The benefits plan year runsNovember 1st through October 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 EnrollmentJS Compliance 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 INSIDE2Employee Resources Employee Contributions Medical Dental Vision Life/AD&D Voluntary Life / AD&D Disability Insurance
EMPLOYEE RESOURCES3Plan Policy Number Phone Number and WebsiteMedicalBlueCross BlueShield of Texas2508481-800-521-2227www.bcbs.com DentalSun Life9504221-800-442-7742www.sunlifedentalbenefits.com VisionSun Life9504221-800-521-2227www.vsp.com/eye-doctor Life and Voluntary Life InsuranceSun Life9504221-800-877-7195 www.sunlife.com Short-Term and Long-Term Disability InsuranceSun Life9504221-800-877-7195 www.sunlife.com Many of our providers have mobile apps that provide personalized access to your benefits when and where you need it! There are also a variety of FREE health and fitness related apps available. Browse and download apps to your smartphone or tablet from the App Store or Google Play.THERE’S AN APP FOR THAT!EMPLOYEE CONTRIBUTIONS PER PAY PERIODBased on 52 pay periods per yearPlan Features Employee Employee + Child(ren) Employee + Spouse FamilyMEDICAL—BlueCross BlueShield $3,000 PPO $90.30 $270.90 $270.90 $451.49$1,500 PPO $101.77 $305.32 $305.32 $508.87DENTAL—Sun LifeDental Plan $4.48 $12.99 $17.10 $25.61VISION—Sun Life / VSP Vision $0.93 $2.80 $3.17 $5.03
4We offer two PPO plans for you to choose from. To locate a participating, in-network provider, visit www.bcbstx.com. Plan FeaturesPlan Option 1$3,000 PPO (S663CHC)Plan Option 2$1,500 PPO (G653CHC)In-Network; YOU PAY In-Network; YOU PAYAnnual DeductibleAmount you must pay before the plan will begin to pay for certain services$3,000 individual$9,000 family$1,500 individual$4,500 familyCoinsuranceCost share 30% after deductible 20% after deductibleAnnual Out-of-Pocket MaximumMaximum amount you pay per year for covered expenses$9,000 individual$18,000 family$6,000 individual$12,000 familyPREVENTIVE SERVICESWell-child visits and immunizations, routine GYN visit, annual adult physical, and other appropriate screenings as outlined in the ACANo charge No chargeOFFICE VISITS, LABS, AND TESTINGPrimary Care Physician VisitsMD Live Virtual VisitsSpecialist Office Visits$45 Copay$45 Copay$90 Copay$40 Copay$40 Copay$80 CopayDiagnostic Test (x-ray, blood work)30% after deductible 20% after deductibleImaging (CT/PET scans, MRIs)$250 per test + 30% after deductible$100 per test + 20% after deductibleHOSPITALInpatient/Outpatient$300 per visit + 30% after deductible20% after deductibleURGENT AND EMERGENCY CAREUrgent Care Facility$100 Copay $75 CopayHospital Emergency Room$600 Copay + 30% after deductible $500 Copay + 20% after deductiblePRESCRIPTION DRUGSRetail Pharmacy, 30-day$0 / $10 / $20 / $50 / $70 / $100 / $120 / $150 / $250 $0 / $10 / $20 / $50 / $70 / $100 / $120 / $150 / $250 Mail Order(90 day supply)$0 / $30 / $150 / $300 $0 / $30 / $150 / $300OUT-OF-NETWORKAnnual Deductible $6,000 individual $18,000 family$3,000 individual$9,000 familyCoinsurance 50% after deductible 40% after deductibleAnnual Out-of-Pocket Maximum Unlimited $6,000 individual $12,000 familyThis 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.MEDICAL & PRESCRIPTION PLAN HIGHLIGHTS PPO PLANS (In and Out-of-Network; No PCP Required)
Dental – Sun Life Financial GroupWe 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.Plan Features In-Network & Out-of-Network*NetworkSun Life Dental NetworkCalendar Year DeductibleAmount you must pay per calendar year before the plan begins to pay benefits waived for preventive$50 individual$150 familyPreventive and Diagnostic ServicesNo charge—no deductibleBasic ServicesDeductible, then 20%Major ServicesDeductible, then 50%Annual Benefit MaximumMaximum amount the plan will pay per calendar year$1,500 per person per calendar year,plus any maximum rollover benefitOut of Network Processing 90th Percentile Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. These chart s are intended for summary purposes only. If there are any discrepancies, the plan document will always govern.*Dental Reimbursement for out-of-network services is based on the maximum contract allowances and not necessarily each dentist’s submitted fees. You will pay less money when you stay within the network. Need to locate a participating, in-network provider?To locate a participating provider, visit www.vsp.com DENTAL & VISION PLAN HIGHLIGHTS5Prevention 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!Vision – Sun Life Financial GroupYour 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 24 months$150 plan allowance + 20% off balance Up to $70Eyeglass Lenses Once every 12 months SingleBifocal TrifocalLenticular$25 copay$25 copay$25 copay$25 copayUp to $30Up to $50Up to $60Up to $100Contact Lenses Once every 12 months in lieu of eyeglassesElective: $150 allowance + 15% off balanceNecessary: $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 INSURANCE6During your benefits enrollment, don’t forget to designate a beneficiary!Life 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 Summary – Sun Life Financial GroupLife Benefit100% of your annual salary to a maximum $100,000Accidental Death Benefit$100,000Reduction ScheduleBy 35% @ 65; 50% @ 70Additional BenefitsConversion, Accelerated Death Benefit, Waiver of PremiumVoluntary Employee Paid Summary- Sun Life Financial GroupLife/AD&D Benefit- Employee- Spouse- Child(ren) [Term Life Only]5x salary up to $300,000$5,000 - $100,000 (cannot exceed 100% of employee amount)$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.
DISABILITY INSURANCE7Why do you need Long-Term Disability?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.Plan Features- 100% Company PaidSun Life Financial GroupBenefit Percentage 66.67% of monthly earningsMonthly Maximum Amount $6,000 per monthElimination Period 90 daysBenefit Duration To age 65 (SSNRA)Pre-Existing Conditions Clause 3/12As an active, full-time employee of JS Compliance, you are automatically enrolled for Long- Term Disability through Sun Life Financial Group at no cost.Why do you need Short- Term Disability? 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.Plan Features- 100% Company PaidSun Life Financial GroupBenefit Percentage 70% of monthly earningsWeekly Maximum Amount $1,500 per monthBenefits Begin After 7 daysPre-Existing Conditions Clause 3/12