The benefits plan year runsJanuary 1st through December 31st. Unless you have a qualified change-in-status event that impacts your eligibility and the change is allowed under the terms of the insurance contract or plan document, you cannot make changes to your benefits until the next Open Enrollment period.Benefit changes must be consistent with your qualified change-in-status event.Mid year changes must be submitted to Human Resources within 30 days of the event; documentation supporting the change will be required.Who is eligible for benefits?All full-time employees who work a minimum of 30 hours per week are eligible for benefits. For new hires, benefits are effective on the first of the month following 30 days of employment.In addition to enrolling yourself, you may also enroll any eligible dependents. Eligible dependents are defined below:• Spouse: a person to whom you are legally married by ceremony• Child(ren): Your biological, adopted, or legal dependents up to age 26 regardless of student, financial, and marital status; coverage for a dependent child will terminate at the end of the month in which the child turns age 26Change-in-Status EventsUnless you have a qualified change-in-status event that impacts your eligibility and the change is allowed under the terms of the insurance contract or plan document, you cannot make changes to the benefits you elect until the next Open Enrollment period. Some examples of qualified change-in-status events are highlighted below:Marriage or divorceBirth, adoption, or deathChange in employment, or employment status for you, your spouse, or your dependent childChange in coverage under another employer plan, such as a change made during your spouse’s Open EnrollmentPusch & Nguyen takes pride in providing a comprehensive employee benefits program, and we recognize the important role employee benefits play as a critical component of your overall compensation. We strive to maintain a benefits program that is rewarding and competitive.WHAT’S INSIDEEmployee Resources Employee Contributions Medical Highlights Flexible Savings Account (FSA / DCFSA) Dental Highlights Vision Plan Highlights Life/AD&D Disability Employee Assistance Program Travel Assistance Program2
EMPLOYEE RESOURCESTHERE’S AN APP FOR THAT!EMPLOYEE CONTRIBUTIONS Based on 26 pay periods per yearPlan Features EmployeeEmployee + SpouseEmployee + Child(ren)FamilyMEDICAL—BlueCross BlueShieldBase: $3,000/70% HMO (MTBAB026)$18.01 $178.59 $212.47 $373.05Mid: $3,000/70% PPO (MTBCB026)$62.99 $263.69 $306.04 $506.73Buy up: $1,500/80% PPO (MTBCB014)$100.44 $334.52 $383.92 $618.00DENTAL—Principal Dental Plan $1.17 $13.81 $18.64 $33.37VISION—PrincipalVision Plan $0.40 $4.25 $4.74 $9.463Plan Policy Number Phone Number and Website/EmailMedicalBlueCross BlueShield311242(800) 521-2227www.bcbstx.comDentalPrincipal1134907(800) 247-4695www.principal.com/dentist VisionPrincipal1134907(800) 877-7195www.principal.com/vspLife and Voluntary Life InsurancePrincipal1134907(800) 245-1522www.principal.comDisability InsurancePrincipal1134907(800) 245-1522www.principal.comEmployee Assistance ProgramPrincipal1134907(800) 450-1327www.magellanhealth.com/member Travel Assistance ProgramPrincipal1134907(888) 647-2611www.principal.com/travelassistance
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.KEY TERMS TO REMEMBER & HDHP/HSA PLAN DETAILSANNUAL DEDUCTIBLEThe amount you must pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).OUT-OF-POCKET MAXIMUMThis is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible*, copays and coinsurance.*Except for Grandfathered medical plansCOPAYS AND COINSURANCEThese expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service and is generally billed to you after the health insurance company reconciles the bill with the provider.Medical4PLAN TYPESPPO – A network of doctors, hospitals, and other healthcare providers. You have coverage in and out of network.HMO – A network of doctors, hospitals, and other healthcare providers that offers only in-network coverage. There is no out-of-network coverage outside of a true emergency. 4
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Overview of Benefit Programs5Pusch & Nguyen provides an array of benefits that can help you enjoy increased well-being, deal with an unexpected illness or accident, build and protect your financial security, balance your personal and professional life and meet everyday needs. These benefits are affordable, comprehensive and competitive.The table below summarizes the benefits available to eligible staff and their dependents. These benefits are described in greater detail in this booklet.5Benefits Funding Carrier Medical & Prescription DrugsEmployee + DependentsShared funding Blue Cross Blue Shield Dental PPO PlanEmployee + DependentsShared funding Principal Life Insurance CompanyVision PlanEmployee + DependentsShared funding Principal Life Insurance Company/ VSPGroup Life / AD&DEmployee Only100% Employer PaidPrincipal Life Insurance CompanyVoluntary Life/AD&DEmployee + Dependents100% Employee PaidPrincipal Life Insurance CompanyShort-Term DisabilityEmployee Only100% Employer PaidPrincipal Life Insurance CompanyLong-Term Disability Employee Only100% Employer PaidPrincipal Life Insurance CompanyEmployee Assistance Program (EAP)Employee + Dependents100% Employer PaidPrincipal Life Insurance CompanyTravel Assistance Program Employee + Dependents100% Employer PaidPrincipal Life Insurance Company
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.MEDICAL & PRESCRIPTION PLAN HIGHLIGHTS6We offer three plans for you to choose from. To locate a participating, in-network provider, visit www.bcbstx.com. Plan Option 1 Plan Option 2 Plan Option 3$3,000 HMO (MTBAB026) $3,000 PPO (MTBCB026) $1,500 PPO (MTBCB014)In-Network ONLY: YOU PAY In-Network ONLY: YOU PAY In-Network: YOU PAYAnnual Deductible$3,000 individual $3,000 individual $1,500 individualAmount you must pay before the plan will begin to pay for certain services.$9,000 family $9,000 family $4,500 familyCoinsuranceYour responsibility after annual deductible has been met.Annual Out-of-Pocket Maximum$7,350 individual $7,350 individual $4,500 individualMaximum amount you pay per year for covered expenses$14,700 family $14,700 family $13,500 familyOFFICE VISITS, LABS, AND TESTINGPreventive Services (wellness visit)No charge No charge No chargePrimary Care Physician Visits$50 Copay $50 Copay $35 CopayVirtual Visit$50 Copay $50 Copay $35 CopaySpecialist Office Visits$100 Copay $100 Copay $70 CopayDiagnostic Test (x-ray, blood work)30% after deductible 30% after deductible 20% after deductibleImaging (CT/PET scans, MRIs)30% after deductible 30% after deductible 20% after deductibleHOSPITALInpatient/Outpatient30% after deductible 30% after deductible 20% after deductibleURGENT AND EMERGENCY CAREUrgent Care Facility$75 Copay $75 Copay $100 Copay$500 Copay + $500 Copay + $500 Copay + 30% after deductible 30% after deductible 20% after deductibleParticipation / Non-Participating Participation / Non-Participating Participation / Non-Participating$0 / $10 / $20 / $50 / $70 / $100 / $120 / $150 / $250$0 / $10 / $20 / $50 / $70 / $100 / $120 / $150 / $250$0 / $10 / $20 / $50 / $70 / $100 / $120 / $150 / $250OUT-OF-NETWORK$6,000 individual $3,000 individual$18,000 family $9,000 familyCoinsurance N/A 50% 50%Out-of-Pocket Maximum (individual / family)N/A Unlimited Unlimited Hospital Emergency RoomPRESCRIPTION DRUGSRetail Pharmacy, 30-day Annual Deductible (individual / family)N/APlan Features30%30%20%
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.FLEXIBLE SPENDING ACCOUNTS7What is a Flexible Spending Account (FSA)?FSAs provide you with an important tax advantage account that can help you pay health care and dependent care expenses on a pre-tax basis. By anticipating your family’s health care and dependent care costs for the next plan year, you can lower your taxable income. There are two types offered: 1. Healthcare FSA – Can be enrolled in any offered medical plans. 2. Dependent Care FSA – Available to any eligible employee, regardless of enrollment in a medical plan.Eligible ExpensesEligible health care expenses for the Health Care FSA include more than just your deductible and copayments. The IRS publishes a detailed annual list of qualified eligible expenses. Please see the FSA enrollment kit for a sample of eligible expenses. You can also visit the website www.irs.gov/publications/p502/index.html.“Use it or Lose it”Unlike an HSA account, according to IRS regulations, the money you contribute to the FSA must be used for expenses incurred during the plan year in which you make the election. Visit www.irs.gov for additional information about Flexible Spending Accounts.The Health Care FSA lets you pay for certain IRS-approved medical care expenses not covered by your insurance plan with pre-tax dollars. For example, cash that you now spend on deductibles, copayments, or other out-of-pocket medical expenses can instead be placed in the Health Care FSA, to pay for these expenses. The annual maximum contribution for 2024 to the Health Care FSA is $3,200. Funds contributed towards the Healthcare FSA are front-loaded. Eligible dependent care expenses include the cost of licensed childcare facility, nursery or preschool, and the cost of an adult dependent’s care inside or outside of your household. Funds contributed towards Dependent Care FSAs are not front-loaded. Keep these things in mind: • $5,000 annual maximum per household or $2,500 if married and filing separate tax returns.• To qualify, you and your spouse must be employed, or your spouse must be a full-time student.• Record expenses for dependent children under age 13 who you claim on your taxes or a disabled spouse/dependent of any age.• If dependent care expenses are reimbursed from your Dependent Care FSA, these expenses cannot be claimed as a dependent care tax credit on your federal tax return.Healthcare FSADependent Care FSA
Dental- PrincipalWe are pleased to offer you a comprehensive dental PPO plan. You can visit any licensed dentist, but your costs are usually lowest with an in-network dentist. In-network dentists accept reduced fees for covered services; out-of-network dentists may balance bill you the difference between their usual fee and what the plan pays.Need to locate a participating, in-network provider?To locate a participating provider, visit www.vsp.com DENTAL & VISION PLAN HIGHLIGHTSPrevention first!Make sure you take advantage of your preventive dental visits. Preventive care services are not subject to the deductible and the plan covers 100% of the cost if you visit an in-network provider!8Vision- Principal / VSPYour vision coverage provides a full range of vision care services. You may receive care from any provider you choose, but your benefits are greater when you see a participating provider in the network. If you choose to receive services from an out-of-network provider, you will be required to pay that provider at the time of service and submit a claim form for reimbursement.Plan Features In-NetworkOut-of-Network ReimbursementVision ExamOnce every 12 months$10 copay Up to $45Eyeglass FramesOnce every 12 months$0 copay; $130 allowance; 20% off balance over allowance Up to $70Eyeglass Lenses Once every 12 monthsSingleBifocal TrifocalLenticular$25 copay$25 copay$25 copay$25 copayUp to $30Up to $50Up to $65Up to $100Contact Lenses Once every 12 months in lieu of eyeglassesElective: $130 allowanceNecessary: $25 copayUp to $105Up to $210
Basic Term Life and AD&D Insurance (Company Paid)All full-time employees working 30 or more hours per week are automatically enrolled in the basic life benefit. While coverage is automatic, is critical that you complete a beneficiary form when first enrolling in benefits. You can change your beneficiary at any time and as frequently as needed. LIFE INSURANCEDuring your benefits enrollment, don’t forget to designate a beneficiary!9Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. Accidental death and dismemberment (AD&D) insurance provides an additional benefit if you lose your life, sight, hearing, speech, or limbs in an accident. Company Paid SummaryLife Benefit$25,000Accidental Death Benefit$25,000Spouse Life Benefit$5,000 or $10,000Reduction ScheduleBy 35% @ 65; 50% @ 70Additional BenefitsConversion, Accelerated Death Benefit, Waiver of PremiumVoluntary SummaryLife/AD&D Benefit- Employee- Spouse- Child(ren) [Term Life Only]$10,000 - $300,000$5,000 - $100,00050% of employee’s benefit up to $10,000Guaranteed Issue Coverage (no medical questions)- Employee- Spouse$100,000$25,000Reduction ScheduleBy 35% @ 65; 50% @ 70Additional BenefitsConversion, Accelerated Death Benefit, Waiver of PremiumVoluntary Term Life and AD&D Insurance (Employee Paid)All full-time employees working 30 or more hours per week are eligible to enroll in additional voluntary life insurance above and beyond the employer paid benefits. Voluntary term life rates are offered at heavily discounted group rates. So long as you enroll when first eligible, guaranteed coverage is also available to you, regardless of your current health status.
VOLUNTARY LIFE/ AD&D RATES10Note: This is an estimate of premium cost. Actual deductions may vary slightly due to rounding. To determine your bi-weekly deduction for Employee and Spouse coverage, use the chart below. First, locate the benefit amount you want. Second, find your age bracket. The premium amount is found in the box where the row (election amount) and column (age bracket) intersect. Example: Benefit Amount = $100,000 Age = 34 Premium = $5.45
DISABILITY INSURANCE11Short-Term Disability Plan Features Principal Group # 1134907Employee Benefit Amount 60%Maximum Benefit Amount $1,500 per WeekElimination Period (Waiting Period) 14 DaysBenefit Duration 11 WeeksPre-Existing Condition Exclusion NoneLong-Term Disability Plan Features Principal Group # 1134907Employee Benefit Amount 60%Maximum Benefit Amount $8,000 per MonthOwn Occupation Period 2 YearsElimination Period (Waiting Period) 90 DaysBenefit Duration Social Security Normal Retirement AgePre-Existing Condition Exclusion 3/12*Why do you need Long-Term Disability? (100% Employer Paid)A lengthy disability can be devastating and is more common than you may think. Long-term disability may lead to a loss of income, independence, and financial security. A disability insurance policy can help provide security when you need it most. It pays you cash benefits when you’re sick or hurt and can’t work. As an active, full-time employee of Pusch & Nguyen who works a minimum of 30 hours per week, you are eligible to elect LTD and take advantage of the group rate through Principal Financial Group.Why do you need Short-Term Disability? (100% Employer Paid)How will you pay your bills if you were sick or injured? Even a short illness or injury could seriously impact your paycheck. What happens when your sick time runs out? Disability replaces part of your income if you are unable to work due to an accident, illness, or if you are expecting a new addition to your family. Maternity Leave is one of the most common uses for disability insurance. Fortunately, all full-time employees who work a minimum of 30 hours per week are eligible to elect Short-Term benefits and take advantage of the group rate.
ADDITIONAL BENEFITS12Employee Assistance Program - 100% Company PaidLife isn’t always easy. Sometimes a personal or professional issue can affect your work, health, and general well-being. During these tough times, it’s important to have someone to talk with to let you know you’re not alone. We are pleased to offer an employee assistance program (EAP) for you and your immediate family members. Our EAP is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is provided by Pusch & Nguyen , at no cost to you, and is available to you and your immediate family members twenty-four hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues. Services include 3 face-to-face counseling or video sessions per household, unlimited phone counseling with master’s-level consultants to help with more serious issues, and online resources. Participation is voluntary and strictly confidential.Sample topics include: Legal and financial matters Work and lifestyle Child / elder care resources and referrals Stress, anxiety, depression Substance abuse and addiction Travel Assistance Program - 100% Company PaidTake comfort in knowing that travel assistance travels with you worldwide, offering access to a network of professionals who can help you with local medical referrals or provide emergency assistance services in foreign locations. Travel assistance can help you avoid unexpected bumps in the road anywhere in the world for you, your spouse, and dependent children on any single trip, more than 100 miles from home.You have options! Don’t delay if you need help. To speak to a counselor, or to learn more about your EAP plan, simply:Pre-Trip Assistance Travel, health advisories, and inoculation requirements for foreign countries Daily Foreign currency exchange rates Consulate and embassy locations Emergency Travel Support 24/7 access to telephonic translation services Assistance with lost, stolen, or delayed baggage while traveling on a common carrier Emergency payment and cashMedical Assistance Help locating medical providers Transportation home for further treatment – in the event of death, assist in the return of mortal remains Coordination with your health insurance carrier during a medical emergency
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