2024 Benefits Guide
2Reliable Parts 2024 Benefits Enrollment GuideTable of ContentsWelcome .................................................................. 3Eligibility .................................................................... 3Qualifying Event ........................................................ 3Medical ..................................................................... 4Prescription Drugs .................................................... 5Pre-Tax Spending ..................................................... 6Pre-Tax Savings ...................................................... 10Dental Plan ............................................................. 12Vision Plan .............................................................. 13Life Insurance ......................................................... 14Disability Insurance ................................................. 15Voluntary Benefits ................................................... 16Additional Benefits .................................................. 17Additional Benefits .................................................. 18Legal Notices ......................................................... 19Benefit Definitions ................................................... 24Summary of Your Contributions .............................. 25Voluntary Benefit Rates ........................................... 26Important Contacts ................................................. 27The information contained in this summary should in no way be construed as a promise or guarantee of employment. The company reserves the right to modify, amend, suspend, or terminate any plan at any time for any reason. If there is a conflict between the information in this brochure and the actual plan documents or policies, the documents or policies will always govern. Complete details about the benefits may be obtained by reviewing current plan descriptions, contracts, certificates, policies and plan documents available from your Benefits Department.This Benefits Enrollment Guide highlights recent plan design changes and is intended to fully comply with the requirements under the Employee Retirement Income Security Act (”ERISA”) as a Summary of Material Modifications and should be kept with your most recent Summary Plan description.If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see page 20 for more details.
3WELCOMEQualifying EventEach year during Open Enrollment you have the opportunity to make changes to your benefits plan elections. Any eligible employee may add or drop dependents, add or drop coverage, or change current levels of coverage. Changes made during the Open Enrollment period are effective January 1, 2024. Any elections made are considered final and cannot be changed unless a qualifying change in status occurs. Qualifying changes in status include, but are not limited to: − Marriage, divorce, or legal separation − Death of spouse or other dependent − Birth or adoption of a child − A spouse’s employment begins or ends − A dependent’s eligibility status changes due to age, student status, marital status, or employment − You or your spouse experience a change in work hours that affect benefit eligibility − Relocation into or outside of your plan’s service − Becoming eligible for Medicare or Medicaid during the yearIf you experience a qualifying change in status, you must provide written notice to Human Resources within 30 days of the event.WelcomeThe purpose of this guide is to acquaint you with the benefits we offer and to serve as a reference source throughout the year. It is important to familiarize yourself with the various options and enroll in the plans that best meet your needs. Reliable Parts is pleased to continue to offer a robust benefits package to our employees.EligibilityAll regular, full-time employees working a minimum of 30 hours per week are eligible to participate in all benefit plans. Eligible employees may participate in the benefit plans effective 1st of the month following 30 days from date of hire or full-time employment.Also eligible for coverage: − Your spouse − Domestic partner − For medical, dental, vision, and voluntary life, children up to age 26 regardless of marital status, student status or employment statusIMPORTANT REMINDERS: − Preventive care is covered at 100% as long as you stay in-network. Make sure you get your annual physical! − You can save time and money by visiting an Urgent Care Center for minor emergencies instead of the Emergency Room. − Save money by switching your medication to a generic. Talk to your doctor to see if a generic medication will work for your condition.
4Reliable Parts 2024 Benefits Enrollment GuideMedicalBCBSTXReliable Parts offers you and your dependents medical benefits through BCBSTX. As a plan member you have access to many consumer education tools and value-added programs designed to help manage your family’s medical care — 24 hours a day, 7 days a week.To obtain plan benefits or network providers, visit the BCBSTX website at www.BCBSTX.com. To speak with a BCBSTX service representative, call the number on the back of your ID card. Medical Plan ComparisonPPO HDHPIn-Network Out-of-Network In-Network Out-of-NetworkDeductibleIndividual $1,500 $3,000 $3,200 $6,400Family $3,000 $6,000 $6,400 $12,800Out-of-Pocket MaximumIndividual $4,000 $8,000 $4,000 $8,000Family $8,000 $16,000 $8,000 $16,000Coinsurance / CopaysMember Coinsurance 20% 40% 20% 40%Preventive Care 100% Ded + 40% 100% Ded + 40%Primary Care Physician $25 Copay Ded + 40% Ded + 20% Ded + 40%Specialist $50 Copay Ded + 40% Ded + 20% Ded + 40%Urgent Care $50 Copay Ded + 40% Ded + 20% Ded + 40%Emergency Room (copay waived if admitted)$250 copay then Ded + 20% Ded + 20%Inpatient Hospitalization Ded + 20% Ded + 40% Ded + 20% Ded + 40%Outpatient Surgery Ded + 20% Ded + 40% Ded + 20% Ded + 40%Please see your Summary of Benefits Coverage (SBC) posted on the ADP portal for a complete listing of all services covered. Including, but not limited to: mental health, chiropractic, lab and X-ray, outpatient rehabilitation.TelemedicineMDLive provides anytime access to board-certified doctors from where it’s most convenient to you - home, office or on the go. MDLive has the nation’s largest telehealth network of doctors ready to provide convenient, quality care by phone or secure video. Doctors can diagnose a wide range of non-emergency medical issues and even prescribe medications to your pharmacy of choice. One consultation through MDLive is considered a visit to the primary care doctor’s office.MDLive physicians can treat the following: Flu, Allergies, Cough/Sore Throat, Respiratory Problems, Fever, Headache, Pink Eye, Ear Problem, and more. To get started, call 888-680-8646 or register at www.mdlive.com.bcbstx.
5PRESCRIPTION DRUGSPrescription DrugsPrescription drug coverage through Prime Therapeutics (BCBSTX) is included with both of our medical plans.Pharmacy Plan ComparisonPPO HDHPIn-Network Out-of-Network In-Network Out-of-NetworkPrescription DrugsRetail Rx (up to 30-day supply)Generic $15 50% Ded + 20% Ded + 40%Preferred Brand $25 50% Ded + 20% Ded + 40%Non-Preferred Brand $60 50% Ded + 20% Ded + 40%Specialty $80 Not Covered Ded + 20% Not CoveredMail Order Rx (up to 90-day supply)Generic $37.50 50% Ded + 20% Ded + 40%Preferred Brand $62.50 50% Ded + 20% Ded + 40%Non-Preferred Brand $150 50% Ded + 20% Ded + 40%BCBSTX offers your mail order prescriptions through Express Scripts Pharmacy to deliver up to a 90-day supply of long-term or maintenance medicines. Register online at www.express-scripts.com/rx or call 833-715-0942.BCBSTX supports members who need self-administered specialty medication and helps them manage their therapy through Accredo. Register online at www.accredo.com or call 833-721-1619.Please reference the BCBSTX 2024 Prescription Drug List (Formulary) for drugs that you are currently taking. You may reference this at www.myprime.com.Generic Drugs vs. Brand-Name DrugsGeneric drugs are FDA-approved and shown to be just as safe and effective as their more expensive brand-name counterparts. BCBSTX regularly reviews the latest prescription drugs on the market and maintains a list of preferred brand drugs that are clinically effective and not cost-restrictive. These drugs are available at a lower price than those not included on the list, which are called non-preferred brand drugs.
6Reliable Parts 2024 Benefits Enrollment GuidePre-Tax SpendingNAVIAFlexible Spending Accounts (FSAs)Flexible Spending Accounts (FSAs) allow you to pay for eligible health care and dependent care expenses using tax-free dollars. There are two types of FSAs — the Health Care FSA and the Dependent Care FSA:Health Care FSA Dependent Care FSAContribute up to $3,050 per year, pretax to pay for services not covered by your medical, dental or vision plan such as copays, coinsurance, deductibles, prescription expenses, lab exams and tests, contact lenses and eyeglasses.Contribute up to $5,000 per year, pretax, or $2,500 if married and filing separate tax returns to pay for day care expenses associated with caring for elder or child dependents that are necessary for you or your spouse to work or attend school full-time. You cannot use your Health Care FSA to pay for Dependent Care expenses.Receive a debit card to pay for eligible medical expenses (funds must be available in your account).You must submit claims and be reimbursed if you enroll in this FSA; no debit cards are provided.Eligible expenses include medical copays, coinsurance, deductibles, eyeglasses, over-the-counter medications prescribed by your doctor.Can only be used to pay for eligible dependent care expenses including day care, after-school programs and elder care programs.If you do not spend all the money in this FSA by the end of the year, per IRS regulations, unused dollars will be forfeited for pretax contributions.If you do not spend all the money in this FSA by the end of the year, per IRS regulations, unused dollars will be forfeited for pretax contributions.Note: You must be enrolled in the PPO plan to enroll in the Health Care FSA.If you are a participant in a Health Savings Account (HSA), you are not eligible for the Health Care FSA reimbursement account.
7PRE-TAX SPENDING Taxes 101The federal government takes about 30% of each dollar you earn in FICA and federal income taxes, and you take home the remaining 70% to use for your living expenses. When you use an FSA, you set aside money before it is taxed, so you spend the entire 100% of your earned income on your day care expenses.How does it work? − During your open enrollment estimate your expenses for the plan year and enroll in the plan. − Your annual election amount will be evenly deducted pre-tax from your paycheck throughout the plan year. − You cannot change your annual election amount after the plan start unless you have a qualified change in status. For example, birth, death, marriage or divorce. − Check out your Navigate My Benefits and Pre-Tax Solutions pages for more details on how your plan works.How much could you save?Let’s look at an example: Employees A and B both earn $55,000 per year. They each have $2,000 in out of pocket day care expenses. Employee A and Employee B have the same earnings and tax bracket, but Employee B saves $600 per year by contributing to an FSA!Visit or contact uswww.naviabenefits.comcustomerservice@naviabenefits.com800-669-3539 | 425-452-3500Employee A Employee BAnnual Gross Income $55,000 Annual Gross Income $55,000Estimated Taxes (30%) -$16,500Out-of-Pocket Care Expenses-$2,000Annual Net Income $38,500 Adjusted Gross Income $53,000Out-of-Pocket Care Expenses-$2,000 Estimated Taxes (30%) -$15,900Actual Take Home Pay $36,500 Actual Take Home Pay $37,100
8Reliable Parts 2024 Benefits Enrollment GuideHow do I access my benefits?Accessing your benefits couldn’t be easier, just swipe your Navia Benefit Card to pay for eligible health care expenses. Funds come directly out of your FSA and are paid to the provider. Some swipes require us to verify the expense, so hang on to your receipts! If we need to see it, we will send you an email or notification via our smartphone app.You can also submit claims online, through our smartphone app for Android and iPhone, email, fax or mail. Claims are processed within a few days and reimbursements are issued according to your employer’s reimbursement schedule. Be sure to include documentation that clearly shows the date, type and cost of the service.Submitting claims is easier than ever using FlexConnectThe FlexConnect feature connects your FSA to your insurance plans and seamlessly creates a claim with proper documentation direct from your insurance carrier! All you have to do is click “reimburse me” and the claim is expedited for payment. Sign up for FlexConnect today!Get more with the MyNavia mobile appThe MyNavia app is free to download on both iPhone and Android. You can manage your benefits and view important details right from the convenience of your phone.Health Care FSAThe Health Care FSA (HCFSA) allows you to pay for out-of-pocket medical expenses with tax-free dollars. Think of the HCFSA as a tool to pay for all your regular medical expenses throughout the plan year. − Expenses for you, your spouse and tax-dependents are eligible for reimbursement, regardless of if they are covered on your medical plan. − The Health Care FSA is a pre-funded benefit. This means you have access to your full annual election amount at any time during the plan year. − Estimating future expenses is an important step as you prepare to enroll in an FSA. The more accurate you are in estimating your expenses the better the plan will work for you!COMMON ELIGIBLE EXPENSES − Prescription drugs − Copays and coinsurance − Deductibles − Office visits − Dental work − Orthodontia − Glasses − Contacts − Chiropractic − MassageNOTE: Expenses that are cosmetic in nature are not eligibleDay Care FSAChild care can be one of the single largest expenses for a family with children. A Day Care FSA (DCFSA) can be used to pay for your qualified day care expenses with pre-tax dollars which can save you up to $1,700 per year! − The DCFSA limit is set by the IRS and is a calendar year limit of $5,000 per household, $2,500 if married and filing separately. If your plan year is not on a calendar year, take extra care in calculating your annual election. − Expenses can be for your dependent children 12 and under, and in some cases elder care, and must be enabling you to work, actively look for work or be a full-time student.COMMON ELIGIBLE EXPENSES − Child Care − Preschool − Before and after school care − Day CampsNOTE: Expenses for school tuition and overnight camps are not eligible
9PRE-TAX SPENDINGElection and Claim Filing PeriodOpen Enrollment period is a great time to look at your benefits and estimate your out-of-pocket expenses. Be sure to only elect an amount that you know you will use during your plan year. At the end of the plan year you will have a claim filing period to turn in any leftover claims for your benefits. Money left in the plan after the end of the claim filing period and 2 ½ month grace period is subject to the use-it-or-lose-it rule and cannot be refunded to you.Grace PeriodYour plan also has a special 2 ½ month grace period after the end of the plan year. This feature gives you an additional 2 ½ months to incur expenses against your Health Care and Day Care arrangements. All expenses incurred during the grace period will automatically deduct out of the prior year’s arrangement, and any remaining balance will then be applied to the current plan year.Navia Benefits CardRather than filing a claim and waiting for reimbursement, you can use the debit card to pay your provider directly for qualified health care expenses. The card is accepted at participating merchants using the Inventory Information Approval System (IIAS) and at medical care merchants using the Mastercard® system. Be sure to hang on to your receipts in case we need to see them to verify the expense eligibility. If we need to see a receipt, you will notice an alert on your mobile app and we will send you an email reminder.Accessing Your BenefitsNavia wants to make accessing your benefits as simple and efficient as possible. − Online Account Access: Order additional debit cards, update bank and address information and see up to date details of your benefits. − Online Claims Submission: Upload your documentation, complete the online wizard, and voila! a reimbursement will be on its way within a few days! − Mobile App: MyNavia allows you to simply snap a photo and submit for reimbursement direct from your mobile device. − FlexConnect: Sync your various medical, dental and vision benefits with your FSA plan for a quick and easy reimbursement. No need to submit documentation, we’ll get it from the insurance carrier!
10Reliable Parts 2024 Benefits Enrollment GuidePre-Tax SavingsNAVIAHealth Savings Accounts (HSA)An HSA is a personal savings account you can use to pay for qualified out-of-pocket medical expenses with pretax dollars — now or in the future. Once you’re enrolled in the HSA, you’ll receive a debit card to help manage your HSA reimbursements. Your HSA can also be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP medical plan.How a Health Savings Account (HSA) WorksEligibility You must be enrolled in the High Deductible Health Plan.If you are claimed as a dependent on someone else’s taxes or are covered by any other health insurance policies that are not considered High Deductible Health Plans, including Medicare and unlimited Flexible Spending Accounts, you are not eligible for an HSA.You and your spouse can each have an HSA if you both have High Deductible Health Plan coverage. If you have family High Deductible Health Plan coverage, the maximum contribution is split equally unless you and your spouse agree on different division.For employees that are switching from a Health Care FSA to the HSA, contributions to the HSA will be delayed until after the 2.5 month grace period is over in the following plan year.Your Contributions You contribute on a pretax basis and can change how much you contribute from each paycheck up to the IRS maximum of $4,150 if you enroll only yourself, or $8,300 if you enroll in family coverage. You can make an additional catch-up contribution if you are age 55. Additional catch-up contribution for over age 55 is $1,000 per year.The Company’s Annual Contribution $500 for employee only coverage. $1,000 for employee + dependents coverage.Note: Employer contributions are made per pay period. New Hires company’s annual contribution will be prorated based on enrollment date.Eligible Expenses Medical, dental, vision and prescription drug expenses incurred by you and your eligible family members.The complete lists of eligible and non-eligible expenses can be found in IRS Publication 502, which can be ordered from the IRS by calling 800-TAX-FORM (800-829-3676) or by visiting www.irs.gov.Using Your Account Use the debit card linked to your HSA to cover eligible expenses, or pay for expenses out of your own pocket and save your HSA money for future health care expenses.Your HSA is always yours – no matter what One of the best features of an HSA is that any money left in your HSA account at the end of the year rolls over so you can use it next year or sometime in the future. And if you leave the company or retire, your HSA goes with you and you can continue to pay and save for future eligible health care expenses.THE TRIPLE TAX ADVANTAGE1You can use your HSA funds to cover qualified medical expenses, plus dental and vision expenses too – tax-free. 2Unused funds grow and can earn interest over time – tax-free.3You can save your HSA funds to use for your health care when you leave the Company or retire – tax-free.
11PRE-TAX SAVINGSEXAMPLE: HOW A HEALTH SAVINGS ACCOUNT CAN GROW OVER TIMEYolanda enrolls herself only in the HDHP with HSA. She chooses to use her HSA to pay for covered services — this reduces her out-of-pocket amount needed to meet her deductible before her health plan begins to pay.Year 1 Year 2Reliable Parts deposits $500 in Yolanda’s HSAReliable Parts deposits $500 in Yolanda’s HSAShe contributes $3,100 for a total of $3,600She contributes $3,100 for a total of $3,600$2,900 rolls over from last year for a total of $6,500She uses her HSA to pay $700 of eligible expensesShe uses her HSA to pay $1,250 of eligible expensesShe has $2,900 in her HSA to roll over to next year!She has $5,250 in her HSA to roll over to next year!How does it work?You’ll be given access to a secure, easy-to-use web portal where you can track your account balance, view your investment accounts and submit requests for reimbursements. In addition, you’ll be issued a Navia Benefits Card you can use at point-of-sale to pay for qualified medical expenses. You can request reimbursement distributions online at www.naviabenefits.com for any purchases not made with your Navia Benefits Card. Payment will be made based on your available funds. Distributions can be made payable to your or a provider.ReimbursementYou don’t have to submit receipts to receive your reimbursement. However, you need to keep receipts and documentation for each year’s federal tax return (Form 8889 attached to Form 1040).You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax-free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distribution as taxable income. You may also use your funds for a spouse or dependent not covered under your HDHP.Common Eligible ExpensesYou can use your HSA dollars on your Navia Benefits Card to pay for: − Prescription and health plan copayments, deductibles and coinsurance − Over-the-counter medicines − Menstrual care products − Orthodontics − Mail-order or online prescription invoices − Vision services, eyeglasses
12Reliable Parts 2024 Benefits Enrollment GuideDental PlanMETLIFEReliable Parts offers you and your dependents an option of two dental plans. Please see page 25 for your payroll deduction.Base Plan Buy-Up PlanDeductibleIndividual $50 $50 Family $150 $150 Is Deductible Waived for Class 1 Services?Annual Maximum (Max Provider will pay PCY) $1,000 $2,000Do Class I Services accumulate towards the benefit maximum? Yes YesCoinsuranceClass I (Preventive Services)Exams, X-rays, Cleanings 0%Class II (Basic Services)Fillings, Basic Root Canals 20%Class III (Major Services)Crowns, Dentures, Bridges Not covered 50%OrthodontiaLifetime MaximumNot covered$2,000Coinsurance 50%Child Age Limit Age 19 − Balance billing may apply if a provider is not contracted. Members are responsible for amounts in excess of the allowable charge. − Pre-Treatment Estimate: If your dental work will be extensive, you should have your dentist submit the proposed treatment plan to the insurance company before you begin treatment. The insurance company will provide you with a summary of the plan’s coverage and your estimated out-of-pocket costs.
13VISION PLANVision PlanMETLIFE (SUPERIOR VISION NETWORK)Reliable Parts will cover the vision plan at no cost to you when you enroll in the medical plan!If you do not elect medical, you may opt to enroll in the vision coverage. If you decide to enroll, you will pay 100% of the cost. Please see page 25 for your payroll deduction.In-Network Out-of-NetworkYou Pay ReimbursementExams (Once every 12 months)Exams $10 $45 allowanceLenses (Once every 12 months)Single$25$30 allowanceBifocals $65 allowanceTrifocals $70 allowanceContact Lenses (Once every 12 months)Medically Necessary Covered in full $210 allowanceElective10% - 20% discount on balance over $150 allowance $105 allowanceOtherFrames (Once every 12 months)20% discount on balance over $150 allowance$70 allowanceNetwork Superior VisionDependent Child Eligibility Age 26
14Reliable Parts 2024 Benefits Enrollment GuideLife InsuranceUNUMGroup Life/AD&D InsuranceEach regular full-time employee will be automatically enrolled with a $25,000 benefit.It is important to keep your beneficiary information up to date to ensure that your life insurance benefits will be allocated to the appropriate parties.This benefit is paid 100% by Reliable Parts.Voluntary Life/AD&D CoverageYou may purchase an additional amount of life insurance for yourself and your dependents. If you elect amounts over the Guaranteed Issue (GI), you will need to submit an Evidence of Insurability (EOI) form to UNUM for approval. You will need to submit an EOI form to UNUM for approval on ADP. If EOI is required, a prompt on ADP will notify you directly.Employee Benefit ($10,000 increments) Up to 5x salary* or $250,000Guarantee Issue $250,000Spouse Benefit ($5,000 increments) Up to $250,000 not to exceed 100% of employee elected amountSpouse Guarantee Issue 100% of employee election up to $50,000Child(ren) Benefit ($2,000 increments) $10,000Voluntary Life (Employee): When electing this coverage as a new hire or the first time you are eligible, you can elect up to the Guaranteed Issue without submitting EOI. If you are considered a late entrant and have been eligible for this coverage previously, you will be required to submit EOI for all amounts of coverage should you choose to elect. If you are currently insured and want to increase at annual enrollment, you may increase in $10,000 increments up to the Guarantee Issue.Voluntary Life (Spouse): When electing this coverage for your spouse as a new hire or the first time you are eligible, you can elect up to the spousal Guaranteed Issue (not to exceed 100% of the employee amount) without submitting EOI. If your spouse is considered a late entrant and was eligible for this coverage previously, your spouse will be required to submit EOI for all amounts of coverage should you choose to elect. If your spouse is currently insured and wants to increase at annual enrollment your spouse may increase in $5,000 increments up to the Guarantee Issue. Employee must elect coverage for spouse to be insured. Voluntary Life (Child(ren): Employees must elect coverage on themselves to elect child coverage.Please Note: Spouse and Dependent Child(ren) coverage is delayed if the spouse or dependent child(ren) is totally disabled on the date of insurance would be effective.AGE REDUCTION:Your Basic Life/AD&D and Voluntary Life/AD&D benefit amounts are subject to age reduction:At age 65 Amounts reduce to 65%At age 70 Amounts reduce to 40%At age 75 Amounts reduce to 25%This benefit is paid 100% by you.* Sales employees to refer to the plan document on earnings definition.
* Sales employees to refer to the plan document on earnings definition.15DISABILITY INSURANCEDisability InsuranceUNUMShort-Term Disability (STD)STD provides income replacement on a weekly basis for a limited period of time in the event that you become ill or disabled in a non-work-related injury.This benefit is paid 100% by Reliable Parts.Weekly Benefit Amount 60% of weekly salary*Maximum Weekly Benefit $1,000Elimination Period • Accident or Illness 14 daysBenefit Duration 11 weeksLong-Term Disability (LTD)LTD provides income replacement on a monthly basis for a longer period of time when you are unable to perform each of the main duties of regular occupation due to a sickness or injury.This benefit is paid 100% by Reliable Parts.Monthly Benefit Amount 60% of monthly salary*Maximum Monthly Benefit $10,000Elimination Period • Accident or Illness 90 daysBenefit Duration5 years: If disabled at age 65+, reduced duration will apply. Please refer to the plan document for the detailed schedule.CALIFORNIA, NEW YORK AND WASHINGTON OFFER A STATE DISABILITY BENEFIT. EMPLOYEES RESIDING IN THESE STATES ARE SUBJECT TO THE STATE DISABILITY BENEFIT. YOU WILL RECEIVE THE DISABILITY BENEFIT PROVIDED BY RELIABLE PARTS AT A MINIMUM.
16Reliable Parts 2024 Benefits Enrollment GuideUNUMAccidentAccident Insurance provides a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more seriousevents. You are eligible to receive a $50 Be Well benefit if enrolled in accident coverage.Hospital InsuranceGroup Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization. You can receive benefits when you’re admitted to the hospital for a covered accident, illness or childbirth. The money is paid directly to you – not to a hospital or care provider.Critical IllnessIf you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want. The money can help you pay out-of-pocket medical expenses, like deductibles. Be Well BenefitWith Unum’s Be Well Benefit, you and other covered family members can receive a valuable incentive for important tests and screenings. Many of these tests are routinely performed, so it’s easy to take advantage of this benefit.Your Be Well benefit is tied to the Critical Illness coverage amount you choose. For instance, if you choose a coverage amount of $10,000, your Be Well benefit will be $50. A coverage amount of $20,000 will have a Be Well Benefit of $75. A coverage amount of $30,000 will have a Be Well benefit of $100.BE WELL SCREENINGS − Annual exams by a physician including sports physicals and well-child visits, dental and vision exams − Cancer screenings including pap smear, colonoscopy − Cardiovascular function screenings − Cholesterol and diabetes screenings − Imaging studies, including chest X-ray, mammography − Immunizations including HPV, MMR, tetanus, influenzaVoluntary BenefitsCritical Illness Benefit AmountBe Well Benefit*Employee $10,000, $20,000, $30,000 $50/$75/$100Spouse $5,000, $10,000, $15,000 $50/$75/$100Children (Live Birth to age 26)Automatically covered at 50% of employee amount$50/$75/$100*Available once per covered person per calendar year
17ADDITIONAL BENEFITSLeave ManagementIf you are absent from work, UNUM can advise you on when to file a claim, Leave request, or job accommodation. If your absence is scheduled ahead of time, be sure to contact them 30 days prior to your last day of work. If unscheduled, please contact them as soon as possible. To file and track a claim, visit UNUM’s online portal at https://portal.unum.com or call 866-868-6737.Life Planning & LegalResourcesYou have automatic access to Life Planning Financial & Legal Resources. This service is provided at no extra cost for employees, spouses and beneficiaries who need help during a terminal illness, or after the loss of a covered employee. When a life claim is submitted and approved, a specially trained consultant will reach out to the employee or beneficiary to provide support. Life Planning consultants are also able to provide financial and legal support regarding estate settlement, Social Security, cash flow, taxes and investment planning. Visit members.healthadvocate.com and enter UNUM - Life Planning, or call 1-800-422-1252 for more information.Travel Assistance with ID Theft ProtectionTravel Assistance with ID Theft Protection includes pre-trip information to help you feel more secure while traveling. It can also help you access professionals across the globe for medical assistance when traveling 100+ miles away from home. ID Theft services are available to you and your family at home or when traveling. In case of a serious medical emergency while traveling, please obtain emergency medical services first (contact the local “911”), and then contact Travel Assistance to alert them.Travel Assistance: − Call: 1-800-872-1414 − From outside the US call: 1-609-986-1234 − Download and Activate the app (Assist America Mobile) from the Apple App Store or Google Play − Reference number: #01-AA-UN-762490Additional BenefitsSEE ADDITIONAL SERVICES BELOW OFFERED THROUGH UNUM
18Reliable Parts 2024 Benefits Enrollment GuideEmployee Assistance ProgramUNUMYour EAP is designed to help you lead a happier and more productive life. You have 24/7 confidential access to a Licensed Professional Counselor to help with the following and more. − Stress, depression, anxiety − Relationship issues, divorce − Job stress, work conflicts − Family and parenting problems − Anger, grief and lossWORK/LIFE BALANCEYou can also reach out to a specialist for help with balancing work and life issues. Call the number below and one of UNUM’s Work/Life Specialists can answer your questions and help you find resources for the following, and more, in your community. − Child care − Elder care − Legal questions − Identity theft − Financial services, debt management, credit report issues − Ways to reduce medical and dental billsYou have unlimited access to online and phone support, 24/7. Three in-person visits with a Licensed Professional Counselor are available at no cost to you. Your counselor may then refer you to resources in your community for ongoing support.For more information on your Employee Assistance Program and Work/Life Balance contact: − Call: 800-854-1446 − To register, visit: www.unum.com/lifebalanceTickets at WorkReliable Parts partners with Working Advantage to provide you with exclusive discounts. Browse through hundreds of offers on products and services from the brands you love. From everyday necessities to big ticket purchases and everything in between. Become a member today by going to www.TicketsatWork.com and use your company code: RELIABLEPARTS to get started!Additional BenefitsSEE ADDITIONAL SERVICES OFFERED BELOW
19LEGAL NOTICESLegal NoticesTHE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). WOMEN’S HEALTH & CANCER RIGHTS ACTIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient,for:• All stages of reconstruction of the breast on which the mastectomy was performed;• Surgery and reconstruction of the other breast to produce a symmetrical appearance;• Prostheses; and• Treatment of physical complications of the mastectomy, including lymphedema.These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan.HIPAA SPECIAL ENROLLMENT RIGHTSOur records show that you are eligible to participate in Reliable Parts, Inc.’s group health plan (to actually participate, you must complete an enrollment form and pay part of the premium through payroll deduction).A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons. • Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).• Loss of Coverage for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program.• New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.• Eligibility for Premium Assistance Under Medicaid or a State Children’s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for suchassistance.To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact Christi Farrow, Sr. Director or Human Resources, 1-877-733-9241, christi.farrow@reliableparts.com.
20Reliable Parts 2024 Benefits Enrollment GuideHIPAA NOTICE OF PRIVACY PRACTICES REMINDERProtecting Your Health Information Privacy Rights. Reliable Parts, Inc. is committed to the privacy of your health information. The administrators of Reliable Parts, Inc.’s health plan (the “Plan”) use strict privacy standards to protect your health information from unauthorized use or disclosure. The plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. You may receive a copy of the Notice of Privacy Practices by contacting Christi Farrow, Sr. Director or Human Resources, 1-877-733-9241, christi.farrow@reliableparts.com.WELLNESS PROGRAMYour health plan is committed to helping you achieve your best health. Employees who received a wellness or preventive exam in 2023 are eligible for the incentive in 2024. If you think you might be unable to meet a standard for an incentive under this wellness program, you might qualify for an opportunity to earn the same incentive by different means. Contact Christi Farrow, Sr. Director or Human Resources, 1-877-733-9241, christi.farrow@reliableparts.com and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same incentive that is right for you in light of your health status.IMPORTANT NOTICE FROM RELIABLE PARTS, INC. ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Reliable Parts, Inc. and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drugcoverage: • Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. • Reliable Parts, Inc. has determined that the prescription drug coverage offered by Reliable Parts, Inc.’s health plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered creditable coverage. Because your existing coverage is creditable coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 – December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two-month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current coverage from Reliable Parts, Inc. may be affected. If you do decide to join a Medicare drug plan and drop your current Reliable Parts, Inc. coverage, be aware that you and your dependents may be able to get this coverage back. When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Reliable Parts, Inc. and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current prescription drug coverage, contact Christi Farrow, Sr. Director or Human Resources, 1-877-733-9241, christi.farrow@reliableparts.com for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Reliable Parts, Inc. changes. You also may request a copy of this notice at any time. For more information about your options under Medicare prescription drug coverage: More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage, visit www.medicare.gov, call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number for personalized help), or call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048.
21LEGAL NOTICESIf you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov or call them at 800-772-1213 (TTY 800-325-0778).Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).Date: 10/15/2023 Name of Entity/Sender: Reliable Parts, Inc. Contact: Christi Farrow, Sr. Director or Human Resources, 1-877-733-9241, christi.farrow@reliableparts.com PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2023. Contact your State for more information on eligibility –ALABAMA – MEDICAIDWebsite: http://myalhipp.com/Phone: 1-855-692-5447ALASKA – MEDICAIDThe AK Health Insurance Premium Payment Program Website: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.comMedicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspxARKANSAS – MEDICAIDWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)CALIFORNIA – MEDICAIDWebsite: Health Insurance Premium Payment (HIPP) Programhttp://dhcs.ca.gov/hippPhone: 916-445-8322Fax: 916-440-5676Email: hipp@dhcs.ca.govCOLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) & CHILD HEALTH PLAN PLUS (CHP+)Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/HIBI Customer Service: 1-855-692-6442FLORIDA – MEDICAIDWebsite: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.htmlPhone: 1-877-357-3268GEORGIA – MEDICAIDGA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162, Press 1GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipraPhone: (678) 564-1162, Press 2INDIANA – MEDICAIDHealthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: https://www.in.gov/medicaid/Phone 1-800-457-4584Legal Notices
22Reliable Parts 2024 Benefits Enrollment GuideIOWA – MEDICAID AND CHIP (HAWKI)Medicaid Website: https://dhs.iowa.gov/ime/membersMedicaid Phone: 1-800-338-8366Hawki Website: http://dhs.iowa.gov/HawkiHawki Phone: 1-800-257-8563HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hippHIPP Phone: 1-888-346-9562KANSAS – MEDICAIDWebsite: https://www.kancare.ks.gov/Phone: 1-800-792-4884HIPP Phone: 1-800-967-4660KENTUCKY – MEDICAIDKentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspxPhone: 1-855-459-6328Email: KIHIPP.PROGRAM@ky.govKCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dmsLOUISIANA – MEDICAIDWebsite: www.medicaid.la.gov or www.ldh.la.gov/lahippPhone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – MEDICAIDEnrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en_USPhone: 1-800-442-6003, TTY: Maine relay 711Private Health Insurance Premium Webpage:https://www.maine.gov/dhhs/ofi/applications-formsPhone: 1-800-977-6740, TTY: Maine relay 711MASSACHUSETTS – MEDICAID AND CHIPWebsite: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840TTY: 711 Email: masspremassistance@accenture.com MINNESOTA – MEDICAIDWebsite: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739MISSOURI – MEDICAIDWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005MONTANA – MEDICAIDWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084Email: HHSHIPPProgram@mt.govNEBRASKA – MEDICAIDWebsite: http://www.ACCESSNebraska.ne.govPhone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178 NEVADA – MEDICAIDMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900NEW HAMPSHIRE – MEDICAIDWebsite: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-programPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext. 5218NEW JERSEY – MEDICAID AND CHIPMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710NEW YORK – MEDICAIDWebsite: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831NORTH CAROLINA – MEDICAIDWebsite: https://medicaid.ncdhhs.gov/Phone: 919-855-4100NORTH DAKOTA – MEDICAIDWebsite: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825OKLAHOMA – MEDICAID AND CHIPWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742OREGON – MEDICAIDWebsite: http://healthcare.oregon.gov/Pages/index.aspxPhone: 1-800-699-9075PENNSYLVANIA – MEDICAIDWebsite: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspxPhone: 1-800-692-7462CHIP Website: Children’s Health Insurance Program (CHIP) (pa.gov)CHIP Phone: 1-800-986-KIDS (5437)RHODE ISLAND – MEDICAID AND CHIPWebsite: http://www.eohhs.ri.gov/Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)SOUTH CAROLINA – MEDICAIDWebsite: https://www.scdhhs.govPhone: 1-888-549-0820
23LEGAL NOTICESSOUTH DAKOTA – MEDICAIDWebsite: http://dss.sd.govPhone: 1-888-828-0059TEXAS – MEDICAIDWebsite: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human ServicesPhone: 1-800-440-0493UTAH – MEDICAID AND CHIPMedicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669VERMONT– MEDICAIDWebsite: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health AccessPhone: 1-800-250-8427VIRGINIA – MEDICAID AND CHIPWebsite: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-selecthttps://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924WASHINGTON – MEDICAIDWebsite: https://www.hca.wa.gov/ Phone: 1-800-562-3022WEST VIRGINIA – MEDICAIDWebsite: https://dhhr.wv.gov/bms/ http://mywvhipp.com/Medicaid Phone: 304-558-1700CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)WISCONSIN – MEDICAID AND CHIPWebsite: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htmPhone: 1-800-362-3002WYOMING – MEDICAIDWebsite: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either:U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565PAPERWORK REDUCTION ACT STATEMENTAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C.3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.OMB Control Number 1210-0137 (expires 1/31/2026) Legal Notices
24Reliable Parts 2024 Benefits Enrollment GuideBenefit DefinitionsIN-NETWORKConsider your health care options highlighted in this guide. Some plans give you the freedom to use any health care provider of your choice. However, when you use an in-network provider, the percentage you pay out-of-pocket will be based on a negotiated fee, which is usually lower than the actual charges. If you use a provider who is outside of the network, you may be responsible for paying the difference between the Reasonable and Customary (R&C) charges and what the provider charges. R&C charges are set by the insurance carrier and are the amounts that are generally considered reasonable based on what most providers charge for a particular service in a geographic area.COPAYMENTS AND COINSURANCEA copayment (copay) is the fixed dollar amount you pay for certain in-network services. In some cases, you may be responsible for coinsurance after copay is made.Coinsurance is the percentage of covered expenses shared by the employee and the plan. In some cases, coinsurance is paid after the insured meets a deductible. For example, if you pay 20% of an in-network covered charge, the plan pays 80%.ANNUAL DEDUCTIBLEYour annual deductible is the amount of money you must first pay out-of-pocket before your plan begins paying for services covered by coinsurance. Some services, such as office visits, require copays and do not apply to the deductible.After you meet your deductible, the plan pays for a percentage of eligible expenses (coinsurance) until you meet your out-of-pocket maximum. If you receive services from an out-of-network provider, the plan pays a lower percentage of coinsurance. Refer to your health care plan summaries for more information.OUT-OF-POCKET MAXIMUMSome plans feature an out-of-pocket maximum, which limits the amount of coinsurance you will pay for eligible health care expenses. Once you reach that maximum, the plan begins to pay 100% of eligible expenses. There may be separate in- and out-of-network annual out-of-pocket maximums. Generally, copays, R&C charges, and deductibles do not apply to your out-of-pocket maximum.PREVENTIVE CARE SERVICESPreventive care is covered in-network at 100% for those services that are generally linked to designated routine wellness exams and screenings. Examples of preventive care include: − Annual routine physicals, immunizations − Bone-density tests, cholesterol screening − Mammograms, pap smears, pelvic exams, PSA exams − Sigmoidoscopies, colonoscopiesThere may be limits on how often you can receive preventive care treatments and services. You should ask your health care provider whether your visit is considered preventive or non-preventive care.
25SUMMARY OF YOUR CONTRIBUTIONSSummary of Your ContributionsSee below for a summary of your contributions for each of the benefits Reliable Parts offers. These deductions are BI-WEEKLY.MedicalPPO HDHPBI-WEEKLY CONTRIBUTIONSEmployee Only $135.61 $105.05Employee + Spouse / Domestic Partner $259.41 $195.13Employee + Child(ren) $236.90 $178.92Family $349.44 $260.89DentalBase Plan Buy-Up PlanBI-WEEKLY CONTRIBUTIONSEmployee Only $5.44 $11.44Employee + Spouse / Domestic Partner $11.08 $23.66Employee + Child(ren) $11.45 $21.95Family $18.22 $36.11VisionWith Medical CoverageWithout Medical CoverageBI-WEEKLY CONTRIBUTIONSEmployee Only $0.00 $2.41Employee + Spouse / Domestic Partner $0.00 $4.58Employee + Child(ren) $0.00 $4.83Family $0.00 $7.09Voluntary Life / AD&DAGEEMPLOYEE AND SPOUSE LIFE BI-WEEKLY RATE RATE PER $1,00015-24 $0.04225-29 $0.04230-34 $0.05135-39 $0.05740-44 $0.08445-49 $0.12550-54 $0.18255-59 $0.28660-64 $0.46965-69 $0.74170-74 $1.45875+ $1.458CHILD LIFE BI-WEEKLY RATE PER $1,000$0.014EMPLOYEE VOL. AD&D RATE PER $1,000$0.007SPOUSE AD&D RATE PER $1,000$0.014CHILD AD&D RATE PER $1,000$0.014Short-Term Disability covered at no cost to youBase Long-Term Disability covered at no cost to youLife/AD&D covered at no cost to youVoluntary Life/AD&D 100% employee paidEmployee Assistance Program covered at no cost to you
26Reliable Parts 2024 Benefits Enrollment GuideVoluntary Benefit RatesSee below for a summary of voluntary benefit rates. These deductions are Bi-Weekly.Critical Illness Per $1,000AGEEMPLOYEE, CHILDREN, SPOUSE BI-WEEKLY CONTRIBUTIONS<25 $0.0825-29 $0.1130-34 $0.1635-39 $0.2340-44 $0.3445-49 $0.5050-54 $0.7255-59 $1.0260-64 $1.4965-69 $2.2270-74 $3.4075-79 $4.8880-84 $6.9085+ $10.99Be Well BenefitBENEFIT AMOUNTEMPLOYEE, CHILDREN, SPOUSE BI-WEEKLY CONTRIBUTIONS$50 $0.86$75 $1.72$100 $2.58AccidentBI-WEEKLY CONTRIBUTIONSEmployee Only $6.71 Employee + Spouse / Domestic Partner $11.83 Employee + Child(ren) $14.47 Family $19.59 Hospital IndemnityBI-WEEKLY CONTRIBUTIONSEmployee Only $5.96 Employee + Spouse / Domestic Partner $12.09 Employee + Child(ren) $8.26 Family $14.40
27IMPORTANT CONTACTSImportant ContactsCoverage Contact Group Number Phone WebsiteMedical BCBSTX 280651 800-521-2227 www.bcbstx.comDental MetLife 5397485 800-GET-MET8 https://mybenefits.metlife.comPrescription DrugsBCBSTX/Prime Therapeutics280651Prime: 877-794-3574Express Scripts: 833-715-0942Accredo: 833-721-1619Prime: www.myprime.comExpress Scripts: www.express-scripts.com/rxAccredo: www.accredo.comVision MetLife 5397485 833-EYE-LIFE https://mybenefits.metlife.comLife and AD&D Unum 945717Customer Service: 800-421-0344 Claims: 800-455-0402www.unum.com/employees/file-a-claimDisability Unum 945717 800-421-0344 www.unum.com/employeesLeave/Accommodation RequestsUnum 945717 866-868-6737 https://portal.unum.comHospital Indemnity Unum 945722 800-635-5597 www.unum.com/claimsCritical Illness Unum 945721 800-635-5597 www.unum.com/claimsGroup Accident Unum 945720 800-635-5597 www.unum.com/claimsLife Planning Financial & Legal ResourcesUNUM (Health Advocate)— 800-422-5142 members.healthadvocate.comEmployee Assistance Program (EAP)UNUM — 800-854-1446 www.unum.com/lifebalanceTravel Assist Assist America —(US) 800-854-1446 (Outside US) + 301 + 656 + 4152www.AssistAmerica.comFlexible Spending AccountsNavia Company Code: RP1 800-284-4885 www.naviabenefits.comHealth Savings AccountNavia Company Code: RP1 800-284-4885 www.naviabenefits.comReliable Parts Human Resources—214-631-4343 (ext. 2880)Dept.HR.US@ReliableParts.com
This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request.The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area.