent co s t a n d m uc h m o re.

How to register for Blueprint Portal • • •

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Go to blueprintportal.com Select Register Follow the instructions. All you need is your: » Member ID or the last four digits of your Social » Security number » Name » Date of birth And anyone covered on your health plan can set up a Blueprint Portal account.

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Already registered?

If you’re already a Blueprint Portal user, simply go to blueprintportal.com and enter your username and password to sign in and access your account.

No ID Card? No Problem!

With the Blueprint Portal app, you can access, share or fax your ID card while in your doctor’s office. You can also access many more Blueprint portal features.

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EMPLOYER PAID EMPLOYEE PAID

DENTAL INSURANCE

H av i n g d ent a l insu ra nce contr ibutes to yo ur over a l l wel l -bein g. D ental i nsurance provi d es cove rage fo r preventative, ba s ic, a n d m a j o r s er v ices. DENTAL BENEFITS DEDUCTIBLES Individual

$50

Family

$150 per family per Benefit Year

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ANNUAL MAXIMUMS Individual

$1,000 per person total per Benefit Year

DIAGNOSTIC & PREVENTATIVE

In-Network

Cleanings, exams and x-rays

100%

Sealants

100%

Brush Biopsy Periodontal Maintenance

100%

BASIC SERVICES

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M A S 100%

In-Network

Out of Network 90% 90% 90% 90% Out of Network

Fillings (amalgam and composite)

80%

70%

Emergency Palliative Treatment

80%

70%

80%

70%

80%

70%

In-Network

Out of Network

Minor Restorative Services Other Basic Services MAJOR SERVICES Orthodontics

50% / $1,000 lifetime maximum

Endodonitics

50%

Oral Surgery

50%

Periodontics

50%

Crowns

50%

Coinsurance

50%

Orthodontia Age Limitation

40% Up to age 19

COVERAGE TIER

Employee

BI-WEEKLY RATES $0.00

Employee + Spouse

$13.16

Employee + Children

$15.69

Family

$31.87

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DELTA DENTAL PORTAL You r oral hea l th is im p o r ta nt to D el ta D enta l — a n d to yo ur overall health! We’ve d esi gned our m o b i l e ap p to m a k e it ea sy fo r yo u to m a k e th e m o s t o f yo ur dental benef i ts. M axi mi ze your health, w h e re ve r yo u a re! S ea rc h fo r a dentis t n ea r yo u, v iew ID c a rds, and more, r i ght on your mobi le de v i ce.

Create your online account in three easy steps: 1. 2. 3.

Identify your user type, selecting “Enrollee/Adult Dependent” from the drop-down list. Enter your personal information. Create your username and password and enter your email address. You will also be asked to choose a challenge question and answer in case you forget your password.

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L o g i n t o your a c c ount from our we bs it e by s e le c t ing t he login b u tto n o r d o w n l o ad th e free De lta De nt a l a pp t o a c c e s s y our a c c ount o n th e g o .

Getting Started

Delta Dental Mobile App Features

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Th e D e lt a D enta l M o b il e App is opt i mi ze d fo r iOS (Appl e) a nd An d ro i d d e vices. To d ow nl o a d ou r ap p on yo u r d evice, visit t he App Sto re (Appl e) o r G o o g l e Pl ay (An dro i d ) an d sea rc h fo r D el t a D enta l M obile Ap p. O r u se yo u r pho ne’s QR Code R e ad e r to sc a n t he co d e b el ow.

Ac ce ss your Mo bil e ID ca r d No n eed fo r a pa pe r c a rd. Vi e w a n d s h a re yo u r ID ca rd fro m you r ph o n e, a n d e a s i l y s ave i t to yo u r d evice fo r qu i c k a cce s s, i n c l u d i n g Appl e Pa ssb o o k a n d G o o g l e Wa l l e t.

Review your p l a n c ov e r ag e C h eck b en efit s a n d e l i gi bi l i ti e s fo r yo u r d ent a l p la n .

See your cl aims

Lo o k u p d et a ile d c l a i ms i n fo r mati o n fo r yo u r d ent ist visit s ove r th e l a s t 1 8 mo nth s.

e stimat e den ta l ca r e c o s t O u r ea sy- to - u s e D e nta l Ca re Co s t E s ti mato r to o l p rovid es e s ti mate d co s t ra n g e s fo r co m m o n d ent al c a re n e e d s. *

find a dentis t I t ’s ea sy to fin d a d e nti s t n e a r yo u. S e a rc h a n d co m p a re d e nta l o f f i ce s to f i n d o n e th at su it s yo u r n eed s. S ave yo u r f a mi l y ’s pre fe r re d d ent ist s to yo u r a cco u nt fo r e a s y a cce s s.

save your pr e f e r r e d de n tis t S ave yo u r favo r i te d e nti s ts u s i n g th e D e l ta D ent a l M o b ile App fo r qu i c k a cce s s to co nta c t in fo r m at io n m a k i n g i t e a s y to s c h e d u l e yo u r ro u t in e c lea n ing.

8 *A p p fe a tu res ma y v a r y b y g e o g r a p h i c a r e a a n d i n d i v i d ual dent is t part ic i pat ion.

EMPLOYER PAID EMPLOYEE PAID

VISION INSURANCE

Vi s i o n i n s u ra nce is o f fered to h el p em pl oyees by prov idin g a fford able access to hi gh- q uali t y eye care an d eyewea r. An indiv idua l o r fa m il y v is io n in s ura n ce pl a n saves you money on f rames, lense s, cont ac t s, eye ex a m s a nd m o re.

VISION SERVICES Exam Copay

$10

Frames and/or Lenses Copay

$10

Contact Lens Fitting Copay

$10

U p to $ 3 6 re ta i l

N o t cove re d

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Elective Allowance

Contact Lens Fitting Exam Specialty

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U p to $ 4 5 re ta i l

CO N TAC TS

Contact Lens Fitting Exam Standard

O u t- o f - N e t wo r k Co s t R e i mbu r s e me nt

I n - Net wo r k

$150 ret a il a llowa n ce

M A S

Covered in fu ll a f ter co p ay

U p to $ 8 0 re ta i l U p to $ 2 1 0 re ta i l

$50 ret a il a llowa n ce a f ter co p ay

N o t Cove re d

$150 ret a il a llowa n ce a f ter co p ay

U p to $ 4 5 re ta i l

Covered in fu ll a f ter co p ay

U p to $ 2 8 re ta i l

Bifocal Allowance

Covered in fu ll a f ter co p ay

U p to $ 4 2 re ta i l

Trifocal Allowance

Covered in fu ll a f ter co p ay

U p to $ 5 6 re ta i l

Lenticular Upgrade

Covered in fu ll a f ter co p ay

U p to $ 7 8 re ta i l

L E NSES Frames Single Vision Allowance

COVERAGE TIER

BI-WEEKLY RATES

SERVICES

FREQUENCY

Exam

1 2 m o nt h s

Employee

$0.00

Lenses

1 2 m o nt h s

Employee + Spouse

$3.35

Frames

1 2 m o nt h s

Employee + Child(ren)

$3.98

Contact Lenses

1 2 m o nt h s

Family

$7.13

Contact Lens Fitting Exam

1 2 m o nt h s

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EMPLOYER PAID

SHORT TERM DISABILITY Shor t te r m d isa b il it y insu ra nce prov ides in co m e pro tec tio n in th e event that you mi ss wor k d ue to an acci d ent o r il l ness.

SHORT TERM DISABILITY BENEFITS BENEFIT AMOUNT

6 0% o f week ly ea r n in gs

M A X I M U M W E E K LY BENEFIT

$ 1,000

MAXIMUM BENEFIT D U R AT I O N

T E R M I N AT I O N S

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E L I M I N AT I O N P E R I O D

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Th e 8t h co n secu t ive d ay o f d isabi l i t y o r i l l n e s s.

1 2 weeks

U p o n ter m in at io n o f em p loy m ent

EMPLOYER PAID

LONG TERM DISABILITY Lo n g te r m disa bil it y insu ra nce prov ides in co m e pro tec tio n in the event that you mi ss wor k d ue to an accident o r il l ness.

LONG TERM DISABILITY Maximum Benefit

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60% of monthly earnings

Maximum Monthly Benefit

$8,000

Elimination Period

90 days

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Own Occupation Period Employer contribution % Age at Disablement 61 or less 62 63 64 65 66 67 68 69 or more

24 months

M A S

100%

Duration of Benefits to age 65

3 1/2 years 3 years 2 1/2 years 2 years 1 3/4 years 1 1/2 years 1 1/4 years 1 year



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VOLUNTARY

CANCER INSURANCE

Can ce r i n su ra nce p ays m ed i c a l a n d n o n -m edic a l ben efits direc t ly to the poli c yhold er to help pay for t h e co st s o f c a ncer treatm ent. A c a n cer in s ura n ce po l ic y h elps employees avoi d the f i nanci al st rai n can cer c a n c reate so t h ey c a n fo c us o n recover y.

CANCER INSURANCE

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ISSUE AGES EMPLOYEE ISSUE AGES

18+

EMPLOYEE & CHILD(REN)

18+

CHILD ISSUE AGE

BIRTH THROUGH 25

BENEFITS

CANCER SELECT PLUS PLAN 1

Surgery Benefits

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M A S

Hospital Benefits (Daily Hospital)

Radiation/Chemotherapy Benefits

$100

$1,000

$10,000

Wellness and Misc Benefits

$100

Cancer Maint. Therapy Benefits

$1,000

First Occurence Rider

$2,000

COVERAGE TIER

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CancerSelect Plus Plan 1 Bi-Weekly Rates

Individual

$8.52

Single Parent Family

$9.86

Family

$15.72

FLEXIBLE SPENDING ACCOUNT An F SA a l l ows yo u to save up to 30% o n yo ur el igibl e h ea l th c a re and /or d epend ent care expenses e ve r y ye a r by u sing re - t a x do l l a r s. O ffer in g a F S A a s pa r t o f a n employee benei f ts program provi d es valu ab le benef it s to bo th e m pl oyer s a n d th eir el igibl e em pl oye es.

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EMPLOYEE BENEFITS •

Reduces income tax (Federal, State, and FICA): pre-tax payroll contributions result in a lower taxable salary. • Saves on the cost of eligible healthcare and/or dependent care expenses: using pre-tax dollars spells out a savings of nearly 30%. • Offers immediate access to elected healthcare FSA funds. • Covers common types of expenses: medical, dental, ortho, vision, prescription drugs, individually purchased health or dental insurance and more.

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HOW IT WORKS

An employee who participates in the FlexSystem FSA must place a certain dollar amount into the FSA each year. This “election” amount is automatically deducted from the employee’s check (for that amount divided by the number of payroll periods). For every dollar you put into these accounts, the more money you save by paying less in taxes. As you incur eligible expenses, you simply submit a request for reimbursement to Consolidated Admin to received reimbursement from your FSA, up to the amount of your annual contribution. For additional convenience, your employer has provided you with a CONSOLIDATED ADMIN card to purchase eligible medical expenses with your FSA funds at the point of purchase, eliminating the need for reimbursement. FOR EMPLOYEES/PARTICIPANTS

• Convenient CAS Card• Consolidated Admin Mobile Technology (mobile app) • Multiple account management tools (web, phone, and fax)• Fast reimbursements• Toll-free Customer Care Center• Easy online enrollment or re-enrollment• Tax Savings Calculator MAXIMUM CONTRIBUTIONS AMOUNTS FOR GRASS ROOTS EMPLOYEES $3,050 Medical Reimbursement

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MEDICAL TRANSPORT SOLUTIONS (MASA) Th e h i gh co st o f em erg ent a n d n o n - em ergent tra n s po r tatio n results i n unexpec ted out of pocket ex p e n s e s. MAS A pro tec ts mem ber s fro m th es e expen s es rel ated to emergenc y ai r transpor tati on an d ground a m b u l a nce c ha rges.

ANY GROUND. ANY AIR. ANYWHERE. BENEFITS

PLATINUM

EMERGENT PLUS

Cost

$39/month

$14/month

Family Included

Yes

Yes

Emergent Ground Transportation (U.S. & Canada)

Yes

Yes

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M A S

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Emergent Air Transportation (U.S. & Canada)

Yes

Yes

Repatriation (Worldwide)

Yes

Yes

Non-Emergent Interfacility Transportation (Worldwide)

Yes

Yes

Return Transportation (Worldwide)

Yes

No

Yes

No

Yes

No

Pet Return (Basic Coverage Area) Yes

No

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Minor Children/Grandchildren Return (Basic Coverage Area)

Yes

No

•

Mortal Remains Transportation (Worldwide)

Yes

No

Vehicle Return (Basic Coverage Area)

Organ Transplant Transportation (U.S. & Canada)

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TM

Global Reach Emergent Plus (US 50/ Canada), Platinum (up to worldwide) Leading company in the Industry The only plans that cover at home and away MASA steps in where insurance falls short by helping protect families against uncovered costs MASA also provides many benefits not covered by insurance Any Ground. Any Air. Anywhere TM Simply contact 911 for Emergency Transport Covers any of the 1,500+ Air Ambulances in US with 300 different Provider Companies Covers any of the 21,000 Ground Ambulance Providers in the US US Based Support, Local Reps, Simple Enrollment, Easy Claims, and Online access

TRANSAMERICA EMPLOYEE BENEFITS

CLAIMS-EXPRESS CANCER & WELLNESS File Claims Quick and Easy File TransConnect, Cancer, and Wellness Claims online. Transamerica’s claim filing process is a snap! Customers can submit claims online, phone or fax for TransConnect and benefits along with wellness claims for cancer benefits. How to File Claims Online Customers register at www.tebcs.com then complete the online form and upload documentation to support their requests. Following submission, customers may view the status, review the submitted claim form and documentation. Once the claim is processed, the Explanation of Benefits (EOB) statement will be available online as well. How to File a Claim by Phone or Fax Contact the Transamerica Claims Customer Service Department at (800) 251-7254 and press 2 or fax directly to the Claims Department at (866) 5866528. The following information must be provided: + Insured’s name/ policy number

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+ Covered person’s name, date of birth and relationship to insured

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+ Doctor and facility name, address and phone number + Name of test/procedure + Date of test/procedure

+ (Fax only) Provider’s billing statement, which includes the test/procedure and the date it was performed File Claims for Other Products Claims for other products may be completed by downloading the respective claim form at www.tebcs.com. Once the proper documentation is received, the claim will be processed.

QUESTIONS ABOUT CLAIMS Call the Claims Customer Service Department at (800) 251-7254 and press 2.

EBD HOWL-1113

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Customer Service Ja ck s o n Wh i tf i e l d 1 ( 50 1 ) 4 0 0 . 1 8 1 8 | ja ck s o n @jts fs.co m M e l y n d a Bats o n 1 ( 50 1 ) 4 4 1 . 3 1 5 7 | m e l y n d a @jts fs.co m Fa x : 1 (8 8 8 ) 9 6 5 . 4 0 5 0 B usi n e s s H o u rs : M onday-Thursday,

8:00-5:00; Fr iday, 8:00-4:00

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