Return to flip book view

EMPLOYEE BENEFITS GUIDE2023

The benefits plan year runsJanuary 1stthrough December 1st.Unless you have a qualifiedchange-in-status event that impacts your eligibility and thechange is allowed under theterms 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 toHuman Resources within 30days of the event;documentation supporting the change will be required.Want to Understand Your Benefits Better?Scan the QR code below or visitwww.pending.comto watch an educational video.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 60days 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 regardlessof 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 andthe 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 Enrollmentperiod. 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 EnrollmentGood Ranchers takes pride in providing acomprehensive employee benefits program, and werecognize the important role employee benefits playas a critical component of your overallcompensation. We strive to maintain a benefitsprogram that is rewarding and competitive.WHAT’S INSIDEEmployee ResourcesEmployee ContributionsMedicalDental Vision Plan HighlightsLife/AD&DDisabilityEmployee Assistance ProgramTravel Assistance Program2

EMPLOYEE RESOURCESPlanPolicy Number Phone Number and Website/EmailMedicalBlue Cross Blue Shield335701PHONE NUMBERwww.bcbstx.comDentalPrincipal Financial1179505-10001(800) 247-4695www.principal.comVisionPrincipal Financial1179505-10001(800) 877-7195www.principal.comLifeand Disability InsurancePrincipal Financial1179505-10001(800) 245-1522www.principal.comEmployee Assistance ProgramPrincipal Financial1179505-10001Use “Principal Core” as program name(800) 450-1327https://magellanascend.comTravel Assistance ProgramPrincipal Financial1179505-10001US: (888) 647-2611; International: (630) 766-7696www.principal.com/travelassistanceMany of our providers have mobile apps that providepersonalized access to your benefits when and where youneed it! There are also a variety of FREE health and fitnessrelated apps available. Browse and download apps to yoursmartphone or tablet from the App Store or Google Play.THERE’S AN APP FOR THAT!EMPLOYEE CONTRIBUTIONS PER PAY PERIODBased on 24 pay periods per yearPlan Features Employee Employee + Spouse Employee + Child(ren) FamilyMEDICAL—Blue Cross$3,000 HMO (S643ADT)$93.80 $187.61 $187.61 $281.41$1,500 HMO (G663ADT)$107.87 $215.73 $215.73 $323.60$3,000 PPO (S663CHC)$144.27 $288.55 $288.55 $432.82$1,250 PPO (P621CHC)$192.14 $384.27 $384.27 $576.41DENTAL—PrincipalPPO Plan$0.00 $10.03 $20.71 $33.23VISION—PrincipalVSP Vision$0.00 $3.68 $3.68 $7.073

MEDICAL & PRESCRIPTION PLAN HIGHLIGHTSHMO PLANS (In Network Only; PCP Required)4We offer two HMO plans and two PPO plans for you to choose from. The below plans summarize the two HMO options. Please refer to the following page for the two PPO plan options. To locate a participating, in-network provider, visit www.bcbstx.com. Plan FeaturesPlan Option 1$3,000 HMO (S643ADT)Plan Option 2$1,500 HMO (G663ADT)In-Network ONLY; YOU PAY In-Network ONLY; YOU PAYAnnual DeductibleAmountyou must pay before the plan will begin to pay for certain services$3,000individual$9,000 family$1,500 individual$4,500familyAnnualOut-of-Pocket MaximumMaximumamount you pay per year for covered expenses$8,700individual$17,400 family$5,000 individual$10,000 familyPREVENTIVESERVICESWell-child visits and immunizations, routine GYN visit, annual adultphysical,and other appropriate screenings as outlined in the ACANo charge No chargeOFFICEVISITS, LABS, AND TESTINGPCP/Specialist Office Visits $50 / $80 $40 / $80DiagnosticTest (x-ray, blood work)Lab: deductible, then 30%X-Rays: $100/test + deductible, & 30%Deductible, then 20%Imaging (CT/PET scans, MRIs) $200/test + deductible, then 30% $250HOSPITALInpatient/OutpatientDeductible, then 30%Facility Fee: additional $300Deductible, then 20%URGENTAND EMERGENCY CAREUrgentCare Facility $100 $100HospitalEmergency Room$600 + deductible, then 30% $500 + deductible, then 20%MENTALHEALTH/SUBSTANCE ABUSEOffice Visits $50 $40Inpatient Services Deductible, then 30% Deductible, then 20%PRESCRIPTIONDRUGSPrescriptionDeductible None NoneRetailPharmacy, up to 30-dayTier 1 GenericTier 2 PreferredTier 3 Non-PreferredTier 4 Specialty$0 - $20$50 - $70$100 - $120$150 / $250$0 - $20$50 -$70$100 - $120$150 / $250MailOrder, 90-day supply3x retail copay 3x retail copayOUT-OF-NETWORKN/ANo out-of-network coverage No out-of-network coverageThis chart is intended for summary purposes only. If there are any discrepancies, the official plan documents will always govern. Pre-certification may be required for certain services.*With the exception of true emergencies and emergency treatment, there is no coverage for out-of-network providers on the two HMO plans.

MEDICAL & PRESCRIPTION PLAN HIGHLIGHTSPPO PLANS (In and Out-of-Network; No PCP Required)5We offer two HMO plans and two PPO plans for you to choose from. The below plans summarize the two PPO options. Please refer to the previous page for the two HMO plan options. To locate a participating, in-network provider, visit www.bcbstx.com. Plan FeaturesPlan Option 3$3,000 PPO (S663CHC)Plan Option 4$1,250 PPO (P621CHC)In-Network: YOU PAY In-Network: YOU PAYAnnual DeductibleAmountyou must pay before the plan will begin to pay for certain services$3,000individual$9,000 family$1,250 individual$3,750familyAnnualOut-of-Pocket MaximumMaximumamount you pay per year for covered expenses$8,550individual$17,100 family$1,250 individual$3,750 familyPREVENTIVESERVICESWell-child visits and immunizations, routine GYN visit, annual adultphysical,and other appropriate screenings as outlined in the ACANo charge No chargeOFFICEVISITS, LABS, AND TESTINGPCP/Specialist Office Visits $40 / $80 $25 / $45DiagnosticTest (x-ray, blood work) Deductible, then 30% Deductible, then 0%Imaging (CT/PET scans, MRIs) $250/test + deductible, then 30% $250HOSPITALInpatient/OutpatientDeductible, then 30%Facility Fee: additional $350Deductible, then 0%Facility Fee: additional $150URGENTAND EMERGENCY CAREUrgentCare Facility $100 $25HospitalEmergency Room$600 + deductible, then 30% $400 + deductibleMENTALHEALTH/SUBSTANCE ABUSEOffice Visits $40 $25Inpatient Services Deductible, then 30% Deductible, then 0%PRESCRIPTIONDRUGSPrescriptionDeductible None NoneRetailPharmacy, up to 30-dayTier 1 GenericTier 2 PreferredTier 3 Non-PreferredTier 4 Specialty$0 - $20$50 - $70$100 - $120$150 / $250$0 - $20$35 -$55$75 -$95$150 / $250MailOrder, 90-day supply3x retail copay 3x retail copayOUT-OF-NETWORKAnnual Deductible $6,000individual$18,000 family$2,500 individual$7,500familyAnnualOut-of-Pocket Maximum Unlimited UnlimitedThis chart is intended for summary purposes only. If there are any discrepancies, the official plan documents will always govern. Pre-certification may be required for certain services.*Out-of-network providers and facilities may balance bill you for any charges in excess of the amount paid by the plan.

DentalWe are pleased to offer you a comprehensive dental PPO plan. You can visit anylicensed 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 maybalance bill you the difference between their usual fee and what the plan pays.Plan Features In-Network & Out-of-Network*NetworkPrincipal PPOCalendarYear Deductible Amount you must pay per calendar yearbeforethe plan begins to pay benefitswaived for preventive$50 individual$150 familyPreventiveand Diagnostic ServicesNo charge—no deductibleBasic ServicesDeductible, then 20%Major ServicesDeductible, then 50%AnnualBenefit Maximum Maximumamount the plan will pay per calendar year$1,500 per person per calendar year, plus any maximum rollover benefitLifetime Orthodontia MaximumMaximumamount the plan will pay per lifetime$1,500 lifetime benefit per child(up to age 19)Limitations or waiting periods may apply for somebenefits; some services may be excluded from your plan.These chart s are intended for summary purposes only. Ifthere are any discrepancies, the plan document will alwaysgovern.*Dental Reimbursement for out-of-network services isbased on the maximum contract allowances and notnecessarily each dentist’s submitted fees. You will pay lessmoney when you stay within the network.DENTAL & VISION PLAN HIGHLIGHTSPrevention first!Make sure you take advantage of yourpreventive dental visits. Preventive careservices are not subject to the deductibleand the plan covers 100% of the cost ifyou visit an in-network provider!Maximum RolloverWith Maximum Rollover, you are eligible toroll over a portion of your unused annualmaximum. To qualify, you must have had adental service performed within thecalendar year and used less than themaximum threshold. The threshold is equalto the lesser of 50% of the maximumbenefit, or $1,000. If the qualification is met,50% of the threshold is carried over to nextyear’s maximum benefit. You canaccumulate no more than four times thecarry over amount. Please be sure toschedule your annual exams because yourentire accumulated amount will be forfeitedif no dental service is submitted within acalendar year.6VSP VisionYour vision coverage provides a full range of vision care services. You may receive carefrom any provider you choose, but your benefits are greater when you see a participatingprovider in the network. If you choose to receive services from an out-of-networkprovider, you will be required to pay that provider at the time of service and submit aclaim form for reimbursement.Plan Features VSP In-NetworkOut-of-Network ReimbursementVision ExamOnceevery 12 months$10 copay Up to $45Eyeglass FramesOnceevery 12 months$150 plan allowance + 20% off balance Up to $70Eyeglass LensesOnce every 12 monthsSingleBifocalTrifocalLenticular$10 copay$10 copay$10 copay$10 copayUp to $30Up to $50Up to $65Up to $100ContactLenses Onceevery 12 monthsinlieu of eyeglassesElective: $150 allowanceNecessary: $10 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!7Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. Accidental deathand dismemberment (AD&D) insurance provides an additional benefit if you lose your life, sight, hearing, speech, or limbs in anaccident.Company Paid SummaryLife Benefit$50,000Accidental Death Benefit$50,000Reduction 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 to $300,000100% of Employee Amount to $100,000$10,000Guaranteed Issue Coverage (no medical questions)-Employee-Spouse-Child(ren)$100,000$25,000$10,000Reduction 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 aboveand beyond the employer paid benefits. Voluntary term life rates are offered at heavily discounted group rates. So long asyou enroll when first eligible, guaranteed coverage is also available to you, regardless of your current health status.

DISABILITY INSURANCEEMPLOYEE ASSISTANCE PROGRAMTRAVEL ASSISTANCE PROGRAM8Short-Term Disability - 100% Company PaidBenefit Percentage60%Weekly Maximum$2,000Benefits BeginAfter 7 daysPre-Existing Condition ExclusionNoneLong-Term Disability - 100% Company PaidBenefit Percentage60%Monthly Maximum$8,000Benefits BeginAfter 90 daysPre-Existing Condition Exclusion3 / 12Employee Assistance Program - 100% Company PaidLifeisn’t always easy. Sometimes a personal orprofessionalissuecan affect your work, health, and general well-being.Duringthese tough times, it’s important to have someonetotalkwith to let you know you’re not alone.Weare pleased to offer an employee assistanceprogram(EAP)for you and your immediate family members. OurEAPisa comprehensive resource providing access toprofessionalassistancefor a wide range of personal and workrelatedissues. This service is strictly confidential and available 24/7,365days per year. Services include unlimitedphonecounseling,online resources, and up to 3 face-to-facesessionswith a counselor per year. Sample topics include:✓Legal and financial matters✓Work and lifestyle✓Child / elder care resources and referrals✓Stress, anxiety, depression✓Substance abuse and addictionTravel Assistance Program - 100% Company PaidTakecomfort in knowing that travel assistance travelswithyouworldwide, offering access to a network ofprofessionalswhocan help you with local medical referrals orprovideemergencyassistance services in foreign locations.Travelassistancecan help you avoid unexpected bumps in theroadanywherein the world for you, your spouse, anddependentchildrenon any single trip, more than 100 miles from home.Sample topics include:✓Pre-trip assistance✓Emergency travel support services✓Telephonic translation / interpreter services✓Document replacement✓Medical assistance✓Identity theft✓Prescription replacement assistance ✓Emergency medical evacuationWhy do you need Disability? How will you pay your bills if you were sick or injured? Even a short illness or injury could seriously impact your paycheck. Whathappens when your sick time runs out? Disability replaces part of your income if you are unable to work due to an accident, illness, or ifyou 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 automatically enrolled in Short-Term & Long-Term Disabilitybenefits.