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.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 60 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 EnrollmentBayou Electrical Services 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 INSIDEVendor Information Employee ContributionsEnrollment InstructionsMedical Health Savings Account (HSA) Dental Vision Plan HighlightsLife/AD&DDisabilityCritical IllnessAccidentHospital Indemnity Employee Assistance ProgramTravel Assistance Program2
VENDOR INFORMATON & EMPLOYEE PREMIUMSBlueCross BlueShield of Texas has a mobile app that provides personalized access to your benefits when and where you need it. Browse and download it to your smartphone or tablet from the App Store or Google Play, or text BCBSTX to 33633.THERE’S AN APP FOR THAT!EMPLOYEE PER PAY PERIOD DEDUCTIONSBased on 52 pay periods per year3PlanPolicy Number Website Phone NumberMedical / Rx111347www.bcbstx.com (800) 521-2227Find a doctor or hospitalBlueCross BlueShield1. Select your state2. Select Plan: PPO = BlueChoice PPO3. Enter search criteriaFind a Preferred Pharmacy1.Visit www.myprime.com 2. Select Health Plan Type "Other BCBSTX Plans"3. On the Find a Pharmacy page, select "Preferred Network"4. Enter additional search criteria and filter by "preferred pharmacies"DentalG000CG3Fwww.mutualofomaha.com(800) 927-9197Mutual of OmahaVisionG000CG3F www.mutualofomaha.com/vision (833) 279-4358Mutual of OmahaGroup Life & Voluntary LifeG000CG3F www.mutualofomaha.com (800) 775-8805Mutual of OmahaVoluntary Disability & Voluntary WorksiteG000CG3F www.mutualofomaha.com(800) 775-8805Mutual of OmahaEmployee Assistance ProgramG000CG3F www.mutualofomaha.com/eap (800) 316-2796Mutual of OmahaBenefit PremiumsEmployee OnlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyMEDICAL—BlueCross BlueShield of Texas$6,000-100% HDHP PPO (MTBCP008H) $10.23 $102.39 $88.35 $153.24$500-100% PPO (MTBCP002) $37.70 $188.73 $162.86 $282.47DENTAL—Mutual of OmahaLow DPPO$4.38 $9.19 $10.50 $15.98High DPPO$7.31 $15.79 $19.09 $25.93VISION—Mutual of OmahaVision PPO$1.82 $4.18 $4.64 $7.08
KEY TERMS TO REMEMBER & HDHP/HSA PLAN DETAILSANNUAL DEDUCTIBLEIs an amount of money you must pay toward the cost of your healthcare bills before the insurance company begins to cover your costs.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.COPAYS 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.4HEALTH SAVINGS ACCOUNT DETAILSIf you are enrolled in the $6,000 HDHP PPO plan, you may contribute towards an Health Savings Account (HSA). There are many advantages to contributing to an HSA account including:· You are not taxed on the money you use to pay for eligible out-of-pocket medical expenses not covered by your medical plan such as deductibles, coinsurance for yourself, spouse, and/or dependent children.· Unused money is not forfeited at the end of the year. Balances are carried forward.· The account is yours to keep. You take it with you if you change jobs or retire.IRS Contribution Limits for HSA PlansThe IRS sets annual contribution limits for HSA plans. The 2024 contribution limit is $4,150 (for employee only coverage) and $8,300 (for employee plus one or more dependent coverage).If you are age 55 or older, you can make additional “catch-up” contributions up to $1,000 per year.According to the IRS, you cannot be covered by a medical plan that is not a High Deductible Health Plan (HDHP) and establish and/or contribute towards an HSA. E.g.: You cannot be covered by a non-HDHP separate individual medical plan, non-HDHP medical coverage through your spouse’s health plan, VA, Medicare, Medicaid, etc. PLAN TYPESPPO – A network of doctors, hospitals, and other healthcare providers. You have coverage in and out of network.HDHP – A plan that has higher deductibles in exchange for lower premiums. HDHPs are compatible with Health Savings Accounts (HSA).MEDICAL TERMS4
5MEDICAL & PRESCRIPTION PLAN HIGHLIGHTSPlan Features BlueCross BlueShield of Texas IN-NETWORK $6,000 HDHP PPO (MTBCP008H) $500 PPO (MTBCP002)Provider Network BlueChoice PPO BlueChoice PPOHSA Compatible? YES – EE & ER Contributions NO Deductibles(Individual / Family)$6,000 / $12,000 $500 / $1,500Coinsurance(Member Responsibility)0% after deductible 0% after deductibleOut-of-Pocket Maximum(Individual / Family)$6,000 / $12,000 $1,500 / $4,500Preventive CareNo Charge No ChargePrimary Care Visit0% after deductible $30 copayMDLive Virtual Visits0% after deductible $0 copaySpecialist Visit0% after deductible $60 copayDiagnostic Lab & X-Ray 0% after deductible No ChargeComplex Imaging0% after deductible 0% after deductibleOutpatient Procedure0% after deductible 0% after deductibleInpatient Stay0% after deductible 0% after deductibleEmergency Room0% after deductible $500 per visitUrgent Care0% after deductible $75 copayRetail Pharmacy (30-day) Preferred / Non-Preferred Preferred / Non-Preferred Preferred Generic 0% after deductible $0 / $10 copayNon-Preferred Generic 0% after deductible $10 / $20 copayPreferred Brand 0% after deductible $50 / $70 copayNon-Preferred Brand 0% after deductible $100 / $120 copayPreferred Specialty 0% after deductible $150 copayNon-Preferred Specialty 0% after deductible $250 copayMail Order Pharmacy (90-day)0% after deductible $0 / $30 / $150 / $300*Excludes Specialty DrugsOUT-OF-NETWORKDeductibles (Individual / Family)$12,000 / $24,000 $10,000 / $20,000Coinsurance(Member Responsibility)30% after deductible 50% after deductibleOut-of-Pocket Maximum(Individual / Family)Unlimited Unlimited
6HEALTH SAVINGS ACCOUNT (HSA)How much can I contribute? IRS ANNUAL LIMITSEmployer Annual Contribution2024 Max Contribution (Employer + Employee)2024 Maximum Employee Contribution Single Only$600 / year $4,150 $3,550Employee + Spouse$900 / year $8,300 $7,400Employee + Child(ren)$900 / year $8,300 $7,400Employee + Family*$1,200 / year $8,300 $7,100Catch-Up Contribution Employees Age 55+ may contribute an additional $1,000Who Is Eligible?* All three criteria must be met:• Enrolled in an IRS “qualified” High Deductible Health Plan (HDHP)• Not covered by another medical plan unless the other plans is also a “qualified” HDHP• Not enrolled in Medicare coverage*It is the employee’s responsibility to notify HR if you are not eligible for HSA.How does it work? The HDHP allows employees to set aside money on a pre-tax basis into a Health Savings Account (HSA). The HSA is an account established exclusively for the purpose of paying for qualified medical expenses for you and your eligible dependents on a tax-free basis. Contributions to the HSA are funded with pre-tax deductions withheld from your paycheck. The funds are deposited into an interest-bearing account in your name. The money in the HSA can be used to reimburse eligible expenses not covered by your insurance plan, including the deductible, coinsurance, and copays. Any money not used for medical reimbursement remains in the account. In the event you leave Bayou Electrical Services, you own the account and the money therein. For a complete list of “qualified medical expenses, please refer to Publication 502 at www.irs.gov.
Voluntary DentalWe are pleased to offer you comprehensive dental plans. 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.mutualofomaha.go2dental.com and follow these steps! DENTAL 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!7Low Dental PPO PlanIn-Network NetworkDentemaxCalendar Year Deductible Amount you must pay per calendar year before the plan begins to pay benefits waived for preventive$50 individual $150 family Preventive and Diagnostic ServicesNo chargeBasic Services20% after deductibleMajor Services50% after deductibleAnnual Benefit Maximum $750 Maximum amount the plan will pay per calendar yearOrthodontiaNot CoveredOut-of-Network Claim Payment BasisMaximum Allowable Charge (MAC)1. Find a Dentist2. Select ‘Dentemax’4. Enter search criteriaHigh Dental PPO PlanIn-NetworkNetworkDentemaxCalendar Year Deductible Amount you must pay per calendar year before the plan begins to pay benefits waived for preventive$50 individual $150 familyPreventive and Diagnostic ServicesNo chargeBasic Services20% after deductibleMajor Services50% after deductibleAnnual Benefit Maximum $1,500 Maximum amount the plan will pay per calendar yearOrthodontia (Child(ren) to age 19)50% after deductibleLifetime Orthodontia Maximum$1,500 lifetime maximumMaximum amount the plan will pay per lifetimeOut-of-Network Claim Payment Basis90th Percentile
Need to locate a participating, in-network vision provider?VISION PLAN HIGHLIGHTS8Voluntary Vision (Employee Paid)Your 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.1. Visit www.mutualofomaha.com/vision 2. Select ‘Find a Provider’ (registration recommended)3. Enter search criteria Plan FeaturesIn-NetworkOut-of-Network ReimbursementProvider Network EyeMedVision Exam$10 copay Up to $37Once every 12 monthsEyeglass Frames$0 copay; $150 allowance + 20% discount off balance Up to $66Once every 24 monthsPrescription Lenses Once every 12 months Single$10 copay Up to $32Lined Bifocal$10 copay Up to $48 Lined Trifocal$10 copay Up to $76Lenticular$10 copay Up to $75Contact LensesOnce every 12 monthsElective: $0 copay; $150 allowance + 15% off balanceMedically Necessary: $0 copay; covered in fullElective: Up to $102Medically Necessary: Up to $210Additional Pair of Glasses or Contacts40% discount off complete pair of eyeglasses and 15% off conventional contact lenses once the funded benefit has been used
Basic Term Life 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, it 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 beneficiary9Life 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. Employer Paid SummaryLife BenefitFlat $10,000Accidental Death BenefitFlat $10,000Reduction ScheduleBenefit Reduces to: 65% at 65, 50% at age 70+Additional BenefitsConversion, Living Care Benefit, Waiver of PremiumVoluntary Term Life 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 SummaryPlan Benefits-Employee (increments of $10,000)5X annual salary to a max of $500,000 -Spouse (increments of $5,000)50% of employee's benefit to a max of $250,000-Child(ren) (to age 26)$10,000Guaranteed Issue Coverage (no medical questions required)-Employee 5X annual salary up to $150,000-Spouse 100% of employee's benefit up to $50,000-Child(ren) $10,000 Reduction Schedule Benefit Reduces to: 65% at 65, 50% at age 70+Additional BenefitsConversion, Living Care Benefit, Waiver of Premium, Portability & Annual Increase Option** Annual Increase Option- if you are enrolled in voluntary life insurance, you have the option of increasing up to $10,000 each year without having to submit evidence of insurability, up to the guaranteed issue amounts.
DISABILITY INSURANCE10Why do you need Voluntary Long-Term Disability? (Employee 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 Bayou Electrical Services, you are eligible to elect LTD and take advantage of the group rate. Why do you need Voluntary Short-Term Disability? (Employee 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 Disability and take advantage of the group rate. Plan FeaturesMutual of Omaha(Employee Paid)Employee Benefit Amount 60% of weekly benefitMaximum Benefit Amount $1,500 per weekElimination Period (Waiting Period)Accident & Sickness7 DaysBenefit Duration 12 WeeksPre-Existing Condition Exclusion 3 / 6*Plan FeaturesMutual of Omaha(Employee Paid)Employee Benefit Amount 60% of monthly earningsMaximum Benefit Amount $8,000 per monthElimination Period 90 days Own Occupation Period 2 YearsBenefit Duration 5 yearsPre-Existing Conditions Clause 6 / 12**A pre-existing condition is one for which you have received medical treatment, consultation, care or services including diagnostic measures, or if you were prescribed or took prescription medications in the predetermined time frame prior to your effective date of coverage. The pre-existing condition under this plan is 3/6 which means any condition (including pregnancy) that you receive medical attention for in the 3 months prior to your effective date of coverage that results in a disability during the first 6 months of coverage, would not be covered.*A pre-existing condition is one for which you have received medical treatment, consultation, care or services including diagnostic measures, or if you were prescribed or took prescription medications in the predetermined time frame prior to your effective date of coverage. The pre-existing condition under this plan is 6/12 which means any condition (including pregnancy) that you receive medical attention for in the 6 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage, would not be covered.
Critical Illness InsuranceCritical illness insurance may help you cover expenses not covered by your health insurance. It’s a cash payment you receive if you ever experience a serious illness like cancer, a heart attack, or a stroke, giving you the financial support to focus on recovery. Critical illness insurance is a supplemental policy for people who already have health insurance. It provides you with an additional payment to cover expenses like deductibles, treatments, and living costs. Critical illnesses include strokes, heart attacks, Parkinson’s disease and cancer. Our policies can cover over 30 major illnesses, helping you stay financially stable by paying you a lump sum if you’re diagnosed with one of them. Please review the benefit summary for more information. Other Voluntary Benefits11Hospital Indemnity InsuranceBeing hospitalized for illness or injury can happen to anyone, at any time. While medical insurance may cover hospital bills, it may not cover all the costs associated with a hospital stay. That’s where hospital indemnity coverage can help. Hospital indemnity insurance is for people who need help covering the costs associated with a hospital stay if they suddenly become sick or injured. Please review the benefit summary for more information. Accident InsuranceNobody can predict when an accident might happen. That’s why accident insurance is an important add-on policy for people who want to supplement the health and disability insurance coverage they already have through Bayou Electrical Services. Accident Insurance pays you lump sum of benefits after you suffer an accident. This could be more than 40 different circumstances, including: emergency treatment, ambulance, burns, dislocations, fractures, hospital confinement, and surgery. Please review the benefit summary for more information.
Employee 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. This service is strictly confidential and available 24/7, 365 days per year. Services include unlimited phone counseling, online resources, and face-to-face sessions with a counselor. EMPLOYEE ASSISTANCE PROGRAM (EAP)12Don’t delay if you need help! Visit Online: www.mutualofomaha.com/eap Or Call: 800-316-2796EAP Benefits:• Access to EAP professionals 24 hours a day, seven days a week• Provides information and referral resources• Service for employees and eligible dependents• Robust network of licensed mental health professionals• Three face-to-face sessions with a counselor (per household per calendar year)• Legal assistance and financial resources• Online will preparation• Legal library & online forms• Financial tools and resources• Resources for:✓ Substance use and other addictions✓ Dependent and elder care resources✓ Access to a library of educational articles, handouts and resourcesThe Employee Assistance Program assists employees and their eligible dependents with personal or job-related concerns, including: • Emotional well-being• Family and relationships• Legal library• Financial wellness
13Will PreparationWorldwide emergency travel services are only a phone call away. When traveling for business or pleasure, in a foreign country or just 100 miles away from home, you and your family can count on getting help in the event of a medical emergency. There are no geographical, coverage maximums or pre-existing condition exclusions. (Travel must be at least 100 miles or further away from home and coverage does not cover a spouse if they are traveling on business) Sample services include:Worldwide Travel AssistanceCreating a will is an important investment in your future. It specifies how you want your possessions to be distributed after you pass away. Whether you’re single, married, have children, or you’re a grandparent, your will should be tailored for your life situation. That’s why it’s good that you have access to FREE online will preparation services provided by Epoq, Inc.Epoq provides the following FREE documents: ➢ Last Will and Testament➢ Power of Attorney➢ Healthcare Directive➢ Living Trust Here’s how it works: 1. Log onto www.willprepservices.com and use code MUTUALWILLS to register2. Answer simple questions and customize your document in real time3. Download, print, and share your documents instantly 4. Don’t forget to update your documents with any major life changes, including marriage, divorce, and birth of a child5. Make the document legally binding – check with your state for requirementsPre-Trip Assistance ➢ Travel, health advisories, and inoculation requirements for foreign countries➢ Daily Foreign currency exchange rates➢ Consulate and embassy locations Emergency Travel Support Services➢ 24/7 access to telephonic translation services➢ Assistance with lost, stolen, or delayed baggage while traveling on a common carrier➢ Coordination of financial assistance.Medical 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 emergencyADDITIONAL BENEFITS (100% Company Paid)