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Texas Pride Disposal Management - Benefit Guide

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Texas Pride Employee Benefits Guide - ManagementMay 2024 – April 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and official summary for further details.EligibilityAll full-time employees working at least 30 hours per week are eligible to enroll in the employee benefits outlined in this guide. If you are a newly hired employee, you become eligible for benefits on the first of the month following date of hire. Employees may also enroll their spouse and any dependent children up to the age of 26 in the benefits they elect. If a dependent child turns 26 during the plan year, he or she will automatically be removed from the benefits at the end of their birth month as they are no longer eligible. For questions on dependent children eligibility, please visit https://www.healthcare.gov/young-adults/children-under-26/. Open EnrollmentOpen Enrollment is from April 9th – April 17th. Every employee must turn in Enrollment Forms to Human Resources by no later than 5pm on April 17th. You cannot make a change to your benefit elections mid-year unless you have a qualifying life event.Qualifying Life EventIf you have a qualifying life event during the plan year, you have 30 days from the date of the event to notify HR of any changes that need to be made to your benefit coverages. Examples of a qualifying life event include marriage, divorce, birth or adoption of a child, change in child’s dependent status, loss of other coverage, or death. BenefitsPage 2 – Minimum Essential Coverage (MEC) (First Health)Page 3 – Major Medical (Blue Cross Blue Shield)Page 4 – Flexible Spending (TPA Systems)Page 5 – Dental, Vision, and Basic Life & AD&D (Guardian)Page 6 – Voluntary Life & AD&D (Guardian)Page 7 – 21 ColonialWhat Do You Need to Do?1. Self Serve on Employee Navigator2. Review the instructions provided to you so you can set up a time to visit with an Enrollment Counselor.3. Set up a time to meet with an Enrollment Counselor in person or by phone.4. Enrollment Counselors will review all lines of coverage and will assist you with plan selection and enrollment.

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Texas Pride Employee Benefits Guide - ManagementMay 2024 – April 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and official summary for further details.Web: www.myfirsthealth.comCustomer Service: 1-800-226-5116 *Medical Plan – First Health Minimum Essential Coverage - MECBasic Benefit OverviewMEC MEC PlusNetworkFirst Health First HealthRoutine Preventive Care VisitNo Cost No CostPrimary Care Office Visit*$15 $15Specialist Office Visit*$25 $25Hospital Stay - Reimbursement Not Covered$1,000 Per Day – Max 3 Days per Visit (9 Max per Plan Year)Hospital Surgical Procedure Out-Patient) - ReimbursementNot Covered $500 Per Day / Max 3 per Plan YearMajor Diagnostic Testing25% - 50% Discount through “Green Imaging”$300 Per Scan / Max 4 per Plan YearLab & X-Ray $25 $25Employee Assistance ProgramIncluded at No Cost Included at No CostEmergency ServicesConvenience Care Clinic$10$10Urgent Care$25 $25Telemedicine*No Cost No CostPrescription DrugsGeneric Drugs ONLY$10 $10Monthly RatesEmployee Only$0.00$52.76Employee + Spouse$34.33$98.77Employee + Child(ren)$34.33$98.77Employee + Family$78.65$149.79Bi-Weekly RatesEmployee Only$0.00$24.35Employee + Spouse$15.84$45.59Employee + Child(ren)$15.84$45.59Employee + Family$36.30$69.13Please note: These services are limited to eight (8) Total Visits COMBINED, per Plan Year.

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Texas Pride Employee Benefits Guide - ManagementMay 2024 – April 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and official summary for further details.Web: www.bcbstx.comCustomer Service: 1-888-697-0683 Medical Plan – Major MedicalBasic Benefit OverviewBase Plan MTBCP014H HSAMid Plan MTBCP025 Buy Up Plan MTBCP012NetworkBlue Choice PPO Blue Choice PPO Blue Choice PPOAnnual Deductible (Single/Family)$5,000 / $10,000 $3,000 / $9,000 $1,500 / $4,500Annual Out-of-Pocket Limit (Single/Family) $5,000 / $10,000 $3,500 / $10,500 $4,500 / $13,500Coinsurance (In-Network/Out-of-Network) 100% / 30% 100% / 30% 100% / 50%Routine Preventive Care VisitNo Cost No Cost No CostPrimary Care Office Visit100% after Ded $35 Copay $30 CopaySpecialist Office Visit100% after Ded $75 Copay $60 CopayOutpatient Surgery and Facility Charge100% after Ded 100% after Ded 100% after DedMajor Diagnostic Testing100% after Ded 100% after Ded 100 % after DedLab & X-Ray 100% after Ded 100% after Ded 100% after DedInpatient Hospitalization (Facility/Physician)100% after Ded 100% after Ded 100% after DedEmergency ServicesEmergency Room (Copay waived if admitted)100% after Ded$500 Copay / Visit $500 Copay / VisitUrgent Care100% after Ded $75 Copay / Visit$75 Copay / VisitTelemedicine100% after Ded $0 copay $0 copayPrescription DrugsRestrictionsPreferred / Non-Preferred Generic100% after Ded. $0 / $10$0 / $10Brand 100% after Ded.$50 / $100 $50 / $100Specialty100% after Ded.$150 / $250 $150 / $250Mail Order (90-day supply) Copay x 3 Copay x 3Copay x 3Monthly RatesEmployee Only$0.00$180.68 $230.98Employee + Spouse$585.66$1,206.94 $1,328.67Employee + Child(ren)$301.40$766.08 $857.13Employee + Family$1,009.71$1,864.62 $2,032.12Bi-Weekly RatesEmployee Only$0.00$83.39 $106.61Employee + Spouse$270.30$557.05 $613.22Employee + Child(ren)$139.11$353.58 $395.60Employee + Family$466.02$860.59 $937.90

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Texas Pride Employee Benefits Guide - ManagementMay 2024 – April 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and official summary for further details.Flexible Spending

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Vision PlanTexas Pride Employee Benefits Guide - ManagementMay 2024 – April 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and official summary for further details.Basic Benefit OverviewExams once per 12 months $50 AllowanceLenses once per 12 months $150 AllowanceFrames once per 24 months$150 Allowance + 20% off balanceRates MonthlyBi-WeeklyEmployee Only$3.00 $1.38Employee + Spouse$9.00 $4.15Employee + Child(ren)$11.00 $5.08Employee + Family$13.00 $6.00Basic Life & AD&DBasic Benefit OverviewBenefit Amount$25,000Dental PlanBasic Benefit OverviewAnnual Deductible/Individual$50Annual Plan Maximum (per person)$1,500Waiting PeriodNoneType IPreventive Services (Oral Exam, Bite-wing X-rays, Cleaning)100%Type IIBasic Services (Fillings, Extractions)80% after DeductibleType IIIMajor Services (Crowns, Inlays, Bridges)50% after DeductibleType IVOrthodontiaNot CoveredRatesMonthlyBi-WeeklyEmployee Only$14.00 $6.46Employee + Spouse$42.00 $19.38Employee + Child(ren)$58.00 $26.77Employee + Family$86.00 $39.69This Benefit is 100% Employer Paid35% Benefit reduction at age 65, 60% at age 70, 75% at age 75, and 85% at age 80.

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Texas Pride Employee Benefits Guide - ManagementMay 2024 – April 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and official summary for further details.Voluntary Life & AD&D PlanBasic Benefit OverviewEmployee BenefitIncrements of $10,000Employee Maximum$300,000Employee Guarantee Issue$200,000Spouse BenefitIncrements of $5,000Spouse Maximum$250,000 (no more than 100% of employee’s)Spouse Guarantee Issue$25,000Child Benefit (14 days or older)Increments of $5,000Child Maximum$10,000 Voluntary Life RatesMonthly Rate per $10,000 of Volume (Employee)29 & Under$0.09530-34 $0.10335-39 $0.14940-44 $0.23245-49 $0.38550-54 $0.61155-59 $0.94360-64 $1.45665-69 $2.37170 & Over$3.953Monthly Rate per $5,000 of Volume (Spouse)$0.95$0.103$0.149$0.232$0.385$0.611$0.943$1.456$2.371$3.953Monthly Rate per $5,000 of Volume (Child)$1.00Voluntary Accidental Death and Dismemberment (AD&D) Monthly RateEmployee and Spouse$0.041AD&D is automatically added to any Voluntary Life benefit elected.

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