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 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 EnrollmentGTI USA, Inc. 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 Contributions Enrollment Instructions Medical Dental Vision Life/AD&D Disability Employee Assistance Program Travel Assistance Program2
VENDOR INFORMATON & EMPLOYEE PREMIUMSEvery carrier 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!THERE’S AN APP FOR THAT!EMPLOYEE PER PAY PERIOD CONTRIBUTIONSBased on 24 pay periods per year3Benefit PremiumsEmployee OnlyEmployee + Spouse Employee + Child(ren)Employee + FamilyMEDICAL—United Healthcare$3,200 HDHP (DJSB)$79.19 $191.65 $143.34 $263.71$4,000 POS (CIVD)$88.23 $213.52 $159.70 $293.82$2,000 POS (CIVH)$147.73 $357.51 $267.40 $491.95DENTAL—PrincipalBase Dental Plan$3.14 $6.48 $7.75 $11.64Buy-Up Dental Plan $8.39 $16.06 $29.07 $39.21VISION—PrincipalVision$1.14 $2.31 $2.53 $3.98Carrier Name Group # Website Phone NumberMedical/RXUnited Healthcare1482697 www.MyUHC.com (866) 414-1959DentalPrincipal Financial1091614 www.principal.com/dentist (800) 247-4695VisionPrincipal Financial / VSP1091614www.principal.com/vsp (Choice network)(800) 877-7195Group Life and AD&DPrincipal Financial1091614 www.principal.com (800) 245-1522Short-Term DisabilityPrincipal Financial1091614 www.principal.com (800) 245-1522Long-Term DisabilityPrincipal Financial1091614www.principal.com(enter Principal Core as program)(800) 245-1522Employee Assistance ProgramPrincipal Financial / Magellan1091614 www.magellanAscend.com (800) 450-1327Travel Assistance ProgramPrincipal Financial1091614 www.principal.com/travelassistance (888) 647-2611
KEY TERMS TO REMEMBERANNUAL DEDUCTIBLEAn annual deductible is the first dollar amount of money that you have to pay out of pocket for covered healthcare services or medications before your insurance plan starts to cover the 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.4PLAN 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).POS - stands for point-of-service and is a type of plan that combines a PPO and HMO plan. The plan provides different benefits depending on whether the member uses in-network or out-of-network providers or services. You do not need to select a Primary Care Physician to manage your care. MEDICAL TERMS4
5MEDICAL & PRESCRIPTION PLAN HIGHLIGHTSPlan FeaturesIN-NETWORK $3,200 HDHP (DJSB) $4,000 Ded POS (CIVD) $2,000 Ded POS (CIVH)Provider Network Choice Plus POS Choice Plus POS Choice Plus POSHSA Compatible? YES NO NODeductibles(Individual / Family)$3,200 / $6,400 $4,000/$8,000 $2,000 / $4,000Coinsurance(Member Responsibility)20% - 50% after deductible 30% - 50% after deductible 20% after deductibleOut-of-Pocket Max(Individual / Family)$6,450 / $12,900 (Includes Deductible & Coinsurance)$8,500/$17,000 (Includes Deductible, Coinsurance, & Copays)$6,000 / $12,000(Includes Deductible, Coinsurance, & Copays)Preventive Care No Charge No Charge No ChargePrimary Care Visit 20% after deductible $25 copay$25 copay($0 copay for children <19)Telehealth(must be designated provider)No copay No copay No copaySpecialist Visit 20% after deductible $50 copay $50 copayDiagnostic Lab & X-RayDesignated Network: 20% after deductibleStandard Network: 50% after deductible30% after deductibleDesignated Network: $40 copay Standard Network: 50% after deductible Complex Imaging Designated Network: 20%after deductible; Standard Network: $500 copay + 50% after deductibleDesignated network: 30% after deductible;Standard Network: $500 copay + 50% after deductibleDesignated network: 20% after deductible;Standard Network: $500 copay + 50% after deductibleEmergency Room 20% after deductible$400 copay + 30% after deductible20% after deductibleUrgent Care 20% after Deductible $75 copay $75 copayRetail Pharmacy RX(30-day supply)Deductible Applies First $10 / $35 / $60 $20 / $55 / $80 / $100 $20 / $55 / $80 / $100Mail Order Pharmacy Rx(90-day supply)*excludes specialty drugs2.5x retail 2.5x retail 2.5x retailOUT-OF-NETWORK $3,200 HDHP $4,000 PPO $2,000 PPODeductibles(Individual / Family)$9,000 / $18,000 $10,000/$20,000 $6,000 / $12,000Coinsurance(member responsibility)50% after deductible 50% after deductible 50% after deductibleOut-of-Pocket Max(Individual / Family)$12,500 / $25,000 $15,000 / $30,000 $12,000 / $24,000
6HEALTH SAVINGS ACCOUNTHow much can I contribute? IRS ANNUAL LIMITSEmployer Annual Contribution2024 Max Contribution (Employer + Employee)2024 Maximum Employee Contribution Single Only*$300 / year $4,150 $3,850Employee + Family*$300 / year $8,300 $8,000Catch-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• 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. You are responsible for tracking your contributions to ensure you do not exceed the maximum allowable contribution.
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.DENTAL PLAN HIGHLIGHTS7Provider NetworkBase PPO Plan Buy-Up PPO PlanIn-Network In-NetworkCalendar Year Maximum $1,000 $2,000Annual Deductible (Individual / Family) $50 / $150 $25/$75Preventive Care•Routine Exam (twice per year)•Routine Cleanings (twice per year)•Bitewing X-ray (once per year)•Fluoride (once per year < age 14)No Charge No ChargeBasic Procedures•Emergency exams•Sealants•Fillings20% After Deductible20% After DeductibleMajor Procedures •Periodontics & Endodontics•Crowns•Bridges (120 months old)•Dentures (60 months old)•Oral surgery50%After Deductible 50% After DeductibleOrthodontia (Dependent Children before age 19)Not Covered50% (deductible waived)$2,000 Lifetime MaximumThreshold** $500 $1,000Carry-over*** $250 $500*This allows for a portion of unused maximum benefit to carry over to next year's maximum benefit amount. To qualify, you must have had a dental service performed within the Calendar year and used less than the maximum threshold. ***You can accumulate no more than 4x the carryover amount.OUT-OF-NETWORKOut-of-Network Claim Payment BasisMaximum Allowable Charge 90th Percentile
Need to locate a participating, in-network vision provider?8VisionYour 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.principal.com/vsp2. Select ‘Find a Provider’ (registration recommended)3. Enter search criteria Plan FeaturesIn-NetworkOut-of-Network ReimbursementProvider Network VSP Vision Exam$10 copay Up to $45Once every 12 monthsEyeglass Frames$150 allowance;20% off retail price over allowanceUp to $70Once every 12 monthsPrescription Lenses Once every 12 months Single$10 copay Up to $30Lined Bifocal$10 copay Up to $50 Lined Trifocal$10 copay Up to $65Lenticular$10 copay Up to $100Contact LensesOnce every 12 months$150 allowanceElective: Up to $60 copay (fitting & evaluation)Medically Necessary: Covered in full after $10 copayElective: Up to $105Medically Necessary: Up to $210*Benefit includes coverage for glasses or contact lenses, not both in the same calendar yearVISION PLAN HIGHLIGHTS
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. During 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 Benefit$50,000Accidental Death Benefit$50,000Guarantee Issue$50,000 Reduction ScheduleBenefit Reduces to: 65% at age 70, 45% at age 75Additional BenefitsConversion, Accelerated Death 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)$300,000 -Spouse (increments of $5,000)$100,000-Child(ren) (increments of $5,000)(to age 26)$25,000Guaranteed Issue Coverage (no medical questions required)(new hires)-Employee $150,000 age <70-Spouse $20,000 age <70-Child(ren) $25,000 Reduction Schedule Benefit Reduces to: 65% at 70, 45% at age 75Additional BenefitsConversion, Accelerated Death Benefit, Waiver of Premium, PortabilityLIFE INSURANCE
10Why do you need Long-Term Disability? (Company 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. Why do you need Short-Term Disability? (Company 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 automatically enrolled in Short-Term & Long-Term Disability benefits and GTI pays 100% of the costs.Plan FeaturesPrincipal Employee Benefit Amount 60% of weekly benefitMaximum Benefit Amount $2,300 per weekElimination Period (Waiting Period)Accident and Injury7 DaysBenefit Duration 12 WeeksPre-Existing Condition Exclusion NonePlan FeaturesPrincipalEmployee Benefit Amount 60% of monthly earningsMaximum Benefit Amount $10,000 per monthElimination Period 90 days Own Occupation Period 2 YearsBenefit Duration<62: To age 65, SSNRA or 3.5 years, whichever is longest62+: Reduced Duration Schedule Pre-Existing Conditions Clause 3 / 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. *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 3/12 which means any condition (including pregnancy) that you receive medical attention for in the 12 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage, would not be covered.DISABILITY INSURANCE
11Employee 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 GTI, 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:Call: (800) 450-1327, orgo online www.magellanAscend.comPre-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 emergencywww.principal.com/travelassistanceADDITIONAL BENEFITS
2022 BENEFITS ENROLLMENT BOOKLETBooklet Developed in Partnership With